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News - September 2007

NICE advises on chronic fatigue syndrome

A new guideline from NICE and the National Collaborating Centre for Primary Care aims to assist with diagnosis and management of adults and children with chronic fatigue syndrome/myalgic encephalomyelitis (encephalopathy) (CFS/ME).

Symptoms include fatigue, headache, disturbed sleep, and muscular pain, which can be debilitating and impact on people with CSF/ME and their carers. In the guideline, emphasis is placed on accuracy of diagnosis and early management of symptoms, as well as on shared decision making with those people affected—the aim is to maintain and, hopefully, improve physical capacity.

Recommendations include:

• referral to a paediatrician within 6 weeks of the first GP visit for people under 18 years of age
• making a diagnosis of CFS/ME when symptoms persist for 4 months in adults and 3 months in a child or young person, after excluding other possible causes
• developing a personalised management plan jointly with the patient—putting them in charge of overall aims and goals
• providing advice on managing activity, rest periods, sleep patterns, diet, and equipment, which can all help to maintain independence
• not advising those with CSF/ME simply ‘to exercise more’ as this may exacerbate symptoms.

www.nice.org.uk

NICE publishes guidance on UTIs in children

Approximately 82,000 children per year are affected by urinary tract infections (UTI) and rapid diagnosis and treatment will help avoid permanent damage. A new guideline from NICE and the National Collaborating Centre for Women’s and Children’s Health advises parents and healthcare professionals on symptoms to note and how to avoid repeat infection.

Signs and symptoms of UTIs in the very young are non-specific and difficult to spot, and this new guideline explains what to look out for. It has clear recommendations on when to consider a diagnosis of UTI, how urine specimens should be collected, and which procedures should be used in children of different ages to enable diagnosis. It also suggests effective treatments and what follow-up care may be required.

The guideline recommends:

• looking for signs of UTI—general symptoms like vomiting and fever, and specific signs such as pain on micturition, and frequency
• immediately referring children less than 3 months old to a paediatric specialist if UTI is suspected.

Current management and investigations for UTI place a burden on NHS resources, and involve investigations that are often unpleasant for the children and upsetting for their carers. The guideline aims for more consistency of clinical practice, enabled by more accurate diagnosis and better management.

www.nice.org.uk

Updated British guideline on asthma management is now available

The British Thoracic Society (BTS) and the Scottish Intercollegiate Guidelines Network (SIGN) have released the 2007 update for the British guideline on the management of asthma. Changes include amendments to sections on preventer therapy, specific management problems, and anti-IgE monoclonal antibody. The revisions include:

• comparing inhaled steroids—limited published evidence was found on the clinical benefit of ciclesonide, as the efficacy to safety ratio is not yet established, and the guideline makes no specific recommendations
• looking at the impact of smoking on the efficacy of inhaled steroids—higher doses may be needed for smokers or ex-smokers
• considering evidence for adjustable dosing of inhaled steroids—in adults, twice the dose given at the time of exacerbation has not been demonstrated as effective, although studies where the dose of the combination inhaler budesonide with formoterol was adjusted according to symptoms gave good asthma control. The guideline makes no specific recommendations
• summarising the latest evidence on the anti-Ig E monoclonal antibody, omalizumab—the lack of active comparative studies meant it was not possible to place omalizumab in the stepwise treatment of asthma.

Reports of a small number of children who developed clinical adrenal insufficiency while being treated for asthma with inhaled corticosteroids are also addressed—the exact dose and duration of inhaled steroid treatment that will introduce this risk is unknown but a good practice point has been included: ‘Specific written advice about steroid replacement in the event of a severe intercurrent illness should be part of the management plan for children treated with ≥800 µg per day of beclomethasone or equivalent. Any child on this dose should be under the care of a specialist paediatrician for the duration of the treatment.’

The British guideline on asthma was originally produced by BTS and SIGN in 2003 and has been updated periodically since then. The entire guideline is scheduled for major review in 2008.

www.sign.ac.uk

Age Concern reports on mental health in later life

Age Concern’s second report from the UK inquiry into Mental Health and Well-being in Later Life considered evidence from older people, their carers, organisations, and professionals.

The inquiry found five main areas for action. These are:

• ending discrimination
• prioritising prevention of mental health problems in later life
• supporting self-help and enabling peer support
• improving services for housing, health, and social care
• facilitating change by improving education, training, and support, through increasing investment, and by strengthening professional, managerial, and political leadership.

www.mhilli.org

Dementia strategy aims to respond to system failings

Care Services Minister Ivan Lewis has announced a national dementia strategy, to be published in 2008, saying: ‘The current system is failing too many dementia sufferers and their carers.’

The aims of the programme are to improve public and professional understanding of dementia; to ensure availability of effective services on a nationwide basis for early diagnosis and treatment; and to generate improved liaison services.

The Care Services Improvement Partnership will support the project by working alongside services and commissioners to deliver improvements at a local level in the short term, and to ensure full implementation of the strategy in the long term.

www.gnn.gov.uk

DH to tackle inequalitties in eligibility for IVF treatment

Results from a survey by Infertility Network UK (I N UK), carried out on behalf of the DH, showed huge variation in eligibility criteria for NHS-funded infertility treatment. Recommended practices set out by NICE in 2004 are not being met, with PCTs failing to adopt a consistent definition of a ‘full cycle’ of in vitro fertilisation (IVF). Many PCTs are failing to fund one round of IVF, even though the guideline recommends that eligible couples should be offered up to three cycles.

New measures to help reduce these inequalities have been announced by the DH, and it is working with I N UK to develop criteria for eligibility for IVF, to produce best-practice guidance for PCTs, and to set up national monitoring of IVF provision.

www.infertilitynetworkuk.com

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