Impact of Prolonged ICU Stay in Cardiac Surgical Patients: A Systematic Review

Survival, Quality of Life, and Functional Status Following Prolonged ICU Stay in Cardiac Surgical Patients: A Systematic Review.
Crit Care Med. 47(1):e52-e63 January 2019

• A systematic review of the outcomes of cardiac surgical patients requiring prolonged intensive care with respect to survival, residential status, functional recovery, and quality of life in both hospital and long-term follow-up.
• The review found consistent evidence that patients with increases in ICU length of stay beyond 48 hours have significantly increasing risk of hospital and long-term mortality.

Pancreatic cancer Quality standard

Pancreatic cancer Quality standard [QS177]
NICE December 2018

• This quality standard covers diagnosis of pancreatic cancer and management of pancreatic ductal adenocarcinoma in adults aged over 18. 
• Quality statements
• Statement 1 Adults with suspected pancreatic cancer have their diagnosis and care agreed by a specialist pancreatic cancer multidisciplinary team (MDT).
• Statement 2 Adults with localised pancreatic cancer on CT have staging using fluorodeoxyglucose positron emission tomography/CT (FDG‑PET/CT) before they have surgery, radiotherapy or systemic therapy.
• Statement 3 Adults with resectable pancreatic cancer and obstructive jaundice have resectional surgery rather than preoperative biliary drainage unless the drainage is specifically indicated.
• Statement 4 Adults with unresectable pancreatic cancer are prescribed enteric-coated pancreatin.
• Statement 5 (placeholder) Effective interventions to address psychological needs.

Integration of specialised services with local health and care systems

Preparing for 2019/20 Operational Planning and Contracting Annex E: Integration of specialised services with local health and care systems
NHS England 21 December 2018

• This document provides detail on how specialised services will be planned in collaboration with local systems to ensure more joined-up care for patients including place-based arrangements.

Non‐pharmacological interventions for chronic pain in multiple sclerosis

Non‐pharmacological interventions for chronic pain in multiple sclerosis: systematic review
Cochrane Library 19 December 2018

• Reviewers found 10 studies (n=565) evaluating different non‐medication treatments to treat chronic pain in persons with Multiple Scloerosis (MS). The treatments evaluated included: transcutaneous electrical nerve stimulation, transcranial direct stimulation, transcranial random noise stimulation, reflexology, psychotherapy and hydrotherapy. 
• Results from these studies show a very low level of evidence for the use of any non‐medication treatments for chronic pain in persons with MS.

Association of BMI and risk of revision or 90 day mortality following total hip replacement

The Association of Body Mass Index with Risk of Long-Term Revision and 90-Day Mortality Following Primary Total Hip Replacement: Findings from the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man.
J Bone Joint Surg Am.100(24):2140-2152. 19 Dec  2018

• A population-based, longitudinal cohort study of the National Joint Registry for England, Wales, Northern Ireland and the Isle of Man, to assess the influence of BMI on the risk of primary total hip replacement revision and 90-day mortality. 38% of the patients were classified as obese. 
• The authors conclude that, although long-term revision rates following total hip replacement were higher among obese patients, they believe that the rates remained acceptable by contemporary standards and were balanced by a lower risk of 90-day mortality.

Oesophago-gastric cancer Quality standard [QS176]

Oesophago-gastric cancer Quality standard [QS176]
NICE December 2018

• This quality standard covers assessing and managing oesophago-gastric cancer in adults. 
• Statement 1 Adults with oesophago-gastric cancer have access to an oesophago-gastric clinical nurse specialist.
• Statement 2 Adults with oesophago-gastric cancer have their treatment reviewed by a multidisciplinary team that includes an oncologist and a specialist radiologist who both have an interest in oesophago-gastric cancer.
• Statement 3 Adults with oesophageal or gastro-oesophageal junctional tumours (except T1a tumours) for whom radical treatment is suitable, have 18‑fluorodeoxyglucose positron emission tomography requested and reported within 1 week.
• Statement 4 Adults with oesophago-gastric cancer have tailored specialist dietetic support before and after radical treatment.

National Bowel Cancer Audit – Annual Report 2018

National Bowel Cancer Audit – Annual Report 2018
HQIP 13 December 2018

• The report highlights falls in mortality rates following both elective and emergency surgery, increased numbers of operations being performed laparoscopically and geographical variation in chemotherapy administration.

Cancer in Children, Teens and Young Adults - high risk patients

Medical & Surgical Review Programme: Cancer in Children, Teens and Young Adults Report
HQIP 13 December 2018

• Cancer outcomes in children and young people have improved dramatically over the last few decades with over 80% of those diagnosed now being cured of their disease. This report deliberately focuses on a sample of patients who were a high-risk group who died or who had an unexpected admission to intensive care. 
• One of the recommendations is that the audit and quality improvement methods, with action plans, are essential for on-going improvement but require access to data eg prescribing, which are not always available.

NUH and Macmillan pilot new ‘virtual clinic’ for tumour patients

NUH and Macmillan pilot new ‘virtual clinic’ for tumour patients
Digital Health 10 December 2018

Nottingham University Hospitals Pioneers Innovative Virtual Clinics in Partnership with Macmillan, Involve 10 December 2018

• Nottingham University Hospitals NHS Trust and Macmillan Cancer Support have piloted a new service that offers patients with brain metastases the option to have their consultation from home via video.
• Virtual Clinic was trialled as part of efforts to help improve care for patients with brain tumours across the East Midlands. After booking an appointment via an online booking system, patients receive a link that enables them to connect to a video meeting with their clinician at the scheduled time.
• Over a seven-month period, 37% of appointments in the brain metastases unit were held via Virtual Clinic. 

Therapy-led spasticity interface service - case study

Case study: Therapy-led spasticity interface service
NHS Improvement 10 December 2018

• A therapy-led spasticity interface service (SIS) run by Northern Devon Healthcare NHS Trust provides a one-stop shop approach to spasticity management, including assessment, pharmacological review, botulinum toxin therapy, rehabilitation, postural management, splinting and orthotics, and support for self-management.

RM Partners Annual Review 2017/18

RM Partners Annual Review 2017/18
RM Partners 10 December 2018
Description of work of the RM Partnership Cancer Alliance including

• Pathway redesign projects (Colorectal pathway redesign, Low dose CT case finding in lung cancer, National Optimal Lung Cancer Pathway, RAPID: shortening the diagnostic prostate pathway, Multidisciplinary diagnostic clinic pilots).
• Digital Solutions programme - aimed at designing a digital infrastructure that improves operational effciencies, as well as enhancing patient and clinician experience. Working with the NHS Healthy London Partnership (HLP) including development of a London Health and Care Information Exchange (LHCIE) infrastructure, which will provide a platform to enable all London NHS and social care providers to access and to share patient documentation based on agreed pathways, including cancer.
• Informatics - including partnership with Public Health England to develop national tools to enable cancer registration data to be used locally by Cancer Alliances and other NHS stakeholders.
• RM Partners pathway groups share experience, best practice and innovation in the delivery of services

Diagnosing skin cancer - the evidence

Diagnosing skin cancer - Special Collection
Cochrane Library 6 December 2018

• This Special Collection brings together a series of new diagnostic test accuracy systematic reviews for diagnosing skin cancer of all types. The reviews aim to identify the most accurate approaches to diagnosis, and so provide the best evidence on which clinical and policy-related decisions can be based.
• Findings relate to diagnosis with the naked eye, smart phone apps, Dermoscopy assisted techniques, Teledermatology and other test including reflectance confocal microscopy (RCM), Optical coherence tomography and high frequency ultrasound.

Mental health crisis services in London - Tier 4 CAMHS

Tier 4 CAMHS
In: Children and Young People’s Mental Health Crisis Peer Review - Summary Findings Report 
Healthy London Partnership November 2018

• This report summarises the findings from peer reviews of London’s nine mental health crisis pathways for children and young people (CYP) conducted between November 2017 and May 2018. The peer review follows publication of HLP CYP mental health crisis guidance and the subsequent CCG self-assessment against the recommendations. 

Findings for Tier 4 CAMHS

A data driven approach to personalised cancer care

A data driven approach to personalised cancer care
Reform 26 October 2018

• This report considers how a better collection and use of data can significantly improve cancer outcomes. 
• The new model of cancer care proposed in this paper looks at how data could be examined and used at every stage of the treatment journey, from prevention and diagnosis through to treatment and recovery. Making better use of data will not only improve cancer outcomes but will also enable the NHS to manage the disease far more effectively, now, and in the future. 
• This paper is sponsored by AbbVie.