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News - April 2011

Contents

Four new quality standards launched by NICE

NICE has released its quality standards for chronic kidney disease (CKD), depression, diabetes, and glaucoma. The quality standard statements are the only healthcare and social care standards that apply across the NHS in England. The NICE quality standards will form a cornerstone of the NHS Outcomes Framework, helping to set out the aims and objectives towards improving outcomes in the NHS.

Chronic kidney disease
The quality standard for CKD in adults consists of 15 statements, which cover the identification, assessment, and clinical management of this disease in adults, including the management of established renal failure.

Depression
The quality standard identifies 13 statements that define high-quality care. These include ensuring people receive an assessment that identifies the severity of the symptoms of depression as well as the degree of functional impairment and the duration of the episode.

Diabetes
The quality standard on diabetes in adults comprises 13 quality statements, which include providing personalised advice on nutrition and physical activity for people with diabetes from an appropriately trained healthcare professional. The statements also cover assessment, treatment initiation, and referral to specialist diabetes teams.

Glaucoma
The glaucoma quality standard is made up of 12 statements, covering topics such as the assessment, monitoring, and follow up of people with diagnosed or suspected chronic open-angle glaucoma, or other ocular hypertension.

www.nice.org.uk

Advice on diagnosis of latent tuberculosis updated by NICE

Although the introduction of the BCG vaccination programmes significantly reduced UK rates of tuberculosis (TB), it remains an important public health issue, with approximately 8500 annual cases. There was a 4.2% increase in the rate of TB cases in 2009 compared with 2008. NICE has published a partial update of Tuberculosis: clinical diagnosis, and measures for its prevention and control.

The new recommendations focus on the diagnosis of latent TB using interferon-gamma tests (IGT). They highlight the most accurate strategies for diagnosing latent TB in people who:

  • are recent arrivals from high-incidence countries
  • are healthcare workers
  • are hard-to-reach groups
  • have a compromised immune system
  • have been in close contact with patients who have active TB.

The new recommendations include:

  • offering Mantoux testing, in line with the Green book, to diagnose latent TB in people who are household contacts of people with the active disease (aged 5 years and older) or non-household contacts (e.g. in workplaces and schools)
  • considering IGT in people who have positive results from Mantoux testing or in people for whom Mantoux testing may be less reliable
  • referring patients to a TB specialist if Mantoux testing is inconclusive
  • offering a Mantoux test followed by IGT if results are positive for people aged 5–15 years old who are from high-incidence countries
  • referring suspected cases of latent TB in people who are immunocompromised to a specialist.

At the launch of the guideline, Dr Fergus Macbeth (Director of the Centre for Clinical Practice at NICE), said: ‘Contrary to popular belief TB is not one of those diseases which, like smallpox, has been all but eradicated from our shores. In fact, latest figures show it is on the increase, particularly in our major cities. It is therefore important that the strategies that are used to detect the disease before it has the opportunity to develop into full-blown TB are as robust as possible and based on the best available evidence.’

www.nice.org.uk

SIGN releases guideline on atopic eczema

SIGN has published, Management of atopic eczema in primary care. Atopic eczema can severely reduce quality of life and the new guideline will focus on providing recommendations for the management of atopic eczema in children and adults based on the best current evidence for clinical practice.

The guideline includes recommendations on:

  • diagnosis and referral
  • emollient therapy
  • topical corticosteroid therapy
  • dietary interventions.

This guideline will be of particular interest to GPs as most of the management of atopic eczema is delivered in primary care.

www.sign.ac.uk

Psychosis with substance misuse guidance released

NICE has published a new guideline, Psychosis with coexisting substance misuse, for the assessment and management of adults and young people who have a clinical diagnosis of this condition. The guideline covers:

  • recognition of psychosis with coexisting substance misuse in adults and young people
  • secondary care mental health services
  • substance misuse services

The guideline aims to help healthcare professionals to improve treatment adherence and outcomes, and enhance the lives of people with psychosis and coexisting substance misuse.

www.nice.org.uk

Commissioning guide for CKD published by NICE

The NICE commissioning guide on chronic kidney disease (CKD) draws on the NICE clinical guideline and the recent quality standard on this disease. It identifies the prospective benefits of effectively commissioning an integrated service for the early identification and management of CKD, including:

  • raising awareness of the risk factors associated with CKD and identifying people through appropriate testing
  • preventing or delaying disease progression through early and effective treatment
  • reducing the costs associated with managing established renal failure.

www.nice.org.uk

NICE releases guide for weight management in pregnancy

NICE has published a guide on commissioning services for weight management before, during, and after pregnancy. If interventions during these periods are successful, potential cost savings through avoidance of complications during pregnancy can be achieved. Key issues in the provision of effective services for weight management before, during, and after pregnancy include:

  • raising awareness of weight management
  • identifying at first contact, pregnant women with a body mass index of 30 kg/m2 or more and measuring and recording data.

www.nice.org.uk

NICE has extended its guidance on drug treatments for Alzheimer’s disease

Donepezil, rivastigmine, and galantamine are recommended as options for managing mild as well as moderate Alzheimer’s disease. Memantine is recommended for severe disease and some cases of moderate disease.

www.nice.org.uk

NICE has published guidance to increase the uptake of HIV testing among black Africans in England

The recommendations include advice on reducing barriers to HIV testing, repeat testing, planning services, and HIV referral pathways.

www.nice.org.uk

A guideline on the management of adult testicular germ cell tumours has been published by SIGN

It includes recommendations on the use of tumour markers, the management of stage I disease, metastatic disease, and treatment of relapsed disease.

www.sign.ac.uk

Guidance to increase the uptake of HIV testing among men who have sex with men has been published by NICE

Healthcare professionals should offer regular, routine testing to all men in areas with a high prevalence of HIV.

www.nice.org.uk

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