[NICE Consultation] Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence

NICE | April 2019 | Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence Clinical guideline [CG115]

The NICE consultation on Alcohol-use disorders: diagnosis, assessment and management of harmful drinking and alcohol dependence Clinical guideline [CG115] is open until 8 May 2019

Full details are available from NICE 

See also: [NICE Surveillance Consultation] Alcohol-use disorders: prevention

Better care of deteriorating patients has reduced US mortality after surgery

NIHR | April 2019 | Better care of deteriorating patients has reduced US mortality after surgery 

A US observational study examines how reductions in postoperative complications and improvements in failure to rescue (when a patient develops complications after surgery and then dies) have contributed to improvements in surgical mortality over the last ten years. 

These US findings support the recently introduced early warning system in the NHS called NEWS2. This aims to detect which patients are deteriorating so that management can be escalated. This is a hospital-wide initiative for all adult patients, not just following surgery (Source: NIHR Signal).

NIHR Better care of deteriorating patients has reduced US mortality after surgery


The study has now been published in the Annals of Surgery

Full reference: Fry, B. | 2019|Ten-year Trends in Surgical Mortality, Complications, and Failure to Rescue in Medicare Beneficiaries | Annals of Surgery | ePub ahead of print

Objective: To evaluate how changes in complication and failure to rescue rates influence hospitals  postoperative mortality rates.

Summary Background Data: Surgical mortality has declined over the last decade, but the mechanisms underlying these improvements are unknown. Specifically, the relative impact of reducing postoperative complications versus improving failure to rescue remains unclear.

Methods: Using Medicare claims data, we performed a retrospective study of abdominal aortic aneurysm repair, pulmonary resection, colectomy, and pancreatectomy patients. We examined risk-adjusted 30-day mortality, serious complications, and failure to rescue for these patients in from 2005 to 2014 (n = 702,268 patients in 3404 hospitals). Hospitals were then stratified into quintiles by their change in mortality over time. Results: After stratifying by reductions in mortality from 2005 to 2014, the top 20% of hospitals decreased mortality by 37%, decreased serious complications by 11%, and decreased failure to rescue by 25%. In contrast, the bottom 20% of hospitals increased mortality by 12%, increased serious complications by 5%, and increased failure to rescue by 4% . Partitioning of variance demonstrated that decreased failure to rescue explained 64% of improvement in hospitals mortality over time, whereas decreased serious complications accounted for only 5% of this improvement.

Conclusions: Hospitals with the largest reductions in surgical mortality achieved these improvements primarily through reducing failure to rescue rates and not by reducing serious complication rates. This suggests that hospitals aiming to reduce surgical mortality should engage in efforts focused on improving rescue.

Rotherham NHS staff  can request the full article from the Library

PHE offers support to UK vaccine heroes

Public Health England | April 2019 | PHE offers support to UK vaccine heroes

To mark European Immunization Awareness Week Public Health England (PHE) have published research that shows that health professionals remain the most trusted source of advice on immunisation (93% of parents agreed), while social media and the internet ranked as the least trusted sources of information. Overall, only 9% of parents have seen, read or heard about something that would make them doubt having their child immunised – a historically low proportion and down from a third (33%) in 2002.


Chief Executive at Public Health England, Duncan Selbie said:

“In a world where mis-information is so easily spread online we must all speak confidently about the value of vaccines and leave the public in no doubt that they are safe and save lives.

It’s testament to our hard-working doctors and nurses that families trust them to provide accurate facts about the effectiveness of vaccines. They’re our vaccine heroes and we all have a role in supporting them.”

The survey by PHE also shows that reported parental confidence in the immunisation programme is very high and the percentage of parents refusing one or more of their child’s vaccines remains very low at only 4%. For those parents who didn’t vaccinate when due, most had postponed, rather than refused vaccination, with their child going on to have it at a later date.

Vaccine coverage remains high for most childhood vaccines. The latest quarterly data suggests that vaccine coverage at 12 months of age increased by 0.4 to 0.9% for all vaccines compared with the previous quarter. This follows slow declines in uptake since 2012 to 13. According to research by the Royal Society of Public Health, these small drops may be due to timing, availability and location of appointments (Source: Public Health England).

Public Health England PHE offers support to UK vaccine heroes [press release]

In the news

BBC News Measles: ‘My baby’s eyes were swollen shut’

ITV News More than 500,000 UK children unprotected against measles after missing vaccinations

Daily Mail Fears of measles ‘timebomb’ as experts reveal half a MILLION British children have not been vaccinated because parents believe ‘antivaxx’ scare stories

Independent Half a million UK children at risk of measles after missing vaccination, Unicef warns 




RCP President: Don’t use the term ‘burn out’

Royal College of Physicians | April 2019| Medicine 2019: Stop using the word burnout says RCP president

In a keynote address at the Royal College of Physicians  annual conference, RCP President Professor Andrew Goddard cautions against using the term burnout in relation to doctors as he says this implies failure of the individual. Instead he highlights how this  a result of  an overstretched system and the growing pressure of emergency admissions and workforce shortages:

“Our trainees are suffering burnout, our consultants are suffering burnout, even our medical students risk burnout. Hang on though, this is not the word we should be using. What we call burnout, that sense of despair, hopelessness and loss of joy is not due to a failure of the individual.” Professor Andrew Goddard


He suggests instead it is a “failure of the environment doctors work in, the culture of the workplace […] Some, particularly in the United States, have started to call this process ‘moral injury’ as it puts the onus back on the system” (Source: Royal College of Physicians).

News release Royal College of Physicians 

OnMedica RCP urges an end to blame implications of ‘burnout’

How the new nursing associate role will break new ground

NHS Confederation | April 2019 | How the new nursing associate role will break new ground

In a recent post on NHS Confederation’s blog the chief executive of NHS Employers explains how the new role of nursing associate will  complement the NHS Long Term Plan’s workforce strategy.

The nursing associate role is a regulated part of the workforce which has been developed to bridge the gap between health and care support workers and registered nurses.

This role is intended to complement registered nurses, enabling them to work to their full scope of practice, as well as offer new routes into registered nursing roles.

Although the role is still gathering pace, it has received significant employer interest since its inception in 2015. The number of trainee nursing associates is increasing, and the government has set a target to see 7,500 trainee nursing associate places this year.

When considered as part of a forward-thinking workforce strategy, the nursing associate role offers an opportunity for employers to make the most of current and emerging talent as part of our teams.

Full story at NHS Confederation 

New respiratory online resource

Respiratory disease affects one in five people, it is the third biggest cause of death in England. To support implementation of the ambitions set out in the NHS Long Term Plan to improve outcomes for patients with respiratory conditions, NHS England and NHS Improvement are working with the British Thoracic Society to establish Respiratory Futures as the central knowledge hub and learning platform for respiratory work supporting the implementation of the Plan.

The platform, aimed at commissioners and health professionals, hosts best practice case studies, interviews, articles and new developments from respiratory professionals across the country. There is also an interactive map where you can find out how Sustainability and Transformation Partnerships (STP) and Integrated Care Systems (ICS) regions are integrating respiratory services.

Full resource: Respiratory Futures