News

News - June 2009

NICE launches low back pain guideline

Low back pain presents a considerable healthcare burden, with around one third of the UK adult population affected by this condition each year. Appropriate management has the potential to reduce the personal and social impact that low back pain can cause. The NICE guideline on Low back pain: early management of persistent non-specific low back pain covers the early treatment and management of persistent or recurrent low back pain that has continued for greater than 6 weeks but less than 12 months. A key issue within the guideline is to promote self-management of back pain, which includes provision of advice and information. Patients should be encouraged to be physically active and continue with normal activities as far as possible. Other advice for healthcare professionals includes:

• offering a tailored exercise programme, a course of manual therapy, or a course of acupuncture depending on patient preference; an alternative may be offered if the chosen treatment does not provide satisfactory improvement
• considering referral for a combined physical and psychological treatment programme of 100 hours over a maximum of 8 weeks for people who have received at least one less-intensive treatment (as defined by the guideline) and who have high disability and/or significant psychological distress
• obtaining and documenting informed consent if prescribing drugs without a marketing authorisation, as no opioids, cyclooxygenase inhibitors or tricyclic antidepressants, and only some non-steroidal anti-inflammatory drugs are licensed for use in treatment of low back pain
• offering a magnetic resonance imaging scan only within the context of a referral for an opinion on spinal fusion.

www.nice.org.uk

Diabetes guideline updated with information on newer agents

The NICE guideline on the management of type 2 diabetes has been partially updated by Type 2 diabetes: newer agents for blood glucose control in type 2 diabetes. Some of the key recommendations are listed below:

• Insulin therapy should begin with neutral protamine Hagedorn insulin. A number of conditions are listed in the guideline when a switch to long-acting insulin analogues is being considered
• A dipeptidyl peptidase-4 inhibitor (sitagliptin) should be considered in patients taking metformin and a sulfonylurea if insulin is inappropriate; sitagliptin and vildagliptin can be added to metformin or a sulfonylurea if contraindications exist for either of these two drugs
• A glucagon-like peptide-1 mimetic (exenatide) may be added to metformin and a sulfonylurea if control of blood glucose remains or becomes inadequate, and the patient has a body mass index of:
• ≥35 kg/m² and experiences problems associated with high body weight
• <35 kg/m² and has a medical problem resulting from being overweight, or for whom insulin is not an option
• A thiazolidinedione (pioglitazone, rosiglitazone) may be added to metformin and/or sulfonylurea if treatment with insulin is inappropriate because of potential hypoglycaemia. Thiazolidinediones should not be given to patients with heart failure or who are at high risk of fracture.

www.nice.org.uk

Advice for coeliac disease published

The NICE guideline on Recognition and assessment of coeliac disease has been produced to help identify people with this condition.

Serological testing for coeliac disease should be offered to children and adults with the following signs and symptoms:

• chronic or intermittent diarrhoea
• failure to thrive or faltering growth (in children)
• persistent or unexplained gastrointestinal symptoms including nausea and
  vomiting
• prolonged fatigue (‘tired all the time’)
• recurrent abdominal pain, cramping or distension
• sudden or unexpected weight loss
• unexplained iron-deficiency anaemia, or other unspecified anaemia.

The guideline also gives recommendations on circumstances and medical conditions that indicate testing for coeliac disease. Prior to serological testing, patients (and their parents or carers if appropriate) should be told that testing is accurate only if they follow a gluten-containing diet, which should include gluten in more than one meal every day for at least 6 weeks before testing.

Patients and their parents or carers should be informed that a delay in the diagnosis of coeliac disease can result in continued ill health, long-term complications, and, in children, growth failure, delayed puberty, and dental problems.

www.nice.org.uk

SIGN produces guidance on head injury

A guideline on the Early management of patients with a head injury has been released by SIGN. The aims of the guideline include identifying those patients who are: at risk of intracranial complications; likely to benefit from transfer to neurosurgical care; and who require follow up after discharge. The recommendations cover:

• pre-hospital assessment
• referral to hospital
• imaging
• indications for admission and discharge from hospital
• inpatient observations
• discharge planning and advice
• referral to neurosurgery
• follow up.

www.sign.ac.uk

Respiratory physiotherapy advice published

The British Thoracic Society and the Association of the Chartered Physiotherapists in Respiratory Care have produced Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. The guideline appraises evidence for respiratory physiotherapy techniques, and provides recommendations where possible. It covers the following disease areas:

• chronic obstructive pulmonary disease
• asthma and disordered breathing
• cystic fibrosis
• non-cystic fibrosis
• restrictive lung conditions
• neuromuscular musculoskeletal disorders of the chest wall.

The guideline also provides advice on physiotherapy workforce planning.

www.brit-thoracic.org.uk

SIGN updates chlamydia guidance

SIGN has updated its guideline on Management of genital chlamydia trachomatis infection to reflect more recent evidence. The guideline aims to consolidate best practice in the management of individual cases of genital chlamydial infection as well as advise on policy for the most cost-effective testing strategy at a population level. It also includes topics not covered in the previous guideline including:

• new variant Chlamydia trachomatis
• rectal and pharyngeal specimens
• postal testing
• treatment of rectal infection in men.

www.sign.ac.uk

Change in measurement for HbA_1c

The Department of Health has announced that from 1 June 2009 long-term blood glucose levels (HbA_1c) in people with diabetes will be measured in millimoles per mol (mmol/mol) as well as in percentages. The change was made in order to make it easier to compare HbA_1c results in laboratories throughout the UK and worldwide. Both measurements will be used for the next 2 years, but as of 31 May 2011, people with diabetes will only receive their HbA_1c measurement in mmol/mol. An online conversion calculator can be found on the Diabetes UK website.

nds.coi.gov.uk

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