NICE: This month in Eyes on Evidence

nice_nhs_evidenceIssue 69
January 2015

 

Pharmacy-based screening for cardiovascular risk
A systematic review suggests that pharmacy-based screening for cardiovascular risk factors may be possible. However, many people do not act on the advice to visit their GP, and the effect of screening on new diagnoses has not been robustly shown.

Self-management of hypertension in people at high risk of cardiovascular events
An open-label randomised controlled trial finds that people with hypertension who self-monitor their blood pressure and up-titrate their antihypertensive medication experience a greater reduction in systolic blood pressure than people who manage hypertension with usual care.

Mental health after stopping smoking
A meta-analysis finds that stopping smoking is associated with reductions in anxiety, depression and stress, and improvements in quality of life and mood.

Alpha-blockers for expulsion of ureteral stones
A Cochrane review reports that alpha-blockers are more effective at expelling ureteral stones less than 10 mm in diameter than standard therapy or calcium channel blockers.

Haemoglobin thresholds for blood transfusion
Two meta-analyses report that restricting transfusion of red blood cells to people with a haemoglobin level of either less than 7.0 g/dl or 6.4 g/dl to 9.7 g/dl reduces mortality and serious infection, but does not significantly affect the overall risk of infection.

Evidence Updates
NICE has recently published Evidence Updates on:

  • Spasticity in children and young people with non-progressive brain disorders
  • Ectopic pregnancy and miscarriage
  • Hyperphosphataemia in chronic kidney disease

Relaxing in the library … is much appreciated

Today’s ‘Relax in the Library’ event was very well attended. The purpose was to encourage staff and students to think about their blood pressure, have it measured (before and after relaxation therapy) and get to know more about what those all important numbers mean – 120/80.

Visitors could choose from a mixture of services – head, neck, shoulder or foot massage whilst others chose instruction on ‘the Alexander Technique’.

Leigh Haslam from Occupational Health took over a quiet corner at the rear of the Library and was kept busy recording peoples’ BP.  It was very interesting to note that there was 100% improvement after relaxation.

DSCF0821Feedback was very positive “Excellent. Enjoyed the head massage which lowered my blood pressure”.

A big ‘thank you’ to all the therapists, (Diana Grant, Tracy Mills, Jenny Fox-Eades, Gillian Pierce, Leigh Haslam and to Lynda Cotterill for providing a range of tasty, healthy snacks.

Don’t worry if you missed today’s event, there may be others in the future plus we stock a selection of books on Hypertension, useful leaflets and published research findings on how you can look after yourself through lifestyle, exercise and diet.

 

NICE guidance – updates

Keeping you up-to-datenice 1

Guidance by topic: the following guidance topics matching your health area preferences have been published or updated

 

NICE Community: March 2013 – Top guidance trends

nice_logoTop Guidance Trends

  • Hypertension: CG127
  • Type 2 diabetes (partially updated by CG87): CG66
  • Intrapartum care: CG55
  • Hypertension: QS28

Plus

Eyes on Evidence for March

This month’s topics in NHS Eyes on Evidence:

Analysis of data from a large randomised controlled trial suggests that intensive glucose control in critically ill patients is associated with moderate to severe hypoglycaemia, and a higher risk of death.

A large scale trial examines the benefits and effectiveness of telehealth and telecare services in helping patients avoid the need for emergency hospital care.
 
A cross-sectional study investigating a possible link between harsh physical punishment and mental health disorders reports that reducing physical punishment may help to reduce the prevalence of mental health disorders in the general population. It suggests giving parents information about alternative discipline strategies, such as positive reinforcement.
The QIPP Collection highlights examples of local best practice, demonstrating how NHS organisations have implemented new practices that have both cut costs and improved quality. We highlight a new example:
Chair of the British HIV Association Guidelines Subcommittee, Martin Fisher, talks about the organisation’s experience of the NICE accreditation process.
Accreditation news  
At its January meeting the NICE Accreditation Advisory Committee accredited 2 guidance programmes.

Evidence Updates 
NICE recently published Evidence Updates on:

  • Strategies to prevent unintentional injuries among children and young people aged under 15
  • Hyperglycaemia in acute coronary syndromes
  • Common mental health disorders
  • Hypertension.

This month in Eyes on Evidence

Data from the National Joint Registry for England and Wales indicates high failure rates for metal-on-metal hip replacements.
A Cochrane review shows cognitive stimulation therapies have beneficial effects on memory and thinking in people with dementia, as well as positive effects for wellbeing.
Developing more integrated support for people with mental and physical health problems could improve outcomes, by recognising the role of emotional and mental health problems in reducing people’s ability and motivation to manage their physical health.

Do renin-angiotensin system drugs reduce mortality in hypertension?

This systematic review provides good quality clinical evidence that  angiotensin-converting enzyme inhibitors reduce the risk of death in patients with hypertension. The benefits of angiotensin receptor blockers in reducing mortality are uncertain.
Angiotensin receptor blockers (ARBs) are no better than placebo or angiotensin-converting enzyme  inhibitors in reducing the risk of death, disability, or hospital admission for any reason. However, more patients stopped treatment early with ARBs than with placebo due to side effects.
An example from the Quality, Innovation, Productivity and Prevention collection on how the University Hospitals of Leicester NHS Trust has reduced delays, complications and costs around central venous access for patients.
Potential disinvestment opportunities highlighted this month are:
  • Biofeedback training for the management of faecal incontinence in children.
  • Non-pharmacological interventions for breathlessness.

Evidence Updates

This month NICE has published online via NHS Evidence an Evidence Update on constipation in children and young people.
How to get access, via NHS Athens on Apple and Android devices, to authoritative and practical information on the selection and clinical use of medicines from the British National Formulary.