End of life care for infants, children and young people with life limiting conditions: summary of NICE guidance

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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.

Suspected sepsis: summary of NICE guidance

nice_logoGuidelines include:

  • “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

Home care visits should be at least 30 minutes long, NICE says

nice_logoMost 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).

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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.

Recognition, assessment, and management of coeliac disease: summary of updated NICE guidance

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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.

NICE recommends tighter blood sugar control in diabetes to reduce risk of complications

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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.


Stand during working day to prevent health risks of sedentary jobs, says guidance

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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

Homeopathy is not an effective treatment for any health condition, report concludes

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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.

Home rather than hospital for low risk pregnancies

Extract from National Health Executive

398BAB -8514“New guidelines from NICE could see thousands more babies born outside of hospital every year.

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.”

Read the full story here

NICE considers preventative treatment for breast cancer

breastc keyboardThe National Health Service is considering giving women with a strong family history of breast cancer treatment to prevent the disease from developing.

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.

New NICE Clinical Guidelines: 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

New guideline on the management of acute upper gastrointestinal bleeding

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.

via NICE publishes new guideline on the management of acute upper gastrointestinal bleeding.

Guidance at a glance on your smartphone

Guidance at a glance on your smartphone.

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.

More than 760 pieces of NICE guidance are contained, such as clinical guidelines on COPD, hypertension and stroke, and the app is automatically updated whenever access to the internet is available.

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.

The NICE Guidance app works on Android Smartphones, Apple iPhones and iPod touch running IOS 4.3 and above. It can be downloaded from Apple’s iStore and the Android Market.

NICE: Update Infection Control guideline

Infection: prevention and control of healthcare-associated infections in primary and community care

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.

Focus on UK Clinical Guidelines

There are a number of UK organisations who write and publish guidelines but the main ones include:

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.

Infection: prevention and control of healthcare-associated infections in primary and community care

National Institute for Health and Clinical Excellence (NICE)

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.

Clinical Evidence Update

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.

Articles from the TRIP database

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))

Kings Fund: 25 November

Royal College of Obstetricians and Gynaecologists (RCOG)

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.

National Institute for Health and Clinical Excellence (NICE)

Caesarean section
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.

Royal College of Midwives

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.

News from the Kings Fund: Fraud costs/Leadership/Industrial action


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.

also …


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.

also ..

NHS Employers

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.