A CROSS-SECTIONAL STUDY ON SODIUM VALPROATE, CARBAMAZEPINE, AND LEVETIRACETAM INDUCING ENURESIS IN EPILEPTIC CHILDREN

Objectives: Enuresis or bedwetting is considered to be an underreported ADR of antiepileptic drugs (AEDs). This study assesses the incidence and comparative rate of occurrence of enuresis in children with epilepsy who are on AEDs treatment such as sodium valproate (SV); carbamazepine and levetiracetam (LEV). Methods: The study was conducted with a sample size of 32 patients. Both inpatients and outpatients between the age group >5–18 years of age previously diagnosed with epilepsy that is on monotherapy and polytherapy with SV or carbamazepine or LEV were included in the study. Patients with urinary complications or urogenital abnormalities past 3 months before admission were excluded from the study. Assessment of enuresis was done based on a questionnaire prepared from NICE guidelines and analyzed using SPSS software version 20. Results: Of 44 patients who were included in the study, only 34 came for review. Analysis of the questionnaire showed the occurrence of enuresis in 12 patients. Drugs prescribed versus assessment questions showed potent significance with eight questions; hence the hypothesis that the prescribed drugs can cause enuresis can be taken into consideration. The rate of occurrence of enuresis was analyzed in all the drugs with their respective doses, but the significant values were found only for SV 200 mg. Conclusion: This study shows the possibility of enuresis in LEV and SV treatment with a significant difference in SV. Furthermore, it showed a relation between the duration of treatment and the occurrence of enuresis.

What practice nurses need to know about the NICE chronic kidney disease guidelines

Chronic kidney disease is highly prevalent in the community. Peter Ellis looks at the role of the practice nurse in diagnosing and managing chronic kidney disease in general practice Chronic kidney disease (CKD) is defined as a reduction in kidney function, or damage to kidney structure, which has persisted for greater than 3 months and which is associated with other health-related issues. While there are many causes of CKD, the most prevalent in western societies, including the UK, are diabetes and hypertension. This article identifies the role of the practice nurse in applying the National Institute for Health and Care Excellence (NICE) guidelines for CKD.

P-P28 Long term follow-up after pancreatico-duodenectomy for chronic pancreatitis; are we compliant with NICE guidelines

Background Patients with chronic pancreatitis experience malnutrition, osteoporosis, pancreatic exocrine insufficiency and have a 80% lifetime risk of diabetes (1). These are progressive consequences and require proactive surveillance for detection and optimisation of treatment. The NICE pancreatitis guidelines recommend long-term follow up for patients with chronic pancreatitis (1). European guidelines recommend regular assessment of bone density, biochemical assessment of micronutrient status and a comprehensive nutritional assessment (2). The aim of this survey was to assess compliance with the NICE guidelines by analysing current practice in patients with chronic pancreatitis after pancreaticoduodenectomy. Methods A UK wide electronic survey was developed using Qualtrics® software (SAP America Inc. USA) to capture all the nutritional aspects of follow-up thought to be relevant in the long term. Markers of endocrine failure and malnutrition (weight, nutritional assessment and biochemical, vitamin and mineral screens), smoking and alcohol cessation advice and the use of dual energy x-ray absorptiometry (DEXA) scans were included. The survey was piloted on 5 staff locally prior to being circulated through a professional network – the Pancreatic Society of Great Britain and Ireland (PSGBI). Data were analysed using Chi-Square tests in SPSS (Version 26). Results One hundred and one (23% response rate) clinicians completed the survey, with 83 useable data sets. Eighty eight percent worked in tertiary centres. Lifelong follow up was only offered in tertiary centres (n = 12) and was only provided by surgeons or dietitians (p = 0.03). The duration of follow up did not vary by region (p = 0.463). Patients in the South of England were more likely to undergo a micronutrient screen (p = 0.027). Only 26% of all patients were offered a DEXA scan. Clinicians with more than 10-years’ experience were more likely to assess weight (p = 0.039), glucose and HbA1c (p = 0.035) and assess symptoms (p = 0.031). Conclusions This survey demonstrated a need to improve the provision of long-term follow up for patients with chronic pancreatitis. Lack of clarity on the format and who within the clinical team should take responsibility may explain the lack of structured follow-up in this patient group. The importance of long-term assessment needs to be included in training programmes for junior clinicians, to standardise management, improve nutritional screening and improve access to bone mineral density scanning and diabetes screening. Responsibility for follow up should be agreed between primary, secondary and tertiary care.

OP256 Recognising The Broader Value Of Vaccines In Health Technology Assessment: Worth A Shot?

IntroductionThe COVID-19 pandemic shows that the impact of effective vaccines extends well beyond vaccinated individuals and healthcare systems. Yet, these externalities are not typically considered in health technology assessments (HTA) which may underestimate vaccines’ broader value. We explored to what extent future vaccines relevant to England might exhibit such broader value.MethodsWe compared the ten value elements of an existing vaccine evaluation framework to the value elements considered in England according to the Joint Committee on Vaccine and Immunisation (JCVI) and the National Institute for Health and Care Excellence's (NICE) guidelines. Using literature and expert opinion we then explored, for a selection of ten vaccines with an expected UK-launch within five years, on which value elements each vaccine might potentially show added value.ResultsUp to five of ten value elements are unlikely to be considered by JCVI or NICE, including patient and carer productivity, enablement value, impact on antimicrobial resistance and transmission value. Of vaccines studied, 100 percent will potentially generate value on at least one broader value element that is currently ignored; 60 percent to 80 percent may increase vaccinee/patient or carer productivity respectively.ConclusionsThere is a substantial gap between value generation and value recognition of vaccines in HTA in England. This might lead to undervaluation and underutilization of vaccines, leaving societies more vulnerable than needed when faced with infectious diseases.

The NICE OECD countries’ geographic search filters: Part 2—validation of the MEDLINE and Embase (Ovid) filters

Objective: We previously developed draft MEDLINE and Embase (Ovid) geographic search filters for Organisation for Economic Co-operation and Development (OECD) countries to assess their feasibility for finding evidence about the countries. Here, we describe the validation of these search filters.Methods: We identified OECD country references from thirty National Institute for Health and Care Excellence (NICE) guidelines to generate gold standard sets for MEDLINE (n=2,065) and Embase (n=2,023). We validated the filters by calculating their recall against these sets. We then applied the filters to existing search strategies for three OECD-focused NICE guideline reviews (NG103 on flu vaccination, NG140 on abortion care, and NG146 on workplace health) to calculate the filters’ impact on the number needed to read (NNR) of the searches.Results: The filters both achieved 99.95% recall against the gold standard sets. Both filters achieved 100% recall for the three NICE guideline reviews. The MEDLINE filter reduced NNR from 256 to 232 for the NG103 review, from 38 to 27 for the NG140 review, and from 631 to 591 for the NG146 review. The Embase filter reduced NNR from 373 to 341 for the NG103 review, from 101 to 76 for the NG140 review, and from 989 to 925 for the NG146 review.Conclusion: The NICE OECD countries’ search filters are the first validated filters for the countries. They can save time for research topics about OECD countries by finding the majority of evidence about OECD countries while reducing search result volumes in comparison to no filter use.

Sex differences in two international guidelines for assessing obstructive coronary artery disease in symptomatic outpatients by coronary computed tomographic angiography

Background Low-risk individuals are unlikely to benefit from noninvasive testing, and women tend to have a lower prevalence of obstructive coronary artery disease (CAD). This study compared the performance of two current guidelines that differ by sex to assess stable chest pain outpatients, including symptom-based (2016 National Institute for Health and Care Excellence, NICE) and risk-based strategies (2019 European Society of Cardiology, ESC). Methods A total of 542 men and women outpatients referred for coronary computed tomography angiography (CCTA) at a single-centre were retrospectively included in this study. A risk assessment was calculated for each outpatient according to the NICE and ESC guidelines. Patients were classified into low-risk and high-risk groups according to each strategy. The presence of obstructive coronary artery disease was the endpoint. Net reclassification improvement (NRI) was used to assess the performance of the two strategies. Results The 2016 NICE guidelines classified 29.39% of women and 34.60% of men into the low-risk group. The 2019 ESC guidelines classified 55.56% of women and 28.14% of men into the low-risk group. The 2019 ESC guidelines had a higher predictive value for coronary artery disease compared to the 2016 NICE guidelines, with a positive NRI in men (15.55%) and women (36.59%) respectively. Conclusion The 2019 ESC guidelines offered a more accurate calculation of risk assessment than the 2016 NICE guidelines. Patient sex influenced applying the recent ESC guidelines, which would result in a significant decrease in inappropriate testing of women but an increase in appropriate noninvasive testing of men.

AN UPDATED GUIDELINES ON POST-OPERATIVE WOUND MANAGEMENT

Introduction: management and prevention of wounds after a surgical procedure, are important and debatable topics. Optimal adoption of guidelines for proper prevention and management of post-surgical wounds must be carried out by any surgeon or institute. Postoperative wound care is done by cleaning and dressing the wounds after the surgical procedure, preventing them from getting contaminated with the external surfaces or the microorganisms on the patient’s body. Surgical Site Infection (SSI) is the infection associated with healthcare in which the infection occurs in the wound after an invasive surgical procedure. A minimum of 5% of the patients who undergo surgical procedures will develop surgical site infections. This study draws the attention of the clinicians to a proper set of guidelines for post-operative care to minimize post-operative complications. Materials and Methods: this study is a Retrospective Cohort design. The study was considered 92 patients who had various types of surgery from during the period of 10 months. The patients who had intra-abdominal surgery are only included. The study divided 92 patients into 2 groups. In each group, 46 patients were assigned based on following NICE guidelines on postoperative wound management. Patients, for whom the NICE guidelines were followed properly at every aspect, were assigned to the first group (Group 1). Otherwise, the patients were assigned to the second group (Group 2). The study adopted a list comprising of NICE guidelines which are applicable to this study. The study assessment was done by observing the appearance of Surgical Site Infection among the patients, 3 to 7 days post-surgery. Results: it as found that 91.30% of the Group 1 patients showed significant improvement in terms of resolution while only 13.04% of the patients in improved significant without any surgical site infection (SSI). Conclusion: the study results show that the patients who were given post-operative care according to NICE guidelines had much lesser Surgical Site Infection (SSI) as compared to those who were not given post-operative care according to NICE guidelines. Keywords: surgical site infection, postoperative care, nice guidelines, wound management