NICE Consultation: Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management

NICE |  August 2019 | Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management | In development [GID-NG10091]

NICE need evidence from the areas listed below for the guideline we are developing on Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome:

1. Studies that evaluate:

  • Management strategies that are adopted while someone is being assessed for a diagnosis of ME/CFS.
  • Methods of monitoring and/or reviewing people with a diagnosis of ME/CFS

NICE are looking for trials that compare different strategies or different methods of monitoring and review. Systematic reviews, randomised controlled trials, non- randomised trials that are prospective or retrospective cohort studies will be considered for inclusion in the guideline.

NICE would like studies that report measurable outcomes on:

  • Mortality
  • Quality of life
  • Fatigue /fatiguability
  • Physical functioning
  • Cognitive function
  • Psychological status
  • Pain
  • Sleep quality
  • Treatment-related adverse effects
  • Activity levels
  • Return to school or work
  • Exercise performance measures.
  • Care needs
  • Impact on families and carers

Full details from NICE

The Good Childhood Report 2019

Since 2009 children and young people have become increasingly unhappy. Based on the latest figures, this new report from The Children’s Society estimates a quarter of a million children are unhappy with their lives, with factors like friends, school and appearance all playing a role.


The report calls on the Government to introduce national measurement of well-being for all children aged 11-18 to be undertaken through schools and colleges once a year. This would enable the experiences of young people to be recorded and issues acted upon for future generations.

The Good Childhood Report 2019 is the eighth in the annual series of reports by The Children’s Society and alongside the latest trends in children’s well-being, also looks at family, financial circumstance, multiple disadvantage and what children and young people think about the future.

Full report: The Good Childhood Report 2019

See also: Children in UK least happy they have been in a decade, says report | The Guardian

Social Prescribing Link Workers AKA ‘The Glue in Health and Social Care’

NHS Confederation | August 2019 | Social Prescribing Link Workers AKA ‘The Glue in Health and Social Care’ 

A new blog post on the NHS Confederation’s blog, argues that social prescribing link workers have become a crucial new profession in helping to move to a social model of health which improves health and wellbeing for the population as opposed to those needing non-medical support being prescribed pills or unnecessarily accessing hospital services. 

The author of the post, Christiana Melam, the Chief Executive Officer of National Association of Link Workers,  argues that social prescribing link workers are essential for personalised care service delivery in secondary care (Source: NHS Confederation).

Read the post in full from NHS Confederation

Family homelessness in England

New report reveals the terrible reality of how some children are living in converted shipping containers and office blocks, and B&Bs, in cramped conditions, often miles away from their schools | Children’s Commisioner

Anne Longfield, the Children’s Commissioner for England, has published new research which shines a light on the thousands of children growing up in homeless families. The report, Bleak houses: Tackling the crisis of family homelessness in England shows that while official statistics show 124,000 children in England living in temporary accommodation, this does not include the hidden homeless who are ‘sofa-surfing’, often in very cramped conditions.  New analysis conducted for the Children’s Commissioner for England estimates that in 2016/17 there were 92,000 children living in sofa-surfing families.

Further analysis conducted for the Children’s Commissioner has found that an estimated 375,000 children are in households that have fallen behind on their rent or mortgage payments, putting them at financial risk of becoming homeless in the future.

Full report: Bleak houses: Tackling the crisis of family homelessness in England

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Fish oil pills ‘no benefit’ for type 2 diabetes

Brown, T., Brainard, J., Song, F., Wang, X., Abdelhamid, A. & Hooper, L. | 2019| Omega-3, omega-6, and total dietary polyunsaturated fat for prevention and treatment of type 2 diabetes mellitus: systematic review and meta-analysis of randomised controlled trials | BMJ|  366 | l4697|  doi: :

Research that investigated whether omega-3 and other fatty acids were beneficial to people with type 2 diabetes has found that increasing long chain omega-3 intake had little or no effect on diagnosis or glucose metabolism; the study’s authors also report that there may be  negative outcomes at high dose. 



Objective To assess effects of increasing omega-3, omega-6, and total polyunsaturated fatty acids (PUFA) on diabetes diagnosis and glucose metabolism.

Design Systematic review and meta-analyses.

Data sources Medline, Embase, Cochrane CENTRAL, WHO International Clinical Trials Registry Platform,, and trials in relevant systematic reviews.

Eligibility criteria Randomised controlled trials of at least 24 weeks’ duration assessing effects of increasing α-linolenic acid, long chain omega-3, omega-6, or total PUFA, which collected data on diabetes diagnoses, fasting glucose or insulin, glycated haemoglobin (HbA1c), and/or homoeostatic model assessment for insulin resistance (HOMA-IR).

Data synthesis Statistical analysis included random effects meta-analyses using relative risk and mean difference, and sensitivity analyses. Funnel plots were examined and subgrouping assessed effects of intervention type, replacement, baseline risk of diabetes and use of antidiabetes drugs, trial duration, and dose. Risk of bias was assessed with the Cochrane tool and quality of evidence with GRADE.

Results 83 randomised controlled trials (mainly assessing effects of supplementary long chain omega-3) were included; 10 were at low summary risk of bias. Long chain omega-3 had little or no effect on likelihood of diagnosis of diabetes or measures of glucose metabolism. A suggestion of negative outcomes was observed when dose of supplemental long chain omega-3 was above 4.4 g/d. Effects of α-linolenic acid, omega-6, and total PUFA on diagnosis of diabetes were unclear (as the evidence was of very low quality), but little or no effect on measures of glucose metabolism was seen, except that increasing α-linolenic acid may increase fasting insulin (by about 7%). No evidence was found that the omega-3/omega-6 ratio is important for diabetes or glucose metabolism.

Conclusions This is the most extensive systematic review of trials to date to assess effects of polyunsaturated fats on newly diagnosed diabetes and glucose metabolism, including previously unpublished data following contact with authors. Evidence suggests that increasing omega-3, omega-6, or total PUFA has little or no effect on prevention and treatment of type 2 diabetes mellitus.

Systematic review registration PROSPERO CRD42017064110.


The full article is available from the  BMJ

In the news:

BBC News Fish oil pills ‘no benefit’ for type 2 diabetes

10000 steps a day is a myth, reports JAMA study

Abbasi J. For Mortality, Busting the Myth of 10 000 Steps per Day|  JAMA |2019322(6):492–493. doi:10.1001/jama.2019.10042

JAMA has published the findings of an observational study that followed more than 6 000 women with an average age of 72 years wore accelerometers during their waking hours. Researchers collected data from the devices on step volume and intensity over 4 to 7 days. The women were divided into 4 groups from low to high, based on how much they walked. The researchers then tracked how many women died in each group over an average of 4 years of follow-up.

For many older people, reaching the target of 10 000 steps every day can feel daunting, and this may discourage them from walking more.

Equally, there may be no scientific basis for the widely used number. Its likely origin: the brand name of a Japanese pedometer sold in 1960s called Manpo-kei, or “10 000 steps meter.”


What the study showed:

  • On average the majority of the participants took 4400 daily steps,
  • Women who averaged approximately 4400 daily steps had lower mortality rates than those who took about 2700 steps a day.

  • There were additional declines in mortality among women who hoofed it more—but only up to about 7500 daily steps, beyond which the death rates leveled out.

  • Walking faster or slower didn’t appear to affect mortality rates when the number of steps was factored in.

  • The study’s lead author, I-Min Lee, of Brigham and Women’s Hospital and Harvard Medical School in Boston, the results likely apply to all individuals who are not very active, including men and younger women.
  • Lee told JAMA:

    “Step more—even a modest number of steps is associated with lower mortality.” And, she added, “all steps count,” not just those taken during exercise. If you already get 10 000 steps or more per day, don’t lower your goal. “There is no harm, and there may be additional benefits for outcomes not studied,” Lee said, like quality of life, physical function, and cognition. “We are continuing to follow the women in our study and hope to report on other outcomes in the future.” I-Min Lee

    (Source: JAMA)

The full article is available to read from JAMA; Athens login required

Alternatively, the Library  is able to provide a copy of this article

Smoking, Drinking and Drug Use among Young People in England

NHS Digital | August 2019 | Smoking, Drinking and Drug Use among Young People in England

smoking yp

The Office for National Statistics  and NHS Digital have released the findings of the biennial survey of secondary school pupils in England in years 7 to 11 (mostly aged 11 to 15), focusing on smoking, drinking and drug use. The survey covers a range of topics including prevalence, habits, attitudes, and for the first time in 2018, wellbeing.

A summary report showing key findings, excel tables with more detailed outcomes, technical appendices and a data quality statement (Source: NHS Digital).

Full details are available from NHS Digital



Hundreds of lives saved through new tech to spot sepsis

NHS England | August 2019 | Hundreds of lives saved through new tech to spot sepsis

An innovation that uses algorithms to to read patients’ vital signs, alerts medics to worsening conditions that are a warning sign of sepsis, has saved hundreds of people from sepsis.  The new ‘alert and action’ technology is already being used in three leading hospitals,  and is now part of a f a major nationwide push to tackle the condition including a one hour identification and treatment option.


In Liverpool, the hospital’s digital system brings together lab results and patient observations into one place to help staff diagnose and treat suspected sepsis, saving up to 200 lives a year.

In Cambridge, deaths from sepsis have fallen consistently over the last three years, with at least 64 lives saved in the past year thanks to the innovative alert and action feature.

In Berkshire since introducing a digital system, the Trust has increased screening rates by 70% with nine in 10 patients now consistently screened for sepsis during admission as opposed to two in ten beforehand, allowing doctors to spot more cases sooner.

The schemes are part of a national effort to push best practice and new technology across the NHS, to help hospitals learn from the success of others and spread use of the best technology further, faster (Source: NHS England).

Read the full press release from NHS England 

Hundreds of lives saved through new tech to spot sepsis


NIHR study: Physician associates appear to make a positive contribution to inpatient care

NIHR | August 2019 | Physician associates appear to make a positive contribution to inpatient care

One of the latest Signals from the National Institute of Health Research (NIHR),  looks at the role of physician associate, albeit a  relatively new profession in the UK, but n with over 3,000 students expected to qualify by 2020. Physician associates have to undergo two years’ intensive postgraduate training based upon a medical, rather than nursing, model.  Consequently, upon qualification, they can undertake a range of diagnostic and clinical duties that would otherwise be done by doctors.

Now an NIHR funded study considers the way that physician associates are deployed and the appropriateness as well as the effectiveness of their work in relation to other team members.

A national survey shows that a small but growing number of hospitals are now using physician associates. It concludes that the profession is being restrained by a lack of autonomy, preventing the role from fulfilling its potential. Statutory regulation and prescribing or X-ray ordering rights may help ease the pressure on doctors and strengthen physician associate roles within the team. Evaluation of the impact of these positions as they become more common will be useful (Source: NIHR).

The full study is available from the NIHR


Background Increasing demand for hospital services and staff shortages has led NHS organisations to review workforce configurations. One solution has been to employ physician associates (PAs). PAs are trained over 2 years at postgraduate level to work to a supervising doctor. Little is currently known about the roles and impact of PAs working in hospitals in England.

Objectives (1) To investigate the factors influencing the adoption and deployment of PAs within medical and surgical teams in secondary care and (2) to explore the contribution of PAs, including their impact on patient experiences, organisation of services, working practices, professional relationships and service costs, in acute hospital care.

Methods This was a mixed-methods, multiphase study. It comprised a systematic review, a policy review, national surveys of medical directors and PAs, case studies within six hospitals utilising PAs in England and a pragmatic retrospective record review of patients in emergency departments (EDs) attended by PAs and Foundation Year 2 (FY2) doctors.

Results The surveys found that a small but growing number of hospitals employed PAs. From the case study element, it was found that medical and surgical teams mainly used PAs to provide continuity to the inpatient wards. Their continuous presence contributed to smoothing patient flow, accessibility for patients and nurses in communicating with doctors and releasing doctors’ (of all grades) time for more complex patients and for attending to patients in clinic and theatre settings. PAs undertook significant amounts of ward-based clinical administration related to patients’ care. The lack of authority to prescribe or order ionising radiation restricted the extent to which PAs assisted with the doctors’ workloads, although the extent of limitation varied between teams. A few consultants in high-dependency specialties considered that junior doctors fitted their team better. PAs were reported to be safe, as was also identified from the review of ED patient records. A comparison of a random sample of patient records in the ED found no difference in the rate of unplanned return for the same problem between those seen by PAs and those seen by FY2 doctors. In the ED, PAs were also valued for the continuity they brought and, as elsewhere, their input in inducting doctors in training into local clinical and hospital processes. Patients were positive about the care PAs provided, although they were not able to identify what or who a PA was; they simply saw them as part of the medical or surgical team looking after them. Although the inclusion of PAs was thought to reduce the need for more expensive locum junior doctors, the use of PAs was primarily discussed in terms of their contribution to patient safety and patient experience in contrast to utilising temporary staff.

Limitations PAs work within medical and surgical teams, such that their specific impact cannot be distinguished from that of the whole team. Conclusions PAs can provide a flexible advanced clinical practitioner addition to the secondary care workforce without drawing from existing professions. However, their utility in the hospital setting is unlikely to be fully realised without the appropriate level of regulation and attendant authority to prescribe medicines and order ionising radiation within their scope of practice. Future research Comparative investigation is required of patient experience, outcomes and service costs in single, secondary care specialties with and without PAs and in comparison with other types of advanced clinical practitioners. Funding The National Institute for Health Research Health Services and Delivery Research programme (Source: NIHR).

The full journal article is available from the Health Services and Delivery Research

Where best next? New NHS plan to help patients avoid long hospital stays

NHS England & NHS Improvement | August 2019 | Where best next?

A new campaign is encouraging NHS doctors, nurses and other staff a to ask themselves ‘Why not home? Why not today?’ when planning care for patients recovering from an operation or illness.  ‘Where Best Next?’  aims to reduce the hospital stay of  140,000 people every year spared a hospital stay of three weeks or longer.


As well as being better for those individuals who get home with the right support quicker, the drive could also free up more than 7,000 beds for other patients – the equivalent of building an extra 15 large hospitals.

The campaign, launched on Monday, will see posters and other information placed in hospitals aimed at different staff groups, encouraging them to take practical steps every day to help get patients closer to a safe discharge – whether to their own home or a more suitable alternative in the community (Source: NHS England).

Full details from NHS England 

See also:

NHS England [blog] Valuing 350,000 patients’ time