NEWS New Crohn’s disease guidelines
NICE has published guidance on the role of new and established treatments for the management of Crohn’s disease in adults and children. There are currently around 115,000 people
living with Crohn’s disease in the UK and between 3000 and 6000 new cases are diagnosed each year. An estimated 5% of patients have severe disease, but the proportion of people with moderate Crohn’s disease is unclear. The condition can lead to delay of growth and puberty in children, as well as affecting fertility and sexual relationships in adults. In the last decade, there have been a number
of new drugs licensed for the condition. Glucocorticosteroids can be offered to induce remission in people with Crohn’s disease and azathioprine or mercaptopurine can be offered as maintenance treatment. The new guidance covers the use of these drugs in the care pathway for Crohn’s disease. Aimed at all healthcare professionals involved
in the management of Crohn’s disease, recommendations include: • Offer monotherapy with a conventional
glucocorticosteroid to induce remission in people with a first presentation or a single inflammatory exacerbation of Crohn’s disease in a 12 month period.
• Discuss with people with Crohn’s disease, and/or their carer, options for managing their disease when they are in remission, including both no treatment and treatment. The discussion should include the risk of inflammatory exacerbations (with and without drug treatment) and the potential side effects of drug treatment. Record the person’s views in their notes.
• Offer azathioprine or mercaptopurine as monotherapy to maintain remission when previously used with a conventional glucocorticosteroid or budesonide to induce remission.
• Consider surgery as an alternative to medical treatment early in the course of the disease for people whose disease is limited to the distal ileum, taking into account the following: benefits and risks of medical treatment and surgery, risk of recurrence after surgery, individual preferences and any
CQC takes action at day surgicalunit
CQC has imposed an urgent legal restriction on the registration of Mid Yorkshire Hospitals NHS Trust, preventing the use of the day surgical unit at Pinderfields Hospital for patient stays in excess of 23 hours. The action follows an unannounced visit
to the hospital by inspectors in September in response to concerns received that the specialist day unit was being used to provide longer term care, without the resources necessary to support this type of service. CQC found that a number of patients had
stayed on the day surgery unit for over 24 hours during July and August 2012. In some
cases patients had stayed on the unit for four days or longer. There was no direct access to washing facilities on the unit and patients were washing from disposable cardboard bowls. Malcolm Bower-Brown, deputy director of
CQC in the North said: “The failings on this unit were completely unacceptable. CQC took swift action following our inspection to ensure the safety and wellbeing of patients. The decision to place an urgent condition on a provider’s registration is not one we take lightly. However, when we find poor practice, as we did in this case, we will take immediate action to ensure patients are not at risk.”
personal or cultural considerations. Record the person’s views in their notes.
• Offer adults, children and young people, and/or their parents or carers, age- appropriate multidisciplinary support to deal with any concerns about the disease and its treatment, including concerns about body image, living with a chronic illness, and attending school and higher education.
A rise in eating disorder hospital admissions
Hospitals recorded 2,290 eating disorder admissions in the 12 months to June 2012; a 16% rise on the previous 12 month period. Children and teenagers aged 10 to 19
accounted for more than half of admissions in the latest 12 month period, up from 49% in the previous 12 months. The biggest number of admissions were for
15-year-old girls (at nearly 10% of all such admissions), who also accounted for the most admissions in the previous 12 months (just over 9% of all such admissions). Commenting on the figures, HSCIC chief
executive Tim Straughan said: “It might be assumed that a person suffering with an eating disorder is cared for in the community through primary services rather than in hospital; with activity in secondary care only part of a bigger picture. However our figures suggest that hospitals in England are admitting a greater number of eating disorder cases than in previous years. “The data points to a relatively small but
nevertheless significant rise in child admissions for the treatment of an eating disorder. This information will be of interest and concern to health professionals and the public alike.”
NICE guidance supports use of safety device
The National Institute for Health and Clinical Excellence (NICE) has published final positive guidance on the use of Mega Soft Patient Return Electrode mats, supplied by Interglobal Surgical in the UK. The NICE guidance recommends the mat for use by selected
patient groups to help reduce the likelihood of burns on patient’s skin during surgery. The device, which is placed on the operating
theatre table and lies beneath the patient during surgery, was designed to eliminate the need for a disposable patient return electrode attached directly to the skin. The latter are currently used in the NHS and can cause skin burns. According to NICE, the device can particularly benefit elderly people, patients with tender or already damaged skin and those whose skin would need shaving first. There are also possible benefits for theatre staff in terms of convenience and reduced setting-up time. The NICE guidance is available at
http://www.nice.org.uk/MTG11
14 THE CLINICAL SERVICES JOURNAL NOVEMBER 2012
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