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News – June 2005

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SIGN launches guideline on bipolar affective disorder

SIGN has developed an evidence-based guideline to improve the diagnosis and appropriate treatment of patients with bipolar affective disorder.

The diagnosis should be made after clinical assessment according to DSM or ICD criteria, the guideline states. The condition can be difficult to diagnose especially if patients are only seen during the depressive phase.

“The intermittent nature of symptoms can make diagnosis difficult. Omitting the question about past episodes of increased activity, overspending or elation while interviewing depressed patients or their families, may result in misdiagnosis,” Professor Klaus Ebmeier, chair of the guideline development group, told Guidelines in Practice.

“Because of the episodic nature of the illness patients can function perfectly well in the interval, while being severely incapacitated during their manic or depressive phase. Nevertheless it is becoming clear that some patients have subclinical symptoms or cognitive difficulties between episodes,” explained Professor Ebmeier, Professor of Psychiatry, University of Edinburgh.

While manic episodes will generally be treated in hospital, many patients will be managed mostly in the community, either by the primary care team or in a shared care scheme with specialist psychiatric services.

“I think the guideline will be welcomed by GPs for its simplicity and also for its unequivocal recommendations (consistently grade A) for the use of lithium for the prevention of relapse,” Lanark GP Dr Jill Murie told Guidelines in Practice.

The guideline recommends that in general practice lithium should be prescribed according to a shared care protocol to minimise sideeffects and toxicity. Copies of SIGN 82. Bipolar affective disorder can be downloaded free of charge from the SIGN website: www.sign.ac.uk

NICE to publish guidelines for suspected cancer

NICE plans to publish evidence-based guidelines for referral of patients with suspected cancer, later this month.

The guidelines will cover the following groups of cancers: lung; upper and lower GI; breast; gynaecological; urological; haematological; skin; head and neck; brain/CNS; bone and sarcoma; and children’s and young people’s cancers.

As well as discussing the symptoms and signs that merit urgent referral, the guidelines look at the role of investigations in primary care. The guidelines will be available on the NICE website: www.nice.org.uk

Your last chance to enter the Guidelines in Practice Awards

If you have successfully completed an innovative project to implement national guidance in the NHS, then don’t forget to enter it for the Guidelines in Practice Awards.

An entry form and full details can be found on pp. 69-71.

The main Award is open to primary or shared care initiatives to implement any national evidence-based clinical guidance. Examples include: National Service Frameworks, NICE, SIGN and academic professional body guidance and the indicators in the nGMS contract.

The overall winner will receive £4000 and the two runners up £1000 each to roll out their projects.

There are also ten sponsored categories for projects in the following clinical areas: asthma; CHD & hypertension; COPD; diabetes; epilepsy; medicines management; mental health; older people; smoking cessation and stroke & TIA. The winning team in each of the sponsored categories will receive £3000.

“Many practices have been very successful in tackling the indicators in the nGMS contract and have developed innovative ways of working to achieve this.

“We are sure that there are many examples of good practice associated with fulfilling the indicators that would form the basis of a suitable project to enter so why not give it a go,” said the judges.

The winners will be presented with their Awards at an after dinner ceremony in London in November and their names will be announced in the journal that month.

See pp. 69-71 of the June issue of Guidelines in Practice for an entry form or download a copy here.

NICE issues guidance on secondary prevention

NICE has published guidance on the use of clopidogrel and modified release dipyridamole in the secondary prevention of occlusive vascular events.

MR dipyridamole in combination with aspirin is recommended for patients who have had a stroke, for two years from the most recent event. After two years, or if the patient cannot tolerate MR dipyridamole, standard care, including long-term treatment with low-dose aspirin, should be given.

Clopidogrel alone is recommended for patients who are unable to take low-dose aspirin and have suffered a stroke or MI or have symptomatic peripheral arterial disease.

Copies of the guidance can be downloaded from the NICE website here

Guidelines in Practice, June 2005, Volume 8(6)
© 2005 MGP Ltd
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