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The Quince ...

Issue 59

The Public Health Network
Clopidogrel and acute coronary syndrome
NICE to publish cancer referral guidelines

The Public Health Network

The article comes from one written by Muir Gray about the situation on England, though there are expected to be lessons for Wales as the networks develop. In a speech to the Faculty of Public Health Medicine, last November, Lord Hunt talked both about public health networks and a Public Health Network.

“The purpose of the network will be to pool expertise and skills in specialist areas of public health which can then be available to all PCTs, share good practice, and manage public health knowledge and, very importantly, act as a source of learning and professional development”.

The local networks will arise by common agreement among public health departments, both academic and service, both NHS and local authority, the organisations in which they are based, and individual public health professionals who wish to work in a network. However, the development of local public health networks also offers the opportunity of creating a single national network.

How else can one find a colleague who knows about, for example, supporting refugees from Kosova, sustainable transport policies, screening for renal cancer, or any one of the host of other issues which public health has to cover.

Public health networks offer public health professionals not only support but also the opportunity for developing their special skills and interests and for finding work and paid employment.

Knowledge is the enemy of disease. For public health this is particularly important because public health professionals rarely make technical interventions like the drugs or operations of the physician or surgeon. Alan Milburn announced the need to create a National Knowledge Service in Learning from Bristol and this requires:

  • An integrated knowledge base for the domain, in this case public health;

  • A single network of organisations – service departments, academic departments and local networks;

  • The creation of virtual teams of individuals who do not work face to face but who are members of a community tackling a particular public health problem;

  • A technical infrastructure that allows all of these to operate and interact with other parts of e-government.

Three projects are under way to facilitate the creation of the Public Health Network:

A project to integrate the various knowledge bases of public health, e.g. the Public Health Observatory, the Public Health electronic Library, and specialised websites such as that of the Public Health Laboratory Service and the National Screening Committee.

The development of common standards for public health departments and, particularly, local networks. The worst option would be for each Public Health Network to go out and buy their own copy of Dreamweaver or Front Page. With only a few simple rules for interaction a network can be created.

The means for individuals who wish to share ideas or find employment for their skills to make their knowledge and skills known to people other than those who come into contact with them face to face.

Perhaps the last of these projects will be most challenging. The number of jobs in public health departments is still unclear. The amount of work to be done is immense and encouraging public health professionals who wish to work, or who have to work, outside the confines of a public health department, either whole time or part time, can at the one time provide a satisfying life for individuals and solve the capacity problem of public health.

Ref: web - Lord Hunt's speech

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Clopidogrel and acute coronary syndrome

Clopidogrel (Plavix – Sanofi-Synthelabo & Bristol-Myers Squibb) blocks platelet aggregation through an action distinct from that of aspirin. In the UK, it is licensed for the secondary prevention of atherosclerotic events and for this, we concluded 3 years ago that clopidogrel “appears to offer no worthwhile advantage over aspirin.” After publication of the CURE (Clopidogrel in Unstable angina to prevent Recurrent Events) trial, which assessed adjunctive use of clopidogrel with aspirin in patients with acute coronary syndrome without ST-segment elevation (unstable angina or non-Q wave infarction), clopidogrel was hailed in the lay media as “the biggest breakthrough in 20 years”. Do the CURE study results warrant the use of clopidogrel in patients with acute coronary syndrome without ST elevation (currently an unlicensed indication)?

The results of the CURE study do not provide evidence that routine use of clopidogrel in addition to conventional therapy including aspirin is warranted in patients with acute coronary syndrome without ST elevation. Clopidogrel might have a role in the treatment of selected patients with acute coronary syndrome at higher risk of progressing to myocardial infarction or death (those with ECG evidence of new ischaemia or raised cardiac markers). However, the net benefit from long-term use in this subgroup of patients may not be worthwhile. For every 100 such patients, adding clopidogrel to aspirin for 9 months prevents an additional 2 events of cardiovascular death, non-fatal myocardial infarction or stroke but causes major bleeding in 1 patient. It is possible that there is a better benefit-harm ratio from a shorter duration of use of the treatment, but this is not clear from data available in the public domain. Unless or until such information is made available, the place of clopidogrel is uncertain

Ref: web

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NICE to publish cancer referral guidelines

NICE is to develop GP referral guidelines for patients with suspected cancer, as part of its latest work programme. The new guidelines will take into account existing referral guidance published by the NHS Executive 2 years ago and the All Wales Minimum Standards for Cancer Services.

At the end of last year NICE published referral advice for GPs on eleven common conditions. The summaries can be found in Guidelines in Practice, Vol 5;6:81 June 2002.

A guidelines on the prevention, treatment and assessment of osteoporosis is planned to complement the guidelines on falls, which is currently under development. Both guidelines will support the NSF for Older People which includes a standard on preventing falls and reducing fractures in the elderly.

An evidence-based guideline on the management of Parkinson’s disease will be produced to tie in with the proposed NSF for long-term conditions announced in February. The seventh NICE work programme also includes guidelines on depression in children and young people, long-acting reversible contraception, TB, woundcare, nutritional supplements, enteral and parenteral feeding methods.

Ref: Nice web

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Copyright 2003 | Norman Vetter


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