Tag Archives: guidelines

Background Observations on fish consumption in general Populations who consume large amounts of oily fish in their diet tend to have lower rates of coronary heart disease (CHD) and sudden cardiac death (SCD). Fish oils are rich in omega-3 polyunsaturated fatty acids (PUFAs), which have demonstrable cardioprotective properties. In line with these observations, extensive epidemiological data – including large meta-analyses – demonstrate clear associations between both increased fish consumption and increased omega-3 PUFA levels with a favourable cardiovascular prognosis.1-3 Most of the evidence for benefits has been observed in individuals

Introduction Myocardial infarction (MI) is a common condition, estimated to affect almost 150,000 people per year in the UK.1 Without effective treatment, the immediate mortality of MI approaches 40% with a further 10% of patients dying in the subsequent year.2 In those who survive the initial post-MI period, an increased risk of death from cardiovascular causes (5% per year) persists indefinitely.2 However, effective secondary prevention measures can significantly reduce this risk.3 An estimated 1.4 million people in the UK have had an MI.4 Reducing morbidity and mortality among this group requires effective secondary prevention measures. In

Findings Nearly 70% of eligible PCTs responded to this survey, with many PCTs admitting to a lack of formal planning for FH, and incomplete knowledge about relevant FH services. Looking at the results as a whole, I think it is safe to say that the failure to implement the guidelines at PCT level suggests that national guidance is not always given local priority. More than 40% of the respondents admitted to a shortage of specialist care for people with FH, including adults, children and pregnant women. A number of PCTs indicated that they face barriers to treating FH patients and these concerns need to be addressed immediately if the guidelin

Gastroenterology guidelines The British Society of Gastroenterology (BSG) guidelines suggest that the opiate is used before the benzodiazepine.3 The BSG guidelines also suggest a maximum dose of 5 mg midazolam and 50 mg pethidine. Mankia et al. seem to permit 10 mg midazolam and 75 mg pethidine in their proposed protocol. Such doses would seem excessive unless you have confidence in your ability to provide assisted ventilation. In the survey nobody appears to have used more than 50 mg pethidine and, therefore, practitioners appear to set their own sensible cut-off points. In gastroscopy, sedation is often avoided, however, the TEE is of a mu

NICE calculates that an estimated 25,000 people who are admitted to hospital die from preventable VTE each year.  The NICE guideline, jointly developed with the National Clinical Guideline Centre for Acute and Chronic Conditions, recommends that all patients should be assessed for risk of developing blood clots on admission to hospital, and then given preventative treatment that suits their individual needs. Options include anticoagulant drugs such as heparin, anti-embolism stockings and foot impulse or pneumatic devices.  This advice covers all patients admitted to hospital – including those having day-case procedures – and not just th

But UK cardiologists and arrhythmia patient/professional groups, led by the Atrial Fibrillation Association and Heart Rhythm UK, have been petitioning to have this draft recommendation overturned. A second NICE meeting on dronedarone was held at the end of February to consider all the comments that have been received, and a final guidance is expected in the next few weeks. As part of the campaign to allow dronedarone to be available for NHS prescription, more than 100 doctors have signed an open letter to NICE setting out reasons why the drug is needed. A Parliamentary Stakeholder Investigation on the issue has been held and a Parliament Earl

Introduction Coronary heart disease (CHD) remains the leading cause of mortality in the UK with over 94,000 attributable deaths in 2006,1 the majority of which were the result of a myocardial infarction (MI). Approximately half of those who suffer an MI die within 28 days,2 however, with modern technology, procedures and new drugs, increasing numbers survive a heart attack, resulting in 1.4 million post-MI survivors in the UK.3 If patients do not receive optimal post-MI care, the individual and socio-economic burden is significant. In monetary terms this is estimated to be around £9 billion per year when both direct and indirect costs are in

Introduction Clinical guidelines are becoming an increasingly important component of clinical practice across Europe as governments, while facing spiralling healthcare costs, still have to maintain an overriding commitment to their citizens to provide best possible medical care. As systematically developed statements that incorporate research evidence and expert consensus views, clinical guidelines represent a means of assisting practitioners and patients on decisions about appropriate healthcare for specific circumstances.1 Adherence to clinical guidelines, thus, will help to reduce practice variation, raise standards of care, improve effici

NICE guidance The NICE review tried to determine which cardiac conditions are associated with increased risk of IE; whether dental treatment is associated with acute risk of developing the condition and whether ABP was effective in prevention of cases and deaths. The NICE guideline concluded that patients with structural heart disease were at increased risk of IE but did not find convincing evidence that dental ABP was cost-effective. They calculated that if amoxicillin prophylaxis was effective then the cost of preventing a single case of IE would be circa £12 million. In the absence of high-quality evidence for clinical effectiveness the

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