Health e-news Friday 3 July

Health E-News is a weekly update on policy and guidelines from organisations including NICE and individual Royal Medical Colleges, and news and views on health related subjects and research from trusted sources such as The King’s Fund, Cochrane, The Health Foundation, the NHS and the Department of Health and Social Care.

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COVID-19 guidance and policy

RCR and SCoR produce guidance for radiology patients

The Royal College of Radiologists (RCR) and the Society and College of Radiographers (SCoR) have produced guidance for patients who are attending hospital for imaging and interventional radiology procedures. The guidance details arrangements that hospitals are putting into place to protect visiting patients from coronavirus. It also reminds patients of the guidance around wearing a face covering or mask while on hospital sites.

CSP video offers easy to follow advice for COVID-19 recovery

A short video recently produced by the Chartered Society of Physiotherapists (CSP), offers practical and easy to follow advice for those recovering from COVID-19. The video shows people what to expect, offering reassurance that it may take time for a return to normal energy and fitness levels, while highlighting the need for a gradual approach. The video is supported by a series of resources to support recovery, including specific advice on breathlessness, and useful strengthening exercises.

BSG publish guidance on reconfiguring services

The British Society of Gastroenterology (BSG) has published guidance on reconfiguring outpatient gastroenterology and hepatology services in the wake of the first peak of COVID-19. The guide is a first step towards restarting services, which will be updated as the situation evolves. It makes a series of recommendations at this stage, including the importance of signposting patients to the correct pathway; the necessity of face to face consultations in some circumstances; and the need for appropriate IT and support to enable successful remote consultations.

COVID-19 related news

Preliminary results suggest no mortality benefits to lopinavir/ritonavir in COVID-19 patients

Further preliminary results from the RECOVERY trial, which is investigating several potential treatments fro COVID-19, have been made available. The new findings suggest that the antiviral drug lopinavir/ritonavir has no significant mortality benefit in hospitalised COVID-19 patients. Noting the need to provide information quickly as effective treatments for the virus are sought, UKRI stressed in its announcement that these results, as with previous findings have not been subjected to peer review.

Evidence from Cochrane on antibody tests for COVID-19

Evidently Cochrane discusses the existing evidence relating to antibody testing and COVID-19, in the light of publication of a rapid review on the topic. The review set out to examine the accuracy of antibody testing, which appears to be heavily reliant upon the timing of when a test is administered. Tests done at 1 to 7 days from onset of symptoms correctly identified only 30% of people known to have COVID-19, rising to 70% between 8 and 14 days and 90% at 15 to 35 days. Other questions remain regarding the usefulness of antibody testing, including the uncertainty as to whether the presence of antibodies provides protection against further infection. The review is a living review, and will be updated on the basis of frequent searches for new relevant studies.

Insufficient evidence to support role for vitamin D in reducing COVID-19 risk

Two new rapid reviews, from the Scientific Advisory Commission on Nutrition (SACN) and the National Institute for Health and Care Excellence (NICE), have found there to be insufficient evidence on the role of vitamin D in reducing the risks of acute respiratory tract infections (ARTIs) or COVID-19. The SACN review did not specifically assess the effect of vitamin D supplementation on COVID-19 risk, but did conclude that the available evidence does not support a role in the prevention of ARTIs. The evidence summary from NICE evaluating vitamin D and COVID-19, meanwhile, pointed to low quality evidence. Both organisations noted that trials on vitamin D and COVID-19 are ongoing, and will assess new evidence as it becomes available.

RCS survey on elective surgery and recommendations

The Royal College of Surgeons of England (RCS) have published results of their survey of elective surgery which was carried out between 8 June and 15 June, along with a series of recommendations aimed at mitigating the challenges currently being faced by surgical teams. Of the 1,741 respondents, 33% reported being unable to undertake elective procedures in the last four weeks; 62% reported being able to access COVID-light facilities for their patients; and 91% of those who had resumed planned procedures reported that patients were receiving pre-operative COVID-19 tests. Recommendations include twice weekly testing for surgical staff; and work to speed up access to patient test results.

Research describes range of complications with potential link to COVID-19

Research published in The Lancet Psychiatry investigates the breadth of COVID-19 complications which affect the brain, including findings of stroke, encephalitis, and altered mental states such as psychosis and catatonia. The study of 153 patients during three weeks at the peak of the virus found that the majority of cerebrovascular  events occurred in those over 60 years of age, while half of the cases with altered mental states were under 60. These complications may not be a direct result of the virus itself, but the findings offer a first view of some of the mental health support that may be required following illness with the virus.

NHS Providers report on recovery of NHS services

NHS Providers have published a report based upon a survey of all NHS trust leaders, which explores the challenges to be faced as the NHS recovers from the initial peak of COVID-19. Drawing on the responses provided by nearly 60% of providers (representing 126 trusts), the report highlights four key findings, including the significantly increased demand for urgent or crisis care; the constraints and uncertainties around restarting services; and the particularly large challenges faced by acute hospitals. The report concludes that ‘sustained realism’ is required from government and national bodies on the return to full services. The report comes in the same week that the Royal College of Physicians (RCP) reported on a survey indicating that almost half of medical specialties expect to be working at less than pre-COVID levels for at least 12 months.

Open letter from medical Royal Colleges call for urgent rapid review on COVID-19

An open letter recently published in the BMJ, signed by the presidents of the UK’s medical Royal Colleges, and others, calls for the government to carry out a rapid review of the current situation with regards to the COVID-19 pandemic, and the actions that are required to prevent, and/or prevent a second wave of infections. The letter calls for specific attention to be paid to the overall governance of the situation, and scrutiny of this; procurement of supplies; the disproportionate burden on black, Asian and minority ethnic communities; and the need for international collaboration.

Other news

King’s Fund discuss forthcoming report on race inequalities and inclusion in the NHS

The King’s Fund discusses the forthcoming publication of its report on workforce race inequalities and inclusion in NHS providers. The report draws upon research carried out with three NHS organisations, and the experiences of ethnic minority staff, and is expected to be published in full later this month. Here, some initial thoughts on the scale of the problem, and the extent of the efforts required to bring about significant change are shared.

NHS Confederation launches Health and Care LGBTQ+ Leaders Network

NHS Confederation recently launched the Health and Care LGBTQ+ Leaders Network, with the aim of promoting and ensuring the equal treatment of members of the LGBTQ+ community, both as patients and members of the health care workforce.  The network will also work collaboratively to engage with the LGBTQ+ community, allies, wider NHS leadership and other organisations, with a view to increasing the LGBTQ+ membership of boards and the representation of the community amongst senior leadership.

RCN joins 13 other health unions in calling for NHS pay rise

The Royal College of Nursing (RCN) has joined unions including the CSP, UNISON, and the Royal College of Midwives (RCM), in writing to the Prime Minister and Chancellor to call for a start to NHS pay discussions. Alongside calls for a fair pay rise, the unions have asked the government to act upon the significant staffing shortages across the NHS, and to work towards a long-term pay deal that will help to attract people to join the NHS.

Londoners set out expectations for appropriate use of health data

In a London-wide Citizen’s Summit, representatives have set out expectations on the appropriate use of individual and aggregated health and social care data. The summit involved 100 individuals, with representation from each London borough, a range of attitudes towards data sharing, and a diversity intended to reflect the broader population. The summit offered almost unanimous support of the joined up use of identifiable data for the provision of health care, and also discussed the benefits – with conditions and appropriate governance and oversight – of using de-personalised data to inform service planning, and for research and development. A report of the findings can be found here.

NICE guidance

Evidence summary

ES28 COVID-19 rapid evidence summary: vitamin D for COVID-19

Interventional procedures guidance

IPG673 Intravascular lithotripsy for calcified coronary arteries during percutaneous coronary intervention

Medical technologies guidance

MTG49 Rezum for treating lower urinary tract symptoms secondary to benign prostatic hyperplasia

Nice guideline

NG167 COVID-19 rapid guideline: rheumatological autoimmune, inflammatory and metabolic bone disorders Updated

Technology appraisal

TA626 Avatrombopag for treating thrombocytopenia in people with chronic liver disease needing a planned invasive procedure

TA634 Daratumumab with lenalidomide and dexamethasone for untreated multiple myeloma (terminated appraisal)

TA635 Ramucirumab with erlotinib for untreated EGFR-positive metastatic non-small-cell lung cancer (terminated appraisal)

TA636 Eculizumab for treating refractory myasthenia gravis (terminated appraisal)

TA637 Ranibizumab for treating diabetic retinopathy (terminated appraisal)

TA638 Atezolizumab with carboplatin and etoposide for untreated extensive-stage small-cell lung cancer

TA639 Atezolizumab with nab-paclitaxel for untreated PD-L1-positive, locally advanced or metastatic, triple-negative breast cancer

NIHR alerts 

Ambulance staff who respond to suicides need more support

Interactive dashboard identifies patients at risk of unsafe prescribing in a flexible and sustainable way

Public health messages on alcohol need to consider how and why people drink, not just how much


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