Treatment for men with enlarged prostate is recommended by NICE for NHS adoption

NICE |Treatment for men with enlarged prostate is recommended by NICE for NHS adoption

A third of men over the age of 50 have symptoms of an enlarged prostate, including needing to visit the toilet more frequently, with more urgency and have difficulty emptying their bladder.

Currently surgery is offered to patients with prostate enlargement if problems passing urine are severe or if drug treatment and lifestyle changes have been unsuccessful.

Now men who suffer with an enlarged prostate could now be treated with technology which reduces the risks of serious complications, NICE has said in final guidance.

NICE’s Medical Technologies Advisory Committee examined evidence that using the PLASMA system is a clinically effective treatment and noted that the evidence shows that the PLASMA system reduces the risk of transurethral resection syndrome and reduces the need for blood transfusion compared with mTURP.

The PLASMA is also a more cost effective ]treatment as it avoids the risk of transurethral resection syndrome and reduces the need for blood transfusion and the length of hospital stay. 

The PLASMA system for transurethral resection and haemostasis of the prostate

Read the final guidance for The PLASMA system for transurethral resection of the prostate

HSIB: National Learning Report Support for staff following patient safety incidents

Healthcare Safety Investigation Branch | January 2021 | National Learning Report Support for staff following patient safety incidents

The medical literature has highlighted a need for support of NHS staff when things go unexpectedly in a patient’s care, which is not always met. This national learning report from the Healthcare Safety Investigation Branch (HSIB) describes the literature around NHS staff support to attempt to identify areas of best practice and the impact of any interventions.

The purpose is to share HSIB’s insights and to develop some key principles, based on those insights, around how NHS staff can be best supported in practice.

The report describes some exemplars of work being undertaken to support NHS staff after patient safety incidents.

National Learning Safety Report

Supplementary materials

Support for staff following patient safety incidents [press release]

Mitigation Policies and COVID-19–Associated Mortality — 37 European Countries, January 23–June 30, 2020 #covid19rftlks

Mitigation Policies and COVID-19–Associated Mortality — 37 European Countries, January 23–June 30, 2020 | Centers for Disease Control and Prevention | 15th January 2021

Mitigation policies, including closure of nonessential businesses, restrictions on gatherings and movement, and stay-at-home orders, have been critical to controlling the COVID-19 pandemic in many countries, but they come with high social and economic costs.

European countries that implemented more stringent mitigation policies earlier in their outbreak response tended to report fewer COVID-19 deaths through the end of June 2020. These countries might have saved several thousand lives relative to countries that implemented similar policies, but later.

Earlier implementation of stringent mitigation policies, even by just a few weeks, appears to be important to prevent widespread COVID-19 transmission and reduce the number of deaths.

Full detail: Mitigation Policies and COVID-19–Associated Mortality — 37 European Countries, January 23–June 30, 2020

Reforming the Mental Health Act

Department of Health and Social Care | January 2021| Reforming the Mental Health Act

The Department of Health and Social Care has opened consultation on changes to the Mental Health Act to help put patients at the centre of decisions about their own care. The consultation is open until 11:59pm on 21 April 2021.

An independent review of the Mental Health Act 1983 (MHA) conducted in 2017 looked at how it’s used and also made suggestions of ways to improve it. The final report from Sir Simon Wessely’s Review of the MHA in 2018 said that the MHA does not always work as well as it should for patients, their families and their carers.

The Department is now proposing a wide range of changes to rebalance the MHA, to put patients at the centre of decisions about their own care and ensure everyone is treated equally.

The changes are based on 4 principles that have been developed with people with lived experience of the MHA. They are:

  • choice and autonomy – ensuring service users’ views and choices are respected
  • least restriction – ensuring the MHA’s powers are used in the least restrictive way
  • therapeutic benefit – ensuring patients are supported to get better, so they can be discharged from the MHA
  • the person as an individual – ensuring patients are viewed and treated as individuals

Landmark reform of mental health laws

Further details on the consultation Reforming the Mental Health Act

See also:

The Mental Health Foundation The Mental Health Foundation’s statement on the Reforming the Mental Health Act White Paper

Local Government Association LGA responds to Mental Health Act reform white paper

Leeds Research: Thousands may have undiagnosed bowel cancer

University of Leeds | January 2021 | Leeds Research: Thousands may have undiagnosed bowel cancer

Between April and October 2020, more than 3,500 fewer patients than expected were diagnosed with bowel cancer in England, finds a study by experts at the University of Leeds. Theirs is the first piece of research to assess the impact of the COVID-19 pandemic on the diagnosis and management of bowel cancer in England.

The researchers assessed the patterns of referral for bowel cancer investigation, diagnosis and treatment within the English NHS between the beginning of January 2019 to the end of October 2020.

Their results showed that, compared with an average month in 2019, during April 2020 at the peak of the first wave of coronavirus:

  • the monthly number of referrals by GPs to hospital clinics for investigation of possible bowel cancer reduced by almost two thirds ( 63 per cent)
  • the number of colonoscopies performed fell by 92% (from 46 441 to 3 484); and
  • the monthly number of people with confirmed bowel cancer referred for treatment fell by over a fifth (22 per cent, from 2,781 to 2,158), and the number of operations performed fell by a third (31 per cent from 2,003 to 1,378).

Co-author of the study, Dr Katie Spencer said: “As a result of the coronavirus pandemic first wave, the NHS National Bowel Cancer Screening Programme was paused, and surgical capacity to treat patients was limited.

“It is very concerning that the improvements we had been seeing because of the early detection of bowel cancer are likely to have been set back during this time, and we need to ensure that patients continue to come forward so we can keep making progress in fighting this disease.” (Source: University of Leeds)

Read the unabridged news release from the University of Leeds 

Summary

Background

There are concerns that the COVID-19 pandemic has had a negative effect on cancer care but there is little direct evidence to quantify any effect. This study aims to investigate the impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England.

Methods

Data were extracted from four population-based datasets spanning NHS England (the National Cancer Cancer Waiting Time Monitoring, Monthly Diagnostic, Secondary Uses Service Admitted Patient Care and the National Radiotherapy datasets) for all referrals, colonoscopies, surgical procedures, and courses of rectal radiotherapy from Jan 1, 2019, to Oct 31, 2020, related to colorectal cancer in England. Differences in patterns of care were investigated between 2019 and 2020. Percentage reductions in monthly numbers and proportions were calculated.

Findings

As compared to the monthly average in 2019, in April, 2020, there was a 63% reduction in the monthly number of 2-week referrals for suspected cancer and a 92% reduction in the number of colonoscopies. Numbers had just recovered by October, 2020. This resulted in a 22% relative reduction in the number of cases referred for treatment (from a monthly average of 2781 in 2019 to 2158 referrals in April, 2020). By October, 2020, the monthly rate had returned to 2019 levels but did not exceed it, suggesting that, from April to October, 2020, over 3500 fewer people had been diagnosed and treated for colorectal cancer in England than would have been expected. There was also a 31% relative reduction in the numbers receiving surgery in April, 2020, and a lower proportion of laparoscopic and a greater proportion of stoma-forming procedures, relative to the monthly average in 2019. By October, 2020, laparoscopic surgery and stoma rates were similar to 2019 levels. For rectal cancer, there was a 44% relative increase in the use of neoadjuvant radiotherapy in April, 2020, relative to the monthly average in 2019, due to greater use of short-course regimens. Although in June, 2020, there was a drop in the use of short-course regimens, rates remained above 2019 levels until October, 2020.

The primary paper is available from The Lancet Gastroenterology & Hepatology

Impact of the COVID-19 pandemic on the detection and management of colorectal cancer in England: a population-based study

Unpaid carers and COVID-19 vaccination – policy briefing #covid19rftlks

Carers UK | January 2021| Unpaid carers and COVID-19 vaccination – policy briefing

Carers UK have published a briefing which sets out the position of unpaid carers and COVID-19 vaccination in more detail; it also explores the charity’s recommendations for deployment of the vaccine to unpaid carers in more detail.

Policy briefing: The COVID-19 vaccination and unpaid carers (ENGLAND ONLY)

Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study

Carr, M.J. et al|2021| Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study | The Lancet Public Health | DOI:https://doi.org/10.1016/S2468-2667(20)30288-7

A team of researchers have looked at how and whether the incidence/ prevalence of mental illness and self-harm was affected by the COVID-19 pandemic. They analysed data from primary care for more than 14 million patients included in the UK Clinical Practice Research Datalink (CPRD). They included patient records from Jan 1, 2010, to Sept 10, 2020, to establish long-term trends and patterns of seasonality (temporal statistical analysis) but focused primarily on the period January, 2019–September, 2020.

The incidence of self-harm was 37·6% (34·8–40·3%) lower than hypothesised by researchers in April, 2020, and the reduction was greatest for females and patients younger than 45 years. By September, 2020, rates of incident depression, anxiety disorder, and self-harm were similar to expected level. The team’s interpetation indicates that considerable reductions in primary care-recorded mental illness and self-harm during the time could mean more patients subsequently presenting with greater severity of mental illness and increasing incidence of non-fatal self-harm and suicide.

Summary

Background

The COVID-19 pandemic has adversely affected population mental health. We aimed to assess temporal trends in primary care-recorded common mental illness, episodes of self-harm, psychotropic medication prescribing, and general practitioner (GP) referrals to mental health services during the COVID-19 emergency in the UK.

Methods

We did a population-based cohort study using primary care electronic health records from general practices registered on the UK Clinical Practice Research Datalink (CPRD). We included patient records from Jan 1, 2010, to Sept 10, 2020, to establish long-term trends and patterns of seasonality, but focused primarily on the period January, 2019–September, 2020. We extracted data on clinical codes entered into patient records to estimate the incidence of depression and anxiety disorders, self-harm, prescriptions for antidepressants and benzodiazepines, and GP referrals to mental health services, and assessed event rates of all psychotropic prescriptions and self-harm. We used mean-dispersion negative binomial regression models to predict expected monthly incidence and overall event rates, which were then compared with observed rates to assess the percentage reduction in incidence and event rates after March, 2020. We also stratified analyses by sex, age group, and practice-level Index of Multiple Deprivation quintiles.

Findings

We identified 14 210 507 patients from 1697 UK general practices registered in the CPRD databases. In April, 2020, compared with expected rates, the incidence of primary care-recorded depression had reduced by 43·0% (95% CI 38·3–47·4), anxiety disorders by 47·8% (44·3–51·2), and first antidepressant prescribing by 36·4% (33·9–38·8) in English general practices. Reductions in first diagnoses of depression and anxiety disorders were largest for adults of working age (18–44 and 45–64 years) and for patients registered at practices in more deprived areas. The incidence of self-harm was 37·6% (34·8–40·3%) lower than expected in April, 2020, and the reduction was greatest for women and individuals aged younger than 45 years. By September, 2020, rates of incident depression, anxiety disorder, and self-harm were similar to expected levels. In Northern Ireland, Scotland, and Wales, rates of incident depression and anxiety disorder remained around a third lower than expected to September, 2020. In April, 2020, the rate of referral to mental health services was less than a quarter of the expected rate for the time of year (75·3% reduction [74·0–76·4]).

Interpretation

Consequences of the considerable reductions in primary care-recorded mental illness and self-harm could include more patients subsequently presenting with greater severity of mental illness and increasing incidence of non-fatal self-harm and suicide. Addressing the effects of future lockdowns and longer-term impacts of economic instability on mental health should be prioritised.

Effects of the COVID-19 pandemic on primary care-recorded mental illness and self-harm episodes in the UK: a population-based cohort study

UCL: Lockdown compliance improving but low take up of Covid tests ‘worrying’ #covid19rftlks

University College London | January 2021 | Lockdown compliance improving but low take up of Covid tests ‘worrying’

UCL’s Covid-19 Social Study shows that more than two fifths (43 per cent) of people who thought they had symptoms for Covid-19 requested a test. This contrast with adults over 60 where three quarters of this group reported they had not had a test despite experiencing possible symptoms.

For younger adults 42 per cent had requested a test when they had a potential Covid symptom, but nearly half (45 per cent) stated that they have never been tested, although they had experienced symptoms.

Lockdown compliance

Majority’ compliance with the rules is being reported by 96 per cent of people; an improvement since the start of the autumn across all demographic groups. ‘Complete’ compliance is lower, but still being reported by the majority of people (56 per cent for the week ending 10th January) and is now at comparable levels to back in May 2020.

Over a third of respondents (38 per cent0 say they are not isolating for the recommended number of days (ten or more) when they develop symptoms of Covid-19, with 13% saying they are not isolating at all.

Lead author, Dr Daisy Fancourt (UCL Epidemiology & Health Care) said: 

“The high number of people not requesting a Covid test when they have symptoms is worrying. One of the key tools in controlling the pandemic is an effective test and trace system, but people are citing problems including being unable to get tests, being unclear on how to request them, having to go long distances to get tested, and being worried about exposure to the virus at test centres. This all suggests that the current system is not working well enough.

“The levels of compliance we are seeing are high and improving week on week. This suggests that the increasing cases we are seeing now cannot be blamed solely on individual behaviours and instead raises the question as to whether the current rules are going far enough to stop the spread of the new variant. Fortunately, data suggest that if stricter measures are brought in, people will continue to comply as compliance across the autumn and winter has been highest in areas when tighter restrictions and tiers have been imposed.” (Source: UCL).

Lockdown compliance improving but low take up of Covid tests ‘worrying’ [news release]