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NHS Sheffield
Framework of NICE Guidance
September 2009
Guideline Title Summary Implications Review Local
No Date Action
TA 179 Sunitinib for the Sunitinib is recommended, within its licensed indication, as treatment NICE state that this guidance August
treatment of option for people with unresectable and/or metastatic malignant is for acute care only. 2011
gastrointestinal gastrointestinal stromal tumours if:
stromal tumours – imatinib treatment has failed because of resistance or intolerance, NICE state that this guidance
and is outside of PBR.
– the drug cost of sunitinib (excluding any related costs) for the first
treatment cycle will be met by the manufacturer. NICE state that the net cost of
The use of sunitinib should be supervised by cancer specialists with implementing this guidance is
experience in treating people with unresectable and/or metastatic £12,000 per 100,000
malignant gastrointestinal stromal tumours after failure of imatinib population. This includes a
treatment because of resistance or intolerance. £3,000 manufacturer refund
TA 180 Ustekinumab for the Ustekinumab is recommended as a treatment option for adults with NICE state that this guidance January
treatment of adults plaque psoriasis when the following criteria are met. is for acute care only. 2010 !
with moderate to – The disease is severe, as defined by a total Psoriasis Area
severe psoriasis Severity Index (PASI) score of 10 or more and a Dermatology Life NICE state that this guidance
Quality Index (DLQI) score of more than 10. is outside of PBR.
– The psoriasis has not responded to standard systemic therapies,
including ciclosporin, methotrexate and PUVA psoralen and long- NICE state that implementing
wave ultraviolet radiation), or the person is intolerant of or has a this guidance is unlikely to
contraindication to these treatments. result in a significant change in
– The manufacturer provides the 90 mg dose (two 45 mg vials) for resource use in the NHS.
people who weigh more than 100 kg at the same total cost as for a
single 45 mg vial.
Ustekinumab treatment should be stopped in people whose psoriasis
has not responded adequately by 16 weeks after starting treatment.
An adequate response is defined as either:
– A 75% reduction in the PASI score (PASI 75) from when treatment
started or
– a 50% reduction in the PASI score (PASI 50) and a 5-point
reduction in the DLQI score from when treatment started.
When using the DLQI, healthcare professionals should take into account
any physical, sensory or learning disabilities, or communication
difficulties that could affect the responses to the DLQI and make any
adjustments they consider appropriate.
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NHS Sheffield
Framework of NICE Guidance
September 2009
Guideline Title Summary Implications Review Local
No Date Action
TA 181 Pemetrexed for the In August 2007, NICE issued technology appraisal guidance 124 NICE state that this guidance July
first-line treatment of ‘Pemetrexed for the treatment of non-small-cell lung cancer’, which is for acute care only. 2010
non-small-cell-lung states that pemetrexed is not recommended for patients with NSCLC
cancer who have had prior chemotherapy. This guidance (technology NICE state that this guidance
appraisal 181) applies to the first-line use of pemetrexed in patients is outside of PBR.
with NSCLC.
Pemetrexed in combination with cisplatin is recommended as an option NICE state that implementing
for the first-line treatment of patients with locally advanced or metastatic this guidance will cost £5,363
non-small-cell lung cancer (NSCLC) only if the histology of the tumour per 100,000 population.
has been confirmed as adenocarcinoma or large-cell carcinoma.
People who are currently being treated with pemetrexed for NSCLC but
who do not meet the criteria in 1 should have the option to continue
their therapy until they and their clinicians consider it appropriate to
stop.
PH 20 Social and Recommendation 1 Strategic framework NICE state that this guidance
emotional well-being Who is the target population? is for primary care, acute care,
in secondary Practitioners working with young people in secondary education. community services and
education Who should take action? education.
Commissioners and providers of services to young people in secondary
education including those working in: NICE state that this guidance
– children’s trusts does not impact on PBR.
– local authorities (in particular, children’s services)
– schools and other secondary education establishments NICE have not released any
– primary care trusts (PCTs) costing information at the time
– child and adolescent mental health services of producing this summary.
– voluntary agencies.
Governors.
What action should they take?
Enable all secondary education establishments to adopt an organisation-
wide approach to promoting the social and emotional wellbeing of young
people. This should encompass organisation and management issues
as well as the curriculum and extra-curriculum provision. The approach
should form part of the local children and young people’s plan and joint
commissioning. It should also be linked to the local area agreement. It
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NHS Sheffield
Framework of NICE Guidance
September 2009
Guideline Title Summary Implications Review Local
No Date Action
should help achieve the Every Child Matters (ECM) Outcome
Framework wellbeing objectives and targets (HM Government 2004). It
should also contribute towards efforts to gain National Healthy Schools
Status (NHSS).
Encourage the appropriate local authority scrutiny committee to assess
the progress made by secondary education establishments in adopting
an organisation-wide approach to social and emotional wellbeing.
Help secondary education establishments to develop the necessary
organisational capacity to promote social and emotional wellbeing. This
includes leadership and management arrangements, specialist skills and
resources.
Help secondary education establishments to share practical advice on
how to promote the social and emotional wellbeing of young people.
Ensure secondary education establishments have access to the
specialist skills, advice and support they require. This may be provided
by public, private, voluntary and community organisations. It may involve
working with local authority advisory services, personal, social, health
and economic (PSHE) education services, educational psychology and
child and adolescent mental health services.
Ensure policies and arrangements are in place to promote the social and
emotional wellbeing of those who work with young people in secondary
education.
Recommendation 2 Key principles and conditions
Who is the target population?
Young people in secondary education, their parents and carers.
Who should take action?
Head teachers, governors, teachers, support staff and other practitioners
working with young people in secondary education.
Those working in (and with) education, children’s and youth services
(including healthy schools teams) within local authorities, primary care
(including school nurses), child and adolescent mental health services
and voluntary agencies.
What action should they take?
Head teachers, governors and teachers should demonstrate a
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NHS Sheffield
Framework of NICE Guidance
September 2009
Guideline Title Summary Implications Review Local
No Date Action
commitment to the social and emotional wellbeing of young people.
They should provide leadership in this area by ensuring social and
emotional wellbeing features within improvement plans, policies,
systems and activities. These should all be monitored and evaluated.
Foster an ethos that promotes mutual respect, learning and successful
relationships among young people and staff. Create a culture of
inclusiveness and communication that ensures all young people’s
concerns can be addressed (including the concerns of those who may
be at particular risk of poor mental health).
Provide a safe environment which nurtures and encourages young
people’s sense of self-worth and self-efficacy, reduces the threat of
bullying and violence and promotes positive behaviours.
Systematically measure and assess young people’s social and
emotional wellbeing. Use the outcomes as the basis for planning
activities and evaluating their impact (informed by Ofsted guidance on
social and emotional wellbeing).
Ensure young people have access to pastoral care and support, as well
as specialist services, so that emotional, social and behavioural
problems can be dealt with as soon as they occur. (Specialist services
include child and adolescent mental health services.)
Recommendation 3 Curriculum approaches
Who is the target population?
Young people in secondary education, their parents and carers.
Who should take action?
Head teachers, governors, teachers, support staff and other practitioners
working with young people in secondary education.
Those working in (and with) education and children’s and youth services
(including healthy schools teams) within local authorities, primary care
(including school nurses), child and adolescent mental health services
and voluntary agencies.
What action should they take?
Provide a curriculum that promotes positive behaviours and successful
relationships and helps reduce disruptive behaviour and bullying. This
can be achieved by integrating social and emotional skills development
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September 2009
Guideline Title Summary Implications Review Local
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within all areas of the curriculum. Skills that should be developed
include: motivation, self-awareness, problem-solving, conflict
management and resolution, collaborative working, how to understand
and manage feelings, and how to manage relationships with parents,
carers and peers.
Tailor social and emotional skills education to the developmental needs
of young people. The curriculum should build on learning in primary
education and be sustained throughout their education.
Reinforce curriculum learning on social and emotional skills and
wellbeing by integrating relevant activities into all aspects of secondary
education. For example, such skills might be developed through
extracurricular activities, using projects set for homework or via
community-based and individual voluntary work.
Recommendation 4 Working with parents and families
Who is the target population?
Parents, carers and other members of the family of young people in
secondary education.
Who should take action?
Head teachers, governors, teachers, support staff and other practitioners
working with young people in secondary education.
Those working in (and with) education and children’s and youth services
(including healthy schools teams) within local authorities, primary care
(including school nurses), child and adolescent mental health services
and voluntary agencies.
What action should they take?
Work in partnership with parents, carers and other family members to
promote young people’s social and emotional wellbeing.
To help reinforce young people’s learning from the curriculum, help
parents and carers develop their parenting skills. This may involve
providing information or offering small, group-based programmes run by
appropriately trained health or education practitioners.
Ensure parents, carers and other family members living in
disadvantaged circumstances are given the support they need to
participate fully in activities to promote social and emotional wellbeing.
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September 2009
Guideline Title Summary Implications Review Local
No Date Action
This should include support to participate fully in any parenting sessions
(for example, by offering a range of times for the sessions or providing
help with transport and childcare). This might involve liaison with family
support agencies.
Recommendation 5 Working in partnership with young people
Who is the target population?
Young people in secondary education, their parents and carers.
Who should take action?
Head teachers, governors, teachers, support staff and other practitioners
working with young people in secondary education.
Those working in (and with) education and children’s and youth services
(including healthy schools teams) within local authorities, primary care
(including school nurses), child and adolescent mental health services
and voluntary agencies.
What action should they take?
Develop partnerships between young people and staff to formulate,
implement and evaluate organisation-wide approaches to promoting
social and emotional wellbeing.
Introduce a variety of mechanisms to ensure all young people have the
opportunity to contribute to decisions that may impact on their social and
emotional wellbeing.
Provide young people with opportunities to build relationships,
particularly those who may find it difficult to seek support when they
need it. This could involve developing a peer education or peer
mediation approach. Note, young people who act as peer supporters
need training and the support of staff and other professionals.
Provide young people with clear and consistent information about the
opportunities available for them to discuss personal issues and
emotional concerns. Any support offered should take account of local
community and education policies and protocols regarding
confidentiality. Make young people aware of their rights on confidentiality
Involve young people in the creation, delivery and evaluation of training
and continuing professional development activities in relation to social
and emotional wellbeing.
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September 2009
Guideline Title Summary Implications Review Local
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Recommendation 6 Training and continuing professional development
Who is the target population?
Professionals working with young people in secondary education.
Governors.
Who should take action?
Those working in (and with) education, children’s and youth services
(including healthy schools teams) within local authorities, primary care
(including school nurses), child and adolescent mental health services
and voluntary agencies.
Head teachers in secondary education.
Organisations concerned with the training and continuing professional
development of those working in secondary education.
What action should they take?
Integrate social and emotional wellbeing within the training and
continuing professional development of practitioners and governors
involved in secondary education.
Ensure practitioners have the knowledge, understanding and skills they
need to develop young people’s social and emotional wellbeing. Training
ay cover:
– listening and facilitating skills and the ability to be non-judgemental
– how to manage behaviours effectively, based on an understanding
of the underlying issues
– identifying and responding to the needs of young people who may
be experiencing emotional and behavioural difficulties
– how to access pastoral care based in secondary education or
specialist services provided by other agencies, such as child and
adolescent mental health services
– the issues in relation to different medical conditions (such as
diabetes, asthma and epilepsy) to ensure young people with these
conditions are not bullied, inappropriately excluded from school
activities or experience any undue emotional distress
– opportunities to reflect upon and develop their own social and
emotional skills and awareness.
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NHS Sheffield
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September 2009
Guideline Title Summary Implications Review Local
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PH 21 Reducing Recommendation 1: immunisation programmes NICE state that this guidance
differences in the Who is the target population? is for primary care, acute care,
uptake of Children and young people aged under 19 years, particularly those who community services and local
immunisations may not have been immunised or may have only been partially government.
immunised.
Parents of children and young people aged under 19 years. NICE state that this guidance
Who should take action? does not impact on PBR.
Commissioners, managers and coordinators in primary care trusts
(PCTs), children‘s services, children’s trusts, Sure Start children’s NICE have not released any
centres and services for vulnerable groups (including those run by family definitive costing information
nurse partnerships). at the time of producing this
Health professionals responsible for children and young people’s summary, but have provided a
immunisation services including paediatricians, health visiting and template on which local
school nursing teams, GPs and practice nurses. calculations may be made.
Directors of public health, immunisation coordinators and others who
provide or commission immunisation services in PCTs and GP practices.
Health protection specialists and immunisation leads in health protection
units (HPUs).
Children‘s service managers and nursing staff in hospital trusts,
children‘s social care organisations and child and adolescent mental
health services.
What action should they take?
Ensure Department of Health (DH) guidance and updates on
immunisations (including official letters from the Chief Medical Officer,
Chief Nursing Officer and Chief Pharmaceutical Officer) are
disseminated to relevant professionals and implemented.
Adopt a multifaceted, coordinated programme across different settings
to increase timely immunisation among groups with low or partial uptake.
The programme should form part of the local child health strategy and
should include the following actions:
– Monitor vaccination status as part of a wider assessment of children
and young people’s health. Ensure there is an identified healthcare
professional in the PCT and every GP practice who is responsible –
and provides leadership – for the local childhood immunisation
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September 2009
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programme.
– Ensure all staff involved in immunisation services have access to
the ‘Green book’. Also ensure updates to the childhood
immunisation programme and schedule are monitored and services
adapted appropriately.
– Improve access to immunisation services. This could be achieved
by extending clinic times, ensuring children and young people are
seen promptly and by making sure clinics are child- and family-
friendly.
– Ensure enough immunisation appointments are available so that all
local children and young people can receive the recommended
vaccinations on time.
– Send tailored invitations for immunisation. When a child or young
person does not attend appointments, send tailored reminders and
recall invitations and follow them up by telephone or text message.
– Provide parents and young people with tailored information, advice
and support to ensure they know about the recommended routine
childhood vaccinations and the benefits and risks. This should
include details on the infections they prevent. Information should be
provided in different formats, for example, for those whose first
language is not English.
– Ensure parents and young people have an opportunity to discuss
any concerns they might have about immunisation. This could either
be in person or by telephone and could involve a GP, community
paediatrician, health visitor, school nurse or practice nurse.
– Ensure young people fully understand what is involved in
immunisation so that those who are aged under 16, but considered
sufficiently capable, can give their consent to vaccinations, as
advised in the ‘Green book’.
– Ensure young people and their parents know how to access
immunisation services.
– Consider home visits to discuss immunisation with parents who
have not responded to reminders, recall invitations or appointments.
Offer to give their children vaccinations there and then (or arrange a
convenient time in the future). Such visits could include groups that
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may not use primary care services, for example, travellers or asylum
seekers.
– Check the immunisation status of children and young people at
every appropriate opportunity. Checks should take place during
appointments in primary care (for example, as part of a child health
review),hospital in- or outpatient and accident and emergency
departments, walk-in centres or minor injuries units. Use the
personal child health record (PCHR, also known as the ‘Red book’)
as appropriate. If any vaccinations are outstanding:
o discuss them with the parent and, where appropriate, the young
person. Where they have expressed concerns about
immunisation and this is documented, these appointments
should be used as an opportunity to have a further discussion
o offer vaccinations by trained staff before they leave the
premises, if appropriate. In such cases, notify the child or young
person’s GP, health visitor or local child health information
department so that records can be updated
o and, if immediate vaccination is not possible, refer them to
services where they can receive any outstanding
immunisations.
Recommendation 2: information systems
Who is the target population?
Children and young people aged under 19 years, particularly those who
may not have been immunised or may have only been partially
immunised.
Parents of children and young people aged under 19 years.
Who should take action?
Those responsible for information services within PCTs, acute trusts and
GP practices.
Strategic health authority immunisation leads, PCT immunisation
coordinators, directors of public health and community paediatricians.
Health protection specialists and immunisation leads in health protection
units.
GPs, practice nurses, health visiting teams and those who commission
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or provide immunisation services.
Independent and private sector providers of immunisation services.
What action should they take?
Ensure PCTs and GP practices have a structured, systematic method for
recording, maintaining and transferring accurate information on the
vaccination status of all children and young people. Vaccination
information should be recorded in patient records, the personal child
health record and the child health information system. The same data
should be used when reporting vaccinations to the child health
department and when submitting returns to the PCT for GP and practice
payments. This will ensure records in both systems are reconciled and
consistent.
Encourage and enable private providers to give the relevant GP practice
or PCT details of all vaccinations administered to children and young
people, so they can be recorded in the appropriate information system.
Record any factors which may make it less likely that a child or young
person will be up-to-date with vaccinations in their patient records and
the personal child health record. For example, note if children and young
people are looked after, have special needs or have any
contraindications to vaccination. Also note if the parents or young person
have expressed concerns about vaccination.
Regularly update and maintain the databases for recording children and
young people’s immunisation status. For example, ensure records are
transferred when a child or young person moves out of the area, ensure
information is not duplicated and follow up on any missing data.
Ensure up-to-date information on vaccination coverage is available and
disseminated to all those responsible for the immunisation of children
and young people. This includes those who are delivering the
vaccinations.
Use recorded information on immunisation, together with surveillance
data on the incidence of infection, to inform local and joint strategic
needs assessments and health equity audits. These data should also be
used to support delivery of an immunisation programme for children and
young people.
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Monitor the age composition of the practice population so that there is
enough capacity to provide timely immunisations. Waiting lists are
unacceptable.
Recommendation 3: training
Who is the target population?
Those who advise on and provide immunisation services including:
– GPs, health visitors, practice nurses, community nurses (including
school nurses), midwives and nurses working in neonatal care,
nurseries, child and adolescent mental health services, young
offender institutions and secure units.
– PCT immunisation coordinators and public health professionals.
– Hospital and community paediatricians, nursing staff in hospital
trusts and walk-in centres and pharmacists.
– NHS health trainers.
– NHS support staff, including clinic clerks and receptionists.
– Managers of children’s services and children’s centres, social care
workers (working with children) and those with parental
responsibility for looked after children.
Who should take action?
Professional bodies, skills councils and other organisations responsible
for setting competencies and developing continuing professional
development programmes for health professionals.
Health protection units.
Employers and managers in PCTs and strategic health authorities,
including GPs whose staff are involved in immunisation services.
Private and independent sector providers of immunisation services for
children and young people aged under 19 years.
What action should they take?
Ensure all staff involved in immunisation services are appropriately
trained. Training should be regularly updated. It should be tailored to
individual needs to ensure staff have the necessary skills and
knowledge, for example, communications skills and the ability to answer
questions about different vaccinations.
Ensure health professionals who deliver vaccinations have received
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training that complies with the ‘National minimum standard for
immunisation training’.
Professional bodies should ensure health professionals working with
children and young people have the appropriate knowledge and skills to
give advice on the benefits and risks of immunisation. Specifically, they
should be well-versed in the core topics defined in the Health Protection
Agency’s ‘Core curriculum for immunisation training’.
Ensure staff are appropriately trained to document vaccinations
accurately in the correct records.
Recommendation 4: contribution of nurseries, schools, colleges of
further education
Who is the target population?
Children and young people aged under 19 years attending nurseries,
schools and colleges of further education, particularly those who may
not have been immunised or may have only been partially immunised.
Parents of children and young people aged under 19 years.
Who should take action?
PCT directors of public health, immunisation coordinators and
community paediatricians.
Health visiting and school nursing teams, GPs and those involved in
family nurse partnerships.
Head teachers, school governors and heads of further education
colleges and pupil referral units.
Nursery, pre-school and early years providers.
Managers, nurses and early years support staff in Sure Start children’s
centres and children’s services.
What action should they take?
The Healthy Child team, led by a health visitor working with other
practitioners, should check the immunisation record (including the
personal child health record) of each child aged up to 5 years. They
should carry out this check when the child joins a day nursery, nursery
school, playgroup, Sure Start children’s centre or when they start
primary school. The check should be carried out in conjunction with
childcare or education staff and the parents.
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School nursing teams, working with GP practices and schools, should
check the vaccination status of children and young people when they
transfer to a new school or college. Working with the PCT, they should
also advise young people and their parents about the vaccinations
recommended at secondary school age.
If children and young people are not up-to-date with their vaccinations,
school nursing teams, in conjunction with nurseries and schools, should
explain to parents why immunisation is important. Information should be
provided in an appropriate format (for example, as part of a question and
answer session). School nursing teams should offer vaccinations to help
them catch up, or refer them to other immunisation services.
Head teachers, school governors, managers of children’s services and
PCT immunisation coordinators should work with parents to encourage
schools to become venues for vaccinating local children. This would
form part of the extended school role.
Recommendation 5: targeting groups at risk of not being fully
immunised
Who is the target population?
Children and young people aged under 19 years at risk of not being
immunised or only being partially immunised.
Parents of these children and young people.
Who should take action?
Commissioners, managers and coordinators of children’s services in
PCTs, children’s trusts, Sure Start children’s centres and immigration
services.
Health professionals responsible for children’s immunisation services
including directors of public health, paediatricians, GPs, practice nurses,
school nursing teams, health visiting teams and those involved in family
nurse partnerships7.
Nurses working in child and adolescent mental health services, young
offender institutions and secure units.
Other health professionals who have contact with children and young
people aged under 19 years.
Immunisation coordinators and others who work in immunisation
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services within PCTs and GP practices.
Managers of children’s services and children’s centres.
Social care workers responsible for children and those with parental
responsibility for looked after children.
What action should they take?
Improve access to immunisation services for those with transport,
language or communication difficulties, and those with physical or
learning disabilities. For example, provide longer appointment times,
walk-in vaccination clinics, services offering extended hours and mobile
or outreach services. The latter might include home visits or vaccinations
at children’s centres.
Provide accurate, up-to-date information in a variety of formats on the
benefits of immunisation against vaccine-preventable infections. This
should be tailored for different communities and groups, according to
local circumstances. For example, offer translation services and provide
information in multiple languages (this information is available from
www.immunisation.nhs.uk/Library/Publications/Translations).
Consider using pharmacies, retail outlets, libraries and local community
venues to promote and disseminate accurate, up-to-date information on
childhood immunisation.
Health professionals should check the immunisation history of new
migrants, including asylum seekers, when they arrive in the country.
They should discuss outstanding vaccinations with them and, if
appropriate, their parents, and offer the necessary vaccinations
administered by trained staff.
Prison health services should check the immunisation history of young
offenders. They should discuss any outstanding vaccinations with the
young person and, if appropriate, their parents, and offer appropriate
vaccines administered by trained staff.
Check the immunisation status of looked after children during their initial
health assessment, the annual review health assessment and statutory
reviews. Ensure outstanding immunisations are addressed as part of the
child’s health plan. Offer opportunities to have any missed vaccinations,
as appropriate, in discussion with the child or young person and those
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with parental responsibility for them.
Recommendation 6: hepatitis B
immunisation for infants
Who is the target population?
Children born to mothers who are hepatitis B-positive.
Parents of children who are hepatitis B-positive.
Who should take action?
GPs, health visitors, midwives, neonatal and community paediatricians,
nursery and neonatal nurses, support workers and those involved in
family nurse partnerships.
PCT directors of public health and immunisation coordinators.
Managers and family health and support teams in children’s services.
Managers, health professionals and early years support staff in Sure
Start children’s centres.
Commissioners and providers of immunisation services.
What action should they take?
PCTs should have an identified person responsible for coordinating the
local hepatitis B vaccination programme for babies at risk of hepatitis B
infection. The person should also be responsible for scheduling and
follow-up to ensure babies at risk are vaccinated at the right time. This
may involve working within and across several PCT areas.
A clear process for the local infant hepatitis B vaccination programme
should be developed and implemented. Antenatal, postnatal, neonatal,
paediatric, primary care and community support teams should
communicate effectively and share information so that the children and
families affected can be contacted and followed up.
Babies born to hepatitis B-positive mothers should be given the first
dose of the vaccine promptly, whether they are delivered in hospital or at
home. They should then receive all other recommended doses, a blood
test to check for infection and, where appropriate, hepatitis B
immunoglobulin, in line with the ‘Green book9’.
Health professionals should record the mother’s hepatitis B status in the
personal child health record as soon as possible after birth, before the
midwife hands over care of the baby to the health visitor. The mother’s
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hepatitis B status should also be entered on the child’s record in the
local Child Health Information System.
Health professionals should provide parents with information, advice and
support on how to prevent the transmission of hepatitis B. They should
emphasise the importance of ensuring babies complete the
recommended vaccination course at the right time. In addition, they
should assess whether or not the baby’s siblings need to be immunised
against hepatitis B or tested for infection and should offer them
vaccinations and blood tests if necessary.
Health professionals should ensure administered doses of hepatitis B
vaccination are recorded in the patient records and the personal child
health record.
All the above actions should be integrated into the local care pathway for
infant hepatitis B. (See also NICE clinical guideline 62 on antenatal care
atwww.nice.org.uk/CG62).
IPG315 Hysteroscopic This document replaces previous guidance on hysteroscopic Acute care only -
sterilisation by tubal sterilisation by tubal cannulation and placement of intrafallopian
cannulation and implants (interventional procedure guidance 44).
placement of Current evidence on the safety and efficacy of hysteroscopic sterilisation
intrafallopian by tubal cannulation and placement of intrafallopian implants is adequate
implants to support the use of this procedure provided that normal arrangements
are in place for clinical governance and audit.
During the consent process clinicians wishing to undertake hysteroscopic
sterilisation by tubal cannulation and placement of intrafallopian implants
should take the following action.
Ensure that patients understand that additional contraception must be
used until appropriate imaging has been done; and that there is a small
risk of pregnancy in the longer term after any form of tubal occlusion
procedure. Patients should be provided with clear written information.
IPG316 Extracorporeal This document replaces previous guidance on extracorporeal albumin Acute care only -
albumin dialysis for dialysis for acute-on-chronic liver failure (interventional procedure
acute liver failure guidance 45).
The evidence on extracorporeal albumin dialysis for acute liver
failure raises no major safety concerns. However, current evidence
573b4b5e-b3ee-42b9-a637-a851dff8236a.doc Page 17
NHS Sheffield
Framework of NICE Guidance
September 2009
Guideline Title Summary Implications Review Local
No Date Action
on its efficacy is inadequate in quality and quantity. Therefore, this
procedure should only be used with special arrangements for clinical
governance, consent and audit or research.
Clinicians wishing to undertake extracorporeal albumin dialysis for
acute liver failure should take the following actions.
– Inform the clinical governance leads in their Trusts.
– Ensure that patients and their carers understand the uncertainty
about the procedure’s efficacy and provide them with clear
written information (subject to the requirement for an emergency
procedure).
– Audit and review clinical outcomes of all patients having
extracorporeal albumin dialysis for acute liver failure.
NICE encourages further research into extracorporeal albumin
dialysis for acute liver failure. This should describe clearly the
indications for treatment. Short- and longer-term survival and the
numbers of patients ‘bridged to transplant’ should be documented
and compared with standard treatments. Further information about
the utility of biochemical markers to guide the frequency of treatment
would be helpful. NICE may review the procedure on publication of
further evidence.
IPG317 Individually Current evidence on the safety and efficacy of individually magnetic Acute care only -
magnetic resonance resonance imaging (MRI)-designed unicompartmental interpositional
imaging-designed implant insertion for osteoarthritis of the knee is inadequate in
unicompartmental quantity and quality. Therefore, this procedure should only be used
interpositional in the context of research studies. These should include clear
implant insertion for descriptions of patient selection; and should report both objective
osteoarthritis of the and patient-reported outcomes and the length of time before joint
knee
replacement is required.
NICE may review the procedure on publication of further evidence.
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