guideline

Document Sample
guideline Powered By Docstoc
					                                                                   SHEFFIELD PCT
                                                              Framework of NICE Guidance
                                                                                                                                                 September 2008

Guideline   Title                              Summary                                                                         Implications              Review   Local
No                                                                                                                                                        Date    Action
TA157       Dabigatran etexilate for the       Dabigatran etexilate, within its marketing authorisation, is                    NICE state that this      June
            prevention of venous               recommended as an option for the primary prevention of venous                   guidance is for both      2011
            thromboembolism after hip or       thromboembolic events in adults who have undergone elective total               primary and secondary
            knee replacement surgery in        hip replacement surgery or elective total knee replacement surgery.             care
            adults
                                                                                                                               NICE state that this is
                                                                                                                               unlikely to result in a
                                                                                                                               significant change in
                                                                                                                               resource use in the NHS
                                                                                                                               It may result in a
                                                                                                                               reduction in district
                                                                                                                               nurse visits to
                                                                                                                               administer injections.
TA158       Oseltamivir, amantadine and        NOTE: This includes a review of guidance TA67                                   NICE state this           Sept
            zanamivir for the prophylaxis of                                                                                   guidance is for primary   2011
            influenza                            Oseltamivir and zanamivir are recommended, within their marketing            care.
                                                authorisations, for the postexposure prophylaxis of influenza if all of
                                                the following circumstances apply.                                             NICE state that these
                                               - National surveillance schemes have indicated that influenza virus is          medicines will be
                                               circulating.                                                                    prescribed in primary
                                               - The person is in an at-risk group as defined in section 3.                    care and are therefore
                                                                                                                               outside of the scope of
                                               - The person has been exposed (as defined in section 4) to an
                                                                                                                               PbR
                                               influenza-like illness and is able to begin prophylaxis within the
                                               timescale specified in the marketing authorisations of the individual           NICE state that the
                                               drugs (within 36 hours of contact with an index case for zanamivir and          costs are (per 100,000
                                               within 48 hours of contact with an index case for oseltamivir).                 population):-
                                               - The person has not been effectively protected by vaccination (as              Recurrent £10,504
                                               defined in section 5).
                                                The choice of either oseltamivir or zanamivir in the circumstances
                                                described in section 1.1 should be determined by the healthcare
                                                professional in consultation with patients and carers. The decision should
                                                take into account preferences regarding the delivery of the drug and
                                                potential adverse effects and contraindications. If all other considerations
                                                are equal, the drug with the lower acquisition cost should be used.




7e293e22-cd7e-4f52-8d96-7e586ef63a3a.doc                                                                                                                 Page 1
                                                               SHEFFIELD PCT
                                                          Framework of NICE Guidance
                                                                                                                                          September 2008

Guideline   Title                          Summary                                                                         Implications         Review   Local
No                                                                                                                                               Date    Action
                                             For the purpose of this guidance, people at risk are defined as those
                                            who fall into one or more of the clinical risk groups defined, and updated,
                                            each year by the Chief Medical Officer. The current list includes people
                                            with:
                                           - chronic respiratory disease (including asthma that requires continuous or
                                           repeated use of inhaled or systemic steroids or with previous
                                           exacerbations requiring hospital admission)
                                           - chronic heart disease
                                           - chronic renal disease
                                           - chronic liver disease
                                           - chronic neurological disease
                                           - immunosuppression
                                           - diabetes mellitus.
                                           People who are aged 65 years or older are also defined as at-risk for the
                                           purpose of this guidance.
                                             Exposure to an influenza-like illness is defined as close contact with a
                                           person in the same household or residential setting who has had recent
                                           symptoms of influenza.
                                             People who are not effectively protected by vaccination include:
                                           - those who have not been vaccinated since the previous influenza season
                                           - those for whom vaccination is contraindicated, or in whom it has yet to
                                           take effect
                                           - those who have been vaccinated with a vaccine that is not well matched
                                           (according to information from the Health Protection Agency) to the
                                           circulating strain of influenza virus.
                                             During localised outbreaks of influenza-like illness (outside the periods
                                            when national surveillance indicates that influenza virus is circulating
                                            generally in the community), oseltamivir and zanamivir may be used for
                                            post-exposure prophylaxis in at-risk people living in long-term residential
                                            or nursing homes, whether or not they are vaccinated. However, this
                                            should be done only if there is a high level of certainty that the causative
                                            agent in a localised outbreak is influenza, usually based on virological
                                            evidence of infection with influenza in the index case or cases.




7e293e22-cd7e-4f52-8d96-7e586ef63a3a.doc                                                                                                        Page 2
                                                                 SHEFFIELD PCT
                                                            Framework of NICE Guidance
                                                                                                                                               September 2008

Guideline   Title                             Summary                                                                       Implications               Review   Local
No                                                                                                                                                      Date    Action
                                               Oseltamivir and zanamivir are not recommended for seasonal
                                              prophylaxis of influenza.
                                               Amantadine is not recommended for the prophylaxis of influenza

CG72        Attention deficit hyperactivity   Trusts should ensure that specialist ADHD teams for children, young            This guidance applies      TBC
            disorder: Diagnosis and           people and adults jointly develop age-appropriate training programmes for     to primary, secondary
            management of ADHD in             the diagnosis and management of ADHD for mental health, paediatric,           and other organisations
            children, young people and        social care, education, forensic and primary care providers and other         outside of the NHS
            adults                            professionals who have contact with people with ADHD.
                                               For a diagnosis of ADHD, symptoms of hyperactivity/impulsivity and/or       NICE state that a
                                               inattention should:                                                          population of 100,000
                                              – meet the diagnostic criteria in DSM-IV or ICD-10 (hyperkinetic disorder)1   could expect to incur
                                              and                                                                           additional recurrent
                                              – be associated with at least moderate psychological, social and/or           costs of £78,000 at full
                                              educational or occupational impairment based on interview and/or direct       implementation, with a
                                              observation in multiple settings, and                                         further £38,000 non-
                                              – be pervasive, occurring in two or more important settings including         recurrent cost
                                              social, familial, educational and/or occupational settings.
                                              As part of the diagnostic process, include an assessment of the person’s
                                              needs, coexisting conditions, social, familial and educational or
                                              occupational circumstances and physical health.
                                              For children and young people there should also be an assessment of
                                              their parents’ or carers’ mental health.
                                               Healthcare professionals should offer parents or carers of pre-school
                                               children with ADHD a referral to a parent-training/education programme
                                               as the first-line treatment if the parents or carers have not already
                                               attended such a programme or the programme has had a limited effect.
                                               Teachers who have received training about ADHD and its management
                                               should provide behavioural interventions in the classroom to help children
                                               and young people with ADHD.
                                               If the child or young person with ADHD has moderate levels of
                                               impairment, the parents or carers should be offered referral to a group
                                               parent-training/education programme, either on its own or together with a
                                               group treatment programme (cognitive behavioural therapy [CBT] and/or




7e293e22-cd7e-4f52-8d96-7e586ef63a3a.doc                                                                                                               Page 3
                                                                  SHEFFIELD PCT
                                                             Framework of NICE Guidance
                                                                                                                                              September 2008

Guideline   Title                              Summary                                                                      Implications            Review   Local
No                                                                                                                                                   Date    Action
                                                social skills training) for the child or young person.
                                                In school-age children and young people with severe ADHD, drug
                                                treatment should be offered as the first-line treatment. Parents should
                                                also be offered a group-based parent-training/ education programme.
                                                Drug treatment for children and young people with ADHD should
                                                always form part of a comprehensive treatment plan that includes
                                                psychological, behavioural and educational advice and interventions.
                                                When a decision has been made to treat children or young people with
                                                ADHD with drugs, healthcare professionals should consider:
                                               – methylphenidate for ADHD without significant comorbidity
                                               – methylphenidate for ADHD with comorbid conduct disorder
                                               – methylphenidate or atomoxetine when tics, Tourette’s syndrome, anxiety
                                               disorder, stimulant misuse or risk of stimulant diversion are present
                                               – atomoxetine if methylphenidate has been tried and has been ineffective
                                               at the maximum tolerated dose, or the child or young person is intolerant
                                               to low or moderate doses of methylphenidate.
                                                Drug treatment for adults with ADHD should always form part of a
                                                comprehensive treatment programme that addresses psychological,
                                                behavioural and educational or occupational needs.
                                                Following a decision to start drug treatment in adults with ADHD,
                                                methylphenidate should normally be tried first.

                                               Care pathways are included separately for adults and children in the Quick
                                               Reference Guide

CG73        Early identification and           D To detect and identify proteinuria, use urine ACR in preference, as it     This guidance is for     TBC
            management of chronic kidney       has greater sensitivity than PCR for low levels of proteinuria. For          primary and secondary
            disease in adults in primary and   quantification and monitoring of proteinuria, PCR can be used as an          care
            secondary care                     alternative. ACR is the recommended method for people with diabetes.
                                                                                                                            NICE state that a
                                                Offer ACE inhibitors/ARBs to non-diabetic people with CKD and              population of 100,000
                                               hypertension and ACR ≥ 30 mg/mmol (approximately equivalent to PCR           could expect to incur
                                               ≥ 50 mg/mmol, or urinary protein excretion ≥ 0.5 g/24 h)1.                   additional costs of
                                                Stage 3 CKD should be split into two subcategories (see the table on       £32,052




7e293e22-cd7e-4f52-8d96-7e586ef63a3a.doc                                                                                                            Page 4
                                                              SHEFFIELD PCT
                                                         Framework of NICE Guidance
                                                                                                                                         September 2008

Guideline   Title                          Summary                                                                     Implications               Review   Local
No                                                                                                                                                 Date    Action
                                              page 6) defined by:
                                           – GFR 45–59 ml/min/1.73 m2 (stage 3A)                                       The early identification
                                           – GFR 30–44 ml/min/1.73 m2 (stage 3B).                                      and management of
                                           D People with CKD in the following groups should normally be referred for   CKD in primary care are
                                           specialist assessment:                                                      outside the scope of
                                           – stage 4 and 5 CKD (with or without diabetes)                              PbR
                                           – higher levels of proteinuria (ACR ≥ 70 mg/mmol, approximately
                                           equivalent to PCR ≥ 100 mg/mmol, or urinary protein excretion ≥ 1 g/24 h)
                                           unless known to be due to diabetes and already appropriately treated
                                           – proteinuria (ACR ≥ 30 mg/mmol, approximately equivalent to PCR ≥ 50
                                           mg/mmol, or urinary protein excretion ≥ 0.5 g/24 h) together with
                                           haematuria
                                           – rapidly declining eGFR (> 5 ml/min/1.73 m2 in 1 year, or > 10
                                           ml/min/1.73 m2 within 5 years)
                                           – hypertension that remains poorly controlled despite the use of at least
                                           four antihypertensive drugs at therapeutic doses (see ‘Hypertension:
                                           management of hypertension in adults in primary care’ [NICE clinical
                                           guideline 34])
                                           – people with, or suspected of having, rare or genetic causes of CKD
                                           – suspected renal artery stenosis.
                                           D Offer people testing for CKD if they have any of the following risk
                                           factors:
                                           – diabetes
                                           – hypertension
                                           – cardiovascular disease (ischaemic heart disease, chronic heart failure,
                                           peripheral vascular disease and cerebral vascular disease)
                                           – structural renal tract disease, renal calculi or prostatic hypertrophy
                                           – multisystem diseases with potential kidney involvement – for example,
                                           systemic lupus erythematosus
                                           – family history of stage 5 CKD or hereditary kidney disease
                                           – opportunistic detection of haematuria or proteinuria.
                                             Take the following steps to identify progressive CKD.
                                           – Obtain a minimum of three GFR estimations over a period of not less
                                           than 90 days.
                                           – In people with a new finding of reduced eGFR, repeat the eGFR within 2




7e293e22-cd7e-4f52-8d96-7e586ef63a3a.doc                                                                                                          Page 5
                                                                   SHEFFIELD PCT
                                                              Framework of NICE Guidance
                                                                                                                                              September 2008

Guideline   Title                               Summary                                                                      Implications             Review   Local
No                                                                                                                                                     Date    Action
                                                weeks to exclude causes of acute deterioration of GFR – for example,
                                                acute kidney injury or initiation of ACE inhibitor/ARB therapy.
                                                – Define progression as a decline in eGFR of > 5 ml/min/1.73 m2 within 1
                                                year, or > 10 ml/min/1.73 m2 within 5 years.
                                                – Focus particularly on those in whom a decline of GFR continuing at the
                                                observed rate would lead to the need for renal replacement therapy within
                                                their lifetime by extrapolating the current rate of decline.
                                                  In people with CKD aim to keep the systolic blood pressure below 140
                                                 mmHg (target range 120–139 mmHg) and the diastolic blood pressure
                                                 below 90 mmHg2.
                                                D is the abbreviation used to indicate implications for Diabetes

PHI15       Identifying and supporting people   Recommendation 1: identifying adults at risk                                 This guidance is for      TBC
            most at risk of dying prematurely   Who is the target population?                                                primary, community and
                                                • Adults who are disadvantaged:                                              other organisations
                                                – who smoke and/or                                                           outside of the NHS
                                                – who are eligible for statins and/or
                                                – who are at high risk of CVD due to other factors.                          The cost needs to be
                                                Who should take action?                                                      assessed locally and
                                                • Service providers and commissioners (for example, general practices,       NICE have produced a
                                                PCTs, community services, local authorities and others with a remit for      costing statement to
                                                tackling health inequalities).                                               assist with this
                                                What action should they take?
                                                • Primary care professionals should use a range of methods to identify
                                                adults who are disadvantaged and at high risk of premature death from
                                                CVD. These include:
                                                – primary care and general practice registers (for example, to identify
                                                adults who smoke; who are from particular minority ethnic groups; or who
                                                have family members who have had premature coronary heart disease)
                                                – primary care appointments (for example, during routine visits and
                                                screening)
                                                – systematic searches in pre-identified areas or with specific populations
                                                (for example, using direct mail or telephone)
                                                – analyses of quality outcomes framework
                                                (QOF) data.




7e293e22-cd7e-4f52-8d96-7e586ef63a3a.doc                                                                                                              Page 6
                                                               SHEFFIELD PCT
                                                          Framework of NICE Guidance
                                                                                                                                          September 2008

Guideline   Title                          Summary                                                                         Implications         Review   Local
No                                                                                                                                               Date    Action
                                           • Those working with communities should use a range of methods to
                                           identify adults who are disadvantaged and at high risk of CVD.
                                           Methods to use include:
                                           – health sessions run at a range of community and public sites, including
                                           post offices, charity shops, supermarkets, community pharmacies,
                                           homeless centres, workplaces, prisons and long-stay psychiatric
                                           institutions. (Lifestyle factors such as smoking or other indicators, such
                                           as blood pressure, could be used to identify those at risk)
                                           – culturally sensitive education sessions that include a CVD risk
                                           assessment and which take place in black and minority ethnic community
                                           settings (including places of worship)
                                           – outreach activities provided by community health workers (including
                                           health trainers).
                                           • Service providers should monitor these methods and adjust them
                                           according to local needs.
                                           • Service providers should encourage everyone who is disadvantaged to
                                           register with a general practice.

                                           Recommendation 2: improving services for
                                           adults and retaining them
                                           Who is the target population?
                                           • Adults who are disadvantaged:
                                           – who smoke and/or
                                           – who are eligible for statins and/or
                                           – who are at high risk of CVD due to other factors.
                                           Who should take action?
                                           • Service providers (for example, PCTs, general practices, community
                                           services, local authorities and other organisations with a remit for tackling
                                           health inequalities).
                                           What action should they take?
                                           • Provide flexible, coordinated services that meet the needs of individuals
                                           who are disadvantaged. For example, this could include providing drop-in
                                           or community based services, outreach and out-of-hours services, advice
                                           and help in the workplace and single-sex sessions.
                                           • Involve people who are disadvantaged in the planning and development




7e293e22-cd7e-4f52-8d96-7e586ef63a3a.doc                                                                                                        Page 7
                                                              SHEFFIELD PCT
                                                         Framework of NICE Guidance
                                                                                                                                         September 2008

Guideline   Title                          Summary                                                                        Implications         Review   Local
No                                                                                                                                              Date    Action
                                           of services. Seek feedback from the target groups on whether the services
                                           are accessible, appropriate and meeting their needs
                                           • Gain the trust of adults who are disadvantaged. Offer them proactive
                                           support. This could include helplines, brochures and invitations to attend
                                           services. It could also include providing GPs with postal prompts to remind
                                           them to monitor people who are disadvantaged and who have had an
                                           acute coronary event.
                                           • Develop and deliver non-judgemental programmes to tackle social and
                                           psychological barriers to change. These should be tailored to people’s
                                           needs. For example, they could make use of social marketing techniques.
                                           (Social marketing involves using marketing and related techniques to
                                           achieve specific behavioural goals.)
                                           • Ensure services are sensitive to culture, gender and age. For example,
                                           provide multilingual literature in a culturally acceptable style and involve
                                           community, religious and lay groups in its production. Where appropriate,
                                           offer translation and interpretation facilities.
                                           Promote services using culturally relevant local and national media, as
                                           well as representatives of different ethnic groups. Consider providing
                                           information in video or web-based format.
                                           • Provide services in places that are easily accessible to people who are
                                           disadvantaged (such as community pharmacies and shopping centres)
                                           and at times to suit them.
                                           • Provide support to ensure people who are disadvantaged can attend
                                           appointments (for example, this may include help with transport, postal
                                           prompts and offering home visits).
                                           • Encourage and support people who are disadvantaged to follow the
                                           treatment that they have agreed to. For example, encourage them to use
                                           self-management techniques (based on an individual assessment) to
                                           solve problems and set goals. It could also involve providing vouchers for
                                           treatments (such as nicotine replacement therapy [NRT]). (For
                                           recommendations on the principles of behaviour change, see ‘Behaviour
                                           change at population, community and individual levels’ [NICE public health
                                           guidance 6].)
                                           • Routinely search GP databases (and other electronic medical records) to
                                           generate lists of patients who have not collected repeat prescriptions or




7e293e22-cd7e-4f52-8d96-7e586ef63a3a.doc                                                                                                       Page 8
                                                               SHEFFIELD PCT
                                                          Framework of NICE Guidance
                                                                                                                                          September 2008

Guideline   Title                          Summary                                                                         Implications         Review   Local
No                                                                                                                                               Date    Action
                                           attended follow-up appointments. Make contact with them.
                                           • Address factors that prevent people who are disadvantaged from using
                                           services (for example, they may have a fear of failure or of being judged,
                                           or they might not know what services and treatments are available).
                                           • Support the development and implementation of regional and national
                                           strategies to tackle health inequalities by delivering local activities which
                                           are proven to be effective.
                                           • Use health equity audits to determine if services are reaching people
                                           who are disadvantaged and whether they are effective2. (For example, by
                                           matching the postcodes of service users to deprivation indicators and
                                           smoking prevalence.)

                                           Recommendation 3: system incentives
                                           Who is the target population?
                                           • Service providers (for example, PCTs, community services, local
                                           authorities and others with a remit for tackling health inequalities) and
                                           practice-based commissioning (PBC) groups.
                                           Who should take action?
                                           • Policy makers, planners and commissioners.
                                           What action should they take?
                                           • Support and sustain activities aimed at improving the health of people
                                           who are disadvantaged by:
                                           – using relevant indicators to measure progress and compare
                                           performance across areas or organisations
                                           – ensuring, wherever possible, that all targets aim to tackle health
                                           inequalities – and do not increase them
                                           – ensuring exception-reporting does not increase health inequalities:
                                           PCTs should be provided with additional levers and tools to monitor and
                                           benchmark exception-reporting and to reduce persistent rates of
                                           exception-coding
                                           – considering the provision of comparative performance data to encourage
                                           providers to meet targets
                                           – using local enhanced services to encourage providers and practitioners
                                           to identify and continue to support those who are at risk of premature
                                           death from CVD and other smoking-related diseases.




7e293e22-cd7e-4f52-8d96-7e586ef63a3a.doc                                                                                                        Page 9
                                                               SHEFFIELD PCT
                                                          Framework of NICE Guidance
                                                                                                                                          September 2008

Guideline   Title                          Summary                                                                         Implications         Review    Local
No                                                                                                                                               Date     Action
                                           • Provide incentives for local projects that improve the health of people
                                           who are disadvantaged, specifically those who smoke or are at high risk of
                                           CVD from other causes or are eligible for statins. Ensure the projects are
                                           evaluated and, if effective, ensure they continue.

                                           Recommendation 4: partnership working
                                           Who is the target population?
                                           • Adults who are disadvantaged:
                                           – who smoke and/or
                                           – who are eligible for statins and/or
                                           – who are at high risk of CVD due to other factors.
                                           Who should take action?
                                           • Planners, commissioners and service providers with a remit for tackling
                                           health inequalities. This includes PCTs, general practices, community
                                           services, PBC groups, local strategic partnerships, local authorities
                                           (including education and social services), the criminal justice system and
                                           members of the voluntary and business sectors.
                                           What action should they take?
                                           • Develop and sustain partnerships with professionals and community
                                           workers who are in contact with people who are disadvantaged. Use joint
                                           strategic needs assessments, local area agreements, local strategic
                                           partnerships, the GP contract, world class commissioning and other
                                           mechanisms. (For recommendations on community engagement see
                                           ‘Community engagement to improve health’ [NICE public health guidance
                                           9].)
                                           • Establish relationships between primary care practitioners and the
                                           community to understand how best to identify and help adults who are
                                           disadvantaged to adopt healthier lifestyles. For example, they should
                                           jointly determine how best to support health initiatives delivered as part of
                                           a local neighbourhood renewal strategy.
                                           • Establish relationships with secondary care professionals (for example,
                                           those working in respiratory medicine and CVD clinics) to help identify
                                           patients at high risk of further cardiovascular events. Offer these patients
                                           support or refer them on, where appropriate.
                                           • Develop and maintain a database of local initiatives that aim to reduce




7e293e22-cd7e-4f52-8d96-7e586ef63a3a.doc                                                                                                        Page 10
                                                              SHEFFIELD PCT
                                                         Framework of NICE Guidance
                                                                                                                                        September 2008

Guideline   Title                          Summary                                                                       Implications         Review    Local
No                                                                                                                                             Date     Action
                                           health inequalities by improving the health of people who are
                                           disadvantaged.
                                           • Develop and sustain local and national networks for sharing local
                                           experiences. Ensure mechanisms are in place to evaluate and learn from
                                           these activities on a continuing, systematic basis.
                                           • Ensure those working in the healthcare, community and voluntary
                                           sectors coordinate their efforts to identify people who need help.

                                           Recommendation 5: training and capacity
                                           Who is the target population?
                                           • Service providers (for example, general practices, PCTs, local
                                           authorities, community and lay workers and others with a remit for
                                           tackling health inequalities).
                                           Who should take action?
                                           • Commissioners and service providers (for example, PCTs, community
                                           services, local authorities and others with a remit for tackling health
                                           inequalities).
                                           What action should they take?
                                           • Ensure there are enough practitioners with the necessary skills to help
                                           people who are disadvantaged to adopt healthier lifestyles. (For examples
                                           of the skills needed see: ‘Brief interventions and referral for smoking
                                           cessation in primary care and other settings’ [NICE public health guidance
                                           1]; ‘Workplace health promotion: how to help employees to stop smoking’
                                           [NICE public health guidance 5]; ‘Smoking cessation services in primary
                                           care, pharmacies, local authorities and workplaces, particularly for manual
                                           working groups, pregnant women and hard to reach communities’ [NICE
                                           public health guidance 10]; and ‘Standard for training in smoking cessation
                                           treatments’ [www.nice.org.uk/ 502591] or updated versions of this.)
                                           • Ensure practitioners have the skills to identify people who are
                                           disadvantaged and can develop services to meet their needs. (For a set of
                                           generic principles to use when planning and delivering activities aimed at
                                           changing health-related behaviour see: ‘Behaviour change at population,
                                           community and individual levels’ [NICE public health guidance 6]. For
                                           advice on getting communities involved see ‘Community engagement to
                                           improve health’ [NICE public health guidance 9].)




7e293e22-cd7e-4f52-8d96-7e586ef63a3a.doc                                                                                                      Page 11
                                                                   SHEFFIELD PCT
                                                              Framework of NICE Guidance
                                                                                                                                                September 2008

Guideline   Title                               Summary                                                                      Implications             Review    Local
No                                                                                                                                                     Date     Action
                                                • Ensure service providers and practitioners have the ability to make
                                                services responsive to the needs of people who are disadvantaged. For
                                                example, they should be able to compare service provision with need,
                                                access, use and outcome using health equity audits. (For examples of the
                                                training and skills needed, refer to national organisations such as the
                                                Faculty of Public Health, British Psychological Society, Skills for Health
                                                and the Institute of Environmental Health.)

IPG273      Balloon catheter dilation of         Current evidence on the short-term efficacy of balloon catheter            This guidance is for       -
            paranasal sinus ostia for chronic   dilation of paranasal sinus ostia for chronic sinusitis is adequate and      acute care only
            sinusitis                           raises no major safety concerns. Therefore, this procedure can be
                                                used provided that normal arrangements are in place for clinical
                                                governance, consent and audit.
                                                 This procedure should only be carried out by surgeons with
                                                experience of complex sinus surgery, and specific training in both the
                                                procedure and the use of fluoroscopy.
                                                 Publication of long-term outcomes will be helpful in guiding the
                                                future use of this technique. NICE may review the procedure upon
                                                publication of further evidence.

IPG274      Autologous pancreatic islet cell    This guidance updates and partially replaces interventional procedure        This guidance is for       -
            transplantation for improved        guidance 13 issued in October 2003                                           acute care only
            glycaemic control after
            pancreatectomy                       The current evidence on autologous pancreatic islet cell
                                                transplantation for improved glycaemic control after pancreatectomy
                                                shows some shortterm efficacy, although most patients require insulin
                                                therapy in the long term. The reported complications result mainly
                                                from the major surgery involved in pancreatectomy (rather than from
                                                the islet cell transplantation). The procedure may be used with normal
                                                arrangements for clinical governance in units with facilities for islet
                                                cell isolation (see also section 2.5.1).
                                                 During consent, clinicians should ensure that patients understand
                                                that they may require insulin therapy in the long term. They should




7e293e22-cd7e-4f52-8d96-7e586ef63a3a.doc                                                                                                              Page 12
                                                             SHEFFIELD PCT
                                                        Framework of NICE Guidance
                                                                                                                                    September 2008

Guideline   Title                          Summary                                                                   Implications         Review    Local
No                                                                                                                                         Date     Action
                                           provide them with clear written information.
                                            Patient selection for this procedure should involve a
                                           multidisciplinary team with experience in the management of benign
                                           complex chronic pancreatic disease. The procedure should be carried
                                           out by surgeons with experience in complex pancreatic surgery and
                                           clinicians with experience in islet cell isolation and transplantation.
                                            Further audit and research should address the long-term efficacy of
                                           the procedure, quality of life, insulin independence and the
                                           management of patients’ diabetes (see section 3.1).




7e293e22-cd7e-4f52-8d96-7e586ef63a3a.doc                                                                                                  Page 13