The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of November 2023. This month there are four guidelines and one technology appraisal that impact upon primary care.
The Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer clinical guideline has been updated. It covers care for people with a family history of breast, ovarian or another related (prostate or pancreatic) cancer. The update removed the off-label warning for anastrozole in the recommendations on chemoprevention for women at moderate or high risk of breast cancer, in line with the MHRA licence variation.
The Acute Respiratory Infection in over 16s: Initial assessment and management guideline has been updated. It covers assessment of people aged 16 and over with symptoms and signs of an acute respiratory infection (both bacterial and viral) at first remote or in-person contact with NHS services. The update clarifies that the threshold for treatment or referral for further assessment may be lower for people with an acute respiratory infection who are more likely to have a poor outcome.
The Hypertension in adults: diagnosis and management guideline has been updated. It covers identifying and treating primary hypertension in people aged 18 and over, including people with type 2 diabetes. The update has amended the recommendations on measuring and managing postural hypotension. Tables have also been added to the section on monitoring treatment and blood pressure targets to summarise blood pressure targets.
The Transient loss of consciousness ('blackouts') in over 16s clinical guideline has been updated. It covers assessment, diagnosis and referral for people over 16 who have had a transient loss of consciousness. This update amended the guidance on assessment and referral for suspected postural hypotension.
The Empagliflozin for treating chronic heart failure with preserved or mildly reduced ejection fraction technology appraisal has been published. This treatment is recommended, within its marketing authorisation, as an option for treating symptomatic chronic heart failure with preserved or mildly reduced ejection fraction in adults.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
During October 2023 Clinical Knowledge Summaries were published or updated in the following areas.
The Sarcoidosis topic is new. The other topics have all been reviewed and updated with minor structural and layout changes. The Neck pain - acute torticollis topic contains a new short section detailing some complications which can arise in people with acute torticollis. The Pelvic inflammatory disease topic has been updated in line with current evidence and information on the antibiotic levofloxacin has been added to the Prescribing information section.
Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.
The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of October 2023. This month there are eight guidelines and two technology appraisals that impact upon primary care.
The following guidelines have all been updated in line with the standards for faster diagnosis of cancer:
The Thyroid disease: assessment and management guideline has been updated. It covers investigating all suspected thyroid disease and managing primary thyroid disease. The update highlights the potential for biotin in dietary supplements to affect the results of thyroid function tests.
The Acute Respiratory Infection in over 16s: Initial assessment and management guideline has been published. It covers assessment of people aged 16 and over with symptoms and signs of an acute respiratory infection (both bacterial and viral) at first remote or in-person contact with NHS services. It also covers the initial management of any infections and aims to support healthcare practitioners in making sure that people’s treatment follows the best care pathway.
The Pneumonia in adults: diagnosis and management clinical guideline has been updated. The update replaced the recommendation on lower respiratory tract infection with links to the new guideline on Acute Respiratory Infection in over 16s.
The Rimegepant for treating migraine technology appraisal has been published. This treatment is recommended as an option for the acute treatment of migraine with or without aura in adults, only if for previous migraines:
- at least 2 triptans were tried and they did not work well enough or
- triptans were contraindicated or not tolerated, and nonsteroidal anti-inflammatory drugs (NSAIDs) and paracetamol were tried but did not work well enough.
The Tirzepatide for treating type 2 diabetes technology appraisal has been published. This treatment is recommended for treating type 2 diabetes alongside diet and exercise in adults when it is insufficiently controlled only if:
- triple therapy with metformin and 2 other oral antidiabetic drugs is ineffective, not tolerated or contraindicated, and
- they have a body mass index (BMI) of 35 kg/m2 or more, and specific psychological or other medical problems associated with obesity, or
- they have a BMI of less than 35 kg/m2, and:
- insulin therapy would have significant occupational implications, or
- weight loss would benefit other significant obesity-related complications.
It is also noted that lower BMI thresholds (usually reduced by 2.5 kg/m2) should be used for people from South Asian, Chinese, other Asian, Middle Eastern, Black African or African-Caribbean family backgrounds.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
During September 2023 Clinical Knowledge Summaries were published or updated in the following areas.
The topics have all been reviewed and updated with minor structural and layout changes. The Bacterial vaginosis topic contains updated advice on screening for sexually transmitted infections and the advice for intravaginal gels has been updated based on the manufacturers' recommendations. The Cardiac arrest - out of hospital care topic now contains two new scenarios, 'Out of hospital post-resuscitation care' and 'Terminating resuscitation'. The Domestic Abuse topic has been renamed from 'Domestic Violence and Abuse' and the content has been updated in line with current evidence in the literature. The Hyperhidrosis topic contains updated management recommendations in line with the current literature.
Action: Clinicians who see patients with any of these conditions may find the new and updated information useful when reviewing current clinical practice.
The National Institute for Health and Care Excellence (NICE) have published new or updated guidance for the month of September 2023. This month there is one clinical guideline and one technology appraisal that impact upon primary care.
The Cirrhosis in over 16s: assessment and management guideline has been updated. It covers assessing and managing suspected or confirmed cirrhosis in people who are 16 years or older. The update adds new or updated recommendations on safe prescribing and use of carvedilol and propranolol in people with cirrhosis, preventing bleeding from medium or large varices, preventing spontaneous bacterial peritonitis and primary prevention of decompensation.
The Semaglutide for managing overweight and obesity technology appraisal has been updated. The update includes an additional requirement that this treatment is available in accordance with a commercial arrangement that discounts the acquisition cost for the NHS.
Action: Clinicians should be aware of this month's new guidance and implement any necessary changes to practice.
