Clinical Knowledge Summaries (CKS) has been updated in May for the following clinical areas:
Action: Clinicians who see patients with any of these conditions may find the updated information useful when reviewing current clinical practice.
The NHS immunisations website has been updated with information about the human papillomavirus vaccine (HPV) and the vaccination programme due to start this autumn. A recent study highlighted that lack of information was a common reason for refusing the vaccination.
This new website contains:
The information currently available is intended for healthcare professionals but it may also prove helpful to patients. The information will continue to be updated with a changing focus to patient orientated information.
Action: Clinicians who want more information about the HPV vaccine and vaccination programme will find this site useful. Patients can also be directed to this resource, especially as the information updates are added.
The Scottish Medicines Consortium has issued its monthly advice on new medicines.
Aliskiren (Rasilez®) has been rejected for the treatment of essential hypertension. Escitalopram (Cipralex®) has been rejected for the treatment of social anxiety disorder. Both rejections we made because the manufacturers failed to make a submission.
Action: Clinicians should be aware of the recommendations of the SMC. Routine use of rejected medicines should be avoided.
The British Medical Journal has published a head to head debate asking if patients should be able to pay top-up fees to get the treatment they want.
James Gubb, director of health unit, argues in favour of top-up fees stating that this practice already happens but is in need of some standardisation in terms of cost and availability. He sites the current situation with hearing aids and also how decisions over funding of NICE rejected anti-cancer drugs differ with location.
Karen Bloor, a researcher at the University of York, argues against top-up fees stating the treatment should be based on clinical need and not on ability to pay. It is also argued that allowing top-up fees could have a significant effect on market prices with emergence of top-up fee insurance and increasing drug costs due to the weaker price negotiating position of multiple purchasers.
This debate serves to highlight the continued tension of providing an enormous range of treatments with a limited resource. This debate is likely to continue, especially while individual patients, pharmaceutical companies and patient groups continue to contest national policy decisions to not fund treatment based upon want rather than need.
Action: Clinicians must ensure that they make optimal use of their allocated NHS resource by prescribing with due regard for cost-efficacy and clinical need.
The Journal of the American Medical Association has published the results of an analysis of data from the Nurses' Health Study that aimed to assess the relationship between cigarette smoking and smoking cessation on mortality.
The Nurses' Health Study is a prospective observational study of 104,519 American female nurses. The data were analysed for mortality from all causes and also categorised into vascular and respiratory diseases, lung cancer, other cancers and other causes. Comparisons were made between never smokers, current smokers and past smokers.
Compared to never smokers:
The study also found that risk was higher in people who started smoking at an earlier age and that risk declined to baseline over a period of 20 years for lung diseases with a more rapid decline for vascular mortality.
Action: These data contribute to what is already known about the harms of smoking and the benefits of smoking cessation. Clinicians may find the numerical risk data useful when encouraging abstinence from smoking.
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