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News - October 2008

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New guidance will help identify people at risk of premature death

NICE has issued guidance on reducing premature deaths from cardiovascular disease (CVD) and other smoking-related diseases. The guideline has been developed for smoking cessation services and prescribers of statins, and is designed to help tackle health inequalities. Recommendations include:

  • primary care professionals and those working with communities should use a range of methods, including GP registers and appointment data, and culturally appropriate education (including CVD risk assessment), to identify disadvantaged adults and those at high risk of early death from CVD
  • providing flexible, co-ordinated services that are tailored to the needs of disadvantaged people, who should be involved in planning and developing them
  • forging partnerships with those in contact with disadvantaged people professionally or in the community
  • ensuring the requisite skills are available from GPs or other professionals to identify people who are disadvantaged and develop services appropriate to their needs.

Professor Catherine Law, Chair of the public health interventions advisory committee at NICE, said: ‘Tackling smoking and providing statins, as recommended, should make a significant contribution to reducing inequalities.’

www.nice.org.uk

Early diagnosis and treatment of CKD recommended by NICE

The NICE guideline on early identification and management of chronic kidney disease (CKD) in adults sets out: how best to identify people with CKD; who is at risk of progression and serious complications; and management of care. It covers:

  • appropriate tests for diagnosis of long-term kidney problems
  • best treatment and care for adults with CKD, and when to refer
  • general management of CKD, including when the condition is a result of diabetes, high blood pressure, and cardiovascular disease.

The guideline advises simple blood and urine tests for people at risk of developing CKD.

www.nice.org.uk

New treatment prevents clots after orthopaedic surgery

Dabigatran etexilate has been approved by NICE for use after elective total hip or knee replacement in adults, for prevention of venous thromboembolism (VTE). It inhibits production of thrombin, a key enzyme in the formation of blood clots, and prevents further clots from forming. This is more likely when patients are inactive for periods or after surgery.

Treatment should start soon after surgery, and be continued for specified periods for knee and hip replacement, respectively. Clot formation after surgery is relatively common and is not itself life threatening. However, if a portion of the clot becomes detached and travels to other parts of the body it can cause problems.

www.nice.org.uk

NICE has published guidance on ADHD diagnosis and management

The NICE guideline on attention deficit hyperactivity disorder (ADHD) in children, young people, and adults has just been published. The disorder is common in children and young people, affecting up to 3% in the UK. It is also diagnosed in about 2% of adults worldwide. As well as its impact on the affected person, ADHD can be very distressing for their family and carers.

Symptoms of ADHD include:

  • inattentiveness—short concentration span; inability to finish a task
  • hyperactivity—fidgeting; restlessness
  • impulsiveness—speaking without considering the consequences.

The guideline makes several key recommendations. These include:

  • specialist teams should jointly develop training programmes in diagnosis and management for professionals working with people with ADHD
  • first-line treatment should involve offering education and training programmes for parents or carers
  • in a classroom setting, appropriately trained teachers should introduce behavioural interventions to assist children and young people with ADHD
  • parents or carers of a child or young person with ADHD with moderate levels of impairment should be referred to a group parent-training/education programme—this may be together with a group cognitive behavioural therapy and/or social skills training programme for the child or young person
  • in school-age children or young people with severe ADHD, first-line treatment should be with pharmacology, coupled with group-based training for parents
  • a comprehensive treatment plan should be initiated for children and young people with ADHD, and should include: pharmacology; psychological, behavioural, and educational advice; and interventions
  • adults with ADHD should be offered a comprehensive treatment programme including: drug treatment and focusing on psychological, behavioural, and educational or occupational needs.

A significant level of impairment is a prerequisite for a diagnosis of ADHD, and symptoms can overlap with those in other disorders so care should be taken with differential diagnosis. Disorders of mood, conduct, learning, motor control and communication, and anxiety occur commonly in children with ADHD. Coexisting disorders in adults include personality disorders, bipolar disorder, obsessive-compulsive disorder, and substance misuse.

www.nice.org.uk

A new guideline from SIGN focuses on acute upper and lower gastrointestinal bleeding

A new guideline from SIGN focuses on acute upper and lower gastrointestinal bleeding. This is a common major medical emergency but National Audit has highlighted service deficiencies. Advice is included on assessment, resuscitation, endoscopy, pharmacology, and prevention of repeated variceal bleeding.

www.sign.ac.uk

NICE has approved oseltamivir and zanamivir for post-exposure prophylaxis or prevention of non-pandemic ‘flu

Before commencing treatment: national surveillance must indicate a virus (not a new strain) is circulating; unvaccinated patient has to be in at-risk group; exposure must have occurred within set time period.

www.nice.org.uk

A booklet from the Medical Foundation for AIDS and Sexual Health will support diagnosis of HIV by non-specialists

Early diagnosis and management enable a better prognosis in patients with HIV, and reduce transmission of the disease.

www.medfash.org.uk

Results from the DIRECT Programme, which studied the effect of treatment with an angiotensin II receptor blocker on incidence and progression of diabetic complications, have shown:

Strongly positive trends towards reduced incidence of diabetic retinopathy in type 1 diabetes; and a significant increase in regression of diabetic retinopathy in type 2 diabetes.

www.easd.org

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