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Daily aspirin treatment for people with Lynch syndrome to reduce the risk of colorectal cancer, and incentives for asthma and COPD management for GPs are included in the summary of this week's recommendations from the National Institute of Health and Care (NICE).
Lynch Syndrome
It is estimated that four out of five people with Hereditary Lynch Syndrome (LS) have a risk of developing bowel cancer during their lifetime.
A previous guideline update in 2017 recommended routine screening for LS for people with colorectal cancer.
Until now, the main management approach consisted of regular colonoscopy and polypectomy screenings to look for precancerous cells.
Now, in a project to update the colorectal cancer guidelines published for consultation, NICE recommends taking aspirin daily for more than 2 years to reduce the risk of colorectal cancer.
NICE has not been able to recommend an ideal dose, but has clarified that 150 mg or 300 mg is commonly used in current practice.
Since Asprin does not have a marketing authorization for the prevention of bowel cancer, NICE therefore requires physicians to obtain the informed consent of the patient in order to make a decision, and to document the process.
The risks of side effects include internal bleeding, but NICE said benefits for people with LS would probably outweigh the disadvantages.
In a statement, Dr. Paul Chrisp, director of the NICE Center for Guidelines, said that all available evidence had been reviewed before formulating the new recommendation: "Although long-term use of aspirin term involves risks, the committee agreed that the benefits would be: likely to outweigh possible damages.
"It is important that clinicians and patients discuss the disadvantages and potential benefits of long-term use of aspirin so that an informed decision can be made."
The updated colorectal cancer guidelines also require physicians to consider neoadjuvant chemotherapy in patients with the most severe form of colon cancer to improve their survival.
Asthma and COPD
Incentives for general practitioners are included in NICE's new indicators to improve care for a range of diseases, including asthma and chronic obstructive pulmonary disease (COPD).
Quality and results framework indicators will be included in the negotiations between NHS England and BMA on the general medical services contract.
Indicators include:
Asthma: Annual review including a questionnaire on management, recording of exacerbations, use of short-acting beta-agonists and a written action plan.
COPD: Objective tests to confirm the diagnosis of COPD, thereby reducing misdiagnosis and excessive treatment.
Cardiac failure: Reduction of the echo cardiac or specialist examination time, ensuring correct diagnosis, prompt treatment, leading to an improvement in the quality of life and a reduction in premature mortality.
In a statement, Professor Gillian Leng, Deputy Director General and Director of Health and Social Services at NICE, said: "There is currently no baseline test for asthma, which makes diagnosis particularly difficult for clinicians.
"It is important for general practitioners to take appropriate measures to avoid a misdiagnosis of the condition, which can lead to over-treatment.These new indicators should increase the chances of achieving better results and support the personalization of care for people with asthma. "
Premature labor and birth
NICE also brought updates to the guidelines on premature labor and birth, some after the review of new evidence. Updates included:
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Review of evidence on the efficacy of prophylactic progesterone and prophylactic cervical cerclage for preterm labor and birth.
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Updated licensing information for the use of erythromycin and magnesium sulfate during pregnancy.
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The period during which corticosteroids are offered to women supposing preterm labor has been updated.
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For consistency, a cervical length of 25 mm or less indicates a high risk of preterm delivery.
Unpaid caregivers
According to NICE, there are around 6.5 million unpaid people in the UK, of which 3 million are associated with taking care of someone else.
According to Carers UK, this saves about 132 billion pounds a year in UK social care budgets. Most social protection costs are borne by local authorities in England rather than the NHS.
NICE's new draft guidelines recommend measures that local authorities and social service practitioners can take to help caregivers.
First, it states that unpaid caregivers must be identified to be aware of any financial, social or emotional support to which they may have access.
Social protection organizations should also consider appointing a "Caregiver Champion" to implement the NICE guidelines and ensure that other rights are respected.
Alternative care should also be made available if necessary, while encouraging peer support groups.
The guidelines suggest employers of unpaid caregivers to offer flexible work spaces and private spaces where phone calls regarding care can be taken.
Professor Leng said, "Many caregivers are not aware of the help available, so it is important for health and social service practitioners to be at the forefront of their identification and support.
"Caring for a loved one can result in a range of responsibilities and concerns.This guide is intended to address these concerns and to ensure that caregivers feel supported enough to provide the best care possible. to those they are taking care of. "
The consultation on the draft directive ends on 13 September 2019 and the final guidelines are expected by January 2020.
Chronic diabetic macular edema
Intravitreal implant of fluocinolone acetonide (Iluvien,
Alimera Sciences) is not recommended as a treatment option for chronic diabetic macular edema in an assessment consultation document.
NICE cited a lack of clinical evidence and uncertain estimates of cost-effectiveness for its decision.
cytomegalovirus
Letermovir (Prevymis, Merck, Sharpe & Dohme) is recommended as a treatment option to prevent the reactivation of cytomegalovirus (CMV) and disease after allogeneic hematopoietic stem cell transplantation in CMV seropositive adults.
NICE stated that the evidence demonstrated that letermovir was effective in reducing CMV infection and reduced the need for preventive treatment.
The decision depends on a special trade agreement with the manufacturer.
Major cardiovascular events
Rivaroxaban (Xarelto, Bayer) with aspirin is recommended as an option in some cases for the prevention of atherothrombotic events in adults with coronary artery disease or symptomatic peripheral arterial disease presenting a high risk of ischemic events.
NICE said that it was proven that the treatment reduced the risk of ischemic stroke, myocardial infarction or death from cardiovascular disease. However, the risk of bleeding was increased.
Liothyronine for hypothyroidism
NHS England clarified earlier advice on prescribing and stopping liothyronine in hypothyroidism.
This followed reports that commissioners had given misleading advice to end all drug prescriptions.
The revised guidelines of the Regional Drug Optimization Committee of NHS England issued in June state: "The prescription of liothyronine is only supported if it is initiated or deemed appropriate as a result of. a review by an NHS consultant endocrinologist.The withdrawal or adjustment of the treatment with liothyronine should also be performed by an NHS consultant endocrinologist or under his supervision. "
Saturated fat
The government's Scientific Advisory Committee on Nutrition (SACN) has issued an updated guideline recommending that a saturated fat intake not exceed 10% of the dietary energy intake. The SACN has analyzed the evidence published on this topic since the last directives in 1994 before making a recommendation for 5 years and over.
He reported "significant relationships between saturated fat intake and cardiovascular disease (CVD) and coronary heart disease (CHD), but not the mortality of CVD and CHD". However, he noted that the events of coronary heart disease and non-fatal coronary heart disease still have a serious impact on a person's health and quality of life.
The report then urges governments to support the reduction of saturated fats in people's diets.
The experts commented on the results via the Science Media Center.
Professor Susan Jebb, professor of dietetics and population health at Oxford University, called the report "authority."
She said, "The biggest challenge is how to help people make this change, and since people buy and eat foods rather than nutrients, what foods should they eat less?
"This is where the report is likely to be criticized because it did not take into account the effects of certain types of saturated fatty acids, but it was not part of the report field – which is already a huge job. . "
She continued, "The fact is that if we want to succeed in reducing saturated fat intake compared to current levels [of] about 13.5% to 10%, it will be extremely difficult to do without reducing saturated fats from dairy products or meat. "
Professor Naveed Sattar, Professor of Metabolic Medicine at the University of Glasgow, said: "The issue of saturated fat continues to be debated and so it is nice to see an impartial and objective look updated on the best evidence available , including randomized trials.
"That evidence continues to suggest that saturated fats increase cholesterol and that the risk of heart disease remains clear, and there is no reason to think otherwise." That's why their recommendation to maintain current advice to reduce cholesterol levels 39; saturated input to less than 10% of the total energy seems quite reasonable. "
"While some complain that some specific types of saturated fats may not be as harmful as others, there is insubstantial evidence to support this view and these commentators should lobby for new tests to verify their hypothesis.But without these proofs at the present time, the best advice to reduce health risks remains the same: reduce the consumption of foods higher in saturated fat and replace them with unsaturated foods or other healthier options. "
Hair dye allergy test
The first hair dye allergy test patch was approved for general sale after being transferred from the Prescription Drug Category (POM) by the Medicines and Health Products Regulatory Agency ( MHRA).
The Colourstart Test self-adhesive kit includes two patches, one with 65 micrograms of paraphenylenediamine (PPD) and a control patch. These are applied on the arm and indicate whether a hair dye should be used or not.
PPD is a common ingredient in hair coloring and allergic reactions can cause itching, redness and blisters, some requiring emergency hospital treatment.
Jan MacDonald, head of the MHRA Group for Access and Information on Medicines and Standards (AIMS) on Vigilance and Risk Management of Drugs, said in a statement: "The decision to making the Colourstart test more widely accessible will make it easier to screen allergy sufferers for hair coloring and to avoid skin reactions if they are allergic to PPD.
"Increased drug availability and improved patient access and choice remain health priorities." MHRA is committed to improving access to medicines for care where it is safe. "
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