Clinical Effectiveness Bulletin No. 51 April 2011

NHS Library and Information Service North Staffordshire
Clinical Effectiveness Bulletin

for PCTs in North Staffordshire
Issue No: 50 – March 2011
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/healthlibrary/usingthehealthlibrary/inter-
libraryloans/#d.en.27437
[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
Bulletin produced by NHS Outreach Librarians

Tel: FeatureNet 8429 (External calls 0300 123 1535 ext 8429)
E-mail: lindsay.snell@northstaffs.nhs.uk
clareh.powell@northstaffs.nhs.uk
North Staffs Health Library

Tel: 01782 556565
Fax: 01782 556582
E-mail: health.library@keele.ac.uk
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Contents in this issue

Alcohol Mental Health
Cancer Nursing
Cardiovascular Diseases Obesity
Care After Death Patient Care and Safety
Children and Young People Prescribing
Commissioning Prison Health
Dementia Public Health
Diabetes Safeguarding Vulnerable
Adults
Emergency Care Service Management
Environment Sexual Health
General Practice Smoking
Guidance Vaccination and
Immunisation
Infections Waste Management
Long Term Conditions Women’s Health
Maternal and Infant Health Workforce
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/
Cochrane Library http://www.thecochranelibrary.com/
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.hta.ac.uk
NICE http://www.nice.org.uk/
NHS Evidence Specialist Collections http://www.library.nhs.uk/specialistcollections/
SIGN http://www.sign.ac.uk/new.html
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Alcohol
Psychological Interventions with Families of Alcohol Misusers: A Systematic Review
Alcohol Education and Research Council
The authors concluded that involving the family in treatment, including responding to their own
needs directly, and largely regardless of the nature of the intervention, can bring huge benefits to
family members, including children and the alcohol misusing relatives, as well as bringing
potential cost-savings to services.
http://www.aerc.org.uk/insightPages/libraryIns0078.html
[back to topics]
Cancer
Interventions for preventing oral mucositis for patients with cancer receiving treatment
Worthington, HV et al.
The authors concluded that two interventions, cryotherapy (ice chips) and keratinocyte growth
factor (palifermin®), showed some benefit in preventing mucositis. Sucralfate is effective in
reducing the severity of mucositis, and a further seven interventions, aloe vera, amifostine,
intravenous glutamine, granulocyte-colony stimulating factor (G-CSF), honey, laser and antibiotic
lozenges containing polymixin/tobramycin/amphotericin (PTA) showed weaker evidence of
benefit. These were evaluated in patients with different types of cancer, undergoing different
types of cancer treatment. Benefits may be restricted to the disease and treatment combinations
evaluated.
http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD000978/frame.html
Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy
Furness, S et al.
The authors concluded that chemotherapy, in addition to radiotherapy and surgery, is associated
with improved overall survival in patients with oral cavity and oropharyngeal cancers. There is
insufficient evidence as to which agent or regimen is most effective and the additional toxicity
associated with chemotherapy given in addition to radiotherapy and/or surgery cannot be
quantified.
Manual for Cancer Services: Network Service User Partnership Group Measures
Department of Health
Following a three month consultation period, this is the final version of the Measures for inclusion
in the Manual of Cancer Services 2008.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D
H_125728
The Acute oncology - including metatastic spinal cord compression measures section of the
manual is at:
H_125727
Medical interventions for high grade vulval intraepithelial neoplasia (VIN)

Pepas, L et al.
Imiquimod appears to be effective, but its safety needs further examination. Its use is associated
with side effects which are tolerable, but more extensive data on adverse effects are required.
[back to topics]
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Cardiovascular Diseases
Angiotensin receptor blockers and risk of myocardial infarction: meta-analyses and trial
sequential analyses of 147,020 patients from randomised trials
Bangalore, S et al.
The authors concluded that this large and comprehensive analysis produced firm evidence to
refute the hypothesis that angiotensin receptor blockers increase the risk of myocardial infarction
(ruling out even a 0.3% absolute increase). Compared with controls, angiotensin receptor
blockers reduce the risk of stroke, heart failure, and new onset diabetes.
BMJ 2011; 342:d2234 doi: 10.1136/bmj.d2234 (Published 26 April 2011)
[back to topics]
Care after Death

Guidance for staff responsible for care after death (last offices)
National End of Life Care Programme
Developed with the National Nurse Consultant Group (Palliative Care), this guidance sets out key
principles. It is intended as a guide for training, as well as for informing the development of
organisational protocols for this area of care, and it aims to provide a consistent view that
accommodates England’s diverse religious and multi-cultural beliefs.
http://www.endoflifecareforadults.nhs.uk/publications/guidance-for-staff-responsible-for-care-
after-death
[back to topics]
Children and Young People

The learning: ‘What good looks like’
The Children and Young People’s Emotional Wellbeing and Mental Health National Support
Team helped Local Authorities, Primary Care Trusts, health organisations, Children’s Trusts and
other statutory and voluntary partners to:
• identify opportunities to improve commissioning and delivery systems to achieve better
outcomes for children and young people’s emotional well-being and mental health; and
• review the whole system from prevention through to specialist services.
This document is based on the learning from the Team’s visits as well as evidence of what works.
H_126001
Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a

systematic review
Van der Pol, R
The authors concluded that Proton-Pump Inhibitors (PPIs) are not effective in reducing
Gastroesophageal Reflux Disease symptoms in infants. Placebo-controlled trials in older children
are lacking. Although PPIs seem to be well tolerated during short-term use, evidence supporting
the safety of PPIs is lacking.
PEDIATRICS (doi:10.1542/peds.2010-2719). Published online April 4, 2011.
Facing the Future: A Review of Paediatric Services

Royal College of Paediatrics and Child Health
This report models the potential implications of the Facing the Future standards for paediatric
services in the UK. It maps the current acute service configuration in the UK, proposes possible
solutions to these problems, and imagines three possible scenarios for the configuration of
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inpatient units. The workforce implications of these scenarios are also explored. It also
recommends the increased involvement of children’s nurses and GP trainees in some aspects of
care.
http://www.rcpch.ac.uk/facingthefuture
Fundamentals of Commissioning Health Services for Children

Child and Maternal Health Observatory
This paper looks at how some primary care trusts have not only reduced admissions but
commissioned services which deliver better outcomes for children and young people.
http://www.chimat.org.uk/resource/item.aspx?RID=106744
Pharmacological treatment for Attention Deficit Hyperactivity Disorder (ADHD) in children

with comorbid tic disorders
Pringsheim, T et al.
Methylphenidate, clonidine, guanfacine, desipramine and atomoxetine appear to reduce ADHD
symptoms in children with tics. Although stimulants have not been shown to worsen tics in most
people with tic disorders, they may nonetheless exacerbate tics in individual cases. In these
instances, treatment with alpha agonists or atomoxetine may be an alternative. Although there is
evidence that desipramine is effective for both tics and ADHD in children, safety concerns will
likely continue to limit its use in this population.
Steroids and bronchodilators for acute bronchiolitis in the first two years of life:
systematic review and meta-analysis
Hartling, L. et al.
The authors concluded that evidence shows the effectiveness and superiority of adrenaline for
outcomes of most clinical relevance among outpatients with acute bronchiolitis, and evidence
from a single precise trial for combined adrenaline and dexamethasone.
BMJ 2011; 342:d1714 doi: 10.1136/bmj.d1714 (Published 6 April 2011)
Items in the Mental Health, Obesity and Sexual Health sections may also be of interest.
[back to topics]
Commissioning
Commissioning for the future: learning from a simulation of the health system in 2013/14
King’s Fund
The reforms set out in the coalition government’s White Paper have wide ramifications,
particularly for GPs. NHS Lincolnshire decided to help GPs to understand the issues and
behaviours that might emerge as a result of the reforms by running a simulation exercise with The
King’s Fund. Observations on the day and reflections provided by the participants are pulled
together into a number of key themes. This simulation provides insight into some of the potential
risks and opportunities of the new regulatory and management structures being implemented.
The report offers observations about individual and organisational behaviours and about system
dynamics as a whole.
http://www.kingsfund.org.uk/publications/future_commissioning.html
Commissioning: further issues

House of Commons Health Select Committee
This report recommends a number of significant changes to the Health and Social Care Bill,
currently before Parliament. It includes proposals that representatives of nurses, hospital doctors,
public health experts and local communities should all be involved as decision makers alongside
GPs in NHS commissioning. The Select Committee believe it is vital to make these changes to
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enable the NHS to meet the unprecedented challenge it faces of finding 4% annual efficiency
savings over the next four years.
http://www.publications.parliament.uk/pa/cm201011/cmselect/cmhealth/796/79602.htm
Guidance on the NHS Standard Contract for Care Home Services 2011/12
This document is to be read be in conjunction with the NHS Standard Contract for Care Homes.
H_126313
Impact of Quality and Outcomes Framework on health inequalities: Summary of full report
King’s Fund
This research aimed to examine whether the GMS contract and, in particular, the QOF was
contributing to improvements in public health and reductions in health inequalities; the focus was
on health inequalities as determined by income deprivation. The research looks at: incentives for
prevention and public health activities; differences in performance by deprivation; impact on
population health; practice characteristics; exception reporting (allowing certain patients to be
excluded from the performance figures); case finding (actively seeking to identify new people at
risk). The paper draws out the implications of those findings for future development of QOF and
other pay-for performance schemes and concludes that general practice should be supported in
its responsibility for improving public health and reducing inequalities.
http://www.kingsfund.org.uk/publications/impact_of_quality.html
Implementing GP Commissioning
Policy Exchange
This report suggests that the Health and Social Care Bill’s proposals to abolish every Primary
Care Trust by 2013 could lead to the new structure replicating the existing system in all but name.
The report says that by slowing down the proposed reforms, the potential to deliver real and
lasting transformation in the NHS is enormous.
http://www.policyexchange.org.uk/publications/publication.cgi?id=233
Liberating the NHS: orders of change?

Health Services Management Centre
This paper suggests that overall, the NHS reform proposals in the current Health and Social Care
Bill represent a large degree of continuity or evolution from previous reform agendas. However,
they also raise the point that the combined impact of the reforms when implemented may have
the potential to bring about radical change as the scale and speed of the proposed changes take
effect. They reflect on the contextual factors likely to affect the implementation of the policy
proposals and raise some practical implications for researchers and practitioners to consider in
relation to this new reform agenda.
http://www.hsmc.bham.ac.uk/news/news/2011/4/policy-paper-eleven.shtml
National Health Service Landscape Review

House of Commons Public Accounts Committee
This report provides an overview of aspects of the NHS reforms to date. The report draws out a
number of risks associated with the transition to the new model that need to be managed. The
Committee intend to review the progress of the reforms at regular intervals and this report signals
the sorts of issues it will want to examine in future. (NHS Sheffield Library Service Daily Health
Bulletin)
http://www.publications.parliament.uk/pa/cm201012/cmselect/cmpubacc/764/76402.htm
The NHS Performance Framework: Implementation guidance - 2011/12

This guidance is intended to support the application of the NHS Performance Framework; to
inform Strategic Health Authorities (SHAs) as the regional system managers and Primary Care
Trusts (PCTs) as the local commissioners of NHS services of when they should intervene to
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address poor performance; and to inform NHS organisations of the criteria against which their
performance will be assessed
H_126030
Reducing expenditure on low clinical value treatments: a health briefing

Audit Commission
This health briefing suggests that the NHS could save up to £500 million a year by carrying out
fewer ineffective or inefficient treatments. It argues that a single approach to defining these low
value treatments could help to reduce the duplication of effort between primary care trusts (PCTs)
and help to ensure consistency across the country. The briefing considers some PCTs' efforts to
decommission treatments of low clinical value. Decommissioning treatments can free up money
that could be better spent on other treatments, but decisions can be controversial. The briefing
shows how strong leadership within PCTs, as well as good communication between PCTs, and
GPs, patients and the public, are crucial success factors.
http://www.audit-commission.gov.uk/health/nationalstudies/financialmanagement/lowclinicalvalue/
Pages/Default_copy.aspx
Shadow consortia: Developing and electing a transitional leadership (updated version)

BMA
This guidance outlines a number of options that will need to be considered when developing the
transitional leadership structures that will take shadow consortia forward. It also gives guidance
on how to appoint the transitional leadership, giving information about elections, and
selection and election processes.
http://www.bma.org.uk/images/whitepapergpcguidance6_apr2011version_tcm41-205257.pdf
Transforming Community Services: Demonstrating and Measuring Achievement:

Community Indicators for Quality Improvement
This document introduces 43 indicators for quality improvement for voluntary, local use in a
community setting. These carefully chosen indicators will help to raise the standard of care
delivered to patients and communities.
H_126110
Variations in health care: the good, the bad and the inexplicable
King’s Fund
This report explores the possible causes of variation, shows the different ways in which variations
can be measured, and analyses variations by PCT in rates of elective hospital admissions for
selected procedures. It also breaks the information down into : variations in common, clinically
effective procedures, trends in variation, variation in day case rates, variation in low effectiveness
procedures, variation in pre-operative health, preference-sensitive variations. Even after allowing
for legitimate factors that affect rates of surgery, significant variations were found between PCTs
– even among common interventions known to be effective. Recommendations are made in the
report for tackling this problem.
http://www.kingsfund.org.uk/publications/healthcare_variation.html
Who pays? Establishing the responsible commissioner

This document sets out a framework for establishing responsibility for commissioning an
individual's care within the NHS, i.e. determining who pays for a patient’s care.
H_078466
Working together for a stronger NHS
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This document describes why the way we provide health and care needs to change and the plan
to modernise the NHS, and invites the reader to get involved in the process.
H_125848
Details of the Listening Exercise: http://healthandcare.dh.gov.uk/listening-exercise-how-to-get-
involved/
Items in the Children and Young People, Diabetes, Maternal and Infant Health, Mental
Health, Prescribing, Public Health, Service Management and Sexual Health sections may
also be of interest.
[back to topics]
Dementia
Lack of Evidence for the Efficacy of Memantine in Mild Alzheimer Disease
Schneider, LS
The authors concluded that, despite its frequent off-label use, evidence is lacking for a benefit of
memantine in mild Alzheimer’s Disease (AD), and there is meagre evidence for its efficacy in
moderate AD. Prospective trials are needed to further assess the potential for efficacy of
memantine either alone or added to cholinesterase inhibitors in mild and moderate AD.
Arch Neurol. Published online April 11, 2011. doi:10.1001/archneurol.2011.69
[back to topics]
Diabetes
Assessment of Services to Reduce Diabetes-related Mortality
This workbook was developed by the Health Inequalities National Support Teams (HINST) with
70 local authorities covering populations in England. Local areas could use this approach when
analysing whether a population level improvements could be achieved from a set of best-practice
and established interventions. This is offered as useful resource for commissioners.
H_126332
[back to topics]
Emergency Care
NHS emergency planning guidance: planning for the management of burn-injured patients
in the event of a major incident: interim strategic national guidance
H_125840
Toolkit to improve quality of urgent and emergency care

Royal College of General Practitioners
This toolkit is for all providers of urgent and emergency care, including clinicians and non-
clinicians, out of hours doctors, emergency departments, walk-in centres, GP medical practices,
pre-hospital emergency care doctors, NHS Pathways, NHS Direct, the Ambulance Service, and
urgent care centres. It provides practical guidance to providers on checking the quality and care
provided and continually improving care regardless of setting.
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http://www.rcgp.org.uk/news/press_releases_and_statements/new_toolkit_to_improve_quality.as
px
[back to topics]
Environment
Update on the Fukushima Incident, 31 March 2011
Health Protection Agency
The HPA, Environment Agency and the Scottish Environment Protection Agency (SEPA) will
jointly provide a weekly update of their air monitoring findings associated with the Fukushima
event via the HPA website. This will be posted at 2pm every Thursday.
The latest weekly update is available at:
http://www.hpa.org.uk/NewsCentre/NationalPressReleases/2011PressReleases/
[back to topics]
General Practice
APHO General Practice Profiles
Association of Public Health Observatories
These profiles are designed to assist GPs, emerging consortia and PCTs to ensure that they are
providing and commissioning effective and appropriate healthcare services for their local
population. In addition to viewing individual practice profiles, you can draw together a cluster of
practices and view the resulting profile. Each constituent practice can be compared with the
cluster and the England average. Alternatively, practices can be compared with their PCT and
England.
http://www.apho.org.uk/PRACPROF/
Guidance: GP extended hours access scheme directed enhanced service – 1 April 2011 to
31 March 2012
Guidance for PCTs to support them in implementing the amended Extended Hours Access
Scheme.
H_125940
Items in the Commissioning and Long Term Conditions sections may also be of interest.
[back to topics]
Guidance
NICE Clinical Guidelines
The diagnosis and treatment of lung cancer
Clinical guidelines CG121
http://guidance.nice.org.uk/CG121
The recognition and initial management of ovarian cancer

Clinical guidelines CG122
http://guidance.nice.org.uk/CG122
NICE Technology Appraisals
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Everolimus for the second-line treatment of advanced renal cell carcinoma

Technology appraisals TA219
http://guidance.nice.org.uk/TA219
Golimumab for the treatment of psoriatic arthritis

Romiplostim for the treatment of chronic immune or idiopathic thrombocytopenic purpura

Trabectedin for the treatment of relapsed ovarian cancer

[back to topics]
NICE Consultation Documents

Colorectal cancer: guideline consultation
Closing date for comments: 24 May 2011
http://guidance.nice.org.uk/CG/Wave16/2/Consultation/Latest
Consultation on NICE's proposals for making the guideline development process more
efficient
Closing date for comments: 19 July 2011
http://www.nice.org.uk/aboutnice/howwework/developingniceclinicalguidelines/clinicalguidelinepro
cessreviewconsultation.jsp
Magnetic resonance image-guided transcutaneous focused ultrasound for uterine fibroids

Interventional Procedure (IPG231)
Closing date for comments 19 May 2011
http://guidance.nice.org.uk/IPG231
Management of multiple sclerosis in primary and secondary care

Clinical Guideline CG8
Only registered stakeholders can comment – register or contact the registered stakeholder
organisation that most closely represents your interests and pass your comments to them.
http://guidance.nice.org.uk/CG8/ReviewProposal
Microwave ablation for the treatment of metastases in the liver

Interventional procedure (IPG220)
http://guidance.nice.org.uk/IPG220
Self-harm (longer term management)

Closing date for comments: 7 June 2011
http://guidance.nice.org.uk/CG/WaveR/82/Consultation/Latest
Smoking harm reduction

Public Health Guidance
http://guidance.nice.org.uk/PHG/Wave23/23/ScopeConsultation
Walking and cycling
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Public Health Guidance

http://www.nice.org.uk/guidance/index.jsp?action=folder&o=54280
[back to topics]
Other Guidance
Revised guidance and competences for the provision of services using GPs with Special
Interests (GPwSIs): Dermatology and skin surgery
NHS Primary Care Commissioning
http://www.pcc.nhs.uk/uploads/commissioning/2011/04/revised_guidance_and_competences_for
_the_provision_of_services_using_gps_with_special_interests.pdf
Prevention and management of venous thromboembolism (audit tool)

SIGN
http://www.sign.ac.uk/guidelines/audit/tools.html
Stroke rehabilitation
SIGN
Patient version of guideline
http://www.sign.ac.uk/patients/publications/118/index.html
Treating psoriasis and psoriatic arthritis

SIGN
Patient version of guideline
http://www.sign.ac.uk/patients/publications/121/index.html
[back to topics]
Other Health Technology Assessments

Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of
rheumatoid arthritis after the failure of a tumour necrosis factor inhibitor: a systematic
review and economic evaluation
Malottki K, et al.
This study found rituximab and abatacept to be more effective compared with supportive care
(including ongoing disease-modifying antirheumatic drugs) in rheumatoid arthritis after failure of a
TNF inhibitor. Use of an alternative TNF inhibitor in this patient population may provide some
benefit according to evidence from observational studies, but there remain uncertainties with
regard to the magnitude of the benefit and its cost-effectiveness.
Health Technol Assess 2011;15(14)
Peginterferon alfa and ribavirin for chronic hepatitis C in patients eligible for shortened
treatment, re-treatment or in HCV/HIV co-infection: a systematic review and economic
evaluation
Hartwell D
This study found that patients may be successfully treated with a shorter course of peginterferon
and ribavirin combination therapy without compromising the likelihood of achieving a sustained
virological response. Economic evaluation showed that treatment with peginterferon alfa in
specified subgroups of patients yielded quality-of-life gains without excessive increases in costs.
Health Technol Assess 2011;15(17)
[back to topics]
Infections
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Explanatory memorandum to the National Health Service (general medical services

contracts) (prescription of drugs etc.) (amendment) regulations 2011. 2011 no. 680.
Legislation.gov.uk
The regulations have been changed to allow Tamiflu and Relenza to be prescribed on the NHS
for patients who ‘are at risk of developing medical complications’ from influenza. The changes will
be important in the future management of flu outbreaks. (Department of Health).
http://www.legislation.gov.uk/uksi/2011/680/pdfs/uksiem_20110680_en.pdf
Results from the mandatory surveillance of meticillin resistant Staphylococcus aureus

(MRSA) bacteraemia
Health Protection Agency
This is the first set of mandatory monthly data for meticillin sensitive Staphylococcus aureus
(MSSA) blood stream infection. The new data comes after last year’s government commitment to
ensure patients have access to a wider range of information about healthcare associated
infections (HCAIs) to improve transparency and help drive down infections.
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/StaphylococcusAureus/Epidemiolo
gicalData/MandatorySurveillance/staphmonthlymandatoryreporting/
Items in the Maternal and Infant Health section may also be of interest.
[back to topics]
Long Term Conditions

The GP Practice index: exploring variation in COPD care and cost. (2nd ed.)
Dr. Foster Intelligence
Dr Foster has reviewed non-elective hospital admissions for COPD from January to December
2010. These admissions, which through improved community care could be preventable, can be
linked to individual GP practices. The report shows:
• Disparity in GP practices with a low number of registered COPD patients but a higher
than expected level of non-elective hospital admissions for COPD, highlighting where
there may be a lack of engagement in primary care.
• Disparity between GP practices with a high level of COPD patients and a higher than
expected level of non-elective admissions, suggesting problems of ongoing care.
• Potential cost savings if GP practices with significantly higher than expected non-elective
admissions matched ‘expected levels’.
The aim of this baseline analysis is to highlight the variation between PCTs from a national
perspective.
http://www.drfosterintelligence.co.uk/downloads/latestnews/GP%20Practice%20Index%202nd
%20Edition.pdf
Snapshot: Co-Creating Health

The Health Foundation
Co-creating health helps people with long-term conditions to take control of their health and
supports them to self-manage. This snapshot provides an overview of the programme and a list of
the sites involved, as well as explaining why self-management support is so important.
http://www.health.org.uk/publications/snapshot-co-creating-health/
[back to topics]
Maternal and Infant Health
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Early versus late epidural analgesia and risk of instrumental delivery in nulliparous
women: a systematic review
Wassen, MMLH et al.
The authors concluded that there is no increased risk of caesarean delivery or instrumental
vaginal delivery for women receiving early epidural analgesia at cervical dilatation of 3 cm or less
in comparison with late epidural analgesia.
BJOG: An International Journal of Obstetrics & Gynaecology 118(6) p.655-61, May 2011
Hepatitis B antenatal screening and newborn immunisation programme: Best practice

guidance
This document contains guidance for commissioners in improving the uptake rate of existing
infant hepatitis B immunisation programmes for newborns who are at risk of hepatitis B infection.
This guidance should be considered as supplementary to UK National Screening Committee and
National Institute of Clinical Excellence guidance.
H_126195
Hepatitis B: Pathway stages to protection - Actions, roles, responsibilities and standards

This document provides commissioners and providers with best practice guidance on screening
and the vaccination of babies born to Hepatitis B positive mothers.
H_126202
Introducing Solid Foods: Giving your baby a better start in life

Patient information leaflet
H_125823
Off to the best start: Important information about feeding your baby
Patient information leaflet
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Parents' views on the maternity journey and early parenthood

The three projects synthesised in these documents explored how parents feel about the
pregnancy and parenthood journeys and their expectations of the health service. The research
gives valuable insights on pregnancy and early parenthood services, and how these might be
improved.
H_125891
[back to topics]
Mental Health
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Count me in 2010
Care Quality Commission
This report calls for organisations outside of the health care sector to help improve mental health
and well-being among black and minority ethnic (BME) groups. This to tackle the economic and
social factors that contribute to higher-than-average hospital admission rates among some ethnic
groups.
http://www.cqc.org.uk/guidanceforprofessionals/mentalhealth/countmeincensus/countmeincensus
2010.cfm
Fulfilling and Rewarding Lives: Evaluating progress

This guidance and self-assessment framework is to help support Local Authorities and NHS
organisations and their partners to implement the statutory guidance ’Implementing ‘Fulfilling and
rewarding lives’ in their localities. The self-assessment is primarily for commissioners as a
template to begin their planning to respond to the statutory guidance
H_125703
Mental health promotion and mental illness prevention: the economic case
This report presents the key findings of a project on the economic case for mental health
promotion and prevention, based on a detailed analysis of costs and benefits for fifteen different
interventions. These included health visiting and reducing post-natal depression; school-based
interventions to reduce bullying; early detection for psychosis; workplace screening for
depression and anxiety disorders; population-level suicide awareness training and intervention;
and tackling medically unexplained symptoms.
H_126085
Social Care and Mental Health Indicators from the National Indicator Set - 2009-10: Final
release
NHS Information Centre
This National Indicator Set (NIS) underpins the performance framework for local government. The
NHS Information Centre collects information on 12 of the indicators which relate to social care
and mental health services. This report relates to the period April 2009 – March 2010. It replaces
information in the provisional report which was published on 30 September 2010.
http://www.ic.nhs.uk/statistics-and-data-collections/social-care/adult-social-care-
information/social-care-and-mental-health-indicators-from-the-national-indicator-set--2009-10-
final-release
Talking therapies: a four-year plan of action

NHS Confederation
This Briefing summarises the main points of the Department of Health’s 'Talking therapies: a four
year plan of action' and outlines the key questions that boards should be asking.
http://www.nhsconfed.org/Publications/briefings/Pages/Talking-therapies.aspx
Items in the Alcohol, Children and Young People and Prison Health sections may also be
of interest.
[back to topics]
Nursing
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Spirituality in nursing care: a pocket guide

Royal College of Nursing
This is a guide to enable nursing staff to address questions about the spiritual part of care. In
2010, the RCN commissioned a survey on spirituality. It revealed that members wanted: more
education and guidance about spiritual care; clarification about personal and professional
boundaries; and support in dealing with spiritual issues. This guide hopes to achieve these by
defining spiritual care, providing tips on preparing to give spiritual care and where to seek further
information.
http://www.rcn.org.uk/__data/assets/pdf_file/0008/372995/003887.pdf
[back to topics]
Obesity
Brief interventions for weight management
National Obesity Observatory
This paper provides a guide to current best available evidence on brief interventions for weight
management with adults. Brief interventions are interventions focused on changing behaviour that
are limited by time – often to a few minutes per session.
http://www.noo.org.uk/gsf.php5?f=10181&fv=10702
National Bariatric Surgery Register report

British Obesity and Metabolic Surgery Society (BOMSS)
The first National Bariatric Surgery Register report has been published - the first comprehensive,
prospective, nationwide analysis of outcomes from bariatric surgery in the United Kingdom and
Ireland. It contains pooled national outcome data for bariatric and metabolic surgery in the United
Kingdom. Eighty four surgeons and their teams working at 86 hospitals contributed data on
patients treated up to March 2010.
http://www.british-obesity-surgery.org/news.htm
Strategic high impact changes: childhood obesity

This document captures the learning and evidence gathered from the Childhood Obesity National
Support Team’s (CONST) 44 visits to local health economies across the country. It translates this
learning into what the CONST believe could make the greatest impact in addressing obesity in a
local area. Identifying four key areas for implementation, the document provides researched
examples and references evidencing the potential impact of the suggested interventions. It
document is a summary of local views on good practice. The suggested approaches are not
mandatory, and reflect learning from a snapshot in time.
H_126104
[back to topics]
Patient Care and Safety

Letter on driving improvement and learning from NHS complaints information
Monitor, Department of Health, CQC et al.
http://www.monitor-nhsft.gov.uk/sites/all/modules/fckeditor/plugins/ktbrowser/_openTKFile.php?
id=4780
Reablement: a cost-effective route to better outcomes

SCIE
15
People using reablement welcome the emphasis on helping them gain independence and better
functioning, although evidence on user and carer views needs to be strengthened. Reablement
improves outcomes, particularly in terms of restoring people’s ability to perform usual activities
and improving their perceived quality of life. From a social care perspective, there is a high
probability that reablement is cost effective. Reablement achieves cost savings through reducing
or removing the need for ongoing support via traditional home care. However, there is currently
little evidence to suggest that it reduces health care costs.
http://www.scie.org.uk/publications/briefings/briefing36/index.asp
UNISON duty of care handbook: For members working in health and social care
Unison
This handbook aims to help all health and social care staff maintain the duty of care to patients/
service users, colleagues and the public, particularly when there is pressure on services. It is a
practical guide to empower UNISON members to have a positive influence and be the guardians
of safe, effective and high-quality services.
http://www.unison.org.uk/healthcare/dutyofcare/index.asp
[back to topics]
Prescribing
All Wales Audit: Towards Appropriate Non-Steroidal Anti- Inflammatory Drug (NSAID)
Prescribing 2010-2012: Quality Improvement Toolkit
All Wales Medicines Strategy Group
This document is for use by primary care general practitioners to highlight safety issues
associated with NSAID prescribing, particularly in patients with a higher risk of side effects.
http://www.wales.nhs.uk/sites3/page.cfm?orgid=371&pid=46937
Cost-effective prescribing: Better Care Better Value (BCBV) indicator on statins

The guidance clarifies that the indicators are not intended for use as targets. It should be read in
conjunction with the guidance on the GP contract for 2011/12.
H_125815
Good practice in prescribing and managing medicines and devices: a draft for
consultation
General Medical Council
This draft guidance is intended to replace Good practice in prescribing medicines, which was
published in 2008. The guidance is for all doctors, whatever their specialty and wherever they
work. The consultation will interest patients, doctors, other healthcare professionals, employers
and organisations that represent their interests.
Consultation closing date: 27 May 2011
https://gmc.e-consultation.net/econsult/consultation_Dtl.aspx?consult_Id=180
Handbook for controlled drugs accountable officers in England

National Prescribing Centre
The purpose of this handbook is to help Accountable Officers (AOs) to fulfil their role, particularly
for those new to the post. The handbook emphasises legal requirements as well as providing
recommendations for further reading. It is intended to supplement existing guidance produced by
the Department of Health (DH) to underpin the regulations and will complement any additional
face to face training designed to support AOs.
http://www.npc.nhs.uk/controlled_drugs/ao_handbook.php
Prescription Cost Analysis, England - 2010
16

Prescription Cost Analysis (PCA) provides details of the number of items and the net ingredient
cost of all prescriptions dispensed in the community in England. The drugs dispensed are listed
by British National Formulary (BNF) therapeutic class.
http://www.ic.nhs.uk/pubs/prescostanalysis2010
Proceed with caution: an economic perspective on the UK’s value based pricing proposals
School of Health and Related Research
Whilst the opportunity to purchase new medicines based on value to society is one that should be
welcomed, we should proceed with caution. We highlight ten issues that should be considered
relating to innovation, the role and meaning of funding threshold and the adjustments to reflect
burden of illness, therapeutic innovation and improvement and wider societal factors.
http://www.shef.ac.uk/content/1/c6/11/94/02/HEDS%20DP%2011-04.pdf
[back to topics]
Prison Health
Environmental Design Guide: adult medium secure services
Department of health
The guidance describes overarching principles for the design of adult medium secure inpatient
services and sets out the security requirements for these services.
H_126178
Good Practice Procedure Guide: The transfer and remission of adult prisoners under s47
and s48 of the Mental Health Act
H_125767
[back to topics]
Public Health
Implementing NICE public health guidance for the workplace: a national organisational
audit of NHS trusts in England
Royal College of Physicians
The audit questions reflect evidence-based guidance from NICE covering:
• Managing long-term sickness absence and incapacity for work (PH19)
• Promoting physical activity in the workplace (PH13)
• Promoting mental wellbeing through productive and healthy working conditions (PH22)
• Workplace interventions to promote smoking cessation (PH5)
• Obesity (CG43)
• Promoting and creating environments that encourage and support physical activity (PH8).
The national results form a baseline relevant to both trusts that participated in the audit and those
that were unable to.
http://www.rcplondon.ac.uk/resources/nice-public-health-guidance-workplace-organisational-audit
The public health national support teams 2006-11

This workbook was developed by the National Support Teams with 70 local authorities in
England. Local areas could use this approach when analysing whether a population level
17
improvement could be achieved from a set of best-practice and established interventions. This is
offered as a useful resource for commissioners; use is NOT mandatory.
H_125789
Items in the Mental Health section may also be of interest.
[back to topics]
Safeguarding Vulnerable Adults

Speaking up for vulnerable adults: what the whistleblowers say
Public Concern at Work
We are calling for proactive promotion of best practice in whistleblowing arrangements and the
support available for whistleblowers. This includes training and guidance for managers on how to
handle concerns, employers providing feedback when responding to concerns, a greater
awareness of rights, zero tolerance of whistleblower victimisation, and clearer guidance about
how and when to approach relevant authorities.
http://www.pcaw.co.uk/news_attachments/Speaking%20up%20for%20vulnerable%20adults,
%20what%20the%20whistleblowers%20say,%20PCAWApril2011.pdf
[back to topics]
Service Management
Budget 2011 - reaction and briefing for members
NHS Confederation
This briefing sets out the main points in the budget for the NHS.
http://www.nhsconfed.org/OurWork/latestnews/Pages/Budget-2011.aspx
Equity and excellence: Liberating the NHS - managing the transition

This guidance outlines the process of aligning PCT employees during the transition to support the
development of emerging GP consortia and associated commissioning support functions. Q&A is
currently being developed to support employers and staff to understand better the Assignment for
Transition guidance. This will be made available on the Social Partnership Forum website.
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_1
24440 NB Transition documents are at the bottom of the page.
How is the NHS performing? Quarterly monitoring report

King’s Fund
This monitoring report is the first of a regular quarterly review, which will combine publicly
available data on selected NHS performance measures with views from a panel of finance
directors on the key issues their organisations are facing.
http://www.kingsfund.org.uk/publications/quarterly_monitoring.html
Lessons from PFI and other projects

National Audit Office
The report concludes that lessons from the large body of experience of using PFI can be applied
to improve other forms of procurement and help Government achieve its aim of securing annual
infrastructure delivery cost savings of £2 billion to £3 billion. Government should also do more to
act as an ‘intelligent customer’ in the procurement and management of projects.
http://www.nao.org.uk/publications/1012/lessons_from_pfi.aspx
18
Measurement for Quality and Cost Case Studies

NHS Institute for Innovation and Improvement
One-page summaries of a number of Quality and Cost case studies from across England.
http://www.institute.nhs.uk/cost_and_quality/qipp/measurement_for_quality_and_cost_case_studi
es.html
More for less 2009/10: are efficiency and productivity improving in the NHS?
Audit Commission
The Audit Commission has produced a number of reports, analyses and updates, as part of the
‘More for Less’ series, looking at how NHS money has been spent, whether primary care trusts
have been successful in keeping more patients out of hospital, and whether hospitals have
become more efficient.
http://www.audit-commission.gov.uk/health/trustpractice/reports/Pages/default_copy.aspx
Public Service Output, Inputs and Productivity: Healthcare

Office for National Statistics
This article updates estimates of changes in UK publicly funded healthcare output, inputs and
productivity that were last published in Total Public Service Output and Productivity in July 2010
and gives the first estimate for 2009.
http://www.statistics.gov.uk/cci/article.asp?ID=2666
Items in the Children and Young People, Commissioning and Safeguarding Vulnerable
Adults sections may also be of interest.
[back to topics]
Sexual Health
Progestin-only contraceptives: effects on weight
Lopez, L et al.
The authors found little evidence of weight gain when using progestin-only contraceptives. Mean
gain was less than 2 kg for most studies up to 12 months, and usually similar for the comparison
group using another contraceptive. Appropriate counselling about typical weight gain may help
reduce discontinuation of contraceptives due to perceptions of weight gain.
“Response to sexual violence” Needs Assessments (RSVNA) toolkit: informing the

commissioning and development of co-ordinated specialist services for victims of sexual
violence
H_125668
Views of contraceptive service delivery to young people in the UK: a systematic review
and thematic synthesis
Baxter, S et al.
This review suggests that the most significant concern for young people is the preservation of
anonymity and confidentiality. The fear of staff being critical or unfriendly also presents a
considerable obstacle to some young people. Issues of service accessibility are also highlighted.
The review suggests that varying preferences among young people with regard to which service
to access requires choice to be preserved and, where possible, extended. This requires services
to work effectively together to consider provision across a locality.
J Fam Plann Reprod Health Care 2011;37(2) p.71-84 doi:10.1136/jfprhc.2010.0014
[back to topics]
19
Smoking
Competitions and incentives for smoking cessation
Cahill, K et al.
The authors concluded that smokers may quit while they take part in a competition or receive
rewards for quitting, but generally do no better than unassisted quitters once the rewards stop.
Competitions and rewards may attract more people to make a quit attempt than might otherwise
do so, but cessation rates remain broadly the same as for non-contestants.
[back to topics]
Vaccination and Immunisation

ImmForm website
The ImmForm website is the system used by the Department of Health, the National Health
Service and the Health Protection Agency to record data in relation to uptake against
immunisation programmes, incidence of flu-like illness and provide vaccine ordering facilities for
the NHS. Further information and helpsheets are available at:
http://www.dh.gov.uk/en/Publichealth/Immunisation/Immform/index.htm
[back to topics]
Waste Management
Freedom of Information report on waste management
Royal College of Nursing
This report gives the results of the survey on waste management in the NHS. It calls for more of a
focus on efficiently managing waste and makes recommendations for improvement.
http://www.rcn.org.uk/__data/assets/pdf_file/0005/372308/004108.pdf
Hospital Inpatient Waste Identification Tool

Institute for Healthcare Improvement
The Waste Identification Tool provides a systematic method for hospital frontline clinical staff,
members of the financial team, and leaders to identify clinical and operational waste and
subsequently prioritize and implement waste reduction initiatives that will result in cost savings for
the organization. Guidance for customizing the tool is included in the paper.
http://www.ihi.org/IHI/Results/WhitePapers/HospitalInpatientWasteIDToolWhitePaper.htm
(Registration with the site required. Registration is free.)
Safe management of healthcare waste

This guidance manual updates the 2006 Health Technical Memorandum (HTM) 07-01. It has
been produced as a best practice guide to the management of healthcare waste. The key
changes include: an update to statutory requirements; a focus on the waste hierarchy through
procurement practices; a drive to address the carbon impact related to waste; the integration of
new sector guides on GPs, dental practices, and community pharmacies; an emphasis on
practical advice through case study examples (in particular on offensive waste streams) and staff
training material; and a review of terminology used for healthcare, clinical and non-clinical wastes.
H_126345
[back to topics]
20
Women’s Health
Items in the Cancer and Sexual Health sections may be of interest.
[back to topics]
Workforce
GMP Framework for appraisal and revalidation
General Medical Council
The Good Medical Practice Framework sets out the broad areas which should be covered in
medical appraisal and on which recommendations to revalidate doctors will be based. The
Framework is based on Good Medical Practice, the GMC’s core ethical guidance for doctors,
which sets out the principles and values on which good practice is founded. The Framework will
form the basis of a standard approach for all appraisals, in which licensed doctors must take part
in order to revalidate.
http://www.gmc-uk.org/doctors/revalidation/revalidation_gmp_framework.asp
Health visiting return to practice and recruitment drive

These documents outline the government’s Health Visitor Implementation Plan recruitment offer,
and provide answers to frequently asked questions for NHS employers.
H_125598
National Allied Health Professional Leadership Challenge Toolkit

The national Allied Health Professional (AHP) Leadership challenge programme provided clinical
leadership development to nearly 1000 AHPs in bands 5-9. This toolkit takes the learning from
that programme providing the information and tools to develop leadership challenges to sit any
organisation’s needs.
H_125817
NHS Workforce: Summary of staff in the NHS: Results from September 2010 Census
This publication covers hospital, community, general and personal medical services. This year's
workforce census shows an increase in almost all staff categories but a decrease in numbers for
managers and senior managers and for bank nursing staff.
http://www.ic.nhs.uk/statistics-and-data-collections/workforce/nhs-staff-numbers
Nursing pre-registration education presentations

NHS Employers
These two presentations are designed to help employers communicate the changes to pre-
registration nursing education.
http://www.nhsemployers.org/PlanningYourWorkforce/Nursing/toolsandresources/Pages/Nursing
PreRegistrationEducationPresentations.aspx
Positive action provisions

NHS Employers
This page includes information about the positive action provisions in relation to the Equality Act
2010.
http://www.nhsemployers.org/EmploymentPolicyAndPractice/EqualityAndDiversity/EqualityAct/Pa
ges/Postiveactionprovisions.aspx
21
Responsible Officers (ROs)

NHS Employers
This page includes information on the Responsible Officer role, including legislation and
guidance, RO training and duties and responsibilities.
http://www.nhsemployers.org/PlanningYourWorkforce/MedicalWorkforce/MedicalRevalidation/Pa
ges/ResponsibleOfficers.aspx
Twenty centres to put health visitors at the heart of the community

Twenty health visiting sites across the country, including NHS Stoke-on-Trent, have been
selected to lead the way in fast tracking the delivery of the Government’s vision to improve the
health and well being of children, families and communities.
http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_125655
Items in the Mental Health, Public Health, Safeguarding Vulnerable Adults and Service
Management sections may also be of interest.
[back to topics]
22

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NHS Library and Information Service North Staffordshire

Clinical Effectiveness Bulletin

About this Bulletin:

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

Bulletin produced by NHS Outreach Librarians

North Staffs Health Library

Contents in this issue

Sources for Clinical Effectiveness Bulletin

Medical interventions for high grade vulval intraepithelial neoplasia (VIN)

Care after Death

Children and Young People

Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a

Facing the Future: A Review of Paediatric Services

Fundamentals of Commissioning Health Services for Children

Pharmacological treatment for Attention Deficit Hyperactivity Disorder (ADHD) in children

Commissioning: further issues

Liberating the NHS: orders of change?

National Health Service Landscape Review

The NHS Performance Framework: Implementation guidance - 2011/12

Reducing expenditure on low clinical value treatments: a health briefing

Shadow consortia: Developing and electing a transitional leadership (updated version)

Transforming Community Services: Demonstrating and Measuring Achievement:

Who pays? Establishing the responsible commissioner

Working together for a stronger NHS

Toolkit to improve quality of urgent and emergency care

The recognition and initial management of ovarian cancer

NICE Technology Appraisals

Everolimus for the second-line treatment of advanced renal cell carcinoma

Golimumab for the treatment of psoriatic arthritis

Romiplostim for the treatment of chronic immune or idiopathic thrombocytopenic purpura

Trabectedin for the treatment of relapsed ovarian cancer

NICE Consultation Documents

Magnetic resonance image-guided transcutaneous focused ultrasound for uterine fibroids

Management of multiple sclerosis in primary and secondary care

Microwave ablation for the treatment of metastases in the liver

Self-harm (longer term management)

Smoking harm reduction

Public Health Guidance

Prevention and management of venous thromboembolism (audit tool)

Treating psoriasis and psoriatic arthritis

Other Health Technology Assessments

Explanatory memorandum to the National Health Service (general medical services

Results from the mandatory surveillance of meticillin resistant Staphylococcus aureus

Long Term Conditions

Snapshot: Co-Creating Health

Maternal and Infant Health

Hepatitis B antenatal screening and newborn immunisation programme: Best practice

Hepatitis B: Pathway stages to protection - Actions, roles, responsibilities and standards

Introducing Solid Foods: Giving your baby a better start in life

Parents' views on the maternity journey and early parenthood

Fulfilling and Rewarding Lives: Evaluating progress

Talking therapies: a four-year plan of action

Spirituality in nursing care: a pocket guide

National Bariatric Surgery Register report

Strategic high impact changes: childhood obesity

Patient Care and Safety

Reablement: a cost-effective route to better outcomes

Cost-effective prescribing: Better Care Better Value (BCBV) indicator on statins