Cancer workforce in England 2017

Cancer workforce in England: A census of cancer, palliative and chemotherapy speciality nurses and support workers in England in 2017
Macmillan Cancer Support 30 April 2018

• Includes profile across different Cancer Alliances, vacancies across different geographies and setting of care.

Cost-effectiveness of unicompartmental compared with total knee replacement

Cost-effectiveness of unicompartmental compared with total knee replacement: a population-based study using data from the National Joint Registry for England and Wales
BMJ Open 2018;8:e020977. doi:10.1136/bmjopen-2017-020977

• This study examines the heath outcomes and lifetime costs (including revision) of unicompartmental knee replacement (UKR) compared to total knee replacement (TKR). 
• Analysis concludes that patients undergoing revision following UKR had better quality of life prior to and following revision than those who had TKR. For all subgroups, the hospital costs of primary and revision surgery were lower for UKR than TKR. The authors highlight a greater uncertainty for younger patients.
• While about half of patients who need knee replacement could be suitable for a partial replacement, but only 9% of the 98,147 knee replacements undertaken in 2016 were partial replacements.
• To achieve the best results, surgeons need to perform a sufficient proportion of knee replacements as UKR.

Balloon pulmonary angioplasty

Balloon pulmonary angioplasty for patients with Chronic Thromboembolic Pulmonary Hypertension
NHS England 2 April 2108

• NHS England is funding a pioneering procedure, called balloon pulmonary angioplasty, for patients who suffer from Chronic Thromboembolic Pulmonary Hypertension (CTEPH). The national service will be carried out in Cambridge’s Royal Papworth Hospital.

Diagnostic digital pathology

Diagnostic digital pathology
Digital health April 2018

• An outline of the development of digital pathology services and its implication on integrated workflow and laboratory information management systems based on an interview with Darren Treanor (clinical lead for diagnostic digital pathology at the Royal College of Pathologists).
• See the Royal College of pathologists Diagnostic digital pathology strategy (Aug 2017)

Prostate cancer - challenges and future

Prostate Cancer: Britain's growing problem
Orchid 9 April 2018

• This report, published to coincide with the 10th Male Cancer Awareness Week (9-15 April), brings together knowledge and experience on prostate cancer. It sets out the main challenges for the future of prostate cancer care and aims to offer some guidance on the priorities for action including diagnosis, treatment and patient care.

HeartFlow Analysis technology to be fast tracked

The HeartFlow Analysis

• HeatFlow Analysis is one of the technologies to be fast-tracked into use through NHS England’s Innovation and Technology Payment programme. (See NHS England News 9 April 2018)
• Using data from a standard CT scan, the non-invasive HeartFlow Analysis creates a personalised 3D model of the coronary arteries and analyses the impact that blockages have on blood flow. 
• NICE estimate up to 35,000 people per year could be eligible.

Risk-reducing mastectomy for the prevention of primary breast cancer

Risk-reducing mastectomy for the prevention of primary breast cancer.
Cochrane Database of Systematic Reviews 2018, Issue 4. 5 April 2018, Art. No.: CD002748. DOI: 10.1002/14651858.CD002748.pub4

• Sixty one studies of interventions involving mastectomy performed for the purpose of preventing breast cancer (n=15,077) were identified. The studies reported that bilateral risk reducing mastectomy reduces the incidence of breast cancer or the number of deaths or both, but many of the studies have methodological limitations. Evidence for contralateral risk-reducing mastectomy is inconclusive.
• Update a review published 2010.

Liver disease profiles include detection rate for hepatitis C

Liver disease profiles: April 2018 update
PHE 4 April 2018

• A new indicator for the detection rate of confirmed chronic hepatitis C has been added to the profiles.
• The highest rate is given as 222.1 per 100,000 in Hammersmith & Fulham.

A structured approach to cognitive rehabilitation for critical care patients

Introduction of a structured approach to cognitive rehabilitation for critical care patients
NICE Shared Learning from Nottingham University Hospitals NHS Trust, April 2018

• Development of a structured approach to delivering cognitive rehabilitation to critical care patients at high risk of developing long-term non-physical symptoms e.g. delirium, loss of memory, attention deficits, lack of insight and awareness, sequencing problems,
• The programme was designed to implement NICE’s guidance for rehabilitation after critical illness in adults (CG83).

Cancer Pathway Redesign Project TV Cancer Alliance

Cancer Pathway Redesign Project
TV Cancer Alliance Spring Newsletter 2018
Full text:

• "Good cancer care begins with good pathways. The NICE guidelines (NG12 2015) moved a few of the goal posts to try and improve referral rates and referral contents.
• Following publication of the NICE guidance, 2 week wait referral forms were made mandatory in Oxford. Educational points were added to help GPs decide who and when to refer. In collaboration with secondary care specialties, the NG12 criteria were adapted to fit the local services and allow ‘right slot, first time’ to be attained.
• By studying the complete pathways where targets were often missed (Urology, Gastro, Gynaecology and Lung), we were able to move some of the diagnostics ahead of the first out-patient appointment to achieve a more streamlined course of care and better outcomes.
• By working together across primary and secondary care, on the four pathways where performance is currently poor, the Cancer Alliance Redesign project aims to achieve a more effective outcome for patients across Thames Valley, even if test results is negative. By referring early into an efficient pathway it is anticipated to reduce the cancer pick up rate to 3% and detect cancers earlier, with all the benefits that these sequelae allow. 
• Dr Shelley Hayles Project Clinical Lead shelley.hayles@nhs.net" 

Robot-assisted kidney transplant [IPG609]

Robot-assisted kidney transplant [IPG609]
NICE April 2018

• This Interventional Procedures Guidance (IPG) concludes that current evidence on the safety and efficacy of robot-assisted kidney transplant is limited in quantity and quality. It presents recommendations in relation to patients with obesity, and patients for whom open kidney transplant surgery is suitable. 
• The procedure should only be done by teams of surgeons with experience in both transplant surgery and robotic surgery.

How digital innovators are transforming the NHS

The Promise of Healthtech: how digital innovators are transforming the NHS
Public, April 2018

• Technological innovation is one way in which the NHS can sustainably relieve the demographic and financial pressure it faces. This report surveys the digital health market and identifies the trends that are contributing to its growth. It also highlights major barriers to innovation in the NHS.
• Includes the HealthTech 27, a list of the most promising HealthTech companies, in nine key areas of opportunity including AI in Pathology & Radiology.

Scaling up single specialty networked care - lessons from Moorfields

Scaling up single specialty networked care: A strategic overview
Networked Care, March 2018 

• In April 2017 the Moorfields vanguard team published a e-toolkit sharing findings from the research into best practice for single specialty networked care. (www.networkedcaretoolkit.org.uk) 
• This report shares findings from semi-structured interviews with more than 35 strategic decision makers across the NHS (providers, commissioners and regulators), and other sectors, as well as a desktop literature review, on the benefits and challenges of scaling up networked care numerically and geographically. 

Moorfields also published two other reports:

Spreading best practice UK Ophthalmology Alliance
Networked Care, March 2018

• Experience and advice from replicating the National Orthopaedic Alliance (NOA) membership model across ophthalmology nationally.

Staff and patients Improving networked care, 
Networked Care, March 2018

• A description of work with the independent charity, the POCF, to understand the best methods and tools to embed staff and patient co-design of services across the Moorfields network.

Spreading best practice UK Ophthalmology Alliance

Spreading best practice UK Ophthalmology Alliance
Networked Care March 2018

• The aim of the National Orthopaedic Alliance (NOA) vanguard programme was to create a UK-wide alliance of orthopaedic providers to deliver outstanding and consistent care in more areas. The NOA vanguard has developed a consistent benchmarking framework, describing not only ‘what good looks like’ in orthopaedic care but also the components of a quality improvement journey. 
• This publication shares experience and advice from replicating the membership model across ophthalmology nationally.

Cardiothoracic surgery - GIRFT report

Cardiothoracic Surgery: GIRFT Programme National Specialty Report
GIRFT March 2018

• Examination of the 31 units providing cardiothoracic surgery in England suggests that smarter bed management and using designated specialist teams for key cardiothoracic surgery procedures will deliver better outcomes.
• The report found variation across the units in patient flow, clinical outcomes and risk management, lung cancer, video-assisted thoracoscopic surgery (VATS), aortovascular surgery and mitral valve repair.
• Appendix 2 highlights some of the processes, practices and measures that have led to positive patient outcomes matched with greater cost efficiencies at University Hospitals Bristol and University Hospital Southampton.

FICM comments on the GIRFT Cardiothoracic Surgery Report here.

The report makes 20 recommendations and identify owners and a timeline for each one -

A Noncultured Autologous Skin Cell Spray Graft for the Treatment of Burns

A Noncultured Autologous Skin Cell Spray Graft for the Treatment of Burns
CADTH March 2018

• A review of the evidence on the ReCell Autologous Cell Harvesting Device, a system that harvests, processes, and delivers an individual’s own skin cells for the treatment of burns. The procedure does not require cell culturing in the laboratory, and takes approximately 30 minutes.

Diagnosis of prostate cancer using AI

Smart software can diagnose prostate cancer as well as a pathologist
European Association of Urology Congress 2018, 16 March 2018

• Chinese scientists and clinicians have developed a learning artificial intelligence (AI) system which can diagnose and identify cancerous prostate samples as accurately as any pathologist. Results showed an accurate diagnosis in 99.38% of cases, which the researchers claim is as accurate as a human pathologist. In the longer term it could lead to automated or partially-automated prostate cancer diagnosis.

Cost-Effectiveness in Adult Spinal Deformity Surgery

Cost-Effectiveness in Adult Spinal Deformity Surgery
Neurosurgery. 2018 Mar 16. doi: 10.1093/neuros/nyx575.

• This paper describes the different types of partial and complete economic analyses and offer a critical review of examples of each in various  Adult Spinal Deformity (ASD) study populations.
• The effect of ASD surgery on health related quality of life has been well documented, but the cost associated with changes in health status has not been well defined.

Frailty as a risk predictor in cardiac surgery

Frailty as a risk predictor in cardiac surgery: Beyond the eyeball test
J Thorac Cardiovasc Surg. 2018 Mar 11. pii: S0022-5223(18)30704-9.

•  The identification of preoperative frailty improves risk prediction and provides targets for optimization for enhanced recovery after cardiac surgery. A frailty outcome modifier in cardiac surgery is described.
• Contents
• I.What is Frailty and is it a Risk Predictor in Cardiac Surgery?
• II.How do we Measure Frailty?
• III.Can Frailty Assessment Help to Determine Whether there is a Net Clinical Benefit of Surgery?
• IV.How can Risk Scores Incorporate Frailty Measures?
• V.Can we “Defrail” the Older Adult Cardiac Surgery Patient?
• VI.Interdisciplinary Team
• VII.An Economic Argument
• VIII.Conclusion

Impact of case management within the NHS England complex rehabilitation pathway

Impact of case management within the NHS England complex rehabilitation pathway
NHS England February 2018

• A case study of case management in a complex rehabilitation pathway.
• Two Complex Rehabilitation Case Managers worked across the NHS England South West hub with all stakeholders and service providers; including the three NHS England Supplier Managers, two major trauma centres (MTCs), ten acute hospital trusts, four specialist rehabilitation providers and 11 CCGs. They drilled down into the problems and developed an action plan to improve the patient flow across the complex rehabilitation pathway.