It’s okay to ask for help

NHS Employers | August 2018 | It’s okay to ask for HELP

NHS Employers have published  a case study from Brighton and Sussex University Hospitals NHS Trust, which  successfully embedded its health, employee, learning and psychotherapy services (HELP) into its staff wellbeing programme to ensure more members of staff were getting the help they need and to reduce sickness absence.


Since BSUH implemented HELP, the service supports around 500 members of staff
every year with individual psychotherapy and counselling.
• 18 workshops and 28 incident debriefs have taken place each year.
• 44 staff members have benefited from specialist EMDR trauma therapy.
• By offering the services internally the trust is reaching more people for the
same cost.
• 98 per cent of staff said the sessions helped them to stay in work, or return to work sooner from sick leave. HELP also runs a placement programme for honorary psychotherapists from Brighton, Sussex and London universities.

This new approach to counselling and psychotherapy services for staff included sessions on trauma as well as  stress management workshops. Since its implementation the service has supported 500 members of staff, with 98 per cent of those who attended saying the service has meant they did not need to take time off work.  (Source: NHS Employers).

Read the full case study at NHS Employers 

Coffee and green tea consumption in relation to brain tumor risk

Ogawa, T. et al. International Journal of Cancer. Published online: 25 August 2016


Few prospective studies have investigated the etiology of brain tumor, especially among Asian populations. Both coffee and green tea are popular beverages, but their relation with brain tumor risk, particularly with glioma, has been inconsistent in epidemiological studies. In this study, we evaluated the association between coffee and greed tea intake and brain tumor risk in a Japanese population.

We evaluated a cohort of 106,324 subjects (50,438 men and 55,886 women) in the Japan Public Health Center-based Prospective Study (JPHC Study). Subjects were followed from 1990 for Cohort I and 1993 for Cohort II until December 31, 2012. 157 (70 men and 87 women) newly diagnosed cases of brain tumor were identified during the study period. Hazard ratio (HR) and 95% confidence intervals (95%CIs) for the association between coffee or green tea consumption and brain tumor risk were assessed using a Cox proportional hazards regression model.

We found a significant inverse association between coffee consumption and brain tumor risk in both total subjects (≥3 cups/day; HR=0.47, 95%CI=0.22-0.98) and in women (≥3 cups/day; HR=0.24, 95%CI=0.06-0.99), although the number of cases in the highest category was small. Furthermore, glioma risk tended to decrease with higher coffee consumption (≥3 cups/day; HR=0.54, 95%CI=0.16-1.80). No association was seen between green tea and brain tumor risk.

In conclusion, our study suggested that coffee consumption might reduce the risk of brain tumor, including that of glioma, in the Japanese population.

Read the abstract here

Guide for Clinical Audit Leads

Allen, K. &  Koplin, J. (2016) New England Journal of Medicine375:e16

Image source: HQIP

This guide is intended to support clinicians who are responsible for leading clinical audit in clinical services and at senior levels in healthcare organisations. Clinical leads have a key role to play in ensuring that clinical audit delivers improvements in the quality of care, and this guide sets out the requirements of the role. It should also be useful for medical and clinical directors and for clinical audit managers.
This is an update to the previous guide for clinical audit leads which was published by HQIP in 2011.

Read the full report here

I Should but I Can’t: Controlled Motivation and Self-Efficacy Are Related to Disordered Eating Behaviors in Adolescents With Type 1 Diabetes

Eisenberg, M.H. Journal of Adolescent Health. Published online: August 2016


Purpose: Among adolescents with type 1 diabetes, disordered eating behaviors (DEBs) are more prevalent and have more serious health implications than in adolescents without diabetes, necessitating identification of modifiable correlates of DEB in this population. This study hypothesized that (1) autonomous motivation and (2) controlled motivation for healthy eating (i.e., eating healthfully because it is important to oneself vs. important to others, respectively) are associated with DEB among adolescents with type 1 diabetes. The third hypothesis was that baseline healthy eating self-efficacy moderates these associations.

Methods: Adolescents with type 1 diabetes (n = 90; 13–16 years) participating in a behavioral nutrition intervention efficacy trial reported DEB, controlled and autonomous motivation, and self-efficacy at baseline, 6, 12, and 18 months. Linear-mixed models estimated associations of controlled and autonomous motivation with DEB, adjusting for treatment group, body mass index, socioeconomic status, age, and gender. Separate models investigated the interaction of self-efficacy with each motivation type.

Results: Controlled motivation was positively associated with DEB (B = 2.18 ± .33, p < .001); the association was stronger for those with lower self-efficacy (B = 3.33 ± .55, p < .001) than those with higher self-efficacy (B = 1.36 ± .36, p < .001). Autonomous motivation was not associated with DEB (B = −.70 ± .43, p = .11).

Conclusions: Findings identify controlled motivation for healthy eating as a novel correlate of DEB among adolescents with type 1 diabetes and show that self-efficacy can modify this association. Motivation and self-efficacy for healthy eating represent potential intervention targets to reduce DEB in adolescents with type 1 diabetes.

Read the abstract here

Psychological interventions in managing postoperative pain in children: a systematic review

Davidson, F. et al. (2016) Pain. 157(9). pp. 1872–1886


Pediatric surgeries are common and painful for children. Postoperative pain is commonly managed with analgesics; however, pain is often still problematic. Despite evidence for psychological interventions for procedural pain, there is currently no evidence synthesis for psychological interventions in managing postoperative pain in children.

The purpose of this review was to assess the efficacy of psychological interventions for postoperative pain in youth. Psychological interventions included Preparation/education, distraction/imagery, and mixed. Four databases (PsycINFO, PubMed, EMBASE, and Certified Index to Nursing and Allied Health Literature) were searched to July 2015 for published articles and dissertations.

We screened 1401 citations and included 20 studies of youth aged 2 to 18 years undergoing surgery. Two reviewers independently screened articles, extracted data, and assessed risk of bias. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using RevMan 5.3. Fourteen studies (1096 participants) were included in meta-analyses. Primary outcome was pain intensity (0-10 metric).

Results indicated that psychological interventions as a whole were effective in reducing children’s self-reported pain in the short term (SMD = −0.47, 95% CI = −0.76 to −0.18). Subgroup analysis indicated that distraction/imagery interventions were effective in reducing self-reported pain in the short term (24 hours, SMD = −0.63, 95% CI = −1.04 to −0.23), whereas preparation/education interventions were not effective (SMD = −0.27, 95% CI = −0.61 to 0.08).

Data on the effects of interventions on longer term pain outcomes were limited. Psychological interventions may be effective in reducing short-term postoperative pain intensity in children, as well as longer term pain and other outcomes (eg, adverse events) require further study.

Read the full review here

Advice on low risk alcohol consumption

The UK Chief Medical Officers have published UK Chief Medical Officers’ low risk drinking guidelines.


The guidelines provide the most up to date scientific information to help people make informed decisions about their own drinking. The intention is to help people understand the risks alcohol may pose to their health and to make decisions about their consumption in the light of those risks, but not to prevent those who want to drink alcohol from doing so.

Additional link: Government response to the public consultation

NICE recommends 3D heart imaging for diagnosing heart disease

Kmietowicz, Z (2016) BMJ.354:i4662


Medical software that helps doctors visualise the blood vessels in the heart without invasive tests could help to diagnose heart conditions in patients with chest pain and suspected angina, the National Institute for Health and Care Excellence (NICE) has said.

NICE says that 36 000 people in England could benefit from the new technology every year, saving the NHS around £7.7m (€9m; $10.2m) by avoiding some invasive investigations and treatment.

In draft guidance,1 NICE provisionally recommends HeartFlow FFRct, which uses data from standard cardiac computed tomography angiography imaging to create 3D models of a patient’s blood vessels. The images are used to estimate fractional flow reserve—the ratio between the maximum blood flow in a narrowed artery and the maximum blood flow in a normal artery—and results are available within 48 hours. Currently, fractional flow reserve is measured invasively by placing a pressure wire across a narrowed artery.

Read the full article here

Read the draft NICE guidance here

The King’s Fund response to NHS Improvement’s finance figures

business-17965_960_720Responding to NHS Improvement’s report on the performance of NHS providers in the first quarter of the year, Richard Murray, Director of Policy at The King’s Fund, said:

‘Today’s report shows that new investment and actions taken to tackle overspending have reduced deficits among NHS providers in the first quarter of the year. This is welcome, but it would be a mistake to suggest that the financial pressures which have engulfed the NHS have eased.

‘While overall NHS trusts met their financial targets in the first quarter, our new survey of NHS finance directors shows only a third are confident this will be the case by the end of the year. It also shows a worrying decline in confidence among commissioners, with twice as many CCGs forecasting end-of-year deficits than at this time last year.

‘Demand for services is rising rapidly, waiting times are continuing to worsen and NHS leaders have been charged with delivering significant changes to services. Extra investment and the hard work of staff mean that NHS organisations are still just about coping for the time being, but the service is reaching a critical point.

‘The government must be honest with the public about what the NHS can achieve with the resources it has been given. It is not credible to argue that it can continue to meet rising demand for services, maintain standards of care and balance its books within its current budget.’

Read the full blog post here

Dietary recommendations


As part of the Eatwell Guide policy tool, Public Health England has published Government dietary recommendations: government recommendations for food energy and nutrients for males and females aged 1-18 years and 19+ years.

This document provides the government’s recommendations for food energy and nutrients for the general population. Anyone with a medical condition should consult their GP or a registered dietitian for dietary advice.

Related: The Eatwell Guide

Excess weight linked to eight more cancer types

Limiting weight gain may help to reduce risk of eight cancers | Science Daily | New England Journal of Medicine


An international team of researchers has identified eight additional types of cancer linked to excess weight and obesity: stomach, liver, gall bladder, pancreas, ovary, meningioma (a type of brain tumor), thyroid cancer and the blood cancer multiple myeloma.

Limiting weight gain over the decades could help to reduce the risk of these cancers, the data suggest.

The findings, published Aug. 25 in The New England Journal of Medicine, are based on a review of more than 1,000 studies of excess weight and cancer risk analyzed by the World Health Organization’s International Agency for Cancer on Research (IARC), based in France.

Full reference: Lauby-Secretan, B. et al.  Body Fatness and Cancer — Viewpoint of the IARC Working Group. New England Journal of Medicine, 2016; 375 (8): 794 DOI: 10.1056/NEJMsr1606602