Cancer guidelines from NICE

New guidelines on referring patients with suspected cancer in England and Wales have been launched by the National Institute for Health and Clinical Excellence (NICE). The document is intended to help to ensure that people wherever they live, who present in primary care with suspected cancer will benefit from a consistent and coherent approach, based on the best available evidence.

The guidelines update previous recommendations from the Department of Health published in 2000, taking account of new evidence from research and from audits. They make recommendations on the diagnostic and referral process for the most common cancers, including lung cancer, breast cancer, skin cancer, upper and lower gastrointestinal cancer, and cancer in children and young people.

For each cancer the guidelines list symptoms that should alert GPs to referring patients either immediately (acute admission or referral within a few hours), urgently (within two weeks), or non-urgently (all other referrals). The recommendations are each graded according to the evidence on which they are based.

Although deaths from some cancers are falling, nearly 140,000 people died from cancer in England and Wales in 2003. A report from the National Audit Office on cancer services in England published last year found that patients in England with cancer of the breast or bowel tended to have more advanced cancer at the time of diagnosis than in some other countries. Older people and those from deprived areas were more likely to have more advanced cancer at diagnosis.

The NHS Cancer Plan identifies early referral as an important element in the improvement of care for people with cancer. This is, therefore, a particularly important guideline which may improve this aspect of the cancer care pathway.

The guideline also covers the support that staff in primary care should offer to people who have symptoms that could be cancer. Offering patients the choice of seeing a male or female GP; proving them with information about the risks and benefits of tests so that they can be involved in making decisions about tests if they wish; and giving details about what to expect when they see a specialist, including their possible diagnosis, are among the recommendations.

The guidelines will help GPs in England and Wales improve the accuracy and speed of the referral process. They will also ensure that those waiting for their referral appointment are given the information and support they need to help reduce uncertainty during what can be an extremely anxious time. We hope that all GPs are made aware of these guidelines and that they are acted on without delay.

Web:source

Back to top

Chloramphenicol eye drops

Chloramphenicol eye drops are unnecessary for uncomplicated conjunctivitis

They are no better than placebo for children with conjunctivitis, a randomised trial has found. The authors think primary care doctors should stop prescribing chloramphenicol  eye drops for children with uncomplicated conjunctivitis and should instead tell parents to keep the affected eye clean and to come back if it doesn't get better.

The trial, which included 326 children aged 12 years or less, reported clinical cure rates of 83% (128/155) among children given placebo drops for seven days compared with 86% (140/162) among children given chloramphenicol. Four fifths of the children had bacterial conjunctivitis. Children given placebo drops were no more likely to relapse and no less likely to report side effects than the others, but they took about a third of a day longer to get better.

This is the first trial done exclusively in primary care, where chloramphenicol eye drops are a standard treatment for conjunctivitis in children. Changing doctors' prescribing habits and patients' expectations will be difficult, particularly in countries such as the UK where schools and nurseries often exclude children until they are treated. The economic arguments are compelling, however. Every year one million children present to UK general practitioners with conjunctivitis; that's over a million consultations and potentially a million prescriptions.

Web: Source

Back to top

Lack of targets leads to underperformance

Many services provided by the NHS in England and Wales have improved over the past year, but others, including mental health, sexual health, maternity, and dental services, have "been left  behind," according to an annual report on the state of health care. The report, presented to parliament this week, said that a lack of targets or requirement to collect information in these areas may underlie the poorer performance.

It says that the NHS still has a long way to go to achieve a "patient-led" service. The annual report from the Healthcare Commission, an independent body that inspects and reviews various aspects of health services, focused for the first time on the experience of patients. It reviewed existing evidence on the  experience of patients, including the commission's own surveys of patients. The results showed that patients were highly satisfied with many NHS services, with more than 90% of patients who took part in the surveys rating their overall care as good, very good, or excellent. However, there were some exceptions. Only 76% of patients in mental health services were satisfied with their care.

Anna Walker, chief executive of the Healthcare Commission, said, "Clear improvements in prevention and treatment have occurred, whether there is some form of target or national service framework. There has been less progress in areas not so thoroughly covered by targets."

The report warned that less than half the people with mental health problems surveyed in 2004 said they had access to crisis care, such as an out-of-hours phone number of a mental health professional, when they needed it.

Also, only two thirds of community based crisis resolution teams operated around the clock, the report found, even though the purpose of these services is to prevent the need to hospitalise adults with acute psychiatric crises by providing 24 hour community based treatment.

The report found long waiting times for sexual health services, with 28% of people who needed to be seen urgently having to wait more than 48 hours and 29% of people who had symptoms of sexual infection waiting more than two weeks.

The report highlighted major problems in some maternity services. It warned that three independent investigations into maternity services over the past two years had shown a range of problems, including inadequate support for women who do not speak English, overcrowding, and poor standards of cleanliness

Web: Source

Back to top