Welcome to the July edition of NICE's monthly E-newsletter.

New NICE guidelines on routine postnatal care will give babies best start in life more>>

New NICE guidance to help psoriasis sufferers more>>

NICE and SCIE issue guidance to help parents and carers who have children with conduct disorders more>>

Bipolar disorder (formerly known as manic depression) is a serious mental health condition characterised by the presence of episodes of mania and depression. During a manic episode, the person usually has feelings of elation, irritability, or both.  They may also feel over-confident and may take unnecessary risks.  During depression symptoms may include feeling low, always tired, feeling worthless and thoughts of suicide or harming oneself.

The guideline calls for more to be done to ensure that bipolar disorder is correctly identified and recognised by health professionals and sets out the criteria for when patients need to be referred on for specialist psychiatric assessment and treatment. It also sets out the drug treatment options for people with bipolar disorder and emphasises the need to involve service users in treatment decisions. Other recommendations cover the need for annual physical health checks for people with bipolar disorder and the need for all healthcare professionals to monitor carefully the medication taken by patients.

Andrea Sutcliffe, Deputy Chief Executive of NICE and Executive Lead for this guideline says: “Bipolar disorder often goes unrecognised or mis-diagnosed and more needs to be done to raise awareness of the condition and the fact that there are effective treatments available. This guideline should help raise that awareness by setting out how people with bipolar disorder should be identified and treated.”

More information is available on the NICE website.

• Bipolar disorder
• Postnatal care

Technology appraisals

• Conduct disorders in children – parent training/education programmes
• Psoriasis – efalizumab and etanercept
• Psoriatic arthritis – etanercept & infliximab

Interventional procedures

• Percutaneous radiofrequency ablation for primary and secondary lung cancers
• Catheterless oesophageal pH monitoring
• Tonsillectomy using laser
• High intensity focused ultrasound for atrial fibrillation in association with other cardiac surgery

Public health

• None

The following consultation documents were issued:

Clinical guidelines

Calls for stakeholder registration:

• None

Scope consultations:

• Stroke (3 July – 31 July)
• Familial hypercholesterolaemia (10 July – 7 August)

Draft consultations:

• Antenatal and postnatal mental health (11 July – 5 September)
• Heavy menstrual bleeding (HMB) (25 July – 18 September 2006)

Technology appraisals

ACD consultations:

• Drug misuse – methadone and buprenorphine (30 June – 21 July)
• Drug misuse – naltrexone (30 June – 21 July)

FAD consultations:

• Breast cancer (early) – paclitaxel (24 July – 7 August)
• Breast cancer (early) – docetaxel (24 July – 7 August )

Appeals heard:

• Alzheimer's disease – donepezil, rivastigmine, galantamine and memantine (review) (13 and 14 July)
• Breast cancer (early) – trastuzumab (26 July)

Interventional procedures

NICE consulted on the following procedures (consultation period 27 June to 25 July)

• Transobturator foramen procedures for stress urinary incontinence (2nd consultation)
• Fetal vesico-amniotic shunt for lower urinary tract outflow obstruction
• Therapeutic amnioinfusion for oligohydramnios during pregnancy (excluding labour)
• Laparoscopic radical prostatectomy (guidance review)
• Intramedullary distraction for lower limb lengthening

Public health

Calls for stakeholder registration:

• None

Stakeholder meeting:

• None

Scope consultations:

• None

Final scope:

• Physical activity and environment (30 June )

Consultation on draft recommendations:

• None

Clinical guidelines:

Atrial fibrillation (guidance published June 2006)

• Costing tools – report and template
• Slide set
• Implementation advice

Bipolar disorder

• Costing tools – report and template
• Slide set
• Implementation advice

Postnatal care

• Costing tools – report and template
• Slide set
• Implementation advice

Technology appraisals

Parent education training models

• Cost template incorporating report
• Slide set
• Implementation advice

Psoriasis – efalizimab and etanercept

• Cost template incorporating report

Psoriatic arthritis – etanercept and infliximab

• Cost template incorporating report

Coming soon

Several web-based costing reports and local cost templates will be published soon to support the forthcoming NICE appraisal on hepatitis C (mild to moderate) - pegylated interferons, ribavarin and alpha interferon.  A slide set and implementation advice will be published soon to support the forthcoming NICE guideline on anaemia management in chronic kidney disease.

Forward planner

The forward planner to assist NHS bodies with horizon scanning and financial planning is available on the NICE website.  It provides a table of published and forthcoming guidance from NICE to help users to plan ahead for implementation.  It also indicates whether the NICE guidance is inside or outside the payment by results tariff. 

The National Institute for Health and Clinical Excellence (NICE) has today (Wednesday 26 July) published best practice guidelines on normal post natal care. The guideline sets out the core care that should be available to women and babies who have uncomplicated care needs from the period immediately after birth to 8 weeks.  It recommends the provision of personalised care for mothers and babies during the post natal period, instead of the currently more common “tick-box” approach.  To give babies the best start in life, the guideline sets out evidence-based advice that healthcare professionals can give to parents about a wide range of issues, including breastfeeding and how to deal with common health problems.

Key recommendations include:

• That each woman has her own personalised care plan which takes into account her and her baby’s individual needs.
• All maternity care providers (whether working in hospital or in primary care) should implement an externally evaluated structured programme that encourages breastfeeding, using the Baby Friendly Initiative (www.babyfriendly.org.uk) as a minimum standard.
• At each postnatal contact, parents should be offered information and advice to enable them to:
  • assess their baby’s general condition
  • identify signs and symptoms of common health problems seen in babies
  • contact a healthcare professional or emergency service if required.
• At each postnatal contact, women should be asked about their emotional well-being, what family and social support they have and their usual coping strategies for dealing with day-to-day matters. Women and their families/partners should be encouraged to tell their healthcare professional about any changes in mood, emotional state and behaviour that are outside of the woman’s normal pattern.

Prof. Rona McCandlish, Chair of the guideline development group said:  “In the past postnatal care has often been considered the ‘Cinderella service’ of maternity care.  This guideline recognises that women, babies and families deserve highest quality care after birth.  It establishes clear, much needed national standards for healthcare professionals to help them offer women the support they need in the hours, days and weeks following birth.”

More information is available on the NICE website.

New NICE guidance to help psoriasis sufferers

NICE has today launched guidance on the use within the NHS in England and Wales of etanercept and efalizumab for the treatment of psoriasis, and etanercept and infliximab for the treatment of psoriatic arthritis (PsA).

Psoriasis is a skin disease, affecting about 2% of the population, in which the normal processes of skin cell replacement are speeded up. This causes raised red patches of skin covered with silvery scales which are known as ‘plaques’. Psoriasis does get worse over time, but it can be unpredictable with symptoms ranging from mild to severe.

PsA is an inflammatory arthritis closely associated with psoriasis. An estimated 5-7% of all people with psoriasis, and approximately 40% of those with extensive skin disease, have PsA. Like psoriasis, PsA is a chronic progressive condition whose course may be erratic, with flare-ups and periods of remission.

The guidance explains when and how each drug can be used to treat the relevant condition.

Andrea Sutcliffe, Executive Lead for the appraisal, said: “Psoriasis and psoriatic arthritis are both extremely distressing conditions. Indeed, psoriasis has been shown to affect health-related quality of life to an extent similar to the effects of other chronic diseases such as depression, myocardial infarction, hypertension, congestive heart failure or type 2 diabetes. Psoriatic arthritis can also significantly impair a person’s quality of life and cause disability and appears to be associated with an increased risk of premature death. By recommending the use of these drugs as options for the treatment of psoriasis and psoriatic arthritis in adults, today’s guidance from NICE will help people in England and Wales with these conditions to receive the best possible treatment.”

More information is available on the NICE website

NICE and SCIE issue guidance to help parents and carers who have children with conduct disorders

NICE and the Social Care Institute for Excellence (SCIE) today issue joint guidance on how parent training/education programmes can help in the management of children with conduct disorders.

The guidance recommends group-based parent training/education programmes in the management of conduct disorders in children under 12 years old, or in children with a developmental age of under 12.  Individual-based parent training/education programmes are recommended only where the family’s needs are too complex for group-based programmes, or where there are particular problems in engaging with the parents.  The main goals of parent training/education programmes are to enable parents, or the main carer, to improve their relationship with the child and to improve the child’s behaviour.

Andrea Sutcliffe, NICE Executive Lead for this guidance, said:

“NICE is delighted to produce this guidance in collaboration with SCIE, to help parents and carers who have children with conduct disorders.

Many children with conduct disorders will have problems that persist into adolescence and adulthood, resulting in future health and social problems for the child, their families and society.  Effectively addressing the situation in childhood benefits not only the families involved, but also creates cost savings for a range of public services, including health, social care and education. 

This guidance recognises the importance of partnership working across health, social care and other sectors to ensure that parents and carers get the support they need.”

More information is available on the NICE website.

NICE will be holding a fringe session at each of the party political conferences this autumn, titled, ‘Being NICE: Making the best use of our health resources’.  Details of dates, times and location of the session at each conference are now available on the NICE website.

Date for your diary! NICE 2006: Tackling health priorities

The 2006 annual NICE conference will take place from 6 to 7 December at the ICC in Birmingham.

‘NICE 2006: Tackling health priorities’ will explore issues raised by the increasing expectations of the public and politicians in the context of finite resources, and the challenges facing decision-makers at all levels of the health and social care sectors in using evidence to inform their decisions and in justifying the choices that they make. The conference programme is now available on the NICE website.

In addition to the early booking rate, NICE is subsidising a number of places at conference for patient and carer organisations and NGOs through its bursary scheme. Please note that forms for the bursary scheme must be returned by 28 July. 

Urinary incontinence in women – educational day

The Royal College of Obstetricians and Gynaecologists (RCOG) and the National Collaborating Centre for Women and Children’s Health are holding an educational day to coincide with the forthcoming NICE guideline on urinary incontinence in women.  The day is for health professionals and patients groups, and takes place on Friday 27th October.

More information is available on the RCOG website or by calling the RCOG Conference Office on 020 7772 6245.

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