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Nice clinical guidelines

Martin Knapp, Derek King, Renée Romeo, Jessica Adams, Ashley Baldwin, Clive Ballard, Sube Banerjee, Robert Barber, Peter Bentham, Richard G Brown, Alistair Burns, Tom Dening, David Findlay, Clive Holmes, Tony Johnson, Robert Jones, Cornelius Katona, James Lindesay, Ajay Macharouthu, Ian McKeith, Rupert McShane, John T O'Brien, Patrick P J Phillips, Bart Sheehan, Robert Howard
OBJECTIVE: Most investigations of pharmacotherapy for treating Alzheimer's disease focus on patients with mild-to-moderate symptoms, with little evidence to guide clinical decisions when symptoms become severe. We examined whether continuing donepezil, or commencing memantine, is cost-effective for community-dwelling, moderate-to-severe Alzheimer's disease patients. METHODS: Cost-effectiveness analysis was based on a 52-week, multicentre, double-blind, placebo-controlled, factorial clinical trial...
October 13, 2016: International Journal of Geriatric Psychiatry
Taru A Muranen, Dario Greco, Carl Blomqvist, Kristiina Aittomäki, Sofia Khan, Frans Hogervorst, Senno Verhoef, Paul D P Pharoah, Alison M Dunning, Mitul Shah, Robert Luben, Stig E Bojesen, Børge G Nordestgaard, Minouk Schoemaker, Anthony Swerdlow, Montserrat García-Closas, Jonine Figueroa, Thilo Dörk, Natalia V Bogdanova, Per Hall, Jingmei Li, Elza Khusnutdinova, Marina Bermisheva, Vessela Kristensen, Anne-Lise Borresen-Dale, Nbcs Investigators, Julian Peto, Isabel Dos Santos Silva, Fergus J Couch, Janet E Olson, Peter Hillemans, Tjoung-Won Park-Simon, Hiltrud Brauch, Ute Hamann, Barbara Burwinkel, Frederik Marme, Alfons Meindl, Rita K Schmutzler, Angela Cox, Simon S Cross, Elinor J Sawyer, Ian Tomlinson, Diether Lambrechts, Matthieu Moisse, Annika Lindblom, Sara Margolin, Antoinette Hollestelle, John W M Martens, Peter A Fasching, Matthias W Beckmann, Irene L Andrulis, Julia A Knight, kConFab/Aocs Investigators, Hoda Anton-Culver, Argyrios Ziogas, Graham G Giles, Roger L Milne, Hermann Brenner, Volker Arndt, Arto Mannermaa, Veli-Matti Kosma, Jenny Chang-Claude, Anja Rudolph, Peter Devilee, Caroline Seynaeve, John L Hopper, Melissa C Southey, Esther M John, Alice S Whittemore, Manjeet K Bolla, Qin Wang, Kyriaki Michailidou, Joe Dennis, Douglas F Easton, Marjanka K Schmidt, Heli Nevanlinna
PURPOSE: CHEK2*1100delC is a founder variant in European populations that confers a two- to threefold increased risk of breast cancer (BC). Epidemiologic and family studies have suggested that the risk associated with CHEK2*1100delC is modified by other genetic factors in a multiplicative fashion. We have investigated this empirically using data from the Breast Cancer Association Consortium (BCAC). METHODS: Using genotype data from 39,139 (624 1100delC carriers) BC patients and 40,063 (224) healthy controls from 32 BCAC studies, we analyzed the combined risk effects of CHEK2*1100delC and 77 common variants in terms of a polygenic risk score (PRS) and pairwise interaction...
October 6, 2016: Genetics in Medicine: Official Journal of the American College of Medical Genetics
Charlotte L Hall, John A Taylor, Karen Newell, Laurence Baldwin, Kapil Sayal, Chris Hollis
BACKGROUND: The landmark US Multimodal Treatment of ADHD (MTA) study established the benefits of individualised medication titration and optimisation strategies to improve short- to medium-term outcomes in attention-deficit hyperactivity disorder (ADHD). This individualised medication management approach was subsequently incorporated into the National Institute for Health and Care Excellence (NICE) ADHD Clinical Guidelines (NICE CG78). However, little is known about clinicians' attitudes towards implementing these medication management strategies for ADHD in routine care...
January 2016: BJPsych Open
Kaushik Guha, Christopher J Allen, Sumir Chawla, Hayley Pryse-Hawkins, Laura Fallon, Vicki Chambers, Ali Vazir, Alex R Lyon, Martin R Cowie, Rakesh Sharma
The National Institute for Health and Care Excellence (NICE) updated its guidelines for chronic heart failure (HF) in 2010. This re-audit assessed interim improvement as compared with an audit in 2011. Patients with HF (preserved and reduced ejection fraction) attending a tertiary cardiac centre over a 2-year period (January 2013-December 2014) were audited. The data collected included demographics, HF aetiology, medications, clinical parameters and cardiac rehabilitation. In total, 513 patients were audited...
October 2016: Clinical Medicine: Journal of the Royal College of Physicians of London
Melvyn W B Zhang, Roger C M Ho
Dementia is known to be an illness which brings forth marked disability amongst the elderly individuals. At times, patients living with dementia do also experience non-cognitive symptoms, and these symptoms include that of hallucinations, delusional beliefs as well as emotional liability, sexualized behaviours and aggression. According to the National Institute of Clinical Excellence (NICE) guidelines, non-pharmacological techniques are typically the first-line option prior to the consideration of adjuvant pharmacological options...
October 22, 2016: Technology and Health Care: Official Journal of the European Society for Engineering and Medicine
Anand Nitin Kanani, Stuart Hartshorn
No abstract text is available yet for this article.
September 28, 2016: Archives of Disease in Childhood. Education and Practice Edition
Rainer Zbinden, Stefanie von Felten, Bastian Wein, David Tueller, David J Kurz, Ivano Reho, Soren Galatius, Hannes Alber, David Conen, Matthias Pfisterer, Christoph Kaiser, Franz R Eberli
AIMS: The British National Institute of Clinical Excellence (NICE) guidelines recommend to use DES instead of BMS only in lesions >15mm in length or in vessels < 3mm in diameter. We analysed the impact of stent length and stent diameter on ISR in the BASKET-PROVE study population and evaluated the cost-effectiveness of DES compared to BMS. METHODS/RESULTS: The BASKET-PROVE trial compared DES vs. BMS in large coronary arteries (≥3mm). We calculated incremental cost-effectiveness ratios (ICERs) and cost-effectiveness acceptability curves with regard to quality-adjusted life years (QALYs) gained and target lesion revascularisations (TLRs) avoided...
September 23, 2016: Cardiovascular Therapeutics
Hiromi Rakugi
European guidelines (ESH-ESC2013) for the elderly have discussed well about treatment blood pressure (BP) levels and targeting BP levels. In general, elderly patients with systolic BP (SBP) ≥160 mmHg including individuals older than 80 years in good physical and mental conditions are recommended reducing SBP to between 150 and 140 mmHg. Furthermore, fit elderly patients <80 years old are recommended to consider antihypertensive treatment at SBP values ≥140 mmHg with a target SBP <140 mmHg. On the other hand, frail elderly patients are recommended to leave decisions on antihypertensive therapy to the treating physician, and based on monitoring of the clinical effects of treatment...
September 2016: Journal of Hypertension
Shayan Abdollah Zadegan, Seyed Mohammad Ghodsi, Jalil Arabkheradmand, Abbas Amirjamshidi, Abdolreza Sheikhrezaei, Masoud Khadivi, Morteza Faghih Jouibari, Seyed Mahmood Tabatabaeifar, Guive Sharifi, Jalal Abbaszadeh Ahranjani, Farhad Motlagh Pirooz, Seyed Fakhredin Tavakoli, Parviz Mohit, Yadollah Alimohammadi, Vafa Rahimi-Movaghar
CONTEXT: The National institute for health and care excellence (NICE) and scottish intercollegiate guidelines network (SIGN) are two well-known sources of clinical guideline development. In the past years, they have developed clinical guidelines for the management of head injury. In this report, we will highlight our modifications to these guidelines according to the domestic situation in a developing country. EVIDENCE ACQUISITION: The guidelines were appraised using the appraisal of guidelines for research and evaluation (AGREE) instrument...
May 2016: Trauma Monthly
J Fistouris, C Bergh, A Strandell
STUDY QUESTION: How do four protocols based on serial human chorionic gonadotropin (hCG) measurements perform when classifying pregnancies of unknown location (PULs) as low or high risk of being an ectopic pregnancy (EP)? SUMMARY ANSWER: The use of cut-offs in hCG level changes published by NICE, and a logistic regression model, M4, correctly classify more PULs as high risk, compared with two other protocols. WHAT IS KNOWN ALREADY: A logistic regression model, M4, based on the mean of two consecutive hCG values and the hCG ratio (hCG 48 h/hCG 0 h) that classify PULs into low- and high-risk groups for triage purposes, identifies more EPs than a protocol using the cut-offs between a 13% decline and a 66% rise in hCG levels over 48 h...
October 2016: Human Reproduction
John P Greenwood, David P Ripley, Colin Berry, Gerry P McCann, Sven Plein, Chiara Bucciarelli-Ducci, Erica Dall'Armellina, Abhiram Prasad, Petra Bijsterveld, James R Foley, Kenneth Mangion, Mark Sculpher, Simon Walker, Colin C Everett, David A Cairns, Linda D Sharples, Julia M Brown
IMPORTANCE: Among patients with suspected coronary heart disease (CHD), rates of invasive angiography are considered too high. OBJECTIVE: To test the hypothesis that among patients with suspected CHD, cardiovascular magnetic resonance (CMR)-guided care is superior to National Institute for Health and Care Excellence (NICE) guidelines-directed care and myocardial perfusion scintigraphy (MPS)-guided care in reducing unnecessary angiography. DESIGN, SETTING, AND PARTICIPANTS: Multicenter, 3-parallel group, randomized clinical trial using a pragmatic comparative effectiveness design...
September 13, 2016: JAMA: the Journal of the American Medical Association
Thomas Pepper, Thomas Konarzewski, Paul Grimshaw, James Combes
We studied the dental records of British military personnel who were less than 20 years old on enlistment, and had at least five years' service with at least five recorded dental inspections, at three military dental centres in the UK. The median (IQR) period from first to last inspection in 720 subjects was 15 (10-19) years, and the median frequency of inspection was every 14 (13-16) months. A total of 288/1250 mandibular third molars were extracted (23%). There were significant increases in the proportion of extractions stating caries in the mandibular third molar or multi-episode pericoronitis as indications (n=13, 14%, p <0...
August 25, 2016: British Journal of Oral & Maxillofacial Surgery
Michael Drummond
The National Institute for Health and Care Excellence (NICE) in the United Kingdom initiated its clinical guidelines program in 2001 and more than 200 guidelines have been produced to date. As with most of NICE's other programs, the clinical guidelines program also must take into account the relative costs and benefits of interventions when deciding whether to recommend them. The three main advantages of the program are that 1) it represents an important collaboration with the medical profession, thereby increasing the likelihood of recommendations being adopted; 2) the guidelines provide an opportunity to review all aspects of the clinical pathway, rather than focusing on only the adoption of a new technology; and 3) the guidelines offer the potential to discuss disinvestment as well as new investment...
July 2016: Value in Health: the Journal of the International Society for Pharmacoeconomics and Outcomes Research
Hasan Raza Mohammad, Jeremy Boardman, Laura Howell, Roger J Mills, Hedley C A Emsley
BACKGROUND: Urgent referral for suspected central nervous system (CNS) cancer is recommended, but little analysis of the referral criteria diagnostic performance has been conducted. New 2015 NICE guidance recommends direct brain imaging for patients with symptoms with positive predictive values (PPV) of 3 %, but further guidance is needed. METHODS: A 12-month retrospective evaluation of 393 patients referred under previous 2005 NICE 2-week rule criteria was conducted...
2016: BMC Neurology
Michael Wonder, Rosalie Fisher
AIMS: Melanoma is the most serious of the three common forms of skin cancer. New Zealand and Australia have the highest melanoma incidence rate in the world. A number of new treatments for melanoma with different modes of action have recently become available. Our aim was to examine their availability and subsidized access in New Zealand and to compare their availability and access in Australia and England. METHODS: We examined the clinical evidence base of the new treatments, their place in treatment guidelines and their consideration for reimbursement by PHARMAC in New Zealand, the PBAC in Australia and NICE in England...
2016: New Zealand Medical Journal
Janna M Vassantachart, Teo Soleymani, Jashin J Wu
Psoriasis is a common, chronic immune-mediated inflammatory skin disorder that significantly impacts quality of life and has potential systemic complications. The majority of psoriatic patients have mild to moderate disease and are adequately controlled with topical medications. However, approximately 20% of patients have moderate-to-severe disease. Phototherapy has remained a mainstay option for patients with moderate-to-severe psoriasis resistant to topical treatments due to its efficacy, cost-effectiveness, and relative lack of side effects, in particular a lack of systemic immunosuppression seen with traditional and biologic systemic therapies...
August 1, 2016: Journal of Drugs in Dermatology: JDD
E Lord, A J Stockdale, R Malek, C Rae, I Sperle, D Raben, A Freedman, D Churchill, J Lundgren, A K Sullivan
OBJECTIVES: European guidelines recommend HIV testing for individuals presenting with indicator conditions (ICs) including AIDS-defining conditions (ADCs). The extent to which non-HIV specialty guidelines recommend HIV testing in ICs and ADCs is unknown. Our aim was to pilot a methodology in the UK to review specialty guidelines and ascertain if HIV was discussed and testing recommended. METHODS: UK and European HIV testing guidelines were reviewed to produce a list of 25 ADCs and 49 ICs...
August 18, 2016: HIV Medicine
Heinke Pülhorn, Leann Westmoreland, Catherine McMahon
OBJECTIVES: To determine the variations in the management of patients with minor head injuries across a Trauma Network. METHODS: An 18-point questionnaire covering aspects of hospital care and follow-up of patients with minor head injuries was sent out to 19 wards in 10 different trauma units within our network. RESULTS: Fifty-eight percent of wards routinely admitting patients with minor head injuries have no management protocol in place...
October 2016: British Journal of Neurosurgery
K Hurst, R Lee, E Sideso, M Giles, A Handa
BACKGROUND: The UK National Institute for Health and Care Excellence (NICE) guidelines state that carotid endarterectomy should be scheduled within 2 weeks of symptoms. The recent National Stroke Strategy has reduced the time interval to 48 h. This study aimed to review the possible delays. METHODS: This study analysed patients with confirmed transient ischaemic attack (TIA) or minor stroke, referred to a single tertiary centre clinic and followed up 1 month after the event...
October 2016: British Journal of Surgery
M H Thornhill, M Dayer, P B Lockhart, M McGurk, D Shanson, B Prendergast, J B Chambers
Since 2008, NICE clinical guidelines have stated: 'Antibiotic prophylaxis against infective endocarditis is not recommended for people undergoing dental procedures'. This put UK guidance at odds with guidance in the rest of the world, where antibiotic prophylaxis is recommended for patients at high-risk of infective endocarditis undergoing invasive dental procedures. Many dentists also felt this wording prohibited the use of antibiotic prophylaxis, regardless of the wishes of the patient or their personal risk of infective endocarditis and made it difficult for them to use their clinical judgment to deliver individualised care in the best interests of their patients...
August 12, 2016: British Dental Journal
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