UK strategy for rare diseases: 2019 update

UK strategy for rare diseases: 2019 update to the implementation plan for England
DHSC 27 February 2019

• The UK strategy for rare diseases: implementation plan for England was published in January 2018.
• This update on the strategy’s progress covers 5 main areas:
• empowering those affected by rare diseases
• identifying and preventing rare diseases
• diagnosis and early intervention
• coordination of care
• the role of research
• It also sets out the actions that DHSC and partner organisations will take over the next year to implement the commitments of the strategy.

How long does a knee replacement last?

How long does a knee replacement last? A systematic review and meta-analysis of case series and national registry reports with more than 15 years of follow-up.
Lancet. 16 Feb 2019,  393(10172):655-663. doi: 10.1016/S0140-6736(18)32531-5.

• Systematic review and meta analysis of case series and cohort studies around survival time of  knee replacements. 
• Pooled registry data shows that approximately 82% of total knee replacements last 25 years and 70% of unicondylar knee replacements last 25 years. 

Abstract

Breast open access follow up programme Royal Marsden NHS FT

Breast open access programme
NHS Improvement 15 February 2019

• This case study from The Royal Marsden NHS Foundation Trust provides information on the change in pathway that allowed the trust to absorb a 22% increase in outpatient breast referrals through through a breast open access follow-up programme.

National Prostate Cancer Audit: Annual Report 2018

National Prostate Cancer Audit: Annual Report 2018
HQIP 14 February 2019

• This report presents results for men diagnosed with prostate cancer between 1st April 2016 and 31st March 2017 in England and Wales. It reports on specific diagnostic, staging and treatment information as well as core performance indicators in order to compare diagnostic specialist MDTs or treatment centres. 
• Reporting on a total of 14 performance indicators, the NPCA is the first national audit which is able to report on process and outcome measures from all aspects of the care pathway for men with prostate cancer.

National Lung Cancer Audit: Clinical Outcome Publication Report 2018

National Lung Cancer Audit: Clinical Outcome Publication Report 2018
HQIP 14 February 2019

• This is the fifth report on the individual activity of surgeons and their contribution to lung cancer care. The data relate to patients diagnosed with lung cancer who underwent surgery during the period between 1 January and 31 December 2016.
• In addition to publishing the number of operations performed by hospitals and by individual consultant surgeons, the following outcomes are reported:
• the proportion of patients who survive at 30 days, 90 days and 1 year after their operation for each unit
• the median length of stay in hospital following an operation
• the proportion of patients who were readmitted within 90 days of hospital discharge
• the pooled resection rates for the lung cancer team meetings (MDTs) which a surgical unit serves.

MRI for patients with cardiac implantable electronic devices: simplifying complexity with a ‘one-stop’ service model

MRI for patients with cardiac implantable electronic devices: simplifying complexity with a ‘one-stop’ service model.
BMJ Qual Saf Published Online First: 13 February 2019. doi: 10.1136/bmjqs-2018-009079

• Evaluation of a streamlined sustainable service that provides timely MRI scans to patients with cardiac implantable electronic devices (CIEDs) whereby devices could be reprogrammed and scans acquired at a single location and visit. Over 2 years MRI provision increased 6 to 20 times the national average with reduced waiting time from 60 to 15 days and no adverse events.
• Location - Barts Health Trust, London

Abstract

The Topol Review - genomics, digital medicine, AI and robotics

The Topol Review

• An independent report on behalf of the Secretary of State for Health and Social Care, 11 February 2019

This report aims to examine

• how technological and other developments (including in genomics, artificial intelligence, digital medicine and robotics) are likely to change the roles and functions of clinical staff in all professions over the next two decades to ensure safer, more productive, more effective and more personal care for patients;

• what the implications of these changes are for the skills required by the professionals filling these roles, identifying professions or sub-specialisms where these may be particularly significant;

• the consequences for the selection, curricula, education, training, development and lifelong learning of current and future National Health Service staff.

Digital healthcare technologies, defined here as genomics, digital medicine, artificial intelligence (AI) and robotics.

The Review proposes three principles to support the deployment of digital healthcare technologies throughout the NHS:

1. Patients need to be included as partners and informed about health technologies, with a particular focus on vulnerable/marginalised groups to ensure equitable access.

2. The healthcare workforce needs expertise and guidance to evaluate new technologies, using processes grounded in real-world evidence.

3. The gift of time: wherever possible the adoption of new technologies should enable staff to gain more time to care, promoting deeper interaction with patients.

Digital technologies will have an impact on patients, carers and the wider community, health workforce, and health service leadership.

Recommendations

Targeted Screening for Lung Cancer with Low Radiation Dose Computed Tomography

Targeted Screening for Lung Cancer with Low Radiation Dose Computed Tomography
NHS England 8 February 2019

• This document outlines the service and quality indicators expected by NHS England to ensure that a high standard of service is provided for targeted screening for lung cancer across England. 
• Standard Protocol prepared for the Targeted Lung Health Checks Programme

Service specification Radiotherapy Operational Delivery Networks

Service specifications for radiotherapy services across England.
NHS England January 2019

• Service specifications include a new specification to establish 11 Radiotherapy Operational Delivery Networks across England which will be responsible for driving improvements in treatment and care through the adoption of best practice standards, improving access for patients to the most advanced and innovative techniques and reducing the variation in quality of services.

Telemedicine in the ICU: clinical outcomes, economic aspects, and trainee education.

Telemedicine in the ICU: clinical outcomes, economic aspects, and trainee education
Curr Opin Anaesthesiol. 28 January 2019

• The value of tele-ICU to improve patient outcomes, optimize ICU bed utilization, increase financial performance and enhance educational opportunities for the next generation of providers has become more evident and differentiated in the last 2 years.

Abstract

Catching cancer early in Greater Manchester: Boosting GP referrals

Catching cancer early in Greater Manchester: Boosting GP referrals
Behavioural Insights Team 28 January 2019

• A trial in the Greater Manchester Area that assessed the impact of social norm feedback via letters to GPs on urgent cancer referral rates. The letters had a statistically significant positive effect on the urgent GP referral rate. 

Results from a large scale randomised trial with 244 GP practices in Greater Manchester with an urgent GP referral rate below the England average. 

Evaluating Tele-ICU Implementation Based on Observed and Predicted ICU Mortality

Evaluating Tele-ICU Implementation Based on Observed and Predicted ICU Mortality: A Systematic Review and Meta-Analysis
Crit Care Med. 24 January 2019

• After evaluating 13 included studies, tele-ICU implementation was associated with an overall reduction in ICU mortality.

Abstract

Anterior cruciate ligament (ACL) reconstruction and meniscal repair rates: hospital statistics from 1997 to 2017

Anterior cruciate ligament (ACL) reconstruction and meniscal repair rates have both increased in the past 20 years in England: hospital statistics from 1997 to 2017
Br J Sports Med 19 January 2019. doi: 10.1136/bjsports-2018-100195

• The rate of ACL reconstruction (12-fold) and MR (2.4-fold) has increased in England over the last two decades. There is variation in these rates across geographical regions and further work is required to deliver standardised treatment guidance for appropriate use.
• [Full text available through NHS OpenAthens ID]

Abstract

Postoperative Medical Complications and Intermediate Care Unit/ICU Admission in Joint Replacement Surgery:

Postoperative Medical Complications and Intermediate Care Unit/Intensive Care Unit Admission in Joint Replacement Surgery: A Prospective Risk Model.
J Arthroplasty. 2019 Jan 5. pii: S0883-5403(18)31236-1. doi: 10.1016/j.arth.2018.12.034.

• The introduced risk-estimation model offers a specialised preoperative resource-stratification method for  measuring the individual probability for intermediate care unit or ICU admission in knee joint replacement surgery. It condenses the most influential, individual risk factors to avoid clinical test redundancy and improve resource efficiency and presurgical care planning.

Abstract

Scoping review of frailty in vascular surgery.

Scoping review of frailty in vascular surgery.
J Vasc Surg. 24 Dec 2018 Dec 24. pii: S0741-5214(18)32465-0. doi: 10.1016/j.jvs.2018.10.053.

• Discussion of the variety of tools available to measure frailty in patients undergoing vascular surgery interventions

Abstract

Cost-Effectiveness of Surgical and Nonsurgical Treatments for Unicompartmental Knee Arthritis

Cost-Effectiveness of Surgical and Nonsurgical Treatments for Unicompartmental Knee Arthritis: A Markov Model.
J Bone Joint Surg Am. 2018 Oct 3;100(19):1653-1660. doi: 10.2106/JBJS.17.00837.

• In this preliminary assessment, recent expansion of surgical treatments into younger and older age demographics appears to be cost-effective in the setting of unicompartmental knee osteoarthritis. Our findings suggest that nonsurgical treatment should be used sparingly in patients below the age of 70 years and unicompartmental knee arthroplasty should be chosen over total knee arthroplasty in order to maximize cost-effectiveness.

Reducing delays in the diagnosis and treatment of muscle-invasive bladder cancer using simulation modelling

Reducing delays in the diagnosis and treatment of muscle-invasive bladder cancer using simulation modelling
Journal of Clinical Urology 18 July 2018, doi.org/10.1177%2F2051415818794089 

• Development of a simulation model to identify key bottlenecks in the bladder cancer pathway at Royal Cornwall Hospital. Simple changes to the pathway based on the model findings led to significant reductions in delays for bladder cancer patients.

Abstract

When Will Telemedicine Appear in the ICU?

When Will Telemedicine Appear in the ICU? [PubMed]
J Intensive Care Med. 2019 Apr; 34(4):271-276. doi: 10.1177/0885066618775956.

• This review examines the clinical evidence supporting the use of telemedicine in the ICU and discusses the impact on clinical efficacy and costs of care. Additionally, we review the current hurdles to more rapid adoption, including the significant financial investment, different models of care affecting the return on investment, and the varied cultural attitudes that impact the success and acceptance of care models using telemedicine in the ICU.

Abstract