News

News - July 2007

New faecal incontinence guideline aims to boost patient confidence

NICE and the National Collaborating Centre for Acute Care have produced guidance on the management of faecal incontinence. This distressing bowel problem affects up to one in 10 people at some time in their lives.

The guidance recommends that healthcare professionals should actively ask people in high-risk groups whether they have any signs of the disorder. These may be frail old people, new mothers, people with diarrhoea or with a neurological or spinal disease.

The guideline outlines treatments that are available to manage or sometimes cure the condition, and gives details of coping strategies for patients whose condition is not treatable. It aims to make patients more confident when discussing faecal incontinence, as well as to reassure them that their symptoms and concerns will be taken seriously by their GP or healthcare professional.

Key recommendations for implementation of the guideline include:

• a full assessment should be carried out, and medical history obtained—patients should be questioned about their bowel habits and how symptoms affect their day-to-day life
• healthcare professionals should offer advice on diet and fluid intake
• patients should be encouraged to establish a regular bowel routine
• patients who travel should be given advice on planning journeys so they can use public toilets—they should be told about the toilet access card and the RADAR key
• if simple measures are unsuccessful at curing the faecal incontinence, pelvic floor exercises should be encouraged
• the patient's condition is assessed after each stage of treatment—those still experiencing problems should be involved in discussions on further treatment and coping, and asked whether they wish to try further treatment
• healthcare professionals involved in offering care to people with reported faecal incontinence should have relevant skills, training, and experience, and work within an integrated continence service.

A costing template and report have also been produced by NICE to aid implementation of the guideline.

www.nice.org.uk

SIGN issues guideline on autism spectrum disorders

Autism spectrum disorder (ASD)—autism, atypical autism, and Asperger's syndrome—is more common in boys than girls (approximately 4:1 ratio). Early diagnosis, with appropriate intervention, specialised education, and structured support can help these young people to maximise their potential.

The new guideline from the Scottish Intercollegiate Guidelines Network, for children and young people with ASD was produced following 2001 figures, which estimated that 7714 children aged under 19 years in Scotland had the disorder.

It concentrates on assessment, diagnosis, and clinical interventions for children up to the age of 18 years who have been diagnosed with ASD. It took into consideration evidence for working with children/young people, and consulting them on their condition. It also recommends that parents/carers should be given written information about their child's condition, as well as an opportunity to ask questions.

A diagnosis of ASD should be considered in pre-school children who exhibit a lack of normal developmental features, as the disorder is difficult to recognise at such a young age. Parents/carers of this age group should also be offered education and skills interventions. Observation of a child's social and communication skills and behaviours, and an ASD-specific diagnostic history are key to helping with identification.

This guideline will be of interest to healthcare professionals and others involved in the care of children/young people with ASD, as well as to the young people affected by the disorder, and their families.

www.sign.ac.uk

Positive results from review of heart failure services

The Healthcare Commission report 'Pushing the boundaries', based on their 2005/2006 review, assessed services from 303 healthcare communities. Most were rated excellent, good, or fair. Only 26 were assessed as weak, and are being asked to produce plans detailing proposed improvements.

The Commission found areas for improvement in most communities, however, with significant variation in the level of services. Some patients had no access to medication or long-term support. Others were left without a confirmed diagnosis.

To combat service discrepancies, the British Society for Heart Failure is developing a national heart failure audit, which is already being piloted.

Draft guideline from NICE on drugs for age-related macular degeneration

Age-related macular degeneration (AMD) impacts on the quality of life of those affected, with increasing loss of central vision. This worsens as the disease spreads to the second eye, which is often the first time that people seek help. It usually affects people aged over 50 years, and the risk increases with age.

Public consultation has taken place on two drugs, ranibizumab and pegaptanib, for treatment of AMD. Only the first of these is recommended by NICE, which should be used under certain circumstances for treatment of wet AMD when both eyes are affected, but should only be applied to the better-seeing eye. Based on the evidence they have seen, the independent advisory committee of NICE considers that the right thing to do is to save as much sight as possible in the better eye.

www.nice.org.uk

Department of Health launches extra tools to tackle spread of tuberculosis

England has seen a re-emergence of tuberculosis (TB) as a public health problem over the past 10 years. The DH action plan of 2004 has sought to tackle the disease within the existing population and in people moving to this country. The online 'TB toolkit' is the latest item to be made available to those commissioning TB services within the NHS, and provides a flexible commissioning framework, models of best practice for delivery of TB services, and guidance on laboratory services and surveillance.

From 1 September 2007, prescription charges will also be removed for drugs supplied by clinics to treat TB. This move aims to ensure infected people are treated as early as possible so that they no longer represent a source of disease for others.

www.gnn.gov.uk

NICE recommends altepase for NHS use but only in accordance with safety rules set out in the drug licence

Risk of stroke before 85 years of age is one in four for men, and one in five for women. Quickly breaking down the clot that causes a stroke with clot-dissolving medications can reduce complications.

www.nice.org.uk

Improvement Foundation issues leaflet on practice-based commissioning and 18 weeks

This contains two case studies which illustrate how service redesign can achieve time-saving. It highlights that the 18-week target is a way of achieving quicker investigation and treatment.

www.improve.nhs.uk

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