Clinical Effectiveness Bulletin 35 - December 2009

NHS Library and Information Service North Staffordshire
Clinical Effectiveness Bulletin

for PCTs in North Staffordshire
Issue No: 35 – December 2009
About this Bulletin:
It aims to draw attention to some of the key documents and reviews on clinical
effectiveness that have been published in the previous month.
Where possible, links to the full text documents are included. If the article is in a
journal, you can contact the Health Library for a copy.
Link to request form: http://www.keele.ac.uk/depts/li/hl/illjournal.htm
[Please note - a charge of £2 per request is payable for most copies]
If you need further assistance, please contact the Health Library or the NHS
Outreach Librarians, details below.
The bulletin can be e-mailed to colleagues who may also find it useful.
A list of websites that are checked in the production of this bulletin are listed on
the first page. Please suggest further useful sites.
Feedback is always welcomed to inform future issues of the bulletin.
Contents in this issue

Contact information
Cancer
Commissioning
Diabetes Bulletin produced by NHS Outreach Librarians
Guidance
Tel: 07834 115958 [please leave a message]
Immunisation/Vaccination E-mail: jayne.hickton@northstaffs.nhs.uk
Infection Control
Medicines Management
Mental Health
Musculoskeletal North Staffs Health Library
Oral Health Tel: 01782 556565
Renal Disease Fax: 01782 556582
Service Management E-mail: health.library@keele.ac.uk
Stroke
Workforce
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Sources for Clinical Effectiveness Bulletin

Please suggest further sites that should be monitored in the production of this bulletin
Websites
Bandolier http://www.medicine.ox.ac.uk/bandolier/
Clinical Knowledge Summaries [NLH] http://cks.library.nhs.uk/
Cochrane Library http://www.library.nhs.uk/
CRD Centre for Reviews and Dissemination http://www.crd.york.ac.uk/crdweb/
- DARE – (Database of Abstracts of Reviews of Effects)
- NHS Economic Evaluation Database
Department of Health http://www.dh.gov.uk/en/index.htm
Health Technology Assessment (HTA) Database http://www.ncchta.org/
NICE http://www.nice.org.uk/
NHS Evidence Specialist Collections http://www.library.nhs.uk/specialistcollections/
SIGN http://www.sign.ac.uk/new.html
Cancer
Cancer reform strategy: achieving local implementation - second annual report
Department of Health
This report sets out the progress made in implementing the strategy since its publication in
December 2007. As with the first annual report, this report covers a wide range of actions that
were set out in the strategy, highlighting areas of particular progress and setting out a range of
priorities for the future. This report also provides detailed information on meeting local progress,
especially regarding standards which should now have been met.
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/D
H_109338
Screening for breast cancer: an update for the U.S. preventive services task force
DARE
Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L
Annals of Internal Medicine 2009; 151(10): 727-737
CRD Summary: This review focused on the effectiveness of mammography and clinical breast
examination in decreasing breast cancer mortality. The authors concluded that mammography
can reduce mortality in women aged 39 to 69 years. Other evidence was inconclusive. The
authors' conclusion reflects the evidence presented, but possible bias in the selection of studies
means that a cautious interpretation is warranted.
http://www.crd.york.ac.uk/CRDWeb/ShowRecord.asp?ID=12009110201
[back to topics]
Commissioning
Beyond practice-based commissioning: the local clinical partnership
Nuffield Trust and NHS Alliance
This joint paper examines how practice-based commissioning can be developed. It considers how
multi-specialty groups of clinicians – for example GPs as well as hospital-based specialists –
could form new ‘Local Clinical Partnerships’ that take on responsibility for designing, delivering
and commissioning local health services. They would be handed real budgets and would have
responsibility for the health outcomes of their local communities.
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http://www.nuffieldtrust.org.uk/publications/detail.aspx?id=145&PRid=659
How to use NICE guidance to commission high quality services

NICE
This document explains how NICE guidance supports the commissioning of high quality services
and describes how the guidance can be used throughout the commissioning cycle. Seeking to
support commissioners in developing systems and processes that entrench NICE guidance into
commissioning, it also highlights sources of further information and practical help.
http://www.nice.org.uk/newsroom/news/CommissioningQualtyServicesNHS.jsp
PCT Spend and Outcome Tool

The Association of Public Health Observatories (APHO)
This tool helps commissioners to link health outcomes and expenditure. The development of this
tool and a Spend and Outcome Factsheet for every PCT in England has been led by Yorkshire
and Humber Public Health Observatory. The tool and factsheets use Programme Budgeting data
and overall indicators of health outcome by programme (where available) to present PCTs with
an analysis of the impact of their expenditure. This allows easy identification of those areas which
require priority attention, where relative potential shifts in investment opportunities will optimise
local health gains and increase quality.
http://www.yhpho.org.uk/resource/view.aspx?RID=49488
Commissioning for quality

NHS Confederation
This paper looks at one of the key roles of a commissioner: acting on behalf of the populations
they serve to ensure local healthcare services are safe, effective and accessible and that quality
of care in and patients’ experience of the NHS continues to improve.
http://www.nhsconfed.org/Publications/Pages/Commissioning-for-quality.aspx
Cancer commissioning guidance - second edition

This guidance sets out key issues and questions that commissioners and cancer network teams
will want to take into consideration when assessing health needs, reviewing services, developing
their contract service specifications and monitoring performance. This updated version includes a
new section on cancer 'Family history services', covering triage patients based on genetic risk,
managing patients from receipt of referral through to determining an individual care pathway
following risk assessment.
H_110115
NHS Evidence - commissioning: December news alert

NHS Evidence
The commissioning specialist collection has published the second edition of their monthly news
alert. NHS Evidence - commissioning is an information resource for all those involved in
commissioning for health and wellbeing. It includes the best available evidence, examples of
good practice, policy and data to support world class commissioning. This monthly news alert
provides an update on the latest additions to the collection.
http://www.library.nhs.uk/COMMISSIONING/
[back to topics]
Diabetes
Diabetes health needs assessment tool
NHS Information Centre
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A Health Needs Assessment tool is now available as part of the National Diabetes Information
Service (NDIS). The 2009/10 Diabetes Health Needs Assessment Data Packs are produced on
behalf of the DH to support PCTs during their commissioning of diabetes services. This online
resource brings together data from multiple sources to provide a profile of individual organisations
and national averages to help monitor trends and make comparisons. It provides the ability to
manipulate data for local requirements and benchmarking for national, regional and most
comparable PCT activity. Covering over 500 indicators, the 2009/10 data packs are designed to
draw together diabetes data from a wide variety of previously un-associated sources. The data is
regularly refreshed.
https://login.ic.nhs.uk/Login.aspx?version=3&referrer=http%3a%2f%2fdhna.ic.nhs.uk%2fDefault.a
spx&info=http%3a%2f%2fdhna.ic.nhs.uk%3a80%2fSignIn.htm
[back to topics]
Guidance
NICE Interventional Procedure Guidance
Negative pressure wound therapy for the open abdomen

Interventional procedure guidance: (IPG322)
http://guidance.nice.org.uk/IPG322
Balloon catheter insertion for Bartholin's cyst or abscess

Electrocautery cutting balloon treatment for pelviureteric junction obstruction

Endopyelotomy for pelviureteric junction obstruction

Laparoscopic augmentation cystoplasty (including clam cystoplasty)

Radiofrequency ablation for the treatment of colorectal liver metastases

Suction diathermy adenoidectomy

Total prosthetic replacement of the temporomandibular joint

Vagus nerve stimulation for treatment-resistant depression

NICE Consultation Documents
-4-
Rheumatoid arthritis - tocilizumab: appraisal consultation document

Closing date is 20 January 2010
http://www.nice.org.uk/guidance/index.jsp?action=article&o=46642
Clinical Knowledge Summaries updated in December 2009
• Fibroids (new)
• GORD in children (new)
• Mumps (new)
• Premenstrual syndrome (new)
• Restless legs syndrome (new)
• Retinal detachment (new)
• Rubella (new)
Health Technology Assessments
Randomised preference trial of medical versus surgical termination of pregnancy less

than 14 weeks' gestation (TOPS) (Robson)
Health Technol Assess 2009; 13.53
Randomised controlled trial of the use of three dressing preparations in the management
of chronic ulceration of the foot in diabetes (Jeffcoate)
VenUS II: a randomised controlled trial of larval therapy in the management of leg ulcers
(Dumville)
A prospective randomised controlled trial and economic modelling of antimicrobial silver

dressings versus non-adherent control dressings for venous leg ulcers: The VULCAN trial
(Michaels)
Communication of carrier status information following universal newborn screening for

sickle cell disorders and cystic fibrosis: qualitative study of experience and practice (Kai)
Antiviral drugs for the treatment of influenza: a systematic review and economic
evaluation (Burch)
Development of a toolkit and glossary to aid in the adaptation of health technology

assessment (HTA) reports for use in different contexts (Chase)
Colour vision testing for diabetic retinopathy: a systematic review of diagnostic accuracy
and economic evaluation (Rodgers)
Systematic review of the effectiveness and cost-effectiveness of weight management

schemes for the under fives: a short report (Bond)
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Are adverse effects incorporated in economic models? An initial review of current practice
(Craig)
[back to topics]
Immunisation/Vaccination
A (H1N1) swine flu influenza: phase two of the vaccination programme; children over 6
months and under 5 years
This letter updates Chief Executives of Primary Care Trusts in England on plans for phase two of
the swine flu vaccination programme.
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_1
09826
HPV vaccination programme: update

This is the final update regarding the death of the young girl from Coventry who died after
receiving an HPV vaccine.
http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Dearcolleagueletters/DH_1
10399
[back to topics]
Infection Control
The Health and Social Care Act 2008: Code of Practice for health and adult social care on
the prevention and control of infections and related guidance
This Code of Practice, which comes into force on 1 April 2010 for the NHS and October 2010 for
all other registered providers, sets out the criteria against which a registered provider will be
assessed by the Care Quality Commission. It also provides guidance on how the provider can
meet the registration requirement relating to healthcare associated infections set out in the
regulations. This document replaces the January 2009 version of the Code which will remain in
force until 1 April 2010.
H_110288
[back to topics]
Medicines Management
A Guide to good practice in the management of controlled drugs in primary care (England)
- Third Edition
National Prescribing Centre
The Controlled Drugs Guide (CDG) takes into account the significant legislative changes,
introduced by the Government to strengthen the governance arrangements for controlled drugs
(CDs) since publication of the first edition in December 2005. This CDG is primarily aimed at
developing good practice for the management of CDs in primary care in England, but also
encompasses issues raised at the interfaces between primary, secondary and social care. This
CDG aims to identify robust systems for obtaining, storing, supplying, recording, monitoring and
disposing safely of CDs, while at the same time helping to ensure appropriate and convenient
access for those patients that require CDs.
-6-
http://www.npci.org.uk/cd/public/docs/controlled_drugs_third_edition.pdf
[back to topics]
Mental Health
Preventing suicide: a toolkit for mental health
National Patient Safety Agency (NPSA)
This update takes account of the lessons learnt since the original toolkit was published in 2003
and reflects the changes in mental healthcare that have happened since that time. The aims of
the toolkit are to: support mental health organisations in establishing a system for suicide audit
which fits their local context; promote the use of case note review as a means of changing how
mental health organisations identify risks and measure performance; support the development of
local suicide prevention strategies; and produce data which could potentially be merged at
regional and national levels to identify trends for further learning.
http://www.nmhdu.org.uk/silo/files/preventing-suicide-a-toolkit-for-mental-health-services-
2009.pdf
New Horizons: a shared vision for mental health

This is a cross-government programme of action with the twin aims to: improve the mental health
and well-being of the population, and improve the quality and accessibility of services for people
with poor mental health. New Horizons sets out an intention across a wide range of agencies to
move towards a society where people understand that their mental well-being is as important as
their physical health if they are to live their lives to the full. It describes some of the factors that
affect well-being and some everyday strategies for preserving and boosting it. It also sets out the
benefits, including economic benefits, of doing so.
H_109705
[back to topics]
Musculoskeletal
Fracture prevention services: an economic evaluation
This economic evaluation models the costs and benefits from establishing a fracture liaison
service, to reduce the risk of secondary fractures.
H_110098
[back to topics]
Oral Health
Special Care Dentistry Annual Evidence Update
NHS Evidence
Topics covered include commissioning, bleeding disorders, cancer patients, cardiovascular
conditions, immunocompromised patients, learning disabilities, mental illness, older people,
physical disabilities and prison populations.
http://www.library.nhs.uk/oralhealth/ViewResource.aspx?resID=292578&pgID=1
[back to topics]
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Renal Disease
Achieving excellence in kidney care: Delivering the National Service Framework for Renal
Services
The National Service Framework for Renal Services set out the first ever set of national
standards for the treatment of renal disease. This report highlights progress over the five years
since the publication of the National Service Framework.
H_109978
[back to topics]
Service Management
NHS Operating Framework 2010/11
This document sets out the priorities for the NHS for the year ahead. The five priorities continue
to be: improving cleanliness and reducing healthcare associated infections; improving access
through achievement of the 18-week referral to treatment pledge and improving access (including
at evenings and weekends) to GP services; keeping adults and children well, improving their
health and reducing health inequalities; improving patient experience, staff satisfaction, and
engagement; and preparing to respond in a state of emergency such as an outbreak of pandemic
flu, learning from the experience of swine flu. During 2010/11, the NHS must also continue its
work to reduce local variation and eliminate poor performance.
H_110107
The NHS Constitution - The State of Readiness Group (SoRG) report

From January 2010, all providers and commissioners of NHS care will be under a new legal
obligation to have regard to the NHS Constitution in all their decisions and actions. This means
that the Constitution, its pledges, principles, values and responsibilities need to be fully
embedded and ingrained into everything the NHS does. The State of Readiness Group (SoRG),
convened at the request of the NHS Management Board, has produced a report containing
recommendations and examples of good practice designed to help.
H_109417
NHS 2010-2015: from good to great - preventative, people-centred, productive

This new five-year plan aims to reshape the NHS to meet the challenge of delivering high quality
health care in a tough financial environment. The report describes practical measures to meet the
demands of an ageing population and the increased prevalence of lifestyle diseases. The vision
is for an NHS that is organised around patients whether at home, in a community setting or in
hospital. There will be a renewed focus on prevention with the ambition of delivering cost-
effective, high quality care across the service.
H_109876
An NHS strategy for a new era

The report describes practical measures to meet the demands of an aging population and the
increased prevalence of lifestyle diseases. The vision is for an NHS that is organised around
-8-
patients whether at home, in a community setting or in hospital. There will be a renewed focus on
prevention with the ambition of delivering cost-effective high quality care across the service.
H_109876
Better Care, Better Value indicators

Institute for Innovation and Improvement
The Better Care, Better Value (BCBV) indicators reveal the potential to make significant cash or
resource savings whilst improving quality. Two guides have been published which contain ten
steps that organisations can take to use the BCBV indicators to maximum effect to improve
quality and increase productivity. One is aimed at NHS commissioners and the other is for
provider organisations.
http://www.institute.nhs.uk/quality_and_value/high_volume_care/better_care_better_value_indica
tors.html
Windmill 2009
King’s Fund
It is clear that the era of unprecedented investment in health care is over, and prospects for future
funding now look bleak. But just how the NHS will respond to this is uncertain. To test how those
in the system might respond, we used a behavioural simulation – Windmill 2009, designed by
Loop2. From this event, and discussions with policy-makers, regulators, commissioners and
providers, managers and clinicians, we developed an analysis of what will be required if health
and social care systems are to respond effectively to the major challenges that lie ahead. We
identify key themes and recommendations for action in each of these.
http://www.kingsfund.org.uk/research/publications/windmill_2009.html
[back to topics]
Stroke
Stroke Rehabilitation Annual Evidence Update
NHS Evidence
The update includes information on organisation of care, upper limb, mobility, speech and
language, basic personal needs, cognition and perception and living with stroke.
http://www.library.nhs.uk/stroke/viewResource.aspx?resid=331186
[back to topics]
Workforce
NHS workforce planning; limitations and possibilities
King’s Fund
This new report calls for a flexible approach to workforce planning to identify potential medium-
term issues and enable the current workforce to adapt to an ever-changing health care
environment.
http://www.kingsfund.org.uk/research/publications/nhs_workforce.html
Developing psychosocial resilience: how to cope in a crisis

This guidance provides a stepped model of care for staff that is sensitive and responsive to their
needs before, during and after emergencies. It will ensure that staff are prepared to cope with
long-sustained demand.
H_110234
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[back to topics]
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NHS Library and Information Service North Staffordshire

Clinical Effectiveness Bulletin

About this Bulletin:

Feedback is always welcomed to inform future issues of the bulletin.

Contents in this issue

Sources for Clinical Effectiveness Bulletin

How to use NICE guidance to commission high quality services

PCT Spend and Outcome Tool

Commissioning for quality

Cancer commissioning guidance - second edition

NHS Evidence - commissioning: December news alert

Negative pressure wound therapy for the open abdomen

Balloon catheter insertion for Bartholin's cyst or abscess

Electrocautery cutting balloon treatment for pelviureteric junction obstruction

Endopyelotomy for pelviureteric junction obstruction

Laparoscopic augmentation cystoplasty (including clam cystoplasty)

Radiofrequency ablation for the treatment of colorectal liver metastases

Suction diathermy adenoidectomy

Total prosthetic replacement of the temporomandibular joint

Vagus nerve stimulation for treatment-resistant depression

NICE Consultation Documents

Rheumatoid arthritis - tocilizumab: appraisal consultation document

Clinical Knowledge Summaries updated in December 2009

Health Technology Assessments

Randomised preference trial of medical versus surgical termination of pregnancy less

A prospective randomised controlled trial and economic modelling of antimicrobial silver

Communication of carrier status information following universal newborn screening for

Development of a toolkit and glossary to aid in the adaptation of health technology

Systematic review of the effectiveness and cost-effectiveness of weight management

HPV vaccination programme: update

New Horizons: a shared vision for mental health

The NHS Constitution - The State of Readiness Group (SoRG) report

NHS 2010-2015: from good to great - preventative, people-centred, productive

An NHS strategy for a new era

Better Care, Better Value indicators

Developing psychosocial resilience: how to cope in a crisis

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