Library Information Alert – A current awareness bulletin for the Somerset NHS health community 27/03/15

Issue 73 27th March 2015

Health Reports, Documents & News

End of life care

The House of Commons Health Select Committee has published its fifth report focused on End of Life Care. The Committee looked at the state

of end of life care since the independent Review of the Liverpool Care Pathway, and found great variation in quality and practice across both acute and community settings. The report makes a number of recommendations for improvement, and in particular recommends that social care should be free at the end of life.

Report Additional links: Commons Select Committee press release

BBC News report

Access to hospital care The Nuffield Trust has published Access to hospital care: is the NHS on target? This fourth policy briefing in the run-up to the General Election 2015 examines how hospital trusts in England are performing against six national targets. The paper argues against the notion that dips in performance can be attributed to a handful of poorly performing hospital trusts, and finds there has been deterioration across the board in some measures. The targets examined are: the four-hour A&E target; the 18-week target for a hospital bed (inpatient treatment); the 18-week target for an outpatient appointment; the six-week target for diagnostic tests; the two-week target for urgent cancer referral; and the 31-day target for cancer treatment. Report Additional link: BBC News report

LIBRARY INFORMATION ALERT

A health current awareness bulletin by email

Somerset Libraries @ MPH, YDH and SomPar

Health Reports, Documents & News click here Mental Health News click here Behind the Headlines click here Evidence Based Practice click here

Library News click here Journal Scan click here

Useful Web Resources click here

Library Information Alert – A current awareness bulletin for the Somerset NHS health community 27/03/15

Work and wellbeing in the NHS: why staff health matters to patient care This report from the Royal College of Physicians shows that staff health and wellbeing in the NHS is often seen as an optional extra - as less than two thirds of trusts have a staff health and wellbeing plan in place. It says that high quality patient care relies on skilled staff who are not only physically and mentally well enough to do their jobs, but also feel valued, supported and engaged. Report NEW Shape of Caring Review report published (England) The Shape of Caring Review report, commissioned by Health Education England (HEE) in partnership with the Nursing and Midwifery Council (NMC) has now been published. In the report Lord Willis, Chair of the review, makes thirty-four recommendations for the future education and training of nurses and care assistants. Report NEW report on priority areas for Health Education England Released this month, Delivering High Quality, Effective, Compassionate Care: Developing The Right People With The Right Skills And The Right Values sets out the priority areas for Health Education England in the delivery of its functions. The mandate for 2015 to 2016 reflects strategic objectives around workforce planning, health education and training and development. It looks at how the healthcare workforce can be supported through excellent education and training to deliver the very best care to patients. Policy paper Primary care in Europe The World Health Organisation has published Building primary care in a changing Europe. This report analyses how primary care is organised and delivered across European countries, looking at governance, financing and workforce aspects and the breadth of the service profiles. It describes wide national variations in terms of accessibility, continuity and coordination. It also reviews the growing evidence on the added value of strong primary care for the performance of the health system overall and explores how primary care is challenged by emerging financial constraints, changing health threats and morbidity, workforce developments and the growing possibilities of technology. Report Acute hospitals and integrated care The Kings Fund has published Acute hospitals and integrated care: from hospitals to health systems. This report describes lessons from five case studies where acute hospitals are working collaboratively with local partners to build integrated models of care. Three of these sites have since been chosen as vanguards by NHS England. The report assesses the achievements made so far, distils the lessons learnt for other local health economies, and makes recommendations for national policy-makers. Report Chlamydia: commissioning internet based screening Public Health England has published Internet-Based Chlamydia Screening: guidance for commissioning. This guidance is intended to assist the commissioning of chlamydia screening accessed by young people using the internet. The advice provided can be adapted to suit local circumstances and provides suggested sections that commissioners may wish to include in their contracts with providers of internet based chlamydia screening. Guidance

Draw the line: managers’ toolkit for raising concerns

NHS Employers has produced a toolkit to help facilitate engagement between managers and the board, senior teams, wider management teams and staff about the importance of raising concerns. Draw the line highlights some key considerations for managers when they are dealing with concerns raised by staff, and showcase different approaches undertaken by other NHS organisations. Toolkit NHS managers: busting the myths The NHS Confederation is publishing a series of myth busters which serve to challenge common misconceptions and enrich debate on topical, sometimes controversial, issues regarding health and care. NHS Managers: busting the myths is the first in the series. NHS Managers: busting the myths

Library Information Alert – A current awareness bulletin for the Somerset NHS health community 27/03/15

Promoting children and young people’s emotional health and wellbeing Public Health England has published Promoting children and young people’s emotional health and wellbeing: a whole school and college approach. This document provides guidance for head teachers and college principals on the 8 principles for promoting emotional health and wellbeing in schools and colleges. This document may also be of interest to school nurses and local public health teams. Guidance Caring for patients with long term conditions Ten leading patient charities (known collectively as The Richmond Group) have published Vital Signs. The report draws on their knowledge, the experiences of people with long-term conditions and the latest academic and policy research. It provides a snapshot of the gaps in care quality that matter most to service users and patients. The group first looked at this topic in 2012 and published `How to deliver high-quality, patient-centred, cost-effective care,` setting out what matters most to people living with long term conditions, their families and carers. Report Hearing Loss NHS England and Department of Health has published a new Action plan on hearing loss to support services for deaf people and those with diminishing hearing. The plan has been developed with a number of organisations including Public Health England, hearing loss charities and those whose hearing is directly affected. Aimed at commissioners, Clinical Commissioning Groups, GPs and healthcare providers, the report identifies multiple health and social issues associated with hearing loss. It recommends ways that services for children, young people, working age and older adults living with hearing loss can be improved. Guidance Additional link: Press release Mobile diagnostics service NHS England is backing the development of a mobile diagnostics service that will deliver laboratory standard test results outside of hospital and allow patients to be diagnosed and treated at the point of care. The Labkit® Near Patient Diagnostics service is a portable bag containing devices capable of producing a range of patient test results including white blood cell count, hemoglobin, glucose, blood gases, electrolytes and urinalysis. Outcomes are captured electronically and can be transferred remotely and securely to the pathology laboratory at the patient’s local hospital, opening up possibilities for how care is delivered. For the first time, clinicians will be able to make diagnoses on the move, allowing them to identify problems and treat patients more effectively in the community, in GP practices and even in their homes. To read more click here Gynaecological cancers The National Cancer Intelligence Network has published three reports on gynaecological cancers. They provide an insight into the health and wellbeing of women living with and beyond cervical, womb and ovarian cancer. The reports aim to: improve understanding of health-status related quality of life outcomes for women following treatment for gynaecological cancers; consider variations in outcomes, for example for different age groups or for those with comorbidities; start to enable health and care services; at a national and local level; to measure the impact of interventions for people living with and beyond cancer over time; and link with hospital episode statistics, cancer registration and other data sets to begin to understand the relationship between health-status related outcomes and types of cancer treatment. To access these documents go to http://www.ncin.org.uk/publications/ and open the ‘most recent’ section. Promotion of healthier diets The World Health Organisation European Office has published Using price policies to promote healthier diets. This publication provides information on using price policies to promote healthy diets and explores policy developments from around the WHO European Region. It examines the economic theory underpinning the use of subsidies and taxation and explores the available evidence. The publication includes several case studies from WHO European Member States where price policies have been introduced, along with a European Union scheme. It concludes with some observations about the design of more effective price policies. Report

Library Information Alert – A current awareness bulletin for the Somerset NHS health community 27/03/15

Innovations helping health care The Kings Fund has published their latest digital report The Future is now, which brings together examples of innovative practice from England and overseas to provide insight into future ways of changing health and health care for the better. Report

Healthcare - the next five years Gathering together leading experts from the health world this report sets out their views on what needs to change to ensure the long-term sustainability of the NHS. With the challenges of austerity, an ageing society and more expensive treatment the authors add their thoughts to the on-going debate on prevention, integration and funding. Smith Institute Report The Care Certificate – coming soon to health and care From 1 April 2015, all new healthcare assistants and social care support workers will be expected to attain the Care Certificate within their first 12 weeks of employment. The Care Certificate sets out the fundamental skills, knowledge and behaviours that are required to provide safe, effective and compassionate care and provides a framework under which they can be assessed. To read more click here Impact of physical activity and diet on health The House of Commons Health Committee has published its Health - Sixth Report: Impact of physical activity and diet on health. The Committee recommended that the next Government prioritises prevention, health promotion and early intervention to tackle the health inequalities and avoidable harm resulting from poor diet and physical inactivity. The Committee also regarded it as inexplicable and unacceptable that the NHS is now spending more on bariatric surgery for obesity than on a national roll-out of intensive lifestyle intervention programmes that were first shown to cut obesity and prevent diabetes over a decade ago. The Committee were also disappointed that although NICE has produced a comprehensive raft of guidance on cost-effective interventions that can be introduced, either by the NHS or by local government, to improve diet and physical activity, that to date there has been very little assessment of how far these guidelines are being implemented. Report SIGN guideline: Glaucoma referral and safe discharge The Scottish Intercollegiate Guidelines Network has published guideline No.144 Glaucoma referral and safe discharge. This guideline provides evidence-based recommendations on the primary-care examination and assessment of patients with suspected glaucoma. Best-practice guidance is provided on which patients should be referred into secondary eye-care services. This guideline also provides guidance on which patients may be discharged from secondary care and safely followed up in the community. T download guideline click here NHS performance The King’s Fund has published The NHS under the coalition government Part two: NHS performance. It draws on surveys of patient and staff experience; access to care as measured by waiting times; and data on outcomes, safety and quality of care. The report concludes with an analysis of NHS productivity and financial performance between 2010 and 2015, and an assessment of its prospects in the next parliament and beyond. Report Additional link: BBC news report

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Library Information Alert – A current awareness bulletin for the Somerset NHS health community 27/03/15

MENTAL HEALTH NEWS Mental health issues during and after pregnancy Research published by the Centre for Mental Health and the Royal College of General Practitioners has found that women who have depression or anxiety during pregnancy or in the year after giving birth are not having their needs recognized and not getting the support they need. Falling through the gaps highlights that women fear disclosing distress to their GPs or other professionals. The report finds that many doctors do not know how to respond effectively or lack confidence in their ability to achieve timely access to local psychological therapy services. It concludes that GPs need more and better information about perinatal depression and anxiety and how to respond. Report Improving mental health services for young people The Department of Health has published Future in mind: promoting, protecting and improving our children and young people’s mental health and wellbeing. This report makes a number of proposals the government wishes to see implemented by 2020. These include: tackling stigma and improving attitudes to mental illness; introducing more access and waiting time standards for services; establishing ‘one stop shop’ support services in the community; and improving access for children and young people who are particularly vulnerable. The report sets out how much of this can be achieved through better working between the NHS, local authorities, voluntary and community services, schools and other local services. It also makes it clear that many of these changes can be achieved by working differently, rather than needing significant investment. Report Additional links: NHS England press release BBC News report Independent Mental Health Advocacy (IMHA) This is a suite of 12 Social Care Institute of Excellence (SCIE) resources and includes short films, reports, at a glance summaries and tools. Some of the resources aim to raise service users’ and mental health staffs’ awareness and understanding of the IMHA role, and address equality of access. Others help advocacy providers, commissioners and mental health trusts to improve access to IMHA, to understand what a good service looks like, and how outcomes can be measured. Resource suite Additional link: SCIE - press release Evidence Update – Psychosis and schizophrenia in children and young people NICE has published a new evidence update Psychosis and schizophrenia in children and young people (Evidence Update 76). It provides a summary of selected new evidence relevant to NICE clinical guideline 155 ‘Psychosis and schizophrenia in children and young people: recognition and management’ (2013). Document NHS mental health apps library launched NHS England has launched an initiative to help treat depression and anxiety and improve access to psychological therapies by unveiling the first ever directory of NHS-endorsed digital mental health services. The Mental Health Apps Library features online tools, resources and apps that have a proven track record of effectiveness in improving mental health outcomes. The library is accessible through the NHS Choices platform. Additional link: NHS England press release See also ‘USEFUL WEB RESOURCES’ section.

Is mental health care improving? This overview uses the available data to assess the quality of health care services for people with mental health problems in England. It focuses on three different groups: adults with common mental health problems, adults with severe and enduring mental health problems, and children and young people. Briefing overview

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Library Information Alert – A current awareness bulletin for the Somerset NHS health community 27/03/15

BEHIND THE HEADLINES Blood test could provide an early arthritis warning Climate change 'might bring rise in UK mosquito-borne diseases' Are half of all children's teeth really rotten? New blood test could help prevent antibiotic misuse Damage to 'heart health' may start in childhood Obese people 'underestimate how much sugar they eat' Could epilepsy drug be used to treat Alzheimer's disease? Does light at night pose a health risk? Do people with depression perceive time differently? Loneliness 'increases risk of premature death' Diet, exercise and brain training may help keep the mind 'sharp' Full list available at: http://www.nhs.uk/News/Pages/NewsIndex.aspx

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EYES ON EVIDENCE

The March edition of has been published by NICE. It includes the following items:

HIV testing in healthcare settings other than specialist clinics

Allopurinol for chronic gout

Genetic testing for fetal chromosome abnormalities

Child safeguarding in acute healthcare services

Local food environment and diet in children and young people

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EXTRACTS FROM THE MENTAL ELF BLOG Keeping you up to date with reliable mental health research, policy & guidance

Antidepressant withdrawal syndromes: time to grasp the nettle?

Depression to blame for violent crime? The curse of the headline writers

Psychosis and schizophrenia in adults: new quality standard from NICE

Peer support workers in mental health: Is the NHS ready for this? Full reviews at: http://www.thementalelf.net/#sthash.1TMfsl0G.dpuf

Library Information Alert – A current awareness bulletin for the Somerset NHS health community 27/03/15

EVIDENCE-BASED PRACTICE

NICE Guidance for March 2015

Ref Title Type

ESUOM42 Digital ulcers: sildenafil

Evidence summary: unlicensed or off-label medicine guidance

QS82 Smoking: reducing tobacco use Quality Standard

QS83 Alcohol: preventing harmful alcohol use in the community Quality Standard

QS84 Physical activity: encouraging activity in all people in contact with the NHS

Quality Standard

QS85 Managing medicines in care homes Quality Standard

QS86 Falls in older people: assessment after a fall and preventing further falls

Quality Standard

TA335 Rivaroxaban for preventing adverse outcomes after acute management of acute coronary syndrome

Technology Appraisal Guidance

TA336 Empagliflozin in combination therapy for treating type 2 diabetes Technology Appraisal Guidance

TA337 Rifaximin for preventing episodes of overt hepatic encephalopathy

Technology Appraisal Guidance

TA338 Pomalidomide for relapsed and refractory multiple myeloma previously treated with lenalidomide and bortezomib

Technology Appraisal Guidance

IPG514 Transanal total mesorectal excision of the rectum Interventional procedure guidance

IPG515 Insertion of a balloon device to disimpact an engaged fetal head before an emergency caesarean section

Interventional procedure guidance

IPG516 Implantation of a left ventricular assist device for destination therapy in people ineligible for heart transplantation

Interventional procedure guidance

IPG517 Insertion of endobronchial nitinol coils to improve lung function in emphysema

Interventional procedure guidance

IPG518 Implantation of a duodenal–jejunal bypass liner for managing type 2 diabetes

Interventional procedure guidance

MTG24 The Sherlock 3CG Tip Confirmation System for placement of peripherally inserted central catheters

Medical Technology Guidance

ESMPB1 Clostridium difficile infection: risk with broad-spectrum antibiotics

Evidence summary: medicines and prescribing briefing

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Library Information Alert – A current awareness bulletin for the Somerset NHS health community 27/03/15

USEFUL WEB RESOURCES

Interactive Tools

Tools that can be found on the site include:

Smokefree App

Eating Disorders Videos

New BMI Healthy Weight calculator and iphone App

Asthma Self Assessment

Mental Health videos

Downloadable Fitness Widget

Blood Pressure Quiz

Dementia Carer’s Experiences

Find out more at: http://www.nhs.uk/tools/pages/toolslibrary.aspx

Additional links: Your NHS guide to long-term conditions and self-care http://www.nhs.uk/Planners/Yourhealth/Pages/Livewelltools.aspx Online Mental Health Services http://www.nhs.uk/Conditions/online-mental-health-services/Pages/introduction.aspx

New reviews:

Adjuvant chemotherapy for resected early-stage non-small cell lung cancer

Chlorhexidine skin or cord care for prevention of mortality and infections in neonates

Cholinesterase inhibitors for rarer dementias associated with neurological conditions

Interventions for improving community ambulation in individuals with stroke

Mini-Mental State Examination (MMSE) for the detection of Alzheimer's disease and other dementias in people with mild cognitive impairment (MCI)

Personalised care planning for adults with chronic or long-term health conditions

Click here to visit The Cochrane Library and read all the latest reviews. Back to top

Library Information Alert – A current awareness bulletin for the Somerset NHS health community 27/03/15

LIBRARY NEWS

For Hospital doctors, Primary care physicians,

Doctors in training, Nurses, Students, Anyone who

works in healthcare

BMJ Learning offers high-quality continuing medical education for doctors and other healthcare professionals. It features hundreds of accredited, peer-reviewed learning modules in text, video, and audio formats. When you sign in to BMJ Learning, you'll see your own personal homepage, which displays modules tailored to you based on your profession, specialty and location. This makes choosing the right modules for your CME/CPD quicker and easier. The learning modules provided by BMJ Learning deal with everyday issues in primary care and hospital medicine. They are evidence based and peer reviewed, and are regularly updated. Most modules take around an hour to complete. Many are free to access. Sign up for free, and start learning BMJ Learning features hundreds of accredited learning modules for doctors, nurses, medical students and other healthcare professionals.

Discover more than 1,000 evidence-based, peer-reviewed learning modules

Stay up to date with the latest practice-changing developments

Use our pre- and post-module assessments to gauge your learning

Choose from audio, video, and interactive case-based formats

Record your learning in BMJ Portfolio

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Please let us know your thoughts of the product and send your feedback to library@tst.nhs.uk Trial ends 18th April 2015

A one month trial of BMJ Learning is now live for Taunton & Somerset Foundation Trust staff and we need your help to evaluate this resource. Go to http://learning.bmj.com/learning/user/login.html

ignore the login boxes and choose You can register for an Athens password at https://openathens.nice.org.uk/

Library Information Alert – A current awareness bulletin for the Somerset NHS health community 27/03/15

JOURNAL SCAN Please contact your designated Trust library service for copies of articles or any related queries. This can be done by email, telephone, post or on-line request forms (available on the library web pages of your Trust Intranet). Full contact details are at the end of this bulletin. 6 Cs 6Cs: Communication is a skill valued by patients and colleagues Jane Cumings British Journal of Healthcare Assistants March 2015 p128-129 Care, compassion and communication Bloomfield, J., Pegram, A Nursing Standard 2015 29(25) p45-9 The meaning of compassion Helen Day British Journal of Nursing 26.3.15 p342-343 Cardiology Patients who demand or refuse treatment Richard Griffith British Journal of Cardiac Nursing March 2015 p150-152 Randomised controlled trial: Bypass surgery is more cost-effective than percutaneous coronary interventions for most patients with multivessel or left main coronary artery disease Shikhar Agarwal, Samir R Kapadia Evidence Based Medicine April 2015 20 p77 Sudden cardiac death in athletes Christopher Semsarian et al BMJ 21.3.15 p27-34 The challenge of measuring blood pressure accurately Noeleen Fallon British Journal of Cardiac Nursing March 2015 p132-139 What is the value of a nurse-led clinic for patients with replacement heart valves? Denise H Parkin, John B Chambers British Journal of Cardiac Nursing March 2015 p145-149 Chief executives Revealed: HSJ’s top provider chief executives HSJ Online 26.3.15 Download the pdf supplement here Community Nursing Mobile working: positively engaging community nurses Christopher Turner British Journal of Community Nursing 2015 20 (3) p134-138

Library Information Alert – A current awareness bulletin for the Somerset NHS health community 27/03/15

Death and Dying Knowledge of impending death and its effect on quality of dying Brian Nyatanga British Journal of Community Nursing 2015 20 (3) p152-152 Delegation/Support workers The art and science of delegation David Stonehouse British Journal of Healthcare Assistants March 2015 p150-153 Diabetic Foot Prevention and management of diabetic foot ulcers Martin Turns British Journal of Community Nursing 2015 20 Supplement3 pS30-S37 Elderly Care Systematic review: Review: nurses predominantly have negative feelings towards the use of physical restraints in geriatric care, though some still perceive a need in clinical practice Jan P H Hamers Evidence Based Nursing April 2015 18 p64 The competent novice: a quick ward assessment of older patients by junior doctors S.E. Kurrle et al BMJ 21.3.15 p32-34 Infection Control A new antibiotic and the evolution of resistance Cesar A. Arias et al New England Journal of Medicine 19.3.15 p1168-170 Chikungunya virus and the global spread of a mosquito-borne disease SC Weaver and M Lecuit New England Journal of Medicine 26.3.15 p1231-1239 Choosing an antibiotic for skin infections [editorial] Michael R. Wessels New England Journal of Medicine 19.3.15 p1164-165 Effect of climate change on vector-borne disease risk in the UK JM Medlock and SA Leach Lancet Infectious Diseases 23.3.15 Qualitative study—other: Infection control practice: interview with 20 nurses reveals themes of rationalising their own behaviour and justifying any deviations from policy Dinah Gould Evidence Based Nursing April 2015 18 p59 Washing uniforms at home: adherence to hospital policy Riley, L et al Nursing Standard 2015 29(25) p37-43 Learning & Development Mentors: supporting learning to improve patient care Kay Norman British Journal of Healthcare Assistants March 2015 p132-137 Long term conditions Ten years on from the National Service Framework for Long-Term Conditions: how far have we come? Aysha Mendes British Journal of Community Nursing 2015 20 (3) p150-151

Library Information Alert – A current awareness bulletin for the Somerset NHS health community 27/03/15

Mental health Budget boost for mental health must rebuild lost nursing posts Nicola Merrifield Nursing Times 25.3.14 p4 Delivery of cognitive remediation therapy within a specialist inpatient psychosis service: a health-care assistant's perspective Franchesca Olaifa et al Journal of Psychiatric Intensive Care April 2015 p 1-6 Nurses' experiences of restraint and seclusion use in short-stay acute old age psychiatry inpatient units: a qualitative study E. C. Muir-Cochrane, J. Baird, T. V. McCann Journal of Psychiatric & Mental Health Nursing March 2015 p109-115 The secret life of ketamine Janna Lawrence Pharmaceutical Journal 21.3.15 p336-339 Nurse prescribing Survey: Registered nurses, nurse specialists and physicians have a neutral to moderately positive view on nurse prescribing, though physicians still have patient safety concerns Merav Ben-Natan Evidence Based Nursing April 2015 18 p60 Pain management Quantitative study—other: Health professionals' pain management decisions are influenced by their role (nurse or physician) and by patient gender, age and ethnicity Sean M Phelan, Rachel R Hardeman Evidence Based Nursing April 2015 p58 Sciatica Allan H Ropper and Ross D Zafonte New England Journal of Medicine 26.3.15 p1240-1248 Patient Care Experience of care: special focus on changing culture to improve care 5 articles focusing on patient empowerment and feedback Nursing Standard 2015 29(26) p18-28 Helping patients who go it alone Trueland, J Nursing Standard 2015 29(25) p22-3 Pressure Ulcers Preventing pressure ulcers in patients in intensive care Gage, W Nursing Standard 2015 29(26) p53-61 Reducing avoidable pressure ulcers in the community Parnham, A et al Nursing Standard 2015 29(26) p 62-70 Pressure-ulcer management and prevention in acute and primary care Roger Newham and Lynne Hudgell British Journal of Nursing 26.3.15 ps4-s11

Library Information Alert – A current awareness bulletin for the Somerset NHS health community 27/03/15

Pressure ulcers: how much do nursing students really know? Hossein Rafiei et al British Journal of Nursing 26.3.15 ps12-s17 Professional development Relationships: Part 2: nurse-patient relationships John Fowler British Journal of Nursing 26.3.15 p350 Research Introduction to the research series: Series of 26 articles to be published Nursing Standard 2015 29(27) p43 Stages in the research process Gelling, L Nursing Standard 2015 29(27) p44-49

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Library Contact Details MPH Library@tst.nhs.uk Tel: 01823 342433 Library web pages at: http://intranet.tsft.nhs.uk/Default.aspx?alias=intranet.tsft.nhs.uk/LibraryService YDH Library@ydh.nhs.uk Tel: 01935 384495 Library web pages at: http://ycloud/teams/Library/SitePages/Home.aspx SomPar Library@sompar.nhs.uk 01823 368210 Library web pages at: http://intranet.sompar.nhs.uk/a_-_z_directory/library_service.aspx

We welcome any feedback about the content or format of the Library Information Alert and are happy to receive items for inclusion. Please contact library@tst.nhs.uk The current issue of this Alert, together with the Archive of previous issues is available via the Library web pages on the Musgrove Park Hospital Intranet.