National Cardiac Audit Programme – Annual Report 2019

National Cardiac Audit Programme – Annual Report 2019
HQIP 12 September 2019

• The National Cardiac Audit Programme 2019 Annual Report covers over 300,000 records across five clinical areas: 
• Adult Cardiac Surgery
• Myocardial Ischaemia (MINAP)
• Percutaneous Coronary Intervention (PCI)
• Heart Failure
• Congenital Heart Disease
• The report focuses on three broad quality improvement themes: timely care, specialist care and evidence-based care delivered to a uniformly high standard.
• It highlights four areas of interest where improvements have been made but some hospitals have been slow to adopt innovation.
• Use of day-case elective PCI
• Use of disease-modifying medicines in heart failure with reduced ejection fraction
• Deep wound infections after cardiac surgery requiring additional surgery
• Use of radial access for PCI procedures

The Get Data Out Programme

The Get Data Out Programme
National Cancer Registration and Analysis Service (NCRAS)

• The Get Data Out programme presents key statistics about cancer patients. 
• Patients diagnosed with a certain type of tumour are split into many smaller groups, each of which contains approximately 100 patients with the same characteristics. These are presented in an interactive dashboard. For each group of patients there are statistics about incidence, routes to diagnosis, treatments and survival.
• Prostate cancers were added to the programme in July 2019.

RightCare Progressive Neurological Conditions Toolkit

RightCare Progressive Neurological Conditions Toolkit
RightCare 15 August 2019

• This toolkit will support systems to understand the priorities in care for people living with various progressive neurological conditions including multiple sclerosis (MS), motor neurone disease (MND), Parkinson's and the atypical Parkinsonism's of multiple system atrophy (MSA), progressive supranuclear palsy (PSP) and corticobasal degeneration (CBD). It provides the opportunity to assess and benchmark current systems to find opportunities for improvement.

Measuring up: how does the UK compare internationally on cancer survival?

Measuring up: how does the UK compare internationally on cancer survival? [blog]
Cancer Research UK, 11 September 2019

• Latest data from International Cancer Benchmarking Partnership indicates that, except for  ovarian and oesophageal, the UK has the lowest survival figures for the cancers studied.
• Commentary on: 
• Progress in cancer survival, mortality, and incidence in seven high-income countries 1995–2014 (ICBP SURVMARK-2): a population-based study Lancet Oncology 11 September 2019 DOI: https://doi.org/10.1016/S1470-2045(19)30456-5

Advanced Pain Discovery Platform

Advanced Pain Discovery Platform
Versus Arthritis 9 September 2019

• A £24 million fund which forms a 5-year partnership between Versus Arthritis and UK Research and Innovation to generate a research platform, known as the Advanced Pain Discovery Platform, which will combine cutting edge technology and science, using artificial intelligence to understand the complex nature of pain in humans.

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 Sep;27(9):1280-1293

• Analysis of the impact of a national Enhanced Recovery After Surgery (ERAS) Programme in total knee replacement (TKR) on patient outcomes (486,579 primary TKRs) in 149 UK NHS trusts (April 2009-March 2011). 
• After ERAS, declining trends in length of stay and bed costs slowed down; Oxford Knee Scores improved, complications remained stable, and revisions at 5 years slightly increased.

The impact of BMI and smoking on risk of revision following knee and hip replacement surgery: evidence from routinely collected data.

The impact of BMI and smoking on risk of revision following knee and hip replacement surgery: evidence from routinely collected data.
Osteoarthritis Cartilage. 2019 Sep;27(9):1294-1300.

• Analysis of data from the Clinical Practice Research Datalink (CPRD) linked to inpatient hospital records, from Hospital Episode Statistics Admitted Patient Care (HES APC) (1997 to 2014) suggests that obesity and smoking do not have a meaningful impact on the risk of revision following TKR and THR.

Abstract

Unrelieved Pain in Palliative Care in England

Unrelieved Pain in Palliative Care in England
OHE September 2019

• This study estimates that currently there are approximately 125,971 end-of-life patients receiving, or in need of, palliative care suffering from unrelieved pain. Of these, an estimated 16,130 patients experience no relief from their pain at all in the last three months of life. There are variations in the quality of care across care settings (e.g. hospice versus at home services).

Consultation and business case for proposals on the future of vascular services across West Yorkshire

Consultation and business case for proposals on the future of vascular services across West Yorkshire
NHS England August 2019

• Part of the consultation on specialised vascular services in West Yorkshire being run by NHS England working with the acute trusts through West Yorkshire Association of Acute Trusts. Consultation closes on 30 November 2019.

Prostate cancer-detecting probe could make surgery more accurate

Prostate cancer-detecting probe could make surgery more accurate
Imperial College London Press release 5 August 2019

• Researchers at the ICL's Institute of Global Health Innovation (IGHI) will enhance an existing surgical probe developed by Lightpoint Medical, to generate ‘visual heat maps’ of prostate tumours. By combining robotics and medical imaging they will develop a system that will highlight cancerous tissue in real-time on screen in the operating theatre.
• If successful, in future this minimally invasive tool could mean that fewer men need to return to hospital for additional treatment, such as radiotherapy or cancer drugs,

The causal effect of hospital volume on health gains from hip replacement surgery

The causal effect of hospital volume on health gains from hip replacement surgery
Centre for Health Economics 20 August 2019

• This study investigates the causal effect of hospital volume on the health gains of patients receiving a primary planned hip replacement procedure in the English NHS in 2015/16. It sought to test for the presence of economies of scale in health outcomes and concludes that hospital volume does not have a causal impact on patient-reported health outcomes for planned hip replacement.

PACAC inquiry into eating disorders: government response

PACAC inquiry into eating disorders: government response
DHSC 13 August 2019

• This document sets out the government’s response to the conclusions and recommendations made in the Public Administration and Constitutional Affairs Committee (PACAC) report: Ignoring the Alarms follow-up: Too many avoidable deaths from eating disorders.
• Discussion relates to training, quality and availability of adult services, and the transition from child to adult services and coordination of services.

Adult eating disorders - updated guidance and resources

Adult eating disorders - updated guidance and resources

Adult Eating Disorders: Community, Inpatient and Intensive Day Patient Care – Guidance for commissioners and providers
NHS England 8 August 2019

• Guidance and helpful resources

Addendum – Inpatient and Intensive Day Care Extension to the Community Eating Disorder Guidance

NHS England 8 August 2019

• Includes: Quality benchmarks for inpatient and intensive day care for eating disorders

Appendices and Helpful Resources for Inpatient and Intensive Day Care – Addendum to the Community Eating Disorder Guidance

NHS England 8 August 2019

• Includes useful websites, commissioning resources, competence frameworks.

CancerData dashboard

CancerData dashboard
NHS England and Public Health England

• The CancerData dashboard brings together data across the whole cancer pathway at CCG, provider and national levels.

Adult Highly Specialist Pain Management Services

Adult Highly Specialist Pain Management Services
NHS England 8 August 2019

• This service specification covers the provision of adult highly specialist pain management services, but there are significant overlaps in relation to young people and the transition from children to adult services. There is a separate service specification for paediatric chronic pain (under the remit of specialised surgery in children).

Best practice for hip and knee arthroplasty surgery

Best practice for hip and knee arthroplasty surgery
GIRFT July 2019

• Professional standards guidance for hip and knee arthroplasty in association with the British Hip Society, British Association for Surgery of the Knee, the British Orthopaedic Association and NHS Resolution.
• The guidance has been produced as part of ongoing work both to improve patient outcomes and to reduce litigation costs within the NHS, and are based on arthroplasty cases in which complaints were made have been reviewed.

Implementation Plan for the UK Strategy for Rare Diseases and progress report

Implementation Plan for the UK Strategy for Rare Diseases
NHS England 29 January 2018

• The Plan sets out NHS England’s proposed actions against all of the commitments in the Strategy for which it has a lead responsibility. In particular, the Plan aims to address the following three objectives: 
• Facilitating earlier diagnosis and intervention.
• Improving care coordination. 
• Promoting research.
• Of particular note are the following key actions:
• The continuing progress of the 100,000 Genomes Project and the concurrent development of a genomic testing strategy that will underpin the development of a new genomic medicine services for the NHS
• The development of a set of criteria that will allow NHS England to hold providers to account for the way in which they treat patients with rare diseases via a rare disease ‘insert’ to the standard NHS Contract
• The development of Rare Disease Collaborative Networks. These will be groups of providers who have a demonstrable research-active interest in a rare/very rare disease, with the aim of improving patient outcomes

Implementation Plan for the UK Strategy for Rare Diseases; progress report

NHS England 11 July 2019

• This update reviews progress against the dashboard of performance measures set out in the Plan and is in the order set out in the Plan for ease of reference.

Analysis and prediction of unplanned intensive care unit readmission

Analysis and prediction of unplanned intensive care unit readmission using recurrent neural networks with long short-term memory
PLoS ONE 14(7): e0218942. 8 July 2019

• Research using machine learning methods on comprehensive, longitudinal clinical data from the MIMIC-III to predict the ICU readmission of patients within 30 days of their discharge.
• Machine learning techniques such as Recurrent Neural Networks (RNN) with Long Short-Term Memory (LSTM) were used to incorporate the multivariate features of EHRs and capture sudden fluctuations in chart event features. These machine learning models identify ICU readmissions at a higher sensitivity rate and an improved Area Under the Curve compared with traditional methods.

Chemotherapy at home in Cheshire and Merseyside

Chemotherapy at home in Cheshire and Merseyside
Innovation Agency, the Academic Health Science Network for the North West Coast, 6 July 2019

• Evaluation of a trial of chemotherapy treatment (subcutaneous administration of trastuzumab) at home and subsequently in the workplace delivered by The Clatterbridge Cancer Centre NHS Foundation Trust.
• Economic analysis by the Royal College of Physicians over the course of 2017 estimated savings to the trust of £182 per treatment episode at home compared to in the hospital, resulting in total estimated savings of nearly £400,000. The research did not take into account NHS patient transport costs or missed appointments, meaning that total savings to the NHS are almost certainly higher.

Seven things we learnt by measuring the length of cancer diagnostic pathways

Seven things we learnt by measuring the length of cancer diagnostic pathways [blogpost]
PHE 1 July 2019

• Commentary on analysis of data for secondary care diagnostic intervals (SCDIs) for cancer patients in England diagnosed in 2014-2015.
• SCDI data can be viewed and downloaded from a Cancer Data online tool, which displays different cancer types by demographic factors and Cancer Alliance. Using this tool, it is possible to understand how these intervals vary across different stages of disease, age, sex, ethnicity, comorbidities, levels of deprivation, routes to diagnosis and in different parts of England, to support initiatives to diagnose cancer faster within the NHS.