NICE guideline aims to cut premature birth rates | The BMJ

BMJ 2015; 351

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The National Institute for Health and Care Excellence (NICE) has produced a new guideline to try to reduce premature birth rates in England and Wales, which have shown no decline over the past 10 years.

More than 52 000 babies—around 7.3% of live births in England and Wales—were born preterm in 2012. Premature birth is the second most common cause of death in children under 5, and babies who are born early are more prone to health problems such as heart defects, lung disorders, cerebral palsy, and delayed development.

The guideline says that intravenous magnesium sulphate should be given to women at risk of preterm birth to reduce the risk of neurological disorders. It should be offered to women at 24 to 29 weeks of pregnancy and considered for women at 30 to 33 weeks who are in established preterm labour or are having a planned preterm birth within 24 hours.

via NICE guideline aims to cut premature birth rates | The BMJ.


Innovation & Improvement News

Doctors should support and educate their patients in the benefits of self-care, the BMA is highlighting during a national-awareness week. Self-Care Week runs from 16 to 22 November in England with the aim of encouraging patients to take control of their health throughout their lives. This includes urging patients to understand better how to look after minor ailments and how to prevent ill health through physical and mental well-being.

Read the BMA guidance on self-care

Find out more about Self Care Week


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Sharing decisions about antibiotics

Richard Lehman for Evidently Cochrane

It’s World Antibiotic Awareness Week, which aims highlight the problem of antibiotic resistance and encourage best practice in antibiotic use. Last week, a new Cochrane review was published which found that helping doctors and patients decide together about using antibiotics to treat some respiratory infections probably results in fewer being prescribed. In this guest blog, retired GP Richard Lehman explains why this is a good thing Sharing decisions about antibiotics – Evidently CochraneEvidently Cochrane.

CCG efficiency targets rise sharply as financial squeeze spreads | Health Service Journal

Clinical commissioning groups’ efficiency targets have risen by over a quarter this year in a sign that the financial strain on the health service is moving beyond the provider sector.

  • CCG QIPP targets up by more than 25 per cent in a year
  • Efficiency requirement shows financial squeeze is spreading beyond provider sector
  • Highest QIPP targets linked to CCGs in deficit
  • Many plans still relying on A&E activity reduction

CCG quality, innovation, productivity and prevention targets, published by NHS England, show that commissioners are aiming to save £1.8bn this financial year through their efficiency plans – an increase of 28 per cent on last year.


The data also shows the CCGs with the biggest QIPP challenges this year have targets to save more than 6 per cent of their annual funding allocation. In 2014-15, the largest QIPP targets were less than 5 per cent of allocation.

The average QIPP target has also risen, from less than 2 per cent of allocation to 2.3 per cent.


via CCG efficiency targets rise sharply as financial squeeze spreads | News | Health Service Journal.

Pulmonary pressure, telemedicine, and heart failure therapy

The Lancet: Published Online: 08 November 2015

Heart failure is a leading cause of hospital admissions in patients with cardiac diseases and poses a huge burden for patients and societies.

In recent years, major advances have been made with the introduction of new drugs and novel interventional approaches such as cardiac resynchronisation therapy. However, there is a need for further improvement, especially considering the projection for increases in heart failure prevalence caused by ageing of the population.

Longer survival of patients with cardiac diseases, an effect of modern life-extending treatments, such as primary angioplasty for myocardial infarction and implantable defibrillators for prevention of sudden cardiac death, also contributes to the need for more effective therapies for heart failure.

via Pulmonary pressure, telemedicine, and heart failure therapy – The Lancet.

Dementia – Immediate Post Diagnosis Support Guidance — London Strategic Clinical Networks

Released: 17.09.2015 | Dementia

living well with dementia

The living well with dementia workstream has created guidance for professionals to support people with dementia and carers immediately following diagnosis. The guidance covers prognosis, mediations, assessing carers needs, signposting, post diagnosis support, information on services available, and signposts the reader to further information.

This guidance has been produced primarily for professionals working with people with dementia in health and social care settings; however it may also be useful to commissioners.

All support should be tailored to the individual’s needs and wishes in order to provide a personalised approach.Not all information below will be appropriate for everyone and it is the diagnosing clinician’s decision what to discuss. It is unlikely that all topics will be covered in one meeting; it is anticipated that support will be offered over a series of meetings as necessary.

All areas should use these indicators as a guide to ensure that everyone receives the same level of post diagnosis support regardless of postcode.

via Dementia – Immediate Post Diagnosis Support Guidance — London Strategic Clinical Networks.

Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality: a prospective cohort study

The Lancet: Published Online 16th September 2015


Alcohol consumption is proposed to be the third most important modifiable risk factor for death and disability. However, alcohol consumption has been associated with both benefits and harms, and previous studies were mostly done in high-income countries. We investigated associations between alcohol consumption and outcomes in a prospective cohort of countries at different economic levels in five continents.

We included information from 12 countries participating in the Prospective Urban Rural Epidemiological (PURE) study, a prospective cohort study of individuals aged 35–70 years. We used Cox proportional hazards regression to study associations with mortality (n=2723), cardiovascular disease (n=2742), myocardial infarction (n=979), stroke (n=817), alcohol-related cancer (n=764), injury (n=824), admission to hospital (n=8786), and for a composite of these outcomes (n=11 963).

We included 114 970 adults, of whom 12 904 (11%) were from high-income countries (HICs), 24 408 (21%) were from upper-middle-income countries (UMICs), 48 845 (43%) were from lower-middle-income countries (LMICs), and 28 813 (25%) were from low-income countries (LICs). Median follow-up was 4·3 years (IQR 3·0–6·0). Current drinking was reported by 36 030 (31%) individuals, and was associated with reduced myocardial infarction (hazard ratio [HR] 0·76 [95% CI 0·63–0·93]), but increased alcohol-related cancers (HR 1·51 [1·22–1·89]) and injury (HR 1·29 [1·04–1·61]). High intake was associated with increased mortality (HR 1·31 [1·04–1·66]). Compared with never drinkers, we identified significantly reduced hazards for the composite outcome for current drinkers in HICs and UMICs (HR 0·84 [0·77–0·92]), but not in LMICs and LICs, for which we identified no reductions in this outcome (HR 1·07 [0·95–1·21]; pinteraction<0·0001).

Current alcohol consumption had differing associations by clinical outcome, and differing associations by income region. However, we identified sufficient commonalities to support global health strategies and national initiatives to reduce harmful alcohol use.

via Alcohol consumption and cardiovascular disease, cancer, injury, admission to hospital, and mortality: a prospective cohort study – The Lancet.

Children of the new century: Mental health findings from the Millennium Cohort Study

Mental health of 11-year-old children living in the UK

mental health children - front

The report finds that about one in ten (10.3 per cent) 11-year-olds in the UK has a mental health problem according to parents – or eight percent as reported by teachers, with symptoms including hyperactivity, conduct problems and peer problems as well as emotional problems.

The report shows that children from the lowest income families are four times more likely to have mental health problems than those from the highest earning backgrounds. It also suggests that not living with both natural parents is associated with mental health problems in children. Geography too has an impact – 11-year-olds in Scotland have a significantly lower prevalence of hyperactivity and peer problems than those in the rest of the UK.mental health children - key facts

via Centre for Mental Health | Children of the new century: Mental health findings from the Millennium Cohort Study.


Evidence and good practice in transfers of care in acute, community, mental health and ambulance services.

Latest statistics highlighted in the report state that delayed transfer of care in August 2015 were caused by a range of complex challenges within the patient journey from health settings back into the community or social care.  Workforce capacity and skills mix, and flow within and between organisations are also key issues – the report makes a link with the Carter efficiency review, which states that improving work flow could save £2bn for the NHS.
The report gives evidence that delays in the discharge of mental health service users are also a key challenge. People in crisis or at suicide risk may face care in inappropriate settings or have to remain as an inpatient when there is no suitable housing or community support package in place.calls to action

The report includes a call to action, calling on providers, local authorities, clinical commissioning groups and health and wellbeing boards to test their assumptions about the causes of delayed transfers of care. National bodies are called on to consider what support they can offer to the sector in terms of definitions, analytical capacity and guidance. The sector is also urged to listen more, to patients, service users, carers and staff.

via NHS Providers.