Post 18: 10 February 2006
Links are given to online full text resources, all other materials can be obtained via the Fade Library, just mail your request to library.services@fade.nhs.uk
Latest Reports
Department of Health (2006) Practice based commissioning: early wins and top tips. London: DoH.
These tips are based on the practical experience of those involved in setting up practice based commissioning. No doubt there will be others as more practices and other professionals develop expertise. Nonetheless they are likely to be a useful "first base" checklist.
European Commission Health and Consumer Protection Directorate-General (2005) Improving the mental health of the population: Towards a strategy on mental health for the European Union. Brussels: EC.
The mental health of the European population is a resource for the attainment of some of the EU’s strategic policy objectives, such as to put Europe back on the path to long-term prosperity, to sustain Europe’s commitment to solidarity and social justice, and to bring tangible practical benefits to the quality of life for European citizens.
NICE (2006)Effective action briefing on breastfeeding - revised in the light of stakeholder comments - for final consultation. London: NICE.
NICE has issued draft evidence-based recommendations for promoting the initiation and continuation of breastfeeding, particularly among population groups where breastfeeding rates are low.
These draft recommendations focus on effective public health interventions that can help increase and maintain breastfeeding rates, and are intended to complement Chapter 5 (Infant Feeding) of the draft clinical guideline on routine postnatal care of recently delivered women and their babies.
Department of Health (2006) NHS Direct Commissioning Framework April 2006–March 2007
Guidance for Primary Care Trusts on Commissioning NHS Direct Services from April 2006. London: DoH.
Latest commissioning framework, which gives further guidance to PCTs in their role as commissioners of NHS Direct services. It covers the period 2006/07 only and replaces the second version of the framework which was published in March 2005.
Bell, D. and Bowes A. (2006) Financial care models in Scotland and the UK. York: Joseph Rowntree Foundation.
The University of Stirling has carried out research into the funding and operation of long-term care policy in Scotland with wider lessons for the UK as a whole, focusing particularly on the policy of free personal and nursing care. Financial care models in Scotland and the UK, published by the Joseph Rowntree Foundation (JRF):
assesses the practical problems encountered introducing the policy in Scotland, from
identifies key threats to the sustainability of the Scottish policy.
Commission for Social Care Inspection (2006) Handled with care: managing medication for residents of care homes and children's homes - a follow up study. London: Commission for Social Care Inspection.
Nearly half of all nursing and care homes fail to meet national minimum standards for how they manage residents' medicines, a new report 'Handled with Care' shows today. Often people are given the wrong medication, someone else’s medication, medication in the wrong doses, or no medication at all, the report finds. Staff are poorly trained and records are not kept properly. Over 5,000 out of 11,500 homes for older people and over 3,000 out of nearly 8,000 homes for younger adults fail to meet national minimum standards. Around 210,000 people live in these 8,000 nursing and care homes
The Social Enterprise Coalition (2006) More for your money – a guide to procuring from social enterprises for the NHS has. London: The Social Enterprise Coalition.
The Social Enterprise Coalition (SEC), in partnership with the NHS Purchasing and Supply Agency (PASA), has published More for your money - a guide to procuring from social enterprises for the NHS, a short guide to achieving better outcomes from NHS procurement and how social enterprises can help in achieving this. The guide explains why the NHS should consider buying goods and services from a social enterprise and what it can do to encourage social enterprises to successfully compete for contracts.
King's Fund (2006) Where the Patient was King? A study of patient choice and its effect on five specialist HIV units in London. London: King's Fund.
Patient choice has been central to the government’s recent NHS reforms, along with a new payment system that rewards hospitals that are attractive to patients. But will these reforms make services more responsive? In the treatment of HIV and AIDS, patients have always had a choice of which hospital to go to. This paper explores the impact of patient choice on services in this area.
Audit Commission (2006) Public Interest Report and Referral to the Secretary of State Cheshire West Primary Care Trust. London: Audit Commission.
As external auditors of Cheshire West PCT, it is our professional opinion that the financial standing problems of Cheshire West PCT should be reported to the public under section 8 of the Audit Commission Act 1998.
House of Commons Health Committee ( 2006)NHS Charges: Third Report of Session 2005–06
Volume II: Written evidence. London: TSO.
When the National Health Service was established in July 1948 the principle was to provide healthcare for all based on need, not on the ability to pay, except where regulations provide otherwise. Initially, the prescription charge was introduced in 1952 based on a charge per form. In 1956 a charge per item prescribed was introduced. The charge was abolished in 1965 and re-introduced in 1968. The categories of exemption are fundamentally unchanged since their introduction in 1968.
Audit Commission (2006) NFI matters: An update on the Audit Commission’s National Fraud Initiative. London: Audit Commission.
In 2004/05, we ran a series of pilots to test the benefit of adding specific new data
matching areas to the NFI portfolio. These were payments to creditors, serial insurance claimants, abuse of blue badges and overpayments to care homes. These pilots have brought some great results, including a number of successful prosecutions as well as the recovery of overpayments.
Evidence from Journals
Latest Questions to the Primary Care Question Answering Service
ASSESSMENT AND DIAGNOSIS
What is the likely cause of a lady in mid 20s with fever, headaches, vomiting, general aching, swollen hands and feet who 2-3 days later starts skin peeling?
Is lamotrigine a liver enzyme inducer? ie would a woman on lamotrigine and an combined oral contraceptive pill need a 50 microgram pill?
What is the effect of anaemia on HbA1c? I have read conflicting evidence on this.
How do you estimate CVD risk in people already on antihypertensive and/or lipid lower therapy?
In patients with ulcerative colitis who are on long term mesalazine treatment, should renal function be checked on a regular basis?
Is isolated vertigo a common presentation of stroke in an elderly patient with cardiovascular risk factors? The patient was diagnosed with acute labyrinthitis, should we have been more reluctant to accept a diagnosis of labyrinthitis in such a case?
I am trying to find out some information on how to interpret the results of a Protein Creatinine Index (PCI) to assess proteinuria
CARDIOVASCULAR DISEASE
Is there any evidence that one statin is better than another statin at lowering triglycerides in a patient with high cholesterol (patients cholesterol is now under control but triglycerides remain high)
In people with hypertension will eating 5 fruit and vegetables a day be more effective at reducing blood pressure than taking anti-hypertensives alone?
CAUSES, RISKS AND PREVENTION
What is the recommended regime for routine immunisation af a)adolescents and b) adults whose previous immunisation history is unknown and unobtainable.
What are the causes of a black tongue in a 10 w old baby?
How suitable is Topiramate for Juvenile Myoclonic Epilepsy in a 15yr old girl and if they experience sided effects in the first 3 weeks of taking in it will these subside or are they likely to remain or worsen?
GASTROENTEROLOGY
Are there any other treatment options for intractable pruritus ani for which bland ointments etc have not helped. I once read something about capsaicin cream. Is there any evidence for this?
EAR, NOSE AND THROAT
In a 45 yr old man with post nasal drip, what is the most effective treatment to reduce symptoms? What alternatives are there?
MUSCULOSKELETAL DISEASES
A lady with terrible restless legs and a low ferritin of 7.5 (ref range 12-230) but a normal Hb. is it worth putting her on iron?
Hitting the Headlines - Evidence Behind the Press Stories
Possible new bird flu vaccine
A new vaccine against bird flu has been developed, reported six newspapers (2nd Feb 2006)(1-6). The reports were based on laboratory studies where a new vaccine had provided protection in mice. Two newspaper articles omitted to mention that it may be several years before a vaccine is available for human use (1,2).
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Hope that a new bird flu vaccine had been developed was reported in six newspapers (1-6). Four reported that unlike conventional vaccines, this one could be stockpiled (3-6).
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The newspaper reports were based on a series of experimental studies which tested a vaccine genetically engineered from the common cold virus (7). The studies were carried out on mice and investigated the ability of the vaccine to protect the mice from three variations of the H5N1 type of avian influenza infection, isolated from people. The researchers also looked at the method of delivery of the vaccine and its ability to produce T cells which fight infections.
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The researchers' findings appear to follow from the results of the experiments. However, as stated in four of the newspapers, further development work and eventually trials in human volunteers are required before such a vaccine is made generally available.
Evaluation of the evidence base for adenoviral-vector-based influenza vaccine against H5N1 strains in mice
Where does the evidence come from?
The research was conducted by Mary A Hoelscher and colleagues at the Influenza Branch, Division of Rickettsial and Viral Diseases, Centers for Disease Control and Prevention, Atlanta USA, and the Department of Veterinary Pathobiology, Purdue University, USA.
What were the authors' objectives?
To develop an influenza vaccine and to assess the immunogenicity and efficacy of the vaccine to confer protection in BALB/c mice.
What was the nature of the evidence?
The researchers developed a vaccine by genetically engineering a common cold virus to produce the protein haemugglutinin subtype 5(H5HA), a component of the H5N1 avian influenza virus. Controlled trials of the vaccine were then carried out on mice in a laboratory.
What interventions were examined in the research?
In a series of laboratory experiments, groups of mice were vaccinated with HAd-H5HA, HAd-deltaE1E3, or rH5HA either in the presence or absence of 1% alum adjuvant. The control groups of mice received phosphate-buffered saline. Two doses of vaccine were given four weeks apart. Four weeks later all the mice were infected with a lethal for mice dose of the H5N1 HK/483/97 virus. The mice were monitored for clinical signs and bodyweight changes for 14 days. Further similar experiments were conducted to test more recent strains of the H5N1 virus isolated from people (eg HK/213/03) and investigate the route of immunisation (intramuscular or intranasal). The researchers used a further trial to determine whether the vaccine induced functional CD 8 T cells in mice, as these cells have been shown to contribute to viral clearance.
What were the findings?
HAd-H5HA and rH5HA plus alum produced better protective effect than the interventions used in the other groups against HK/156/97 virus. However, HAd-H5HA was the most effective against the two other virus strains tested. Overall, intramuscular delivery of HAd-H5HA vaccine induced consistently higher responses than intranasal delivery. Mice that received the HAd-H5HA vaccine had a three to eight fold higher frequency of CD8 T cells compared to the other groups.
What were the authors' conclusions?
That BALB/c mice immunised with HAd-H5HA vaccine were effectively protected from H5N1 disease. The authors also said the findings highlight the potential of an Ad-vector-based delivery system which offers stockpiling options for the development of a pandemic influenza vaccine.
How reliable are the conclusions?
As the studies are laboratory studies no formal assessment of the reliability of the authors' conclusions has been made. However, they would appear to be reasonable, given that the authors word their discussion in terms of what the research could 'potentially' lead to. Clearly further development work and eventually trials in human volunteers are required before such a vaccine becomes widely available.
Systematic reviews
Information staff at CRD searched for systematic reviews relevant to this topic. Systematic reviews are valuable sources of evidence as they locate, appraise and synthesize all available evidence on a particular topic.
There were no related systematic reviews identified on the Cochrane Database of Systematic Reviews (CDSR) or on the Database of Abstracts of Reviews of Effects (DARE).
References and resources
1. GM vaccine raises hopes of beating bird flu. The Guardian, 2 February 2006, p7.
2. Common cold cure for bird flu. Daily Mirror, 2 February 2006, p11.
3. New bird flu vaccine may be key to preventing pandemic. The Times, 2 February 2006, p8.
4. Cold virus link for bird flu vaccine. The Daily Telegraph, 2 February 2006, p13.
5. Vaccine hope on bird flu. The Sun, 2 February 2006, p27.
6. Scientists create a new bird flu vaccine. Daily Mail, 2 February 2006, p35.
Consumer information
Health Protection Agency - Influenza
Science and development network - Bird flu: the facts
Previous Hitting the Headlines summaries on this topic
Antiviral treatment for avian flu. Hitting the Headlines archive, 19 January 2006.
'New drug promises to hit flu where it hurts'. Hitting the Headlines archive, 23 January 2003.
Drug stops flu's spread through families. Hitting the Headlines archive, 14 February 2001.
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