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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

NICE Guidance - June 2020

The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of June 2020. This month is one guideline, one medtech innovation briefing and one evidence summary related to COVID-19 that impact upon primary care.

The Joint replacement (primary): hip, knee and shoulder guideline has been published. It covers care before, during and after a planned knee, hip or shoulder replacement. It includes recommendations to ensure that people are given full information about their options for surgery, including anaesthesia. It offers advice for healthcare professionals on surgical procedures and ensuring safety during operations. It also offers guidance on providing support and rehabilitation before and after surgery.

The FibroScan for assessing liver fibrosis and cirrhosis in primary care medtech innovation briefing has been published. This briefing notes that the intended place in therapy would be in primary care for people with liver fibrosis or cirrhosis and recognises that the technology is already used extensively in specialised care settings. It is also noted that it is unclear if every primary care centre would be able to support a FibroScan clinic.

The COVID-19 rapid evidence summary: vitamin D for COVID-19 evidence summary has been published. It notes that there is no evidence to support taking vitamin D supplements to specifically prevent or treat COVID‑19. However, it is also noted the everyone should continue to follow UK Government advice on daily vitamin D supplementation to maintain bone and muscle health during the COVID‑19 pandemic.

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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Drug Safety Update - June 2020

The Medicines and Healthcare products Regulatory Agency (MHRA) has published Drug Safety Update for June 2020 (PDF).

This month readers are advised of revised measures to minimise risk of meningioma associated with the use of cyproterone acetate. It is now recommended that cyproterone is contraindicated in patients with previous or current meningioma (for all indications) and should only be considered for control of libido in severe hypersexuality or paraphilias in adult men when other interventions are inappropriate.

Readers are also reminded to be vigilant for signs and symptoms of bleeding when prescribing direct-acting oral anticoagulants (DOACs), especially in those patients with increased bleeding risks. There is an excellent summary of dose adjustments at differing levels of renal function for all four currently available agents. Readers are also advised of the available reversal agents.

The summary of letters to healthcare professionals includes details for drug trials of hydroxychloroquine and dexamethasone in the treatment or prevention of coronavirus (COVID-19), as well as several letters regarding product supply noting that Clenil®, Semglee® and Adoport® packaging or product may be in a different language or have a different appearance as imported stock is used to ease supply constraints.

Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.

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CKS Updates - May 2020

During May 2020 Clinical Knowledge Summaries were published or updated in the following areas.

All of the topics have been reviewed and undergone minor restructuring. The Sprains and strains topic has been restructured and recommendations have been updated in line with current evidence; the prognosis and complications section has been split and the referral and prescribing sections have been moved into the Management section.

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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