News - July 2012
Approximately 1000 people are diagnosed each week with a blood clot in the legs or lungs; in 2007 almost 17,000 deaths were recorded in England and Wales as a result of deep vein thrombosis (DVT) and pulmonary embolism (PE).
In Clinical Guideline 144, NICE recommends that people who present to hospital with blood clots in their legs or lungs should be offered treatment within 4 hours and have investigative tests, including scans, within 24 hours.
The NICE guideline recommendations cover:
- Diagnostic investigations for DVT and PE, including use of the appropriate two-level Wells score
- Patients with signs or symptoms of both DVT and PE
- Pharmacological interventions
- Thrombolytic therapy
- Mechanical interventions
- patient information including provision of an anticoagulant information booklet and anticoagulant alert card
- self-management and self-monitoring for patients treated with a vitamin K antagonist
- investigations for cancer
- information on who should be offered thrombophilia testing.
- Estimates suggest that one in ten people with a blood clot have an underlying cancer. It is therefore, recommended that all patients diagnosed with unprovoked DVT or PE and who are not known to have cancer are offered the following
- investigations for cancer:
- Physical examination and
- Chest X-ray and
- Blood tests (full blood count, serum calcium, and liver function tests) and
The guideline also provides recommendations for treating blood clots in patients with cancer who use different blood thinners.
Acute upper gastrointestinal (GI) bleeding is responsible for at least 50,000 hospital admissions per year in the UK and it is estimated that roughly one in ten of these admissions results in the patient's death. Despite changes in management, the mortality rate associated with upper GI bleeding has not improved in the past 50 years.
NICE Clinical Guideline 141 aims to identify diagnostic and therapeutic steps that are useful in managing upper GI bleeding, therefore enabling hospitals to deliver an optimum service for people with the condition.
The new guidance features recommendations on:
- risk assessment
- resuscitation and initial management
- timing of endoscopy
- management of non-variceal bleeding:
- endoscopic treatment
- proton pump inhibitors
- treatment after first or failed endoscopic treatment
- management of variceal bleeding:
- oesophageal varices
- gastric varices
- control of bleeding and prevention of re-bleeding in patients on non-steroidal anti-inflammatory drugs, aspirin, or clopidogrel
- primary prophylaxis for acutely ill patients in critical care
- information and support for patients and carers.
The guideline recommends that unstable patients with severe acute upper GI bleeding should be offered endoscopy immediately after resuscitation and that all other patients with upper GI bleeding should be offered endoscopy within 24 hours.
NICE has published a new guideline that offers best practice advice on the care of adults with autism. This lifelong neurodevelopmental condition features difficulties in social interaction, repetitive behaviour, and strong resistance to change.
There is a wide variation in the rates of identification and referral for diagnostic assessment of autism and these, combined with other factors, cause delays in reaching a diagnosis and subsequent access to the appropriate services for treatment.
Clinical Guideline 142 features recommendations within the following key areas:
- General principles of care
- Identification and assessment
- Identifying the correct interventions and monitoring their use
- Interventions for autism, challenging behaviour, and coexisting mental disorders
- Assessment and interventions for families, partners, and carers
- Organisation and delivery of care.
The guideline recommends that people with autism should have the opportunity to make informed decisions about their care, in partnership with their healthcare professionals.
NICE has also developed:
- an online learning resource to help GPs improve the quality of care that they provide for patients with autism
- an AQ-10 test to help identify if an individual requires a full autism assessment.
Estimates suggest that there are between 12,500 and 15,000 people in the UK with sickle cell anaemia—a blood condition that can have a serious impact on morbidity and mortality.
NICE Clinical Guideline 143 features recommendations on how to manage an acute painful sickle cell episode in people presenting to hospital. The recommendations include topics, such as:
- individualised assessment at presentation
- primary analgesia
- reassessment and ongoing management
- possible acute complications
- management of underlying pathology
- non-pharmacological interventions
- settings and training
- discharge information.
The recommendations within the NICE guideline apply to all patients presenting with an acute painful sickle cell episode, including children and young people, and pregnant women.
The guideline does not make recommendations on drug dosage.
NICE has released the following four technology appraisals:
- Breast cancer (metastatic hormone-receptor)—lapatinib and trastuzumab (with an aromatase inhibitor) (guidance.nice.org.uk/TA257)
- Lung cancer (locally advanced or metastatic epidermal growth factor receptor—tyrosine kinase mutation- positive non-small-cell)—erlotinib (first line) (guidance.nice.org.uk/TA258)
- Prostate cancer (castration resistant metastatic)—abiraterone (following docetaxel therapy) (guidance.nice.org.uk/TA259)
- Chronic migraine—botulinum toxin type A (guidance.nice.org.uk/TA260).
News in brief - A UK guideline has been developed for the diagnosis of complex regional pain syndrome
This guideline provides recommendations on the diagnosis and management of this syndrome, which tends to occur after a limb injury. They were developed by a panel of UK experts in association with the Pain Relief Foundation.
News in brief - The RCGP has launched a practical guide to assist GPs and healthcare professionals in identifying people at risk of disease-related malnutrition
Managing adult malnutrition in the community is based on clinical experience and evidence, and includes a pathway on the appropriate use of oral nutritional supplements.
News in brief - NHS Evidence has released a new Evidence Update on constipation in children and young people
Evidence Update 20 does not include any evidence that could potentially impact on NICE Clinical Guideline 99 on constipation in children and young people.
News in brief - Two new measures have been published within the NHS Outcomes Framework
These measures relate to serious mental health conditions and emergency readmission rates. A further six measures have been updated, including four in unplanned hospitalisation.
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