NICE gets tooled up

2001 ◽  
Vol 6 (4) ◽  
pp. 231-232 ◽  
Author(s):  
Valerie Beattie ◽  
Brian Hockley
Keyword(s):  
Essential Element ◽  
Clinical Governance ◽  
Audit Process ◽  
Nice Guidelines ◽  
Practical Support ◽  
Nice Guidance ◽  
Multi Level ◽  
Minimum Dataset

To date over 20 guidelines or technology appraisals have been issued. At first, it seemed implicit that these guidelines would be subject to the audit process and that NICE would provide guidance and practical support for undertaking this activity. NICE have now issued a template for the audit of NICE guidelines based on a multi‐level approach. While audit of NICE guidance is an essential element of the whole clinical governance agenda, the burden of work that this could introduce to Trusts may be unsustainable. Suggests possible alternatives to auditing NICE guidance and proposes the use of a minimum dataset and full exploitation of electronic means of data harvesting.

Referral patterns for catheter-directed thrombolysis for iliofemoral deep venous thrombosis

2021 ◽  
pp. 026835552097728
Author(s):  
Kirtan D Patel ◽  
Alison YY Tang ◽  
Ashik DJ Zala ◽  
Rakesh Patel ◽  
Kishan R Parmar ◽  
...  
Keyword(s):  
Lower Limb ◽  
Management Option ◽  
Venous Anatomy ◽  
Nice Guidelines ◽  
Patient Demographics ◽  
Radiology Reports ◽  
Catheter Directed Thrombolysis ◽  
Nice Guidance ◽  
Icd 10 ◽  
Venous Thromboses

Objectives Post thrombotic syndrome (PTS) is a serious complication of deep venous thromboses (DVTs). PTS occurs more frequently and severely following iliofemoral DVT compared to distal DVTs. Catheter directed thrombolysis (CDT) of iliofemoral DVTs may reduce PTS incidence and severity. We aimed to determine the rate of iliofemoral DVT within our institution, their subsequent management, and compliance with NICE guidelines. Methods Retrospective review of all DVTs diagnosed over a 3-year period was conducted. Cases of iliofemoral DVT were identified using ICD-10 codes from patient notes, and radiology reports of Duplex scans. Further details were retrieved, such as patient demographics and referrals to vascular services. NICE guidance was applied to determine if patients would have been suitable for CDT. A survey was sent to clinicians within medicine to identify awareness of CDT and local guidelines for iliofemoral DVT management. Results 225 patients with lower limb DVTs were identified. Of these, 96 were radiographically confirmed as iliofemoral DVTs. The median age was 77. 67.7% of iliofemoral DVTs affected the left leg. Right leg DVTs made up 30.2% and 2.1% were bilateral DVTs. Of the 96 iliofemoral DVTs, 21 were deemed eligible for CDT. Only 3 patients (14.3%) were referred to vascular services, and 3 received thrombolysis. From our survey, 95.5% of respondents suggested anticoagulation alone as management for iliofemoral DVT. Only one respondent recommended referral to vascular services. There was a knowledge deficiency regarding venous anatomy, including superficial versus deep veins. Conclusions CDT and other mechanochemical procedures have been shown to improve outcomes of patients post-iliofemoral DVT, however a lack of awareness regarding CDT as a management option results in under-referral to vascular services. We suggest closer relations between vascular services and their “tributary” DVT clinics, development of guidelines and robust care pathways in the management of iliofemoral DVT.

scholarly journals Minor Head Injury: Quality Improvement Project

2021 ◽  
Vol 19 (2) ◽  
Author(s):  
Shabana Shaheen ◽  
Muhammad Hameed ◽  
Yousef Essam Hassan Qabeel
Keyword(s):  
Quality Improvement ◽  
Head Injury ◽  
Key Words ◽  
Head Injuries ◽  
Quality Improvement Project ◽  
Improvement Project ◽  
Nice Guidelines ◽  
Salient Points ◽  
Nice Guidance ◽  
Quality Improvement Tool

The aim of this paper was to provide a Quality Improvement Tool for head injury patients.Using NICE guidance on head injury (Jan 2014), 9 salient points in history and 8 in examination were chosen to be audited and given a tabulated form. Key words: Quality Improvement, Head Injuries, NICE Guidelines

scholarly journals Monitoring energy audit for energy savings using non cost technique at electronics company

2021 ◽  
Vol 5 (1) ◽  
pp. 71-79
Author(s):  
Ahmad Razlan Yusoff ◽  
M.N. Mohd Foudzi ◽  
M.Y. Taib ◽  
A.S. Arnizam Shah
Keyword(s):  
Energy Consumption ◽  
Energy Demand ◽  
Energy Savings ◽  
Essential Element ◽  
Modern Society ◽  
High Energy ◽  
Energy Audit ◽  
Audit Process ◽  
Energy Saving Technique ◽  
Economical Growth

Energy is essential element for economical growth in industry and it measures directly the standard of living for a country.  The economical growth and energy demand in the modern society need to be reduced the energy consumption. In this paper, energy consumption was monitored and audited for an electronic company in  Malaysia. The energy consumption was analysed based on electrical bill and then the power consumption has been verified based on energy audit process using power analyser for this electronic company. It is monitored that the energy audit for the whole company and point out the possiblity of non cost energy saving technique. From 10 locations analyses, 3 locations are main soursces contribite to high energy consumption. There are compressor room, busbar 15 and busbar 16 relates to chiller room that supply the air conditioning system in the company. The energy audit can provide the non cost suitable technique for energy savings and profit improvement in this electronic company. 

EP.FRI.461 Management of acutely ill surgical patients NICE guidance CG50: a complete audit cycle

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shrinivas Kalaskar ◽  
Mathew Bonomoully
Keyword(s):  
General Surgery ◽  
Surgical Patients ◽  
Initial Assessment ◽  
Audit Tool ◽  
Trigger System ◽  
Nice Guidelines ◽  
Suboptimal Care ◽  
Nice Guidance ◽  
Audit Cycle ◽  
Time Of Admission

Abstract Aim NICE CG50 guidelines are a response to evidence suggesting patients who are, or become, acutely unwell may receive suboptimal care. The guidelines suggest: After previously unsuccessful audits a fourth re-audit was designed to re-assess compliance with the CG 50 guidelines. Method After implementing previous recommendations like, keeping a poster of recommendations in the handover room and making these guidelines as part of surgical induction, a re-audit was planned. A prospective random sample of 40 patients admitted during the general surgery was taken. Using the audit tool the following parameters were recorded for each patient in the sample: Results The compliance was 100% for patients who have had their physiological observations recorded at the time of admission or initial assessment, the percentage of patients monitored using a physiological track and trigger system, and the percentage whose physiological observations were monitored at least every 12 hours. The compliance was 95% for the percentage of patients with a clear written monitoring plan. Conclusions Following the interventions detailed above, there is now 95 to 100% compliance with NICE guidelines in the documentation.

scholarly journals P87 CCG biologics pathways: re-introduction of the postcode lottery by stealth

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Jatin Mistry ◽  
Diane Hill ◽  
Arvind Kaul
Keyword(s):  
Geographical Location ◽  
Freedom Of Information ◽  
Solid Organ ◽  
Expensive Drug ◽  
Nice Guidelines ◽  
Solid Malignancies ◽  
Tnf Α ◽  
Nice Guidance ◽  
Approved Drugs ◽  
Inadequate Responders

Abstract Background NICE guidance approves pathways for inflammatory arthritis biologic therapies. Locally, CCG's commission pathways based on their interpretation of NICE guidance. For patients to have equal access to biologics, CCG pathways in different areas must be uniform. We examined whether CCG biologics pathways complied with this standard. Methods Using Freedom of Information requests, direct requests and internet searches, we found 21 approved biologics pathways in England for rheumatoid arthritis, 12 for psoriatic arthritis and 11 for ankylosing spondylitis. This covered 22.8 million people in England for RA (2017 population estimates). CCG Pathways were compared to NICE guidance with respect to restrictions and number of therapies allowed before an Individual Funding Request (IFR) was needed. Results We studied NICE guidance and determined an 'ideal' pathway for patients requiring > 1 biologic. All CCG pathways followed NICE guidance for 1st line biologics but there was significant variation for biologic failures. 18/21 CCG RA pathways indicated the maximum number of drugs that the CCG would commission without the clinician needing IFR. 7/18 allowed 1-3 biologics serially, 10/18 allowed 4-6 and 1/18 was unrestricted. Rituximab is NICE approved in RA in inadequate responders/intolerance to DMARDs/anti-TNF-α. 17/21 RA pathways allowed rituximab 1stline for haematological or treated solid malignancies, 4/21 did not. 6/21 CCG’s allowed rituximab 5 years after solid organ malignancy, 5/21 after 10 years, 10/21 did not specify or allow this usage. NICE guidelines for RA approve 11 biologics. 14/21 RA pathways allowed all 11 biologics, 7/21 pathways excluded sarilumab, tofacitinib or baricitinib or all three. NICE guidelines for PsA recommend the least expensive drug used first of the injected biologics or JAK inhibitors. IFR was required after 3 drugs in 9/12 pathways with 1/12 allowing 4 lines of therapy. For AS, 5/11 allowed 2 lines of therapy, the remainder 3 or 4 lines. Again, many pathways pre-specified which biologics could be used and excluded other NICE approved drugs at specific stages. Conclusion NICE specify the least expensive drug should be used for injected biologics with variation for administration mode/dosage. CCG’ s commission variably restrictive pathways potentially against NICE guidance, both with number and type of therapies before IFR submission is required. Some pathways allowed little scope to use therapies from earlier pathway points without breaching CCG limits. The IFR process for NICE approved therapies can exhibit wide variation in our experience with different outcomes for similar cases, and is time consuming with CCG decision making being opaque, despite NICE approval being legally enforceable. CCG biologic pathways introduce wide regional variation and potential unfairness in their interpretation of NICE guidance. This may disadvantage the worst affected patients who fail several therapies and prevent access to life changing therapy depending on geographical location. Disclosures J. Mistry None. D. Hill None. A. Kaul None.

scholarly journals EP.WE.802Are we over-zealous in our management of acute diverticulitis?

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Guillaume Lafaurie ◽  
James Butterworth ◽  
Alec Engledow
Keyword(s):  
Biochemical Markers ◽  
Acute Diverticulitis ◽  
Vital Signs ◽  
District General Hospital ◽  
Ambulatory Setting ◽  
Nice Guidelines ◽  
Intravenous Antibiotics ◽  
Review Management ◽  
Nice Guidance ◽  
Austere Environment

Abstract Aims Of the 25% of people with diverticula who develop symptomatic diverticular disease, approximately 75% will have at least one episode of diverticulitis. However according to the latest NICE guidance those with diverticulitis who are not systemically unwell may not require either admission or antibiotics. In the financially austere environment facing the NHS within the COVID 19 pandemic, prudence in such resource allocation is of vital importance. We aim to review management of patients with acute diverticulitis over a 6-month period in a district general hospital against the 2019 NICE guidelines. Methods 29 patients presenting with acute diverticulitis, M:F ratio 12:17, median age 55 (range 24-82), median ASA 2 (range 0-3) were retrospectively reviewed. Biochemical markers, lactate and vital signs were used to assess if attending patients were systemically unwell. Results 23 patients were admitted and 6 managed as outpatients via the surgical ambulatory unit. Of the 29 patient cohort, 9 (31%) were systemically unwell. All 9 unwell patients received antibiotics. Of the 20 patients not considered systemically unwell, 11 (55%) received antibiotics. 16 (80%) that were admitted did not require admission on retrospective review. Conclusion Prompt administration of intravenous antibiotics for septic patients with diverticulitis reduces associated morbidity and mortality and the observed adherence to this principle is encouraging. For systemically well patients, increased clinical discernment is required to consider managing patients in the surgical ambulatory setting, avoiding unnecessary admissions. Similar caution must be used in appropriate use of antimicrobials to avoid unnecessary adverse consequences.

Verlaufsanalyse wöchentlicher Selbst- und Fremdeinschätzungen in der Langzeittherapie suchtkranker Jugendlicher

2019 ◽  
Vol 47 (2) ◽  
pp. 126-137
Author(s):  
Ferdinand Keller ◽  
Tatjana Stadnitski ◽  
Jakob Nützel ◽  
Renate Schepker
Keyword(s):  
Allen Vier ◽  
Multi Level

Zusammenfassung. Fragestellung: Über Veränderungen in der emotionalen Befindlichkeit von Jugendlichen während einer Suchttherapie ist wenig bekannt. Methode: Die Jugendlichen füllten wöchentlich einen entsprechenden Fragebogen aus, analog ihre Bezugsbetreuer eine parallelisierte Kurzfassung. Von 42 Jugendlichen liegen insgesamt 853 Bogen und von den Bezugsbetreuern 708 Bogen vor. Die Fragebogen wurden zunächst faktorenanalytisch hinsichtlich ihrer Dimensionalität ausgewertet, anschließend wurden gruppenbezogene Verlaufsanalysen (Multi-Level-Modelle) und Abhängigkeitsanalysen auf Einzelfallebene (Zeitreihenanalysen) durchgeführt. Ergebnisse: Im Jugendlichenfragebogen ergaben sich vier Faktoren: negative Befindlichkeit, Wertschätzung von Therapie/Betreuung, Motivation und Suchtdynamik. Die Übereinstimmung zwischen den Jugendlichen- und der (einfaktoriellen) Betreuereinschätzung fiel insgesamt niedrig bis mäßig aus, brachte aber auf Einzelfallebene differenziertere Ergebnisse. Im Verlauf nahmen die Werte auf allen vier Jugendlichenskalen ab. Einzig der Verlauf der Wertschätzung in der Eingewöhnungsphase war prädiktiv für den späteren Abbruch der Maßnahme: Bei den Abbrechern nahm die Wertschätzung ab, während sie bei den Beendern initial stieg. Schlussfolgerungen: Der bedeutsamste Faktor in Bezug auf die Therapiebeendigung suchtkranker Jugendlicher scheint die Wertschätzung von Therapie/Betreuung zu sein, während die Motivation jugendtypische Schwankungen aufweist. Der Suchtdynamik kam eine deutlich weniger bedeutende Rolle zu als allgemein angenommen. Programme in der Langzeittherapie sollten die Wertschätzung von Therapie/Betreuung künftig mehr fokussieren als die Suchtdynamik.

The Multilevel p2 Model

Methodology ◽  
2006 ◽  
Vol 2 (1) ◽  
pp. 42-47 ◽  
Author(s):  
Bonne J. H. Zijlstra ◽  
Marijtje A. J. van Duijn ◽  
Tom A. B. Snijders
Keyword(s):  
Social Network ◽  
Network Data ◽  
Mcmc Algorithm ◽  
Independent Observation ◽  
Single Observation ◽  
Multiple Networks ◽  
Social Network Data ◽  
Multiple Observations ◽  
Practical Support ◽  
The Social

The p 2 model is a random effects model with covariates for the analysis of binary directed social network data coming from a single observation of a social network. Here, a multilevel variant of the p 2 model is proposed for the case of multiple observations of social networks, for example, in a sample of schools. The multilevel p 2 model defines an identical p 2 model for each independent observation of the social network, where parameters are allowed to vary across the multiple networks. The multilevel p 2 model is estimated with a Bayesian Markov Chain Monte Carlo (MCMC) algorithm that was implemented in free software for the statistical analysis of complete social network data, called StOCNET. The new model is illustrated with a study on the received practical support by Dutch high school pupils of different ethnic backgrounds.

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