Clinical Effectiveness Bulletin 44, September 2010

NHS Library and Information Service North Staffordshire
Clinical Effectiveness Bulletin

for PCTs in North Staffordshire
Issue No: 44 – September 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
Bulletin produced by NHS Outreach Librarians

Tel: 07834 115958 [please leave a message]
E-mail: Frances.Griffiths@uhns.nhs.uk
clare.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 /
Le
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Di
sa
bili
tie
s
Allied Health Midwifery
Cancer Musculoskeletal
Cardiovascular Obesity
Diseases
Commissioning Olderpeople
Dementia Patient Care and
Safety
Diabetes Renal Diseases
End of Life Respiratory
Diseases
Epilepsy Screening
Eye Disorders Service
Management
General Practice Sexual Health
Guidance Skin Disorders
Hearing Disorders Stroke
Immunisations / Urology
Vacci Sources for Clinical Effectiveness
natio Bulletin
ns
Infection Control Women's Please suggest further sites that should
He be monitored in the production of this
alt bulletin
h/ Websites
Pr
eg Clinical Knowledge Summaries [NLH]
http://cks.library.nhs.uk/
na Cochrane Library
nc http://www.library.nhs.uk/
y CRD Centre for Reviews and
Long Term Workforce Dissemination
Cond http://www.crd.york.ac.uk/crdweb/
- DARE – (Database of
itions Abstracts of Reviews of
Effects)
- NHS Economic Evaluation Database
Daily Health Bulletin http://www.sheffield.nhs.uk/healthbulletin/
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Department of Health http://www.dh.gov.uk/en/index.htm

Department of Health Bulletins http://www.dh.gov.uk/en/Publicationsandstatistics/Bulletins/
Health Technology Assessment (HTA) Database http://www.ncchta.org/
NeLM (National Electronic Library for Medicines) news bulletin http://www.nelm.nhs.uk/en/
NHS Information Centre http://www.ic.nhs.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
Alcohol
Alcohol framework for primary care updated
NHS Primary Care Commissioning
The Primary Care Service Framework is for adult patients who are drinking to hazardous and
harmful or dependent levels. This document has been updated to include recent policy changes
and is supported by a range of enhanced tools to support implementation. A complementary suite
of resources and supportive notes is also available.
Framework:
http://www.pcc.nhs.uk/uploads/primary_care_service_frameworks/2009/primary_care_service_fra
mework_-19may09_clean.doc
Supporting Documents:
http://www.pcc.nhs.uk/alcohol
Acamprosate for alcohol dependence

Cochrane Library Systematic Reviews Database
Susanne Rösner, Andrea Hackl-Herrwerth, Stefan Leucht, Philippe Lehert, Simona Vecchi,
Michael Soyka
Background: Alcohol dependence is among the main leading health risk factors in most
developed and developing countries. Therapeutic success of psychosocial programs for relapse
prevention is moderate, but could potentially be increased by an adjuvant treatment with the
glutamate antagonist acamprosate. Authors' conclusions: Acamprosate appears to be an
effective and safe treatment strategy for supporting continuous abstinence after detoxification in
alcohol dependent patients. Even though the sizes of treatment effects appear to be rather
moderate in their magnitude, they should be valued against the background of the relapsing
nature of alcoholism and the limited therapeutic options currently available for its treatment.
http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD004332/frame.html
[back to topics]
Allied Health
Engagement exercises to seek views on possibilities for introducing independent
prescribing responsibilities for physiotherapists and podiatrists
Department of Health
The Allied Health Professionals Prescribing and Medicines Supply Mechanisms Scoping Project
recommended further work be undertaken to take forward independent prescribing by
physiotherapists and podiatrists. The two engagement exercises are seeking views on the
development of independent prescribing for physiotherapists and for podiatrists. Depending on
the outcome, and subject to agreement by Ministers, these views may then inform and assist the
development of a formal public consultation led by the Medicines and Healthcare products
Regulatory Agency (MHRA) proposing specific amendments to the relevant legislation.
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Responses can be made online, by email or in writing and are welcomed from individuals, groups
and organisations.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D
H_119164
[back to topics]
Cancer
Interventions for the treatment of oral cavity and oropharyngeal cancer: chemotherapy
Susan Furness, Anne-Marie Glenny, Helen V Worthington, Sue Pavitt, Richard Oliver, Jan E
Clarkson, Michaelina Macluskey, Kelvin KW Chan, David I Conway, The CSROC Expert Panel
Chemotherapy for mouth and throat cancer
Oral cavity (mouth) cancer is usually detected earlier and treated with surgery and radiotherapy.
Oropharyngeal (throat) cancer may be advanced when it is found and is treated with
radiotherapy. Both treatments may be associated with disfigurement and decreased ability to eat,
drink and talk. Treatment with chemotherapy (drugs which kill cancer cells), in addition to
radiotherapy (and surgery where possible) offers prolonged survival. Chemotherapy given at the
same time as radiotherapy, is more effective than chemotherapy given before radiotherapy, and
may reduce the need for surgery. The side effects of chemotherapy are nausea, vomiting,
diarrhoea, hair loss, and infections but these generally stop at the end of treatment.
Pilot campaigns to promote early diagnosis of bowel cancer

A Dear Colleague letter 'Pilot campaigns to promote early diagnosis of bowel cancer' has been
published by the Department of Health. This letter contains information on plans to run large-
scale pilot campaigns to promote early diagnosis of bowel cancer.
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_1
19664
Urological cancer hub

Urological Cancer Hub
South West Public Health Observatory has launched a 'Urological cancer hub'. This website aims
to equip health professionals and others with information on urological cancers and their
treatment. It also contains information about the current picture and past trends of urological
cancers in England.
http://www.swpho.nhs.uk/urologicalcancerhub/home.aspx
[back to topics]
Cardiovascular Diseases
Grown-Up Congenital Heart Disease (Management of)
European Society of Cardiology
These guidelines summarise and evaluate the currently available evidence on the management
of grown-up congenital heart disease. The guidelines update a previous version and were
developed by the Task Force on the Management of Grown-up Congenital Heart Disease of the
European Society of Cardiology (ESC).
http://www.escardio.org/knowledge/guidelines/Management_of_Grown-
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Up_Congenital_Heart_Disease.htm
Guidelines on Management of Atrial Fibrillation

European Society of Cardiology
The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology
(ESC) has published updated guidelines for the management of atrial fibrillation (AF).
http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/guidelines-afib-
FT.pdf
Nurse led interventions to improve control of blood pressure in people with hypertension:
systematic review and meta-analysis
Database of Abstracts of Reviews of Effects (DARE)
Clark CE, Smith LF, Taylor RS, Campbell JL
Nurse-led interventions for hypertension in primary care that included a structured treatment
algorithm were beneficial in blood pressure management, but there was insufficient evidence to
support their widespread use within the UK healthcare system. The authors' conclusions seem
reasonable and are likely to be reliable.
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12010005893
[back to topics]
Commissioning
Corporate News: Keep on top of Payment by Results with NHS Comparators
NHS Information Centre
NHS commissioners can now monitor their Payment by Results (PbR) expenditure and providers
can keep track of income using NHS Comparators. Seven new indicators have been added,
including percentage of excess bed days and the percentage of non-PbR qualified events, in
addition to over 200 other ‘core' comparators, ranging from emergency admissions to maternity
care that can be used for benchmarking. The online tool has now been updated with the latest
data for Q3 (October to December) 2009/10.
http://www.ic.nhs.uk/news-and-events/news/corporate-news-keep-on-top-of-payment-by-results-
with-nhs-comparators
Developing a Compact – A brief guide for commissioners

NHS Institute for Innovation and Improvement
The NHS Institute for Innovation and Improvement has published 'Developing a compact: a brief
guide for clinical commissioners'. A compact is a local agreement that pro-actively shapes the
relationship between clinical commissioners and partner organisations. This new guide is aimed
at commissioners and GP consortia to give guidance for putting a compact together in the most
effective and efficient way.
http://www.institute.nhs.uk/world_class_commissioning/general/compacts.html?
utm_source=Sign-Up.to&utm_medium=email&utm_campaign=208922-
NHS+Institute+Newsletter+August+2010
Referral Management: lessons for success

King’s Fund
General practitioners make over 9 million referrals each year, triggering many billions of pounds
of expenditure. There is also significant variation in the quality and rate of referral between GPs
and GP practices. As the NHS faces a prospective funding gap of £14–£20 billion and GPs take
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the lead for commissioning services, it is the perfect time to examine whether referral
management in its many forms will help GP commissioners deliver savings and improve care.
http://www.kingsfund.org.uk/publications/referral_management.html
Commissioning Guide - The management of lower urinary tract symptoms in men

This commissioning guide provides support for the local implementation of NICE guidance
through commissioning, and is a resource for people involved in commissioning health and social
care services and public health programmes within the NHS and partner organisations in
England. Although this guide focuses on lower urinary tract symptoms in men (LUTS), health and
social care and public health commissioners may wish to consider the needs of their whole
population, especially older people (including those living in nursing homes), when
commissioning urinary continence services.
Joint commissioners and people working in local authorities may find this guide useful to inform
partnership working and joint planning.
http://www.nice.org.uk/usingguidance/commissioningguides/luts/LUTS.jsp
GP Commissioning Consortia: Building a better health system for patients

Tribal
Tribal has launched the first in a series of white papers exploring how GP commissioning
consortia can meet the new responsibilities they will face under the proposed government
reforms for the NHS. It also suggests how the process of transferring the various tasks and
functions from the Primary Care Trusts (PCTs) can be managed. The paper also maps out how
sector relationships are likely to change in this shift from PCTs to GP commissioning consortia.
http://www.tribalgroup.com/Documents/Health/WhitePaperGPCommissioningConsortia1.pdf
Items in the General Practice section may also be of interest for GP commissioning.
[back to topics]
Dementia
Statins for the treatment of dementia
NHS Evidence Special Collections – Supportive and Palliative Care / Cochrane Library
Systematic Reviews
Background: The use of statin therapy in established Alzheimer's disease (AD) or vascular
dementia (VaD) is a relatively unexplored area. In AD ß-amyloid protein (Aß) is deposited in the
form of extracellular plaques and previous studies have determined Aß generation is cholesterol
dependent. Hypercholesterolaemia has also been implicated in the pathogenesis of VaD. Due to
the role of statins in cholesterol reduction it is biologically plausible they may be efficacious in the
treatment of AD and dementia. Conclusion: There is insufficient evidence to recommend statins
for the treatment of dementia. Analysis from the studies available, including one large RCT,
indicate statins have no benefit on the outcome measures ADAS-Cog or MMSE. We need to
await full results from CLASP 2008 before we can be certain. Systematic Review
Alzheimer's Disease and Dementia Annual Evidence Update 2010: Contents

NHS Evidence Special Collections – Later Life
NHS Evidence - later life's Alzheimer's Disease and Dementia Annual Evidence Update 2010
aims to provide healthcare professionals with a clear path to the most important recent evidence
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surrounding the five major types of dementia: Alzheimer’s; Vascular dementia; Dementia with
Lewy bodies; Frontotemporal dementia; and Mixed dementias.
http://www.library.nhs.uk/laterlife/viewResource.aspx?
resid=384150&code=b1fd3602b972fd12037ae1c2bfaba8fe
Quality outcomes for people with dementia: Building on the work of the National Dementia
Strategy
This document presents the Department’s revised, outcomes focused implementation plan for
‘Living well with dementia: A National Dementia Strategy’, which was published in February 2009.
It updates the previous implementation plan for the Strategy, which was published in July 2009.
At the heart of this vision is the Government’s commitment to putting patients and the public first;
improving health and social care outcomes; ensuring autonomy, accountability and democratic
legitimacy and improving efficiency. It describes what the Department of Health considers as its
priorities for policy development in its role of enabler for continued progress in improving
outcomes for people with dementia and their carers.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digita
lasset/dh_119828.pdf
[back to topics]
Diabetes
2010 Annual Evidence Update on Diabetic Retinopathy
NHS Evidence Special Collections – Diabetes
Diabetic retinopathy is the most common cause of blindness in working age people in the UK.
The Annual Evidence Update on Diabetic Retinopathy (DR) provides an opportunity to present an
up-to-date comprehensive collection of information that has been subject to rigorous selection
criteria. The coverage of the Annual Evidence Update has been developed on the basis of topics
suggested by UK diabetic retinopathy experts. Information is organised by topic areas and links
are provided within each topic to the relevant systematic reviews, primary research, guidelines
and patient information. Topics include: incidence and prevalence of DR, epidemiology and
progression of DR, factors influencing development of DR, screening for DR, treatment, surgery,
modern therapies, blindness and visual impairment, and assessment of retinopathy by automated
computer algorithm.
http://www.library.nhs.uk/DIABETES/ViewResource.aspx?resID=387096
National Service Framework for Children, Young People and Maternity Services – Type 1
Diabetes in childhood and adolescence
The Department of Health has published the following guidance 'Diabetes type 1 in childhood.
National Service Framework for children, young people and maternity services'. This exemplar
describes a care pathway for a child with Type 1 diabetes.
[back to topics]
End of Life
End off Life Care Strategy: second annual report
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In July 2008 the Department of Health published the End of Life Care Strategy - promoting high
quality care for all adults at the end of life. This second annual report sets out the continuing
progress in implementing the strategy, highlights the need for further work and identifies the
action intended for this coming year.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasse
t/dh_086345.pdf
Improving end of life care in neurological disease: An executive summary

NHS National End of Life Care Programme
This executive summary outlines the challenges in providing end of life care for patients with
neurological diseases alongside the potential ways of improving care in this area. The full
framework will be published in November 2010
http://www.endoflifecareforadults.nhs.uk/assets/downloads/Neurological_exec_summary_201009
21.pdf
[back to topics]
Epilepsy
2010 Annual Evidence Update on Epilepsy
NHS Evidence Special Collections – Neurological Conditions
The 2010 Epilepsy Annual Evidence Update is our third on this topic, and examines knowledge
on the diagnosis and management of epilepsy published since the 2009 Update. As with previous
Zeus, the focus is on systematic reviews, carefully appraised to inform clinical practice, rather
than primary research. The Neurological Conditions Specialist Collection Project Team has
carried out a systematic literature search on Epilepsy to identify all high level evidence published
since the date of the last Epilepsy Annual Evidence Update in 2009, including guidelines,
systematic reviews, health technology assessments and economic evaluations.
http://www.library.nhs.uk/NEUROLOGICAL/ViewResource.aspx?resID=384385
Frequency and prognosis of convulsive status epilepticus of different causes: a

systematic review
NHS Evidence Special Collections – Neurological Conditions
A systematic review of all studies of status epilepticus (SE) with more than 30 patients published
between January 1, 1990, and December 31, 2008, to determine the frequencies of the common
underlying causes and the extent to which the underlying causes affect the prognosis of an
episode of SE. The frequencies of underlying causes vary among studies and show marked
geographic differences, but in most studies, the most common underlying causes were
cerebrovascular disease and low antiepileptic drug levels. A relatively good prognosis of SE is
found when the underlying cause is associated with low antiepileptic drug levels or alcohol abuse,
and a relatively poor outcome occurs when the underlying cause is cerebrovascular disease,
particularly in the case of SE due to acute cerebral anoxia, but in most conditions, the reported
prognosis is variable. Also, when SE occurs in the context of an acute cerebral insult, such as
cerebral infection or cerebrovascular disease, the prognosis of the acute cerebral event is
worsened.
http://www.library.nhs.uk/neurological/ViewResource.aspx?resID=386541
(NHS Athens login required)
[back to topics]
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Eye Disorders
Punctal occlusion for dry eye syndrome
The Cochrane Library
Ann-Margret Ervin, Robert Wojciechowski, Oliver Schein
Background: Dry eye syndrome is a disorder of the tear film and is associated with symptoms of
ocular discomfort. Punctal occlusion is a mechanical treatment in which the tear drainage system
is blocked in order to aid in the preservation of natural tears on the ocular surface. Authors'
conclusions: This systematic review shows a relative scarcity of controlled clinical trials assessing
the efficacy of punctal occlusion therapy in dry eye. Although the evidence is very limited, the
data suggest that silicone plugs can provide symptomatic relief in severe dry eye. Moreover,
temporary collagen plugs appear similarly effective to silicone plugs on a short-term basis.
2010 Annual Evidence Update on Amblyopia

NHS Evidence Specialist Collections – Eyes and Vision
Amblyopia is the term used to describe the clinical scenario of impaired vision, most commonly
affecting one eye, which arises through degraded visual stimulation during critical periods of
visual development in early childhood. Clinicians treating ophthalmic disease in children always
have to consider, and often have to manage, amblyopia - either as the main disorder causing
impaired vision or as a contributing condition. The 2010 Evidence Update focuses on the clinical
and functional outcomes of amblyopia and highlights the: clinical outcomes of treatment -
focussing on aspects of visual acuity, stereopsis, and ocular alignment; functional outcomes of
treatment - focussing on aspects of quality of life and visual functioning; adverse events of
treatment; current uncertainties in the effectiveness of treatments.
http://www.library.nhs.uk/eyes/viewResource.aspx?resid=387844
[back to topics]
General Practice
A pro-active approach. Health promotion and ill-health prevention
King’s Fund
As part of the work surrounding a GP Inquiry, the panel commissioned research on the
appropriate contribution of general practice to health promotion and ill-health prevention.
Case studies on childhood immunisations, smoking cessation, cardiovascular disease, and
obesity are used to illustrate the larger role GPs can play in health promotion and prevention in
their day-to-day duties.
Readers are invited to read the research paper and then leave comment on it.
http://www.kingsfund.org.uk/current_projects/gp_inquiry/dimensions_of_care/health_promotion.ht
ml
General Practitioners Committee guide to the NHS White Paper - GP consortia

commissioning: initial observations
British Medical Association
This document sets out how GPs in England could progress with making consortia arrangements.
This guidance covers areas such as: determining commissioning population size, responsibilities
and governance, funding and budget setting and ensuring probity.
http://www.bma.org.uk/images/whitepapergpcguidence4sept2010_tcm41-199838.pdf
Related document BMA press release about this guide:
http://web2.bma.org.uk/pressrel.nsf/wlu/RWAS-896HTT?OpenDocument&vw=wfmms
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Update on Commissioning Activity

Royal College of General Parishioners
This paper focuses on the Royal College of General Practitioners' current and future engagement
with commissioning, and suggests potential ways to support their members in the delivery of the
reforms suggested in the White Paper. It is not a comprehensive review of the White Paper and
does not in any way pre-empt the results of the RCGP consultation process on the White paper.
http://www.rcgp.org.uk/pdf/Update_on_Commissioning_Activity.pdf
Statistical Press Notice – GP Patient Survey July 2009 to June 2010 National Results
Ipsos-MORI have published the results of four quarterly collections of the GP Patient Survey
covering July 2009 to June 2010 which they are carrying out on behalf of the Department of
Health.
http://www.dh.gov.uk/en/MediaCentre/Pressreleases/DH_119453
Survey Results
http://www.gp-patient.co.uk/surveyresults/
Letter to all GPs setting out the next steps on GP-led commissioning
The Department of Health has published the following relating to the development of GP-led
commissioning:
- Letter to all GPs setting out the next steps on GP-led commissioning
A letter from the Secretary of State for Health to GPs about the proposals for GP commissioning
and reiterating the intention that the formation of consortia would be a bottom up approach, led by
GP practices.
- Letter to all SHA and PCT Chief executives about the proposals for GP-led commissioning
This letter refers to the above letter.
19741
Meeting the Healthcare Needs of Veterans - A guide for general practitioners

The British Legion
The Royal College of General Practitioners (RCGP), The Royal British Legion and Combat Stress
have launched guidance to support GPs in identifying and meeting the healthcare needs of
veterans more effectively - including accessing the priority treatment to which all veterans are
entitled for Service-related conditions. The jointly-produced guidance for GPs looks at how best to
care for veterans' physical and mental health after they have left the Forces and rejoined civilian
life. It provides useful advice on medical records and accessing priority treatment, along with
dedicated sections including mental health needs, health behaviours, the provision of prostheses
and hospital waiting lists.
http://www.britishlegion.org.uk/media/1163063/veteranshealthcareneedsgps.pdf
Items in the Commissioning section may also be of interest.
[back to topics]
Guidance
NICE Clinical Guidelines
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The management of bacterial meningitis and meningococcal septicaemia in children and

young people younger than 16 years in primary and secondary care
Clinical Guideline GC102
An important change has been made to recommendation 1.4.45 of the NICE guideline. The
recommendation at publication contained an incorrect dose of hydrocortisone. This has now
been corrected
http://guidance.nice.org.uk/CG102
CG110 Pregnancy and complex social factors (full guideline and appendices)
Clinical Guideline GC110
http://guidance.nice.org.uk/CG110/Guidance
Other related guidance documents
http://www.nice.org.uk/guidance/index.jsp?action=byID&o=13167
NICE Technology Appraisals
Hepatitis C - peginterferon alfa and ribavirin

Technology appraisal TA200
http://www.nice.org.uk/guidance/index.jsp?action=byID&o=13180
NICE Consultation Documents
Chronic lymphocytic leukaemia - ofatumumab: final appraisal determination

Appeal period for appraisal closes 5pm on 30 September 2010.
http://www.nice.org.uk/guidance/index.jsp?action=folder&o=50757
Gastro-intestinal stromal tumours (unresectable/metastatic) - imatinib (review): final

appraisal determination
Appeal period for appraisal closes 5pm on 30 September 2010.
Epilepsy (update): guideline consultation

Closing date for comments: 30 September 2010
Only registered stakeholders can comment – register or contact the registered stakeholder
organisation that most closely represents your interests and pass your comments to them
Psoriasis: draft scope consultation

Closing date for comments: 1 October 2010
Aripiprazole for the treatment of schizophrenia in people aged 15 to 17 years (Appraisal

Consultation Document)
http://guidance.nice.org.uk/TA/Wave22/10/Consultation/DraftFullGuidance
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Ovarian cancer (relapsed) - trabectedin: final appraisal determination

Appeal period for appraisal closes 5pm on 1 October 2010.
http://guidance.nice.org.uk/TA/Wave19/47/FAD
Psychosis with substance misuse: guideline consultation

Only registered stakeholders for this guideline can comment.
Diabetic foot problems - inpatient management: guideline consultation

Hepatitis B and C: ways to promote and offer testing - draft scope

Ovarian cancer: guideline consultation

Closing date for comments: 19 November 2010
Only registered stakeholders can comment – register or contact the registered stakeholder
organisation that most closely represents your interests and pass your comments to them
Increasing the uptake of HIV testing among men who have sex with men: draft guidance
consultation
Increasing the uptake of HIV testing among black Africans in England: draft guidance
consultation
NICE Interventional Procedure Guidance
Endoscopic submucosal dissection (ESD) of oesophageal dysplasia and neoplasia

Interventional procedure guidance: (IPG355)
http://www.nice.org.uk/IPG355
Laparoscopic hysterectomy (including laparoscopic total hysterectomy and

laparoscopically assisted vaginal hysterectomy) for endometrial cancer
Percutaneous intradiscal laser ablation in the lumbar spine

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Phototherapeutic laser keratectomy for corneal surface irregularities

Clinical Knowledge Summaries updated in September 2010
• Alcohol – problem drinking
• Addison's disease (new)
• Cataracts (new)
• Constipation in children (new)
• Cough (new)
• Gilbert's syndrome (new)
• Glaucoma and ocular hypertension (new)
• Neuropathic pain - drug treatment
Other Guidance
Guidance – Equality Act 2010

In October, the Equality Act commences with measures gradually being introduced after that
date. The Equality and Human Rights Commission (EHRC) have produced initial guidance for
service users, providers, and employers.
NHS chief executives and directors of social care will wish to use this guidance in preparation for
the commencement of the Equality Act in October.
http://www.equalityhumanrights.com/advice-and-guidance/guidance-equality-act-2010/equality-
act-2010-guidance/
Management of chronic venous leg ulcers

SIGN
The Scottish Intercollegiate Guidelines Network (SIGN) has published a new guideline on the
'Management of chronic venous leg ulcers' (Guideline 120). This guideline provides evidence
based recommendations on the management of venous leg ulcers and examines assessment,
treatment and the prevention of recurrence. Evidence on provision of care is also presented.
http://www.sign.ac.uk/pdf/SIGN120.pdf
Health Technology Assessments
Systematic review and economic modelling of the effectiveness and cost-effectiveness of

non-surgical treatments for women with stress urinary incontinence
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Health Technol Assess: 14.40
A multicentred randomised controlled trial of a primary-care based cognitive behavioural

programme for low back pain. The Back Skills Training (BeST) trial
Recombinant human growth hormone for the treatment of growth disorders in children: a
systematic review and economic evaluation
[back to topics]
Immunisations / Vaccinations
Data suggest introduction of pneumococcal conjugate vaccination has reduced hospital
admissions for childhood bacterial pneumonia and empyema
Thorax
Elizabeth Koshy1, Joanna Murray, Alex Bottle, Mike Sharland, Sonia Saxena
Thorax, September 2010, Volume 65, Issue 9, Pages 770-774
According to research published in Thorax, a reduction in hospital admission rates for childhood
bacterial pneumonia and empyema has been seen following the introduction of the seven-valent
pneumococcal conjugate vaccination (PCV7) into the childhood national immunisation
programme in England.
http://thorax.bmj.com/content/65/9/770.abstract
(Athens login required to access full text)
Efficient Use of Vaccines

The Department of Health has recently been undertaking work, in conjunction with NHS
colleagues to encourage the efficient use of vaccines. This letter from the Acting Head of
Immunisation at the Department of Health aims to update Strategic Health Authority and PCT
Immunisation leads, on the work done on VESPA (Vaccine Efficiency Savings Programme Audit)
and advises of future developments.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_1192
97.pdf
Seasonal flu campaign information 2010

The Department of Health has published information on the seasonal flu campaign for 2010. The
campaign aims to encourage take-up of the vaccine by everyone aged 65 or over, people who
live in residential or nursing home, people who are carers, and pregnant women. Please see link
below for details.
http://www.dh.gov.uk/en/Publichealth/Flu/Flugeneralinformation/DH_119312
Interventions to increase influenza vaccination rates of those 60 years and older in the
community
Roger E Thomas, Margaret Russell, Diane Lorenzetti
Background: Although the evidence to support influenza vaccination is poor, it is promoted by
many health authorities. There is uncertainty about the effectiveness of interventions to increase
influenza vaccination rates in those 60 years or older. Authors' conclusions: Personalized
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postcards or phone calls are effective, and home visits, and facilitators, may be effective.
Reminders to physicians are not. There is insufficient good evidence for other interventions.
Influenza vaccines in children

MHRA – Central Alerting System
The MHRA, via the Central Alerting System, has issued a Dear Doctor letter regarding monitoring
the safety of seasonal influenza vaccines in children. Doctors are encouraged to promptly report
any cases of febrile convulsion occurring within 72 hours of receiving an influenza vaccine.
https://www.cas.dh.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=101460
[back to topics]
Hearing Disorders
Cognitive behavioural therapy for tinnitus
Pablo Martinez-Devesa, Rafael Perera, Megan Theodoulou, Angus Waddell
Background: This is an update of a Cochrane Review originally published in Issue 1, 2007 of The
Cochrane Library. Tinnitus is an auditory perception that can be described as the experience of
sound, in the ear or in the head, in the absence of external acoustic stimulation. Cognitive
behavioural therapy (CBT) uses relaxation, cognitive restructuring of the thoughts and exposure
to exacerbating situations in order to promote habituation and may benefit tinnitus patients, as
may the treatment of associated psychological conditions. Authors' conclusions : In six studies we
found no evidence of a significant difference in the subjective loudness of tinnitus. However, we
found a significant improvement in depression score (in six studies) and quality of life (decrease
of global tinnitus severity) in another five studies, suggesting that CBT has a positive effect on the
management of tinnitus.
[back to topics]
Infection Control
HPA updates guidance on management of infections in primary care
Health Protection Agency
The Health Protection Agency has updated its guidance on management of common infections in
primary care. The recommendations are in agreement with other guidance, including that from
NICE, SIGN and CKS.
http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1279888711402
Healthcare-Associated Infections and Antimicrobial Resistance: 2009/10

The Health Protection Agency has published 'Healthcare-associated infections and antimicrobial
resistance: 2009/10'. This annual report shows that a total of 1,898 cases of MRSA bacteraemia
were reported in 2009/10, representing a 35% reduction in cases from the previous year when
2,935 cases were reported. In the same period, 25,604 cases of clostridium difficile infection were
reported, representing a 29% reduction from the previous year when 36,095 cases were
reported.
- 15 -
[back to topics]
Long Term Conditions

Annual Evidence Update 6 September 2010: Treatments for anorexia and cachexia in
chronic disease and palliative care
NHS Evidence Special Collections – Supportive and Palliative Care
It focuses on the best new evidence on treatments for anorexia and cachexia in chronic disease
and palliative care.
http://www.library.nhs.uk/PALLIATIVE/ViewResource.aspx?resID=386964
Managing people with long-term conditions

The King’s Fund
This report examines what constitutes best practice in managing long-term conditions, and how
can this be measured. It also assesses the scope for significant quality improvements in this
aspect of general practice care, with a specific focus on arthritis, diabetes, dementia and
depression.
http://www.kingsfund.org.uk/current_projects/gp_inquiry/dimensions_of_care/the_management_o
f_1.html
[back to topics]
Mental Health / Learning Disabilities

The Triangle of Care - Carers included: a guide to best practice in acute mental health care
NHS Evidence Special Collections – Mental Health
A new report has been published by the National Mental Health Development Unit, in
collaboration with The Princess Royal Trust for Carers and Acute Care Declaration: The Triangle
of Care - carers included: a guide to best practice in acute mental care report. The guide
emphasises the need for better local strategic involvement of carers and families in the care
planning and treatment of people with mental ill-health and recommends better partnership
working between service users and their carers, and organisations.
http://its-services.org.uk/silo/files/triangle-of-care-carers-included.pdf
Cost-effectiveness of atypical antipsychotics for the management of schizophrenia in the

UK
NHS Economic Evaluation Database (NHS EED)
Davies A, Vardeva K, Loze JY, L'Italien GJ, Sennfalt K, van Baardewijk M
This study examined the cost-effectiveness of 12 treatment sequences for the management of
stable schizophrenia. The authors concluded that aripiprazole followed by risperidone was the
most cost-effective treatment sequence for these patients in the UK. Despite limited reporting of
the effectiveness data, the methods were valid and the authors' conclusions appear to be
appropriate.
http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=22009102543
The IAPT data handbook: guidance on recording and monitoring outcomes to support
local evidence-based practice - Version 1.0
NHS Evidence Special Collections – Health Management
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This handbook is the latest guidance for all data collection issues within the IAPT Programme. It
replaces the IAPT Outcomes Toolkit, the IAPT Key Performance Indicators Technical Guidance
and the IAPT Data Quality Assurance Process and Metrics. All versions of these documents are
superseded by this single document.
The purpose of this handbook is to:
Enable local partners to make the best use of IAPT outcomes data to put patients at the centre of
the care pathway, deliver outcomes appropriate to need, and improve clinical practice and service
quality.
Provide definitive guidance to enable services to collect routine outcome measures using
standard clinical metrics
Introduce a new Clinical Record which develops the extant IAPT Minimum Data Set and will form
the basis of the future National Data Set.
http://www.iapt.nhs.uk/wp-content/uploads/iapt-data-handbook-v10.pdf
Information on the Mental Health Act

The Department of Health has updated its mental health pages:
http://www.dh.gov.uk/en/Healthcare/Mentalhealth/index.htm
A) Mental Health Act 1983

http://www.dh.gov.uk/en/Healthcare/Mentalhealth/InformationontheMentalHealthAct/DH_4001
816
B) Cross-border transfers of patients under the Mental Health Act

The Mental Health Act 1983 (“the Act”) permits some patients who come under its provisions
to be transferred to Scotland, Northern Ireland, the Channel Islands and the Isle of Man. It
states that a hospital in England must obtain the authorisation of the Secretary of State for
Health before it can transfer such a patient to a location in one of these jurisdictions. There
are three related documents under this title:
-one covering Cross border patient transfer arrangements;
- one looking at Transfer of non-restricted patients to a hospital outside England and Wales;
- and another detailing Transfer of responsibility of supervised community treatment patients
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc
e/DH_119129
C) Section 67 of the Mental Health Act

Section 67 of the Mental Health Act 1983 gives the Secretary of State for Health a
discretionary power to refer cases involving certain patients subject to the provisions of the
Act to the First-tier Tribunal. Two documents have been made available:
- Section 67 of the Mental Health Act 1983 References by the Secretary of State for Health to
the First-tier Tribunal
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/d
igitalasset/dh_119207.pdf
- Applications to the First-Tier Tribunal (Mental Health)
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/d
igitalasset/dh_119193.pdf
Community mental health services survey

Care Quality Commission
The Care Quality Commission has published the results of its community mental health services
survey. The survey took the views of more than 17,000 people who received specialist care or
treatment for a mental health condition, including those who received care co-ordinated under the
Care Programme Approach (CPA), between July and September 2009. The survey covered 66
NHS trusts. The results show that people are generally very positive about the health and social
- 17 -
care workers they had seen for their mental health condition. However, many reported that they
were not as involved in aspects of their care as they would have liked.
Survey results:
http://www.cqc.org.uk/aboutcqc/howwedoit/involvingpeoplewhouseservices/patientsurveys/comm
unitymentalhealthservices.cfm
Computerised cognitive behaviour therapy for depression and anxiety update: a

systematic review and economic evaluation
Kaltenthaler E, Brazier J, De Negris E, Tumur I, Ferriter M, Beverley C, Parry G, Rooney G,
Sutcliffe P
This generally well-conducted review found some evidence that computerised cognitive
behavioural therapy (CBT) was as effective as therapist-led CBT in treating phobia/panic, and
was more effective than treatment as usual for depression/anxiety. Computerised CBT was not
as effective as therapist-led CBT for the treatment of obsessive compulsive disorder. The authors'
conclusions are likely to be reliable.
[back to topics]
Midwifery
Midwifery 2020: Delivering expectations
The Midwifery 2020 programme was commissioned in 2008 by the Chief Nursing officers for
England, Wales, Northern Ireland and Scotland.
This document is the programme’s final report. It underpins the vision of how midwives can lead
and deliver care in a changing health care environment, reflecting policy and service direction. It
also identifies the changes required to the way that midwives work, their role, responsibilities,
education and/or professional development to meet the vision.
Insights from users and providers of maternity services in rural England: Summary report
Commission for Rural Communities
The Commission for Rural Communities project on major life events aims to collect and provide
evidence from rural people about the challenges of using and delivering specific services in rural
areas. This summary report focuses on insights from users and providers of maternity services in
rural England.
http://ruralcommunities.gov.uk/wp-content/uploads/2010/09/havingababysummary.pdf
[back to topics]
Musculoskeletal
2010 Annual Evidence Update (AEU) on Hip Fracture
NHS Evidence Specialist Collections – Emergency and Urgent Care
The scope of the literature search covers fractures affecting the proximal femur, and the AEU will
appeal to all health professionals, reflecting the multidisciplinary approach required across both
primary and secondary care. However, there may be clinicians who are involved in the
- 18 -
management of polytrauma and high energy injuries that affect the hip joint who will find that our
update is offset from their area of interest.
http://www.library.nhs.uk/Emergency/ViewResource.aspx?resID=381172
The National Hip Fracture Database National Report 2010

National Hip Fracture Database
A national report for 2010 has been produced from the National Hip Fracture Database. It
provides details on the casemix, care and outcomes of 36,556 cases of hip fracture from the 129
hospitals that submitted more than 100 cases over the year 1 April 2009 to 31 March 2010; and
from three smaller hospitals with fewer than 100 cases, but with 100% of cases submitted. This
report shows how the care provided matches up to the standards set out in the Blue Book, and
offers a detailed picture of hip fracture care in England, Wales, Northern Ireland and the Channel
Islands in 2009/10.
http://www.ccad.org.uk/nhfd.nsf/NHFD%20National%20Report%202010.pdf
2010 Annual Evidence Update on Osteoarthritis

NHS Evidence Specialist Collections – Musculoskeletal
Includes the results of a search for new national guidance and systematic reviews published
since August 2009. To accompany this update there are also commentaries discussing the new
evidence.
http://www.library.nhs.uk/musculoskeletal/ViewResource.aspx?
resID=387802&tabID=289&catID=1013
[back to topics]
Obesity
Shedding the pounds "Obesity management, NICE guidance and bariatric surgery in
England"
Office of Health Economics
The Office of Health Economics has published a report, 'Shedding the pounds', which details the
results of an exercise looking at: trends in obesity; current provision of bariatric surgery in
England with particular reference to the NICE clinical guideline for obesity; and potential
economic benefits that could be achieved through adherence to the NICE guideline.
http://www.ohe.org/lib/liDownload/692/OHE_Spreads.pdf?CFID=2940322&CFTOKEN=67410226
Evaluation of Weight Management Interventions: Collection of Resources on Evaluation -

CoRE
National Obesity Obervatory (NOO)
The National Obesity Observatory (NOO) has compiled a collection of resources to support
practitioners with the evaluation of weight management and related interventions. 'CoRE'
(Collection of Resources on Evaluation) covers: evaluation guidance (including NOO’s Standard
Evaluation Framework); reports from evaluation of nationally-initiated schemes; and evaluation
websites. The collection will be developed over the next year to include more detailed guidance,
quality appraisal of evaluation; links to ongoing evaluations; and case studies.
http://www.noo.org.uk/evaluation_portal
[back to topics]
Older People
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Supporting People in Later Life Annual Evidence Update 2010: Contents

NHS Evidence Special Collections – Later Life
NHS Evidence - later life's Supporting People in Later Life Annual Evidence Update 2010 aims to
provide healthcare professionals with a clear path to the most important recent evidence about
caring for older people who are experiencing difficulties with independent living due to health
problems. Older people may experience these difficulties for a number of reasons. Some may
lack social networks, others may be experiencing a general functional decline or increasing
frailty. Still others may have carers who are finding it increasingly difficult to cope. It is in the
interests of patients, carers and health professionals alike to be able to recognise, evaluate and,
hopefully, prevent or delay the transition to hospital care in patients who are finding it hard to
cope
http://www.library.nhs.uk/laterlife/viewResource.aspx?
resid=346692&code=3bf5d4c4785c63f356d544887baebf72
[back to topics]
Patient Care and Safety

Guidance on equality and human rights for inspectors and assessors
The Care Quality Commission and the Equality and Human Rights Commission are now
consulting on joint draft guidance for CQC inspectors and assessors.
http://www.equalityhumanrights.com/human-rights/new-guidance-for-inspectors-and-assessors/
A report on the management of diarrhoea in care homes

The Health Protection Agency has published 'A report on the management of diarrhoea in care
homes'. This report presents the findings of a study which investigated how well diarrhoea is
managed and treated in nursing and residential homes (care homes), to identify areas where
knowledge and practice could be improved.
National Audit of Continence Care – Management of continence Care

Royal College of Physicians
The Royal College of Physicians has published 'National audit of continence care: combined
organisational and clinical report'. This latest audit demonstrates that, although the amount of
authoritative guidance is increasing, the quality of continence care remains variable and in some
respects remains poor. The purpose of the audit is to enable those involved in managing
continence, whether commissioners or providers of services and care to individuals, to compare
their performance to evidence based quality standards and against other audit participants. This
allows variations in the standards of care and delivery to be highlighted and should lead to
improvement in the standard of care provided.
http://www.rcplondon.ac.uk/clinical-standards/ceeu/Current-work/Documents/National-Audit-of-
Continence-Care-combined-organisational-clinical-report.pdf
Analysis of consultation on Assessments of quality in 2010/11

Earlier this year, we consulted on our proposals for the assessment of quality for health and adult
social care in 2010/11.
- 20 -
The consultation provided a high level overview of our planned approach to carrying out periodic
reviews and special reviews and studies, and how we plan to publish information about them. We
described these three activities as ‘assessments of quality’.
The consultation ran from 2 February to 27 April 2010 and we received over 462 responses to our
proposals.
http://www.cqc.org.uk/_db/_documents/Analysis_of_consultation_on_CQC_assessments_2010-
11_201009133532.pdf
Confirmed approach for Annual performance assessment 2010/11

The Care Quality Commission have streamlined our approach to focus on the three outcomes
that cover particularly important issues in adult social care. This represents a significant change
in approach to the assessment for 2009/10, which was based on seven outcome areas.
http://www.cqc.org.uk/guidanceforprofessionals/councils/annualassessments/annualperformance
assessment2010/11.cfm
[back to topics]
Respiratory Diseases
Non-steroid agents for idiopathic pulmonary fibrosis

Paolo Spagnolo, Cinzia Del Giovane, Fabrizio Luppi, Stefania Cerri, Sara Balduzzi, E. Haydn
Walters, Roberto D'Amico, Luca Richeldi
Background: Idiopathic pulmonary fibrosis is a chronic progressive lung disease with poor
outcome and no effective treatment to date. This is an update of a Cochrane Review first
published in 2003. Authors' conclusions: Based on available data, partly still unpublished,
pirfenidone appears to improve progression-free survival and, to a lesser extent, pulmonary
function in patients with idiopathic pulmonary fibrosis. More data are needed on overall survival
and quality of life on treatment. From the studies in this review, interferon gamma-1beta has not
been shown to affect survival. Other agents evaluated in single studies either failed to provide
evidence for a benefit or need to be assessed in larger randomised controlled trials.
[back to topics]
Renal Diseases
Mupirocin for preventing exit-site infection and peritonitis in patients undergoing
peritoneal dialysis
Xu G, Tu W, Xu C
Mupirocin prophylaxis was effective in preventing exit-site infection and peritonitis due to S.
aureus and other organisms in patients who underwent peritoneal dialysis. The optimal strategy
for using this topical antimicrobial and minimising the emergence of resistance remained unclear.
This review was generally well conducted and the conclusions are likely to be reliable.
[back to topics]
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Screening
Managing Serious Incidents in National Screening Programmes
This guidance is endorsed by the National Patient Safety Agency and its purpose is to make
explicit the requirements for national screening programme related serious incidents and to
provide clarity and understanding for all staff providing NHS funded care.
www.screening.nhs.uk/getdata.php?id=9902
[back to topics]
Service Management
Briefing: Learning from the first wave of CCP merger reviews.
NHS Confederation
The Co-operation and Competition Panel (CCP) has now been in existence for more than 18
months. At the time of writing, 20 cases have been taken up by the panel. The majority of these
relate to decisions to merge primary care trust (PCT) provider arms with other organisations
under the Transforming Community Services programme.
This Briefing shares the learning of PCTs which have been through the CCP
process so that PCTs embarking on a CCP merger review in the next 18 months
can benefit from their experiences.
http://www.nhsconfed.org/Publications/Documents/PCTN_briefing_206_0810.pdf
(Requires NHS Confederation login)
The new number for non-emergency health services – the launch of 111
A new three-digit number that will make it easier for patients to access non-emergency NHS
healthcare wherever they are, 24 hours a day, was launched earlier this week.
The new 111 service, launched in parts of the North East of England on Monday, marks the first
step towards a national roll-out and is the beginning of a significant White Paper commitment to
make care more accessible by introducing a single telephone number for every kind of non-
emergency healthcare.
NHS 111 your questions answered

The NHS 111 service – currently available in County Durham and Darlington - provides a quick,
convenient and accessible way for people to navigate their way around local healthcare services
at any time of day whether at home, at work or visiting a different area, and will put patients in
touch with the right NHS service, first time.
http://www.dh.gov.uk/en/MediaCentre/FAQ/DH_119189
Toolkit for the NHS and pharmaceutical industry

The following guidance has been published by the Department of Health 'Moving beyond
sponsorship: Interactive toolkit for joint working between the NHS and the pharmaceutical
industry'. The NHS and pharmaceutical industry share a common agenda to improve patient
outcomes through joint working to ensure that patients get optimal care, with support to help them
maximise the benefits of treatment. The purpose of this toolkit is to encourage NHS organisations
- 22 -
and staff to consider joint working as a realistic option for the delivery of high-quality healthcare
and a way to drive efficiency in the delivery of services in both primary and secondary care, and
to provide the necessary information and have easy access to the tools which will help to
enter into joint working.
H_082840
Implementing trauma systems: key issues for the NHS

NHS Confederation
This report highlights the key questions that regional commissioners and trauma care providers
(ambulance services, hospitals, and rehabilitation units) will need to address to develop regionally
appropriate changes to save more lives and reduce long-term disability. The report also analyses
the key issues and summarises the debates surrounding trauma system development, and also
emphasises that a single model will not be appropriate for all localities
http://www.nhsconfed.org/Publications/Documents/Liberating_the_NHS-
White_paper_consultation.pdf
Transparency in outcomes - a framework for the NHS

Department of Health / NHS Evidence Special Collections – National Library for Public Health
The Government White Paper, Equity and excellence: liberating the NHS, set out how the
Secretary of State for Health will hold the NHS Commissioning Board to account for delivering
better health outcomes through a nation NHS Outcomes Framework. The DH are now launching
a full consultation and engagement process on how they should develop the NHS Outcomes
Framework. Alongside the consultation document, a response form and impact assessment
document is also available. The consultation closes on 11th October 2010.
http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_117583
Department of Health response to the public's comments on The Coalition: Our

Programme for Government on public health
This document contains the Department of Health’s response to the public’s comments on public
health. The response is based on the top three issues raised by the public: the need for better
health prevention, the need for better sexual health services and whether the NHS should charge
patients who are treated for lifestyle illnesses.
H_118127
The future of the National Programme for IT

A Department of Health review of the National Programme for IT has concluded that a
centralised, national approach is no longer required, and that a more locally-led plural system of
procurement should operate, whilst continuing with national applications already procured.
Primary Care Trust Prescribing for April to June 2010

NHS Information Centre
This data release form the NHS Information Centre contains the latest data on Primary Care
Trust prescribing. The data is being made available via a tool called iView which will allow users
to manipulate and extract data. Readers will need to create an account with the NHS IC in order
to use iView. Details on how to create an account can be accessed via the link below.
- 23 -
http://www.ic.nhs.uk/statistics-and-data-collections/primary-care/prescriptions/primary-care-trust-
prescribing-for-april-to-june-2010
(NHS IC account required – registration is free)
White Paper FAQs - Transitional arrangements - FAQs

NHS Employers
As more information is released about the Government's health white paper and plans for the
NHS in transition, NHS Employers is updating its health white paper web pages and keeping you
informed. We have produced a set of white paper FAQs covering the practical questions
employers have asked us about the white paper, the reduction in management costs and
transitional arrangements
http://www.nhsemployers.org/HealthWhitePaper/Pages/Workforce-transitional-arrangements-
FAQs.aspx
Learning Lessons From the audit of IFRS-compliant NHS Accounts 2009/10

Audit Commission
Significant financial reporting issues arose during the 2009/10 audit of IFRS-compliant NHS
accounts. Our briefing paper ‘Learning lessons from the audit of IFRS-compliant NHS accounts
2009/10’ summarises our overall findings from the audit. It reviews the issues that arose, and
highlights those that will require particular attention from NHS bodies in the future.
We found that:
- overall, NHS bodies coped well with producing their IFRS-compliant accounts for 2009/10;
- disclosures, property, plant and equipment issues, and accounting for leases were the most
significant financial reporting issues; and
- most NHS bodies engaged effectively with auditors to resolve IFRS reporting issues.
NHS bodies will need to continue to improve their approach to financial reporting in the run up to
the proposed structural changes in the NHS, and keep up to date with other emerging financial
reporting issues in future years.
http://www.audit-
commission.gov.uk/SiteCollectionDocuments/Downloads/20100909ifrsnhsbriefing8.pdf
The impact of incentives on the behaviour and performance of primary care professionals
National Institute for Health Research Service Delivery and Organisation programme / NHS
Evidence Special Collections – Health Management
This report is the result of a study on the influence of incentives on the behaviour of primary care
professionals. Using incentives can produce benefits for patients but it may also have complex
and unintended outcomes. The aim of this study is to produce evidence to help policy makers
design incentive structures which help to maximise outcomes for patients.
http://www.sdo.nihr.ac.uk/files/project/158-final-report.pdf
Telehealthcare Commissioning & Evaluation Toolkit

NHS West Midlands
This is a support aid for NHS staff to help make a viable business case for the introduction of new
technology to assist with the provision of healthcare in the home. This toolkit gives suggestions,
information and advice about how to make ideas for technological changes in home healthcare
provision become a reality
http://www.nhslocal.nhs.uk/sites/default/files/WM_NHS_Telehealthcare_Commissioning_Toolkit_
Full_PDF_Version.pdf
Liberating the NHS: managing the transition

- 24 -
NHS Chief Executive Sir David Nicholson has written to the chief executive community providing
further information about the proposed changes set out in the NHS White Paper, and the role of
leaders in the NHS in the coming weeks and months. Communication also provides an FAQ
document to provide answers to questions that have arisen during recent engagement with the
NHS leadership community, a timeline setting out key dates and a list of regional appointments
as referenced in his letter.
19311
The Foundations of Good Governance

NHS Confederation
This report discusses governance and looks at:
• What is corporate governance
• The corporate board
• The role of the board of governors
• Independence and interests
• Governance between organisations
• Assurance and risk
The conclusion notes that an understanding of effective governance should be shared by and
demanded of all those who work in and with foundation trusts. Governance is a complex
discipline, not completely understood and not everywhere fully in place. It has, nevertheless,
become even more critical at this time of unprecedented change in the NHS and more widely.
The Foundation Trust Network will soon be producing detailed practical advice for foundation
trusts on the key facets of their governance.
http://www.nhsconfed.org/Publications/Documents/foundations_good_governance140910.pdf
Independent sector treatment centre programme - workforce guidance

NHS Employers
This guidance is for both trusts and current providers involved in the Independent Sector
Treatment Centre (ISTC) programme where a wave one scheme contract will come to an end
shortly.
http://www.nhsemployers.org/PLANNINGYOURWORKFORCE/ITCP/Pages/ISTC.aspx
Delivering Enhanced Pharmacy Services in a Modern NHS: Improving Outcomes in Public

Health and Long-Term Conditions
The Bow Group
The Bow Group have published this research paper concluding that Enhanced Pharmacy
Services, which include smoking cessation, sexual health and weight loss programmes, are an
under-utilised resource that can deliver innovative, cost-effective services to patients in a highly
accessible manner. It also suggests that such services can help the NHS achieve its Quality,
Innovation, Productivity and Prevention (QIPP) objectives.
http://www.bowgroup.org/files/bowgroup/Delivering%20Enhanced%20Pharmacy%20Services
%20%2016%2009%2010%20FINAL_0.pdf
QIPP website
NHS Improvement / Daily Health Bulletin
NHS Improvement has launched EQIPP, a new comprehensive resource designed to help clinical
networks and NHS teams meet and deliver the QIPP challenge. The site provides access to a
wide range of useful information and tools to make sustainable improvements to NHS services.
This website allows users to navigate and explore the examples where achievements have been
made across the patient pathway via the various clinical work strands. Many of the improvements
are generic so can be adopted and adapted to other clinical areas and settings. The site is
- 25 -
currently under further development so additional information, improvement tools and examples
will be added.
http://www.improvement.nhs.uk/Default.aspx?alias=www.improvement.nhs.uk/qipp
Safer design and safer implementation clinical risk guidance

NHS Connecting for Health
NHS Connecting for Health has published two clinical risk guides to help healthcare organisations
develop and implement new software solutions, safely and efficiently. Safer Design – Key Clinical
Safety Activities and Safer Implementation – Key Clinical Safety Activities contain real life
examples drawn from previous experience and learning, and practical checklists that may be
used to ensure risk and harm are minimised
- Safer Implementation – Key Clinical Safety Activities: A Guide to Implementation
- Safer Design - Key Clinical Safety Activities: Clinic al Risk Guidance Document
http://www.connectingforhealth.nhs.uk/engagement/clinical/occo/safety
Items in the General Practice section may also be of interest for information relating to the
government’s White Paper.
[back to topics]
Sexual Health
Linking family planning with HIV/AIDS interventions: a systematic review of the evidence
Spaulding AB, Bain Brickley D, Kennedy C, Almers L, Packel L, Mirjahangir J, Kennedy G, Collins
L, Osborne K, Mbizvo M
The authors concluded that interventions linking family planning and HIV (human
immunodeficiency virus) services were generally considered feasible and effective, although the
overall study quality was low. The review had some methodological problems, but the authors’
conclusions are suitably cautious and appear appropriate
[back to topics]
Skin Disorders
Investigating secondary hyperhidrosis
BMJ Practice
This is one a series of occasional articles published in the BMJ to provide an update on the best
use of key diagnostic tests in the initial investigation of common or important clinical
presentations. The article uses a case vignette to discuss the investigation of hyperhidrosis
(excessive sweating). Excessive sweating can be caused by the menopause or drugs but can
also be due to underlying medical conditions, such as neoplastic and neurological disease and
endocrine or metabolic disorders.
http://www.bmj.com/content/341/bmj.c4475.full
2010 Annual Evidence Update on Atopic Eczema

NHS Evidence Special Collections – Skin Disorders
- 26 -
NHS Evidence - skin disorders is producing its fourth Annual Evidence Update on Atopic Eczema
on 13 September 2010, with the results of a search for new national guidance and systematic
reviews published since the 2009 Annual Evidence Update. There will be the Library’s usual
“what’s new” analysis, discussing the new evidence and its implications for clinical practice.
http://www.library.nhs.uk/skin/ViewResource.aspx?resID=386959&tabID=289&catID=8310
[back to topics]
Stroke
National Sentinel Stroke Audit – organisational audit 2010: public report for England,
Wales and Northern Ireland
Royal College of Physicians
This audit, commissioned by the Healthcare Quality Improvement Partnership, investigates the
follow-up care that patients receive when they are discharged from hospital. It found that while
many aspects of acute care have improved, post acute services have not kept up and there is a
lack of access to long term rehabilitation services, particularly to help people return to work
http://www.rcplondon.ac.uk/clinical-standards/ceeu/Current-work/stroke/Documents/2010-Stroke-
Public-Report.pdf
Botulinum neurotoxins for post-stroke spasticity in adults: a systematic review

Elia AE, Filippini G, Calandrella D, Albanese A
The authors concluded that botulinum neurotoxins of type A reduced upper limb spasticity in
patients post stroke, but improvement in functional ability remained to be established. This was
generally a well conducted review and these conclusions are likely to be reliable.
http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=12009107197
Effects of task-oriented circuit class training on walking competency after stroke: a

systematic review
Wevers L, van de Port I, Vermue M, Mead G, Kwakkel G
This review supported use of task-oriented circuit class training to improve gait and gait-related
activities in patients with chronic stroke. Overall the review was well conducted and the
conclusions appear appropriate and reliable.
[back to topics]
Urology
Guidelines on Chronic Pelvic Pain
European Association of Urology
Pain is the most common symptom of any illness. In its management, firstly, the physician needs
to discover and treat the cause of the pain, secondly, to treat the pain itself, whether or not the
underlying cause is treatable, and thirdly to relieve the suffering caused by the pain. Conditions
associated with chronic urogenital pain are becoming better understood. Pain syndrome terms
were introduced to indicate the multiple mechanisms involved, both physical and psychological.
This approach has been reviewed on many occasions over the past few years and has been
found to be robust. These guidelines expand this approach, so avoiding spurious diagnostic
- 27 -
terms, which are associated with inappropriate investigations, inappropriate treatments,

inappropriate patient expectations and ultimately a worse prognostic outlook.
http://www.uroweb.org/gls/pdf/Chronic%20Pelvic%20Pain%202010.pdf
[back to topics]
Women’s Health / Pregnancy
2010 Annual Evidence Update on Antenatal and Pregnancy Care

NHS Evidence Specialist Collections – Women’s Health
Antenatal Care Evidence Update builds on the accumulated knowledge-base and provides an up-
to-date summary of the latest evidence in this area including the provision of antenatal care,
patient information needs, common pregnancy problems, antenatal ultrasound and foetal
monitoring. All the information contained in our AEU has been subject to rigorous selection
criteria.
http://www.library.nhs.uk/WOMENSHEALTH/ViewResource.aspx?
resID=380453&tabID=289&catID=6036
[back to topics]
Workforce
Medical leadership competency framework: enhancing engagement in medical leadership
(3rd edition)
NHS Institute for Innovation and Improvement
A revised and updated edition of this guidance has been issued. This document describes the
leadership skills that doctors need to become more actively involved in the planning, delivery and
transformation of health services.
http://www.institute.nhs.uk/images/documents/Medical%20Leadership%20Competency
%20Framework%203rd%20ed.pdf
Pillars of the community: the RCN’s UK position on the development of the registered
nursing workforce in the community
Royal College of Nursing
This policy statement highlights 27 core conditions that the Royal College of Nursing believes
should be satisfied for community services to survive and develop as more care is delivered
closer to home, while helping health services throughout the UK to become more efficient.
http://www.rcn.org.uk/__data/assets/pdf_file/0009/335475/003843.pdf
BMA Cohort Study of 2006 Medical Graduates: Fourth Report

BMA
The fourth report of the BMA's Cohort Study, which traces the career progression of 430 medical
graduates who qualified in 2006, shows that junior doctors now spend more time carrying out
administrative tasks than they do in formal training. The BMA Cohort Study provides information
on the career pathways of the first doctors who have come through a new system of training
doctors introduced in 2006 created as part of Modernising Medical Careers.
http://blogs.bma.org.uk/files/Cohort.pdf
Pre-employment health questionnaire - Equality Act 2010
- 28 -
NHS Employers
On the 1 October 2010, s60 of the Equality Act 2010 will come into force. This will make asking
questions about the health status of an individual applying for a post illegal until after they have
been made a conditional offer of a post.
http://www.nhsemployers.org/HEALTHYWORKPLACES/STAFFHEALTHANDWELL-BEING/PRE-
EMPLOYMENTHEALTHQUESTIONNAIRES/Pages/Pre-employment-health-questionnaire.aspx
[back to topics]
- 29 -

Clinical Effectiveness Bulletin 44, September 2010

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NHS Library and Information Service North Staffordshire

Clinical Effectiveness Bulletin

Issue No: 44 – September 2010

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

Department of Health http://www.dh.gov.uk/en/index.htm

Acamprosate for alcohol dependence

Pilot campaigns to promote early diagnosis of bowel cancer

Urological cancer hub

Guidelines on Management of Atrial Fibrillation

Developing a Compact – A brief guide for commissioners

Referral Management: lessons for success

Commissioning Guide - The management of lower urinary tract symptoms in men

GP Commissioning Consortia: Building a better health system for patients

Alzheimer's Disease and Dementia Annual Evidence Update 2010: Contents

Improving end of life care in neurological disease: An executive summary

Frequency and prognosis of convulsive status epilepticus of different causes: a

2010 Annual Evidence Update on Amblyopia

General Practitioners Committee guide to the NHS White Paper - GP consortia

Update on Commissioning Activity

Meeting the Healthcare Needs of Veterans - A guide for general practitioners

Items in the Commissioning section may also be of interest.

The management of bacterial meningitis and meningococcal septicaemia in children and

NICE Technology Appraisals

Hepatitis C - peginterferon alfa and ribavirin

NICE Consultation Documents

Chronic lymphocytic leukaemia - ofatumumab: final appraisal determination

Gastro-intestinal stromal tumours (unresectable/metastatic) - imatinib (review): final

Epilepsy (update): guideline consultation

Psoriasis: draft scope consultation

Aripiprazole for the treatment of schizophrenia in people aged 15 to 17 years (Appraisal

Ovarian cancer (relapsed) - trabectedin: final appraisal determination

Psychosis with substance misuse: guideline consultation

Diabetic foot problems - inpatient management: guideline consultation

Hepatitis B and C: ways to promote and offer testing - draft scope

Ovarian cancer: guideline consultation

NICE Interventional Procedure Guidance

Endoscopic submucosal dissection (ESD) of oesophageal dysplasia and neoplasia

Laparoscopic hysterectomy (including laparoscopic total hysterectomy and

Percutaneous intradiscal laser ablation in the lumbar spine

Phototherapeutic laser keratectomy for corneal surface irregularities

Clinical Knowledge Summaries updated in September 2010

• Alcohol – problem drinking

• Addison's disease (new)

• Constipation in children (new)

• Gilbert's syndrome (new)

• Glaucoma and ocular hypertension (new)

• Neuropathic pain - drug treatment

Guidance – Equality Act 2010

Management of chronic venous leg ulcers

Health Technology Assessments

Systematic review and economic modelling of the effectiveness and cost-effectiveness of

Health Technol Assess: 14.40

A multicentred randomised controlled trial of a primary-care based cognitive behavioural

Efficient Use of Vaccines

Seasonal flu campaign information 2010

Influenza vaccines in children

Healthcare-Associated Infections and Antimicrobial Resistance: 2009/10

Long Term Conditions

Managing people with long-term conditions

Mental Health / Learning Disabilities