Clinical Effectiveness Bulletin 47, December 2010

NHS Library and Information Service North Staffordshire
Clinical Effectiveness Bulletin

for PCTs in North Staffordshire
Issue No: 47 – December 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 / Learning
Disabilities
Cardiovascular Diseases Musculoskeletal
Commissioning Neurology
Diabetes Obesity
End of Life Oral Health
General Practice Pain
Genetic Conditions Palliative Care
Guidance Pregnancy
HIV Public Health
Hospital Admissions Rehabilitation Medicine
Immunisations / Renal Diseases
Vaccinations
Infection Control Respiratory Diseases
Influenza Service Management
Liver Disease Stroke
Long Term Conditions Urology
Medicines 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/
Clinical Knowledge Summaries [NLH] http://cks.library.nhs.uk/
Cochrane Library http://www.library.nhs.uk/
CRD Centre for Reviews and Dissemination http://www.crd.york.ac.uk/crdweb/
- DARE – (Database of Abstracts of Reviews of Effects)
- NHS Economic Evaluation Database
Department of Health http://www.dh.gov.uk/en/index.htm
Health Technology Assessment (HTA) Database http://www.ncchta.org/
NICE http://www.nice.org.uk/
NHS Evidence Specialist Collections http://www.library.nhs.uk/specialistcollections/
SIGN http://www.sign.ac.uk/new.html
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Alcohol
Opioid antagonists for alcohol dependence
Cochrane Database of Systematic Reviews
Rösner S., Hackl-Herrwerth A., Leucht S., Vecchi S., Srisurapanont M., Soyka M.
Background: Alcohol dependence belongs to the globally leading health risk factors. Therapeutic
success of psychosocial programs for relapse prevention is moderate and could be increased by
an adjuvant treatment with the opioid antagonists naltrexone and nalmefene. Objectives: To
determine the effectiveness and tolerability of opioid antagonists in the treatment of alcohol
dependence. Authors' conclusions: Naltrexone appears to be an effective and safe strategy in
alcoholism treatment. Even though the sizes of treatment effects might appear moderate in their
magnitudes, these 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/CD001867/frame.html
[back to topics]
Cardiovascular Diseases
Prevention and management of venous thromboembolism
SIGN
This guideline will be of particular interest to medical practitioners in a wide range of specialties
including general practice, nurses, pharmacists and dentists. The guideline identifies adult patient
groups at risk of VTE and describes the available methods of prophylaxis. Important advances in
the diagnosis of DVT and PE are described, including the use of diagnostic algorithms
incorporating D-dimer assay. Finally, recommendations are made on treatment options for
thrombosis in various anatomical regions, including choice of anticoagulant and duration of use,
taking account of evidence of risks and benefits of anticoagulant use.
http://www.sign.ac.uk/guidelines/fulltext/122/index.html
[back to topics]
Commissioning
Commissioning Zone
NHS Networks
NHS Networks has launched the Commissioning Zone, an online information portal designed to
make it easier for commissioners to find the information they need and to connect them with
colleagues via the NHS Networks hub.
http://www.networks.nhs.uk/commissioning
Local innovations in wheelchair and seating services

Department of Health
This document aims to support PCTs and local wheelchair service managers in their
commissioning and delivery of wheelchair and seating services by capturing current examples of
local innovations that improve quality in wheelchair commissioning and delivery.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@ps/documents/digita
lasset/dh_122492.pdf
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Provider economics impact assessment model

The Department in partnership with the NHS Confederation have produced the Provider
economics commissioning impact assessment model, with associated guidance and summary,.
to better understand provider economics. The purpose of the model is to enable commissioners
and providers: to analyse the potential impact of commissioning decisions on service continuity
and provider sustainability; and to understand how the financial system risks of decommissioning
and reconfiguring services will materialise in differing economic scenarios and whether services
provide value for money.
Accessible via:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D
H_122570
Liberating the NHS: developing the healthcare workforce

The Commissioning for Quality and Innovation (CQUIN) payment framework enables
commissioners to reward excellence by linking a proportion of providers’ income to the
achievement of local quality improvement goals. This Summary guide provides an overview of
key publications and resources, and includes an updated set of Frequently Asked Questions
(FAQs).
Guidance on the national goals for 2011/12 supports use of the two national CQUIN goals for
acute schemes, as set out in the NHS Operating Framework for 2011/12. The original guidance,
published in 2008, introduced the CQUIN payment framework in context and remains the key
point of reference. It describes the framework, setting out the timetable and scope, before
explaining the content that local schemes should cover, how the framework is funded, an outline
of how it might be used, and the support and assurance for local schemes.
http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_122590
Items in the Mental Health, Public Health, Rehabilitation Medicine and Service
Management sections may also be of interest.
[back to topics]
Diabetes
Glucose Self-Monitoring in Diabetes NHS Diabetes – factsheet No. 32
NHS Diabetes
NHS Diabetes has published a new factsheet on the self-management of blood glucose (SMBG),
including recommendations on self-monitoring for all people with Type 2 diabetes
Currently the first item in the list accessible via:
http://www.diabetes.nhs.uk/publications_and_resources/factsheets_and_case_studies/factsheets
/
Altered dietary salt intake for preventing and treating diabetic kidney disease
Cochrane Database of Systematic Reviews
Suckling R.J., He F.J., MacGregor G. A.
Background: There is strong evidence that our current consumption of salt is a major factor for
increased blood pressure (BP) and a modest reduction in salt intake lowers BP whether BP levels
are normal or raised. Tight control of BP in diabetics lowers the risk of strokes, heart attacks and
heart failure and slows the progression of diabetic kidney disease (DKD). Currently there is no
consensus in restricting salt intake in diabetic patients. Objectives: To evaluate the effect of
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altered salt intake on BP and markers of cardiovascular disease and DKD. Authors' conclusions:
Although the studies are not extensive, this meta-analysis shows a large fall in BP with salt
restriction, similar to that of single drug therapy. All diabetics should consider reducing salt intake
at least to less than 5-6 g/day in keeping with current recommendations for the general population
and may consider lowering salt intake to lower levels, although further studies are needed.
http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD006763/frame.html
[back to topics]
End of Life
Deaths in Older Adults in England
NHS National End of Life Care Intelligence Network
This report, the fourth published by the National End of Life Care Intelligence Network, highlights
the importance of understanding the differing needs of older adults at the end of life.
Third publication in the list:
http://www.endoflifecare-intelligence.org.uk/resources/publications.aspx#neolcin
[back to topics]
General Practice
Healthy Working UK (HWUK) - website
Healthy Working UK / GP and Practice Team Bulletin
This online resource for GPs and other primary care health professionals contains information,
training and decision aids to support the management of health and work, including guidance on
the fit note. The site was developed by the Royal College of General Practitioners, the Faculty of
Occupational Medicine and Society of Occupational Medicine. Additional resources, including e-
learning on health and work for primary care professionals and specific programmes on the fit
note and health and work in secondary care, are now being developed and will be available by
March 2011.
http://www.healthyworkinguk.co.uk/
[back to topics]
Genetic Conditions
2010 Annual Evidence Update on Familial hypercholesterolaemia
NHS Evidence Specialist Collections - Genetic conditions
This is the second Annual Evidence Update on Familial Hypercholesterolaemia. This update
which identifies the best clinical information since the first Annual Evidence Update from 2009.
This update includes a list of relevant guidelines, systematic reviews, meta-analyses and selected
randomised controlled trials published in the last year, together with a commentary written by a
relevant expert.
http://www.library.nhs.uk/geneticconditions/viewResource.aspx?resid=395178
[back to topics]
Guidance
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NICE Clinical Guidelines
Sedation in children and young people: Sedation for diagnostic and therapeutic
procedures in children and young people
Clinical guideline: (CG112)
http://www.nice.org.uk/nicemedia/live/13296/52130/52130.pdf
NICE Technology Appraisals
Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular

events (Review of TA90)
Technology appraisal: (TA210)
Prucalopride for the treatment of chronic constipation in women

Bevacizumab in combination with oxaliplatin and either fluorouracil plus folinic acid or
capecitabine for the treatment of metastatic colorectal cancer
NICE Consultation Documents
CG27 Referral for suspected cancer: review proposal consultation

Closing date for comments: 3 January 2011
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://www.nice.org.uk/guidance/index.jsp?action=folder&o=52087
MoorLDI2 Burns Imager a laser Doppler blood flow imager for the assessment of burn
wounds: consultation document
http://www.nice.org.uk/guidance/index.jsp?action=article&o=51949
Breast cancer - bevacizumab (in combination with a taxane): final appraisal determination
http://guidance.nice.org.uk/TA/Wave21/7/FAD
Follicular non-Hodgkin's lymphoma - rituximab: appraisal consultation document

http://guidance.nice.org.uk/TA/Wave19/59/Consultation/DraftGuidance
Thrombocytopenic purpura - romiplostim: appraisal consultation document

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Hip fracture: guideline consultation

Closing date for comments: 5pm, 12 January 2011
Physical activity and the environment: review proposal consultation

Type 2 diabetes - preventing pre-diabetes in adults: consultation on the draft guidance

http://guidance.nice.org.uk/PHG/Wave19/6/Consultation/Latest
Breast cancer (metastatic hormone-receptor) - lapatinib and trastuzumab (with aromatase

inhibitor): appraisal consultation document
Leukaemia (lymphocytic) - bendamustine: final appraisal determination

http://guidance.nice.org.uk/TA/Wave23/16/FAD
Colonoscopic surveillance for colorectal cancer in high-risk groups: inflammatory bowel

disease and polyps: 2nd draft guideline consultation
Stent insertion for bleeding oesophageal varices - Consultation Document

Endovascular repair of popliteal aneurysms - Consultation Document

Carotid artery stent placement for asymptomatic extracranial carotid stenosis -

Consultation Document
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Colonoscopic surveillance for colorectal cancer in high-risk groups: inflammatory bowel

disease and polyps: 2nd draft guideline consultation
Stable angina: guideline consultation

Closing date for comments: 9 February 2011
NICE Interventional Procedure Guidance
Cryotherapy for the treatment of liver metastases

Interventional procedure guidance: (IPG369)
http://guidance.nice.org.uk/IPG369
Percutaneous closure of patent foramen ovale for recurrent migraine

Percutaneous closure of patent foramen ovale for the secondary prevention of recurrent
paradoxical embolism in divers
Percutaneous radiofrequency ablation for primary and secondary lung cancers

Selective dorsal rhizotomy for spasticity in cerebral palsy

Low intensity pulsed ultrasound to promote fracture healing

Clinical Knowledge Summaries updated in December 2010
Cervical cancer and HPV (new)
Diabetes - type 1 (new)
Diarrhoea - adults assessment (new)
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Insulin therapy in type 1 diabetes (new)
Pancreatitis - acute (new)
Pancreatitis - chronic (new)
Pityriasis rosea (new)
Whooping cough (new)
Other Guidance
Items in the Cardiovascular Diseases and Influenza sections may also be of interest.
Health Technology Assessments
Clinical effectiveness and cost-effectiveness of stem cell transplantation in the

management of acute leukaemia: a systematic review
Health Technol Assess; 14.54
[back to topics]
HIV
Time to test for HIV: Expanded healthcare and community HIV testing in England; interim
report
Health Protection Agency
The Department of Health funded eight demonstration projects to pilot the expansion of HIV
testing outside traditional settings. Three types of settings were assessed: hospitals, primary care
and community outreach. The results of these projects will inform an evidence base for
successful strategies to increase HIV testing and reduce the proportion of individuals who are
undiagnosed and present late. This interim report includes a summary of the projects and
individual results from each pilot. The projects have been assessed within the criteria of:
feasibility, acceptability, effectiveness and cost effectiveness, and sustainability.
http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1287145497243
Increasing the uptake of HIV testing to reduce undiagnosed infection and prevent
transmission among black African communities living in England: Barriers to HIV testing -
Final full report.
NICE
The aim of this project was to systematically review qualitative literature that identifies the barriers
and facilitators to the uptake of HIV testing among African communities in England. The review
addresses the following questions:
- What factors help or hinder the uptake of HIV testing by black African communities living in
England and how can the barriers be overcome?
- What interventions have successfully reduced the social, personal and cultural barriers
associated with testing among black African communities in the UK?
- What (if any) are the adverse or unintended consequences (positive or negative) of the
interventions?
- What environmental, social and cultural factors prevent or support the uptake of HIV testing?
- How does HIV-related stigma affect the uptake of HIV testing?
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[back to topics]
Hospital Admissions
Avoiding hospital admissions: What does the research evidence say?
King’s Fund
Emergency admissions to hospital are costly to the NHS and also cause disruption to planned
health care. Considerable efforts have been made within the health service to reduce emergency
admissions, but few primary care trusts have been successful, with some primary care trusts
recording an increase.
This paper aims to address the following questions:
What interventions work in reducing avoidable admissions?
Who is at risk, and how do we identify them?
Which admissions are potentially avoidable?
Which interventions work in:
– primary care
– social care
– emergency care
– discharge from hospital.
The summary is accessible via:
http://www.kingsfund.org.uk/publications/avoiding_hospital.html
[back to topics]
Immunisations / Vaccinations
Routine childhood immunisations from November 2010
The routine childhood immunisation schedule from November 2010, showing the immunisations
that were previously given at two separate visits at 12 and 13 months of age now combined into
one visit between 12 and 13 months.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_1224
01.pdf
Rubella resources
The Department of Health has published the following 'Rubella resources'. These include posters
and leaflets for expectant mothers on protection against German measles (rubella).
H_122409
Flu Vaccination for Pregnant Women

This letter from the Director of Immunisation to the Royal College of Midwives, Royal College of
Obstetricians and Gynaecologists and the BMA, is asking for their support to urge members to
encourage all pregnant women, no matter what stage of pregnancy, to get their flu vaccine as
soon as possible.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_1228
51.pdf
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Immunisation against infectious disease - 'The Green Book'

This new edition (2006) presents latest information on vaccines and vaccination procedures for all
the vaccine preventable infectious diseases that may occur in the UK. In particular it deals with
those immunisations that comprise the routine immunisation programme for all children from birth
to adolescence. All health professionals that give immunisations or provide information and
advice on them will find that this edition of the Green Book has been fully updated and gives a
comprehensive and invaluable source of current information. All the new chapters are also
available below to download in Portable Document Format (PDF)
H_079917
Items in the Influenza section may also be of interest.
[back to topics]
Infection Control
The Health and Social Care Act 2008: Code of Practice on the prevention and control of
infections and related guidance
This Code of Practice comes into force on 1 April 2011 for existing registered providers and
primary dental care and independent sector ambulance providers, and 1 April 2012 for primary
medical care providers. It sets out the criteria against which a registered provider's compliance
with the requirements relating to cleanliness and infection control will be assessed by the Care
Quality Commission. It also provides guidance on how the provider can interpret and meet the
registration requirement and comply with the law. This document takes account of responses to
the consultation on the draft Code of Practice and related guidance that ran from 26 March to 15
July 2010. The December 2009 version of the Code will remain in force until 1 April 2011.
However, existing registered providers may wish to be aware that this new Code contains
updated references in the bibliography and takes account of the Equality Act 2010 in terms of
pre-employment health assessments. The code of practice and consultation document response
can be accessed via:
H_122604
Items in the Influenza section may also be of interest.
[back to topics]
Influenza
Treatment guidelines for patients with influenza 2010/2011
Professor David Salisbury wrote last week on the use of antivirals for individuals suspected to
have influenza, particularly in the context of primary care. The purpose of this letter is to provide
an update on appropriate guidelines for treatment in secondary care and other settings.
Accessible via:
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http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_1
22682
2010/11 Seasonal Influenza: Prescription of Antivirals

NHS Central Alerting System
This letter contains information about the prescription of antivirals (oseltamivir and zanamivir) to
meet clinical circumstances arising during the current seasonal influenza outbreak.
https://www.cas.dh.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=101515
Items in the Immunisations/Vaccinations section may also be of interest.
[back to topics]
Liver Disease
2010 Annual Evidence Update on Alcoholic Liver Disease
NHS Evidence Specialist Collections – Gastroenterology and liver diseases
This is the second Annual Evidence Update on alcoholic liver disease. It highlights knowledge
published since the 2009 Update on the diagnosis, treatment and management of alcoholic liver
disease. The information is provided along with additional expert commentary. The evidence has
been split into sections: epidemiology, treatment and adverse effects.
http://www.library.nhs.uk/GASTROLIVER/ViewResource.aspx?resID=395097
[back to topics]
Long Term Conditions

The E's of self management
The Long Term Conditions Quality, Innovation, Prevention and Productivity Team have produced
the E's of Self Management, which is aimed at professionals who are commissioning and
providing services for people with long term conditions and summarises support for professional
engagement in self management of long term conditions.
Accessible via:
http://www.dh.gov.uk/en/Healthcare/Longtermconditions/DH_123018
[back to topics]
Medicines
Trading Medicines for Human Use: Shortages and Supply Chain Obligations
This paper sets out the key legal and ethical obligations on manufacturers, wholesalers, NHS
Trusts, registered pharmacies and dispensing doctors in relation to the supply and trading of
medicines. Recent increases in the export of medicines are a major contributor to supply
problems and risk jeopardising patient care.
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[back to topics]
Mental Health / Learning Disabilities

Mental health and the productivity challenge: improving quality and value for money
King’s Fund
The King’s Fund and Centre for Mental Health, with the support of the Royal College of
Psychiatrists and the NHS Confederation’s Mental Health Network, have worked together to
explore how mental health services could be delivered in a different and more cost-effective way
The consensus reached is that there is scope for mental health services not only to improve their
own productivity but also to support productivity improvements in other parts of the NHS. This
report focuses on: immediate priorities for improving productivity in existing mental health
services, what mental health services can offer to improve productivity in the NHS as a whole, the
economic benefits beyond the NHS of improved mental health care, and the longer-term
challenge of building a preventive and empowering mental health system. The report suggests
that there are real opportunities to change the way mental health services are delivered in order
to achieve more within existing budgets.
http://www.kingsfund.org.uk/publications/mental_health_and.html
Commissioning Mental Wellbeing

National Mental Health Development Unit
Using a public health approach that identifies root causes of poor mental health, this brief offers
cost-effective evidence based interventions and approaches to promote wellbeing. It will be of
interest to all those working at senior level in the NHS, Local Government and the Voluntary
Sector and in or through the proposed Health and Wellbeing Boards, which will have the central
and leading role in improving population health and mental wellbeing at a local level. This brief
provides a summary and guide to action and includes:
- Making sense of Mental Wellbeing, Mental Health and Mental Illness
- Action for wellbeing
- Commissioning for mental health and wellbeing
- The Case for Wellbeing Interventions
- Commissioning cost effective interventions
http://www.nmhdu.org.uk/silo/files/commissioning-for-wellbeing-and-population-mental-health.pdf
Valuing People Now: Summary Report March 2009 - September 2010

This report includes findings from the Learning Disability Partnership Board Self-Assessments in
2009-10. The report covers progress that has been made within the last 18 months under
Valuing People Now. It focuses on the key priorities of improving outcomes for people with
learning disabilities in health, housing, and employment, and shows where more work is needed
to make the lives of people with learning disabilities better. Published with the report is additional
guidance containing good practice examples about different aspects of the Valuing People Now
programme.
The report and good practice examples are accessible via:
H_122385
Implementing “Fulfilling and rewarding lives”: Statutory guidance for local authorities and
NHS organisations to support implementation of the autism strategy
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The purpose of this guidance is to secure the implementation of 'Fulfilling and Rewarding Lives:
The strategy for adults with autism in England' by giving guidance to local authorities, NHS
bodies and NHS Foundation Trusts around training of staff, the diagnosis of autism and the
leadership and planning of services. This guidance will help these bodies to develop services that
support and meet the locally identified needs of people with autism and their families and carers.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@pg/documents/digita
[back to topics]
Musculoskeletal
2010 Annual Evidence Update on Complimentary and Alternative Medicine (CAM) for Low
Back Pain
NHS Evidence Specialist Collections - Complementary and alternative medicine
This update aims to identify, organise and present the latest information on Complimentary and
Alternative Medicine for lower back pain this topic. A large number of databases have been
searched for studies published or updated between September 2009 and September 2010. The
update includes a list of systematic reviews, meta-analyses and selected randomised controlled
trials, along with commentaries from experts.
http://www.library.nhs.uk/CAM/ViewResource.aspx?resID=396560&tabID=289
Spinal diseases Annual Evidence Update

NHS Evidence Specialist Collections - Trauma and orthopaedics
As in previous years, the update includes guidelines and systematic reviews which have been
published within the last year. This Update includes reviews covering disc surgery and minimally
invasive surgery along with various therapies and treatments. This topic should be of particular
interest to all health professionals working in this field.
http://www.library.nhs.uk/TRAUMA_ORTHOPAEDICS/ViewResource.aspx?resID=396623&tabID
=289&catID=1135
[back to topics]
Neurology
A guide to MS for GPs and primary care professionals
Multiple Sclerosis Society
Second edition of the guide to MS for anyone working in primary care. It includes information on
diagnosis, symptoms, treatments and support.
http://www.mssociety.org.uk/downloads/A_guide_to_MS_for_GPs_and_primary_care_profession
als_2009-1.c70914a7.pdf
Anti-inflammatory drugs and risk of Parkinson disease: a meta-analysis

Gagne J. J., Power M. C,
Database of Abstracts of Reviews of Effects (DARE)
This review concluded that non-aspirin non-steroidal anti-inflammatory drugs may provide a
protective effect against Parkinson disease. Overall, this was a well-conducted systematic review
and the authors' conclusion is likely to be reliable.
http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=12010002640
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Item in the Pain section may also be of interest
[back to topics]
Obesity
Long-term cost-effectiveness of weight management in primary care
NHS Economic Evaluation Database (NHS EED)
Haynes S.M., Lyons G.F., McCombie E.L. et al.
This study examined the long-term cost-effectiveness of an obesity-reduction programme within a
primary-care setting. The authors concluded that the Counterweight programme was a highly
cost-effective intervention for obesity management, from the perspective of the health care
system, compared with no intervention. The methods were valid and generally well described
and the authors’ conclusions appear to be valid and robust.
Weight loss and proteinuria: systematic review of clinical trials and comparative cohorts
Afshinnia F., Wilt T.J., Duval S., Esmaeili A., Ibrahim H.N.
This review aimed to determine the effects of intentional weight loss on proteinuria and kidney
function and found that weight loss was associated with decreased proteinuria and
microalbuminuria, which suggested a beneficial effect on surrogate outcomes of the decrease of
urinary protein excretion. Overall the review appeared well conducted and the conclusions are
likely to be reliable.
The National Obesity Observatory e-atlases

National Obesity Observatory (NOO)
The National Obesity Observatory has published new data from the National Child Measurement
Programme (NCMP). The Child e-atlas now includes four years data from 2006/07 to 2009/10.
The e-atlases are interactive mapping tools for the analysis of data on the prevalence of obesity
and its determinants at Local Authority (LA) and Primary Care Trust (PCT) level in England. The
child e-atlases enable users to view and compare data at PCT and LA level, for both single and
dual maps.
Child single map LA/PCT e-atlas:
http://www.sepho.nhs.uk/noo/eatlas/childsingle/atlas.html
Child dual map LA/PCT e-atlas:
http://www.sepho.nhs.uk/noo/eatlas/childdouble/atlas.html?indicator=i9&date=2009/10&indicator2
=i37&date2=2007
[back to topics]
Oral Health
NHS Dental Contract: Proposals for Pilots
From April 2011 the government will be running a new series of pilots in 50 to 60 locations around
the country. Designed to test three different contract models, this exercise will help inform the
development of a new national NHS dental contract. Based on registration, capitation and quality,
the new contract will have three main objectives: improve the quality of patient care; increase
access to NHS dental services; and improve oral health, especially the oral health of children
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[back to topics]
Pain
2010 Annual Evidence Update on Headache
NHS Evidence Specialist Collection – Neurological conditions
This is the third Annual Evidence Update. NHS Evidence has carried out a systematic literature
search on headache to identify all high level evidence published since the date of the last
Headache AEU in August 2009, including guidelines, systematic reviews, health technology
assessments and economic evaluations. Leading headache and migraine experts from around
the UK have read and appraised these for their validity and relevance to the busy clinician. Expert
commentaries are included.
http://www.library.nhs.uk/neurological/ViewResource.aspx?resID=389283
[back to topics]
Palliative Care
The Palliative Care Funding Review - interim report
Palliative Care Funding Review
This report makes recommendations for immediate improvements to the palliative care system,
including investment to support 24/7 access to community services. It highlights the need to
define the core services that should be funded by the NHS as a statutory responsibility and how
these can be balanced with services that are supported by society.
http://www.palliativecarefunding.org.uk/InterimReport.pdf
[back to topics]
Pregnancy
Brief screening questionnaires to identify problem drinking during pregnancy: a
systematic review
Burns E., Gray R., Smith L.A.
This review assessed performance of brief alcohol screening questionnaires in identifying risk
drinking in pregnant women. The authors concluded that T-ACE, TWEAK and AUDIT-C showed
promise for identifying risk drinking and AUDIT-C for identifying alcohol dependency or abuse;
further evaluation was needed. These conclusions were appropriately cautious.
[back to topics]
Public Health
Healthy lives, healthy people White Paper: Our strategy for public health in England
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The White Paper sets out the Government’s long-term vision for the future of public health in
England. The aim is to create a ‘wellness’ service (Public Health England) and to strengthen both
national and local leadership.
White Paper and Impact Assessments available via:
http://www.dh.gov.uk/en/Publichealth/Healthyliveshealthypeople/index.htm
Healthy lives, healthy people: consultation on the funding and commissioning routes for
public health
This consultation explores the proposed funding and commissioning routes for public health,
including the ring-fenced budget provided to local authorities. The consultation closes on 31
March, after which a summary of responses received will be published.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasse
t/dh_123114.pdf
[back to topics]
Rehabilitation Medicine
Medical rehabilitation in 2011 and beyond.
Royal College of Physicians
This working party report, examines the current state of rehabilitation medicine, and considers
how it is likely to develop over the coming years. The report revises the definitions around
rehabilitation medicine, in line with current practice. It also places rehabilitation in the broader
context of acute illness management, arguing that commissioning - in the format newly proposed
by the coalition government - should support interdisciplinary practice and clinical pathways which
reflect the widespread overlap with other areas of medicine. The report argues that, while shorter-
term programmes are functioning well, longer-term pathways need to integrate high-intensity
treatments, greater consideration of the individual's participation in life, vocational needs, family
relationships, and the need to return to as normal a life as possible. This report is essential
reading, not just for rehabilitation medicine physicians, but also specialists in stroke, palliative,
acute, geriatric medicine, and neurology. It also contains guidance for current commissioners,
planners and providers of healthcare and social care, and for GPs for their clinical practice as well
as for their commissioning work in the near future.
http://bookshop.rcplondon.ac.uk/contents/pub320-b2f017c5-09ef-42fa-a306-6f30956b9186.pdf
[back to topics]
Renal Diseases
2010 Annual Evidence Update on Post Transplant Lymphoproliferative Disorders in Renal
Transplant patients
NHS Evidence Specialist Collections – Kidney diseases and male urogenital disorders
NHS Evidence has reviewed the literature for relevant systematic reviews, randomised controlled
trials and cohort studies, and assessed the impact of this new evidence published since the
introduction of the BSH/BTS guidelines for the diagnosis and management of PTLD which were
published in June 2010.
http://www.library.nhs.uk/KIDNEY/ViewResource.aspx?resID=394440
[back to topics]
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Respiratory Diseases
Cost-effectiveness of school-based asthma screening in an urban setting
Gerald J.K., Grad R., Bailey W.C., Gerald L.B.
The objective was to evaluate the cost-effectiveness of four school-based asthma screening
strategies for elementary school children from urban, low income, ethnic minority populations.
The authors concluded that these screening strategies were not cost-effective and more certainty
on the value of a day with symptoms was needed. The methods were good, but were
insufficiently reported around the identification of the effectiveness data. Given the scope of the
analysis, the conclusions appear to be valid, but should be interpreted with caution
[back to topics]
Service Management
Measuring social value: How five social enterprises did it
Social enterprises have real potential to refresh and reinvigorate health and social care services.
They provide more services than ever before, with more than 6,000 schemes estimated to be
delivering health and social care in the UK. Providing more choice and better quality, responsive
and innovative services, social enterprises also are distinctive features and a key part of what
social enterprises do, but it may not be easy to describe it in ways that make sense to business
partners.
Clinical and service integration: The route to improved outcomes

King’s Fund
Over the past decade a number of health policies have sought to put the patient first and to
improve health outcomes. Choice and competition have been key elements of these policies, but
the importance of integrated care was highlighted by Lord Darzi in the final report of the NHS
Next Stage Review. Does integration of care act as a barrier to choice and competition? This
report describes integrated care and identifies the different forms it takes; explores the different
levels within the system at which it operates and sets out the evidence for the different systems.
Integration can take a variety of forms, involving either providers, or providers and
commissioners, who work together to deliver better outcomes at a number of levels within the
system. This report summarises relevant evidence about high-profile integrated systems in the
United States, such as Kaiser Permanente and Geisinger Health System and outlines examples
of integrated care in North America and Europe for particular groups, such as older people or
patients with long-term conditions – for example, the integrated health and social care teams in
Torbay. It also explores the range of approaches to improving co-ordination for individual patients
and carers – for example, the Care Programme Approach in mental health. The report focuses on
examples that are most relevant to the NHS in England in the context of the coalition
government's programme.
http://www.kingsfund.org.uk/publications/clinical_and_service.html
Guidance on safe nurse staffing levels in the UK

Royal College of Nursing
Staffing levels have always been an issue. “What is the optimal level and mix of nurses required
to deliver quality care as cost-effectively as possible?” is a perennial question. This report sets
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out the range of different factors that influence the total demand for staff and highlights the variety
of methods for planning or reviewing staffing levels.
http://www.rcn.org.uk/__data/assets/pdf_file/0005/353714/003860.pdf
Transfer and transform: The challenges for community health services

NHS Confederation – Primary Care Trust Network
Plans are underway to transfer community service provision from primary care trusts (PCTs) by
April 2011. The presence of these services in the community and their close day-to-day working
relationships with GPs means they are well placed to deliver the improvements that strike at the
heart of the Government’s planned NHS reforms.
This Briefing sets out the key points from our discussions with members who have experience of
transferring services, including their learning about how best to transfer services, what exactly
should be transferred, the cultural issues to consider and the necessary governance
arrangements.
http://www.nhsconfed.org/Publications/Documents/PCTN%20briefing_209_Nov2010.pdf
Liberating the NHS: Legislative framework and next steps

Published in July 2010, the White Paper ‘Equity and Excellence: Liberating the NHS’ outlines our
vision to make the NHS a truly world class healthcare service that puts patients at its heart and
clinicians in the driving seat, focused on outcomes. Following three months of consultation on its
plans for the service, the Government’s response published 14th December 2010 sets out further
policy development based on substantial feedback and reaffirms the strong commitment to the
reforms.
Clinical responses to the downturn: Seven medical specialties address how they can help
tackle the NHS financial challenge
NHS Confederation
This joint publication brings together practical recommendations from focus groups with seven
specialty medical societies and royal colleges, each of which were asked to suggest ways that
clinicians in their own specialties can release NHS resources while maintaining or enhancing
quality. Seven medical specialties address how they can help tackle the NHS financial challenge.
This report examines how to release NHS resources across the seven specialties of:
neurosurgery, geriatrics, vascular services, pathology, orthopaedics, neonatology, dermatology.
The answers tackle issues with referrals, discharge, follow-up, procedures of low or questionable
value, workforce profiles, commissioning, waste, and productivity, among others. The
recommendations will be of use to local commissioners and providers, clinical leaders, policy
makers and anyone else seeking to address the most serious period of financial constraint in the
history of the NHS.
http://www.nhsconfed.org/Publications/Documents/Clinical_responses_to_downturn_full_Dec201
0.pdf
The Operating Framework for the NHS in England 2011/12

This year’s Operating Framework sets out what needs to happen over the transition year
2011/12. All parts of the health service are required to work across organisational boundaries to
respond positively to the reform set out in Equity and Excellence: Legislation for, whilst ensuring
that service quality and financial performance are maintained and improved at a time of change.
H_122738
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NHS allocations
The Department of Health allocates recurrent revenue funding to primary care trusts (PCTs) on
the basis of the relative needs of their populations and in line with pace of change policy.
Available via:
http://www.dh.gov.uk/en/Managingyourorganisation/Financeandplanning/Allocations/index.htm
Implementing Fulfilling and Rewarding Lives: Summary and response to the findings from
the consultation
This document is a summary of the responses received to the consultation on Implementing
Fulfilling and Rewarding Lives, the draft statutory guidance for health and social care to support
the implementation of the national autism strategy. It highlights the key themes from the
consultation and sets out the Government's response.
t/dh_122907.pdf
Implementing “Fulfilling and rewarding lives”: Statutory guidance for local authorities and
NHS organisations to support implementation of the autism strategy
The purpose of this guidance is to secure the implementation of 'Fulfilling and Rewarding Lives:
The strategy for adults with autism in England' by giving guidance to local authorities, NHS
bodies and NHS Foundation Trusts around training of staff, the diagnosis of autism and the
leadership and planning of services. This guidance will help these bodies to develop services that
support and meet the locally identified needs of people with autism and their families and carers.
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/@pg/documents/digita
Payment by Results 2011-12 road test package

The road test exercise provides an opportunity for the service to test out the new tariff, and
supports the planning process. The main focus of the road test is to gather comments on the draft
2011-12 PbR guidance and PbR Code of Conduct.
The covering letter from David Flory, NHS Deputy Chief Executive, details the changes made to
the proposed 2011-12 tariff arrangements since his letter of 30 September 2010.
Road test documents, feedback form, draft guidance and covering letter are all accessible via:
Healthy Lives, Healthy People: transparency in outcomes, proposals for a public health
outcomes framework
This consultation explores the proposed public health outcomes framework. The consultation
closes on 31 March, after which a summary of consultation responses received will be published.
t/dh_123113.pdf
Joined-up care delivering seamless care: A practical guide to

making change happen
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NHS Institute for Innovation and Improvement

This guide is a practical guide to making change happen, which succinctly outlines the principles
and methods needed to enable you to successfully develop patient centred Joined-up care.
http://www.institute.nhs.uk/images/documents/Joined_Up_Care/NHSI%20JOINED%20UP%20CA
RE%20DOCUMENT.pdf
Related case studies, literature review, measuring improvement documents and links are
accessible via:
http://www.institute.nhs.uk/qipp/joined_up_care/joined_up_care_homepage.html
[back to topics]
Stroke
Effects of vitamin E on stroke subtypes: meta-analysis of randomised controlled trials
Schurks M., Glynn R.J., Rist P.M., Tzourio C., Kurth T.
This review evaluated the effect of vitamin E supplementation on the incidence of total, ischaemic
and haemorrhagic stroke. The authors concluded that vitamin E increased the risk for
haemorrhagic stroke by 22% and reduced the risk for ischaemic stroke by 10%. The authors'
conclusions and recommendations for research and practice seem likely to be reliable.
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12010007595
[back to topics]
Urology
Cost effectiveness of management strategies for urinary tract infections: results from
randomised controlled trial
Turner D., Little P., Raftery J., Turner S., Smith H., Rumsby K., Mullee M., UTIS Team
This study assessed the cost-effectiveness of five management strategies for suspected urinary
tract infections. The authors concluded that dipstick testing followed by targeted antibiotics was
likely to be the most cost-effective strategy, if the value of a day without moderate symptoms was
at least 10 UK pounds sterling. There were a few limitations to the study, but the methods and
results were generally well reported and the authors' conclusions reflect the evidence available.
[back to topics]
Workforce
Support workforce – new webpages
NHS Employers
NHS Employers have brought all their support workforce resources into one place. The new web
pages discuss the need to invest in the development of support workers, utilising the assistant
practitioner and apprenticeship models and education and training options, as well as providing
links to tools and resources to assist in implementation.
http://www.nhsemployers.org/PlanningYourWorkforce/SupportWorkforce/Pages/SupportWorkforc
e.aspx
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Maternity issues for doctors in training

NHS Employers
This factsheet provides guidance for doctors in training who need to plan maternity leave. The
factsheet includes information on timelines for telling your employer you are pregnant, when to
take maternity leave, maternity pay and advice for doctors in training who may be moving
between employers.
http://www.nhsemployers.org/Aboutus/Publications/Documents/Maternity%20issues%20for%20d
octors%20in%20training.pdf
The Back on Track Framework for Further Training: Restoring practitioners to safe
and valued practice
NHS National Clinical Assessment Service
The National Clinical Assessment Service (NCAS) has published a new good practice guide
aimed at helping doctors, dentists and pharmacists return to safe and valued practice. The Back
on Track Framework is a completely new edition of the guide published in 2006. The guild builds
on NCAS’s ten years of experience in tackling concerns about professional practice.
http://www.ncas.npsa.nhs.uk/resources/good-practice-guides/back-on-track/
Human Rights and Human Rights Legislation (in recognition of Human Rights Day 10
December 2010)
NHS Employers
In recognition of Human Rights Day on 10 December 2010, NHS Employers have published
information for employers about what human rights and human rights legislation mean for the
NHS workforce. Our web page includes information on articles of the Human Rights Act (1998)
that can be applied directly to the workplace, as well as advice for employers, and case studies
from NHS organisations that have embedded human rights into their service delivery.
http://www.nhsemployers.org/EmploymentPolicyAndPractice/EqualityAndDiversity/Diversity-
calendar/Pages/HumanRightsDay10December2010.aspx
Simplified KSF
NHS Employers
In response to requests from employers, a Word version of the NHS Staff Council's Appraisals
and KSF made simple - a practical guide is now available on our KSF pages for trusts to tailor to
their local needs. All the appraisal templates are available as individual Word documents on our
appraisal tools and tips page.
http://www.nhsemployers.org/PayAndContracts/AgendaForChange/KSF/Simplified-
KSF/Pages/SimplifiedKSF.aspx
Liberating the NHS: developing the healthcare workforce

This consultation document sets out proposals to establish a new framework for developing the
healthcare workforce and seeks views on the systems and processes that will be needed to
support it. The final date for responses is 31st March 2011, but earlier expressions of view would
be helpful.
http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_122590
[back to topics]
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Clinical Effectiveness Bulletin 47, December 2010

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Clinical Effectiveness Bulletin 47, December 2010

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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

Local innovations in wheelchair and seating services

Provider economics impact assessment model

Liberating the NHS: developing the healthcare workforce

NICE Clinical Guidelines

NICE Technology Appraisals

Clopidogrel and modified-release dipyridamole for the prevention of occlusive vascular

Prucalopride for the treatment of chronic constipation in women

NICE Consultation Documents

CG27 Referral for suspected cancer: review proposal consultation

Follicular non-Hodgkin's lymphoma - rituximab: appraisal consultation document

Thrombocytopenic purpura - romiplostim: appraisal consultation document

Hip fracture: guideline consultation

Physical activity and the environment: review proposal consultation

Type 2 diabetes - preventing pre-diabetes in adults: consultation on the draft guidance

Breast cancer (metastatic hormone-receptor) - lapatinib and trastuzumab (with aromatase

Leukaemia (lymphocytic) - bendamustine: final appraisal determination

Colonoscopic surveillance for colorectal cancer in high-risk groups: inflammatory bowel

Stent insertion for bleeding oesophageal varices - Consultation Document

Endovascular repair of popliteal aneurysms - Consultation Document

Carotid artery stent placement for asymptomatic extracranial carotid stenosis -

Colonoscopic surveillance for colorectal cancer in high-risk groups: inflammatory bowel

Stable angina: guideline consultation

NICE Interventional Procedure Guidance

Cryotherapy for the treatment of liver metastases

Percutaneous closure of patent foramen ovale for recurrent migraine

Percutaneous radiofrequency ablation for primary and secondary lung cancers

Selective dorsal rhizotomy for spasticity in cerebral palsy

Low intensity pulsed ultrasound to promote fracture healing

Clinical Knowledge Summaries updated in December 2010

Cervical cancer and HPV (new)

Diabetes - type 1 (new)

Diarrhoea - adults assessment (new)

Insulin therapy in type 1 diabetes (new)

Pancreatitis - acute (new)

Pancreatitis - chronic (new)

Pityriasis rosea (new)

Whooping cough (new)

Health Technology Assessments

Clinical effectiveness and cost-effectiveness of stem cell transplantation in the

Flu Vaccination for Pregnant Women

Immunisation against infectious disease - 'The Green Book'

Items in the Influenza section may also be of interest.

Items in the Influenza section may also be of interest.

2010/11 Seasonal Influenza: Prescription of Antivirals

Items in the Immunisations/Vaccinations section may also be of interest.

Long Term Conditions

Mental Health / Learning Disabilities

Commissioning Mental Wellbeing

Valuing People Now: Summary Report March 2009 - September 2010

Spinal diseases Annual Evidence Update

Anti-inflammatory drugs and risk of Parkinson disease: a meta-analysis

Item in the Pain section may also be of interest

The National Obesity Observatory e-atlases

Clinical and service integration: The route to improved outcomes

Guidance on safe nurse staffing levels in the UK

Transfer and transform: The challenges for community health services