News

News - January 2011

Contents

SIGN publishes guideline on prevention and treatment of VTE Commissioning guide on biological drugs published NICE releases commissioning guide for paediatric services RCPCH specifies minimum standards for paediatric services Recommendations on child sedation developed by NICE DH guidance aims to improve health of adults with autism News in brief - NICE does not recommend bevacizumab in combination with oxaliplatin and either fluorouracil plus folinic acid or capecitabine for the treatment of patients with metastatic colorectal cancer News in brief - Guidance on the use of clopidogrel and modified-release dipyridamole has been released by NICE News in brief - The use of prucalopride for women with chronic constipation in whom laxatives have not provided adequate relief has been approved by NICE News in brief - NICE will be developing 31 new quality standards, on topics including asthma, bipolar disorder, diabetes, and four types of cancer

SIGN publishes guideline on prevention and treatment of VTE

The Scottish Intercollegiate Guidelines Network (SIGN) has brought together new evidence on primary and secondary prophylaxis and treatment of venous thromboembolism (VTE) in a single guideline: Prevention and management of venous thromboembolism.

Venous thromboembolism is likely to be an increasing public health issue due to the prominence of age as a risk factor and the increasing age of the population. The condition has a high mortality when untreated, but treatment also carries risks, mainly, haemorrhage.

Patients who are hospitalised after trauma, surgery, or immobilising medical illness, and pregnant and puerperal women have a significantly higher risk of VTE. There is evidence that routine prophylaxis reduces morbidity, mortality, and health service costs in hospitalised patients at risk of deep vein thrombosis or pulmonary embolism.

The SIGN guideline on VTE identifies risk factors and at-risk patient groups, and includes algorithms for assessing patients admitted to hospital. In addition to generic recommendations on methods of VTE prophylaxis, SIGN provides recommendations on specific patient groups and circumstances.

The recommendations on the management of VTE cover:

• diagnosis
• clinical and laboratory investigations that should be performed before providing anticoagulant therapy
• initial management
• choice and duration of anticoagulant, and use of graduated elastic compression stockings
• monitoring the anticoagulant effect
• outpatient management of acute VTE.

Healthcare professionals should be aware of the adverse effects of VTE prophylaxis and treatment, which include:

• bleeding
• heparin-induced thrombocytopenia
• reduced bone mineral density
• embryopathy and foetal haemorrhage (caused by vitamin K antagonists).

A checklist on information relating to VTE that patients/carers may find useful is also included in the SIGN guideline.

www.sign.ac.uk

Commissioning guide on biological drugs published

NICE has produced a commissioning guide on Biological drugs for the treatment of inflammatory disease in rheumatology, dermatology and gastroenterology. This document is part of a series of guides developed to support commissioners with the redesign of services to improve outcomes for patients and make better use of NHS resources.

The guide identifies the potential benefits of effectively commissioning biological drugs for the treatment of inflammatory diseases. It is based on guidance produced by NICE within its technology appraisals programme.

An algorithm to support implementation of NICE guidance on biological drugs for the treatment of rheumatoid arthritis is available, with other algorithms to follow after publication.

www.nice.org.uk

NICE releases commissioning guide for paediatric services

The latest commissioning guide from NICE on paediatric continence services, outlines how best to effectively commission such a service. The guide addresses the key components of:

• early identification, assessment, and initial treatment of children with continence problems
• managing long-term continence problems in children and young people
• developing a high-quality integrated paediatric continence service.

It is recommended that commissioners should collaborate with clinicians, local stakeholders, and service users, including children and young people and their parents or carers, when determining requirements for local services.

www.nice.org.uk

RCPCH specifies minimum standards for paediatric services

The Royal College of Paediatrics and Child Health has published Facing the future: Standards for paediatric services. This new policy document sets out 10 service standards to ensure all children and young people receive high quality care, delivered by trained and competent professionals in a timely manner, and in appropriate settings.

All of the service standards have been approved by the College Council and represent the minimum requirement for all acute general paediatric services. An explanatory guide is included for each standard that provides more detail on what the standard is setting out to achieve and how it will be implemented.

www.rcpch.ac.uk

Recommendations on child sedation developed by NICE