[NICE guideline [NG125] Surgical site infections: prevention and treatment

NICE | April 2019 | Surgical site infections: prevention and treatment

This guideline covers preventing and treating surgical site infections in adults, young people and children who are having a surgical procedure involving a cut through the skin. It focuses on methods used before, during and after surgery to minimise the risk of infection.


This guideline includes new and updated recommendations on:

It also includes recommendations on:

Full information is available from NICE 

University of Leeds research: Key step forward in tackling neurodegenerative diseases

University of Leeds | April 2019 | Key step forward in tackling neurodegenerative diseases

protein complex has been shown to play a key role in preventing the build-up of toxic plaques in the brain linked to neurodegenerative disorders such as Alzheimer’s and Huntington’s disease.

A research team including experts from the University of Leeds, Standford University and the University of Konstanz  have discovered that a protein helps to prevent the aggregation of damaging proteins within the cell.

This nascent polypeptide-associated complex (NAC) has been patented by the scientists, NAC, is a molecular chaperone found in all eukaryotic organisms, and is required for healthy cellular activity. NAC is known to help in the production of new proteins, and has now been shown to play an additional role in preventing cellular degeneration, by ‘catching out’ the proteins responsible for plaque formation.

This is a key step forward in tackling neurodegenerative diseases

Read the full news story from the University of Leeds 

Shen, Koning et al. | 2019| Dual Role of Ribosome-Binding Domain of NAC as a Potent Suppressor of Protein Aggregation and Aging-Related Proteinopathies |Molecular Cell | Published: April 11, 2019DOI:https://doi.org/10.1016/j.molcel.2019.03.012


The nascent polypeptide-associated complex (NAC) is a conserved ribosome-associated protein biogenesis factor. Whether NAC exerts chaperone activity and whether this function is restricted to de novo protein synthesis is unknown. Here, we demonstrate that NAC directly exerts chaperone activity toward structurally diverse model substrates including polyglutamine (PolyQ) proteins, firefly luciferase, and Aβ40. Strikingly, we identified the positively charged ribosome-binding domain in the N terminus of the βNAC subunit (N-βNAC) as a major chaperone entity of NAC. N-βNAC by itself suppressed aggregation of PolyQ-expanded proteins in vitro, and the positive charge of this domain was critical for this activity. Moreover, we found that NAC also exerts a ribosome-independent chaperone function in vivo. Consistently, we found that a substantial fraction of NAC is non-ribosomal bound in higher eukaryotes. In sum, NAC is a potent suppressor of aggregation and proteotoxicity of mutant PolyQ-expanded proteins associated with human diseases like Huntington’s disease and spinocerebellar ataxias.

The full research article is available in Molecular Cell, where it may be read in full.




Out of Area Placements in mental health services

Latest statistics show that mentally ill patients are still being sent outside of their local areas for treatment | NHS Digital | via OnMedica


The government has set a national ambition to eliminate inappropriate Out of Area Placements (OAPs) in mental health services for adults in acute inpatient care by 2020-21. However, OnMedica reports that the latest data suggests the government is not on track to achieve this ambition.

National statistics for January 2019, reveal there were 675 OAPs active at the end of January, 785 at the start, and that 40 OAPs were for a distance of 300km or greater, with a further 115 at distances greater than 200km, and 325 at distances greater than 100km.

Full story at OnMedica

Latest data: Out of Area Placements in Mental Health Services January 2019 | NHS Digital, April 2019.

Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study

Huan, S., et al. | 2019|  Stress related disorders and risk of cardiovascular disease: population based, sibling controlled cohort study| 

Using data from nationwide population and health registers in Sweden a team of researchers were able to conduct a population based sibling analysis and a matched cohort study to elucidate the role of stress related disorders in the development of cardiovascular disease.


The researchers conclude that their analysis demonstrates a clear association between clinically confirmed stress related disorders and a higher subsequent risk of cardiovascular disease, particularly during the months after diagnosis of a stress related disorder, in the Swedish population. This association applies equally to men and women and is independent of familial factors, history of somatic/psychiatric diseases, and psychiatric comorbidities (Source: The BMJ).


Objective To assess the association between stress related disorders and subsequent risk of cardiovascular disease.

Design Population based, sibling controlled cohort study.

Setting Population of Sweden.

Participants 136 637 patients in the Swedish National Patient Register with stress related disorders, including post-traumatic stress disorder (PTSD), acute stress reaction, adjustment disorder, and other stress reactions, from 1987 to 2013; 171 314 unaffected full siblings of these patients; and 1 366 370 matched unexposed people from the general population.

Main outcome measures Primary diagnosis of incident cardiovascular disease—any or specific subtypes (ischaemic heart disease, cerebrovascular disease, emboli/thrombosis, hypertensive diseases, heart failure, arrhythmia/conduction disorder, and fatal cardiovascular disease)—and 16 individual diagnoses of cardiovascular disease. Hazard ratios for cardiovascular disease were derived from Cox models, after controlling for multiple confounders.

Results During up to 27 years of follow-up, the crude incidence rate of any cardiovascular disease was 10.5, 8.4, and 6.9 per 1000 person years among exposed patients, their unaffected full siblings, and the matched unexposed individuals, respectively. In sibling based comparisons, the hazard ratio for any cardiovascular disease was 1.64, with the highest subtype specific hazard ratio observed for heart failure, during the first year after the diagnosis of any stress related disorder. Beyond one year, the hazard ratios became lower, ranging from 1.12 for arrhythmia to 2.02 for artery thrombosis/embolus. Stress related disorders were more strongly associated with early onset cardiovascular diseases than later onset ones. Except for fatal cardiovascular diseases, these associations were not modified by the presence of psychiatric comorbidity. Analyses within the population matched cohort yielded similar results.

Conclusion Stress related disorders are robustly associated with multiple types of cardiovascular disease, independently of familial background, history of somatic/psychiatric diseases, and psychiatric comorbidity.


Read the full article from the BMJ 

LIFE a new smartphone app to train healthworkers to save lives

University of Oxford | April 2019 | LIFE a new smartphone app to train healthworkers to save lives

Life-saving Instruction for Emergencies (LIFE) is a free 3D simulation training app for smartphones developed by a research group based at KEMRI-Wellcome Trust – Kenya and Oxford University. 

The app is scenario-based and teaches healthcare workers to identify and manage medical emergencies using game-like training techniques to reinforce key steps that need to be performed to save lives.

The app was launched at the  Kenya Paediatric Association 2019 annual conference in Mombasa, Kenya.

The first three scenarios available for LIFE teach healthcare workers how to resuscitate a newborn baby (source: University of Oxford).

The app is available for Android 

It can also be downloaded from the OXlife project 

See also Health Informatics Forum 

Practical guidance supporting the 2019-20 Commissioning for Quality and Innovation (CQUIN): Six month reviews for stroke survivors

NHS England| April 2019| Practical guidance supporting the 2019-20 Commissioning for Quality and Innovation (CQUIN): Six month reviews for stroke survivors

This supporting guidance for the Community CQUIN applicable for providers of stroke community services, outlines how to undertake the six month post stroke reviews and record these on SSNAP (the Sentinel Stroke National Audit Porgramme), supporting personalised stroke care and ongoing support for stroke survivors (Source: NHS England)

Practical guidance supporting the 2019-20 Commissioning for Quality and Innovation (CQUIN): Six month reviews for stroke survivors

[NICE Surveillance report] Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes

NICE | April 2019 | Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes

NICE will not update the following guidelines on medicines adherence and medicines optimisation: