This article is available freely via Open Access. Please click on the above link to view it fully.
Effect of caudal epidural steroid or saline injection in chronic lumbar radiculopathy: multicentre, blinded, randomised controlled trial
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Daily Archives: September 15, 2011
CCGs setting spending priorities urged to ‘be brave’
Source: CCGs setting spending priorities urged to ‘be brave’ | News | Health Service Journal.
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
Most primary care trust commissioners believe they have struggled with setting priorities for health spending in their area, according to a new research report.
Legal costs could see CCGs allowances ‘wiped out’ | News | Health Service Journal out’
Source: Legal costs could see CCGs allowances ‘wiped out’ | News | Health Service Journal.
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
Clinical commissioning groups are being warned they could be “wiped out” by legal challenges made by providers or resulting from service reconfigurations, treatment decisions and contract awards.
DH reinterprets research showing NHS has competition advantage
Source: DH reinterprets research showing NHS has competition advantage | News | Health Service Journal.
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
An economic study previously interpreted by officials as showing that the “majority” of market distortions worked against the private sector has been reinterpreted by the Department of Health.
Midwife shortages in England ‘risking lives’
Parts of England are facing big midwife shortages, putting mothers and babies at risk, midwives have said.
via BBC News – Midwife shortages in England ‘risking lives’.
Report calls for more failing care home protection
More needs to be done to protect people from failing care services in England, a report says.
via BBC News – Report calls for more failing care home protection.
DH paid £8m to exit private contract following suspension of services
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
The Department of Health paid £8m to end early a contract with a private health provider whose services had twice been suspended.
CCP backs commissioners in care home procurement row
Source: CCP backs commissioners in care home procurement row | News | Health Service Journal.
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
The Cooperation and Competition Panel has ruled against care home associations in two regions after they claimed procurement rules and prices for continuing healthcare were too low.
Women’s cancers reach two million
Two million women were diagnosed with breast or cervical cancer last year, according to global figures
Practice ‘federations’ frustrated by reform
Source:Practice ‘federations’ frustrated by reform – Gerada | News | Health Service Journal.
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
Moves to create groups of GP practices which can share and expand services have been frustrated by the commissioning reforms, Clare Gerada said.
DH will ‘create pressure’ to ensure quality – Easton
Source: DH will ‘create pressure’ to ensure quality – Easton | News | Health Service Journal.
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
The Department of Health will increasingly place trusts under “high pressure” not to make cuts that damage services and to “encourage” the “right” actions.
Foundation trusts consider moving away from national pay deal
Source: Foundation trusts consider moving away from national pay deal | News | Health Service Journal.
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
Foundation trusts are showing an unprecedented willingness to publicly consider moving away from nationally negotiated staff terms and conditions.
Strike fears build as union anger grows over public sector cuts
Source: Strike fears build as union anger grows over public sector cuts | News | Health Service Journal.
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
Rising fears of highly disruptive industrial action by NHS workers this autumn are revealed in documents seen by HSJ
Fall assessment in older people
Source:Fall assessment in older people — Close and Lord 343 — bmj.com
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Summary points
Fall risk screening identifies people at increased risk of falls who need detailed fall risk assessment and intervention, which can in turn prevent falls and fall related injury
Quick validated fall risk screening tools for older people are available for community, hospital, and nursing and residential care settings
Screen older people living in the community for fall risk every 12 months and assess for risk factors after a fall
Fall risk in hospital inpatients is changeable because physical and cognitive abilities may alter during a hospital stay
Although all older people in nursing and residential care are at high risk of falls, a screening tool that includes their ability to stand unaided and risk factors such as cognitive impairment, incontinence, and drug use can provide extra information about fall risk
A nudge in the right direction for organ donation—but is it enough?
A nudge in the right direction for organ donation—but is it enough? — Wellesley 343 — bmj.com.
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Clinical commissioners need ‘bold’ approach, report claims
Source: Clinical commissioners need ‘bold’ approach, report claims | News | Health Service Journal.
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
New clinical commissioning groups within the NHS must change the system and “deliver results”, a report by an expert group has claimed.
CQC leadership failed to act with urgency
via CQC leadership failed to act with urgency | News | Health Service Journal.
This article is solely the work of the HSJ. For a full copy of the article please contact the library.
MPs have criticised the leadership of the Care Quality Commission for failing to stand up to ministers in the face of “unrealistic statutory obligations”.
Manchester asks its residents if they are feeling blue
Are you feeling blue? Or a little green with envy? Or are you having a purple day?
The mood of people in Manchester has been measured by researchers in the Great Manchester Health Experiment.
via BBC News – Manchester asks its residents if they are feeling blue.
Mortality after hospital discharge for people with schizophrenia or bipolar disorder: retrospective study of linked English hospital episode statistics, 1999-2006
This article is available freely via Open Access. Please click on the above link to view it fully.
Abstract
Objective To investigate whether the mortality gap has reduced in recent years between people with schizophrenia or bipolar disorder and the general population.
Design Record linkage study.
Setting English hospital episode statistics and death registration data for patients discharged 1999-2006.
Participants People discharged from inpatient care with a diagnosis of schizophrenia or bipolar disorder, followed for a year after discharge.
Main outcome measures Age standardised mortality ratios at each time, comparing the mortality in people with schizophrenia or bipolar disorder with mortality in the general population. Poisson test of trend was used to investigate trend in ratios over time.
Results By 2006 standardised mortality ratios in the psychiatric cohorts were about double the population average. The mortality gap widened over time. For people discharged with schizophrenia, the ratio was 1.6 (95% confidence interval 1.5 to 1.8) in 1999 and 2.2 (2.0 to 2.4) in 2006 (P<0.001 for trend). For bipolar disorder, the ratios were 1.3 (1.1 to 1.6) in 1999 and 1.9 (1.6 to 2.2) in 2006 (P=0.06 for trend). Ratios were higher for unnatural than for natural causes. About three quarters of all deaths, however, were certified as natural, and increases in ratios for natural causes, especially circulatory disease and respiratory diseases, were the main components of the increase in all cause mortality.
Conclusions The total burden of premature deaths from natural causes in people with schizophrenia or bipolar disorder is substantial. There is a need for better understanding of the reasons for the persistent and increasing gap in mortality between discharged psychiatric patients and the general population, and for continued action to target risk factors for both natural and unnatural causes of death in people with serious mental illness.
Effect of mammography screening on surgical treatment for breast cancer in Norway: comparative analysis of cancer registry data
This article is available freely via Open Access. Please click on the above link to view it fully.
Abstract
Objective To determine the effect of mammography screening on surgical treatment for breast cancer.
Design Comparative analysis of data from Norwegian cancer registry.
Setting Mammography screening, Norway (screening of women aged 50-69 was introduced sequentially from 1996 to 2004).
Participants 35 408 women aged 40-79 with invasive breast cancer or ductal carcinoma in situ treated surgically from 1993 to 2008.
Main outcome measures Rates of breast surgery (mastectomy plus breast conserving treatment) and rates of mastectomy for three age groups of women: 40-49, 50-69, and 70-79. Changes in rates from pre-screening period (1993-5) to introduction of screening phase (1996-2004) and then to screening period (2005-8) are presented as hazard ratios in invited and non-invited women.
Results The annual rate for breast surgery from the pre-screening period (1993-5) to screening period (2005-8) in Norway increased by 70% (hazard ratio 1.70, 95% confidence interval 1.62 to 1.78), from 180 to 305 per 100 000 women in the invited age group (50-69 years). In the younger, non-invited age group (40-49 years), however, the increase was only 8% (1.08, 1.00 to 1.16), from 133 to 144 per 100 000 women per year, whereas in the older, non-invited age group (70-79 years) the rate decreased by 8% (0.92, 0.86 to 1.00), from 227 to 214 per 100 000 women per year. The rates for mastectomy decreased similarly from the pre-screening period to screening period in invited and non-invited women. From the pre-screening period to the introduction phase of screening (1996-2004), however, the annual mastectomy rate in women aged 50-69 invited to screening increased by 9% (1.09, 1.03 to 1.14), from 156 to 167 per 100 000 women, and in the younger non-invited women declined by 17% (0.83, 0.78 to 0.90), from 109 to 91 per 100 000 women. In consequence, the mastectomy rate was 31% (1.31, 1.20 to 1.43) higher in the invited than in the non-invited younger age group.
Conclusions Mammography screening in Norway was associated with a noticeable increase in rates for breast cancer surgery in women aged 50-69 (the age group invited to screening) and also an increase in mastectomy rates. Although over-diagnosis is likely to have caused the initial increase in mastectomy rates and the overall increase in surgery rates in the age group screened, the more recent decline in mastectomy rates has affected all age groups and is likely to have resulted from changes in surgical policy.
Hospital admission for schizophrenia and bipolar disorder
Source: Hospital admission for schizophrenia and bipolar disorder — Miller 343 — bmj.com.
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A critical window to recognise and modify the risk of mortality
TB: Plan to tackle rise in drug-resistant cases
A plan has been drawn up to try to tackle cases of drug-resistant tuberculosis in 53 European countries
via BBC News – TB: Plan to tackle rise in drug-resistant cases.
PM backs MPs’ criticism of health regulator
The prime minister has added his voice to calls for the health regulator to get back to its core function of inspecting hospitals and care homes.
Dedicated outreach service for hard to reach patients with tuberculosis in London: observational study and economic evaluation
This article is available freely via Open Access. Please click on the above link to view it fully.
Abstract
Objective To assess the cost effectiveness of the Find and Treat service for diagnosing and managing hard to reach individuals with active tuberculosis.
Design Economic evaluation using a discrete, multiple age cohort, compartmental model of treated and untreated cases of active tuberculosis.
Setting London, United Kingdom.
Population Hard to reach individuals with active pulmonary tuberculosis screened or managed by the Find and Treat service (48 mobile screening unit cases, 188 cases referred for case management support, and 180 cases referred for loss to follow-up), and 252 passively presenting controls from London’s enhanced tuberculosis surveillance system.
Main outcome measures Incremental costs, quality adjusted life years (QALYs), and cost effectiveness ratios for the Find and Treat service.
Results The model estimated that, on average, the Find and Treat service identifies 16 and manages 123 active cases of tuberculosis each year in hard to reach groups in London. The service has a net cost of £1.4 million/year and, under conservative assumptions, gains 220 QALYs. The incremental cost effectiveness ratio was £6400-£10 000/QALY gained (about €7300-€11 000 or $10 000-$16 000 in September 2011). The two Find and Treat components were also cost effective, even in unfavourable scenarios (mobile screening unit (for undiagnosed cases), £18 000-£26 000/QALY gained; case management support team, £4100-£6800/QALY gained).
Conclusions Both the screening and case management components of the Find and Treat service are likely to be cost effective in London. The cost effectiveness of the mobile screening unit in particular could be even greater than estimated, in view of the secondary effects of infection transmission and development of antibiotic resistance.
The impact of genital warts: loss of quality of life and cost of treatment in eight sexual health clinics in the UK
This article is available freely via Open Access. Please click on the above link to view it fully.
Abstract
Objectives To estimate the loss of quality of life and cost of treatment associated with genital warts seen in sexual health clinics.
Methods A cross-sectional questionnaire study and case note review of individuals with genital warts, carried out in eight sexual health clinics in England and Northern Ireland. Individuals with genital warts attending the participating clinics were invited to take part in the questionnaire study. 895 participants were recruited. A separate sample of 370 participants who had attended a participating clinic with a first visit for a first or recurrent episode of genital warts between April and June 2007 was included in the case note review. Quality of life was measured using the EQ-5D questionnaire and the cost of an episode of care was derived from the case note review.
Results The weighted mean EQ-5D index score was 0.87 (95% CI 0.85 to 0.89). The weighted mean disutility was 0.056 (95% CI 0.038 to 0.074). The estimated mean loss of quality-adjusted life-years associated with an episode of genital warts was 0.018 (95% CI 0.0079 to 0.031), equivalent to 6.6 days of healthy life lost per episode. The weighted mean cost per episode of care was £94 (95% CI £84 to £104), not including the cost of a sexually transmitted infection screen.
Conclusions Genital warts have a substantial impact on the health service and the individual. This information can be utilised for economic evaluation of human papillomavirus vaccination.
Genital warts and cost of care in England
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Abstract
Objectives To estimate the total number of cases of, and cost of care for, genital warts (GWs) in England, to inform economic evaluations of human papillomavirus vaccination.
Methods The number of GW cases seen in general practices (GPs) and in genitourinary medicine (GUM) clinics was estimated using the General Practice Research Database and the GUM Clinic Activity Dataset. The overlap in care of cases in the two settings was estimated. The calculated costs of care in GP and hospitals were added to the costs of care in GUM clinics (estimated elsewhere) to estimate the cost of care for GWs in England.
Results In England, in 2008, GP and GUM saw 80 531 new (157/100 000 population) and 68 259 recurrent (133/100 000 population) episodes, giving a total of 148 790 episodes of care of GWs (289/100 000 population). Seventy-three per cent of cases were seen only in GUM clinics, 22% were seen by a GP before being referred to GUM, and 5% by GPs only. Hospital care was given in 1.3% of cases and contributed 8% of the costs. The average cost of care per episode was £113, and the estimated annual cost of care in England was £16.8 million.
Conclusions This study provides a fairly comprehensive measure of GW frequency and care in England. GWs exert a considerable impact on health services, a large proportion of which could be prevented through immunisation using the quadrivalent human papillomavirus vaccine.
Increased gonorrhoea and chlamydia testing did not increase case detection in an HIV clinical cohort 1999–2007
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Abstract
Objectives Since 2003, US organisations have recommended universal screening, rather than targeted screening, of HIV-infected persons for gonorrhoea and chlamydia. The objective of this study was to determine whether wider testing resulting from these guidelines would produce an increase in gonorrhoea/chlamydia diagnoses.
Methods 3283 patients receiving HIV care in 1999–2007 in the Johns Hopkins Hospital HIV clinic were studied. The two primary outcomes were the occurrence of any gonorrhoea/chlamydia testing in each year of care and the occurrence of any positive result(s) in years of testing. The proportion of all patients in care who were diagnosed with gonorrhoea/chlamydia was defined as the number of patients with positive results divided by the number of patients in care. Trends were analysed with repeated measures logistic regression.
Results The proportion of patients tested for gonorrhoea/chlamydia increased steadily from 0.12 in 1999 to 0.33 in 2007 (OR per year for being tested 1.17, 95% CI 1.15 to 1.19). The proportion positive among those tested decreased significantly after 2003 (OR per year 0.67, 95% CI 0.55 to 0.81). The proportion of all patients in care diagnosed with gonorrhoea/chlamydia therefore remained generally stable in 1999–2007 (OR per year 0.97, 95% CI 0.91 to 1.04).
Conclusions Universal annual screening, as implemented, did not increase the proportion of all patients in care who were diagnosed with gonorrhoea/chlamydia. Similarly low implementation rates have been reported in cross-sectional studies. If future efforts to enhance implementation do not yield increases in diagnoses, then guidelines focusing on targeted screening of high-risk groups rather than universal screening may be warranted
Scotland will set minimum price for a unit of alcohol
Source: Scotland will set minimum price for a unit of alcohol — Christie 343 — bmj.com.
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The Scottish parliament has announced that it will introduce legislation to set a minimum price on alcohol to curb the damage to health from overconsumption.
British public is sceptical about minimum price on alcohol
Source: British public is sceptical about minimum price on alcohol — Hunter 343 — bmj.com.
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Plans to introduce minimum pricing on a unit of alcohol in UK countries could be undermined by public mistrust and misunderstanding of the policy, concludes research announced this week.
Second US appeal court rules in favour of US health reform
via Second US appeal court rules in favour of US health reform — Tanne 343 — bmj.com.
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The Obama administration gained a second appeal court victory last week concerning its health reform law
