Intensive Care Unit Telemedicine

Intensive Care Unit Telemedicine
Critical Care Clinics v35(3), July 2019

• A special issue dedicated to telemedicne in the ICU including:
• Intensive Care Unit Telemedicine in the Era of Big Data, Artificial Intelligence, and Computer Clinical Decision Support Systems p483-495

[Contact your local NHS Library for a copy of this journal]

Review of national cancer screening programmes in England

Review of national cancer screening programmes in England
NHS England 6 February 2019 with updates

Independent Review of National Cancer Screening Programmes in England. Interim Report of Emerging Findings
Prof Sir Mike Richards, 24 May 2019

• This interim report presents emerging findings around
• Governance and accountability
• Uptake and coverage
• Delays in implementation
• IT
• Poor performance in meeting other KPIs
• Population and targeted screening
• Workforce
• Research access

Review of national cancer screening programmes in England
NHS England 7 February 2019

• This document provide details, including the terms of reference, for an independent review of national cancer screening programmes in England.
• The programme was launched by Professor Sir Mike Richards and is part of the Long Term Plan. It will make a series of recommendations to the NHS England board about the future delivery of cancer screening programmes and is expected to be published by summer 2019. [NHS England announcement here.]

Specialised health services recommendations 2019

Specialised health services recommendations 2019 
DHSC 24 May 2019

• At its meeting in January the Prescribed Specialised Services Advisory Group (PSSAG) considered 2 services for recommendation to ministers on services that NHS England should commission.
• Management of POEMS (polyneuropathy-organomegaly-endocrinopathy-M protein-skin lesions syndrome) - PSSAG will call for further information before NHS England could become responsible commissioner.
• use of Voriconazole in patients with fungal asthma and Aspergillus bronchitis, including those with cystic fibrosis - PSSAG agreed that it would not be appropriate to recommend to NHS England to add this as a specialised service at this stage. 

A pathway for post-transplant care

A pathway for post-transplant care
Anthony Nolan May 2019

• A post-transplant care pathway has been developed by Anthony Nolan under the leadership of an Expert Steering Group for patients who have had stem cell transplants.
• The pathway consists of five main building blocks: (1) throughout recovery, (2) preparation for transplant, (3) early post-transplant care, (4) ongoing prevention and monitoring, and (5) additional treatment and support.

Segregation in mental health wards for children and young people and in wards for people with a learning disability or autism

Segregation in mental health wards for children and young people and in wards for people with a learning disability or autism
CQC 21 May 2019

• Interim report of the CQC review of restraint, prolonged seclusion and segregation for people with a mental health problem, a learning disability or autism.
• This interim report focuses on 39 people who are cared for in segregation on a learning disability ward or a mental health ward for children and young people. It recommends that an independent review is undertaken of every person placed in segregation, and a strengthening of the safeguards that protect the safety, welfare and human rights of these people. 
• However the CQC are advocating a better system which makes sure that people, and particularly children and young people, with behaviour that others find challenging receive effective help and so prevent admission to hospital.

New measures to improve care for people with autism and learning disabilities  [News]
DHSC 21 May 2019

• It has been announced that the DHSC will accept all of the CQC report’s recommendations and has announced a wider package of measures to improve care for autistic people and those with learning disabilities, including:
• funding for specialist advocates to review the care of every patient in long-term seclusion or segregation
• a new working group for learning disabilities and autism, bringing together experts, clinicians, parents and carers to develop a new model of care
• a new awareness campaign, to encourage staff, families and friends to come forward if they have concerns about care.

Can Machine Learning Algorithms Predict Which Patients Will Achieve Minimally Clinically Important Differences From Total Joint Arthroplasty?

Can Machine Learning Algorithms Predict Which Patients Will Achieve Minimally Clinically Important Differences From Total Joint Arthroplasty?
Clin Orthop Relat Res. 2019 Jun;477(6):1267-1279.

• The three machine learning algorithms were tested using hospital registry data regarding total joint arthroplasty (TJA) patients.They were found to have the potential to improve clinical decision-making and patient care by helping to prioritize resources for postsurgical monitoring and informing presurgical discussions of likely outcomes of TJA.

See also

• Artificial Intelligence May Lead to Better Outcomes After Joint Surger, PRNewswire 16 May 2019

National Prostate Cancer Audit – Patient Summary 2018

National Prostate Cancer Audit – Patient Summary 2018
HQIP 15 May 2019

• The NPCA collects clinical information about the treatment and outcomes (what happens after treatment) of all patients newly diagnosed with prostate cancer in England and Wales. This includes information collected from hospital records and directly from patients diagnosed with prostate cancer.

Partial knee replacements have some short-term advantages compared to total knee replacements

Partial knee replacements have some short-term advantages compared to total knee replacements
NIHR Signal 14 May 2019

• Analysis of 60 studies published in the past 20 years, comparing outcomes of primary unicompartmental knee replacement (UKA) with Total Knee replacement ( TKA) in adult patients. By directly comparing the two treatments, this study demonstrates better results for UKA in several outcome domains. However, the risk of revision surgery was lower for TKA.

Living with a rare disease

Living with Ehlers-Danlos Syndrome and why better data is so important [Comment]
Nuffield Trust 14 May 2019

• Sophie Castle-Clarke describes what it’s like to live with Ehlers-Danlos Syndrome, the cost to the NHS of a system currently failing rare disease patients, and what can be done to improve matters.

Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement:

Impact of a national enhanced recovery after surgery programme on patient outcomes of primary total knee replacement: an interrupted time series analysis from "The National Joint Registry of England, Wales, Northern Ireland and the Isle of Man"
Osteoarthritis Cartilage. 2019 May 10. pii: S1063-4584(19)30976-8.

• Outcomes of a national Enhanced Recovery After Surgery (ERAS) Programme in total knee replacement (TKR) included decreased LOS and bed-day costs, improvement in Oxford knee score and decrease in complications, however 5-year revision rates remained stable. 
•  After ERAS, declining trends in LOS and bed costs slowed down; OKS improved, complications remained stable, and revisions slightly increased.

Abstract

Cancer outcome metrics: Emergency Presentations

Cancer outcomes: Emergency Presentations May 2019
NCRAS 10 May 2019

• The Emergency Presentation metric shows the estimated proportion of all malignant cancers which present as an emergency. The metric estimates the true proportion of emergency presentations using first admissions to hospital as a proxy for diagnosis to allow more rapid reporting. The spreadsheet contains emergency presentations presented at CCG and Alliance level quarterly and with a 1-year rolling average.
• Main findings include:
• in England, the annual average proportion of cancer patients who first presented as an emergency has gradually fallen over the last five years reported, from 20.2% in October 2013 to September 2014 to 18.7% in October 2017 to September 2018
• over the last five years reported (between October 2013 to September 2014 and October 2017 to September 2018), the proportion of cancer patients presenting as an emergency has fallen for 150 CCGs, and either risen or remained unchanged for 41 CCGs.

Adult health screening - PAC report

Adult health screening
House of Commons Public Accounts Committee 10 May 2019

• The PAC took evidence on the management of four of the 11 health screening programmes operating in England: bowel, breast and cervical cancers and abdominal aortic aneurism. It found that none of the screening programmes examined met their targets for ensuring the eligible population was screened in 2017–18. 
• The IT used to identify the eligible population for screening has been unfit for purpose for screening programmes since 2011, but still has not been replaced. 
• Overall it was concluded that the national oversight of screening programmes has failed patients, resulting in thousands of women not being invited for breast and cervical screenings or waiting too long for their cervical screening results.

Summary 

Streamline trials :Whole-body MRI (WB-MRI) for assessing cancer spread

Whole-body MRI (WB-MRI) could reduce treatment waiting times, save lives and reduce NHS costs. [news]
NIHR 10 May 2019

• Two new research studies (1,2) indicate that, for patients with non-small cell lung cancer (NSCLC) and colorectal cancer, one whole-body MRI (WB-MRI) scan can work just as well as multiple scans at assessing cancer spread and leads to the same treatment decisions - but is quicker, cheaper, preferred by patients and involves less exposure to radiation.
• Using WB-MRI, NSCLC patients were fully assessed within an average of 13 days, compared to 19 days using multiple scans. For colorectal cancer, the difference was eight days compared with 13 days. The average cost of a WB-MRI scan for NSCLC patients was £317, half the £620 cost for multiple scans. The cost of a WB-MRI scan for colorectal patients was £216, compared with £285 for multiple scans.
• When asked, most patients said they would prefer assessment via WB-MRI.

Original research: Comprehensive staging of newly diagnosed lung and colorectal cancer: Prospective multicentre comparison of whole body Magnetic Resonance Imaging with standard diagnostic imaging pathways

1. Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed colorectal cancer: the prospective Streamline C trial
Lancet Gastroenterology and Hepatology, 09 May 2019,  http://dx.doi.org/10.1016/S2468-1253(19)30056-1

2. Diagnostic accuracy of whole-body MRI versus standard imaging pathways for metastatic disease in newly diagnosed non-small-cell lung cancer: the prospective Streamline L trial
Lancet Respiratory Medicine 09 May 2019, https://doi.org/10.1016/S2213-2600(19)30090-6

National Paediatric Diabetes Audit Report 2017-18: Care processes and outcomes

National Paediatric Diabetes Audit Report 2017-18: Care processes and outcomes
HQIP 9 May 2019

• This report provides an analysis of data from all 173 Paediatric Diabetes Units in England and Wales caring for children and young people with diabetes in England and Wales over 2017/18. The report includes information on prevalence of diabetes, diabetes-related outcomes and complications, compliance with health care checks recommended by NICE, and recommendations for improvements in care.

ACE PROGRAMME (WAVE 2): Key messages from the evaluation of MDCs

ACE PROGRAMME (WAVE 2): Key messages from the evaluation of Multidisciplinary Diagnostic Centres (MDC)
Cancer Research UK May 2019

• This summary report highlights the key findings from the five MDC projects and draws together the learning gained from their implementation. It also includes the most recent data on patient characteristics, cancer yield, and pathway activity.
• Headline findings from the MDC evaluation currently suggest that the MDC model: 
• has value as a cancer diagnostic pathway for patients presenting with non-specific but concerning symptoms
• is diagnosing a broad range of cancer types, including rare and less common cancers
• should be considered as an approach to achieving earlier diagnoses of cancer for patients presenting with non-specific symptoms, given the types of cancer being detected
• provides a broad diagnostic approach encompassing a range of cancer and non-cancer conditions
• provides a planned and rapid pathway for patients with complex presentation

Prostate cancer: diagnosis and management NICE guideline [NG131]

Prostate cancer: diagnosis and management; NICE guideline [NG131]
NICE May 2019

• Diagnosis and management of prostate cancer in secondary care, including information on the best way to diagnose and identify different stages of the disease, and how to manage adverse effects of treatment.
• This guideline includes new and updated recommendations on:
• MRI and biopsy
• localised and locally advanced prostate cancer
• follow-up for localised or locally advanced prostate cancer
• treatment for metastatic prostate cancer
• bone-targeted therapies

Crohn’s disease: management [guidance]

Crohn’s disease: management [NG129]
NICE May 2019

• This guideline covers the management of Crohn’s disease in children, young people and adults. It includes new recommendations on maintaining remission after surgery.

Leeds Neonatal and Maternity Services reconfiguration

Leeds Neonatal and Maternity Services
Yorkshire & Humber Clinical Senate April 2019

• Case study of consideration for centralisation of all neonatal provision and obstetric led maternity care (including specialised services) on a single site (Leeds General Infirmary), with the development of a new midwifery-led unit on the same site.

Rates of knee arthroplasty within one-year of undergoing arthroscopic partial meniscectomy

Rates of knee arthroplasty within one-year of undergoing arthroscopic partial meniscectomy in England: temporal trends, regional and age-group variation in conversion rates.
Osteoarthritis Cartilage.26 Apr 2019. DOI: 10.1016/j.joca.2019.03.009

• Analysis of HES data for patients undergoing arthroscopic partial meniscectomy indicates a significant increase in the proportion of patients undergoing arthroplasty within one-year of APM. 
• There was greater than 10-fold variation by CCG.

Abstract

PET-CT imaging in patients with anal cancer

PET-CT imaging in patients with anal cancer
SHTG Advice Statement and Evidence Note, April 2019

Advice for NHS Scotland