Ninety-Day Costs, Reoperations, and Readmissions for Primary Total Knee Arthroplasty Patients With Varying Body Mass Index Levels.

Ninety-Day Costs, Reoperations, and Readmissions for Primary Total Knee Arthroplasty Patients With Varying Body Mass Index Levels. [PubMed]
J Arthroplasty. 2018 Jul;33(7S):S157-S161.

• A retrospective review of a Canadian institutional database of total knee arthroplasty patients from 2006 to 2013 with a minimum of 3-year follow-up found that 90 day costs were signficantly higher for super- and morbidly- obese patients resulting from higher readmission.

Abstract

Obesity Increases the Risk of Postoperative Complications and Revision Rates Following Primary Total Hip Arthroplasty.

Obesity Increases the Risk of Postoperative Complications and Revision Rates Following Primary Total Hip Arthroplasty: An Analysis of 131,576 Total Hip Arthroplasty Cases. [PubMed]
J Arthroplasty. 2018 Jul;33(7):2287-2292.e1

• Analysis of 131,576 total hip arthoplasties recorded by a German insurance company 2012-2014 indicates that the odds ratio for 1-year revision procedures and 90-day surgical complications increased with every BMI category.

Abstract

Radiology Information Systems

Special Report: Radiology Information Systems
Digital Health June 2018

• This briefing addresses how radiology information systems could to support management of radiology workload by sharing the reporting workload across NHS trusts, and by using artificial intelligence to automate some of the work currently performed by clinicians.

Clinical oncology UK workforce census 2017

Clinical oncology UK workforce census 2017
Royal College of Radiologists 26 June 2018

• The clinical oncology UK workforce census report provides a profile of the clinical oncology workforce in the UK. 
• Based on data from every UK cancer hospital the key findings show that:
• Demand for cancer services continues to outstrip the workforce supply
• Increased pressure on services mean that time allocated to supporting professional activities is being erroded, potentially impacting on the quality of services
• Training numbers are insufficient to replenish the current shortages in the workforce
• Experienced oncologists are being lost from the workforce through retirements.

Advancing Care, Advancing Years: Treating and Caring for an Ageing Population

Advancing Care, Advancing Years: Treating and Caring for an Ageing Population
Health Services Management Centre (Birmingham), ICF International, 26 June 2018

• This report examines the specific needs of older patients with cancer, and explores the process of clinical decision-making for older people with cancer across the UK.
• It discusses why older people’s needs not being identified or sufficiently well-understood, issues with the knowledge and awareness of the cancer workforce about the specific challenges of treating older patients, and lack of evidence to support new cancer treatments in older populations.
• The research involved a literature review, clinical observations at eight case study sites, interviews with 15 national decision-makers and 80 health professionals, and three UK-wide surveys (of primary care professionals, secondary care professionals and older people affected by cancer). The direction of the research was also informed by engagement with a group of older people affected by cancer, and by extensive engagement and interviews with national policymakers. 

GIRFT Review of cranial neurosurgery services in England

GIRFT Review of cranial neurosurgery services in England
GIRFT 22 June 2018

• The report focuses on the cranial neurosurgery service pathways and changes that will help avoid bottlenecks and free up hospital beds. It highlights how cranial neurosurgery providers could deliver a better service to patients by treating them more promptly and minimising cancellations and delays and identifies 15 recommendations to support a more productive cranial neurosurgery service.
• The report suggests that there are opportunities to improve patient experience and outcomes, and deliver cost efficiencies of up to £16.4m through smarter procurement, avoiding unnecessary admissions and using critical care only when clinically required.

Multi-disciplinary diagnostic centre at University College London Hospital

Multi-disciplinary diagnostic centre at University College London Hospital
NHS England 20 June 2018

• This case study shows how the multidisciplinary diagnostic centre (MDC), at University College London Hospital, delivers faster diagnosis and improved patient journeys, to patients presenting with complex or vague abdominal symptoms.

National Audit of Breast Cancer in Older Patients: 2018 Annual Report

National Audit of Breast Cancer in Older Patients: 2018 Annual Report
Healthcare Quality Improvement Partnership 18 June 2018

• The National Audit of Breast Cancer in Older Patients (NABCOP) was commissioned to evaluate the quality of care provided to women aged 70 years or older by breast cancer services in England and Wales from the point of initial diagnosis to the end of primary treatment, and to provide information on the comparative performance of NHS breast cancer units. 
• The report describes how these patterns of care differ between women in younger (50-69yrs) and older (>70yrs) age groups, distinguishing between three main groups of breast cancer.

Service specification: Auditory brainstem implant

Service specification: Auditory brainstem implant
NHS England 15 June 2018

• This specification covers provision of auditory brainstem implant (ABI) services for children with congenital abnormalities of the auditory nerves or cochleae.

Service specification: Stevens-Johnson syndrome and toxic epidermal necrolysis

Service specification: Stevens-Johnson syndrome and toxic epidermal necrolysis
NHS England 15 June 2018

• This service specification covers the provision of services for Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson syndrome (SJS) (all ages). 
• CCGs commission care for patients at Specialist Burn Care Centres once the burn care episode is complete.

Service specification: Adult primary ciliary dyskinesia

Service specification: Adult primary ciliary dyskinesia
NHS England 15 June 2018

• NHS England commissions management services for adults with primary ciliary dyskinesia from Highly Specialist Primary Ciliary Dyskinesia Management centres, including services delivered on an outreach basis delivered as part of a provider network. CCGs commission inpatient care for adults with PCD. 
• Activity is identified via local data flows, which apply to Highly Specialised Primary Ciliary Dyskinesia Management centres only.

Waiting times for suspected and diagnosed cancer patients - 2017/18 Annual Report

Waiting times for suspected and diagnosed cancer patients - 2017/18 Annual Report
National Statistics 14 June 2018
Information on the waiting times of patients with suspected cancer and those subsequently diagnosed with cancer.

• These reports present the validated results of the monitoring of waiting times for cancer services in England and the information on the number of people who attended outpatient appointments within two weeks of an urgent referral by their GP for suspected cancer or breast symptoms and, for patients with cancer, on the numbers who started treatment within 31 and 62 days are included for each organisation. 
• The numbers who started some types of subsequent treatments within 31 days are also given for each organisation. 
• Numbers of patients who were not seen or treated within the specified times are also included.

Cancer survival in England – childhood: patients followed up to 2017

Cancer survival in England – childhood: patients followed up to 2017
ONS 14 June 2018

• Long-term survival trends for children (aged 0 to 14 years) diagnosed with cancer in England.

Can Charlson Co-Morbidity Index Predict ICU Survival?

Can Charlson Co-Morbidity Index Predict ICU Survival?
Journal of the Intensive Care Society 2018, Vol. 19(2) Supplement 1–162, Abstract EP.060

• In a study of 64 patients aged over 50 years admitted for more than 24 hours to ICU in a DGH (Warrington and Halton Foundation Trust, Warrington, UK), Apache II score and Charlson Co-Morbidity Index appear to be predictive of survival

Abstract

Outcomes in critically ill octogenarians and older: A clinically relevant tool to inform admission decision making

Outcomes in critically ill octogenarians and older: A clinically relevant tool to inform admission decision making
Journal of the Intensive Care Society 2018, Vol. 19(2) Supplement 1–162, Abstract EP.83
Analysis of 705 emergency elderly admissions to ICU (Aintree University Hospital NHS Foundation Trust, Liverpool, UK) found that APACHE II score was a fair predictor of hospital mortality but a poor predictor of one year mortality.

Abstract

TAILORx trail testing Oncotype DX breast recurrence score

TAILORx: Many Women With Early Breast Cancer Can Avoid Chemotherapy
ASCO conference 2018, Press briefing 4 June 2018

• Results of the TAILORx breast cancer trial which correlated Oncotype DX Breast Recurrence Score and impact of chemotherapy on invasive disease–free survival (iDFS) when added to adjuvant ET found that "the vast majority of women who have this test performed on their tumor can be told that they don’t need chemotherapy, and that can be said with tremendous confidence and reassurance”. 
• The study results are expected to be immediately practice-changing, Harold Burstein, MD, PhD, FASCO, of Dana-Farber Cancer Institute, commented during the press conference. 

Full abstract presented 3 June

TAILORx: Phase III trial of chemoendocrine therapy versus endocrine therapy alone in hormone receptor-positive, HER2-negative, node-negative breast cancer and an intermediate prognosis 21-gene recurrence score.

Bundle of care for blunt chest trauma patients improves analgesia but increases rates of intensive care unit admission

Bundle of care for blunt chest trauma patients improves analgesia but increases rates of intensive care unit admission: A retrospective case-control study
Anaesthesia Critical Care and Pain Medicine; Jun 2018; vol. 37 (no. 3); p. 211-215

• In patients with blunt chest trauma and more than 3 rib fractures and no indication of mechanical ventilation were compared to a retrospective cohort over two 24-month periods, before and after the introduction of a multidisciplinary clinical pathway ("bundle of care"). 
• The bundle of care model significantly improved pain control after ED management, but increased the rate of primary ICU admission without significant reduction of secondary respiratory complications.
• Study: Single centre retrospective case control study; CHU de Bordeaux, France; 69 pairs of patients

Abstract

Outcomes from the first year of the DaVinci Robot

Outcomes from the first year of the DaVinci Robot
NHS Fab Academy, May 2018

• Lancashire Teaching hospitals has conducted 248 robotic procedures using the DaVinci Xi robotic systems in the first year. Read comments from staff.

MDC based pathways for patients with non-specific but concerning symptoms

Multidisciplinary Diagnostic Centre (MDC) based pathways for patients with non-specific but concerning symptoms. Interim report v2.4
ACE 30 May 2018

• Wave 2 of the ACE programme focuses on the potential for Multidisciplinary Diagnostic Centre (MDC) based pathways to support earlier and faster detection of cancers amongst patients with non-specific symptoms, who do not meet current thresholds for urgent referral. MDCs provide rapid access to a range of diagnostic tests, ideally in one location and conducted on one visit when possible, with a number of specialists working together to speed up diagnosis for the patient
• Eight MDC sites were established, based in Airedale, Greater Manchester (2), Leeds, London (3) and Oxford. As of 30th November 2017, 1,034 patients had been referred into the MDC sites.
• This report provides an interim analysis of activity, outlines the current limitations of the data and planned approaches to improve its quality and robustness and information relating to practical learning from the projects. A full evaluation of MDC approaches will be produced at the end of 2018.
• The Resource pack - Emerging multidisciplinary diagnostic centre (MDC) models and design principles - presents the key design principles of a MDC pathway.