• Allogeneic pancreatic islet cell transplantation for type 1 diabetes mellitus
• Intraoperative red blood cell salvage during radical prostatectomy or radical cystectomy
• Interstitial photodynamic therapy for malignant parotid tumours
• Perioperative hypothermia (inadvertent)
• Ulcerative colitis - infliximab
• Abatacept for the treatment of rheumatoid arthritis

Today’s post based on the excellent material from the NLH Search 2.0 SHA Representatives group.

When to use them?

Whenever you need ready done quality synthesised reviews of the best available evidence.

The Content

• Bandolier - advice about particular treatments for health professionals and consumers based on primary and secondary research.
• Cochrane Library Database of Systematic Reviews - systematic reviews and protocols for future reviews.
• Database of Abstracts of Reviews of Effects - abstracts of systematic reviews published in places other than the Cochrane Library Database of Systematic Reviews.
• NHS Economic Evaluation Database - structured economic evaluations of health care interventions.
• Health Technology Assessment Database - focussing on prevention and rehabilitation, vaccines, pharmaceuticals and devices, medical and surgical procedures and the systems within which health is protected and maintained.

Searching Evidence Based Reviews

Check the Evidence Based Reviews check box in the search box at the top of the NLH page.

This will allow you to conduct a simple search across all of the evidence based review databases and materials.

As yesterday’s post suggested there are key linking phrases available to allow you to define the relationship between concepts in your search. As a reminder we’ve detailed them again below.

• AND - to make sure the words used appear in the results - this will limit your search results.
• OR - to create an either/or link to expand your search
• NOT - to exclude a word from a search (this will limit your search).
• EXACT PHRASE - by putting your search in “speech marks” you will search for the phrase as you type it. This technique also works with Google and other search engines and is a Fade top tip to find relevant material on the internet.

Searching indivdual or Multiple Evidence Based Reviews Whilst Ignoring Others

If you click on the Evidence Based Reviews Link (as illustrated below)

You will be taken to a specific Evidence Based Reviews Search where you can use the check boxes to select the resources as illustrated below. The usual range of linking terms are available to design your search to bring back optimum results (as detailed above).

Advanced searches can also be run using the same set of parameters as described yesterday.

Saving Search Results

To save results requires you to be logged into Athens (which you can get from the NHS here, providing you work for the NHS). Check the check boxes of the items you want to save and then click the button. Alternatively just click on Save Search Result for individual items.

To retrieve items you’ve saved when you’ve logged in with your Athens password jsut click on the Saved Search Results link in the MY SEARCH section of the page.

This is also where you can find Saved Search Histories, Saved Search Criteria and your Search Profiles.

E-Mailing Search Results

You can e-mail individual search results by clicking on the More Details link. This will then bring up an e-mail form (shown below) which you can mail to yourself or a colleague you think will be interested in the item. It has space for you to add your own message.

Reducing Drug Use, Reducing Reoffending (summary)  from the UK Drug Policy Commission considers whether the evidence supports programmes in the UK for problem drug-using offenders in the criminal justice system (CJS).  It finds:

• The principle of using CJS-based interventions to encourage engagement with treatment is supported by the evidence.
• Following a period of expansion and a focus on quantity, attention should now focus on quality.
• “Net-widening” to include additional groups of drug-using offenders in CJS‑based interventions may have negative consequences.
• Community punishments are likely to be more appropriate than imprisonment for most problem drug-using offenders.
• Prison drug services frequently fall short of even minimum standards.
• Given the sizeable investment in CJS interventions for drug-dependent offenders, we know remarkably little about what works and for whom.

Some Evidence
There is evidence to support the use of drug courts; community sentences such as DTTOs and DRRs; prison-based therapeutic communities; opioid detoxification and methadone maintenance within prisons and the community; and the RAPt 12-step abstinence-based programme.

Mixed Evidence 

Mixed evidence exists for Criminal Justice Integrated Teams; Restrictions on Bail; and the added value of drug testing as part of a community order.

No Evidence 

CARAT interventions; drug-free wings; programmes based on cognitive behavioural therapy, such as short-duration programmes and ASRO (Addressing Substance Related Offending) programmes; conditional cautions; diversion from prosecution schemes; and Intervention Orders have no evidence to support their effectiveness.

The Government’s Response to the Health Select Committee’s First Report of Session 2007-08 on the National Institute for Health and Clinical Excellence sets out the Government’s response to the Health Select Committee’s report on the National Institute for Health and Clinical Excellence (NICE). It welcomes and endorses the Committee’s expression of support for and confidence in NICE. Separate reports by the World Health Organisation on NICE’s technology appraisal and clinical guidelines programmes have commended the way in which it discharges its vital responsibilities.

In the Know  (Executive Summary) from the Audit Commision aims to encourage people to think about the information they use whenever they make decisions. It has examples, drawn from many different sources, of how information has been used in improving public services. It notes:

When decision makers use information well, local public services improve.

• The quality and cost of our local public services depend upon the decisions that many people make: users make choices; professionals exercise judgement; managers prioritise; and politicians allocate resources.
• Using information well in decision making leads to better local public services. Examples vary from reducing the number of young people not in education, employment or training to increasing the number of ambulances reaching incidents quickly; improvements include reducing fly-posting by 90 per cent, and increasing library membership by 58 per cent.
• Two-thirds of 3 and 4 star councils use information well, but only a tenth of 1 and 2 star councils do.

Information needs to be relevant for the decision at hand.

• Different decisions require different information, and judging what information is relevant for a decision is not easy.
• Performance indicators alone will not be adequate for important decisions.
• Aggregating information (for example over geography or time), using a range of information from different sources, and sharing information, will generate a fuller picture.

Good quality data are the foundation of good quality information.

• Data should be captured once and used numerous times.
• Data should be sufficiently accurate for the intended purpose. Highly accurate data are often neither cost-effective nor possible for many decisions.
• Decision makers need to judge how quickly and frequently they need information. Some information may need to be updated and available immediately, in real-time, but for many political, financial and strategic issues, understanding trends over time is more important than immediacy.

The way information is presented is important for accurate interpretation.

• Relevant, good quality, information will not help decision makers if they cannot understand it.
• How information is presented, and what story it helps to tell, can affect the decisions based upon it.
• The way information is presented, therefore, needs to be tailored for both the audience and the decision at hand.

Using information well requires decision makers and analysts to have particular skills.

• Decision makers need to be able to identify the information they need and to interpret it accurately.
• Those providing information need strong analytical and presentation skills.
• Evidence suggests that these skills are in short supply.

People need to think carefully about the information they use whenever they make decisions.

• Those who make important decisions about local public services should demand better and clearer information.
• Public bodies need to evaluate whether their information is fit for purpose and used to best effect.
• Relevance, quality and presentation, summarised as RQP, are the key characteristics for useful information.

Updated from Prodigy to new CKS Format:

• Anaemia - iron deficiency
• Immunizations - childhood
• Leg ulcer - venous
• Opioid dependence
• Palliative cancer care - constipation

Clinical summaries of the Topic Reviews issued in February 2008 please follow the links below:

• Clinical summary: Iron deficiency anaemia – assessment
• Clinical summary: Iron deficiency anaemia - management
• Clinical summary: Immunizations childhood programme
• Clinical summary: Immunizations childhood – children up to 1 year of age
• Clinical summary: Immunizations childhood – children 1-2 years of age
• Clinical summary: Immunizations childhood – children 2-10 years of age
• Clinical summary: Immunizations childhood – children over 10 years of age
• Clinical summary: Immunizations childhood – additional immunizations
• Clinical summaries: Leg ulcer venous – uncomplicated venous leg ulcer
• Clinical summaries: Leg ulcer venous – infected venous leg ulcer
• Clinical summaries: Leg ulcer venous – healed venous leg ulcer
• Clinical summaries: Leg ulcer venous – persistent venous leg ulcer
• Clinical summaries: Opioid dependence – new presentation
• Clinical summaries: Opioid dependence – Considering substitution therapy
• Clinical summaries: Opioid dependence –Starting and stabilizing on maintenance therapy
• Clinical summaries: Opioid dependence – Continuing maintenance therapy
• Clinical summaries: Opioid dependence – Detoxification – from maintenance therapy
• Clinical summaries: Opioid dependence – Detoxification – not on maintenance therapy
• Clinical summary: Opioid dependence – Missed or vomited doses
• Clinical summary: Opioid dependence – Acute withdrawal syndrome
• Clinical summary: Opioid dependence – Collapse due to opioid overdose
• Clinical summary: Opioid dependence – Travelling abroad
• Clinical summary: Opioid dependence – Unknown patient
• Clinical summary: Palliative cancer care – constipation

To access this video you will be required to give some details about yourself to HealthExecTV.

The World Class Commissioning initiative provides a major opportunity for Trusts to transform care services and develop new ways of maximising the value of limited healthcare budgets.

While Trusts wait for the WCC Assurance Framework, there are many ways to start planning the transition to World Class Commissioning. Evidence-based analysis of population requirements, how money has been spent and how other organisations are approaching commissioning is a key starting point.

In this interview, Andrew Beale, Executive Director of Matrix Knowledge Group consultancy, discusses how evidence-based analysis can help Trusts to better understand their current position, population healthcare patterns and to maximise the benefit of their investments within the available resources.

Consultations from NICE seeking views on a clinical practice guideline developments for:

• Familial hypercholesterolaemia: consultation
• Lipid modification: Consultation on section 4.3 - Cardiovascular risk assessment

and requesting views on the use of erlotinib to treat small-cell cancer.

• Lung cancer (non-small cell) - erlotinib (appraisal consultation)

From the Center for Evidence Based Physiotherapy based at the School of Physiotherapy at the University of Sydney, as a database it provides the model for yesterdays OT Seeker.  The aim of PEDro is to make the bibliographic details and abstracts of randomised controlled trials, systematic reviews and evidence-based clinical practice guidelines in physiotherapy readily available.

OT Seeker is a database of systematic reviews and randomised controlled trials relevant to occupational therapy and was developed by OTs at the University of Queensland and University of Western Sydney.

The House of Commons Health Committee. National Institute for Health and Clinical Excellence: First Report of Session 2007–08, Volume I: Report, together with formal minutes

The report identifies the following problems

• Topic selection. Only a few selected medical technologies are chosen as suitable for assessment as technology appraisals. There is also far too little emphasis on disinvestment. Here we found NICE’s responses to our questions disingenuous. While few older treatments may do no good at all, many will not be cost-effective;

• The wider benefits of treatment to society, for example to carers, are not included in NICE’s economic evaluations;

• NICE often does not have all the information it needs to make a full assessment. It does not have access to all the information the Medicines and Healthcare products Regulatory Agency (MHRA) uses and clinical trials are usually designed without NICE’s work on cost-effectiveness in mind;

• Experts are not sufficiently well used; and

• Publication of guidance is slow; licensed medicines are often not prescribed while PCTs and clinicians wait for NICE to make a decision.

Key recommendations are:

• The need for a system whereby all medicines are assessed at launch. A shorter, less in-depth evaluation should be made between the time of licensing authorisation and marketing, so that clinicians can prescribe useful and cost-effective drugs as soon as they are launched.  A lower cost-per-quality adjusted life year (QALY) threshold should be employed during this early assessment to ensure that only the products that are most cost- and clinically effective are available straightaway.

• NICE should have access to the same material used by the licensing body, clinical trials should be registered and there should be closer working between NICE and the pharmaceutical industry.

• Evaluation of older, possibly cost ineffective therapies should take place too

• Legislation shoul be changed to accommodate the need to ensure that assessments of products take account of the wider benefits to society

• The threshold used by NICE in its full assessments be reviewed; further research comparing thresholds used by PCTs and those used by NICE should be undertaken. An independent body should determine the threshold used when making judgements of the value of technologies to the NHS.

• Elements of clinical guidelines should be made mandatory. A suitable example would be risk assessment for all patients at risk of developing venous thromboembolism.

• Better mechanisms are needed to ensure that the NHS pays a fair and affordable price for medicines. We recommend that NICE should be involved in any new system and that any change to its remit should be adequately resourced.

• Risk-sharing schemes, such as the recently approved case of bortezomib (Velcade) and the older example of beta interferon and glatiramer acetate, should be used with caution. They hould not be used as a catch-all in cases of uncertainty over a drug’s benefit. Uncertainty could be better addressed by the careful design and performance of a publicly funded randomised controlled clinical trial. Better use should be made of NICE’s ‘only in research’ recommendation in this regard.

The rport identifies issues with uptake of guidance by PCTs to ensure this happens NICE should offer:

• More help for PCTs to implement guidance
• Better assessment of the level of uptake
• PCTs should play a larger role in the development of guidance
• Better use of experts in the development of guidance

The report though concludes that conclude that NICE does a vital job in difficult circumstances. The development of more and more health technologies and procedures, alongside rising patient expectations and the ageing population, is going to make it even more difficult in the future. Healthcare budgets in England, as in other countries, are limited. Patients cannot expect to receive  every possible treatment. Demand outstrips resources and priorities have to be determined.  Rationing is essential, and NICE has a key role to play.

A New Health Service for Liverpool Strategic Plan 2008 – 11: A Discussion Document(Summary) is the developing strategic business plan that sets out Liverpool PCT’s top priorities for the next three years and the thinking behind them. It has 8 priorities:

1. Delivering the things that make a big difference

• Cut deaths from cardiovascular disease by half in under-75-year-olds, compared with 2004
• Cut deaths from accidents by 20% in under-75-year-olds, compared with 2004
• Cut deaths from cancer by 20% in under-75-year-olds, compared with 2004
• Improve the health and well being of children and young people through the initiative - ‘Young Healthy Liverpool’
• Everyone living in Liverpool will know more about how to look after their own health and that of their family
• Everyone living in Liverpool with a health problem will know the right place to go to receive help
• A NHS dentist will be available for anyone within a maximum 15-minute, public transport ride of their home
• Reduce admissions to hospital due to alcohol misuse and work with Liverpool people to encourage a more sensible approach to alcohol consumption

2. A better understanding of self-care and how health services can support it

3. Gold standard primary care and community services

4. Gold standard hospitals

5. End of life services

6. Personalised care

7. An end to waiting

8. Joined-up services

To underpin these and enable NHS Liverpool to improve continuously the strategy recognises and values:

1. Developing a NHS Liverpool workforce

2. Research and Development

3. Managing the Resources

4. Making decisions

5. Making it all happen

New from the Trip Database comes the Critical Care Trip Search which searches the following journals alongside core Trip resources.

Critical Care Medicine
Pediatric Critical Care Medicine
Intensive Care Medicine
American Journal of Respiratory and Critical Care Medicine
Intensive Care Medicine
Critical Care Nurse
Dimensions of Critical Care Nursing
American Journal of Critical Care
Australian Critical Care
Anesthesiology
Anesthesia and Analgesia
British Journal of Anaesthesia
Anaesthesia

Advanced warning the Fade Nativity is on the way…

The following Prodigy guidance have been reviewed and converted to the Clincal Knowledge Summaries (CKS) format

• Asthma
• Conjunctivitis — infective
• Gingivitis and periodontitis
• Herpes simplex — oral
• MI—secondary prevention

If you’re not familiar with Clinical Knowledge Summaries, they are concise summaries on the management of 500 commonly encountered scenarios in primary and first-contact care, based on the latest evidence on common acute and chronic diseases and disease prevention.

CKS can be accessed from the National Library for Health via your Athens password (register here if you work in the NHS in the North West).

If you need any training in using this or any other electronic resources and you work for Liverpool PCT, contact us using the form below.

Latest Nice Guidelines are:

• Interventions in medicines reconcilliation at the point of admission (PSP)
• Atopic eczema in children (CG)
• Thoracoscopic aortopexy for severe primary tracheomalacia (IP)
• Circumferential epithelial radiofrequency ablation for Barrett’s oesophagus (IP)
• Thoracoscopically-assisted mitral valve surgery (IP)
• Hybrid procedure for interim management of hypoplastic left heart syndrome in newborns (IP)
• Thoracoscopic excision of mediastinal parathyroid tumours (IP)
• Endoscopic saphenous vein harvest for coronary artery bypass graft (IP)

Apologies for the title which will only make sense if you are familiar with the work of the Jazz Butcher but a pun is always worthwhile.

How to change practice: Understand, identify and overcome barriers to change  aims to support the NHS and the wider public health community in understanding, identifying and overcoming barriers to change. Set out in three parts, the guide:

• discusses the types of barriers to change encountered in healthcare, highlighting how awareness and knowledge of what needs to change, and why, are important first steps in enabling change to occur

• offers practical suggestions on how to identify the barriers to change faced by organisations

• provides evidence-based advice on what methods work to overcome these barriers, and highlights potential levers to help do this

The Stroke Specialist Library is being developed to provide high quality, evidence-based information on all of aspects of Stroke. This site is aimed at health professionals with an interest in Stroke.

Using the traditional NLH hub approach with information divided into Guidance & Pathways, Evidence, Reference, Education/CPD and Patient Information the Library offers information on the following topics.

Ischaemic Stroke

• General / Overviews
• Causes / Risk Factors
• Diagnosis
• Disease Management
• Prevention
• Patient Information
• Rehabilitation

Haemorrhagic Stroke

• General / Overviews
• Causes / Risk Factors
• Diagnosis
• Disease Management
• Rehabilitation
• Prevention
• Patient Information

Subarachnoid Haemorrhage

• General / Overviews
• Causes / Risk Factors
• Diagnosis
• Disease Management
• Rehabilitation
• Prevention
• Patient Information

Intracerebral Haemorrhage

• General / Overviews
• Causes / Risk Factors
• Diagnosis
• Disease Management
• Rehabilitation
• Prevention
• Patient Information

Transient Ischaemic Attack

• General / Overviews
• Causes / Risk Factors
• Diagnosis
• Disease Management
• Prevention
• Patient Information

Unusual / Complex cases of stroke

• Causes / Risk Factors
• Diagnosis
• Disease Management
• Rehabilitation
• Prevention
• Patient Information

Common sequelae of stroke

• Aphasia
• Apraxia
• Emotional sequelae

Causes / Risk Factors

• General
• Arteriosclerosis
• Alcohol Drinking
• Cardiac Causes
• Diabetes Mellitus
• Diet
• Genetics
• Hypertension
• Hyperlipidemia
• Smoking
• Vessel dissection
• Thrombosis

Diagnosis

• General
• Angiography
• Blood Tests
• CT Scan

• MRI Scan
  • MRA
• Ultrasound Scan
• Electrocardiogram
• Physical examination

Disease Management

• Emergency Care
  • Pre-hospital
  • Tools to identify stroke
  • Emergency Brain Imaging
  • Thrombolysis
  • Acute Stroke Care
    • Oxygen Therapy
    • Management of early dysphagia
    • Early therapy interventions
    • Cerebral monitoring
    • Early carotid endarterecomy

• Anti-platelet Drugs
  • Aspirin
  • Dipyridamole
  • Clopidogrel
  • Glycoprotein llb/lla inhibitors
• Thrombolytics
• Neuroprotective Agents
• Secondary Prevention
  • Anti-platelet Drugs
    • Aspirin
    • Dipyridamole
    • Clopidogrel
  • Anti-hypertensive drugs
    • ACE Inhibitors
    • Beta-blockers
    • Calcium Channel blockers
  • Lipid Regulating drugs
    • Statins
  • Anticoagulants
    • Warfarin
    • Phenindione
    • Acenocoumarol
• Surgical Interventions

Rehabilitation

• Assistive Technologies
• Carers
• Community Care
• Dysphagia Management
• Nursing Home Care
• Occupational Therapy
• Physiotherapy
• Psychotherapy
• Orthoptics and Visual Therapy
• Speech Therapy
• General/Other

• Prevention
  • Diet
  • Primary Prevention
  • Lipids Management
  • Physical Activity
  • Smoking Cessation
  • Overweight and Obesity
  • Hypertension management
  • General / Other
• Key Policies and related publications

• Management Issues
  • Clinical Governance
  • Economic Evaluations
  • Networks
  • Performance Indicators
  • Service Models
  • Specialist Stroke Units
  • Statistics
• Professional Bodies
• Support Groups

Sounds Healthy - Internet Radio for the 3rd Healthcare Revolution, a podcasting service bringing evidence based health information to you in an audio format. Voiced by Sir Muir Grey and extremely well produced - it’s definitely worth a listen.  With audio based e-learning and glossary it’s mightily impressive.

Mind you as the corner of the library with unimpeachably indie tastes, I could have done without the Queen on the about cast!

Clinical guidelines intravenous immunoglobulin provide guidance on appropriate use of immunoglobulin products and a framework for the promotion of evidence based clinical practice to help improve consistency in patient care.

The guidelines support the Demand management plan for immunoglobulin use use makes recommendations on appropriate indications for immunoglobulin and the processes to be implemented by Trusts or SHAs to ensure that immunoglobulin is used appropriately by means of local Immunoglobulin Assessment Panels.

Research evidence on the effectiveness of self care support from the Department of Health, provides an evidence base on the effectiveness of self care support, such as information, self care support devices, self care skills training and self care support networks in the care of people with long term health conditions, short term ailments and among those taking initiatives to stay healthy.