Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - February 2010

The National Institute of Health and Clinical Excellence has published new guidance for the month of February 2010.

There is one guidance document that has an impact in primary care. Public health guidance has been published regarding school-based interventions to prevent the uptake of smoking among children.

This guidance recommends that information on smoking is integrated into the school curriculum, smoking policies should support both prevention and stop smoking activities and that these activities are coordinated with outside agencies.

Action: Clinicians should be aware of this guidance and support local activities where appropriate.

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CKS Update – February 2010

Clinical Knowledge Summaries (CKS) has been updated in February 2010 for the following clinical areas:

Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.

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Homeopathy a waste of NHS money

The Commons Science and Technology Committee has recommended that the NHS should cease funding homeopathy after a review of the available evidence for efficacy. This recommendation has been reported in the general media (BBC).

The committee aims to assess if Government policy is backed by sound scientific evidence. The committee found no evidence that homeopathy works beyond the placebo effect. They also conclude that further trial work on homeopathy is unjustified.

The press release also notes that the Government acknowledges the lack of evidence for homeopathy and that it does not intend to review or change current NHS policy. The chairman of the committee stated that the decision to fund such treatments "sends out a confused message, and has potentially harmful consequences".

Action: Clinicians should be aware of this recommendation. Clinicians within the NHS who prescribe homeopathic remedies should individually review their continued use of these products.

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Statins and diabetes risk

The Lancet has published the results of a meta-analysis of randomised statin trials with the aim of establishing whether any association exists between statin use and development of diabetes. This analysis has been reported in the general media (BBC).

This analysis included data from 13 trials involving 91,140 participants. 4,278 participants developed diabetes during the trial periods (mean duration 4 years) with 2,226 assigned statins and 2,052 assigned control treatment.

Statin therapy was found to be associated with a statistically significant 9% increase in the risk of developing diabetes (odds ratio [OR] 1·09; 95% CI 1·02–1·17). The risk was found to be highest in older participants while baseline BMI and change in low-density lipoprotein-cholesterol (LDL-C) concentrations appear to be unimportant predictive factors.

Despite this finding the authors conclude that, "in view of the overwhelming benefit of statins for the reduction of cardiovascular events, the small absolute risk for development of diabetes is outweighed by cardiovascular benefit in the short and medium term". They recommend that current practice for statin therapy remains unchanged.

The authors also note that this analysis does not prove a causal relationship and that the observed difference may be due to residual confounding factors. They therefore also suggest that development of diabetes is included in future statin studies as a secondary outcome.

Action: Clinicians should be aware of these results and the associated media reports. Patients taking statins should be reassured that the benefits of therapy outweigh the risks. Screening for diabetes in patients taking statins, especially in older patients, may be a sensible strategy.

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Pandemic Flu Service closed

The NHS Pandemic Flu Service has been closed in response to the decline in swine flu cases. The closure of the service has been reported in the general media (BBC).

The telephone service and web based assessment tool have both been suspended but could be reinstated within seven days if needed. Patients who suspect that they have flu-like symptoms are now being directed to their own doctor for assessment and treatment authorisation.

Action: Clinicians should be aware of the closure of this service and that responsibility for assessment and treatment has been transferred back to primary care services.

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