No smoke ...

A study questioning the efficacy of nicotine replacement therapy (NRT) gained the attention of the press. The prospective cohort study carried out by the Harvard School of Public Health looked at relapse rates for quitters, finding that "persons who have quit smoking relapsed at equivalent rates, whether or not they used NRT to help them in their quit attempts". According to the study's authors, NRT is wrongly perceived to help with quitting, rather than simply withdrawal symptoms. A meta-analysis of varenicline for smoking cessation considered 10 trials, finding the treatment effective over 52 weeks, although with the caveat that psychiatric adverse effects merited caution as regards people with pre-existing mental illnesses.

Croydon strikes again

Low clinical priority procedures (aka those that appear on the Croydon list) returned to the top of the pile briefly at the end of last year as the Right Care elective surgery project released its phase 1 report. The programme was prompted by an earlier Audit Commission study on reducing spending on low clinical priority procedures. The government took to heart the recommendation that national guidance be developed. However, critics (amongst which was the Federation of Surgical Specialty Associations - FSSA) have argued that the evidence base for this kind of decision-making is poor and that it doesn't sit at all well with the patient choice agenda. Hence the Right Care project, which involved the FSSA. Initial themes from the project include guarded support for national guidance, the suggestion that, since the current terms of art are unhelpful, "there should be a change in terminology to reflect a more holistic approach" and that blanket bans and resultant postcode lotteries should be avoided. A briefing from solicitors Mills and Reeve looks at the legal issues behind decisions about restricting access to low priority procedures.

Endgame

Over a fifth of people in England and Wales are dying at home, a study published in Palliative Care reports. The time series analysis, which covered 2004-2010, showed a steady rise, from 18.3% in 2004 to 20.8% in 2010. This increase was also more marked amongst people with cancer and in the older population: it is the first rise in home deaths since 1974 amongst people over 85 years old. Guidance from NICE on commissioning end of life care focuses on designing "high quality evidence based services" supporting the national End of Life Care Strategy and the NICE quality standard. It also includes a benchmarking tool that promises a 10% reduction in hospital admissions that end in death and a possible £52million cost saving. The National End of Life Care Programme has produced guidance for professionals on developing bereavement services.

Trying to be heard

A paper from the NHS Confederation and the Royal College of Paediatrics and Child Health considers options for involving children and young people in decisions about health and wellbeing services. Looking back at survey data since 2000, it seems that "the voice of under 16s is not included in most national surveys". A study based on experience at Sheffield Children's Foundation Trust assesses effective surveys to measure patient experience amongst children and young people. Meanwhile, Penny Woods from the Picker Institute explains in Pulse how this survey forms the basis for the Children's Patient Experience Questionnaire, from which the new Outcomes Framework indicator on young people's experience of care.

Data monitor

NHS Information Centre has launched a very useful indicator portal, bringing together in one handy place all those pesky health and social care indicators. The 20th annual Health Survey for England was released last month. Special focus for this issue is respiratory health.

An aspirin a day?

Widely reported in the press was a large-scale review that questioned the use of aspirin for primary prevention in cardiovascular disease. The meta-analysis published in the Archives of Internal Medicine looked at data from 9 RCTs each involving over 1000 participants. Researchers found reductions in non-fatal heart attacks in each trial, but also the chance of suffering serious internal bleeding increased by about 30%. The study's authors conclude that while the benefit for people who already had a history of heart attack or stroke was not in doubt, "routine use of aspirin for primary prevention is not warranted and treatment decisions need to be considered on a case-by-case basis." An article in Pulse quoted several GPs who already advised against aspirin taken in this way and noted doctors should be aware that there was a tendency for patients to self-medicate.

Futurology

The rallying cry to "make every contact count" has formed the headlines about the NHS Future Forum's latest offering. However, it's by no means the only thing the Forum has to say. The other areas attended to are integration, information and education and training. Regarding information (as leaked just before Christmas), there's a stress on effective data sharing and interoperability rather than a national system, along with more explicit support systems to facilitate the roll-out of full patient access to health records by 2015 and a back-to-basics proposal of universal use of the NHS number at the point of data capture (again!). The proposals about integration focus on the principle of "integration around the patient" and the role of electronic accessible care records and patient reported experience measures. Along with the Future Forum's report on education, there is also a paper out from DH on the subject.