Clinical Excellence Guidelines (clinical + excellence_guideline)

Distribution by Scientific Domains

Selected Abstracts

Towards consensus in the long-term management of relapse prevention in schizophrenia

M. Taylor
Abstract Approach to developing guidance When developing guidance for the long-term management of schizophrenia, one approach is to adopt a proactive strategy that sets out clear treatment goals and strategies. This should involve a broad view being taken, embracing overall mental and physical well-being rather than simply the absence of illness. Although relapse prevention is an important goal of any long-term management strategy, there are other aspects that need to be considered, such as reintegration into society, regaining independence and quality of life. Current treatment To help achieve these goals, a range of interventions can be incorporated into long-term management strategies for schizophrenia, including pharmacological interventions, psychosocial therapies and alliance-building initiatives. The current UK National Institute for Clinical Excellence guidelines already recommend that continuous therapy should be practised using an atypical (second-generation) antipsychotic drug, whenever possible, in preference to older typical drugs. The launch of the first long-acting atypical antipsychotic is an interesting new advance that may benefit many patients with schizophrenia. Psychosocial interventions, particularly family-based therapies, as well as cognitive behavioural and compliance therapies, when used alongside antipsychotics, have been shown to reduce relapse rates dramatically and to assist in social reintegration. In addition, forging collaborative alliances with patients and their carers can help to demystify schizophrenia and empower patients to take responsibility for their illness. Consensus statement This article outlines a consensus reached by a panel of leading UK healthcare professionals working with schizophrenia brought together to discuss long-term management strategies. Copyright 2005 John Wiley & Sons, Ltd. [source]

Non-adherence to antihypertensive medication and impaired cognition: which comes first?

Paul R. Gard
Abstract Objective, Antihypertensive medications are important in the prevention of serious consequences of hypertension, such as stroke and heart failure. Up to one-third of elderly hypertensive patients, however, do not adhere to their medication. Adherence to medication decreases with increasing age, and with decreasing cognitive ability, thus elderly, cognitively-impaired patients have poorer control of blood pressure. Good control of blood pressure is associated with decreased prevalence of dementia and Alzheimer's disease. This study assessed the evidence that antihypertensive medications have effects on the prevalence or severity of mild cognitive impairment, dementia or Alzheimer's disease. Methods, The ISI Web of Knowledge database was searched; including replicates, the nine searches identified 14 400 publications since 1952, of which 9.9% had been published in 2009. This review considers the 18 studies meeting the set criteria published in 2009 or later. Key findings, Not all antihypertensive medications are equivalent in their positive cognitive effects, with brain-penetrating angiotensin-converting-enzyme inhibitors and possibly angiotensin receptor antagonists being the most effective. Conclusions, Based on evidence of blood-pressure control and cost, UK National Institute for Health and Clinical Excellence guidelines recommend calcium-channel blockers or thiazide-type diuretics for the treatment of hypertension in patients over 55 years. These guidelines take no account of the potential cognitive effects of the antihypertensive therapies, consideration of which might lead to a review. There may be benefit in stressing that adherence to antihypertensive medication not only decreases the risk of cardiovascular disease and death, but may also decrease the risk or severity of mild cognitive impairment, dementia and Alzheimer's disease. [source]

Prevalence of anaemia and the contribution of functional iron deficiency in diabetes related chronic kidney disease

MRCP Specialist Registrar in Diabetes & Endocrinology, MS Rathi MBBS
Abstract Anaemia is often an unrecognised complication of diabetes that has an adverse effect on the progression of diabetes related complications. Anaemia predicts mortality in diabetes related chronic kidney disease (CKD). Contributors to its development include absolute and/or functional iron deficiency and erythropoietin insufficiency. This study aimed to look at the prevalence of anaemia and markers of iron deficiency in patients with diabetes related CKD. An analysis was done of the results from all patients (225 men, 93 women; mean age 70 years) attending joint diabetes,renal clinics over a 12-month period. Haemoglobin (Hb) was measured in 88%. The mean Hb was 12.6g/dl in men and 11.7g/dl in women. A total of 21.5% (11.5% men, 10% women) had Hb <11g/dl who should have anaemia management as per National Institute for Health and Clinical Excellence guidelines. Among the anaemic population, CKD stage 3 was present in 25% of men and in 8% of women, with CKD stage 4 present in 20% of men and in 32% of women. Fifty-three percent had absolute iron deficiency (serum ferritin <100,g/L) and 41% had inadequate iron stores (serum ferritin between 100 and 500,g/L). Functional iron deficiency defined by serum ferritin >100,g/L and red cell hypochromasia ,6% was noted in 21.6% of anaemic patients. Anaemia is a frequent finding in patients with diabetes related CKD. A significant proportion of patients had functional iron deficiency that required iron therapy for optimisation of their iron stores before starting erythropoiesis-stimulating agents. Measurement of red cell hypochromasia is a valuable tool to detect this group of patients. Copyright 2010 John Wiley & Sons. [source]

ORIGINAL ARTICLE: The ability of anaesthetists to identify the position of the right internal jugular vein correctly using anatomical landmarks

ANAESTHESIA, Issue 9 2010
C. R. Harber
Summary We performed a study of 85 consenting anaesthetists to assess their ability to locate the right internal jugular vein using a landmark technique. Initially, a questionnaire was completed ascertaining previous user experience. An ultrasound probe, using the midpoint as an ,imaginary needle', was placed on the neck of a healthy volunteer (with previously confirmed normal anatomy) and the image recorded. Both anaesthetist and volunteer were blinded to the screen until the image was stored. Anaesthetists were grouped into those in training before 2002 (Pre-2002, n = 58), when National Institute for Health and Clinical Excellence guidelines recommending ultrasound guidance were published, and those training after this time point (Post-2002, n = 27). The success rate for identifying the internal jugular vein using the landmark technique was 36/58 (62%) in the Pre-2002 group and 6/27 (22%) in the Post-2002 group (p < 0.001). Three participants in each group would have hit the carotid artery (5% Pre-2002 and 11% Post-2002 respectively; p = 0.2). The advent of routine use of ultrasound has resulted in a cohort of anaesthetists who are unable to use a landmark technique effectively or safely. This has significant training implications. [source]

Therapeutic hypothermia for neonatal encephalopathy: a UK survey of opinion, practice and neuro-investigation at the end of 2007

Andrew Kapetanakis
Abstract Background: The 2007 Cochrane review of therapeutic hypothermia for neonatal encephalopathy (NE) indicates a significant reduction in adverse outcome. UK National Institute for Clinical Excellence guidelines are awaited. Objective: To benchmark current opinion and practice to inform future strategies for optimal knowledge transfer for therapeutic hypothermia. Methods: A web based questionnaire (30 sections related to opinion and practice of management of NE) sent to the clinical leads of Level I, II and III neonatal units throughout the UK in November/December 2007. Results: One hundred and twenty-five (out of 195) UK neonatal units responded (response rate 66%). Ten percent, 37.5% and 51.5% responses were from level I, II and III units respectively. Twenty eight percent of all units provided therapeutic hypothermia locally (52% of level III units), however 80% of responders would offer therapeutic hypothermia if there was the facility. Overall, 57% of responders considered therapeutic hypothermia effective or very effective , similar for all unit levels; 43% considered more data are required. Regional availability of therapeutic hypothermia exists in 55% of units and 41% of units offer transfer to a regional centre for therapeutic hypothermia. Conclusion: In the UK in 2007, access to therapeutic hypothermia was widespread although not universal. More than half of responders considered therapeutic hypothermia effective. Fifty-five percent of perinatal networks have the facility to offer therapeutic hypothermia. The involvement of national bodies may be necessary to ensure the adoption of therapeutic hypothermia according to defined protocols and standards; registration is important and will help ensure universal neurodevelopmental follow up. [source]