Children and young people can have a wide range of life limiting conditions and may sometimes live with such conditions for many years. This guideline recommends that end of life care be managed as a long term process that begins at the time of diagnosis of a life limiting condition and entails planning for the future. Sometimes it may begin before the child’s birth. It is part of the overall care of the child or young person and runs in parallel with other active treatments for the underlying condition itself. Finally, it includes those aspects related to the care of the dying.
“Think sepsis” in any person with suspected infection
Sepsis may present with non-specific symptoms and signs and without fever
Have a high index of suspicion of sepsis in those who are aged <1 year or >75 years, pregnant, or immunocompromised, and those who have a device or line in situ or have had recent surgery
Use risk factors and any indicators of clinical concern to decide if full assessment is required
Offer people at high risk of sepsis broad spectrum antibiotics and intravenous fluids in hospital
Most home care visits should be at least half an hour long to enable carers to provide the personalised and dignified care that elderly patients need when being supported to stay in their own home, says a guideline on social care services from the National Institute for Health and Care Excellence (NICE).
Shorter visits would be appropriate only rarely, said the finalised guideline on home care, published on 23 September. This might be when the visit is part of a wider package of support, made by a carer who is known to the patient, or made to complete a specific time limited task, such as checking that a medicine has been taken or that a person is safe and well.
Coeliac disease is a common autoimmune condition, in which the ingestion of gluten (present in wheat, barley, and rye) activates an abnormal immune response, leading to chronic inflammation of the small intestine and malabsorption of nutrients. It affects about 1% of the UK population.
NICE recommendations are based on systematic reviews of the best available evidence and explicit consideration of cost effectiveness.
The National Institute for Health and Care Excellence (NICE) has recommended tighter blood sugar control for patients with diabetes, to minimise the risk of long term vascular complications, according to the BMJ.
An updated NICE guideline on diagnosing and managing type 1 diabetes in adults is now available.
The Royal College of Obstetricians and Gynaecologists has revised its guideline on female genital mutilation to clarify healthcare professionals’ legal responsibilities, the requirements to notify cases, and the management of women who have undergone mutilation who are pregnant or giving birth.
People whose jobs are predominantly desk based should be encouraged to stand up and walk about for at least two hours during each working day, says the first UK guidance developed to reduce the health risks of prolonged sitting at work.
Growing evidence has shown links between a sedentary lifestyle and an increased risk of cardiovascular disease, diabetes, and some cancers. To help reduce this risk Public Health England and a UK community interest company, Active Working, asked an international group of experts in the field to review the available evidence and develop guidelines for employers to promote avoidance of prolonged periods of sedentary work
A large review by the Australian National Health and Medical Research Council has reported that homeopathy is not an effective treatment for any health condition. It cautioned that “people who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence.”
The council, the country’s highest medical research body, conducted an extensive assessment of scientific evidence to develop a position statement on the use of homeopathy. The report incorporated an evaluation of more than 1800 papers, including systematic reviews, published guidelines, and information provided by homeopathy advocacy groups. The analysis identified a total of 225 studies that compared a homeopathic treatment group with a control group and therefore met criteria to be further examined for effectiveness.
A diet that simply encourages people to eat 30 g or more of fibre a day may be a good alternative to a far more complex weight loss regimen recommended by the American Heart Association (AHA), a US study has shown.
Nearly 700,000 babies were born in England and Wales last year, nine out of 10 of whom were delivered in hospital under the ultimate supervision of obstetricians, but NICE wants women to be given greater freedom to choose where they give birth.”
The National Institute for Health and Clinical Excellence (NICE) is currently in the process of updating its clinical guideline on familial breast cancer[i]. Today (15 January), NICE has begun a consultation on a draft version of the guideline with new, provisional recommendations relating to genetic testing[ii], screening and the use of preventive treatments. The draft update also, for the first time, makes recommendations for people with a recent diagnosis of breast cancer who also have a family history of the disease.
Patients with blood clots should be treated within 4 hours, says NICE
People who present to hospital with blood clots in the legs or lungs should be offered treatment within 4 hours and have their investigative tests including scans within 24 hours, according to latest guidelines.
27 June 2012
NICE has published new recommendations on the management of acute upper gastrointestinal (GI) bleeding.
25 June 2012
Clinical guidelines and technology appraisals published in June by NICE
- CG141 Acute upper GI bleeding Clinical guidelines
- CG142 Autism in adults Clinical guidelines
- TA257 Breast cancer (metastatic hormone-receptor) – lapatinib and trastuzumab (with aromatase inhibitor) Technology appraisals
- IPG428 Extracorporeal membrane carbon dioxide removal Interventional procedures
- TA258 Lung cancer (non small cell, EGFR-TK mutation positive) – erlotinib (1st line) Technology appraisals
- TA260 Migraine (chronic) – botulinum toxin type A Technology appraisals
- TA259 Prostate cancer (metastatic, castration resistant) – abiraterone (following cytoxic therapy) Technology appraisals
- CG143 Sickle cell acute painful episode Clinical guidelines
- CG144 Venous thromboembolic diseases Clinical guidelines
to view any of the above please click here: NICE guidelines
NICE publishes new guideline on the management of acute upper gastrointestinal bleeding
NICE, the healthcare guidance body, has today (Wednesday 13 June) published a new guideline on the management of acute upper gastrointestinal (GI) bleeding.
Bleeding in the oesophagus, stomach or duodenum is the most common emergency managed by gastroenterologists in the UK, with at least 50,000 hospital admissions per year.
Despite changes in management, mortality has not improved over the past 50 years. It is estimated that around one in ten hospital admissions for upper gastrointestinal bleeding results in the patient’s death – around 5000 deaths per year in the UK.
Upper gastrointestinal bleeding is usually caused by peptic ulcers, which can bleed as the ulcer erodes into an underlying artery, or oesophago-gastric varices (dilated veins in the oesophagus).
The guideline makes a number of key recommendations, including:
Offer endoscopy to unstable patients with severe acute upper gastrointestinal bleeding immediately after resuscitation.
Offer endoscopy within 24 hours of admission to all other patients with upper gastrointestinal bleeding.
Offer interventional radiology to unstable patients who re-bleed after endoscopic treatment. Refer urgently for surgery if interventional radiology is not promptly available.
Continue low-dose aspirin for secondary prevention of vascular events in patients with upper gastrointestinal bleeding in whom haemostasisi has been achieved.
The official NICE Guidance app is available to download now for users of Android and iPhone smartphones.
The free app allows quick and easy access to all of NICE’s recommendations and advice, and has been developed in response to demand from users of NICE guidance.
Aimed at healthcare professionals, including doctors, nurses and medical students, the app allows users to search, browse and explore all of the guidance produced by NICE.
Guidance is arranged by clinical or public health topic, and particular sections can be bookmarked for easy access, or sent via email.
Other features include receiving automatic updates and new guidance as soon as it is published on the NICE website, adjustable font size for readability, and the ability to ‘swipe’ between chapters when looking at guidance.
Clinical guidelines, CG139 – Issued: March 2012
This clinical guideline (published March 2012) updates and replaces NICE clinical guideline 2 (published June 2003). It offers evidence-based advice on the prevention and control of healthcare-associated infections in primary and community care. New and updated recommendations address areas in which clinical practice for preventing healthcare-associated infections in primary and community care has changed, where the risk of healthcare-associated infections is greatest, and where the evidence has changed.
- NICE National Institute for Health and Clinical Excellence
- SIGN Scottish Intercollegiate Guidelines Network
- GAIN Guidelines and Audit Implementation Network <!–
- CKS – Clinical Knowledge Summaries (formerly Prodigy)
- Professional Organisations and Royal Colleges
Doctors from Patient.co.uk have collated a directory of clinical guidelines that have been recently published by the above organisations and similar reputable organisations. Not everyone agrees with guidelines – for a fuller discussion on the pros and cons of guidelines, see the folowing series of articles written in the British Medical Journal.
This guideline provides a blueprint for the infection prevention and control precautions that should be applied by everyone involved in the care of people who are having treatment or care either in their own home or elsewhere in the community (for example, in a care home, a GP surgery, health centre, school or prison and by the ambulance service) where NHS healthcare is provided or commissioned.
In addition to regular updates to systematic reviews and guidelines, the new Clinical Evidence website includes additional educational and practical resources. Discover more about evidence based medicine.
Estimates of prevalence of this condition vary widely depending on population and study recruitment criteria. What is clear, though, is that the condition is common, and that women with severe prolapse can suffer unpleasant and debilitating symptoms. Our latest update covers important new evidence on hormone treatments and surgical options.
Visit the Clinical Evidence website to see the full review.
For more information on all the above systematic reviews, visit the Clinical Evidence website.
See the new statistics calculator resource.
Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. (Lancet) Abstract available – Full text articles may be ordered from other libraries in the region.
MRI for breast cancer screening, diagnosis, and treatment. (Lancet) (Abstract only)
Colorectal cancer: the diagnosis and management of colorectal cancer (National Institute for Health and Clinical Excellence – Clinical Guidelines (UK))
The care of women requesting induced abortion: evidence-based clinical guideline number 7
These guidelines are for all healthcare professionals and aim to ensure that all women considering induced abortion have access to a high quality service based on national standards. The recommendations cover commissioning and organising services, possible side effects and complications, pre-abortion management, abortion procedures and follow up care.
NICE has published an update to its existing guidelines on caesarean section. It is hoped that these new recommendations mean more women may avoid unnecessary surgery and that changes in practice will reduce post-operative infections. It also recognises that mental health issues, as well as physical conditions, are possible indications for caesarean section.
State of maternity services report 2011
This report looks at a number of indicators of the pressures on maternity care and the resources available to cope in each of the four United Kingdom countries. It finds that a significant increase in the number of births in each of the four countries, and a trend towards older mothers, is increasing the pressures on maternity care throughout the UK. In England, and in the last few years Wales, this has led to a substantial deficit in the workforce needed to provide a safe level of care to women and their babies.
The financial cost of healthcare fraud: what data from around the world shows
This report investigates the true financial cost of fraud to the NHS. It estimates that the NHS loses £3 billion per year in fraud and in light of financial pressures, minimising fraud has the potential to aid with efficiency savings.
What makes a top hospital? Leadership
This is the third in a series of publications centred around quality in hospital services. This report looks at the features of leadership that are found in top performing acute organisations.
Guidance on emergency cover during industrial action
Unison and Unite have both produced guidance on emergency cover and exemptions from industrial action. It encourages their branches to engage with employers when they seek to discuss levels of cover.
The UK influenza preparedness strategy 2011
This strategy describes the Government’s approach for responding to an influenza pandemic. It updates and replaces the previous guidance ‘Pandemic flu: a national framework for responding to an influenza pandemic 2007’.