National Institute For Clinical Excellence Guidelines Research Articles

The Use of Mechanical Bowel Preparation and Oral Antibiotic Prophylaxis in Elective Colorectal Surgery: A Call for Change in Practice

Elective colorectal surgery is associated with one of the highest rates of surgical site infections (SSIs), which result in prolonged length of stay, morbidity, and mortality for these patients and have a significant financial burden to healthcare systems. In an effort to reduce the frequency of SSI rates associated with colorectal surgery, the 2018 World Health Organisation (WHO) guidelines recommend the routine use of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (OAP) in adult patients undergoing elective colorectal surgery. However, this recommendation remains a topic of debate internationally. The National Institute of Clinical Excellence (NICE) guidelines, last revised in 2019, recommend against the routine use of MBP and do not address the issue of OAP. In this communication, we reviewed the current guidelines and examined the most recent evidence from randomised-control trials (RCTs) and meta-analyses on the effect of MBP and OAP on SSI rates since the 2019 NICE guideline review. This recent evidence clearly demonstrated an SSI-risk-reduction benefit with the additional use of OAP and the combination of MBP and OAP in this group of patients, and we therefore highlight the need for change of the current NICE guidelines.

ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes.

ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes.

Transitioning from child to adult cleft lip and palate services in the United Kingdom: Are the NICE Guidelines reflected in young adults’ experiences?

ABSTRACT Cleft lip and/or palate (CL/P) is one of the most common congenital conditions worldwide. Individuals born with CL/P will embark on a long-term treatment pathway throughout childhood and often into adulthood. As they grow older, young people become more involved in medical decisions. The National Institute for Clinical Excellence (NICE) has published guidance for health professionals on how transitions of responsibility should be managed in health services. The aim of the current study was to examine the extent to which the NICE recommendations are currently being implemented in UK CL/P services according to young adults’ first-hand accounts. Semi-structured interviews were carried out with 15 young adults with CL/P aged 16-25 years. Interview questions were designed to map onto the NICE guidance. Data were analysed to assess whether each guideline was met, partially met, or not met for each individual participant. Overall, findings suggest that further consideration is needed as to how best to implement the recommendations effectively. The introduction of assigned transition workers in CL/P services to co-ordinate transition to adult care offers one possible solution. Focusing on the provision of holistic, patient-centred care, this aspect of the CL/P service could include giving patients access to medical history documentation, liaison with key health professionals including GPs and dental practitioners, and the development of age-appropriate resources to facilitate the transition process.

513 - Lithium monitoring in Old Age Psychiatry – a quality improvement project

INTRODUCTION:Lithium has a narrow therapeutic index with a risk of toxicity and potential to increase morbidity and mortality, particularly in the elderly with co-morbid illness and polypharmacy. Lithium therapy and monitoring of lithium levels require precision and several guidelines have been issued including recommendations for strict control of lithium levels in the elderly population.RESEARCH OBJECTIVE:We evaluated the effect of implementation of a multifaceted management programme on the compliance with international practice standards for lithium monitoring in patients under the care of Psychiatry of Old Age (POA), Sligo Leitrim Mental Health Services in the North West of Ireland.METHODS:Results from a prior audit performed in February 2020 involving a cohort of 18 patients prescribed lithium under the care of POA were analysed and compared to accepted standards. The guideline used as the benchmark for compliance was the National Institute for Clinical Excellence (NICE) guidelines on the use and monitoring of lithium therapy, as published in 2014. Several deficits were found and therefore a designated Lithium Management Programme was established. A subsequent audit, performed using a simplified audit tool incorporating the NICE guidelines, delivered results which were directly compared to the initial findings and analysed to evaluate the effect of the implemented management programme.PRELIMINARY RESULTS OF THE ONGOING STUDY:In comparison with findings from 2020, there had been a significant improvement in most facets of lithium management and compliance to practice standards. Of particular note was the improvement of biochemical monitoring, side effect screening, polypharmacy surveillance, patient education and interdisciplinary communication.CONCLUSION:The launch of a dedicated Lithium Management Programme with specific features aimed at identifying and addressing poor compliance with monitoring guidelines has led to improved adherence to accepted international practice standards. Our model provides a dynamic, multi-layered system which paves the way for better patient outcomes, timely access to care and furthering education for patients and staff members.

Adherence to NICE Guidelines on Colorectal Cancer Follow-Up: A Cross-Sectional Analysis

Purpose: Our aims were to determine adherence to National Institute of Clinical Excellence (NICE) guidelines on colorectal cancer (CRC) surveillance and to evaluate local practice patterns determine how it can be further improved. Patients and methods: Patients with colorectal cancer resection between January 1, 2017 and December 31, 2017 were identified, and their records retrospectively reviewed. Results: A total of 18 patients were eligible. Surveillance patterns, including blood tests and colonoscopies, were inconsistent with NICE recommendations in a significant proportion of patients. Follow up appointments and CT imaging occurred more frequently in line with the guidelines. For recurrences detected by surveillance, 66.6% were resectable whereas 0% of those detected by symptoms were resectable. Conclusions: The results prove that a moderately intensive follow-up strategy can positively identify resectable recurrence thus increasing overall survival. Our data highlights the need for local improvement to adherence to NICE guidelines regarding CRC follow-up. We have created a pro forma which is attached to the patient’s clinical notes. It will aid clinicians in reminding them when appropriates tests should be completed. A re-audit will be completed in December 2020 which will include looking at the effectiveness of the new pro forma.

Acute traumatic brain injury and the use of head computed tomography scans in the emergency department

Introduction The use of CT head scanning for traumatic brain injury (TBI) is a vital diagnostic tool, guided by risk stratification tools. This study aims to review the use of CT head scans and adherence to guidelines for TBI in two New Zealand emergency departments (EDs). Methods Retrospective observational study of patients referred for head CT from EDs to exclude a significant intracranial injury between 1st September 2018 and 31st August 2019. Clinical data were collected regarding presenting patterns, identification of injuries on CT scan and adherence to National Institute of Clinical Excellence (NICE) CT head guidelines. Results Out of 425 included cases, 41 (10%) patients had an intracranial injury seen on their CT head scan. Patients who reported loss (32% vs 20%, p < 0.05) or possible loss of consciousness (34% vs 22%, p < 0.05) and had a Glasgow Coma Score (GCS) <13 (17% vs 8%, p < 0.05) or focal neurology (10% vs 3%, p < 0.05) were more likely to have an intracranial injury on CT. Interestingly, 17 (41%) patients with CT diagnosed injuries had a GCS 15 and no focal neurology. NICE guidelines were adhered to in 364 (86%) of CT requests. In the 14% of cases that did not meet guideline criteria, all CT head scans were negative. Conclusion CT head scans are a valuable tool in TBI, and guidelines successfully identify those with significant intracranial injuries. However, the rate of significant injury for the total population requiring head CT remains low, with over 90% of head CTs in the population normal, despite high guideline compliance, perhaps identifying a role for novel objective tests in ED guidelines internationally.

Transition from Methylphenidate to Atomoxetine: reasons for switching and clinical outcome

AimsAttention Deficit Hyperactivity Disorder (ADHD) is a behavior disorder originating in childhood comprising of a constellation of features including inattention, impulsivity, and hyperactivity. The National Institute of Clinical Excellence (NICE) Guidelines 2018 recommends methylphenidate as a first line pharmacological agent for treatment of children aged 5 years and over with ADHD. Lisdexamfetamine, dexamfetamine and atomoxetine are recommended in this order if methylphenidate is not tolerated or if symptoms did not respond to separate 6-week trials. Our aim was to, assess the transition of methylphenidate to atomoxetine, the reasons for switching and its clinical outcome in order to make recommendations to current practice regarding treatment of ADHD.MethodThe study examined a total of 53 children between 0-16 years of age who were being treated for ADHD with atomoxetine at CYPS till September 2018. Data was collected from patients’ files retrospectively by using a proforma based on the NICE guidelines 2018 ADHD: diagnosis and management.ResultOut of 53 patients’ on atomoxetine in September 2018, 49 were included in the study. Results recorded side-effects as the main reason for switching from methylphenidate to atomoxetine. Unwanted side-effects were documented in 71.7% of patients of which 57.9% exhibited more than 1 side-effect with the two commonest side-effects documented being weight loss and decreased appetite. The audit highlighted the fact that the correct dose of atomoxetine was only administered in 17.2% of children with 56.9% of patient's being given a higher dose than recommended. Initial weight was not documented in 19% and hence, ideal dose could not be calculated. Overall, atomoxetine was shown to be an effective treatment. Out of the 40 patients documented to have hyperactivity this symptom was decreased in 82.5% whilst 82.9% were shown to have increased concentration. 35 patients had documented impulsivity and this was decreased in 62.9% of cases. 11 patients had documented anxiety with 72.7% being treated effectively with atomoxetine. 31% of patients’ had documented side-effects with 16% of these being tics. 20% of patient's required augmentation.ConclusionThe results indicate that the majority of doctors at CYPS in Malta adhered to the NICE guidelines 2018 and atomoxetine was proven to be efficacious as a second line drug in the treatment of ADHD. However, better adherence to NICE guidelines is required when it comes to the calculation of appropriate dosage. Our prediction is had dose recommendations according to weight been adhered to there may have been less side-effects documented.

Audit on antipsychotic prescribing in children and young people with a learning disability under the care of mental health services in Surrey

AimsTo check the extent to which National Institute of Clinical Excellence (NICE) guidelines were being followed in clinical practice with regards to prescribing antipsychotic medication to Child and Adolescent Mental Health Services (CAMHS) patients with a diagnosed learning disability (LD).MethodA data collection tool (based on a similar Royal College of Psychiatrists [RCPsych] audit) was filled out with retrospective data from patients’ clinical records, then analysed using Microsoft Excel and Microsoft Powerpoint.The agreed standards were the NICE guidelines.There were no ethical issues as the data were retrospective and anonymised.Sample size was 13, comprising 7 males and 6 females.All service users were less than 18 years of age.Result7 out of the 13 patients who were prescribed antipsychotics had a Severe/Profound LD.Among the 5 patients who had been prescribed antipsychotic medication, 4 were on Risperidone and 2 were on Aripiprazole. The reasons for starting antipsychotic medication were clearly documented for all 5, the most common reasons being overt aggressive behaviour and general agitation/anxiety.Only 1 patient had antipsychotic medication initiated in the previous 12 months. NICE guidelines had been generally followed for the management of this case, with good documented evidence.For the other 4 patients, in whom antipsychotic medication was initiated more than 12 months ago, there was a lack of documentation of the subsequent assessment of side effects, extra-pyramidal side effects, body weight, blood pressure, glycaemic control and lipid profile. 1 of these patients did not have a documented review of antipsychotic medication in the previous 6 months. For the other 3 patients, their medication reviews did not consider whether to reduce the dose or stop antipsychotic medication.1 patient had been transferred to primary care, with a clear transfer of prescribing responsibility and documented evidence that written guidance was provided to primary care which addressed all the necessary management details.ConclusionAlthough there was clear documentation of reasons for initiating antipsychotics, there appeared to be a lack of awareness of NICE guidelines for antipsychotic medication reviews, side effect and metabolic markers assessment, and their documentation. This is an area for potential change in practice to conform better to national guidelines and improve patient care.

Type 2 Diabetic Retinopathy Screening in a General Practice: A Five-Year Retrospective Analysis.

AimTo assess current standards of diabetic retinopathy screening in primary care against the National Institute of Clinical Excellence (NICE) guidelines for type 2 diabetes mellitus. Moreover, to determine whether individuals with diabetes were screened for diabetic retinopathy no later than three months from referral to the local eye screening service and no later than one year from their last retinal screen.Materials and methodsA single-center, retrospective audit was undertaken at a small general practice. Data was collected from the health records of individuals placed on the type 2 diabetes register from 01/01/2013 to 01/01/2018. Individuals who were diagnosed with diabetes whilst registered at a different practice, who had pre-diabetic retinal screening or were referred onto a different screening pathway were excluded. A total of 50 records were audited and data collection involved demographics, dates individuals were placed on the diabetes register and dates of attendance and non-attendance to screening.Results16.0% of individuals with type 2 diabetes underwent retinal screening which adhered to the NICE guidelines. Of the cohort which did not adhere, 59.5% experienced an interval greater than three months between diagnosis and first retinal screening and 64.3% experienced a screening interval greater than one year.ConclusionsDiabetic retinopathy screening of individuals must be improved to meet the NICE standards. Interventions should be implemented to increase the awareness within general practitioners and practice nurses to ensure all people with diabetes receive their first retinal screen within the first three months of diagnosis with regular annual screening thereafter.

Assessment of pre-operative investigation cost and associated factor on surgical patients at Gondar university hospital, Gondar, Ethiopia, 2019

Background: Pre-operative investigations are performed before any surgical intervention under anesthesia. Many are considered as routine. However, there are no clear guidelines regarding these in Gondar University general comprehensive specialized hospital. We aimed to investigate the relevance of the laboratory investigations ordered routinely and their cost implications and associated factor compared with the National Institute of Clinical Excellence (NICE) guidelines. Methods: Institutional based cross-sectional study was carried out at University of Gondar general comprehensive specialized hospital. A total of 300 patients scheduled for elective surgical procedures included in this study. Neither the surgeons nor anesthetists involved were aware of the study. The laboratory investigations of the patients who underwent surgery were noted and the prescriber and site of the investigation done was also noted. All values were categorized as normal or abnormal and they were assessed as indicated or unindicated based on NICE guidelines. Results: A total of 688 laboratory tests and 172 instrumental tests were done. Out of 688 laboratory tests 639 was indicated as per NICE guideline and 49 was unindicated; from those investigations 600 was ordered by surgical teams and the rest 88 was ordered by anesthetists. And from 172 instrumental tests 152 was indicated as per NICE guideline 20 was unindicated, out of those instrumental tests 140 was ordered by surgical team and the rest 12 was ordered by anesthetists. In instrumental tests chest X- ray and ECG accounts the majority (82.89%). The additional cost incurred towards unindicated tests was 13.89% of the total cost for the tests. Conclusion: Pre‑operative laboratory investigations add to cost with large amount. Patient premorbid conditions and surgical grade should guide the clinician to request for the relevant laboratory tests.

An Expert Discussion on Autism in the COVID-19 Pandemic.

An Expert Discussion on Autism in the COVID-19 Pandemic.

P610 Optimising biological therapy in inflammatory bowel disease patients: the role of a virtual biological clinic

Abstract Background The National Institute of Clinical Excellence (NICE) recommends that patients with inflammatory bowel disease (IBD) taking biologic agents are reassessed every 12 months, to determine whether continuation of therapy is appropriate. Only those with evidence of ongoing active disease, determined by clinical symptoms, biochemical markers, endoscopic or radiological investigations, should continue with therapy. With the increasing use of biologics, this represents a major challenge and may result in biologic agents being inappropriately continued, at significant cost to the NHS. A virtual biologics MDT (VMDT), consisting of 2 IBD consultants and 2 specialist nurses, was launched in 2017 at Russells Hall Hospital (RHH) to address this issue. We aim to evaluate its performance in 2018. Methods We performed a retrospective case note review of all patients discussed at the VMDT in 2018. Clinic letters, blood results, endoscopy reports and radiological investigations were examined to determine adherence to NICE guidelines. Results Out of a total 223 patients using biologics in 2018, 119 (51.2% male, 79.8% Crohn’s disease, mean age 42.7 years, 57.9% taking adalimumab) were discussed at the VMDT. 67/119 patients were taking a second immunosuppressant agent and out of the remaining 58, 32 had documented evidence of treatment failure or side effects on these agents and 23 were planned to commence them from the MDT. Fourteen patients (11.8%) had their biologic de-escalated post MDT and 5 (4.2%) were switched to a second-line agent. 1 patient’s planned de-escalation was prevented by ankylosing spondylitis. 26/119 patients had no recent or planned radiological or endoscopic reassessment of their disease at 12 months. Of these 26 patients, 17 had ongoing clinical symptoms preventing treatment withdrawal, 2 were de-escalated and 6 had plans to add a second agent prior to reassessment. Only 1 patient continuing treatment had a good indication for de-escalation. Of the 89 patients eligible for therapeutic drug monitoring, 8 were found to have no levels within 12 months of the VMDT (all taking adalimumab). All of these patients were identified at the time and 7 were sent for levels. The remaining patient had their drug discontinued. Conclusion The virtual biologics MDT at RHH has been shown to be an effective way of monitoring patients’ disease activity and drug levels, optimising drug therapy and appropriately de-escalating biologic agents. It was only possible to discuss 53.4% of our patients at the virtual MDT and we recommend this service is expanded by allocating a formal monthly session to ensure that all patients can be reviewed. Work is now underway to assess performance in 2019 and follow-up patients who have had their biologics discontinued.

A015 Time to be NICE New Zealand? Evolving Chest Pain Assessment Pathways in Hauora Tairāwhiti

National Institute of Clinical Excellence guidelines (NICE) recommend CT coronary angiography (CTCA) as first line investigation in patients (pts) with suspected stable angina. We report our early experience with CTCA, impact on pt assessment and resource utilisation. A retrospective review of all pts referred for CTCA in Hauora Tairāwhiti from 1/11/18 until 31/1/ 20. A total of 158 pts underwent CTCA with the indication in over 2/3rds non acute chest discomfort or exertional breathless. Mean age 59 years (29-77years). 58% male, 46% NZ Māori. 18% (28/158) were diabetic, 67% (107/158) hypertension 27% % (43/158) current or ex-smokers. Mean LDL cholesterol was 2.6 mmol/l with 53% (83/158) on lipid lowering therapy. Treadmill testing was performed in 26% (41/158), 59% (24/41) post CTCA. stress echo in 16% (25/158) with the majority, 76% (19/25) performed post CTCA. A 47% reduction in outpatient treadmill testing was noted from 2018 to 2019 (153 v 81) No difference was seen in stress echo (114 v 114). Limited CTCA image interpretation was available in 6 pts. A Calcium score of 0 was noted in 41 pts and was predictive of the absence of atherosclerosis in all but 1.63% (99/158) had atherosclerosis with 14% (22/158) considered to have at least 1 stenosis > 50% and 8% (12/158) a focal stenosis < 50%. Following CTCA 6% (9/158) were waitlisted for invasive angiography. CTCA has impacted positively on the assessment of chest pain in Hauora Tairāwhiti with availability also influencing utility and timing of stress testing modalities.

“A picture tells a thousand words” smartphone-based secure clinical image transfer improves compliance in open fracture management

BackgroundBOAST (British Orthopaedic Association Standards for Trauma) and NICE (National Institute of Clinical Excellence) guidelines recommend clinical photography of all open fractures on admission and at key stages of patient care for objective wound documentation and to avoid repeated examination. Recording and handling photographs in a compliant and confidential manner in the setting of acute trauma management can prove challenging. To facilitate clinical photography at our Major Trauma Centre (MTC) institution, a smartphone-based Secure Clinical Image Transfer (SCIT) app was introduced and integrated with the existing clinical photography database to allow clinicians to take photographs, which are saved directly to patient records. ObjectivesTo compare rates of information governance (IG)-compliant clinical photography of wounds of patients with open fractures before and after introduction of departmental smartphones loaded with the clinical photography app SCIT. MethodsAdmission lists were inspected retrospectively for patients admitted with open fractures between August and October 2016, before SCIT was introduced. The Trust clinical photography database was searched for corresponding patient images and where present, graded out of three for clarity, comprehensiveness and context. The procedure was repeated prospectively from August to October 2017 after rollout of SCIT. The uptake and quality of photography were statistically compared (Fisher’s exact test, significance level p < 0.05). Results42 open fractures were identified in the 2016 period and 40 in the 2017 period. None of the 42 patients in the 2016 cohort had records of IG-compliant clinical photography on admission. 16 of 40 patients in the 2017 cohort had IG-compliant clinical photography on admission. This was statistically significant (p < 0.0001). 5 of 42 patients in the 2016 cohort and 8 of 40 patients in the 2017 cohort had photographs after first debridement. This was statistically insignificant (p = 0.375). All five photographs in the 2016 cohort scored 3/3. 18 of 21 photographs in the 2017 cohort scored 3/3, one scored 2/3 and two scored 1/3. ConclusionsIntegrating commonplace smartphone technology with a secure platform for taking and storing photographs can improve rates of IG-compliant clinical photography of open fractures. This may improve documentation, communication and patient care.

AB156. 129. Surveillance strategies for patients at a family history risk assessment clinic

Background: Women with a family history of breast cancer are assessed in University Hospital Limerick (UHL) using the Family History Risk Assessment Software (FaHRAS, Nottingham, UK) tool, which allows risk stratification of women using the International Breast Cancer Intervention Study (IBIS) risk model. Follow up surveillance of these women is then arranged according to the National Institute for Clinical Excellence (NICE) guidelines on Familial Breast Cancer. The aim was to assess the compliance of follow-up of patients attending the Family History Breast Clinic at UHL with the corresponding NICE guidelines. To establish the outcomes of patients who were assessed with the FaHRAS risk assessment software.

Managing hypertension in people of African origin with diabetes: Evaluation of adherence to NICE Guidelines

BackgroundThe pathophysiology of hypertension in people of African origin differs from other ethnicities. This effect may be exacerbated in people with type 2 diabetes mellitus (T2DM), hence control of hypertension is particularly important in this population. AimsThe primary aim was to evaluate the adherence to National Institute of Clinical Excellence (NICE) guidance (National Guidelines NG28) for hypertension management in African origin patients with T2DM. MethodsThis study was done using electronic health records at a large primary care centre based in Birmingham, UK. Strict exclusion criteria were applied to identify individuals with T2DM, African origin patients and a diagnosis of hypertension. Retrospectively participants were identified, and NICE guideline adherence was assessed using descriptive statistics. Results78 patients were included in the study of which 28 (36%) were on the NICE recommended combination of antihypertensives, suggesting poor adherence to the guidance in primary care prescribing. The blood pressure control of 35 (44.9%) patients was suboptimal, although this group received more frequent blood pressure monitoring. Microalbuminuria remains a problem in the suboptimal group. ConclusionThis study provides insight into adherence to NICE guidance for managing hypertension in African origin patients with diabetes. Further work should be done to explore the effects of hypertension in this ethnic group and if there is a need for a more refined management guideline.

Preoperative laboratory testing - Comparison of National Institute of Clinical Excellence guidelines with current practice - An observational study.

Background and Aims:Preoperative laboratory testing is done to detect abnormalities in the body not detected by clinical examination. Often a battery of tests is advocated as a routine for patients scheduled for low or intermediate risk surgery. This prospective observational study was aimed to assess agreement of the current practice of preoperative laboratory investigations with the National Institute of Clinical Excellence (NICE) guidelines, and the impact of investigations on patient care and costs.Material and Methods:The study was conducted at a tertiary referral center on 385 patients aged 18-70 years of either gender, posted for elective general surgical, gynaecological or otolaryngological surgery. Sixteen investigations were examined: hemogram, blood urea, serum creatinine, serum electrolytes, coagulation profile, urinalysis, thyroid function tests, electrocardiogram, echocardiogram, chest x-ray, pulmonary function tests, blood sugar, glycosylated hemoglobin, liver function tests, treadmill test and coronary angiogram. The history and physical examination were reviewed to examine for indication for these laboratory investigations. These were compared with NICE guidelines. Impact of these investigations on anesthetic decision-making was noted.Results:There was almost no agreement of the current practice with the NICE guidelines. The total cost of all tests obtained was Rs 5,48,755. Total additional cost of unindicated tests was Rs 5,10,730 (93%). Average amount spent on additional investigations per patient was Rs 1326.57.Conclusion:Most investigations are overprescribed and have minimal agreement with NICE guidelines. None of the tests had any impact on clinical care. Nearly a million rupees is incurred per year in one referral hospital alone, when NICE guidelines are not followed.

Audit of physical health monitoring in children and adolescents receiving antipsychotics in neurodevelopmental clinics in Northumberland.

AIMTo ascertain performance against the standards set by National Institute for Clinical Excellence (NICE) guidelines on physical health monitoring of thirty children and adolescents prescribed antipsychotics in neurodevelopmental clinics in Northumberland and identifying areas for improvement in practice.METHODSThe audit involved a review of recorded documentation pertaining to physical health monitoring in patient electronic records pertaining to children and adolescents attending neurodevelopmental clinics in Northumberland prescribed antipsychotics. Clients were also contacted by telephone if relevant documentation could not be identified or retrieved to confirm the details. 32 case notes were perused of which 2 were excluded as they had refused to have venepuncture which was documented in the electronic records.RESULTSThe overall audit results demonstrated partial compliance with NICE guidelines on physical health monitoring in children and adolescents prescribed antipsychotics. Bi-annual recording of height, weight, blood pressure, pulse rate and review of side effects was completed in 100% of subjects. However, annual monitoring for blood tests including liver function, renal function full blood count as well as biannual monitoring of serum prolactin, serum lipid profile was completed only in 56% of subjects. Comparative baseline characteristics between the two groups (compliant and non-compliant with guidelines) found no differences based on any socio-demographic or clinical variables. However, the proportion of patients in the group compliant to guidelines was higher in the age group of 12-17 years as compared to < 12 years (70.58% vs 38.46%), though not statistically significant (χ2 = 1.236; P = 0.24).CONCLUSIONDevelopment of tailored and specific guidelines for physical health monitoring in children and adolescents prescribed antipsychotics taking into consideration clinical effectiveness and safety profile is likely to improve adherence rates.

A cost effectiveness study establishing the impact and accuracy of implementing the NICE guidelines lowering plasma NTproBNP threshold in patients with clinically suspected heart failure at our institution

AimsThe 2014 National Institute of Clinical Excellence (NICE) guidelines on the management of acute heart failure recommended using a plasma NT-proBNP threshold of 300pg/ml to assist in ruling out the diagnosis of heart failure (HF), updating previous guidelines recommending using a threshold of 400pg/ml. NICE based their recommendations on 6 studies performed in other countries. This study sought to determine the diagnostic and economic implications of using these thresholds in a large unselected UK population. MethodsPatient and clinical demographics were recorded for all consecutive suspected HF patients over 12months, as well as clinical outcomes including time to HF hospitalisation and time to death (follow up 15.8months). ResultsOf 1995 unselected patients admitted with clinically suspected HF, 1683 (84%) had a NTproBNP over the current NICE recommended threshold, of which 35% received a final diagnosis of HF. Lowering the threshold from 400 to 300pg/ml would have involved screening an additional 61 patients and only would have identified one new patient with HF (sensitivity 0.985, NPV 0.976, area under the curve (AUC) at 300pg/ml 0.67; sensitivity 0.983, NPV 0.977, AUC 0.65 at 400pg/ml). The economic implications of lowering the threshold would have involved additional costs of £42,842.04 (£702.33 per patient screened, or £ 42,824.04 per new HF patient). ConclusionApplying the recent updated NICE guidelines to an unselected real world population increases the AUC but would have a significant economic impact and only identified one new patient with heart failure.

EAU and NICE guidelines for the diagnosis and management of prostate cancer. How wide is the channel?

Background: Prostate cancer is the most common cancer in men in Europe. Both the European Association of Urologists (EAU) and the National Institute of Clinical Excellence (NICE) provide evidence-based guidelines for the diagnosis and management of prostate cancer. NICE is a national body involved in the production of efficacious guidelines for a wide spectrum of diseases across many specialities, whereas EAU is a specialist body of urologists and members of the urology multidisciplinary team across Europe. This paper describes the areas of agreement and explains the variations between these two often-quoted documents. Objectives: The objective of this paper is to review the guidelines of prostate cancer and to offer a comparison of prostate cancer guidance management for urologists and associated healthcare professionals. Conclusion: Both guidelines agree on areas of established consensus, especially in the diagnosis and staging of prostate cancer. There are however differences in the treatment algorithms, especially in advanced and metastatic disease. The differences in general seem to be due to the different functions and make-ups of the two bodies rather than disagreement on current evidence.