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This study aims to investigate the impact of the national guideline on the prevalence and outcome in patients with soft-tissue sarcoma (STS) who had undergone inadvertent excisions. A total of 2336 patients were referred to a tertiary sarcoma centre from six regions (North East, North West, East Midlands, West Midlands, Wales, and South West) in the United Kingdom with a diagnosis of STS between 1996 and 2016, of whom 561 patients (24.0%) had undergone inadvertent excisions. Patients were categorised into two groups of 10-year periods pre and post the National Institute for Health and Clinical Excellence (NICE) guideline implementation in 2006. The proportion of inadvertent excisions decreased after the NICE guideline implementation: 27.2% (pre-NICE) versus 19.8% (post-NICE) (p = 0.001). A substantial regional variation (17.4%–34.5%) in the proportion of inadvertent excisions in the pre-NICE era was reduced in the post-NICE era (14.3%–22.4%). The 5-year disease-specific survival was 77.7% (pre-NICE) versus 75.6% (post-NICE) (p = 0.961) and there was a trend toward lower incidence of local recurrence in the post-NICE era; 13.5% (pre-NICE) versus 10.5% (post-NICE) (p = 0.522). Multivariate analyses revealed that residual tumours in re-resection specimens were independently associated with an increased risk of disease-specific mortality (HR, 3.35; p < 0.001) and local recurrence (HR, 1.99; p = 0.017), which was significantly reduced after the NICE guideline implementation (53.2% versus 42.0%; p = 0.022). The NICE guideline implementation reduced the proportion of patients with STS who had undergone inadvertent excisions and residual tumour in re-resection specimens, indicating an improved pre-referral management of STSs. [ABSTRACT FROM AUTHOR]

Summary: Objective: To audit the performance of the paediatric epilepsy services in a district general hospital based on NICE guidelines and parent satisfaction. Design: Retrospective audit. Setting: Paediatric epilepsy clinic in a district general hospital. Patients: Consecutive children (n =54) with epilepsy attending the paediatric epilepsy clinic over a 4-month period. Methodology: Data from hospital notes was recorded in standardized study forms, which was subsequently entered into database and analysed independently. A parent/patient satisfaction survey was also conducted over the same period involving the same study population by sending out a postal questionnaire. Outcome measure: NICE epilepsy audit criteria and patient/carer satisfaction measured using the standards published by Webb et al. Results: The results show that the service achieved almost all the key targets set out in the NICE guidelines but performed less well in the parent satisfaction survey. Conclusion: This audit suggests that in addition to NICE guidelines, an evaluation of parent/patient satisfaction should form part of assessment of the quality of paediatric epilepsy service. [Copyright &y& Elsevier]

Summary: In 2001, the National Institute for Health and Clinical Excellence commissioned the National Collaborating Centre for Women and Children''s Health to produce clinical guidelines for clinically effective, cost-effective and appropriate infertility treatment. These guidelines were to build on the existing Royal College of Obstetricians and Gynaecologists’ guidelines on the management of infertility, incorporating any new published scientific evidence available, in order to produce a seamless guide to the management of the infertile couple. In addition, the guideline needed to address the clinical criteria that had to be met to qualify for National Health Service (NHS) treatment, as well as the cost implications of implementing the guideline for the NHS. Three versions of the guideline were published in March 2004. This article describes the process of developing the guideline, the major recommendations included in the report and their implications for the health service. [Copyright &y& Elsevier]