Health E-news Friday 9 October

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

Announcement of forthcoming guideline on persistent effects of COVID-19

NICE, and the Scottish Intercollegiate Guidelines Network (SIGN) have announced that they will work with the Royal College of General Practitioners (RCGP) to develop a guideline for the persistent effects of COVID-19, or long covid. The guideline will address, among other things, a formal definition of the disease, and how to identify on-going symptoms, which can include on-going shortness of breath, fatigue, heart, lung, kidney, neurological and musculoskeletal problems. It will also provide a definition of best practice investigation and treatment options to support the management of the condition. Publication is expected before the end of the year.

COVID-19 related news

Cochrane review on anticoagulants for people hospitalised with COVID-19

A recently published Cochrane review explores the use of prophylactic anticoagulants for those who are hospitalised with COVID-19, to see whether preventive use of anticoagulants reduced mortality or the need for respiratory support, compared with placebo or no anticoagulant treatment. The studies found for inclusion in the review were retrospective studies from hospitals in China, Italy, Spain and the USA, and the variance in reporting of results, along with incomplete reporting, means the review authors have low confidence in the current evidence. 22 ongoing studies on the topic, including 20 RCTs, were identified, and the review will be updated when results of these are published.

Other news

Cochrane brings together recent reviews relevant to nursing, midwifery and allied health

On the Evidently Cochrane blog this week, collections of recent Cochrane reviews have been brought together for several staff groups. The individual collections offer an overview of recent evidence relating to nursing, reviews relevant for allied health professionals, and for midwives. Each collection offers several different topics, provides a summary of the findings, and links to the full reviews.

Cancer Research UK publication on the early detection and diagnosis of cancer

Cancer Research UK have published the ‘Early Detection and Diagnosis of Cancer Roadmap’, a report which aims to help bring together the UK efforts in early detection and diagnosis of cancer. The document aims to define a shared vision amongst healthcare professionals, healthcare service commissioners, academia, research funders, patients and other stakeholder sectors, and makes recommendations for overcoming the existing challenges to progress in this area.

NHS Employers resources for World Mental Health Day

Ahead of World Mental Health Day on Saturday 10 October, NHS Employers have rounded up a range of resources relevant to mental health and wellbeing amongst the healthcare workforce. The resources include a toolkit developed in partnership with Mind, and a variety of resources relating to mental wellbeing throughout the ongoing pandemic, including some specific advice on mental health for those working from home.

International consensus statement on preventing opioid-related harm

An international multi-disciplinary consensus statement on the prevention of opioid-related harm in surgical patients has been published in Anaesthesia. The authors of the statement include anaesthetists, pain specialists, surgeons, a primary care physician, nurse and pharmacist from Australia, India, Italy, the Netherlands, the UK and the USA, selected on the basis of clinical or academic expertise. The statement offers guidance on the safe peri-operative use of opioids in adult surgical patients, and includes recommended strategies to reduce the potential harms of postoperative use of opioids.

Nuffield Trust report considers mental health nurse education

A report from the Nuffield Trust, commissioned by NHS Employers and the Mental Health Network, looks at ways more people might be attracted to apply to study mental health nursing, and considers the reasons why numbers are currently limited. ‘Laying foundations: Attitudes and access to mental health nurse education’, identifies five broad areas where efforts can be made to encourage and support an increased number of students in mental health nursing education. These include improving understanding of mental health nursing roles and mental health patients, and enabling access to courses across the country, from across the breadth of the population.

NICE guidance

Medtech innovation briefing

MIB229 AnaConDa-S for sedation with volatile anaesthetics in intensive care

NICE guideline

NG170 COVID-19 rapid guideline: cystic fibrosis Updated

NG183 Behaviour change: digital and mobile health interventions

Technology appraisal

TA652 Alpelisib with fulvestrant for treating hormone-receptor positive, HER2-negative, PIK3CA-positive advanced breast cancer (terminated appraisal)

NIHR alerts 

Working may improve quality of life for carers of people with dementia

A decision aid may help people with newly-diagnosed multiple sclerosis consider their options for treatment

People with anorectal melanoma may not benefit from radical surgery


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Health E-news Friday 2 October

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 related news

Cochrane Review examines the accuracy of chest imaging for COVID-19 diagnosis

A recent Cochrane Review considers the evidence for thoracic imaging tests in the diagnosis of COVID-19. Noting the continuing challenges of accurate diagnosis by reverse transcriptase polymerase chain reaction (RT‐PCR) testing, the review assessed studies on the use of chest imaging tests, including CT, X-ray and ultrasound, to see how accurate these tests are in diagnosing cases of suspected or confirmed COVID-19. On the basis of the included studies, the review suggests that chest CT and chest X-ray may be useful for confirming COVID-19 diagnosis, but that CT scans may be less accurate in suspected cases.

Study findings show high prevalence of infection, but suggest growth rate may be slowing

Interim findings from the Real-time Assessment of Community Transmission (REACT) study have been published, offering a view of the levels of infection in the general population in England. The study, led by Imperial College Healthcare NHS Trust, tests over 150,000 participants each month over a 2-week period, and the published findings shows prevalence of infection increased across all age groups and regions. Infection was highest in those aged 18 to 24 with 1 in 100 people infected, and cases increased seven-fold in those aged over 65. The North West had the highest levels of infection and the number of infections in London increased five-fold. The current prevalence of infection is the highest recorded to date by the study team.

Other news

GMC publish updated guidance on Decision making and consent

The General Medical Council have published new guidance on Decision making and consent, effective from Monday 9 November. The guidance is intended to help doctors have meaningful conversations with patients about their treatment and care options, and is designed to be easy to follow, taking account of the work pressures faced by doctors. A single page summary with key principles doctors need to know, a focus on the importance of taking a proportionate approach, tailored to individual patients, and information on how healthcare colleagues can support decision making.

Professional bodies for radiology and cancer radiotherapy call for dedicated investment

The Royal College of Radiologists (RCR), Society and College of Radiographers (SCoR) and the Institute of Physics and Engineering in Medicine (IPEM) have each submitted cases to the Treasury, ahead of the forthcoming Comprehensive Spending Review. The organisations are united in their calls to the Government to combat staff shortages and inadequate and outdated equipment and IT, the primary obstacles that slow down care for cancer and imaging patients. The full submissions of each organisation can be accessed from this page.

RCoA and Association of Anaesthetists publish guidance on safe drug management

The Royal College of Anaesthetists (RCoA) and the Association of Anaesthetists have published guidance on the Safe Drug Management in Anaesthetic Practice. This guidance has been endorsed by the Royal Pharmaceutical Society (RPS), the Faculty of Intensive Care Medicine and the College of Operating Department Practitioners. The guidance builds upon 2016 guidance, ‘Storage of drugs in anaesthetic rooms’, extending its scope to include other areas where anaesthesia is routinely administered, such as emergency departments and labour wards.

King’s Fund considers the trade-offs between digital and face-to-face care

With the move from face-to-face to digital provision of some health care services during the first stages of the pandemic, there is a need to consider the gains, the losses and the balance between the two options, ahead of lasting decisions being made, suggests the King’s Fund. Noting some of the benefits that digital solutions offer patients and staff, and highlighting some of the obstacles preventing access to digital solutions, the argument is made for a balance which draws on the strengths of both face-to-face and digital, taking proper account of the needs and preferences of patients and healthcare professionals.

Resources, events and celebrations for Black History Month

As Black History Month begins, with restrictions limiting face-to-face events, NHS Employers is keen for staff to engage with celebrations, and share stories and resources online. Their website lists some events that NHS trusts have planned throughout the month, links to further information and resources on Black History Month specifically, as well as resources on inclusion and diversity more broadly. They also offer some key facts, figures and information about the current NHS workforce.

NHS Confederation report calls for ‘re-imagining’ of the NHS

Bringing together NHS Confederation members and partners, the NHS Reset campaign has convened the health and care system to reflect on the learning from the last six months and what it means for the future. The report reflects the views of the NHS Confederation, and highlights five factors which are central to helping reset the way health and care is planned, commissioned and delivered.


NICE guidance

Technology appraisal

TA650 Pembrolizumab with axitinib for untreated advanced renal cell carcinoma

TA651 Naldemedine for treating opioid-induced constipation


NIHR alerts 

Tackling fear and misinformation may help increase hepatitis C testing in prison

Tranexamic acid should not be used for patients with severe gastrointestinal bleeding


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Health E-News Friday 25 September

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

New guidance on preparing anaesthesia and critical care for a second COVID-19 surge

New joint guidance produced by the Faculty of Intensive Care Medicine, the Intensive Care Society, the Association of Anaesthetists and the Royal College of Anaesthetists, outlines key principles for clinical directors to consider when planning service changes. The guidance aims to enable services to increase the availability of critical care facilities for COVID-19, while also protecting planned surgery, preserving training, and protecting the health and wellbeing of healthcare staff.

COVID-19 related news

New discovery in structure of Coronavirus could offer way of stopping virus

A new discovery in the structure of the SARS-CoV-2 Spike protein could offer a potentially significant means of eliminating the COVID-19 virus. An international team led by the University of Bristol, who have been examining the molecular composition of the virus, have made a finding that suggests that it might be possible to develop anti-viral drugs to target a particular part of the virus spike, thereby stopping its infectivity. The full findings are available in an article published in Science.

Cochrane blog offers summary of existing evidence on COVID-19

A piece on the Cochrane blog offers a summary of the existing Cochrane Reviews and Special Collections on various aspects of the virus. These include reviews on detecting COVID-19, testing and screening options, measures for controlling the spread – which include PPE, quarantine and travel-based measures – and treatment options for patients with COVID-19. The piece also considers the impact of the pandemic on other areas of health and wellbeing, and links to relevant reviews. Keep up to date with Cochrane news and reviews on COVID-19 at their page dedicated to Coronavirus resources.

Other news

Healthcare regulators publish annual joint report on whistleblowing disclosures

The GMC, NMC and the six other UK healthcare regulators have published their joint ‘Whistleblowing disclosures report 2020’. The report covers any disclosures made between 1 April 2019 and 31 March 2020, and outlines the number of disclosures received by each of the regulating bodies, as well as summarising the actions taken as a result of these disclosures.

Latest evidence from Cochrane on psychological therapies for chronic pain

A recently published Cochrane review investigates the use of three common psychological therapies for chronic pain in adults: cognitive behavioural therapy (CBT), behavioural therapy (BT) and acceptance and commitment therapy (ACT). The review is based upon studies of face to face treatment delivered by trained psychological therapists, and found that CBT offers small benefits on pain, disability and distress, while the evidence for ACT and BT was uncertain.

King’s Fund report examines the workplace needs of nurses and midwives

A report from the King’s Fund, ‘The courage of compassion: Supporting nurses and midwives to deliver high-quality care’, examines the pressures faced by nursing and midwifery staff, and investigates the workplace transformations that could contribute to improved health and wellbeing, decreased stress, and increased motivation. The report suggests that three core needs of autonomy, belonging and contribution must be met, and provides recommendations for how these can be achieved.

Flu vaccination programme aiming to reach 30 million people

This year’s flu vaccination programme will be expanded in an attempt to provide the vaccine to 30 million people, as findings from Public Health England (PHE) research earlier this year suggests that the risk of death more than doubled for people who tested positive for both flu and COVID-19, compared to those with COVID-19 alone. The vaccine will first be offered to all primary school children, two and three year olds, and the most at-risk groups, including adults over 65 and those with long term health conditions, before being rolled out to others later in the season. All staff at St George’s can, of course get their flu jab from the daily flu clinic.

Evidence review on the influences of improvement processes in healthcare

An evidence review commissioned by The Healthcare Improvement Studies (THIS) Institute at the University of Cambridge, and carried out by the RAND Corporation, explores the key influences affecting the implementation of improvement processes in healthcare. Based upon a review of publications covering a range of improvement approaches, six factors were found to be key influences on the successful implementation of improvement. These include leadership, patient and public involvement, and the use of data. The review is intended to highlight the issues that need to be considered when designing improvement initiatives.

NICE guidance

Clinical guideline

CG173 Neuropathic pain in adults: pharmacological management in non-specialist settings Updated

Interventional procedures guidance

IPG680 Transcranial magnetic stimulation for auditory hallucinations

Medtech innovation briefing

MIB227 t:slim X2 insulin pump for managing blood glucose levels in type 1 diabetes

MIB228 Novii Wireless Patch System for maternal and fetal monitoring

NICE guideline

NG59 Low back pain and sciatica in over 16s: assessment and management Updated

NG182 Insect bites and stings: antimicrobial prescribing

Technology appraisal

TA649 Polatuzumab vedotin with rituximab and bendamustine for treating relapsed or refractory diffuse large B-cell lymphoma


NIHR alerts 

New research provides insights into the distress experienced by transgender adults

More precise classification of risk in prostate cancer reveals a huge variation in treatment

Terminally ill patients and their families often need more help to manage their medicines

More health research should take place in the areas and populations with most disease

Cultural and language barriers need to be addressed for British-Pakistani women to benefit fully from breast screening

Community-based medicine collection improves access to lifesaving HIV treatment in South Africa

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Health E-news Friday 4 September

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 related news

Further evidence for benefits of corticosteroids in COVID-19 treatment

Findings in papers published this week in Journal of the American Medical Association (JAMA), have reinforced evidence that outcomes for patients severely affected by COVID-19 can be significantly improved by corticosteroids. The first of the papers examines the effect of hydrocortisone on mortality and organ support, finding more rapid recovery and better survival rates in treatment with the steroid. The second paper looked at mortality over a 28-day period after the start of treatment with corticosteroids, estimating a 20 percent reduction in risk of death.

Government announce funding of increased testing capacity

The government has announced funding for increasing the current capacity for existing polymerase chain reaction (PCR) COVID-19 testing, with the aim of enabling large-scale repeat population testing. In addition, funds will go to expanding pilot trials of new testing techniques and technology, including a rapid test that could provide results in as little as 20 minutes.

New findings add to picture of COVID-19 risks in pregnancy

A systematic review published in the BMJ offers further detail to the known risk factors, clinical manifestations, and outcomes in pregnant and recently pregnant women with COVID-19. The key findings of the review are: that increasing maternal age, existing co-morbidities or high BMI are risk factors for severe COVID-19 in pregnancy; that women with the virus are more likely to experience preterm birth; and pregnant women are less likely to manifest symptoms of fever and myalgia than non-pregnant women with COVID-19.

Nuffield Trust briefing on impact of COVID-19 on use of technology in NHS

A briefing from the Nuffield Trust explores how the pandemic has pushed the adoption of technology in the delivery of NHS services and notes the increased usage of digital health services by patients. The report examines what has enabled these changes, considers possible risks of the move to remote service delivery alongside the positive outcomes, and calls for the balancing of change with evidence of its benefit. Finally, the funding, infrastructure and workforce requirements of sustaining any lasting technological adoptions is highlighted.

Other news

RCPCH statement on paediatrician role in supporting mental health

The Royal College of Paediatrics and Child Health (RCPCH) has published a statement on the role of paediatricians in supporting the mental health of children and young people. Noting the increasing incidence of mental health issues among children and young people, the heightened risks for those in vulnerable groups, and the anticipated increase in support needs resulting from COVID-19, the statement makes a series of recommendations relating to training for paediatricians, and also for service developments.

NICE guidance

Diagnostics guidance

DG41 Implantable cardiac monitors to detect atrial fibrillation after cryptogenic stroke

Medtech innovation briefing

MIB225 Helge for detecting haemolysis

Medical technologies guidance

MTG50 Axonics sacral neuromodulation system for treating refractory overactive bladder

NICE guideline

NG159 COVID-19 rapid guideline: critical care in adults Updated

Technology appraisal

TA645 Avelumab with axitinib for untreated advanced renal cell carcinoma

TA646 Glasdegib with chemotherapy for untreated acute myeloid leukaemia (terminated appraisal)

TA647 Eculizumab for treating relapsing neuromyelitis optica (terminated appraisal)


NIHR alerts 

Male prisoners develop unhealthy hearts at younger ages than people on the outside

Teams of healthcare professionals from a wide range of disciplines and pay grades are most effective at delivering improvements in patients’ experiences

Psychiatric drugs given to children and adolescents have been ranked in order of safety

Anti-inflammatory drugs do not lift depression in bipolar disorder


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Health e-news Friday 28 August

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.

Click here to sign up to this bulletin via email.

COVID-19 guidance and policy

Joint vision for eye care services during and beyond COVID-19

The College of Optometrists and The Royal College of Ophthalmologists (RCOphth) have developed a joint vision for the two professions to continue to work together to support the delivery of safe and sustainable eye care services in England. The vision sets out three key principles and recommendations for the development and governance of high quality eye care service. The three principles are: balancing visual loss due to delays against the risk of acquiring COVID-19; decisions about the most effective patient care being made by the appropriate clinician, and; all pathways to be underpinned by the highest standards of joint optometry and ophthalmology clinical governance.

COVID-19 related news

Study offers more detailed picture of COVID-19 risk factors and outcomes in children

Findings, published in the BMJ, of an observational study of 651 children and young people (aged less than 19 years) with COVID-19 admitted to hospitals across England, Wales and Scotland between 17 January and 3 July 2020, offer further details of the symptoms, risks and outcomes of the virus in children. The nationwide study highlights that a very small number of children (six) died, and that those children most at risk of requiring intensive care are babies under one month old, and children aged 10 to 14 years. In common with adults, the study found that obesity, and black ethnicity were factors that increased the risk of requiring intensive care.

New measures to support development and rollout of COVID-19 vaccines announced

The government has outlined a number of measures that will allow the safe future mass rollout of a COVID-19 vaccine. These include an expansion of the trained workforce that can administer vaccines, in order to increase access; and giving the Medicines and Healthcare products Regulatory Agency (MHRA) powers to consider approving use of a vaccine ahead of a full product licence; providing that robust clinical trials demonstrate its safety and effectiveness. Linked with these proposals, a consultation is seeking views on the safe distribution of potential COVID-19 vaccines and treatments.

Other news

RCN launches fresh campaign for nursing pay rise

The Royal College of Nursing (RCN) has launched a new ‘Fair pay for nursing’ campaign, seeking an immediate pay rise of 12.5% for all NHS nursing staff. The RCN highlight that the pay rise is needed to: provide safe and effective patient care for all people of the UK by addressing the staffing crisis within nursing; recognise the skill, accountability and expertise of a safety critical profession; and recognise that the salaries of nursing staff have not kept pace with increases in the cost of living. The campaign page also notes the political nature of health care funding in its call for action to address the years of inadequate support for nurses.

RCPCH on declining vaccination rates in the UK

The Royal College of Paediatrics and Child Health (RCPCH) considers some of the factors that are contributing to the ongoing trend of declining vaccination rates in the UK. The piece highlights some of the potential barriers that prevent access to vaccines; considers the significant role of misconceptions, misinformation and belief; and in light of the pandemic, also discusses the impact of disruption to routines and the development and distribution of new vaccines.

NHS Confederation calls for inspections to be paused until after winter

The NHS Confederation has written to the Secretary of State for Health and Social Care, calling for the routine inspections of hospitals and other health care providers to be put on hold until after winter. Pausing inspections, the organisation says, will enable hospitals and other providers to focus on the backlog of treatment that has built up, as well as address issues like staff exhaustion, while also managing the ongoing threat from coronavirus. A recent report by the NHS Confederation makes the case for learning from the present moment, and asks questions of what governance and regulation of healthcare could look like if bureaucracy were reduced.

NHS Providers report on meeting the needs of everyone

A report from NHS Providers, ‘Getting it right for everyone: Meeting the needs of people with a learning disability and autistic people in NHS services’ looks at the longstanding structural inequities faced by people with a learning disability and autistic people, and the further  impact of the pandemic upon these inequalities. Drawing upon interviews with leaders in trusts providing good and outstanding learning disabilities and autism services, the report sets out in detail the common themes behind high quality care, offering detailed case studies of how they have succeeded.

NICE guidance

Clinical guideline

CG134 Anaphylaxis: assessment and referral after emergency treatment Updated

Diagnostics guidance

DG40 High-sensitivity troponin tests for the early rule out of NSTEMI

Medtech innovation briefing

MIB224 FebriDx for C-reactive protein and myxovirus resistance protein A testing

Quality standard

QS196 Community pharmacies: promoting health and wellbeing

QS197 Faltering growth

NIHR alerts

Screening for lymphoedema after breast cancer surgery could identify women likely to benefit from compression sleeves

The weekly break from dialysis is harmful to patients with kidney failure

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Health E-news 21 August

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 related news

Joint letter urges recruitment of COVID-19 patients onto RECOVERY trial

In a joint letter sent to every NHS trust in the country, the UK’s four Chief Medical Officers and NHS England and Improvements’ National Medical Director have urged continued recruitment of high numbers of patients onto the RECOVERY trial, which is exploring potential treatments for the virus. The letter also discusses the next phase of the research response, which includes preparation to support a number of large-scale COVID-19 vaccine studies and driving forward the studies on convalescent plasma.

Considering the evidence on the efficacy of masks

Researchers at the University of Edinburgh, exploring the effectiveness of surgical and single-layer cotton masks on mitigating dispersion of large respiratory droplets (i.e. non aerosol), have made their findings available as a pre-print, non peer reviewed paper on medRxiv. The authors estimate that wearing even a basic, single layer mask decreases the number of projected droplets by over 1000 times in comparison to not wearing any face covering. The authors note that their research explores respiratory droplets, warning that any emerging evidence on aerosol transmission could impact the findings. Related to this, a separate paper in the BMJ calls for further research on the airborne transmission of COVID-19, and the measurement of viral aerosol outputs during respiratory activity and medical procedures. The authors in this case suggest that the infection risk associated with deep breathing, talking, and singing indoors is underappreciated and urgently needs attention.

Other news

Government announces creation of new public health protection organisation

The government announced the creation of a new organisation, with a primary focus on public health protection and infectious disease capability. The National Institute for Health Protection (NIHP), which will bring together Public Health England (PHE) and NHS Test and Trace, as well as the analytical capability of the Joint Biosecurity Centre (JBC) under a single leadership team, will start work immediately. Responses from a range of organisations, including the BMA, the AOMRC, the Academy of Medical Sciences, the Health Foundation and The King’s Fund raise a number of concerns. Primary amongst these are the timing of the reorganisation, the degree of independence that the body will have from government, and what will happen to the broader, prevention focused elements of PHE’s work.

Draft guidance makes new recommendation for lymphoma treatment

In new draft guidance, NICE has recommended use of combination treatment involving polatuzumab vedotin for adults with diffuse large B-cell lymphoma (DLBCL). The combination treatment will be available from today for patients whose cancer has relapsed or not responded to primary treatment, and who cannot have a haematopoietic stem cell transplant.

Findings from international study suggest efficacy of single-dose radiotherapy for breast cancer treatment

A study involving 32 centres in 10 countries, including the UK, has published findings in the BMJ. The TARGIT-A study examined the effectiveness of Targeted Intraoperative Radiotherapy (TARGIT-IORT), which uses just one shot of radiotherapy, compared to conventional external beam radiotherapy (EBRT), which requires daily treatment sessions over three to six weeks. The trial showed TARGIT-IORT  had comparable long-term efficacy for cancer control and lower non-breast cancer mortality.


NICE guidance

NICE guideline

NG125 Surgical site infections: prevention and treatment Updated

NG172 COVID-19 rapid guideline: gastrointestinal and liver conditions treated with drugs affecting the immune response Updated

NG178 COVID 19 rapid guideline: renal transplantation Updated

NG180 Perioperative care in adults

NG181 Rehabilitation for adults with complex psychosis


NIHR alerts 


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Health E-news, 31 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

Latest guidance updates from NHS Employers

NHS Employers have information on the latest COVID-19 guidance updates. Updates include: details on the government announcement confirming that registered health and care professionals travelling to the UK from high-risk countries will be required to self-isolate for 14 days; revised guidance on quarantine, including leave and pay options for staff required to quarantine; and guidance relating to the pausing of shielding, which is effective 1 August.

COVID-19 related news

NHS Confederation on ONS excess mortality statistics and test and trace figures

In a response to the publication of Office for National Statistics (ONS) comparison of all-cause mortality between European countries, and the latest figures for the test and trace programme, Dr Layla McCay, a director at NHS Confederation, expressed concerns over the week-on-week decreases in the percentage of close contacts being reached by tracing system, and stressed the importance of this system to the ability to identify and manage any surges in infections.

Chief executives of NHS trusts voice concerns over staff wellbeing

In a report published by the NHS Confederation this week, chief executives from NHS trusts across England revealed concerns about the impacts of COVID-19 on their staff. Executives voiced serious concerns over: the increasing levels of anxiety and fatigue reported by staff during the pandemic; the safety of BME staff, in light of the disparities of COVID-19 impacts; and protecting the safety of patients and staff as routine services are resumed.

NIHR announce funding of projects to investigate higher COVID-19 risk among certain ethnic groups

The National Institute for Health Research (NIHR) has announced joint funding with UK Research and Innovation (UKRI) of six new research projects to eek to explain and mitigate the disproportionate death rate from COVID-19 among people from Black, Asian and minority ethnic (BAME) backgrounds. One of the studies, UK-REACH, led by the University of Leicester, will establish a unique partnership between national healthcare organisations to specifically address the prevalence of COVID-19 amongst BAME healthcare workers.

NHS England launch online portal to support COVID-19 rehabilitation

A new website from NHS England has been launched, offering an ‘online portal’ to help the rehabilitation of patients discharged from hospital post COVID-19 and those managing their illness at home. The site has been developed with the support and input of several royal colleges, professional bodies and charities. The site offers support for managing a variety of common physical effects those recovering from the virus may experience, as well as for supporting mental health and wellbeing.

PHE report confirms increased COVID-19 risks of being obese or excessively overweight

A report from Public Health England (PHE), which summaries findings from recent publications examining he effects of excess weight and obesity on COVID-19, confirms that the data show that obese people are significantly more likely to become seriously ill and be admitted to intensive care with COVID-19 compared to those with a healthy BMI. The report also summarises evidence regarding the nation’s eating and exercise habits during the COVID-19 pandemic. While some data suggests that more people have exercised during lockdown, evidence indicates that the nation’s exercise levels have not increased overall since before the pandemic.

Other news

NHS England sets out plan to roll out new A&E standards before winter

NHS England is planning to roll out new emergency care standards, designed to replace the four-hour A&E target, before this winter. The new standards have not been published or consulted on and do not have official sign-off from ministers, though the plans have the backing of the Royal College of Emergency Medicine and other royal colleges. Details of the proposed changes are outlined in a paper discussed at an NHSE and NHS Improvement board meeting.

Induction of labour: if, and when, to induce

Evidently Cochrane discusses a recently updated Cochrane review, ‘Induction of labour at or beyond 37 weeks’ gestation, looking at the effects for women and their babies of inducing labour towards the end of pregnancy. The review found evidence that induction later in pregnancy, when compared to waiting for birth to happen, reduced the number of perinatal deaths, led to fewer babies requiring intensive care, and a probable reduction in the number of caesareans required. The review does highlight the variation in values and preferences, and reiterates the need for collaborative discussion and shared decision-making.

New e-learning resource for those working with people with dysphagia

A new Dysphagia Guide, developed in conjunction between Health Education England (HEE), Sheffield Teaching Hospitals NHS Foundation Trust, and the Royal College of Speech and Language Therapists has been made available to access without registration on the HEE e-Learning for Healthcare website. The guide is intended as a resource for health and care professionals working with people with dysphagia, as well as carers and those living with dysphagia themselves.

NHS People Plan published

The NHS People Plan has today (30 July) been published, outlining actions that organisations, employers and staff will need to take in the coming months.
We are the NHS: People Plan 2020/21 sets out guidelines for employers and systems within the NHS, as well as actions for NHS England and NHS Improvement and Health Education England throughout the coming months and year. While welcomed by royal colleges and professional bodies representing health professionals, there was widespread comment on the need for action on staff shortages and a commitment to funding. This was echoed by the Health Foundation in it’s response.


NICE guidance

Medtech innovation briefing

MIB220 Prontosan for acute and chronic wounds

NICE Guideline

NG164 COVID-19 rapid guideline: haematopoietic stem cell transplantation Updated

NG179 COVID-19 rapid guideline: arranging planned care in hospitals and diagnostic services

Quality standard

QS195 Renal and ureteric stones


NIHR alerts


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Health e-news Friday 24 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 related news

Resuming health services during COVID-19 – learning from other countries

The Nuffield Trust have published a briefing examining how other countries are handling issues relating to health service resources and capacity, and the resumption of services as lockdown measures are eased. The report, drawing upon data from the WHO, the European Commission, the European Observatory on Health Systems and Policies, and the OECD, also considers what lessons the NHS might learn from the experiences of other countries.

ONS bulletin examines COVID-19 mortality rates by area and deprivation

The Office for National Statistics (ONS) have published a bulletin on deaths involving COVID-19 by local area and socioeconomic deprivation. Presenting figures at national, regional and local authority level, the bulletin offers provisional analysis of deaths between March 1 and 30 June, focusing on differences between local areas. The analysis also shows the differences between proportion of COVID-19 related deaths as they relate to an area’s level of deprivation. Mortality rates in the most deprived areas of both England and Wales were around twice those of the least deprived areas.

UKRI funded vaccine trial publishes results from early trial stages

The team of scientists at Oxford University’s Jenner Institute and Oxford Vaccine Group have published results from Phase I/II trials in The Lancet this week. The study, which involves researchers from St George’s, has found that the vaccine candidate produces both T-cell and antibody responses against the SARS-CoV-2 virus, including robust neutralising antibody responses. No safety concerns were noted.

Other news

Pay rise for doctors and dentists in England announced

The government has accepted the recommendations in the latest Review Body on Doctors’ and Dentists’ Remuneration (DDRB) report, which will see pay for NHS doctors and dentists in England rise by 2.8%. The rise will be backdated to April 2020.

Partial update to back pain and sciatica guidelines out for consultation

A draft partial update of the National Institute for Health and Care Excellence (NICE) 2016 guideline on the assessment of low back pain and sciatica has been published for consultation. The draft guideline says that people with acute or chronic sciatica should not be offered gabapentinoids, other antiepileptics, oral corticosteroids or benzodiazepines. It also recommends that people with chronic sciatica should not be offered opioids, and states that no evidence recommends the use of antidepressants for sciatica. The Chartered Society of Physiotherapy intends to respond to the consultation, and recommends that individual members also contribute.

 
NICE guidance

Evidence summary

ES29 Remsima (infliximab biosimilar) for subcutaneous injection for managing rheumatoid arthritis

Interventional procedures guidance

IPG674 Artificial iris insertion for acquired aniridia

IPG675 Artificial iris insertion for congenital aniridia


NIHR alerts 

Drug users who lack access to clean water use dangerous alternatives to prepare injections

Most patients leaving hospital in India are given inadequate medical information

Loneliness in people with dementia is linked to social isolation and depression

Most people caring for relatives with dementia experience loneliness


Statistics

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Health e-news Friday 17 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

AOMRC recommendations for COVID-19 winter surges

The Academy of Medical Royal Colleges (AOMRC) have published a statement, further to a report by the Academy of Medical Sciences warning of the potential for a higher winter peak of coronavirus infections. Acknowledging the risks highlighted, the AOMRC make a series of recommendations for preparatory action across key areas, including: system capacity; workforce requirements; infection control and PPE; and testing, amongst others. In each area, they outline actions that need to be taken at a national level, together with necessary local and regional actions.

 

Joint statement on improving medical pathways for acute care

The Royal College of Emergency Medicine (RCEM), Royal College of General Practitioners (RCGP), Royal College of Physicians (RCP) and the Society for Acute Medicine (SAM) have published joint recommendations for transformation of the urgent and emergency care pathway, in light of the continuing COVID-19 pandemic. The statement includes a number of recommendations which they hope can enable organisations to provide care in such a way that appropriately manages risks of crowding of emergency services, and infection prevention and control.

FSRH update guidance to patients of sexual and reproductive health services

The Faculty of Sexual & Reproductive Health (FSRH) have published an update to their advice for patients who need to access contraception, abortion care and other sexual and reproductive health services. The update contains information on which services are likely to be available, along with contact information for relevant services in all countries of the United Kingdom. The guidance is designed for use and distribution by any healthcare workers supporting women with their sexual and reproductive health needs.

Government publishes guidance on managing local COVID-19 outbreaks

New guidance from the government has been published, setting out how national and local organisations should work together in order to contain and manage local COVID-19 outbreaks. The guidance outlines local authority plans and powers, and the roles and responsibilities of both local authorities and national organisations including NHS Test and Trace and the Joint Biosecurity Centre (JBC), and Public Health England (PHE).

COVID-19 related news

Research questions the effectiveness of aerosol boxes

A recently published study in Anaesthesia, suggests that aerosol boxes that have been manufactured in order to protect healthcare workers from COVID-19 might actually be increasing the risks of exposure to airborne particles carrying the virus. The devices are intended for use during tracheal intubation in patients requiring ventilation, but the paper builds on concerns from the medical community that the devices may either not work, or could be causing unforeseen harm to medical staff. The paper notes the untested nature of such devices and their absence from recommendations or endorsement in any existing guidelines, and calls for appropriate testing and regulation.

Transparent face masks for health and care professionals

The Royal College of Speech and Language Therapists (RCSLT) have been lobbying for the introduction of transparent face masks for use in health and social care settings over the past few months, in light of the communication barriers caused by opaque face coverings. In an update to these efforts, the government has accepted the importance of transparent face masks, and have placed an order with the one supplier whose offerings meet the necessary standards. The masks on order are single use, will not require FIT testing, and will not be suitable for use in high-risk environments.

Other news

PHSO report paints stark picture of NHS complaint handling

A report from the Parliamentary and Health Service Ombudsman (PHSO), paints a stark picture of the state of NHS complaint handling, drawn from evidence taken from interviews with a wide range of individuals and organisations who have first-hand experience of how the NHS and UK Government departments approach complaints. The report highlights three areas of particular concern: a lack of consistency in how staff are expected to handle and resolve complaints; inconsistent training on handling complaints; and a negative view of complaints at the organisational level. The report recommends establishment of a complaints standards framework, similar to that pioneered by the Scottish Public Services Ombudsman, which would provide better consistency in the handling of complaints across public services.

RCN survey results reveal increase in numbers considering leaving profession

Initial results of a survey of Royal College of Nursing (RCN) members have been revealed in the first published report. The survey received 42,000 responses, and offers a view of how nursing staff feel about their professional lives. Across both NHS and independent sectors, the percentage of those considering leaving the profession has risen to 36%, up from 27% last year. A high percentage of those considering leaving cited pay as a factor (61%), along with the way nursing staff have been treated during the pandemic (44%), low staffing levels (43%) and lack of management support (42%). The report also notes that while 74% of those responding felt more valued by the public throughout the recent months of COVID-19, only 18% felt more valued by the government.

SOM report on mental health and wellbeing of nurses and midwives

A report from the Society of Occupational Medicine (SOM) offers a summary of the research evidence on the mental health and wellbeing of UK nurses and midwives. The report considers a variety of questions relating to the topic, highlights key findings from the relevant studies found, and makes a series of recommendations for improving current working conditions. The report identifies considerable risk of stress, burnout and mental health problems related to work amongst nurses and midwives; low satisfaction with job demands, control and support; a high risk of bullying and harassment; and a variety of other working conditions that not only threaten the health of nurses and midwives, but also impact on their ability to deliver high quality care to patients.

NHS Employers guidance on supporting staff with childcare responsibilities

NHS Employers have published updated guidance on how NHS organisations can support staff with childcare responsibilities. The guidance covers issues relating to childcare through the summer, the beginning of the new school term in September, and on providing flexibility as an employer.

King’s Fund on obesity and the need for significant government action

The King’s Fund here consider the potential forms of government action to tackle rising rates of obesity in the UK, and the evidence for their likely success or failure. Obesity is a well-established risk factor for diabetes and a range of other diseases and chronic health conditions, to which list can now be added COVID-19, and the piece argues for a strategy that goes beyond public information campaigns, and which makes use of existing evidence demonstrating the need for fiscal and structural actions.

 
NICE guidance

Quality standard

QS193 Specialist neonatal respiratory care for babies born preterm


NIHR alerts 

Some antidepressants can help people quit smoking, but other medications may offer greater benefits

Most patients undergoing planned surgery do not need compression stockings

Asthma patients with a history of opioid use have worse outcomes


Statistics

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Health e-news Friday 10 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.

Click here to sign up to this bulletin via email.

COVID-19 guidance and policy

BSG issue two further guidance updates

The British Society of Gastroenterology (BSG), with input from organisations including the British Liver Trust and NHS Blood & Transplant, have provided guidance on patient groups who should be considered highly vulnerable, or advised to shield. In addition to this, guidelines for triage of patients referred for upper gastrointestinal (UGI) physiology investigations have also been made available. These latter guidelines apply to new referrals and referrals from prior to the pandemic.

Government adopts RCPCH guidance on children and shielding

Recent guidance from the Royal College of Paediatrics and Child Health (RCPCH), on COVID-19 shielding in children and young people, has now been adopted by the government. The guidance gives recommendations on which patients should continue to shield, and notes that patients should only be removed from the shielding patient list by their GP or specialist doctor, following consultation. The recommendations have been incorporated into Public Health England guidance on shielding.

COVID-19 related news

Cochrane Review on signs and symptoms of COVID-19

A new Cochrane Review explores the available evidence on the signs and symptoms of COVID-19, in an effort to inform timely and accurate diagnosis of the virus. The review considered studies published between January and April 2020, addressing the accuracy of any signs and symptoms, either alone or in combination, for the diagnosis of COVID-19. The 16 studies included, covering 27 signs and symptoms, so far provide little in the way of reliable evidence for diagnosis, and the authors conclude that “neither absence nor presence of signs or symptoms are accurate enough to rule in or rule out disease.” As with all COVID-19 related Cochrane Reviews, this one will be updated as new evidence becomes available.

Independent SAGE report on COVID-19 and ethnicity

Independent SAGE have released a report examining the question of why more people from black and ethnic minority (BME) backgrounds appear to be at greater risk of hospitalisation and deaths with COVID-19. As with previous reports on the topic, the evidence considered appears to point to a complicated picture involving interplay between socio-economic disadvantage in BME populations, high prevalence of chronic diseases and the impact of long-standing racial inequalities being key explanations.

Oxford CEBM examine ONS figures on COVID-19 mortality

Here, the Oxford based Centre for Evidence Based Medicine (CEBM) examine the latest Office for National Statistics (ONS) data on deaths. Looking at figures for the week ending 26 June (Week 26), as well as comparing data for this year so far against five year averages, they consider what the numbers of ‘excess deaths’ can tell us about the impact of COVID-19.

UKRI and NIHR announce funding for study of long-term impacts of COVID-19

UK Research and Innovation (UKRI) and the National Institute for Health Research (NIHR) have announced funding of a study into the long term health impacts of COVID-19. The PHOSP-COVID study will aim to recruit patients who have been discharged from hospital after having COVID-19, and will set out to determine the short to long terms health issues experienced and to explore the effectiveness of medicines, treatments and care pathways for particular disease characteristics.

Report on divergent mental health experiences during pandemic

The Mental Health Foundation have shared further findings from their ongoing Coronavirus: Mental Health in the Pandemic study. Exploring the divergent mental health experiences of different population groups, the report highlights those groups identified as being at high-risk from mental health problems, and the impact that the pandemic and the measures to manage it has had on these groups.

Other news

IMMDR publishes ‘First Do No Harm’ report

The Independent Medicines and Medical Devices Safety Review (IMMDR) has published its report, ‘First Do No Harm’, following a two year long examination of how the English healthcare system responds to reports from patients on the harmful side effects of medical devices and medicines. The report focuses on three interventions: Primodos, sodium valproate and pelvic mesh, setting out a series of recommendations for the support of those who suffered as a result of these, and to reduce the future risk of avoidable harms from medical interventions. The report also highlights some of the themes to come from patient evidence, relating to a lack of information enabling informed choices, and a struggle to be properly listened to by healthcare professionals, amongst others.

FSRH amongst signatories of letter calling for reversal of cuts to PrEP funding

Charities and health organisations including the Faculty of Sexual & Reproductive Healthcare (FSRH), have written to the Secretary of State for Health and Social Care, Matt Hancock, to express concerns over the announcement that the budget for local authority implementation of HIV Pre-Exposure Prophylaxis (PrEP) is to be cut by £5 million this year, and to request that the decision be reconsidered. The cut represents a reduction of almost a third of the promised budget of £16 million. PrEP has proven to be highly effective in preventing HIV transmission, and signatories of the letter fear that the budget cut will hamper the delivery of equitable access of PrEP to all communities that might benefit.

King’s Fund on interventions to improve inclusion in NHS providers

The King’s Fund have published research, carried out before the pandemic, on three NHS case studies seeking to address workforce race inequalities and develop positive and inclusive working environments. The three trusts included in the research were selected on the basis of showing promising signs of positive change on inclusion and addressing race inequalities. Work in each of the three organisations included interventions such as establishing staff networks, ensuring safe routes for staff to raise concerns, and enabling staff development and career progression.

 


NICE guidance

Medtech innovation briefing

MIB219 CFHealthHub for managing cystic fibrosis during the COVID-19 pandemic


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