Clinical Effectiveness Bulletin, No. 48 January 2011

NHS Library and Information Service North Staffordshire
Clinical Effectiveness Bulletin

for PCTs in North Staffordshire
Issue No: 48 – January 2011
About this Bulletin:
It aims to draw attention to some of the key documents and reviews on clinical
effectiveness that have been published in the previous month.
Where possible, links to the full text documents are included. If the article is in a
journal, you can contact the Health Library for a copy.
Link to request form: http://www.keele.ac.uk/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: lindsay.snell@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 Palliative Care

Cancer Patient Care and Safety
Cardiovascular Diseases Public Health
Commissioning Research
Dementia Service Management
Guidance Sexual Health
Immunisations / Smoking
Vaccinations
Influenza Stroke
Long Term Conditions Substance Abuse
Mental Health / Learning Urology
Disabilities
Obesity Women's Health
Older People
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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Cancer
Draft teenagers and young adults cancer measures for the Manual for Cancer Services:
consultation
Department of Health
The purpose of this consultation is to make sure that the new 'Teenagers and Young Adults
Cancer Measures' are clear and comprehensive for inclusion in the Manual for Cancer Services
2008. All comments on the draft measures should be sent directly to the National Peer Review
Team using the attached template.
Draft and supporting documents accessible via:
http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_123365
Draft brain and CNS measures for consultation: Manual for Cancer services.
A draft version of the Brain and CNS measures for inclusion in the Manual for Cancer Services is
being issued for a three month consultation. Comments are invited by 31 March 2011.
Draft and supporting documents accessible via:
http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_123352
Improving Outcomes: A Strategy for Cancer

‘Improving outcomes: a strategy for cancer’ aims to help the reformed NHS deliver cancer
outcomes that are amongst the best in the world.
Strategy and supporting documents are accessible via:
http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_1233
94.pdf
Bowel Cancer Resources for pilot campaign (GP Resource Pack, Factsheets and
Awareness Materials)
Bowel Cancer UK / Department of Health
The first ever Government cancer campaign to raise awareness of the key signs and symptoms
of bowel cancer, and to prompt those with the relevant symptoms to visit their GP, has been
launched. The pilot campaign hopes to raise awareness of the symptoms, encourage people to
visit their GP if they have had the symptoms for three weeks or more and gives reassurances that
these symptoms are likely to be nothing to worry about.
The GP Resources Pack, Factsheets and Awareness Materials can be downloaded from:
http://www.bowelcanceruk.org.uk/home/bowel-cancer/downloads
[back to topics]
Cardiovascular Diseases
The clinical and economic burden of non-adherence with antihypertensive and lipid-
lowering therapy in hypertensive patients
NHS Economic Evaluation Database (NHS EED)
Cherry S.B., Benner J.S., Hussein M.A., Tang S.S., Nichol M.B.
This study examined the cost-effectiveness of antihypertensive therapy and statin therapy for
hypertensive patients, with total cholesterol of 6.5mmol/L or less, considering their
treatment adherence. Low adherence reduced the benefits of treatment, but therapy was still
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cost-effective with real-world adherence. Greater cost-effectiveness was achieved with the
adherence found in clinical trials. The methods were valid and the extensive analysis of
uncertainty showed that the results were robust, which supports the authors’ conclusions.
http://www.crd.york.ac.uk/crdweb/ShowRecord.asp?LinkFrom=OAI&ID=22009102026
[back to topics]
Commissioning
Commissioning guide: The management of lower urinary tract symptoms in men
NICE
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.
http://www.nice.org.uk/media/C58/73/LUTSCommissioningGuide.pdf
Commissioning: Third Report of Session 2010–11

House of Commons Health Committee / Daily Health Bulletin
The Health Select Committee has published this report. The report states that the White Paper
proposal to abolish Primary Care Trusts and transfer commissioning responsibility to GP-led
consortia was not foreshadowed in the Coalition Programme and came as a surprise to most
observers. This "surprise" approach created uncertainty among commissioners and therefore
increased the risks and costs associated with delivery of the Nicholson Challenge. The pace of
events since publication of the White Paper has required a pragmatic management response
ahead of Parliamentary consideration of the proposals. The Committee intends to follow through
its report with further work on the detailed proposals for commissioning in the Government’s
forthcoming Health Bill.
http://www.publications.parliament.uk/pa/cm201011/cmselect/cmhealth/513/513i.pdf
GP commissioning: insights from medical groups in the United States

The Nuffield Trust
This report provides an international comparison on GP commissioning. It concludes that there
are clear risks of introducing GP commissioning when the government has placed such a strong
emphasis on reducing management costs, and when proposals to develop more extensive co-
operation between primary and secondary care remain under-developed.
Accessible via:
http://www.nuffieldtrust.org.uk/publications/detail.aspx?id=145&prID=756
Quitting smoking in pregnancy and following childbirth: Implementing NICE guidance

Commissioning guide
NICE
This guide has been produced to help effectively commission evidence-based services to help
women who smoke during pregnancy and after childbirth to quit. The guide provides support for
local implementation of NICE guidance through commissioning.
http://www.nice.org.uk/media/BC7/AB/QSIP_commissioning_guide.pdf
Commissioning health services: A guide for RCN activists and nurses

Royal College of Nursing
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Commissioners are increasingly under pressure to deliver improved services with fewer
resources and hard decisions need to be made in the current economic climate. Activists who
understand the commissioning process are in a strong position to influence decisions and protect
the interests of patients and RCN members. The earlier activists and nurses get involved in these
decision-making processes, the more likely it is that they will have a positive influence on behalf
of patients and nurses. This publication covers what commissioning is, who leads commissioning
and where it takes place, as well as detailing six keys to help activists and nurses in unlocking
and understanding the commissioning process.
http://www.rcn.org.uk/__data/assets/pdf_file/0010/359308/003853.pdf
Items in the Sexual Health and Service Management sections may also be of interest.
[back to topics]
Dementia
Living well with dementia: A National Dementia Strategy Good Practice Compendium – an
assets approach
This good practice compendium has been brought together from across the regions to support
local delivery of the national dementia strategy and improve outcomes for people with dementia
and their carers. It is an enabler for local change, as described in the Department of Health's
revised outcomes focused implementation plan.
75.pdf
Support. Stay. Save. Report

Alzheimer’s Society
A report has found that many people with dementia and carers receive insufficient support and
care at home. The report found that people with dementia and carers greatly value living in their
own home and being able to play a part in the community, and want services to enable them to
meet these aspirations. However, many are not receiving sufficient support and care for this to be
a reality. This lack of support can lead to admission to hospital and early entry into care homes
and risks leaving unpaid carers at risk of stress, depression and other serious illnesses.
http://alzheimers.org.uk/site/scripts/download_info.php?fileID=1030
[back to topics]
Guidance
NICE Clinical Guidelines
Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults
(partial update)
Clinical guideline: (CG113)
http://guidance.nice.org.uk/CG113
NICE Technology Appraisals

Alendronate, etidronate, risedronate, raloxifene and strontium ranelate for the primary
prevention of osteoporotic fragility fractures in postmenopausal women
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Technology appraisal: (TA160)

http://guidance.nice.org.uk/TA160
Aripiprazole for schizophrenia in people aged 15 to 17 years

http://guidance.nice.org.uk/TA213
Costing statement
http://www.nice.org.uk/nicemedia/live/13317/52626/52626.pdf
Osteoporosis - secondary prevention including strontium ranelate

http://www.nice.org.uk/TA161
NICE Public Health Guidance
Skin cancer prevention: information, resources and environmental changes

Public Health Guidance (PH32)
http://guidance.nice.org.uk/PH32
Costing statement:
http://www.nice.org.uk/nicemedia/live/13310/52591/52591.pdf
NICE Interventional Procedure
Distal iliotibial band lengthening for refractory greater trochanteric pain syndrome
Interventional Procedure: (IPG375)
http://guidance.nice.org.uk/IPG375
Extracorporeal shockwave therapy for refractory greater trochanteric pain syndrome

Off-pump coronary artery bypass grafting

Percutaneous laser coronary angioplasty

Thoracoscopic repair of congenital diaphragmatic hernia in neonates

NICE Consultation Documents
Ambulight photodynamic therapy for the treatment of non-melanoma skin cancer: medical
technologies consultation
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Closing date for comments: 2 February 2011

http://www.nice.org.uk/guidance/index.jsp?action=folder&o=52399
Inditherm Mattress for the prevention of inadvertent perioperative hypothermia: medical

technologies consultation
Prevention of sexually transmitted infections and under 18 conceptions: review proposal

consultation
Only registered stakeholders can comment – register or contact the registered stakeholder
organisation that most closely represents your interests and pass your comments to them.
Stable angina: guideline consultation

Conduct disorders in children and young people: scope consultation

CG30 Long-acting reversible contraception: review consultation

Chronic heart failure: quality standard consultation

Closing date for comments: 5 pm, 16 February 2011
http://www.nice.org.uk/guidance/qualitystandards/indevelopment/chronicheartfailure.jsp
Alcohol dependence: quality standard consultation

http://www.nice.org.uk/guidance/qualitystandards/indevelopment/alcoholdependence.jsp
Peritoneal dialysis: draft guideline consultation

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Trabecular stent bypass microsurgery for open-angle glaucoma - Interventional

Procedures Consultation
http://www.nice.org.uk/guidance/index.jsp?action=byID&o=13157
Trabeculotomy ab interno for open-angle glaucoma - Interventional Procedures

Consultation
External aortic root support in Marfan syndrome - Interventional Procedures Consultation

Endoscopic radiofrequency therapy of the anal sphincter for faecal incontinence -

Interventional Procedures Consultation
Percutaneous tibial nerve stimulation (PTNS) for faecal incontinence - Interventional

Procedures Consultation
24 January 2011 - 21 February 2011
Idiopathic pulmonary fibrosis: scope consultation

Autism spectrum disorders in children and young people: guideline consultation

Closing date for comments: 25 March 2011
NICE Interventional Procedure Guidance
Distal iliotibial band lengthening for refractory greater trochanteric pain syndrome
Interventional procedure guidance: (IPG375)
Extracorporeal shockwave therapy for refractory greater trochanteric pain syndrome

Off-pump coronary artery bypass grafting

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Percutaneous laser coronary angioplasty

Thoracoscopic repair of congenital diaphragmatic hernia in neonates

Clinical Knowledge Summaries updated in August 2010
• Analgesia - mild-to-moderate pain (new)
• Bedwetting (enuresis)
• Hyponatraemia (new)
• Prostate cancer (new)
Other Guidance
Pharmacological treatment and prophylaxis of influenza

Health Protection Agency (HPA)
The HPA has issued an update of its guidance summarising its current recommendations on the
antiviral treatment and prophylaxis of influenza, available from the link below.
http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1287147812045
Health Technology Assessments
H1N1 influenza and pandemic flu themed issue 3

Health Technol Assess; 14.55
[back to topics]
Immunisations / Vaccinations
Seasonal influenza vaccine uptake and vaccine supply
This letter from Professor Dame Sally Davies, Interim Chief Medical Officer, provides an update
on the seasonal influenza vaccine uptake and vaccine supply.
It also reminds of who is and is not eligible for flue vaccinations.
41.pdf
Annual HPV vaccine coverage in England in 2009/2010

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A summary of HPV vaccination coverage across England at PCT, SHA and Description national
level for the second year of the programme. This includes additional data from Devolved
Authorities and comparisons with available international equivalent programmes.
26.pdf
[back to topics]
Influenza
(Increase in co-infections with flu)
Influenza, meningococcal infection and other bacterial co-infection including
pneumococcal and invasive Group A streptococcal Infection (iGAS)
Daily Health Bulletin / Central Alerting System – Department of Health
The Chief Medical Officer, via the Central Alerting System, has issued a letter which contains an
alert to an increase in a number of significant bacterial infections such as those caused by
Neisseria meningitidis (meningococcal disease) and others that may occur as co-infections with
flu.
https://www.cas.dh.gov.uk/ViewandAcknowledgment/ViewAlert.aspx?AlertID=101528
Access via the link to the letter at the bottom of the page.
Typical Q & As received on influenza vaccination and use of antivirals

Health Protection Agency
The Health Protection Agency (HPA) has produced a list of answers to common questions
received regarding the influenza vaccination and the use of antivirals.
http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/1287147885006
[back to topics]
Long Term Conditions
Please see the Palliative Care section.
[back to topics]
Mental Health / Learning Disabilities

Special briefing on the public health white paper: Healthy Lives, Healthy People
National Mental Health Development Unit
This is a briefing paper on the Public Health White Paper, Healthy Lives, Healthy People. This
briefing is primarily aimed at NHS, Local Government, Voluntary sector and Private sector
agencies working in or interested in the arenas of population mental health, well-being and / or
mental health services and those working in and interested in public health and health
improvement. The Public Health White Paper introduces a new approach for public health, with
mental health identified as an integral and complementary part of the proposed new direction for
public health in England.
http://www.nmhdu.org.uk/silo/files/public-health-white-paper-briefing-special.pdf
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Health and Social Care Bill - Amendments to the Mental Health Act 1983
The Health and Social Care Bill currently before Parliament includes a number of proposed small
amendments to the Mental Health Act. This letter summarises these amendments.
16.pdf
Learning from the past – setting out the future: developing learning disabilities nursing in
the United Kingdom
Royal College of Nursing
The population of children, adults and older people with learning disabilities is increasing and
there is a higher number of people living into adulthood with a range of complex needs. This is
resulting in children, young people and adults presenting with patterns of complex learning
disabilities unlike those experienced by existing services and healthcare services will experience
higher demand from this group in the future. Learning disability nurses play a central role in the
lives of people with learning disabilities, from developing and implementing care plans to
providing advice, education and support to people throughout their care journey. This publication
sets out the key issues and actions required, both now and in the future, to enable learning
disability nursing to develop and progress in line with the increased demand on its services. It
also details areas of priority for the RCN.
http://www.rcn.org.uk/__data/assets/pdf_file/0006/359367/003871.pdf
Items in the Service Management section may also be of interest.
[back to topics]
Obesity
Obesity and ethnicity
National Obesity Observatory (NOO)
This paper provides an overview of the current evidence on the relationship between obesity and
ethnicity for adults and children in the UK - summarising evidence on:
- variations in obesity prevalence between and within minority ethnic groups;
- differences in obesity-related disease prevalence between minority ethnic groups, with particular
reference to cardiovascular disease and type 2 diabetes;
- measures of obesity including the issue of central adiposity and the use of BMI; and
- the role of potential determinants of obesity for minority ethnic groups such as migration, cultural
variations in diet, socioeconomic status, local area characteristics and physical activity levels.
http://www.noo.org.uk/uploads/doc/vid_9444_Obesity_and_ethnicity_270111.pdf
[back to topics]
Older People
How can local authorities with less money support better outcomes for older people?
Joseph Rowntree Foundation
Research shows that older people want and value low-level support - 'that bit of help' - but the
benefits of investing in this are realised over many years, making it harder to prove impact and
protect funding in the face of severe pressure on spending. This document provides examples of
imaginative, affordable and effective ways of supporting older people’s health, well-being, social
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engagement and independence. It highlights projects with some local authority involvement
whether as lead commissioner, subsidiary partner, or through small grants or seed-funding.
The projects demonstrate the importance of: involving people who use support and services in
shaping them; investing in collective solutions, small grants or seed-funding for self-help groups,
and developing local markets to provide the support people want and value; greater emphasis on
the assistance that older people need and choose, and their experiences rather than on
conventional social care and/or services; developing place-based approaches that reflect the
whole of people's lives, and delivering value for money, for example by including transport,
leisure, and fire and rescue services to co-ordinate support.
http://www.jrf.org.uk/sites/files/jrf/authorities-supporting-older-people-summary.pdf
[back to topics]
Patient Care and Safety

Migrant Health Guide
Health Protection Agency (HPA)
This guide is intended to be a "one stop shop" for information to support GPs and nurses in
assessing and treating migrant patients, in recognition of the fact that these patients sometimes
have health needs which are more complex than those of UK born patients.
http://www.hpa.org.uk/migranthealthguide
[back to topics]
Palliative Care
Annual Evidence Update 2011: Patient and carer involvement in chronic disease
NHS Evidence Specialist Collections – Supportive and Paliative Care
This is the third Annual Evidence Update on patient and carer engagement in chronic disease
management. NHS Evidence have continued to broaden the scope of the literature accessed, in
order to reflect the widening field of supportive and end of life care. In this update, they have
included literature mainly from 2010 but also included a few publications of note from earlier
years which were not included in the previous updates.
http://www.library.nhs.uk/PALLIATIVE/ViewResource.aspx?resID=401513
[back to topics]
Public Health
Please see the Mental Health/Learning Disabilities section.
[back to topics]
Research
A new pathway for the regulation and governance of health research
The Academy of Medical Sciences
The report was prepared by a working group convened in response to an invitation from
Government to review the regulation and governance of UK health research involving human
participants, their tissue or their data. The report proposes four key principles that should
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underpin the regulation and governance framework around health research in the UK, and makes
recommendations to:
- Create a new Health Research Agency (HRA) to rationalise the regulation and
governance of all health research.
- Include within the HRA a new National Research Governance Service to facilitate timely
approval of research studies by NHS Trusts.
- Improve the UK environment for clinical trials.
- Provide access to patient data that protects individual interests and allows approved
research to proceed effectively.
-Embed a culture that values research within the NHS.
The report is the first link at the bottom of the webpage.
http://www.acmedsci.ac.uk/index.php?pid=47&prid=88
[back to topics]
Service Management
Briefing: The operating framework for the NHS in England 2011/12
NHS Confederation
This Briefing from the NHS Confederation outlines the key points from the operating framework
for the NHS in England for 2011/12 which was published in mid-December.
http://www.nhsconfed.org/Publications/Documents/Operating_framework_2011_12_final_for_web
site.pdf
NHS Confederation login might be required.
Lessons learned from recent NHS foundation trust applications

Monitor – Independent Regulator of NHS Foundation Trusts
Monitor periodically reviews recent assessments of applications for foundation trust status to
identify the reasons why some have been unsuccessful. This short report sets out some of the
lessons learned from applicants who have been deferred, rejected or have postponed their
application.
http://www.monitor-nhsft.gov.uk/sites/default/files/Lessons_learned_report_Jan2011_0.pdf
FAQs: Transition (NHS Reform)

NHS Employers
NHS Employers has produced this set of frequently asked questions - or FAQs - to help NHS
trusts understand the arrangements for organisations in transition following the publication of the
health white paper Liberating the NHS -and subsequent command paper published on 15
December 2010.
http://www.nhsemployers.org/ManagingTheTransition/Pages/Workforce-transitional-
arrangements-FAQs.aspx
Other related documents are available via:
http://www.nhsemployers.org/ManagingTheTransition/Pages/Managingthetransition.aspx
NHS support for social care: 2010/11 – 2012/13

Following recent announcements about NHS support for social care, including those made at the
Spending Review, this letter sets out for clarity how the different funding streams relate to each
other and the expectations placed on Primary Care Trusts and local authorities in spending these
resources in line with the Operating Framework for the NHS in England 2011/12.
The leter and 2 suppporting documents are accessible via:
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http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_1
23460
Remote control the voice of NHS leadership: The patient-practitioner relationship in a

digital age
NHS Confederation
Many local health systems see new technology as an integral part of their service redesign in the
coming years. While the cost and quality aspects of telehealth continue to be keenly debated,
what is less often considered is what effects digital healthcare can have on the fundamental
relationships between patients and practitioners. This report is designed to challenge and
stimulate thinking about how powerful 'multi-channel' healthcare can be at disrupting established
roles and ways of working in the NHS.
http://www.nhsconfed.org/Publications/Documents/Remote_control_200111.pdf
Technical Guidance for the 2011/12 Operating Framework

The purpose of this technical guidance is to list all the indicators against which the NHS will be
held accountable nationally during 2011/12.
60.pdf
Health and Social Care Bill 2010-11

House of Parliament / NHS Evidence Soecialist Collections – Service Management
This Focus On brings together a range of resources around the Health and Social Care Bill 2011.
It includes documents relating to the bill, reaction, analysis and press coverage.
http://www.library.nhs.uk/healthManagement/page.aspx?pagename=HEALTHBILL
Health and Social Care Bill 2011 Impact Assessments

This document is the Impact Assessments (IAs) for the Health and Social Care Bill, 2011. It
provides the six IAs that accompany the Bill, which cover:
Annex A Commissioning for patients
Annex B Regulating providers
Annex C Local democratic legitimacy
Annex D HealthWatch
Annex E Public bodies
Annex F Public health
The impact assessments and related documents can be accessed via:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsLegislation/DH_12358
3
National Health Service Landscape Review

National Audit Office
This is a review of the new arrangements for the NHS proposed in the Health White Paper. The
review's purpose is to inform the Public Accounts Committee so that it can take stock of the
proposals as they currently stand and discuss their implementation with the Department of Health
and NHS.
Accessible via:
http://www.nao.org.uk/publications/1011/nhs_landscape_review.aspx
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Health Profiles 2010 Regional Profiles

Association of Public health Authorities
Regional Health Profiles show the data used in the 2010 local authority and county health profiles
at a regional level and present further information for each region.
http://apho.org.uk/resource/view.aspx?RID=95272
Liberating the NHS. What might happen?

NHS Confederation / Daily Health Bulletin
Following the Roger Bannister Health Summit in November 2010, this report sets out the key
points from the discussions and what was seen as the outstanding issues that the Health and
Social Care Bill must address as it enters Parliament. It also sets out 12 points for policy-makers
to bear in mind to minimise the risks associated with moving to a new system.
http://www.nhsconfed.org/Publications/Documents/liberating_NHS_leedsJan2011.pdf
Modernisation of health and care: News, information and conversations

A new web channel is available on the Department of Health website that provides healthcare
professionals with all the latest news on the plans for health and social care. NHS and local
authority chief executives are encouraged to keep up-to-date on developments via this channel
and to encourage their staff to use it as a source of information and point of reference.
http://healthandcare.dh.gov.uk/
PCT Cluster Implementation Guidance

This publication provides guidance to the NHS on the creation of PCT clusters, as announced in
2011/12 Operating Framework and outlines the process of consolidating management capacity,
with single executive teams each managing a cluster of PCTs.
96.pdf
A covering letter is available via:
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D
H_123933
[back to topics]
Sexual Health
Commissioning for sexual health – Better for Less Update Briefing
NHS Yorkshire and the Humber
Commissioning effective sexual health services can significantly reduce physical and emotional ill
health whilst providing over £16m of cost savings to the NHS in our region. This document
includes recommendations for commissioners which will help improve quality and reduce cost
including:
• Health professionals having the knowledge and skills to offer women seeking contraception an
informed choice and access to long-acting reversible methods
• Prevention and early diagnosis of sexually transmitted infections including HIV
• Effective measures to reduce rates of repeat abortions.
http://www.healthyambitions.co.uk/Uploads/BetterForLess/22%20BETTER%20FOR%20LESS%2
0Sexual%20Health.pdf
Antioxidants for male subfertility
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Cochrane Database of Systematic Reviews

M.G. Showell, J. Brown, A. Yazdani, M.T. Stankiewicz, R.J. Hart
Between 30% to 80% of male subfertility cases are considered to be due to the damaging effects
of oxidative stress on sperm. Oral supplementation with antioxidants may improve sperm quality
by reducing oxidative stress. Authors' conclusions: The evidence suggests that antioxidant
supplementation in subfertile males may improve the outcomes of live birth and pregnancy rate
for subfertile couples undergoing ART cycles. Further head to head comparisons are necessary
to identify the superiority of one antioxidant over another
http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD007411/frame.html
[back to topics]
Smoking
Reducing smoking – a comprehensive approach – Better for Less Update Briefing
NHS Yorkshire and the Humber
Prevention of smoking has more potential for improving public health, and to do so quickly,
than any other clinical intervention. A comprehensive ‘whole systems’ approach to reducing
smoking provides an immediate return on investment, with significant reductions in NHS
healthcare resource expenditure. Robust research has identified that no one intervention will
reduce smoking. A comprehensive approach including a range of evidence based strategies
implemented simultaneously aimed at both the micro and macro level provides the quickest,
greatest and most sustainable impact on smoking prevalence.
http://www.healthyambitions.co.uk/Uploads/BetterForLess/19%20BETTER%20FOR%20LESS%2
0Reducing%20Smoking.pdf
An item in the Commissioning section may also be of interest.
[back to topics]
Stroke
Supporting life after stroke: A review of services for people who have had a stroke and
their carers
Care Quality Commission
This review looked at the 'pathway' of care provided to people who experienced a stroke or a
'mini-stroke' (called a transient ischemic attack) and their carers. The review was conducted
throughout 2010, and focused on care from the point where people prepared to leave hospital, to
the ongoing care and support in their homes. Both health and adult social care, as well as other
relevant services, were reviewed during this period. PCTs are the main organisations responsible
for commissioning health care for people who have had a stroke. Local councils, particularly the
adult social services departments, also have an important role in assessing peoples’ social needs
and commissioning a range of community based support, care and advice services.
http://www.cqc.org.uk/_db/_documents/CQC_Stroke_review_national_report.pdf
Cilostazol versus aspirin for secondary prevention of vascular events after stroke of
arterial origin
A.K. Kamal, I. Naqvi, M.R. Husain, B.A. Khealani
Background: Aspirin is widely used for secondary prevention after stroke. Cilostazol has shown
promise as an alternative to aspirin in Asian people with stroke. Authors' conclusions: Cilostazol
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is more effective than aspirin in the prevention of vascular events secondary to stroke. Cilostazol
has more minor adverse effects, although there is evidence of fewer bleeds.
[back to topics]
Substance Abuse
Statistics on Drug Misuse: England, 2010
NHS Information Centre for Health and Social Care
This annual statistical report presents information on drug misuse among both adults and
children. It includes a focus on young adults. The topics covered include:
- Prevalence of drug misuse, including the types of drugs used;
- Trends in drug misuse over recent years;
- Patterns of drug misuse among different groups of the population; and
- Health outcomes related to drug misuse including hospital admissions, drug treatment and
number of deaths.
- The bulletin also summarises Government plans and targets in this area.
http://www.ic.nhs.uk/webfiles/publications/003_Health_Lifestyles/Statistics_on_Drug_Misuse%20
_England_2010.pdf
[back to topics]
Urology
2011 Annual Evidence Update on Male Urinary Incontinence
NHS Evidence Specialist Collections – Kidney Diseases and Male Urogential Disorders
Thus Update provides a critical update of the latest information and looks at ongoing randomised
control trials
http://www.library.nhs.uk/kidney/ViewResource.aspx?resID=401615
2011 Annual Evidence Update on Urinary Incontinence (Female)

NHS Evidence Specialist Collections – Women’s Health
The Women's Health Specialist Collection have identified and reviewed new evidence on the
diagnosis and management of urinary incontinence published during the last 12 months. The
Women's Health Specialist Collection provides an update on the latest evidence on the
management of female urge urinary incontinence/overactive bladder and the pharmacotherapy,
surgical and conservative management of female stress urinary incontinence.
http://www.library.nhs.uk/WOMENSHEALTH/ViewResource.aspx?resID=397707&tabID=289&cat
ID=6740
An item in the Commissioning section may also be of interest.
[back to topics]
Women’s Health
Acupuncture for period pain
- 17 -
C. A. Smith, X. Zhu, L. He, J. Song

Dysmenorrhoea, known as period pain, is commonly experienced by younger women. Symptoms
may include cramping pain in the lower abdomen that may radiate to the lower back or anterior
thigh, nausea, vomiting, diarrhoea, headache, fatigue, anxiety, and dizziness. The review found
some evidence for the use of acupuncture in managing period pain. However, these findings
should be interpreted with caution due to the small number of studies and study participants. No
significant adverse effects were identified in this review.
[back to topics]
- 18 -

Clinical Effectiveness Bulletin, No. 48 January 2011

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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 Palliative Care

Sources for Clinical Effectiveness Bulletin

Improving Outcomes: A Strategy for Cancer

Commissioning: Third Report of Session 2010–11

GP commissioning: insights from medical groups in the United States

Quitting smoking in pregnancy and following childbirth: Implementing NICE guidance

Commissioning health services: A guide for RCN activists and nurses

Support. Stay. Save. Report

NICE Technology Appraisals

Technology appraisal: (TA160)

Aripiprazole for schizophrenia in people aged 15 to 17 years

Osteoporosis - secondary prevention including strontium ranelate

NICE Public Health Guidance

Skin cancer prevention: information, resources and environmental changes

NICE Interventional Procedure

Extracorporeal shockwave therapy for refractory greater trochanteric pain syndrome

Off-pump coronary artery bypass grafting

Percutaneous laser coronary angioplasty

Thoracoscopic repair of congenital diaphragmatic hernia in neonates

NICE Consultation Documents

Closing date for comments: 2 February 2011

Inditherm Mattress for the prevention of inadvertent perioperative hypothermia: medical

Prevention of sexually transmitted infections and under 18 conceptions: review proposal

Stable angina: guideline consultation

Conduct disorders in children and young people: scope consultation

CG30 Long-acting reversible contraception: review consultation

Chronic heart failure: quality standard consultation

Alcohol dependence: quality standard consultation

Peritoneal dialysis: draft guideline consultation

Trabecular stent bypass microsurgery for open-angle glaucoma - Interventional

Trabeculotomy ab interno for open-angle glaucoma - Interventional Procedures

External aortic root support in Marfan syndrome - Interventional Procedures Consultation

Endoscopic radiofrequency therapy of the anal sphincter for faecal incontinence -

Percutaneous tibial nerve stimulation (PTNS) for faecal incontinence - Interventional

Idiopathic pulmonary fibrosis: scope consultation

Autism spectrum disorders in children and young people: guideline consultation

NICE Interventional Procedure Guidance

Extracorporeal shockwave therapy for refractory greater trochanteric pain syndrome

Off-pump coronary artery bypass grafting

Percutaneous laser coronary angioplasty

Thoracoscopic repair of congenital diaphragmatic hernia in neonates

Clinical Knowledge Summaries updated in August 2010

• Analgesia - mild-to-moderate pain (new)

• Prostate cancer (new)

Pharmacological treatment and prophylaxis of influenza

Health Technology Assessments

H1N1 influenza and pandemic flu themed issue 3

Annual HPV vaccine coverage in England in 2009/2010

Typical Q & As received on influenza vaccination and use of antivirals

Long Term Conditions

Please see the Palliative Care section.

Mental Health / Learning Disabilities

Items in the Service Management section may also be of interest.

Patient Care and Safety

Lessons learned from recent NHS foundation trust applications

FAQs: Transition (NHS Reform)

NHS support for social care: 2010/11 – 2012/13

Remote control the voice of NHS leadership: The patient-practitioner relationship in a