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Objective In July 2018, NHS England, introduced a pause on vaginal mesh, including the mid-urethral sling (MUS) for treatment of stress urinary incontinence (SUI). NICE guidelines recommend MUS as one of the surgical options for SUI. The aim of our study was to investigate healthcare professionals choices for surgical treatment of SUI, if conservative measures failed. Study design The urogynaecology department at our tertiary level hospital devised a questionnaire using SurveyMonkey. This was distributed via email to 1058 healthcare professionals of different medical backgrounds. The surgical options were based on the NICE guideline and its patient decision making aid. We also used surgical information from the British society of Urogynaecology (BSUG) and British association of urological surgeons (BAUS). Results We received 214 responses of which 204 were complete. Twenty six percent of replies were from obstetricians and gynaecologists, 36 % had over 20 years experience and 79 % were female. Forty four percent had no previous knowledge of surgical options. Mid-urethral sling was the most popular choice based on description, success and specific complications. Urethral bulking agent was the only option that increased in popularity after describing complications. Twenty two percent would avoid surgery due to the risk of complications. Conclusion This is the first study evaluating healthcare professionals surgical choice for SUI. Despite negative media publicity and NHS pause on MUS, it was still the most popular choice before and after informing of specific complications. The urethral bulking agent was the only surgical treatment, which increased in popularity after considering complications.

Pelvic organ prolapse (POP) is a common presenting complaint in gynaecology. In the UK, prolapse accounts for 20% of women on the waiting list for major gynaecological surgery. It is therefore important that clinicians understand how accurately to assess women with prolapse. The aim of this review is to provide a comprehensive description of the assessment required. Anatomical assessment should be made using the standardized Pelvic Organ Prolapse quantification system (POP-Q). The use of POP-Q in women with POP is recommended by the NICE guideline because allows effective communication between clinicians, reproducible evaluation of surgical outcomes, meaningful comparison of published series and comparison of different populations. The main focus of the review is a detailed and practical explanation of the POP-Q.

Intra-uterine insemination (IUI) is a cheaper, less intensive treatment modality for achieving a pregnancy in couples with specific indications. The use of IUI seems to have declined after NICE guideline 2013 (CG 156) recommended IVF over IUI in couples with unexplained and mild male factor infertility. This review examines the current evidence and the applicability of IUI as a first-line option of treatment in couples with unexplained and mild male factor subfertility. The outcome of the review supports this argument. It is likely that IUI will re-emerge as an effective treatment option and thereby increase the choice to patients. However, there is a need for ongoing research and investment into funding of good quality trials to improve and strengthen the evidence base.

Background Home phototherapy programmes are being developed internationally despite concerns of their safety and feasibility. The NICE guideline on Neonatal Jaundice published in 2010 does not acknowledge these practices. However, a drive towards early hospital discharge with increasing financial pressures to move care into the community has raised an important question of "Is home phototherapy in the term neonate with physiological jaundice a feasible practice?" Methods A 3-stage literature review was carried out. Stage 1 selected inclusion criteria. Stage 2 assessed the evidence for methodological quality. Stage 3 extracted and synthesised data, grouping it into ten themes applicable to the measurement of feasibility of home phototherapy. Results There was no high quality research available to support or refute home phototherapy. There are many differing and personal practices reported. Conclusion Practice is currently building an evidence base in the field of home phototherapy. Further research is required in context of newer technologies and guidelines. An awareness of the known risks and benefits within the limited evidence begins to determine the feasibility of home phototherapy in local areas. Reference: National Institute for Health and Clinical Excellence (NICE), 2010. Neonatal Jaundice. NICE, London .

Objectives This quality improvement project sought to streamline diagnosis and management of women with a pregnancy of unknown location (PUL) by applying the National Institute for Health and Care Excellence (NICE) guidelines (2012) for the management of PUL. Methods A retrospective review of 30 charts with the diagnosis of PUL was conducted at the early pregnancy assessment clinic at Mount Sinai Hospital, Toronto, Canada. Outcomes including services provided, ER visits, number of ultrasounds, beta-hCG measurements, methotrexate use and surgical intervention were compared to the NICE guidelines. Process measures included adherence to the NICE PUL protocol. Balancing measures included measurement of increased risk of ruptured ectopic or surgical procedures with expectant management. An additional 30 charts were reviewed following the implementation of the NICE guidelines for the same outcome variables listed above. Results Prior to NICE guideline implementation, a 37% compliance rate with respect to ultrasound follow up, beta-hCG measurements and instructions for follow up was determined. It was found that 80% of patients were discharged from the clinic with a positive beta-hCG and 10% of women received methotrexate without a definitive diagnosis of ectopic pregnancy. Following NICE guideline implementation, compliance increased to 100% with respect to protocol and discharge criteria and there was no inappropriate methotrexate use or surgical procedures prior to diagnosis. Utilization of blood work and ultrasound resources remained unchanged. Conclusions Implementation of a standardized management algorithm for patients with a PUL can decrease unsafe management strategies, including inappropriate methotrexate use and premature follow up discharge.

Background: Both the 2004 NICE depression guidelines and 2006 general practice Quality Outcomes Framework (QOF) encouraged improved targeting of antidepressant treatment for depression.Methods: Possible effects of the NICE guideline from January 2005, and QOF from April 2006, on rates of GP antidepressant prescribing were examined using time trend analyses of anonymised data from 142 English practices contributing to the Clinical Practice Research Datalink (CPRD), 2003-2013. Results: Sustained reductions were found in the proportion of first-ever depression episodes treated within 12 months, of 4.2% (95% C.I. 1.0%-7.3%) following introduction of the NICE guideline, and 4.4% (2.3%-6.5%) following introduction of the QOF. Treatment rates for first-ever episodes fell from 72.5% (70.8%-74.1%) in Quarter 2 (Q2) 2003 to 61.0% (59.3%-62.7%) in Q1 2012, but treatment rates for recurrent episodes increased from 74.3% (72.8%-75.8%) to 77.8% (76.5%-79.1%), so overall rates remained around 70%. Mean prescriptions per patient per year doubled from 2.06 (2.05-2.07) to 3.98 (3.97-3.99). Limitations: Participating practices were larger than average and not representative across regions. Inferences of cause and effect from time trend analyses are subject to the possibility of unidentified confounders. No data were available on depression severity or appropriateness of prescribing.Conclusions: Rates of GP antidepressant treatment for patients with incident depression fell following introduction of NICE depression guidelines and the QOF, but treatment rates for recurrent depression increased. Prescription numbers increased due to longer treatment courses. To impact on antidepressant prescribing rates, guidelines and performance indicators must address recurrent and long-term prescribing, rather than initial treatment decisions.

The prescription of intravenous fluids is common in hospitalized patients and is increasingly recognized as a potential source of harm if administered inappropriately. The recently published NICE guideline seeks to provide a simple and consistent approach to assessing, prescribing and re-evaluating fluid status in sick patients. There has been a long-running debate regarding the optimal fluid to prescribe which has shifted in recent years to consider not only which type of fluid to prescribe but also how much and when. This article summarizes the physiology of fluid and electrolyte homeostasis and the latest evidence for each of the common fluids available. We aim to highlight specific circumstances where the choice of fluid may vary from normal practice.

Objective The accuracy of various 10-year cardiovascular disease (CVD) risk calculators in Indians may not be the same as in other populations. Present study was conducted to compare the various calculators for CVD risk assessment and statin eligibility according to different guidelines. Methods Consecutive 1110 patients who presented after their first myocardial infarction were included. Their CVD risk was calculated using Framingham Risk score- Coronary heart disease (FRS-CHD), Framingham Risk Score- Cardiovascular Disease (FRS-CVD), QRISK2, Joint British Society risk calculator 3 (JBS3), American College of Cardiology/American Heart Association (ACC/AHA), atherosclerotic cardiovascular disease (ASCVD) and WHO risk charts, assuming that they had presented one day before cardiac event for risk assessment. Eligibility for statin uses was also looked into using ACC/AHA, NICE and Canadian guidelines. Results FRS-CVD risk assessment model has performed the best as it could identify the highest number of patients (51.9%) to be at high CVD risk while WHO and ASCVD calculators have performed the worst (only 16.2% and 28.3% patients respectively were stratified into high CVD risk) considering 20% as cut off for high risk definition. QRISK2, JBS3 and FRS-CHD have performed intermediately. Using NICE, ACC/AHA and Canadian guidelines; 76%, 69% and 44.6% patients respectively were found to be eligible for statin use. Conclusion FRS-CVD appears to be the most useful for CVD risk assessment in Indians, but the difference may be because FRS-CVD estimates risk for several additional outcomes as compared with other risk scores. For statin eligibility, however, NICE guideline use is the most appropriate.

Summary Background The National Institute for Health and Clinical Excellence (NICE) COPD 2004 guidelines recommend: ∗ COPD patients who smoke should be encouraged to stop at every opportunity; ∗ Inhaled corticosteroid should be used only among patients with moderate to severe COPD; ∗ Pharmacists should identify smokers and provide smoking cessation advice. The community pharmacy contract requires pharmacists to review patients’ medications, creating an opportunity for reviewing the prescribing of inhaled corticosteroids in COPD. The survey explored the degree to which community pharmacists in North West England identify and provide advice to smokers and assess prescribed inhaled corticosteroids among COPD patients. Methods A self-completion questionnaire was sent to 2080 community pharmacists from the 2005 pharmacist census database. Results Of the 1051 (50.5%) respondants, 37.1% mentioned COPD as a risk from smoking most or every time and 54.5% sometimes or rarely, and 19.6% routinely asked about smoking status when dispensing COPD medication. Pharmacists with more than 20 years experience were more likely to have read the Guideline compared to pharmacists with 10 years or less (OR: 1.54; 95% CI: 1.13 to 2.10). Pharmacists who had read the NICE Guideline (46.8%) were around twice as likely to mention COPD as a risk of smoking, ask about COPD if inhaled corticosteroids were dispensed and ask about smoking routinely if COPD medication was dispensed. (p Conclusion The NICE guidelines on COPD encourage community pharmacists to carry out smoking cessation and educational interventions, but further support is needed.

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.

The Cochrane Collaboration (CC) celebrates its 20th anniversary in 2013 and the Cochrane Neuromuscular Disease Group (CNMDG) its fifteenth. The Cochrane Database of Systematic Reviews is an internet-based resource of systematic reviews. The CNMDG has contributed over 100 Cochrane Systematic Reviews (CSRs) of interventions in neuromuscular disease, with almost 40 in preparative pre-publication. Over 100 potential titles still await author groups to tackle them. Cochrane Systematic Reviews not only provide the best summary of the evidence for individual interventions for diseases, but have contributed high quality and valuable data to international neuromuscular guidelines, each review coming at 1/10th of the cost of a NICE guideline. This efficient but high quality contribution is due both to the systematized Cochrane methods and the invaluable participation of over 26,000 Cochrane volunteer authors. Without Cochrane Systematic Reviews some questions about interventions for neuromuscular diseases would still remain ‘unanswered’. The CNMDG has made substantial contributions to literature in specific topics areas of both peripheral nerve and muscle disease. In Guillain-Barre Syndrome (GBS) one meta-analysis demonstrates the ineffectiveness of steroids and more importantly their potential harms, not evident from individual trials [1]. Systematized international multilingual searches for other treatments for GBS have uncovered potential new treatments requiring trial, such as the extract of Tripterygium wilfordii [2]. In Duchenne Muscular Dystrophy a meta-analysis of data from 249 children confirmed effectiveness of glucocorticoid corticosteroids in stabilizing muscle strength and improving function [3], and this is now considered the

The National Institute for Clinical Excellence (NICE) published its recommendations for the routine care of the healthy pregnant woman in December 2003 and the guidelines for intrapartum and postpartum care are due for release in 2005. The recommendations are the result of a working party comprising relevant experts and representatives from a variety of interested parties, including professional and consumer groups, although none

s / Injury Extra 43 (2013) 71–127 123 new osteoporosis related fractures in the outpatient orthopaedic setting. A lead clinician for osteoporosis had been appointed at 46% of responding Trusts, with a consultant rheumatologist the lead at most. Conclusion: A large number of NHS Trusts across England do not have someone employed to identify fragility fractures associated with osteoporosis other than the orthopaedic doctor, and a lead clinician overseeing osteoporosis management is not appointed in more than half of responding Trusts in this study. We feel that this will lead to patients with osteoporotic fractures not being identified, as well as lack of assessment and overall treatment. Consequently, there is a missed chance for secondary prevention measuresandpotentiallypreventionof futureosteoporotic fragility fractures. http://dx.doi.org/10.1016/j.injury.2012.07.346