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News - June 2007
New NICE guideline will help to assess children with fever
A new guideline to give all healthcare professionals a practical tool for the assessment and management of feverish symptoms in children under 5 years of age was recently issued jointly by NICE and the National Collaborating Centre for Women and Children's Health.The guidance incorporates a new traffic light system that will facilitate more accurate diagnosis according to key signs based on the patient's normal skin colour, level of activity, respiratory signs, and level of hydration. Other signs to look out for should include fever, swellings, a new lump, non-blanching rash, neck stiffness, fitting or seizures, and vomiting.
Although feverish illness is common in young children, with 20–40% of parents seeking medical care for children with such symptoms each year, most fevers will subside naturally. However, a few result from serious, life-threatening infections such as meningitis or pneumonia.
The guideline recommends that:
- healthcare professionals use the 'traffic light' tool to predict the risk of a serious infection being present, based on the presence or absence of key symptoms
- if 'red' features are present in a child (who, therefore, may be at high risk), he or she should be seen by a healthcare professional as a matter of urgency
- if a parent thinks that their child has a fever it should be taken seriously by the healthcare professional
- a child who is not thought to be at high risk of a serious infection may be cared for at home but the carer should be given information on warning symptoms to look out for, direct access to out-of-hours medical care, and a follow-up appointment schedule if appropriate.
The Chief Executive of NICE, Andrew Dillon pointed out that infections remain the leading cause of death in children under 5 years of age, with fever being one of the main symptoms. He said: 'This guideline will help healthcare professionals to pick up the high-risk symptoms that indicate a child needs urgent medical attention — this will save children's lives.'
New guidance on secondary prevention of MI is patient-centred
NICE has issued a new guideline on secondary prevention in primary and secondary care following a myocardial infarction (MI). This replaces the previous advice on prophylaxis for patients who have experienced an MI. The guideline supports implementation of the coronary heart disease national service framework and updates its advice on post-MI secondary prevention. According to NICE, about 838,000 men and 394,000 women in the UK have had an MI. The new guideline is aimed at giving them the benefit of a more patient-centred secondary care approach, and allowing them to make informed decisions on their care and treatment in partnership with their healthcare professionals.
NICE highlights the importance of good communications between doctor and patient. Evidence-based written information, tailored to suit each patient, should be provided on their condition, care, and treatment, taking into account cultural and language issues, and any physical, sensory or learning disabilities.
Other key recommendations for implementation of the guideline include the following:
- after acute MI, the discharge summary should include information on diagnosis and investigations, future management, and advice on secondary prevention
- patients should be given lifestyle advice on taking regular physical activity and eating a Mediterranean diet
- smokers should be advised to quit and offered referral to a smoking cessation service
- cardiac rehabilitation should be equally available to all patients, taking into consideration people who are less likely to use the service—including black and minority ethnic groups, lower socioeconomic groups, people from rural communities, older patients, women, and those with mental or physical health co-morbidities
- appropriate pharmacological treatment should be offered to patients
- cardiological assessment should be available to all to assess if coronary revascularisation is appropriate, taking into account other co-morbidities.
To aid implementation of the guidance, NICE has produced a costing template and report, and future tools to be issued will include implementation advice, a slide set, and audit criteria.
Pilot project launched to test evidence for NHS patient safety solutions
Following recommendations in the Chief Medical Officer's report, Safety first: a report for patients,clinicians and healthcare managers, NICE is working together with the National Patient Safety Agency to assess the clinical and cost-effectiveness of new patient safety solutions within the NHS. The scheme will lead to production of guidance on measures to prevent or mitigate harm to patients within the NHS. The pilot project is running from April to November 2007 and will look at new systems-based and IT-based interventions to address problems with medicines reconciliation, which can cause errors in medication given to patients, and potentially result in harm. The second area to be assessed covers antibiotic interventions and oral decontamination for the prevention of ventilator-associated pneumonia.
The safety guidance is expected to be issued to the NHS on completion of the pilot project in November 2007. An overview of the patient safety pilot process is available on the NICE website.
More research into maternal consumption needed
A BMA report has called for more guidance to help doctors diagnose and treat children suffering from fetal alcohol spectrum disorder (FASD) and highlighted the need for clear evidence-based guidelines on alcohol consumption during pregnancy and for women who are planning a pregnancy.
The report—Fetal alcohol spectrum disorders–also recommends that GPs provide clear and coherent advice for expectant mothers and anyone planning a pregnancy on the risks of maternal alcohol consumption, and that this should be given as part of routine clinical care. It also advises that those women who are identified as being at high-risk of prenatal alcohol consumption should be offered referral to specialist alcohol services for appropriate treatment followed by assessment at regular intervals. In addition, health departments in the UK should implement guidance and training programmes for healthcare professionals on the prevention, diagnosis, and management of FASD. Dr Vivienne Nathanson, Head of BMA Science and Ethics, said: 'We need to raise awareness of the emerging evidence on FASD among healthcare professionals. They need training and guidance on how to identify these disorders so that affected children are diagnosed quickly and get the help they need.'
Men's Health Forum toolkit
The Men's Health Forum toolkit will assist PCTs in fulfilling their new gender equality duty to provide gender-sensitive services. It aims to improve poorer than necessary male health, and also female health.
The European Society of Cardiology condenses its guideline on valvular heart disease into pocket format.
The focus is on management of the disease in adults and adolescents and is based on expert consensus opinion.
NICE backs refunds from manufacturers for ineffective treatment
It proposes that treatment for patients with full or partial response is NHS funded, and for manufacturers to reimburse costs when patients show little or no improvement.
The DH revises heatwave contingency plan
It calls for 'cool rooms' in residential homes and for NHS trusts to check they can keep temperatures below 26°C. A Heat-Health Watch system will also operate in England from 1 June to 15 September.
Working together for better diabetes care
The Department of Health has published Working together for better diabetes care, a report about the future of diabetes services. It recommends that annual diabetes check-ups should take place in GP practices to take pressure off hospitals, and calls for more joined up care and improved patient knowledge. By moving these services to primary care, it is hoped that more comprehensive check-ups and less duplication of tests will occur. The importance of partnerships between patients and clinicians is also highlighted.
Guideline for the management of gout
A guideline for the management of gout has been produced by the British Society for Rheumatology and British Health Professionals in Rheumatology. It provides concise, patient-focused, evidence-based recommendations for healthcare professionals in primary care and hospital practice in the UK, and is also a useful resource for patients. Recommendations on lifestyle modifications, and pharmacological/non-pharmacological modalities of therapy are included. Audit recommendations are also covered.
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Guidelines in Practice, June 2007, Volume 10 (6)
© 2007 MGP
Ltd
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