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https://www.readbyqxmd.com/read/29775736/surgical-consent-practice-in-the-uk-following-the-montgomery-ruling-a-national-cross-sectional-questionnaire-study
#1
Chris McKinnon, Dafydd Loughran, Roísín Finn, Madeline Coxwell-Matthewman, Deva Sanjeeva Jeyaretna, Adam P Williams
BACKGROUND: The Supreme Court case of Montgomery vs Lanarkshire Health Board in 2015 was a landmark case for consent practice in the UK which shifted focus from a traditional paternalistic model of consent towards a more patient-centered approach. Widely recognised as the most significant legal judgment on informed consent in the last 30 years, the case was predicted to have a major impact on the everyday practice of surgeons working in the UK National Health Service (NHS). Two years after the legal definition of informed consent was redefined, we carried out an audit of surgical consent practice across the UK to establish the impact of the Montgomery ruling on clinical practice...
May 15, 2018: International Journal of Surgery
https://www.readbyqxmd.com/read/29773969/cost-effectiveness-of-umeclidinium-compared-with-tiotropium-and-glycopyrronium-as-monotherapy-for-chronic-obstructive-pulmonary-disease-a-uk-perspective
#2
Dhvani Shah, Maurice Driessen, Nancy Risebrough, Timothy Baker, Ian Naya, Andrew Briggs, Afisi S Ismaila
Background: Cost-effectiveness of once-daily umeclidinium bromide (UMEC) was compared with once-daily tiotropium (TIO) and once-daily glycopyrronium (GLY) in patients with chronic obstructive pulmonary disease (COPD) from a UK National Health Service (NHS) perspective. Methods: A linked-equation model was implemented to estimate COPD progression, associated healthcare costs, exacerbations rates, life years (LY) and quality-adjusted LY (QALYs). Statistical risk equations for endpoints and resource use were derived from the ECLIPSE and TORCH studies, respectively...
2018: Cost Effectiveness and Resource Allocation: C/E
https://www.readbyqxmd.com/read/29773610/nhs-constitution-values-for-values-based-recruitment-a-virtue-ethics-perspective
#3
Johanna Elise Groothuizen, Alison Callwood, Ann Gallagher
Values-based recruitment is used in England to select healthcare staff, trainees and students on the basis that their values align with those stated in the Constitution of the UK National Health Service (NHS). However, it is unclear whether the extensive body of existing literature within the field of moral philosophy was taken into account when developing these values. Although most values have a long historical tradition, a tendency to assume that they have just been invented, and to approach them uncritically, exists within the healthcare sector...
May 17, 2018: Journal of Medical Ethics
https://www.readbyqxmd.com/read/29773220/nhs-breast-screening-multidisciplinary-working-group-guidelines-for-the-diagnosis-and-management-of-breast-lesions-of-uncertain-malignant-potential-on-core-biopsy-b3-lesions
#4
S E Pinder, A Shaaban, R Deb, A Desai, A Gandhi, A H S Lee, S Pain, L Wilkinson, N Sharma
Needle core biopsy is considered the histological diagnostic method of choice for screen-detected breast lesions. Although the majority are definitively diagnosed as normal, benign, or malignant, approximately 7% are categorised as B3, of uncertain malignant potential. These include a wide range of lesions with different risks of associated malignancy from <2% to approaching 40% from literature review in UK practice. Historically, these have typically been surgically excised as a diagnostic procedure but the majority are then proven to be benign...
May 15, 2018: Clinical Radiology
https://www.readbyqxmd.com/read/29766842/continuous-low-dose-antibiotic-prophylaxis-to-prevent-urinary-tract-infection-in-adults-who-perform-clean-intermittent-self-catheterisation-the-antic-rct
#5
Robert Pickard, Thomas Chadwick, Yemi Oluboyede, Catherine Brennand, Alexander von Wilamowitz-Moellendorff, Doreen McClurg, Jennifer Wilkinson, Laura Ternent, Holly Fisher, Katherine Walton, Elaine McColl, Luke Vale, Ruth Wood, Mohamed Abdel-Fattah, Paul Hilton, Mandy Fader, Simon Harrison, James Larcombe, Paul Little, Anthony Timoney, James N'Dow, Heather Armstrong, Nicola Morris, Kerry Walker, Nikesh Thiruchelvam
BACKGROUND: People carrying out clean intermittent self-catheterisation (CISC) to empty their bladder often suffer repeated urinary tract infections (UTIs). Continuous once-daily, low-dose antibiotic treatment (antibiotic prophylaxis) is commonly advised but knowledge of its effectiveness is lacking. OBJECTIVE: To assess the benefit, harms and cost-effectiveness of antibiotic prophylaxis to prevent UTIs in people who perform CISC. DESIGN: Parallel-group, open-label, patient-randomised 12-month trial of allocated intervention with 3-monthly follow-up...
May 2018: Health Technology Assessment: HTA
https://www.readbyqxmd.com/read/29761488/psychological-therapies-for-treatment-resistant-depression-in-adults
#6
REVIEW
Sharea Ijaz, Philippa Davies, Catherine J Williams, David Kessler, Glyn Lewis, Nicola Wiles
BACKGROUND: Antidepressants are a first-line treatment for adults with moderate to severe major depression. However, many people prescribed antidepressants for depression don't respond fully to such medication, and little evidence is available to inform the most appropriate 'next step' treatment for such patients, who may be referred to as having treatment-resistant depression (TRD). National Institute for Health and Care Excellence (NICE) guidance suggests that the 'next step' for those who do not respond to antidepressants may include a change in the dose or type of antidepressant medication, the addition of another medication, or the start of psychotherapy...
May 14, 2018: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/29756285/evolution-of-a-rapid-onsite-evaluation-rose-service-for-endobronchial-ultrasound-guided-ebus-fine-needle-aspiration-fna-cytology-in-a-uk-hospital-a-7-year-audit
#7
Tracey Stevenson, Manish Powari, Christopher Bowles
OBJECTIVE: Endobronchial ultrasound fine needle aspiration (EBUS FNA) is a well-established procedure for the diagnosis and staging of lung cancer. We review our provision of this service at the Royal Devon and Exeter NHS Foundation Trust and the role of rapid onsite evaluation (ROSE) with the increasing demand for molecular markers in this era of personalized medicine. METHODS: A review of the changes in the Endoscopy clinic over the 7 years from the introduction of EBUS at the end of 2010 until 2017 was carried out...
May 13, 2018: Diagnostic Cytopathology
https://www.readbyqxmd.com/read/29754836/misoprostol-for-small-bowel-ulcers-in-patients-with-obscure-bleeding-taking-aspirin-and-non-steroidal-anti-inflammatory-drugs-masters-a-randomised-double-blind-placebo-controlled-phase-3-trial
#8
Ali S Taha, Caroline McCloskey, Paula McSkimming, Alex McConnachie
BACKGROUND: The incidence of obscure gastrointestinal bleeding, which originates from the small bowel and is mainly associated with the use of aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), is rising. We assessed the efficacy and safety of misoprostol for the treatment of small bowel ulcers and erosions in patients taking low-dose aspirin or NSAIDs with obscure gastrointestinal bleeding. METHODS: In this randomised, double-blind, placebo-controlled, phase 3 trial, we recruited patients (aged ≥18 years) with small bowel ulcers who were taking low-dose aspirin, NSAIDs, or both for a minimum of 4 weeks, at University Hospital Crosshouse (Kilmarnock, UK)...
May 10, 2018: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/29753350/societal-preferences-for-funding-orphan-drugs-in-the-united-kingdom-an-application-of-person-trade-off-and-discrete-choice-experiment-methods
#9
Siobhan M Bourke, Catrin O Plumpton, Dyfrig A Hughes
BACKGROUND: It is unclear whether UK National Health Service (NHS) policies for orphan drugs, which permit funding of non-cost-effective treatments, reflect societal preferences. METHODS: We conducted person trade-off (PTO) and discrete choice experiment (DCE) among 3950 adults selected to be representative of the UK general population. Experimental design was informed by surveys of patients affected by rare diseases, their caregivers, health care staff, and policymakers...
May 2018: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
https://www.readbyqxmd.com/read/29744539/community-based-pre-pregnancy-care-programme-improves-pregnancy-preparation-in-women-with-pregestational-diabetes
#10
Jennifer M Yamamoto, Deborah J F Hughes, Mark L Evans, Vithian Karunakaran, John D A Clark, Nicholas J Morrish, Gerry A Rayman, Peter H Winocour, Clare Hambling, Amanda W Harries, Michael J Sampson, Helen R Murphy
AIMS/HYPOTHESIS: Women with diabetes remain at increased risk of adverse pregnancy outcomes associated with poor pregnancy preparation. However, women with type 2 diabetes are less aware of and less likely to access pre-pregnancy care (PPC) compared with women with type 1 diabetes. We developed and evaluated a community-based PPC programme with the aim of improving pregnancy preparation in all women with pregestational diabetes. METHODS: This was a prospective cohort study comparing pregnancy preparation measures before and during/after the PPC intervention in women with pre-existing diabetes from 1 June 2013 to 28 February 2017...
May 9, 2018: Diabetologia
https://www.readbyqxmd.com/read/29741534/a-brief-look-at-the-history-of-the-deaconess-hospital-edinburgh-1894-1990
#11
E R McNeill, D Wright, A K Demetriades
The Deaconess Hospital, Edinburgh, opened in 1894 and was the first establishment of its kind in the UK, maintained and wholly funded as it was by the Reformed Church. Through its 96-year lifetime it changed and evolved to time and circumstance. It was a school: for the training of nurses and deaconesses who took their practical skills all over the world. It was a sanctum: for the sick-poor before the NHS. It was a subsidiary: for the bigger hospitals of Edinburgh after amalgamation into the NHS. It was a specialised centre: as the Urology Department in Edinburgh and the Scottish Lithotripter centre...
March 2018: Journal of the Royal College of Physicians of Edinburgh
https://www.readbyqxmd.com/read/29734935/east-lancashire-hospital-trust-creates-an-open-culture-paving-the-way-for-service-improvement-below-ten-thousand
#12
Robert Tomlinson
Reacting to a never event is difficult and often embarrassing for staff involved. East Lancashire Hospitals NHS Trust has demonstrated that treating staff with respect after a never event, creates an open culture that encourages problem solving and service improvement. The approach has allowed learning to be shared and paved the way for the trust to be the first in the UK to launch the patient centric behavioural noise reduction strategy 'Below ten thousand'.
May 2018: Journal of Perioperative Practice
https://www.readbyqxmd.com/read/29731412/comparison-of-effectiveness-and-cost-effectiveness-of-an-intensive-community-supported-discharge-service-versus-treatment-as-usual-for-adolescents-with-psychiatric-emergencies-a-randomised-controlled-trial
#13
Dennis Ougrin, Richard Corrigall, Jason Poole, Toby Zundel, Mandy Sarhane, Victoria Slater, Daniel Stahl, Paula Reavey, Sarah Byford, Margaret Heslin, John Ivens, Maarten Crommelin, Zahra Abdulla, Daniel Hayes, Kerry Middleton, Benita Nnadi, Eric Taylor
BACKGROUND: Intensive community treatment to reduce dependency on adolescent psychiatric inpatient care is recommended in guidelines but has not been assessed in a randomised controlled trial in the UK. We designed a supported discharge service (SDS) provided by an intensive community treatment team and compared outcomes with usual care. METHODS: Eligible patients for this randomised controlled trial were younger than 18 years and had been admitted for psychiatric inpatient care in the South London and Maudsley NHS Foundation Trust...
May 3, 2018: Lancet Psychiatry
https://www.readbyqxmd.com/read/29730549/can-conditional-health-policies-be-justified-a-policy-analysis-of-the-new-nhs-dental-contract-reforms
#14
Louise Laverty, Rebecca Harris
Conditional policies, which emphasise personal responsibility, are becoming increasingly common in healthcare. Although used widely internationally, they are relatively new within the UK health system where there have been concerns about whether they can be justified. New NHS dental contracts include the introduction of a conditional component that restricts certain patients from accessing a full range of treatment until they have complied with preventative action. A policy analysis of published documents on the NHS dental contract reforms from 2009 to 2016 was conducted to consider how conditionality is justified and whether its execution is likely to cause distributional effects...
April 26, 2018: Social Science & Medicine
https://www.readbyqxmd.com/read/29721332/a-pilot-randomised-double-blind-controlled-trial-of-the-efficacy-of-purified-fatty-acids-for-the-treatment-of-women-with-endometriosis-associated-pain-purfect-study-protocol
#15
Ibtisam M Abokhrais, Philippa T K Saunders, Fiona C Denison, Ann Doust, Linda Williams, Andrew W Horne
Background: Endometriosis affects 6-10% of women and is associated with debilitating pelvic pain. It costs the UK > £2.8 billion per year in loss of productivity. Endometriosis can be managed by surgical excision or medically by ovarian suppression. However, ~ 75% symptoms recur after surgery and available medical treatments have undesirable side effects and are contraceptive. Omega-3 purified fatty acids (PUFA) have been shown in animal models to reduce factors that are thought to lead to endometriosis-associated pain, have minimal side effects, and no effects on fertility...
2018: Pilot and Feasibility Studies
https://www.readbyqxmd.com/read/29718171/improved-management-of-acute-kidney-injury-in-primary-care-using-e-alerts-and-an-educational-outreach-programme
#16
James Tollitt, Emma Flanagan, Sheila McCorkindale, Sam Glynn-Atkins, Lauren Emmett, Denise Darby, James Ritchie, Brandon Bennett, Smeeta Sinha, Dimitrios Poulikakos
Purpose: Acute kidney injury (AKI) detected in primary care is associated with increased morbidity and mortality. AKI electronic alerts (e-alerts) and educational programmes have recently been implemented but their contribution to improve AKI care is unknown. This project aimed to improve response to AKI detected in primary care and used a factorial design to evaluate the impact of the UK National Health Service (NHS) AKI e-alert and AKI educational outreach sessions on time to response to primary care AKI stages 2 and 3 between April and August 2016...
April 28, 2018: Family Practice
https://www.readbyqxmd.com/read/29715437/a-factor-analysis-of-functional-independence-and-functional-assessment-measure-scores-among-focal-and-diffuse-brain-injury-patients-the-importance-of-bi-factor-models
#17
Sarah Gunn, Gerald H Burgess, John Maltby
OBJECTIVE: To explore the factor structure of the UK Functional Independence Measure and Functional Assessment Measure (FIM+FAM) among focal and diffuse acquired brain injury patients. DESIGN: Criterion standard. SETTING: An NHS acute acquired brain injury inpatient rehabilitation hospital. PARTICIPANTS: Referred sample of 447 adults (835 cases after exclusions) admitted for inpatient treatment following an acquired brain injury significant enough to justify intensive inpatient neurorehabilitation...
April 28, 2018: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/29701091/a-comparison-of-the-cost-effectiveness-of-intramedullary-nail-fixation-and-locking-plate-fixation-in-the-treatment-of-adult-patients-with-an-extra-articular-fracture-of-the-distal-tibia
#18
M Maredza, S Petrou, M Dritsaki, J Achten, J Griffin, S E Lamb, N R Parsons, M L Costa
Aim The aim of this study was to compare the cost-effectiveness of intramedullary nail fixation and 'locking' plate fixation in the treatment of extra-articular fractures of the distal tibia. Patients and Methods An economic evaluation was conducted from the perspective of the United Kingdom National Health Service (NHS) and personal social services (PSS), based on evidence from the Fixation of Distal Tibia Fractures (UK FixDT) multicentre parallel trial. Data from 321 patients were available for analysis. Costs were collected prospectively over the 12-month follow-up period using trial case report forms and participant-completed questionnaires...
May 1, 2018: Bone & Joint Journal
https://www.readbyqxmd.com/read/29699552/rationing-elective-surgery-for-smokers-and-obese-patients-responsibility-or-prognosis
#19
Virimchi Pillutla, Hannah Maslen, Julian Savulescu
BACKGROUND: In the United Kingdom (UK), a number of National Health Service (NHS) Clinical Commissioning Groups (CCG) have proposed controversial measures to restrict elective surgery for patients who either smoke or are obese. Whilst the nature of these measures varies between NHS authorities, typically, patients above a certain Body Mass Index (BMI) and smokers are required to lose weight and quit smoking prior to being considered eligible for elective surgery. Patients will be supported and monitored throughout this mandatory period to ensure their clinical needs are appropriately met...
April 24, 2018: BMC Medical Ethics
https://www.readbyqxmd.com/read/29699001/national-implementation-of-multi-parametric-mri-for-prostate-cancer-detection-recommendations-from-a-uk-consensus-meeting
#20
REVIEW
Mrishta Brizmohun Appayya, Jim Adshead, Hashim U Ahmed, Clare Allen, Alan Bainbridge, Tristan Barrett, Francesco Giganti, John Graham, Phil Haslam, Edward W Johnston, Christof Kastner, Alexander P S Kirkham, Alexandra Lipton, Alan McNeill, Larissa Moniz, Caroline M Moore, Ghulam Nabi, Anwar R Padhani, Chris Parker, Amit Patel, Jacqueline Pursey, Jonathan Richenberg, John Staffurth, Jan van der Meulen, Darren Walls, Shonit Punwani
OBJECTIVES: To identify areas of agreement and disagreement in the implementation of multi-parametric MRI (mpMRI) of the prostate in the diagnostic pathway. MATERIALS AND METHODS: Fifteen UK experts in prostate mpMRI and/or prostate cancer management across the UK (involving 9 NHS centres to provide for geographical spread) participated in a consensus meeting following the UCLA-RAND Appropriateness Method, and were moderated by an independent chair. The experts considered 354 items pertaining to who can request an mpMRI, prostate mpMRI protocol, reporting guidelines, training, quality assurance (QA) and patient management based on mpMRI levels of suspicion for cancer...
April 26, 2018: BJU International
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