News – January 2005

Contents

Incontinence guideline will improve quality of life
Communicating with your deaf patients
Rehabilitation after brain injury
Guidelines in Practice launches 2005 Awards

Incontinence guideline will improve quality of life

Even mild urinary incontinence can have a serious effect on patients’ quality of life. New guidance from SIGN recommends that GPs should use a validated questionnaire to assess the severity of symptoms and their impact on quality of life, as part of their initial assessment.

The evidence-based guideline, published in December, recommends that initial assessment should also include taking a clinical history, physical examination, completion of a voiding diary and urinalysis. Estimation of post void residual volume should be carried out in male patients and in female patients where symptoms of voiding dysfunction are present or there have been recurrent UTIs. Digital rectal examination is recommended in men.

Effective treatment depends on thorough assessment and diagnosis, the guideline states.

“Knowledge about how best to treat incontinence could be better. The evidence produced in the guidelines will help GPs and nurses better understand what treatment is available,” said Dr Ken McLean, spokesperson for the RCGP (Scotland).

The guideline contains separate care pathways for male and female patients presenting with urinary incontinence in primary care, from initial assessment through to treatment and referral.

Pelvic floor muscle exercises are the treatment of choice for patients with stress or mixed incontinence but the programme must be tailored to the individual. Patients with urge incontinence should be offered bladder retraining.

Female patients with symptomatic pelvic organ prolapse or suspected voiding dysfunction should be referred as should male patients with reduced urinary flow rates or raised post void residual volumes. Patients should also be referred if previous treatments have failed or surgery is being considered.

Copies of the full guideline SIGN 79. Management of urinary incontinence in primary care and the quick reference guide can be downloaded free of charge from the SIGN website: www.sign.ac.uk.

• SIGN is developing an evidence-based guideline on the diagnosis and management of epilepsies in children and young people, which is due to be published in March. The guideline covers diagnosis, investigation and drug treatment and has a section on the management of prolonged or serial seizures and status epilepticus. There is also a chapter on behaviour and learning. The guideline will be available free of charge from the SIGN website: www.sign.ac.uk.

Communicating with your deaf patients

The RNID has produced guidance to help GPs communicate better with deaf patients.The guide, endorsed by the RCGP, recommends that at least one front-line member of staff undergoes basic deaf awareness training. The RNID provides one-day training courses tailored to GPs, practice nurses and receptionists. Copies of GP Guidance: Deaf and hard of hearing patients can be downloaded from the RCGP website: www.rcgp.org.uk

Rehabilitation after brain injury

The RCP has published interagency guidelines on the vocational assessment and rehabilitation of patients following acquired brain injury. The guidelines are aimed at doctors and others involved in helping brain damaged patients rehabilitate and assessing their fitness to return to work. The guidelines can be obtained from the RCP publications dept, tel: 020 7935 1174 ext 358.

Guidelines in Practice launches 2005 Awards

If you have successfully completed an innovative project to implement national guidance that has significantly improved patient care why not enter it for this year’s Guidelines in Practice Awards.

Entry for the Guidelines in Practice main Award is open to primary or shared care projects to implement any national evidence-based clinical guidance in the NHS.

Examples of suitable guidance include National Service Frameworks, NICE, SIGN or academic professional body guidelines – and also this year the indicators in the quality and outcomes framework of the nGMS contract.

The overall winner will receive £4000 to carry on their project and the two runners up will receive £1000.

There is also a series of sponsored categories for projects to implement national guidance in the following areas: CHD & hypertension; COPD; Diabetes; Epilepsy; Medicines management; Mental health; Older people; Smoking cessation; Stroke & TIA.

In 2004 the overall winners were a team from NHS Forth Valley for their outstanding shared care initiative which “has set the gold standard for epilepsy care,” the judges said.

“I would actively encourage healthcare professionals to enter their work for these Awards. The whole experience has been most positive and has brought benefits to our service, the patients and also the staff at the frontline,” said project lead Dr Lesley Holdsworth.

“It has raised the profile locally within the population about how important correct management of epilepsy is and we as healthcare providers have been acknowledged for our efforts.

“It makes things really worthwhile when these efforts are recognised so widely,” she told Guidelines in Practice.

“The epilepsy patient forum was consulted about how the Award money should be spent. It is being used to develop more patient and staff information resource materials,” she added.

See also editorial here and entry form, here.