A round-up of the latest guidance from the National Institute for Clinical Excellence

Published: 04/03/2004, Volume II4, No. 5895 Page 29

Trauma care: use of pre-hospital intravenous

Limiting the use of pre-hospital intravenous fluid for trauma patients could save time at the accident scene, contributing to improved ambulance response times and small overall efficiency improvements, according to the National Institute for Clinical Excellence. The guidance recommends that IV fluid should only be administered to a person injured as a result of trauma if a radial pulse - or for penetrating torso injuries, a central pulse - is absent. Administration should be in boluses of no more than 250 ml and carried out en route to hospital wherever possible, by appropriately trained professionals.

Surgery: three new procedures cause concerns

Evidence on the safety and efficacy of three new surgical procedures is lacking, according to NICE. Radiofrequency volumetric tissue reduction for turbinate hypertrophy, transilluminated powered phlebectomy for varicose veins and extracorporeal membrane oxygenation in adults should not be carried out without consultants informing clinical governance leads and making sure patients are aware of the situation.

Hepatitis C: combination therapy will increase drug costs

Recommendations for the use of combination therapy for people with moderate to severe chronic hepatitis C will cost at least£10m a year, according to NICE. The guidance says that combination therapy with peginterferon alfa and ribavirin is cost effective. It recommends that people currently treated with interferon alfa, either as combination therapy or monotherapy, be switched to the corresponding therapy with peginterferon alfa. Peginterferon alfa combination therapy costs about£3,200 more per patient than interferon alfa combination therapy.

Diabetes: prevention and management of foot problems

The fifth and final guideline on type-2 diabetes covers the education of people with diabetes and their carers about foot problems, identification of those at risk and the prevention, detection and treatment of foot problems. Key themes include a systematic approach to primary and secondary prevention, surveillance to identify people at risk and to offer them preventive foot care, and prompt and appropriate handling of any problems that arise. The guideline was developed for NICE by the national collaborating centre for primary care.

Eating disorders: care guidelines

Adolescents and young people are singled out for specific recommendations in these guidelines because of their unique needs and the high incidence of eating disorders. The guidelines advise on the identification, treatment and management of anorexia nervosa, bulimia nervosa and atypical eating disorders in adults, adolescents and children from the age of eight. Recommendations include effective assessment; involving family members; managing most adults with anorexia nervosa as outpatients with psychological treatment by professionals experienced in treating eating disorders; and behaviour therapy for bulimia nervosa.

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