Showing posts with label 201907. Show all posts
Showing posts with label 201907. Show all posts

31 July 2019

Impact of frailty on outcomes in surgical patients: A systematic review and meta-analysis.

Impact of frailty on outcomes in surgical patients: A systematic review and meta-analysis.
Am J Surg. 2019 Aug;218(2):393-400
  • Meta-analysis of 16 RCTs (n=683,487 patients, 444,885 frail) to understand the association between modified Frailty Index and post-operative complications, re-admission, re-operation, discharge to a skilled care facility, and mortality.
  • Frail patients (modified Frailty Index) were more likely to experience complications, major complications and wound complications. Furthermore, frail patients had higher risk of readmission and discharge to skilled care. Notably, the risk of mortality was 4.19 times more likely in frail patients.

Abstract

Racial Disparities in Total Knee Replacement Failure are not Explained by Poverty

Racial Disparities in Total Knee Replacement Failure are not Explained by Poverty
Arthritis Care Res 15 Jul 2019 doi.org/10.1002/acr.24028
  • A US study of total knee replacement failure found there was a trend towards higher TKR revision risk in blacks. Poverty did not modify the relationship between race and TKR revision or failure.

Intensive Care Unit Telemedicine

Special issue on Intensive Care Unit Telemedicine,
Critical Care Clinics  July 2019

Task and Finish Group on Critical Care - Wales

Task and Finish Groupon Critical Care
Welsh Government July 2019
  • Report of a task and finish group asked to develop a phased approach to redesigning services for people who are critically ill in Wales, by providing support to services which are already in place to ensure the best use of existing capacity, develop and expand the skilled workforce, and ensure that investment in critical care capacity is targeted to support the development of specialist services.

Proton Beam Therapy evaluation

Proton Beam Therapy
NHS England 23 July 2019

25 July 2019

Rapid Diagnostic Centres: Vision and 2019/20 Implementation Specification

Rapid Diagnostic Centres: Vision and 2019/20 Implementation Specification
NHS England 25 July 2019
  • This document outlines the vision and approach for how Rapid Diagnostic Centres will develop and support the transformation of cancer diagnosis services over time. It also provides an implementation specification for Cancer Alliances to begin setting up Rapid Diagnostic Centres in 2019/20. 
  • The RDC service model has evolved from the Multidisciplinary Diagnostic Centre (MDC) service model.
  • See Diagnosing cancer earlier and faster (NHS England)

24 July 2019

Hand and Upper Limb Transplant Service (Adults)

Hand and Upper Limb Transplant Service (Adults)
NHS England 24 July 2019

  • Service specification. 

Fixing the present, building for the future: newborn screening for rare conditions

Fixing the present, building for the future: newborn screening for rare conditions
Genetic Alliance 24 July 2019
  • This report presents the evidence around newborn bloodspot screening and gives views of people living with rare and genetic diseases. It contains recommendations to adapt decision-making to fit rare diseases, to embrace the potential of screening as a rare disease identification system, and to take advantage of developments in technology.

23 July 2019

Complex Gynaecology: Congenital Gynaecological Anomalies

Complex Gynaecology: Congenital Gynaecological Anomalies (Children of 13 years and above and Adults)
NHS England 23 July 2019
  • This service specification covers the provision of specialised, multi-disciplinary team gynaecological management, including surgery in some cases, for girls from 13 years of age and women with rare, congenital anomalies of the female genital tract.

Whole-body MRI is effective for identifying metastatic disease in colorectal cancer patients - prospective Streamline C trial

Whole-body MRI is effective for identifying metastatic disease in colorectal cancer patients - prospective Streamline C trial
NIHR Signal 23 July 2019
  • Initial investigation which includes whole-body magnetic resonance imaging (MRI) is as good as standard pathways for detecting metastatic disease in adults with newly diagnosed colorectal cancer. The study also found that whole-body MRI reduces the number of investigations needed, the length of the staging process, and costs less than standard pathways.
  • Current NICE guidance recommends a sequence of investigations for staging, with MRI only recommended after biopsies and other imaging investigations. This study suggests that MRI could be used earlier in the process, instead of the currently recommended investigations. However, any changes to guidance would need to take into account the availability of this resource.
  • Study: The Streamline C trial was a prospective, multicentre trial done in 16 hospitals in England between 26 March 26 2013 and 19 Aug 2016. Eligible patients were 18 years or older, with newly diagnosed colorectal cancer, 1020 patients were screened for eligibility. 370 patients were recruited, 299 of whom completed the trial.

Whole-body MRI scans are as accurate as standard imaging pathways for lung cancer staging - the Streamline L trial.

Whole-body MRI scans are as accurate as standard imaging pathways for lung cancer staging - the prospective Streamline L trial.
NIHR Signal 23 July 2019
  • Using whole-body magnetic resonance imaging (WB-MRI) in the initial investigation pathway is as good as standard pathways for detecting metastatic disease in adults with non-small-cell lung cancer. The study (Streamline L trial) also found that WB-MRI used for diagnosis and staging is quicker, cheaper and requires fewer other investigations than standard pathways.
  • Current NICE guidance recommends a sequence of investigations for staging – assessing the extent of cancer in order to plan appropriate treatment. MRI of different areas of the body is only recommended after other imaging investigations. This study suggests that whole-body MRI could have a role earlier in the pathway.
  • Study: The Streamline L trial was a prospective, multicentre trial done in 16 hospitals in Englandca rried out between 26 Feb 2013 and 5 Sept 2016. 976 patients were screened for eligibility. 353 patients were recruited, 187 of whom completed the trial.

18 July 2019

Genome Sequencing and the NHS: The views of rare disease patients and carers

Genome Sequencing and the NHS: The views of rare disease patients and carers
Genetic Alliance 18 July 2019
  • Report of a survey to capture the views of patients with a rare or undiagnosed condition and their carers to help inform the implementation of the 100,000 Genomes Project.

11 July 2019

Specialist Haemoglobinopathy Services

Specialist Haemoglobinopathy Services
NHS England 11 July 2019
  • These service specifications cover haemoglobinopathy coordinating centres and specialist haemoglobinopathy teams to support the provision of specialist and non-specialist haemoglobinopathy services to adults and children and to provide expert opinion and management for complex patients.

National Bowel Cancer Audit Short Report – End of Life

National Bowel Cancer Audit Short Report – End of Life
HQIP 11 July 2019
  • Patients are defined as approaching the ‘end of life’ when they are identified as being likely to die within 12 months. Concerns have been raised about the variation in the quality of end of life care received by patients, with several reports highlighting poor care. This short report aimed to look at patients diagnosed with colorectal cancer who were at the ‘end of life’.
  • As expected, patients who did not live for more than a year from diagnosis tended to be older, have metastases, have poorer performance status, and to undergo no surgical procedure. 
  • However, what was not known was that these patients had, on average, two hospital admissions with a length of stay of 18 days each and that a third spent over a month of their last year in hospital. 
  • 86% of those who lived for less than one year had at least one emergency hospital admission and, if  that admission was in their last month, nearly two thirds died in hospital.
  • Of concern, patients with higher levels of deprivation appear to be more likely to die within 12 months of diagnosis, despite adjustment for other factors. This suggests that there may be some inequalities in access to colorectal cancer care services.

Prescribed Specialised Services CQUIN 2019/20 Scheme

Prescribed Specialised Services CQUIN 2019/20 Scheme
NHS England March 2019 updated 11 July 2019
  • Detailed specification for the 2019/20 Prescribed Specialised Services Commissioning for Quality and Innovation (CQUIN) schemes.

10 July 2019

Sarcoma Services (all ages)

Sarcoma Services (all ages)
NHS England 10 July 2019
  • This service specification covers the provision of care for people with sarcoma cancer, including bone sarcoma, soft tissue sarcoma and gastrointestinal stromal sarcomas.

NHS insert - rare disease "alert card"

NHS insert
Extract from: We need national debate on rare diseases to offer the best possible care
Speech by Baroness Blackwood at the British Paediatric Surveillance Unit rare disease summer tea party at the Royal College of Paediatrics and Child Health, 10 July 2019
NHS Insert
"Another very exciting initiative I want to share with you is the NHS insert, which I announced in February and the NHS are now implementing. The insert gives NHS England a way to hold providers to account and improve services for rare diseases. I have met with NHS England just this week, who have assured me that the insert has been included and will be monitored through the Quality Surveillance Systems, with trusts reporting on it for the first time this September.

There will be up to 3 criteria providers report on:

  • care co-ordination
  • an alert card
  • transition

Let me explain these each in turn.

Firstly, the provider must ensure that there is a person responsible for co-ordinating the care of any patient with a rare disease. Secondly, the provider must give every patient with a rare disease an ‘alert card’. This will include information about their condition, treatment regime and contact details for the individual expert involved in their care. Finally, the provider must ensure that every child has an active transition to an appropriate adult service, even if that adult service is not the commissioning responsibility of NHS England."

See
Implementation Plan for the UK Strategy for Rare Diseases, NHS England January 2018
"We will develop [2017/18] and implement [2018/19] a rare disease ‘insert’. This will be a set of criteria that will sit alongside those NHS England service specifications (see enablers) for services that treat patients with rare diseases. "

4 July 2019

Association of quality of paediatric epilepsy care with mortality and unplanned hospital admissions among children and young people with epilepsy in England

Association of quality of paediatric epilepsy care with mortality and unplanned hospital admissions among children and young people with epilepsy in England: a national longitudinal data linkage study
The Lancet Child & Adolescent Health 4 July 2019 DOI: https://doi.org/10.1016/S2352-4642(19)30201-9
  • An investigation into the association between quality of care quality and outcomes among children and young people with epilepsies in England concludes that 
    • among adolescents with epilepsy, greater involvement of tertiary specialists in paediatric care is associated with decreased all-cause mortality in the period after transition to adult services. 
    • Reduced access to an epilepsy specialist nurse was associated with an increase in paediatric epilepsy admissions.
  • Data:  Epilepsy12 national clinical audit, death registrations from the UK Office for National Statistics and data for unplanned hospital admissions from Hospital Episode Statistics.
  • Nuffield Trust blog: Invest early: how to improve the health of young adults with epilepsy

1 July 2019

The Arthroplasty Candidacy Help Engine tool to select candidates for hip and knee replacement surgery: development and economic modelling

The Arthroplasty Candidacy Help Engine tool to select candidates for hip and knee replacement surgery: development and economic modelling
Health Technol Assess 2019;23(32) July 2019
  • Use of the Arthroplasty Candidacy Help Engine (ACHE) tool helps doctors decide who to refer for joint replacement and prevents patients who are unlikely to benefit from joint replacement being referred unnecessarily. This review examines the evidence to support the use of patient-reported outcome measures in setting preoperative thresholds for referral for hip and knee replacement surgery, and identified the Oxford Knee Score (OKS) and Oxford Hip Score (OHS) as the most appropriate scores to use in developing the ACHE tool.