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					                                                                    SHEFFIELD PCT
                                                               Framework of NICE Guidance
                                                                                                                                                       January 2009

Guideline   Title                   Summary                                                                           Implications                     Review     Local
No                                                                                                                                                      Date      Action
TA165       Organ preservation      This technology appraisal covers the available methods of storing kidneys         NICE state that this              None
            (renal) - machine       from deceased donors – that is, LifePort kidney transporter, Belzer University    guidance is for acute care        stated
            perfusion and static    of Wisconsin (Belzer UW) storage solution and Marshall‟s hypertonic citrate       only.
            storage                 solution. No cost data were available to the Committee to allow
                                    recommendations to be made for the RM3 renal preservation system.                 NICE state this guidance is
                                     Machine perfusion using the LifePort kidney transporter and cold static         outside PbR. It is anticipated
                                        storage using Belzer UW storage solution or Marshall‟s hypertonic citrate     that this guidance will only
                                        solution are recommended as options for the storage of kidneys from           affect a small number of
                                        deceased donors.                                                              service providers.
                                     The choice of storage method should take into account clinical and
                                        logistical factors in both the retrieval teams and transplant centres. In     NICE state that this
                                        situations where different storage methods are considered equally             guidance is unlikely to result
                                        appropriate, then the least costly should be used.                            in a significant resource use
                                                                                                                      in the NHS.
TA166       Hearing impairment -    This technology appraisal examined the currently available devices for            NICE state that this             February
            cochlear implants       cochlear implantation. No evidence was available to the Committee to allow        guidance is for acute care         2011
                                    recommendations to be made for devices manufactured by Neurelec.                  only.
                                     Unilateral cochlear implantation is recommended as an option for people
                                        with severe to profound deafness who do not receive adequate benefit          NICE state that this
                                        from acoustic hearing aids, as defined below. If different cochlear implant   guidance will not impact on
                                        systems are considered to be equally appropriate, the least costly should     PbR, although the appraisal
                                        be used. Assessment of cost should take into account acquisition costs,       may affect the number of
                                        long-term reliability and the support package offered.                        procedures carried out in
                                     Simultaneous bilateral cochlear implantation is recommended as an               secondary care.
                                        option for the following groups of people with severe to profound
                                        deafness who do not receive adequate benefit from acoustic hearing            At the time of production of
                                        aids, as defined below:                                                       this document NICE have
                                        – children                                                                    not released any costing
                                        – adults who are blind or who have other disabilities that increase their     information.
                                             reliance on auditory stimuli as a primary sensory mechanism for
                                             spatial awareness.
                                        Acquisition of cochlear implant systems for bilateral implantation should
                                        be at the lowest cost and include currently available discounts on list
                                        prices equivalent to 40% or more for the second implant.




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                                                                    SHEFFIELD PCT
                                                               Framework of NICE Guidance
                                                                                                                                                      January 2009

Guideline   Title                   Summary                                                                            Implications                   Review     Local
No                                                                                                                                                     Date      Action
                                       Sequential bilateral cochlear implantation is not recommended as an
                                        option for people with severe to profound deafness.
                                     People who had a unilateral implant before publication of this guidance,
                                        and who fall into one of the categories described in 2, should have the
                                        option of an additional contralateral implant only if this is considered to
                                        provide sufficient benefit by the responsible clinician after an informed
                                        discussion with the individual person and their carers.
                                     For the purposes of this guidance, severe to profound deafness is
                                        defined as hearing only sounds that are louder than 90 dB HL at
                                        frequencies of 2 and 4 kHz without acoustic hearing aids. Adequate
                                        benefit from acoustic hearing aids is defined for this guidance as:
                                        – for adults, a score of 50% or greater on Bamford–Kowal–Bench
                                             (BKB) sentence testing at a sound intensity of 70 dB SPL
                                        – for children, speech, language and listening skills appropriate to age,
                                             developmental stage and cognitive ability.
                                     Cochlear implantation should be considered for children and adults only
                                        after an assessment by a multidisciplinary team. As part of the
                                        assessment children and adults should also have had a valid trial of an
                                        acoustic hearing aid for at least 3 months (unless contraindicated or
                                        inappropriate).
                                     When considering the assessment of adequacy of acoustic hearing aids,
                                        the multidisciplinary team should be mindful of the need to ensure
                                        equality of access. Tests should take into account a person‟s disabilities
                                        (such as physical and cognitive impairments), or linguistic or other
                                        communication difficulties, and may need to be adapted. If it is not
                                        possible to administer tests in a language in which a person is sufficiently
                                        fluent for the tests to be appropriate, other methods of assessment
                                        should be considered.
CG76        Medicines               N.B. This guideline contains a large number of elements. The following are         NICE State that this            t.b.c.
            adherence               described by NICE as “Key principles”                                              guidance covers all sectors,
                                     Healthcare professionals should adapt their consultation style to the            primary, acute and mental
                                        needs of individual patients so that all patients have the opportunity to be   health.
                                        involved in decisions about their medicines at the level they wish.
                                     Establish the most effective way of communicating with each patient and,         NICE cannot state whether




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                                                                       SHEFFIELD PCT
                                                                  Framework of NICE Guidance
                                                                                                                                                          January 2009

Guideline   Title                   Summary                                                                              Implications                     Review   Local
No                                                                                                                                                         Date    Action
                                           if necessary, consider ways of making information accessible and              the guidance will affect PbR.
                                           understandable (for example, using pictures, symbols, large print,
                                           different languages, an interpreter or a patient advocate).                   This guideline covers
                                          Offer all patients the opportunity to be involved in making decisions         interventions to support the
                                           about prescribed medicines. Establish what level of involvement in            process of shared decision-
                                           decision-making the patient would like.                                       making about medicines,
                                          Be aware that increasing patient involvement may mean that the patient        and promoting adherence in
                                           decides not to take or to stop taking a medicine. If in the healthcare        medicine-taking. It covers all
                                           professional‟s view this could have an adverse effect, then the               consultations with healthcare
                                           information provided to the patient on risks and benefits and the patient‟s   professionals in any NHS
                                           decision should be recorded.                                                  setting that relate to the
                                          Accept that the patient has the right to decide not to take a medicine,       initiation or review of
                                           even if you do not agree with the decision, as long as the patient has the    prescribed medication.
                                           capacity to make an informed decision and has been provided with the
                                           information needed to make such a decision.                                   NICE state that this
                                          Be aware that patients‟ concerns about medicines, and whether they            guidance is unlikely to result
                                           believe they need them, affect how and whether they take their                in a significant resource use
                                           prescribed medicines.                                                         in the NHS.
                                          Offer patients information that is relevant to their condition, possible
                                           treatments and personal circumstances, and that is easy to understand
                                           and free from jargon.
                                          Recognise that non-adherence is common and that most patients are
                                           non-adherent sometimes. Routinely assess adherence in a non-
                                           judgemental way whenever you prescribe, dispense and review
                                           medicines.
                                          Be aware that although adherence can be improved, no specific
                                           intervention can be recommended for all patients. Tailor any intervention
                                           to increase adherence to the specific difficulties with adherence the
                                           patient is experiencing.
                                          Review patient knowledge, understanding and concerns about
                                           medicines, and a patient‟s view of their need for medicine at intervals
                                           agreed with the patient, because these may change over time. Offer
                                           repeat information and review to patients, especially when treating long-
                                           term conditions with multiple medicines.




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                                                                     SHEFFIELD PCT
                                                                Framework of NICE Guidance
                                                                                                                                                      January 2009

Guideline   Title                    Summary                                                                           Implications                   Review     Local
No                                                                                                                                                     Date      Action
CG77        Antisocial personality   Developing an optimistic and trusting relationship                                NICE State that this            t.b.c.
            disorder                  Staff working with people with antisocial personality disorder should           guidance covers all sectors,
                                         recognise that a positive and rewarding approach is more likely to be         primary, acute and mental
                                         successful than a punitive approach in engaging and retaining people in       health.
                                         treatment. Staff should:
                                         – explore treatment options in an atmosphere of hope and optimism,            Mental health is currently
                                              explaining that recovery is possible and attainable                      outside the scope of PbR.
                                         – build a trusting relationship, work in an open, engaging and non-
                                              judgemental manner, and be consistent and reliable.                      NICE calculate that
                                     Cognitive behavioural interventions for children aged 8 years and older           implementation of this
                                     with conduct problems                                                             guidance will cost
                                      Cognitive problem-solving skills training should be considered for              approximately £50,000 per
                                         children aged 8 years and older with conduct problems if:                     100,000 population. PCTs
                                         – the child‟s family is unwilling or unable to engage with a parent-          that are responsible for the
                                              training programme                                                       provision of treatment in
                                         – additional factors, such as callous and unemotional traits in the child,    prisons would incur
                                              may reduce the likelihood of the child benefiting from parent-training   approximately £8,000 per
                                              programmes alone.                                                        year.
                                     Assessment in forensic/specialist personality disorder services
                                      Healthcare professionals in forensic or specialist personality disorder
                                         services should consider, as part of a structured clinical assessment,
                                         routinely using:
                                         – a standardised measure of the severity of antisocial personality
                                              disorder such as the Psychopathy Checklist–Revised (PCL-R) or
                                              Psychopathy Checklist–Screening Version (PCL-SV)
                                         – a formal assessment tool such as the Historical, Clinical, Risk
                                              Management-20 (HCR-20) to develop a risk management strategy.
                                     Treatment of comorbid disorders
                                      People with antisocial personality disorder should be offered treatment
                                         for any comorbid disorders in line with recommendations in the relevant
                                         NICE clinical guideline, where available. This should happen regardless
                                         of whether the person is receiving treatment for antisocial personality
                                         disorder.
                                     The role of psychological interventions




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                                                                    SHEFFIELD PCT
                                                               Framework of NICE Guidance
                                                                                                                                     January 2009

Guideline   Title                   Summary                                                                           Implications   Review   Local
No                                                                                                                                    Date    Action
                                       For people with antisocial personality disorder with a history of offending
                                        behaviour who are in community and institutional care, consider offering
                                        group-based cognitive and behavioural interventions (for example,
                                        programmes such as „reasoning and rehabilitation‟) focused on reducing
                                        offending and other antisocial behaviour.
                                    Multi-agency care
                                     Provision of services for people with antisocial personality disorder often
                                        involves significant inter-agency working. Therefore, services should
                                        ensure that there are clear pathways for people with antisocial
                                        personality disorder so that the most effective multi-agency care is
                                        provided. These pathways should:
                                        – specify the various interventions that are available at each point
                                        – enable effective communication among clinicians and organisations
                                             at all points and provide the means to resolve differences and
                                             disagreements.
                                        Clearly agreed local criteria should also be established to facilitate the
                                        transfer of people with antisocial personality disorder between services.
                                        As far as is possible, shared objective criteria should be developed
                                        relating to comprehensive assessment of need and risk.
                                     Services should consider establishing antisocial personality disorder
                                        networks, where possible linked to other personality disorder networks.
                                        (They may be organised at the level of primary care trusts, local
                                        authorities, strategic health authorities or government offices.) These
                                        networks should be multi-agency, should actively involve people with
                                        antisocial personality disorder and should:
                                        – take a significant role in training staff, including those in primary
                                             care, general, secondary and forensic mental health services, and in
                                             the criminal justice system
                                        – have resources to provide specialist support and supervision for staff
                                        – take a central role in the development of standards for and the
                                             coordination of clinical pathways
                                        – monitor the effective operation of clinical pathways.




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                                                                   SHEFFIELD PCT
                                                              Framework of NICE Guidance
                                                                                                                                                 January 2009

Guideline   Title                   Summary                                                                       Implications                   Review     Local
No                                                                                                                                                Date      Action
CG78        Borderline              Access to services                                                            NICE State that this            t.b.c.
            personality disorder     People with borderline personality disorder should not be excluded from     guidance covers all sectors,
            (BPD)                      any health or social care service because of their diagnosis or because    primary, acute and mental
                                       they have self-harmed.                                                     health.
                                    Autonomy and choice
                                     Work in partnership with people with borderline personality disorder to     Mental health is currently
                                       develop their autonomy and promote choice by:                              outside the scope of PbR.
                                       – ensuring they remain actively involved in finding solutions to their
                                           problems, including during crises                                      NICE state that, because of
                                       – encouraging them to consider the different treatment options and life    the range of services
                                           choices available to them, and the consequences of the choices they    covered in the guideline and
                                           make.                                                                  the lack of detailed
                                    Developing an optimistic and trusting relationship                            information about the
                                     When working with people with borderline personality disorder:              prevalence of borderline
                                       – explore treatment options in an atmosphere of hope and optimism,         personality disorder, it has
                                           explaining that recovery is possible and attainable                    not been possible to
                                       – build a trusting relationship, work in an open, engaging and non-        establish a baseline
                                           judgemental manner, and be consistent and reliable                     measure of existing service
                                       – bear in mind when providing services that many people will have          provision and the likely
                                           experienced rejection, abuse and trauma, and encountered stigma        change in resources
                                           often associated with self-harm and borderline personality disorder.   following implementation.
                                    Managing endings and transitions
                                     Anticipate that withdrawal and ending of treatments or services, and
                                       transition from one service to another, may evoke strong emotions and
                                       reactions in people with borderline personality disorder. Ensure that:
                                       – such changes are discussed carefully beforehand with the person
                                           (and their family or carers if appropriate) and are structured and
                                           phased
                                       – the care plan supports effective collaboration with other care
                                           providers during endings and transitions, and includes the
                                           opportunity to access services in times of crisis
                                       – when referring a person for assessment in other services (including
                                           for psychological treatment), they are supported during the referral
                                           period and arrangements for support are agreed beforehand with
                                           them.




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                                                                     SHEFFIELD PCT
                                                                Framework of NICE Guidance
                                                                                                                                      January 2009

Guideline   Title                   Summary                                                                            Implications   Review   Local
No                                                                                                                                     Date    Action
                                    Assessment
                                     Community mental health services (community mental health teams,
                                       related community-based services, and tier 2/3 services in child and
                                       adolescent mental health services – CAMHS) should be responsible for
                                       the routine assessment, treatment and management of people with
                                       borderline personality disorder.
                                    Care planning in community mental health teams
                                     Teams working with people with borderline personality disorder should
                                       develop comprehensive multidisciplinary care plans in collaboration with
                                       the service user (and their family or carers, where agreed with the
                                       person). The care plan should:
                                       – identify clearly the roles and responsibilities of all health and social
                                            care professionals involved
                                       – identify manageable short-term treatment aims and specify steps
                                            that the person and others might take to achieve them
                                       – identify long-term goals, including those relating to employment and
                                            occupation, that the person would like to achieve, which should
                                            underpin the overall long-term treatment strategy; these goals
                                            should be realistic, and linked to the short-term treatment aims
                                       – develop a crisis plan that identifies potential triggers that could lead
                                            to a crisis, specifies self management strategies likely to be effective
                                            and establishes how to access services (including a list of support
                                            numbers for out-of-hours teams and crisis teams) when self-
                                            management strategies alone are not enough
                                       – be shared with the GP and the service user.
                                    The role of psychological treatment
                                     When providing psychological treatment for people with borderline
                                       personality disorder, especially those with multiple comorbidities and/or
                                       severe impairment, the following service characteristics should be in
                                       place:
                                       – an explicit and integrated theoretical approach used by both the
                                            treatment team and the therapist, which is shared with the service
                                            user
                                       – structured care in accordance with this guideline
                                       – provision for therapist supervision.




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                                                                    SHEFFIELD PCT
                                                               Framework of NICE Guidance
                                                                                                                                   January 2009

Guideline   Title                   Summary                                                                         Implications   Review   Local
No                                                                                                                                  Date    Action
                                      Although the frequency of psychotherapy sessions should be adapted to
                                       the person‟s needs and context of living, twice-weekly sessions may be
                                       considered.
                                     Do not use brief psychological interventions (of less than 3 months‟
                                       duration) specifically for borderline personality disorder or for the
                                       individual symptoms of the disorder, outside a service that has the
                                       characteristics outlined above.
                                    The role of drug treatment
                                     Drug treatment should not be used specifically for borderline personality
                                       disorder or for the individual symptoms or behaviour associated with the
                                       disorder (for example, repeated self-harm, marked emotional instability,
                                       risk-taking behaviour and transient psychotic symptoms).
                                    The role of specialist personality disorder services within trusts
                                     Mental health trusts should develop multidisciplinary specialist teams
                                       and/or services for people with personality disorders. These teams
                                       should have specific expertise in the diagnosis and management of
                                       borderline personality disorder and should:
                                       – provide assessment and treatment services for people with
                                            borderline personality disorder who have particularly complex needs
                                            and/or high levels of risk
                                       – provide consultation and advice to primary and secondary care
                                            services
                                       – offer a diagnostic service when general psychiatric services are in
                                            doubt about the diagnosis and/or management of borderline
                                            personality disorder
                                       – develop systems of communication and protocols for information
                                            sharing among different services, including those in forensic
                                            settings, and collaborate with all relevant agencies within the local
                                            community including health, mental health and social services, the
                                            criminal justice system, CAMHS and relevant voluntary services
                                       – be able to provide and/or advise on social and psychological
                                            interventions, including access to peer support, and advise on the
                                            safe use of drug treatment in crises and for comorbidities and
                                            insomnia
                                       – work with CAMHS to develop local protocols to govern




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                                                                   SHEFFIELD PCT
                                                              Framework of NICE Guidance
                                                                                                                                                    January 2009

Guideline   Title                   Summary                                                                         Implications                    Review     Local
No                                                                                                                                                   Date      Action
                                              arrangements for the transition of young people from CAMHS to
                                              adult services
                                         – ensure that clear lines of communication between primary and
                                              secondary care are established and maintained
                                         – support, lead and participate in the local and national development
                                              of treatments for people with borderline personality disorder,
                                              including multi-centre research
                                         – oversee the implementation of this guideline
                                         – develop and provide training programmes on the diagnosis and
                                              management of borderline personality disorder and the
                                              implementation of this guideline
                                         – monitor the provision of services for minority ethnic groups to ensure
                                              equality of service delivery.
                                    The size and time commitment of these teams will depend on local
                                    circumstances (for example, the size of trust, the population covered and the
                                    estimated referral rate for people with borderline personality disorder).
PH17        Promoting physical      The quick reference guide                                                       NICE state that the guidance     t.b.c.
            activity for children   (http://www.nice.org.uk/nicemedia/pdf/PH017QuickRefGuide.PDF) contains a        promotes physical activity,
            and young people        comprehensive list of recommendations, grouped under the following              play and sport for pre-school
                                    headings:-                                                                      and school age children in
                                    National Campaign (pp 6-7)                                                      family, pre-school and
                                    Raising awareness of the importance of physical activity (pp 8-9)               community settings. The
                                    Developing physical activity plans (p10)                                        long-term health benefits
                                    Planning the provision of spaces and facilities (pp 11-12)                      outweigh the initial costs of
                                    Local transport plans (p13)                                                     implementation. The
                                    Responding to children and young people (p14)                                   guidance has no effect on
                                    Leadership and instruction (p15)                                                PBR.
                                    Training and continuing professional development (p16)
                                    Multi-component school and community programmes (pp16-17)                       NICE state that it has not
                                    Facilities and equipment (p17-18)                                               been possible to quantify the
                                    Supporting girls and young women (p18)                                          resource implications due to
                                    Active and sustainable school travel plans (p19)                                a lack of data on baseline
                                    Helping children to be active (p20)                                             compliance and the varied
                                    Helping girls and young women to be active (p21)                                way local organisations may
                                    Helping families to be active (p22)                                             implement the




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                                                                       SHEFFIELD PCT
                                                                  Framework of NICE Guidance
                                                                                                                                            January 2009

Guideline   Title                   Summary                                                                              Implications       Review     Local
No                                                                                                                                           Date      Action
                                                                                                                         recommendations.
IPG278      Functional electrical         Current evidence on the safety and efficacy (in terms of improving gait)      Acute care only      -
            stimulation for drop           of functional electrical stimulation (FES) for drop foot of central
            foot of central                neurological origin appears adequate to support the use of this
            neurological origin            procedure provided that normal arrangements are in place for clinical
                                           governance, consent and audit.
                                          Patient selection for implantable FES for drop foot of central neurological
                                           origin should involve a multidisciplinary team specialising in
                                           rehabilitation.
                                          Further publication on the efficacy of FES would be useful, specifically
                                           including patient-reported outcomes, such as quality of life and activities
                                           of daily living, and these outcomes should be examined in different
                                           ethnic and socioeconomic groups.
IPG279      Autologous blood              Current evidence on the safety and efficacy of autologous blood injection     Acute care only      -
            injection for                  for tendinopathy is inadequate in quantity and quality. Therefore this
            tendinopathy                   procedure should only be used with special arrangements for clinical
                                           governance, consent and audit or research.
                                          Clinicians wishing to undertake autologous blood injection for
                                           tendinopathy should take the following actions.
                                           – Inform the clinical governance leads in their Trusts.
                                           – Ensure that patients understand the uncertainty about the
                                                procedure‟s efficacy, especially in the long term, make them aware
                                                of alternative treatments and provide them with clear written
                                                information.
                                           – Audit and review clinical outcomes of all patients having autologous
                                                blood injection for Tendinopathy.
                                          Future research should be in the context of randomised controlled trials
                                           that define chronicity of tendinopathy and clearly describe any previous
                                           or adjunctive treatments (including physiotherapy and „dry needling‟) as
                                           well as the tendons treated. They should address the role of ultrasound
                                           guidance and include functional and quality of life outcomes with a
                                           minimum follow-up of 1 year. NICE may review the procedure upon
                                           publication of further evidence.
IPG280      Infracoccygeal                Current evidence on the efficacy and safety of infracoccygeal sacropexy       Acute care only      -




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                                                                      SHEFFIELD PCT
                                                                 Framework of NICE Guidance
                                                                                                                                          January 2009

Guideline   Title                   Summary                                                                             Implications      Review     Local
No                                                                                                                                         Date      Action
            sacropexy using             using mesh for uterine prolapse repair is inadequate in quantity and
            mesh for uterine            quality. Therefore this procedure should only be used with special
            prolapse repair             arrangements for clinical governance, consent and audit or research.
                                     Clinicians wishing to undertake infracoccygeal sacropexy using mesh for
                                        uterine prolapse repair should take the following actions:
                                        – Inform the clinical governance leads in their Trusts.
                                        – Ensure that patients understand the uncertainty about the
                                             procedure‟s safety, including mesh erosion (for example, into the
                                             vagina) and the risk of recurrence, and provide them with clear
                                             written information.
                                     The procedure should only be carried out by surgeons specialising in the
                                        management of pelvic organ prolapse and female urinary incontinence.
                                     The British Society for Urogynaecology runs a database on
                                        urogynaecological procedures, and clinicians should enter details about
                                        all patients undergoing this procedure onto this database
                                        (www.bsug.net).
                                     NICE encourages further research into infracoccygeal sacropexy using
                                        mesh for uterine prolapse repair, and may review the procedure on
                                        publication of further evidence on different types of mesh. Clinicians are
                                        encouraged to collect long-term data on clinical outcomes and patient-
                                        reported quality-of-life outcomes using validated scales.
IPG281      Infracoccygeal          This document replaces previous guidance on posterior infracoccygeal                Acute care only     -
            sacropexy using         sacropexy for vaginal vault prolapse (Interventional Procedure Guidance
            mesh for vaginal        125).
            vault prolapse repair
                                          Current evidence on the efficacy and safety of infracoccygeal sacropexy
                                           using mesh for vaginal vault prolapse repair is inadequate in quantity and
                                           quality. Therefore this procedure should only be used with special
                                           arrangements for clinical governance, consent and audit or research.
                                          Clinicians wishing to undertake infracoccygeal sacropexy using mesh for
                                           vaginal vault prolapse repair should take the following actions:
                                           – Inform the clinical governance leads in their Trusts.
                                           – Ensure that patients understand the uncertainty about the
                                                procedure‟s safety, including mesh erosion (for example, into the




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                                                                       SHEFFIELD PCT
                                                                  Framework of NICE Guidance
                                                                                                                                          January 2009

Guideline   Title                   Summary                                                                             Implications      Review     Local
No                                                                                                                                         Date      Action
                                                vagina) and the risk of recurrence, and provide them with clear
                                                written information.
                                          The procedure should only be carried out by surgeons specialising in the
                                           management of pelvic organ prolapse and female urinary incontinence.
                                          The British Society for Urogynaecology runs a database on
                                           urogynaecological procedures, and clinicians should enter details about
                                           all patients undergoing this procedure onto this database
                                           (www.bsug.net).
                                          NICE encourages further research into infracoccygeal sacropexy using
                                           mesh for vaginal vault prolapse repair, and may review the procedure on
                                           publication of further evidence on different types of mesh. Clinicians are
                                           encouraged to collect long-term data on clinical outcomes and patient-
                                           reported quality-of-life outcomes using validated scales.
IPG282      Insertion of mesh             Current evidence on the safety and efficacy of insertion of mesh uterine     Acute care only     -
            uterine suspension             suspension sling (including sacrohysteropexy) for uterine prolapse repair
            sling (including               is inadequate in quantity. Therefore this procedure should only be used
            sacrohysteropexy)              with special arrangements for clinical governance, consent and audit or
            for uterine prolapse           research.
            repair                        Clinicians wishing to undertake insertion of mesh uterine suspension
                                           sling (including sacrohysteropexy) for uterine prolapse repair should take
                                           the following actions.
                                           – Inform the clinical governance leads in their Trusts.
                                           – Ensure that patients understand the uncertainty about the
                                                procedure‟s safety, including mesh erosion (for example, into the
                                                vagina) and the risk of recurrence, and provide them with clear
                                                written information.
                                          The procedure should only be carried out by surgeons specialising in the
                                           management of pelvic organ prolapse and female urinary incontinence.
                                          The British Society for Urogynaecology runs a database on
                                           urogynaecological procedures, and clinicians should enter details about
                                           all patients undergoing this procedure onto this database
                                           (www.bsug.net).
                                          NICE encourages further research into mesh uterine suspension sling
                                           (including sacrohysteropexy) for uterine prolapse repair and may review




b2245400-295b-480d-aedd-871a4aa6dd31.doc                                                                                                        Page 12
                                                                      SHEFFIELD PCT
                                                                 Framework of NICE Guidance
                                                                                                                                         January 2009

Guideline   Title                   Summary                                                                            Implications      Review     Local
No                                                                                                                                        Date      Action
                                        the procedure on publication of further evidence on different types of
                                        mesh. Future research should include short- and long-term efficacy,
                                        safety outcomes (such as mesh erosion in the long term), patient-
                                        reported quality-of-life outcomes using validated scales and subsequent
                                        successful pregnancy.
IPG283      Sacrocolpopexy          This document replaces previous guidance on mesh sacrocolpopexy for                Acute care only     -
            using mesh for          vaginal vault prolapse (Interventional Procedure Guidance 215).
            vaginal vault
            prolapse repair               Current evidence on the safety and efficacy of sacrocolpopexy using
                                           mesh for vaginal vault prolapse repair appears adequate to support the
                                           use of this procedure provided that normal arrangements are in place for
                                           clinical governance and audit.
                                          During the consent process, clinicians should ensure patients
                                           understand that there is a risk of recurrence of vaginal vault prolapse
                                           after any prolapse repair procedure, and that there is also a risk of
                                           complications, including mesh erosion (for example, into the vagina), and
                                           provide them with clear written information.
                                          The procedure should only be carried out by surgeons specialising in the
                                           management of pelvic organ prolapse and female urinary incontinence.
                                          Evidence on safety and efficacy outcomes is limited to 5 years. Evidence
                                           on outcomes beyond 5 years and on different types of mesh would be
                                           useful. Further research should include patient reported quality-of-life
                                           outcome measures using validated scales.
IPG284      Sacrocolpopexy with           Current evidence on the safety and efficacy of sacrocolpopexy with          Acute care only     -
            hysterectomy using             hysterectomy using mesh for uterine prolapse repair is inadequate in
            mesh for uterine               quantity and quality. Therefore this procedure should only be used with
            prolapse repair                special arrangements for clinical governance, consent and audit or
                                           research.
                                          Clinicians wishing to undertake sacrocolpopexy with hysterectomy using
                                           mesh for uterine prolapse repair should take the following actions.
                                           – Inform the clinical governance leads in their Trusts.
                                           – Ensure that patients understand the uncertainty about the
                                                procedure‟s safety, including mesh erosion (for example, into the
                                                vagina) and the risk of recurrence, and provide them with clear




b2245400-295b-480d-aedd-871a4aa6dd31.doc                                                                                                       Page 13
                                                                       SHEFFIELD PCT
                                                                  Framework of NICE Guidance
                                                                                                                                            January 2009

Guideline   Title                   Summary                                                                               Implications      Review     Local
No                                                                                                                                           Date      Action
                                                written information.
                                          The procedure should only be carried out by surgeons specialising in the
                                           management of pelvic organ prolapse and female urinary incontinence.
                                          The British Society for Urogynaecology runs a database on
                                           urogynaecological procedures, and clinicians should enter details about
                                           all patients undergoing this procedure onto this database
                                           (www.bsug.net).
                                          NICE encourages further research into sacrocolpopexy with
                                           hysterectomy using mesh for uterine prolapse repair, and may review the
                                           procedure on publication of further evidence on different types of mesh.
                                           Future research should address short- and long-term efficacy, erosion
                                           rates and patient-reported quality-of-life outcome measures using
                                           validated scales.
IPG285      Ultrasound-guided             Current evidence on the safety and efficacy of ultrasound-guided               Acute care only     -
            regional nerve block           regional nerve block appears adequate to support the use of this
                                           procedure provided that normal arrangements are in place for clinical
                                           governance, consent and audit.
                                          Clinicians wishing to perform this procedure should be experienced in
                                           the administration of regional nerve blocks and trained in ultrasound
                                           guidance techniques.
IPG286      Thoracoscopic                 There is evidence of efficacy for thoracoscopic epicardial radiofrequency      Acute care only     -
            epicardial                     ablation for atrial fibrillation (AF) in the short term and in small numbers
            radiofrequency                 of patients. The assessment of cardiac rhythm during follow-up varied
            ablation for atrial            between studies, and some patients were concomitantly treated with
            fibrillation                   anti-arrhythmic medication. Evidence on safety shows a low incidence of
                                           serious complications but this is also based on a limited number of
                                           patients. Therefore the procedure should only be used with special
                                           arrangements for clinical governance, consent and audit or research.
                                          Clinicians wishing to undertake thoracoscopic epicardial radiofrequency
                                           ablation for AF should take the following actions.
                                           – Inform the clinical governance leads in their Trusts.
                                           – Ensure that patients understand the uncertainty about the
                                                procedure‟s safety and efficacy, and provide them with clear written
                                                information.




b2245400-295b-480d-aedd-871a4aa6dd31.doc                                                                                                          Page 14
                                                                      SHEFFIELD PCT
                                                                 Framework of NICE Guidance
                                                                                                                                       January 2009

Guideline   Title                   Summary                                                                             Implications   Review   Local
No                                                                                                                                      Date    Action
                                          Patient selection for thoracoscopic epicardial radiofrequency ablation for
                                           AF should involve a multidisciplinary team including a cardiologist and a
                                           cardiac surgeon, both with training and experience in the use of
                                           intraoperative electrophysiology.
                                          The procedure should only be carried out by surgeons with specific
                                           training and experience in both thoracoscopic surgery and
                                           radiofrequency ablation.
                                          The NHS Information Centre for Health and Social Care runs the UK
                                           Central Cardiac Audit Database (CCAD), and is developing a database
                                           for this procedure. Clinicians should collect data on the procedure and
                                           submit them to the database when it becomes available
                                           (www.ccad.org.uk).
                                          NICE encourages further comparative research into the treatment and
                                           management of AF, with clearly defined outcomes. NICE may review this
                                           procedure on publication of further evidence.




b2245400-295b-480d-aedd-871a4aa6dd31.doc                                                                                                   Page 15

				
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