KNOWLEDGE ALERT Date: 12th August 2016

This bulletin highlights recently produced documents and items of interest that have appeared on websites (coverage may not be comprehensive). If you have any comments or suggestions regarding this Bulletin, please email the library library@sthk.nhs.uk. All links are correct at time of publishing. If a link is broken please email the library and we will send you the correct link/document. Some documents are large and may take time to open so please be patient when waiting for links to open. If you have received this bulletin from a third party and would like to receive it direct please email the library. Library Contact Details: Library and Knowledge Service, St Helens & Knowsley Health Informatics, Level 1 Nightingale House, Whiston Hospital, Warrington Road, Prescot, Merseyside L35 5DR www.knowledge-nw.nhs.uk

CONTENTS:

ANAESTHESIA CANCER CARDIOLOGY CHILDREN & YOUNG PEOPLE COMMISSIONING DERMATOLOGY DIABETES DIAGNOSTICS EDUCATION & TRAINING EMERGENCY MEDICINE/CRITICAL CARE GENERAL MEDICINE GENERAL PRACTICE AND PRACTICE MANAGEMENT GENERAL SURGERY HEALTH SERVICES MANAGEMENT IMMUNISATION INFECTION CONTROL AND INFECTIOUS DISEASES MATERNITY & GYNAECOLOGY MEDICINES MANAGEMENT/PHARMACY MENTAL HEALTH AND WELLBEING NEUROLOGY NURSING PRACTICE OLDER PEOPLE OPHTHALMOLOGY PATHOLOGY PUBLIC HEALTH/HEALTH IMPROVEMENT RHEUMATOLOGY SAFEGUARDING UROLOGY

ANAESTHESIA Anaesthetic Assessors for Mothers and Babies: Reducing Risk through Audits and Confidential Enquiries across the UK (MBRRACE-UK) Confidential Enquiries into Maternal Deaths The Royal College of Anaesthetists (RCoA) and Obstetric Anaesthetists’ Association (OAA) are seeking to appoint new anaesthetic assessors for the MBRRACE-UK Confidential Enquiries into Maternal Deaths. In the first instance we are seeking to appoint five national assessors to replace existing assessors who have come to the end of their term. Further information: http://www.rcoa.ac.uk/news-and-bulletin/rcoa-news-and-statements/anaesthetic-assessors-mbrrace-uk-confidential-enquiries

CANCER Nivolumab in renal cell cancer: Indication of added benefit Patients with advanced renal cell cancer have weaker symptoms and side effects and patients with an unfavourable prognosis survive longer using Nivolumab than those receiving the comparator therapy. News: https://www.sciencedaily.com/releases/2016/08/160810104242.htm Hospitalization risks for patients with diabetes and solid-organ malignancy New research suggests diabetes increases the risk of hospitalization for patients suffering solid-organ malignancy and highlights a need for further understanding of the mechanisms and economic implications. News: https://www.sciencedaily.com/releases/2016/08/160810104406.htm Abstract: http://www.future-science.com/doi/abs/10.4155/fsoa-2016-0020 Full text article (PDF): http://www.future-science.com/doi/pdfplus/10.4155/fsoa-2016-0020 Research reveals insights into genetics behind common blood cancer Scientists have identified how an inherited genetic variant, associated with an increased risk of developing the most common type of leukaemia, helps cancer cells survive. The findings could lead to new ways to target the disease. News: http://www.icr.ac.uk/news-archive/research-reveals-insights-into-genetics-behind-common-blood-cancer Abstract: http://www.cell.com/cell-reports/abstract/S2211-1247(16)30984-6 Full text article (PDF): http://www.cell.com/cell-reports/pdfExtended/S2211-1247(16)30984-6

CARDIOLOGY Blood pressure variability and cardiovascular disease: systematic review and meta-analysis The authors concluded that long term variability in blood pressure is associated with cardiovascular and mortality outcomes, over and above the effect of mean blood pressure. Associations are similar in magnitude to those of cholesterol measures with cardiovascular disease. Limited data for mid-term and short term variability showed similar associations. Systematic review: http://www.bmj.com/content/354/bmj.i4098 Lipid Screening in Childhood and Adolescence for Detection of Familial Hypercholesterolemia Evidence Report and Systematic Review for the US Preventive Services Task Force This review found that screening can detect familial hypercholesterolemia (FH) in children, and lipid-lowering treatment in childhood can reduce lipid concentrations in the short term, with little evidence of harm. There is no evidence for the effect of screening for FH in childhood on lipid concentrations or cardiovascular outcomes in adulthood, or on the long-term benefits or harms of beginning lipid-lowering treatment in childhood. Systematic review: http://jama.jamanetwork.com/article.aspx?articleid=2542641 Lipid Screening in Childhood and Adolescence for Detection of Multifactorial Dyslipidemia Evidence Report and Systematic Review for the US Preventive Services Task Force This review found that the diagnostic yield of lipid screening varies by age and body mass index. No direct evidence was identified for benefits or harms of childhood screening or treatment on outcomes in adulthood. Intensive dietary interventions may be safe, with modest short-term benefit of uncertain clinical significance. Systematic review: http://jama.jamanetwork.com/article.aspx?articleid=2542640

CONSULTATION: Cardiovascular events (reducing, high risk) - ticagrelor [ID813]: Appraisal consultation This document summarises the evidence and views that have been considered, and sets out the recommendations made by the National Institute for Health and Care Excellence (NICE) Appraisal Committee. Consultation: https://www.nice.org.uk/guidance/indevelopment/gid-ta10016/consultation/html-content Associations of retinal artery occlusion and retinal vein occlusion to mortality, stroke, and myocardial infarction: a systematic review The authors of this review concluded that there is a positive association of retinal vascular events to mortality, stroke, and myocardial infarction (MI). Retinal artery occlusion (RAO) is associated with a higher risk of stroke. Given that RAO and retinal vein occlusion (RVO) patients would generally present to ophthalmologists, their high cardiovascular risk should include a referral for cardiovascular assessment as part of their management protocol. Systematic review: http://www.nature.com/eye/journal/v30/n8/abs/eye2016111a.html

CHILDREN & YOUNG PEOPLE Oral immunotherapy is safe, effective for peanut-allergic preschoolers, study suggests Nearly 80 percent of peanut-allergic preschool children successfully incorporated peanut-containing foods into their diets after receiving peanut oral immunotherapy (OIT), a clinical trial has found. Low-dose and high-dose OIT were safe and equally effective at suppressing allergic immune responses to peanut, investigators found. News: https://www.sciencedaily.com/releases/2016/08/160810104017.htm Abstract: http://www.jacionline.org/article/S0091-6749(16)30531-0/abstract Distraction in action Researchers have developed an app that parents can access via their mobile, table or computer that can be used to distract children during painful medical procedures. Further information: https://now.uiowa.edu/2016/08/distraction-action Is depression in parents, grandparents linked to grandchildren's depression? Having both parents and grandparents with major depressive disorder (MDD) was associated with higher risk of MDD for grandchildren, which could help identify those who may benefit from early intervention, according to a study. News: https://www.sciencedaily.com/releases/2016/08/160810113654.htm Abstract: https://archpsyc.jamanetwork.com/article.aspx?articleid=2542680 New, improved guidelines for diagnosing foetal alcohol spectrum disorder (FASD) A group of experts has produced proposed clinical guidelines for diagnosing FASD. The proposed guidelines include a new definition of documented prenatal alcohol exposure, guides to evaluating facial and physical deformities characteristic of FASD, and updated information about the cognitive and/or behavioural impairments seen in different FASD subtypes. News: https://www.sciencedaily.com/releases/2016/08/160810181031.htm Abstract: http://pediatrics.aappublications.org/content/138/2/e20154256.abstract

COMMISSIONING Residents in Millom Will Receive Community Support Thanks To New Initiative CHAIN is a cost free service that coordinates volunteers to help other residents with anything from mowing a lawn to doing their shopping. Short for Community Help and Information Network and created by Better Care Together and Millom Health Action Group the overall aim of CHAIN is to help individuals stay in their own homes for longer, improve their health and wellbeing and reduce social isolation. Further information: http://fabnhsstuff.net/2016/08/10/residents-millom-will-receive-community-support-thanks-new-initiative/ IV treatment for osteoporosis

Principia MCP Vanguard in Rushcliffe, South Nottinghamshire has commissioned a community Fracture Liaison Service to work in conjunction with an established acute Fracture Liaison Service. This new community service identifies patients with first/secondary low-trauma hip and fragility fractures in order to provide intravenous treatments in the community, reducing the number of IV treatments provided in hospital or by out-sourced services, outpatient clinic follow-ups and the associated costs and inconvenience of travel. Further information: http://fabnhsstuff.net/2016/08/10/richards-story-iv-treatment-osteoporosis/ EVENT: Implementing Better Births: Transforming Midwifery Services to Improve Quality, Safety and Choice This timely symposium provides an invaluable opportunity for all practitioners working in midwifery and maternity services, to explore how to achieve the aims set out in the Maternity Review to ensure consistent improvements in midwifery services across England in the coming years. Further information: http://www.publicpolicyexchange.co.uk/events/GJ12-PPE3 CONSULTATION: End of life care for adults in the last year of life: service delivery: call for evidence The National Institute for Health and Care Excellence (NICE) have issued a call for evidence for this guidance which they are developing. They are particularly interested in information promoting equality of opportunity relating to age, disability, gender, gender identity, ethnicity, religion and belief, sexual orientation or socio-economic status. Consultation: https://www.nice.org.uk/guidance/indevelopment/GID-CGWAVE0799/consultation/html-content-3 Improvement directory (Updated) The directory has been updated with a range of new resources, including Beautiful Information, cases studies from the Richmond Group, National Joint Registry (NJR) and a perinatal mental health toolkit from the Royal College of General Practitioners (RCGP). Resource: https://improvement.nhs.uk/resources/improvement-directory/ Delayed Discharges and Hospital Type: Evidence from the English NHS Delayed discharges of patients from hospital, commonly known as bed-blocking, is a long standing policy concern. The authors of this Centre for Health Economics (CHE) research report found that hospitals which are Foundation Trusts have fewer delayed discharges and might therefore be used as exemplars of good practice in managing delays. Mental Health Trusts have more delayed discharges than Acute Trusts but a smaller proportion of them are attributed to the NHS, possibly indicating a relatively greater lack of adequate community care for mental health patients. Report: http://www.york.ac.uk/che/news/2016/che-research-paper-133/ EVENT: Successful change agents This one-day workshop is for managers undergoing and supporting staff through change programmes. The content explores the merits of different approaches to implementing change and an understanding of the role and skills of an effective change agent. Birmingham: https://www.pccevents.co.uk/pcc/frontend/reg/thome.csp?pageID=757291&eventID=1444 Leeds: https://www.pccevents.co.uk/pcc/frontend/reg/thome.csp?pageID=757711&eventID=1445 Syndromic surveillance summary: 11th August 2016 week 31 This weekly summary highlights changes in the number of people visiting GPs, going to emergency departments, and calling NHS 111. It will help GPs and other public health professionals identify trends and prepare for public health threats, like high levels of flu or heat-related illnesses. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545214/PHESyndromicSurveillanceSummary2016Week31.pdf Previous bulletins: https://www.gov.uk/government/publications/syndromic-surveillance-summary Emergency department bulletin: 11th August 2016 week 31 The Emergency Department Syndromic Surveillance System (EDSSS) monitors the patient attendances each day, and what symptoms patients have, in a network of emergency departments across England and Northern Ireland. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545226/EDSSSBulletin2016wk31.pdf

Previous bulletins: https://www.gov.uk/government/publications/emergency-department-bulletin Remote health advice: 11th August 2016 week 31 Monitoring patterns in phone calls to the NHS 111 service each day across England, to track the spread of infectious diseases like flu and norovirus. These data provide early warning of community-based infectious diseases. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545217/PHE_Remote_Health_Advice_Weekly_Bulletin_2016_Week_31.pdf Previous bulletins: https://www.gov.uk/government/publications/remote-health-advice-bulletin GP out-of-hours consultations bulletin: 11th August 2016 week 31 Monitoring the number of people contacting their GPs outside of surgery hours. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545221/GPOOHSSEngBulletin2016Wk31.pdf Previous bulletins: https://www.gov.uk/government/publications/gp-out-of-hours-syndromic-surveillance-bulletin GP in-hours consultations bulletin: 11th August 2016 week 31 Monitoring the number of visits to GPs during regular surgery hours for important clinical indicators. This system reports daily, and covers over 55% of England’s population. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545218/GPinHoursEngBulletin2016Wk31.pdf Previous bulletins: https://www.gov.uk/government/publications/gp-in-hours-bulletin

DERMATOLOGY Combining biologic and phototherapy treatments for moderate-to-severe psoriasis Although the efficacy and safety of biologic and phototherapeutic treatments in treating moderate-to-severe psoriasis are well known, not all patients respond well to monotherapy and may require a combination of both types of therapy. There have been few studies investigating the safety and efficacy of combination treatment; now, a review shows that combination treatment is safe and viable. News: https://www.sciencedaily.com/releases/2016/08/160810104414.htm Abstract: https://www.dovepress.com/combining-biologic-and-phototherapy-treatments-for-psoriasis-safety-ef-peer-reviewed-article-PTT Full text article (PDF): https://www.dovepress.com/getfile.php?fileID=31615

DIABETES Hospitalization risks for patients with diabetes and solid-organ malignancy New research suggests diabetes increases the risk of hospitalization for patients suffering solid-organ malignancy and highlights a need for further understanding of the mechanisms and economic implications. News: https://www.sciencedaily.com/releases/2016/08/160810104406.htm Abstract: http://www.future-science.com/doi/abs/10.4155/fsoa-2016-0020 Full text article (PDF): http://www.future-science.com/doi/pdfplus/10.4155/fsoa-2016-0020

DIAGNOSTICS Lancaster helps develop revolutionary rapid blood-testing technology A portable bedside blood diagnostics device is the focus of a collaborative research project that promises to improve healthcare treatments for cancer patients, post-operative care and monitor the health of babies in the womb. News: http://www.alphagalileo.org/ViewItem.aspx?ItemId=166930&CultureCode=en Diagnoses: When are several opinions better than one?

A new study has shed new light on how medical diagnostics can be boosted by obtaining several independent judgements. The researchers also found that the group composition is decisive for the quality of the diagnosis. News: https://www.sciencedaily.com/releases/2016/08/160810113702.htm Abstract: http://www.pnas.org/content/113/31/8777.abstract Full text article (PDF): http://www.pnas.org/content/113/31/8777.full.pdf?with-ds=yes

EDUCATION & TRAINING Virtual reality in surgery - a coaching tool for trainees? Blog from: Ossama Al-Obaedi, who has just begun his orthopaedic themed core surgical training program in the West Midlands Deanery. Blog: http://blogs.bmj.com/bmj/2016/08/11/ossama-al-obaedi-virtual-reality-in-surgery-a-coaching-tool-for-trainees/

EMERGENCY MEDICINE/CRITICAL CARE Syndromic surveillance summary: 11th August 2016 week 31 This weekly summary highlights changes in the number of people visiting GPs, going to emergency departments, and calling NHS 111. It will help GPs and other public health professionals identify trends and prepare for public health threats, like high levels of flu or heat-related illnesses. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545214/PHESyndromicSurveillanceSummary2016Week31.pdf Previous bulletins: https://www.gov.uk/government/publications/syndromic-surveillance-summary Emergency department bulletin: 11th August 2016 week 31 The Emergency Department Syndromic Surveillance System (EDSSS) monitors the patient attendances each day, and what symptoms patients have, in a network of emergency departments across England and Northern Ireland. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545226/EDSSSBulletin2016wk31.pdf Previous bulletins: https://www.gov.uk/government/publications/emergency-department-bulletin New hope for shock patients in intensive care Care for critically-ill patients with shock could be improved, it is hoped, after the first successful testing of a new machine to record oxygen consumption in real time. The new device combines laser spectroscopy and precise flow measurement of breath in a single medical device which fits into a standard ventilation tube. News: https://www.sciencedaily.com/releases/2016/08/160810180653.htm Abstract: http://advances.sciencemag.org/content/2/8/e1600560.abstract Full text article (PDF): http://advances.sciencemag.org/content/advances/2/8/e1600560.full.pdf

GENERAL MEDICINE Oral immunotherapy is safe, effective for peanut-allergic preschoolers, study suggests Nearly 80 percent of peanut-allergic preschool children successfully incorporated peanut-containing foods into their diets after receiving peanut oral immunotherapy (OIT), a clinical trial has found. Low-dose and high-dose OIT were safe and equally effective at suppressing allergic immune responses to peanut, investigators found. News: https://www.sciencedaily.com/releases/2016/08/160810104017.htm Abstract: http://www.jacionline.org/article/S0091-6749(16)30531-0/abstract Diagnoses: When are several opinions better than one? A new study has shed new light on how medical diagnostics can be boosted by obtaining several independent judgements. The researchers also found that the group composition is decisive for the quality of the diagnosis. News: https://www.sciencedaily.com/releases/2016/08/160810113702.htm Abstract: http://www.pnas.org/content/113/31/8777.abstract Full text article (PDF): http://www.pnas.org/content/113/31/8777.full.pdf?with-ds=yes

Alcohol, drugs and the workplace – The role of medical professionals: A briefing from the British Medical Association (BMA) Occupational Medicine Committee This guidance has been updated and chapter 9 (Occupational health support for job applicants) added in response to a Department for Work and Pensions review into how best to support benefit claimants with addictions and potentially treatable conditions back into work. While aimed primarily at medical professionals, this booklet may also assist other health care professionals, managers, human resources specialists and employee representatives. Guidance: https://www.bma.org.uk/-/media/files/pdfs/practical%20advice%20at%20work/contracts/occupational%20health/alcohol%20and%20drugs%20in%20the%20workplace%20july%202016%20final.pdf?la=en Further information: https://www.bma.org.uk/advice/employment/occupational-health/alcohol-drugs-and-the-workplace News: http://www.alcoholpolicy.net/2016/08/alcohol-drugs-and-the-workplace-bma-guidance.html Leaving the European Union: What Needs to Happen to Maintain the Quality and Standards of Healthcare in the UK Following consultation with its member organisations the Academy of Medical Royal Colleges has agreed a set of principles that should be followed to maintain quality and standards in the NHS and healthcare following the decision to leave the EU. The paper also raises specific issues that will need to be addressed by Government or other national bodies in negotiations on withdrawal from the EU. Paper: http://www.aomrc.org.uk/wp-content/uploads/2016/07/2016-07-20_EU_Requirements_Paper-5.pdf News: http://www.aomrc.org.uk/news-and-views/maintaining-quality-standards-healthcare-uk-leaving-eu/ Junior doctors call for ‘escalated’ industrial action Junior doctors in England will take ‘escalated’ industrial action if the Government refuses to address concerns over patient safety and fairness in its proposed new contract. Yesterday, the BMA junior doctors committee called for an extraordinary council meeting to approve a rolling programme of industrial action in September. News: https://www.bma.org.uk/news/2016/august/junior-doctors-call-for-escalated-industrial-action How to define a junior doctor Blog from: Michael Moran, clinical lecturer and registrar in ENT surgery at University College London (UCL)/University College London Hospitals (UCLH), and is a member of the Royal College of Surgeons of Edinburgh Trainees’ Committee. Blog: http://blogs.bmj.com/bmj/2016/08/12/michael-moran-how-to-define-a-junior-doctor/ What to call junior doctors - a patient’s perspective Blog from: Rosamund Snow, patient editor, The BMJ. Blog: http://blogs.bmj.com/bmj/2016/08/12/rosamund-snow-what-to-call-junior-doctors-a-patients-perspective/

GENERAL PRACTICE AND PRACTICE MANAGEMENT Blood pressure variability and cardiovascular disease: systematic review and meta-analysis The authors concluded that long term variability in blood pressure is associated with cardiovascular and mortality outcomes, over and above the effect of mean blood pressure. Associations are similar in magnitude to those of cholesterol measures with cardiovascular disease. Limited data for mid-term and short term variability showed similar associations. Systematic review: http://www.bmj.com/content/354/bmj.i4098 Lipid Screening in Childhood and Adolescence for Detection of Familial Hypercholesterolemia Evidence Report and Systematic Review for the US Preventive Services Task Force This review found that screening can detect familial hypercholesterolemia (FH) in children, and lipid-lowering treatment in childhood can reduce lipid concentrations in the short term, with little evidence of harm. There is no evidence for the effect of screening for FH in childhood on lipid concentrations or cardiovascular outcomes in adulthood, or on the long-term benefits or harms of beginning lipid-lowering treatment in childhood. Systematic review: http://jama.jamanetwork.com/article.aspx?articleid=2542641

Lipid Screening in Childhood and Adolescence for Detection of Multifactorial Dyslipidemia Evidence Report and Systematic Review for the US Preventive Services Task Force This review found that the diagnostic yield of lipid screening varies by age and body mass index. No direct evidence was identified for benefits or harms of childhood screening or treatment on outcomes in adulthood. Intensive dietary interventions may be safe, with modest short-term benefit of uncertain clinical significance. Systematic review: http://jama.jamanetwork.com/article.aspx?articleid=2542640 EVENT: Implementing Better Births: Transforming Midwifery Services to Improve Quality, Safety and Choice This timely symposium provides an invaluable opportunity for all practitioners working in midwifery and maternity services, to explore how to achieve the aims set out in the Maternity Review to ensure consistent improvements in midwifery services across England in the coming years. Further information: http://www.publicpolicyexchange.co.uk/events/GJ12-PPE3 Mind finds ‘Worrying’ levels of stress among primary care staff Mind has released research revealing that almost nine in ten (88%) primary care workers find their work life stressful, significantly higher than the wider UK workforce (56%). The poll of over 1,000 NHS workers in primary care, including GPs, practice nurses, practice managers and their colleagues, also showed that work is currently the most stressful area of their lives, ahead of their finances, health, family life and relationships. News: http://www.mind.org.uk/news-campaigns/news/mind-finds-worrying-levels-of-stress-among-primary-care-staff/#.V62J100rLcs Syndromic surveillance summary: 11th August 2016 week 31 This weekly summary highlights changes in the number of people visiting GPs, going to emergency departments, and calling NHS 111. It will help GPs and other public health professionals identify trends and prepare for public health threats, like high levels of flu or heat-related illnesses. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545214/PHESyndromicSurveillanceSummary2016Week31.pdf Previous bulletins: https://www.gov.uk/government/publications/syndromic-surveillance-summary Remote health advice: 11th August 2016 week 31 Monitoring patterns in phone calls to the NHS 111 service each day across England, to track the spread of infectious diseases like flu and norovirus. These data provide early warning of community-based infectious diseases. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545217/PHE_Remote_Health_Advice_Weekly_Bulletin_2016_Week_31.pdf Previous bulletins: https://www.gov.uk/government/publications/remote-health-advice-bulletin GP out-of-hours consultations bulletin: 11th August 2016 week 31 Monitoring the number of people contacting their GPs outside of surgery hours. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545221/GPOOHSSEngBulletin2016Wk31.pdf Previous bulletins: https://www.gov.uk/government/publications/gp-out-of-hours-syndromic-surveillance-bulletin GP in-hours consultations bulletin: 11th August 2016 week 31 Monitoring the number of visits to GPs during regular surgery hours for important clinical indicators. This system reports daily, and covers over 55% of England’s population. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545218/GPinHoursEngBulletin2016Wk31.pdf Previous bulletins: https://www.gov.uk/government/publications/gp-in-hours-bulletin Oral immunotherapy is safe, effective for peanut-allergic preschoolers, study suggests Nearly 80 percent of peanut-allergic preschool children successfully incorporated peanut-containing foods into their diets after receiving peanut oral immunotherapy (OIT), a clinical trial has found. Low-dose and high-dose OIT were safe and equally effective at suppressing allergic immune responses to peanut, investigators found.

News: https://www.sciencedaily.com/releases/2016/08/160810104017.htm Abstract: http://www.jacionline.org/article/S0091-6749(16)30531-0/abstract Combining biologic and phototherapy treatments for moderate-to-severe psoriasis Although the efficacy and safety of biologic and phototherapeutic treatments in treating moderate-to-severe psoriasis are well known, not all patients respond well to monotherapy and may require a combination of both types of therapy. There have been few studies investigating the safety and efficacy of combination treatment; now, a review shows that combination treatment is safe and viable. News: https://www.sciencedaily.com/releases/2016/08/160810104414.htm Abstract: https://www.dovepress.com/combining-biologic-and-phototherapy-treatments-for-psoriasis-safety-ef-peer-reviewed-article-PTT Full text article (PDF): https://www.dovepress.com/getfile.php?fileID=31615 Distraction in action Researchers have developed an app that parents can access via their mobile, table or computer that can be used to distract children during painful medical procedures. Further information: https://now.uiowa.edu/2016/08/distraction-action Diagnoses: When are several opinions better than one? A new study has shed new light on how medical diagnostics can be boosted by obtaining several independent judgements. The researchers also found that the group composition is decisive for the quality of the diagnosis. News: https://www.sciencedaily.com/releases/2016/08/160810113702.htm Abstract: http://www.pnas.org/content/113/31/8777.abstract Full text article (PDF): http://www.pnas.org/content/113/31/8777.full.pdf?with-ds=yes Frozen embryos more effective than fresh in women with polycystic ovary syndrome Women with polycystic ovary syndrome (PCOS) who receive frozen embryos during in vitro fertilization have safer and more successful pregnancies than those who get fresh embryos, according to the results of a recent study. News: https://www.sciencedaily.com/releases/2016/08/160810174352.htm Abstract: http://www.nejm.org/doi/abstract/10.1056/NEJMoa1513873 Alcohol, drugs and the workplace – The role of medical professionals: A briefing from the British Medical Association (BMA) Occupational Medicine Committee This guidance has been updated and chapter 9 (Occupational health support for job applicants) added in response to a Department for Work and Pensions review into how best to support benefit claimants with addictions and potentially treatable conditions back into work. While aimed primarily at medical professionals, this booklet may also assist other health care professionals, managers, human resources specialists and employee representatives. Guidance: https://www.bma.org.uk/-/media/files/pdfs/practical%20advice%20at%20work/contracts/occupational%20health/alcohol%20and%20drugs%20in%20the%20workplace%20july%202016%20final.pdf?la=en Further information: https://www.bma.org.uk/advice/employment/occupational-health/alcohol-drugs-and-the-workplace News: http://www.alcoholpolicy.net/2016/08/alcohol-drugs-and-the-workplace-bma-guidance.html Making vulnerable practices resilient Primary Care Commissioning (PCC) is working with practices looking for support to make sustainable improvements to their finances, workforce and business processes. Further information: http://www.pcc-cic.org.uk/article/making-vulnerable-practices-resilient Leaving the European Union: What Needs to Happen to Maintain the Quality and Standards of Healthcare in the UK Following consultation with its member organisations the Academy of Medical Royal Colleges has agreed a set of principles that should be followed to maintain quality and standards in the NHS and healthcare following the decision to leave the EU. The paper also raises specific issues that will need to be addressed by Government or other national bodies in negotiations on withdrawal from the EU. Paper: http://www.aomrc.org.uk/wp-content/uploads/2016/07/2016-07-20_EU_Requirements_Paper-5.pdf News: http://www.aomrc.org.uk/news-and-views/maintaining-quality-standards-healthcare-uk-leaving-eu/

GENERAL SURGERY Virtual reality in surgery - a coaching tool for trainees? Blog from: Ossama Al-Obaedi, who has just begun his orthopaedic themed core surgical training program in the West Midlands Deanery. Blog: http://blogs.bmj.com/bmj/2016/08/11/ossama-al-obaedi-virtual-reality-in-surgery-a-coaching-tool-for-trainees/ Trajectory of functional recovery after postoperative delirium Delirium is a common, serious, often fatal disorder occurring in 11% to 50% of hospitalized older patients, although it is significantly underdiagnosed. Postoperative delirium negatively impacts recovery in older adults, new research confirms. News: https://www.sciencedaily.com/releases/2016/08/160810143657.htm Abstract: http://journals.lww.com/annalsofsurgery/Abstract/publishahead/Trajectory_of_Functional_Recovery_After.96463.aspx

HEALTH SERVICES MANAGEMENT IV treatment for osteoporosis Principia MCP Vanguard in Rushcliffe, South Nottinghamshire has commissioned a community Fracture Liaison Service to work in conjunction with an established acute Fracture Liaison Service. This new community service identifies patients with first/secondary low-trauma hip and fragility fractures in order to provide intravenous treatments in the community, reducing the number of IV treatments provided in hospital or by out-sourced services, outpatient clinic follow-ups and the associated costs and inconvenience of travel. Further information: http://fabnhsstuff.net/2016/08/10/richards-story-iv-treatment-osteoporosis/ EVENT: Implementing Better Births: Transforming Midwifery Services to Improve Quality, Safety and Choice This timely symposium provides an invaluable opportunity for all practitioners working in midwifery and maternity services, to explore how to achieve the aims set out in the Maternity Review to ensure consistent improvements in midwifery services across England in the coming years. Further information: http://www.publicpolicyexchange.co.uk/events/GJ12-PPE3 Give us the money News and Comment from Roy Lilley. Newsletter: http://campaign.r20.constantcontact.com/render?m=1102665899193&ca=80efe074-9e44-4c89-b139-da84d63c5491 CONSULTATION: End of life care for adults in the last year of life: service delivery: call for evidence The National Institute for Health and Care Excellence (NICE) have issued a call for evidence for this guidance which they are developing. They are particularly interested in information promoting equality of opportunity relating to age, disability, gender, gender identity, ethnicity, religion and belief, sexual orientation or socio-economic status. Consultation: https://www.nice.org.uk/guidance/indevelopment/GID-CGWAVE0799/consultation/html-content-3 Improvement directory (Updated) The directory has been updated with a range of new resources, including Beautiful Information, cases studies from the Richmond Group, National Joint Registry (NJR) and a perinatal mental health toolkit from the Royal College of General Practitioners (RCGP). Resource: https://improvement.nhs.uk/resources/improvement-directory/ Delayed Discharges and Hospital Type: Evidence from the English NHS Delayed discharges of patients from hospital, commonly known as bed-blocking, is a long standing policy concern. The authors of this Centre for Health Economics (CHE) research report found that hospitals which are Foundation Trusts have fewer delayed discharges and might therefore be used as exemplars of good practice in managing delays. Mental Health Trusts have more delayed discharges

than Acute Trusts but a smaller proportion of them are attributed to the NHS, possibly indicating a relatively greater lack of adequate community care for mental health patients. Report: http://www.york.ac.uk/che/news/2016/che-research-paper-133/ Syndromic surveillance summary: 11th August 2016 week 31 This weekly summary highlights changes in the number of people visiting GPs, going to emergency departments, and calling NHS 111. It will help GPs and other public health professionals identify trends and prepare for public health threats, like high levels of flu or heat-related illnesses. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545214/PHESyndromicSurveillanceSummary2016Week31.pdf Previous bulletins: https://www.gov.uk/government/publications/syndromic-surveillance-summary Emergency department bulletin: 11th August 2016 week 31 The Emergency Department Syndromic Surveillance System (EDSSS) monitors the patient attendances each day, and what symptoms patients have, in a network of emergency departments across England and Northern Ireland. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545226/EDSSSBulletin2016wk31.pdf Previous bulletins: https://www.gov.uk/government/publications/emergency-department-bulletin Remote health advice: 11th August 2016 week 31 Monitoring patterns in phone calls to the NHS 111 service each day across England, to track the spread of infectious diseases like flu and norovirus. These data provide early warning of community-based infectious diseases. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545217/PHE_Remote_Health_Advice_Weekly_Bulletin_2016_Week_31.pdf Previous bulletins: https://www.gov.uk/government/publications/remote-health-advice-bulletin SURVEY: Health Care Information Costing Systems (PLICS) The Burden Advice and Assessment team (BAAS) are evaluating an application to collect data for Health Care Information Costing Systems (PLICS). They would like you to let them know your views on this collection. This information will help them to provide accurate information as to the overall burden that will be imposed upon the NHS as a result of this data collection. Survey: https://hscic-standards.citizenspace.com/rocr/r01205-1/consult_view EVENT: Freedom to Speak Up (FTSU) Guardian workshops This series of eight workshops, developed by the National Guardian Office with Health Education England (HEE) and Public Concern at Work, are designed to help the FTSU Guardians understand more about the role and expectations. Further information: https://www.eventbrite.co.uk/e/freedom-to-speak-up-ftsu-guardian-workshops-tickets-26966962912 Creating Effective Hospital-Community Partnerships to Build a Culture of Health Effective and sustainable hospital-community partnerships are critical to building a Culture of Health. The partnerships can create a greater impact by aligning resources, knowledge, skills and expertise. This guide focuses on how hospitals and communities can develop and sustain partnerships in a way that will have an impact on the health of the community. Guide: http://www.hpoe.org/Reports-HPOE/2016/creating-effective-hospital-community-partnerships.pdf Further information: http://www.hpoe.org/resources/hpoehretaha-guides/2862 Regulating the duty of candour: A report by Action against Medical Accidents on Care Quality Commission (CQC) inspection reports and regulation of the duty of candour This report finds the inspections of 2015 were very inconsistent and often superficial in how they assessed compliance with the duty. It calls on the CQC to make urgent improvements to how it regulates the duty of candour and makes several recommendations to that end. Report: https://www.avma.org.uk/?download_protected_attachment=Regulating-the-duty-of-candour.pdf News: https://www.avma.org.uk/news/care-quality-commission-told-it-must-improve-on-duty-of-candour/

Alcohol, drugs and the workplace – The role of medical professionals: A briefing from the British Medical Association (BMA) Occupational Medicine Committee This guidance has been updated and chapter 9 (Occupational health support for job applicants) added in response to a Department for Work and Pensions review into how best to support benefit claimants with addictions and potentially treatable conditions back into work. While aimed primarily at medical professionals, this booklet may also assist other health care professionals, managers, human resources specialists and employee representatives. Guidance: https://www.bma.org.uk/-/media/files/pdfs/practical%20advice%20at%20work/contracts/occupational%20health/alcohol%20and%20drugs%20in%20the%20workplace%20july%202016%20final.pdf?la=en Further information: https://www.bma.org.uk/advice/employment/occupational-health/alcohol-drugs-and-the-workplace News: http://www.alcoholpolicy.net/2016/08/alcohol-drugs-and-the-workplace-bma-guidance.html Junior doctors call for ‘escalated’ industrial action Junior doctors in England will take ‘escalated’ industrial action if the Government refuses to address concerns over patient safety and fairness in its proposed new contract. Yesterday, the BMA junior doctors committee called for an extraordinary council meeting to approve a rolling programme of industrial action in September. News: https://www.bma.org.uk/news/2016/august/junior-doctors-call-for-escalated-industrial-action

IMMUNISATION Distraction in action Researchers have developed an app that parents can access via their mobile, table or computer that can be used to distract children during painful medical procedures. Further information: https://now.uiowa.edu/2016/08/distraction-action

INFECTION CONTROL AND INFECTIOUS DISEASES Syndromic surveillance summary: 11th August 2016 week 31 This weekly summary highlights changes in the number of people visiting GPs, going to emergency departments, and calling NHS 111. It will help GPs and other public health professionals identify trends and prepare for public health threats, like high levels of flu or heat-related illnesses. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545214/PHESyndromicSurveillanceSummary2016Week31.pdf Previous bulletins: https://www.gov.uk/government/publications/syndromic-surveillance-summary Remote health advice: 11th August 2016 week 31 Monitoring patterns in phone calls to the NHS 111 service each day across England, to track the spread of infectious diseases like flu and norovirus. These data provide early warning of community-based infectious diseases. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545217/PHE_Remote_Health_Advice_Weekly_Bulletin_2016_Week_31.pdf Previous bulletins: https://www.gov.uk/government/publications/remote-health-advice-bulletin Public Health England (PHE) Weekly National Norovirus and Rotavirus report for weeks 26 - 30 (11 August 2016) National report summarising laboratory surveillance of norovirus and rotavirus, including norovirus activity in prisons. Latest report: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/544894/Norovirus_update_2016_weeks_26_30.pdf Previous reports: https://www.gov.uk/government/statistics/norovirus-national-update Statutory notifications of infectious diseases (NOIDs) weekly report: week 31 (2016) Reports of suspected cases of notifiable illnesses in England and Wales. Latest report:

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/544903/NOIDs_weekly_report_week31_2016.pdf Previous reports: https://www.gov.uk/government/publications/notifiable-diseases-weekly-report-2016 Statutory notifiable diseases: cases reported in last 52 weeks (Updated) Notifications of infectious diseases (NOIDs) for the last 52 weeks. Added data for week 31 (2016). Latest data: https://www.gov.uk/government/publications/notifiable-diseases-last-52-weeks

MATERNITY & GYNAECOLOGY EVENT: Implementing Better Births: Transforming Midwifery Services to Improve Quality, Safety and Choice This timely symposium provides an invaluable opportunity for all practitioners working in midwifery and maternity services, to explore how to achieve the aims set out in the Maternity Review to ensure consistent improvements in midwifery services across England in the coming years. Further information: http://www.publicpolicyexchange.co.uk/events/GJ12-PPE3 Breastfeeding twice as likely after home births than hospital births There is a strong positive relationship between planned birth at home and breast feeding, research has found: breastfeeding was twice as likely after planned home births compared to hospital births. The research involved the largest population cohorts comprehensively examined to date for an association between breast feeding outcomes and place of birth in low risk pregnancies. News: https://www.sciencedaily.com/releases/2016/08/160810084628.htm Abstract: http://bmjopen.bmj.com/content/6/8/e010551.abstract Full text article (PDF): http://bmjopen.bmj.com/content/6/8/e010551.full.pdf+html Frozen embryos more effective than fresh in women with polycystic ovary syndrome Women with polycystic ovary syndrome (PCOS) who receive frozen embryos during in vitro fertilization have safer and more successful pregnancies than those who get fresh embryos, according to the results of a recent study. News: https://www.sciencedaily.com/releases/2016/08/160810174352.htm Abstract: http://www.nejm.org/doi/abstract/10.1056/NEJMoa1513873

MEDICINES MANAGEMENT/PHARMACY CONSULTATION: Cardiovascular events (reducing, high risk) - ticagrelor [ID813]: Appraisal consultation This document summarises the evidence and views that have been considered, and sets out the recommendations made by the National Institute for Health and Care Excellence (NICE) Appraisal Committee. Consultation: https://www.nice.org.uk/guidance/indevelopment/gid-ta10016/consultation/html-content Nivolumab in renal cell cancer: Indication of added benefit Patients with advanced renal cell cancer have weaker symptoms and side effects and patients with an unfavourable prognosis survive longer using Nivolumab than those receiving the comparator therapy. News: https://www.sciencedaily.com/releases/2016/08/160810104242.htm

MENTAL HEALTH AND WELLBEING Mind finds ‘Worrying’ levels of stress among primary care staff Mind has released research revealing that almost nine in ten (88%) primary care workers find their work life stressful, significantly higher than the wider UK workforce (56%). The poll of over 1,000 NHS workers in primary care, including GPs, practice nurses, practice managers and their colleagues, also showed that work is currently the most stressful area of their lives, ahead of their finances, health, family life and relationships. News: http://www.mind.org.uk/news-campaigns/news/mind-finds-worrying-levels-of-stress-among-primary-care-staff/#.V62J100rLcs

Is depression in parents, grandparents linked to grandchildren's depression? Having both parents and grandparents with major depressive disorder (MDD) was associated with higher risk of MDD for grandchildren, which could help identify those who may benefit from early intervention, according to a study. News: https://www.sciencedaily.com/releases/2016/08/160810113654.htm Abstract: https://archpsyc.jamanetwork.com/article.aspx?articleid=2542680 Gene patterns may explain brain's Alzheimer's vulnerability Behind the Headlines critiques a story that appears in the media. Further information: http://www.nhs.uk/news/2016/08August/Pages/Gene-patterns-may-explain-brains-Alzheimers-vulnerability.aspx

NEUROLOGY Treating at the earliest sign of MS may offer long-term benefit Starting medication for multiple sclerosis (MS) in people who show the beginning signs of the disease is associated with prolonging the time before the disease is definitively diagnosed, according to a long-term study. News: https://www.sciencedaily.com/releases/2016/08/160810174409.htm Abstract: http://www.neurology.org/content/early/2016/08/10/WNL.0000000000003078.abstract Full text article (PDF): http://www.neurology.org/content/early/2016/08/10/WNL.0000000000003078.full.pdf+html Gene patterns may explain brain's Alzheimer's vulnerability Behind the Headlines critiques a story that appears in the media. Further information: http://www.nhs.uk/news/2016/08August/Pages/Gene-patterns-may-explain-brains-Alzheimers-vulnerability.aspx

NURSING PRACTICE Mind finds ‘Worrying’ levels of stress among primary care staff Mind has released research revealing that almost nine in ten (88%) primary care workers find their work life stressful, significantly higher than the wider UK workforce (56%). The poll of over 1,000 NHS workers in primary care, including GPs, practice nurses, practice managers and their colleagues, also showed that work is currently the most stressful area of their lives, ahead of their finances, health, family life and relationships. News: http://www.mind.org.uk/news-campaigns/news/mind-finds-worrying-levels-of-stress-among-primary-care-staff/#.V62J100rLcs Journal of Clinical Nursing e-Magazine – August/September 2016 Latest issue. Bulletin: http://www.jcn.co.uk/enewsletter/browser_view.php?hash=58c035a400b2fb1945d59f2216052903

OLDER PEOPLE Residents in Millom Will Receive Community Support Thanks To New Initiative CHAIN is a cost free service that coordinates volunteers to help other residents with anything from mowing a lawn to doing their shopping. Short for Community Help and Information Network and created by Better Care Together and Millom Health Action Group the overall aim of CHAIN is to help individuals stay in their own homes for longer, improve their health and wellbeing and reduce social isolation. Further information: http://fabnhsstuff.net/2016/08/10/residents-millom-will-receive-community-support-thanks-new-initiative/

OPHTHALMOLOGY Associations of retinal artery occlusion and retinal vein occlusion to mortality, stroke, and myocardial infarction: a systematic review

The authors of this review concluded that there is a positive association of retinal vascular events to mortality, stroke, and myocardial infarction (MI). Retinal artery occlusion (RAO) is associated with a higher risk of stroke. Given that RAO and retinal vein occlusion (RVO) patients would generally present to ophthalmologists, their high cardiovascular risk should include a referral for cardiovascular assessment as part of their management protocol. Systematic review: http://www.nature.com/eye/journal/v30/n8/abs/eye2016111a.html

PATHOLOGY CONSULTATION: End of life care for adults in the last year of life: service delivery: call for evidence The National Institute for Health and Care Excellence (NICE) have issued a call for evidence for this guidance which they are developing. They are particularly interested in information promoting equality of opportunity relating to age, disability, gender, gender identity, ethnicity, religion and belief, sexual orientation or socio-economic status. Consultation: https://www.nice.org.uk/guidance/indevelopment/GID-CGWAVE0799/consultation/html-content-3 Public Health England (PHE) Weekly National Norovirus and Rotavirus report for weeks 26 - 30 (11 August 2016) National report summarising laboratory surveillance of norovirus and rotavirus, including norovirus activity in prisons. Latest report: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/544894/Norovirus_update_2016_weeks_26_30.pdf Previous reports: https://www.gov.uk/government/statistics/norovirus-national-update Lancaster helps develop revolutionary rapid blood-testing technology A portable bedside blood diagnostics device is the focus of a collaborative research project that promises to improve healthcare treatments for cancer patients, post-operative care and monitor the health of babies in the womb. News: http://www.alphagalileo.org/ViewItem.aspx?ItemId=166930&CultureCode=en Research reveals insights into genetics behind common blood cancer Scientists have identified how an inherited genetic variant, associated with an increased risk of developing the most common type of leukaemia, helps cancer cells survive. The findings could lead to new ways to target the disease. News: http://www.icr.ac.uk/news-archive/research-reveals-insights-into-genetics-behind-common-blood-cancer Abstract: http://www.cell.com/cell-reports/abstract/S2211-1247(16)30984-6 Full text article (PDF): http://www.cell.com/cell-reports/pdfExtended/S2211-1247(16)30984-6 Two Zika proteins responsible for microcephaly identified Researchers have tracked down two Zika proteins potentially responsible for thousands of microcephaly cases in Brazil and elsewhere -- taking one small step toward preventing Zika-infected mothers from birthing babies with abnormally small heads. News: https://www.sciencedaily.com/releases/2016/08/160811131554.htm Abstract: http://www.cell.com/cell-stem-cell/abstract/S1934-5909(16)30214-4 Full text article (PDF): http://www.cell.com/cell-stem-cell/pdfExtended/S1934-5909(16)30214-4

PUBLIC HEALTH/HEALTH IMPROVEMENT Residents in Millom Will Receive Community Support Thanks To New Initiative CHAIN is a cost free service that coordinates volunteers to help other residents with anything from mowing a lawn to doing their shopping. Short for Community Help and Information Network and created by Better Care Together and Millom Health Action Group the overall aim of CHAIN is to help individuals stay in their own homes for longer, improve their health and wellbeing and reduce social isolation. Further information: http://fabnhsstuff.net/2016/08/10/residents-millom-will-receive-community-support-thanks-new-initiative/

Lipid Screening in Childhood and Adolescence for Detection of Familial Hypercholesterolemia Evidence Report and Systematic Review for the US Preventive Services Task Force This review found that screening can detect familial hypercholesterolemia (FH) in children, and lipid-lowering treatment in childhood can reduce lipid concentrations in the short term, with little evidence of harm. There is no evidence for the effect of screening for FH in childhood on lipid concentrations or cardiovascular outcomes in adulthood, or on the long-term benefits or harms of beginning lipid-lowering treatment in childhood. Systematic review: http://jama.jamanetwork.com/article.aspx?articleid=2542641 Lipid Screening in Childhood and Adolescence for Detection of Multifactorial Dyslipidemia Evidence Report and Systematic Review for the US Preventive Services Task Force This review found that the diagnostic yield of lipid screening varies by age and body mass index. No direct evidence was identified for benefits or harms of childhood screening or treatment on outcomes in adulthood. Intensive dietary interventions may be safe, with modest short-term benefit of uncertain clinical significance. Systematic review: http://jama.jamanetwork.com/article.aspx?articleid=2542640 E. coli O157 national outbreak update Public Health England (PHE) has been investigating a national outbreak of a rare strain of E. coli O157 that was identified by PHE’s whole genome sequencing (WGS) technology. There have been 161 cases of this strain of E. coli identified (England 154, Wales 6 and Scotland 1). As the latest date of onset in a primary case is 5 July, this outbreak has now been declared over. News: https://www.gov.uk/government/news/update-as-e-coli-o157-investigation-continues Syndromic surveillance summary: 11th August 2016 week 31 This weekly summary highlights changes in the number of people visiting GPs, going to emergency departments, and calling NHS 111. It will help GPs and other public health professionals identify trends and prepare for public health threats, like high levels of flu or heat-related illnesses. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545214/PHESyndromicSurveillanceSummary2016Week31.pdf Previous bulletins: https://www.gov.uk/government/publications/syndromic-surveillance-summary Remote health advice: 11th August 2016 week 31 Monitoring patterns in phone calls to the NHS 111 service each day across England, to track the spread of infectious diseases like flu and norovirus. These data provide early warning of community-based infectious diseases. Latest bulletin: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/545217/PHE_Remote_Health_Advice_Weekly_Bulletin_2016_Week_31.pdf Previous bulletins: https://www.gov.uk/government/publications/remote-health-advice-bulletin Public Health England (PHE) Weekly National Norovirus and Rotavirus report for weeks 26 - 30 (11 August 2016) National report summarising laboratory surveillance of norovirus and rotavirus, including norovirus activity in prisons. Latest report: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/544894/Norovirus_update_2016_weeks_26_30.pdf Previous reports: https://www.gov.uk/government/statistics/norovirus-national-update Statutory notifications of infectious diseases (NOIDs) weekly report: week 31 (2016) Reports of suspected cases of notifiable illnesses in England and Wales. Latest report: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/544903/NOIDs_weekly_report_week31_2016.pdf Previous reports: https://www.gov.uk/government/publications/notifiable-diseases-weekly-report-2016 Statutory notifiable diseases: cases reported in last 52 weeks (Updated) Notifications of infectious diseases (NOIDs) for the last 52 weeks. Added data for week 31 (2016). Latest data: https://www.gov.uk/government/publications/notifiable-diseases-last-52-weeks

Zika virus: epidemiology and cases diagnosed in the UK (Updated) The number of UK cases has been updated. Guidance: https://www.gov.uk/government/publications/zika-virus-epidemiology-and-cases-diagnosed-in-the-uk The healthiest eaters are the most culturally 'fit' How to be a healthy eater depends on culture. A recent study shows that in the US and Japan, people who fit better with their culture have healthier eating habits. The findings highlight the importance of understanding cultural differences in shaping healthy behaviour and have implications for designing health-promoting interventions. News: https://www.sciencedaily.com/releases/2016/08/160810104000.htm Abstract: http://psp.sagepub.com/content/early/2016/08/11/0146167216658645.abstract Tighter air pollution standards may save thousands of lives, greatly improve public health Reducing outdoor concentrations of two air pollutants, ozone and fine particulate matter to levels below those set by the US Environmental Protection Agency would likely save thousands of lives each year, result in far fewer serious illnesses and dramatically reduce missed days of school and work, according to a new analysis. News: https://www.sciencedaily.com/releases/2016/08/160810113649.htm Abstract: http://www.atsjournals.org/doi/abs/10.1513/AnnalsATS.201602-103AR Full text article (PDF): http://www.atsjournals.org/doi/pdf/10.1513/AnnalsATS.201602-103AR Is depression in parents, grandparents linked to grandchildren's depression? Having both parents and grandparents with major depressive disorder (MDD) was associated with higher risk of MDD for grandchildren, which could help identify those who may benefit from early intervention, according to a study. News: https://www.sciencedaily.com/releases/2016/08/160810113654.htm Abstract: https://archpsyc.jamanetwork.com/article.aspx?articleid=2542680 Champs News Issue 2 August 2016 Latest issue. Newsletter: http://www.champspublichealth.com/sites/default/files/Champs_newsletter_issue_2.pdf

RHEUMATOLOGY IV treatment for osteoporosis Principia MCP Vanguard in Rushcliffe, South Nottinghamshire has commissioned a community Fracture Liaison Service to work in conjunction with an established acute Fracture Liaison Service. This new community service identifies patients with first/secondary low-trauma hip and fragility fractures in order to provide intravenous treatments in the community, reducing the number of IV treatments provided in hospital or by out-sourced services, outpatient clinic follow-ups and the associated costs and inconvenience of travel. Further information: http://fabnhsstuff.net/2016/08/10/richards-story-iv-treatment-osteoporosis/

SAFEGUARDING EVENT: Freedom to Speak Up (FTSU) Guardian workshops This series of eight workshops, developed by the National Guardian Office with Health Education England (HEE) and Public Concern at Work, are designed to help the FTSU Guardians understand more about the role and expectations. Further information: https://www.eventbrite.co.uk/e/freedom-to-speak-up-ftsu-guardian-workshops-tickets-26966962912

UROLOGY Surgical Management of Stones: American Urological Association/Endourological Society Guideline This Guideline provides a clinical framework for the surgical management of patients with kidney and/or ureteral stones. Guideline: https://www.auanet.org/common/pdf/education/clinical-guidance/Surgical-Management-of-Stones.pdf News: http://www.uab.edu/news/innovation/item/7508-new-guidelines-published-for-physicians-treating-patients-with-kidney-stones