The National Institute for Health and Care Excellence (NICE), in its final draft guidance issued this week, has recommended ixekizumab, an antibody that inhibits interleukin-17A, as an option for treating adults with severe plaque psoriasis that doesn’t respond to standard therapies.
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.
The number of people with many long-term health conditions is set to rise and physicians need to discuss both the benefits and any adverse effects of treatments with patients.
Aimed at healthcare professionals, GPs and physicians, a new NICE guideline (Multimorbidity: clinical assessment and management, NG56) sets out ways to put patients with complex health issues at the heart of decisions about their care, including how to decide between different medicines and treatments. It should also help clinicians to work with their patients to deliver person centred care suited to their needs.
The news release can be read here and the full guideline is Multimorbidity: clinical assessment and management NICE guideline [NG56]
Two drugs currently provided under the Cancer Drugs Fund (CDF) should cease to be available because they are not cost effective, the National Institute for Health and Care Excellence (NICE) has concluded.
Everolimus for breast cancer (Afinitor, Novartis) and ibrutinib for mantle cell lymphoma (Imbruvica, Janssen) do not meet the grade, says NICE in draft guidance now open for consultation.
“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
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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.
Antenatal and postnatal mental health: clinical management and service guidance
This updated guideline from NICE makes recommendations for the recognition, assessment, care and treatment of mental health problems in women during pregnancy and up to 1 year after childbirth, and in women who are planning a pregnancy.
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.”
Please note that ‘NICE BNF and BNFC Mobile Applications’ has changed to http://www.nice.org.uk/About/What-we-do/NICE-apps-for-smartphones-and-tablets.
NICE has published new guidance for ‘red flag events’ where nurses in charge of shifts must act immediately to ensure they have enough staff to meet the needs of patients on that ward.
This month in Eyes on Evidence
Acid-suppressive drugs and oesophageal adenocarcinoma in Barrett’s oesophagus
A systematic review and meta-analysis indicates that proton pump inhibitors reduce the risk of oesophageal adenocarcinoma and high-grade dysplasia in people with Barrett’s oesophagus.
Prescriptions for anxiolytics and hypnotics and risk of death
A population-based cohort study in UK primary care suggests that people who are prescribed anxiolytic and hypnotic drugs have a significantly increased risk of death from any cause over a 7-year period.
Assessment and treatment of dementia in older adults
A systematic review finds that brief cognitive assessment tools can adequately detect early dementia, but whether interventions for mild cognitive impairment or early dementia have a clinically significant effect is unclear.
Bedtime schedules and children’s cognition and behaviour
Two analyses of 7-year-olds in the UK Millennium Cohort Study suggest that not having a regular bedtime is associated with impaired cognition in girls and behavioural difficulties in both girls and boys.
Trained glycaemia alert dogs for people with type 1 diabetes
A small UK intervention study suggests that trained glycaemia alert dogs may be able to notify people with type 1 diabetes during blood glucose variations.
NICE opens consultation on the NICE Accreditation Process Manual Update
NICE is inviting comments on its proposals to update the NICE Accreditation Process Manual.
NICE has recently published Evidence Updates on:
- Physical activity and the environment
- Autism in adults
- Opioids in palliative care
NICE has published final guidance today which does not recommend ustekinumab (Stelara) for psoriatic arthritis.
The National Institute for Health and Care Excellence (NICE) has recommended the use of Genzyme?s multiple sclerosis drug alemtuzumab (also known as Lemtrada).
Adults who are overweight or obese can improve their health by losing even a small amount of weight if they keep it off, according to health watchdog NICE.
Patient needs must come first when determining safe staffing for nursing in wards
Today, on the anniversary of the birth of Florence Nightingale, NICE has issued draft recommendations on safe staffing for nursing in adult inpatient wards in acute hospitals. May 12, 2014
Here are the latest modules in gastroenterology from BMJ Learning
When you only have 10 minutes with a patient, where do you start and how do you finish? This BMJ Learning module will look at the key elements of a consultation and ensure nothing of importance is forgotten.
Here are 3 other modules you may find useful:
Healthcare professionals should wash their hands before and after seeing every patient to help prevent the spread of infections such as MRSA and C difficile in the NHS. One in 16 people being treated on the NHS picks up an infection. As a result, more NHS resources are consumed and the affected patients are at increased risk.
See the latest NICE quality standard which contains six statements designed to reduce infection rates, including a statement recommending that patients should be looked after by healthcare workers who always clean their hands thoroughly, both immediately before and immediately after contact or care.
Scenario from BMJ Learning – what would you do?
A 6 week old baby is examined at his baby check. His legs appear to be the same length but he has asymmetrical leg creases. You perform Ortolani’s test and feel a clunk. What is likely to be going on? If you are not sure, then this module should help. Click on the link to complete it today:
And here are our most popular modules in emergency medicine for you to complete:
This month in Eyes on Evidence
E-cigarette awareness and use to quit smoking
A survey suggests that awareness and use of e-cigarettes has increased over the past few years, but a randomised controlled trial indicates that the products are only modestly effective at helping people to quit smoking.
Beta-2 agonists and exercise-induced asthma
A Cochrane review has assessed the effects of short and long-acting beta-2 agonists for the prevention of exercise-induced asthma in adults and children; the majority of included studies assessed the effect of a single dose of a beta-2 agonist. The Medicines and Healthcare Products Regulatory Agency has previously issued advice recommending that long-acting beta-2 agonists should not be prescribed for the relief of exercise-induced asthma symptoms in the absence of regular inhaled corticosteroids.
Blood pressure control with home telemonitoring and pharmacist management
A US-based cluster randomised trial indicates that home telemonitoring with pharmacist medication management provides better blood pressure control than usual primary care, even once telemonitoring has finished.
Risk factors for congenital abnormalities
A prospective study of a UK multi-ethnic birth cohort suggests that consanguinity is a major risk factor for congenital abnormalities, in particular in children of parents of Pakistani origin.
Antidepressant use late in pregnancy and risk of postpartum haemorrhage
A cohort study of women with low income in the USA suggests that use of antidepressants near delivery is associated with an increased risk of postpartum haemorrhage.
CT scans in childhood or adolescence and risk of cancer
A population-based cohort study in Australia suggests that people who undergo CT scans in childhood or adolescence are at increased risk of developing solid, lymphoid and haematopoietic cancers.
NICE has recently published an Evidence Update on:
Alcohol-use disorders: preventing harmful drinking
This month from NICE, Eyes on Evidence topics as follows:
Blood oxygen levels in preterm infants
One randomised controlled trial reports that preterm infants with low blood oxygen levels have higher mortality at discharge than infants with high levels. However, a second randomised controlled trial finds no difference in mortality on the basis of blood oxygen level.
Premature mortality in people with epilepsy
A Swedish total population study finds that people with epilepsy are at increased risk of premature death, with the risk even higher among those with psychiatric disorders.
Oral contraceptive pills in preventing ovarian cancer
A meta-analysis reports a lower incidence of ovarian cancer in women who have ever used oral contraceptive pills than in women who have never used oral contraceptives.
Tamsulosin for benign prostatic hyperplasia and risk of severe hypotension
An observational study suggests that tamsulosin for benign prostatic hyperplasia is associated with an increased risk of severe hypotension during the first 8 weeks after both starting and restarting treatment.
Socioeconomic disadvantage and onset of disabling chronic conditions in childhood
A longitudinal study of census data from England and Wales shows a link between socioeconomic disadvantage in early childhood and later development of disabling chronic conditions.
NICE has recently published Evidence Updates on:
- Patient experience in adult NHS services
- The epilepsies
Click on any of the links below to complete these online modules from BMJ Learning
- Idiopathic constipation and nocturnal enuresis in childhood: a guide to management – in association with NICE
- Lower urinary tract symptoms in men: a guide to management – in association with NICE
- Erectile dysfunction: diagnosis and treatment
- Managing patients at risk of prostate cancer: in association with the NHS prostate cancer management programme
- Urinary tract infection in children: diagnosis, treatment, and long term management – in association with NICE