Search

Introduction and aim NICE guideline surveillance determines whether previously published guidelines need updating. The surveillance process must balance time constraints with methodological rigor. It includes a rapid review to identify new evidence to contradict, reinforce or clarify guideline recommendations. Despite this approach, the screening burden can still be high. Applying additional search techniques may increase the precision of the database searches. Methods A retrospective analysis was conducted on five surveillance reviews with less than 2% of the studies included after screening. Modified searches were run in MEDLINE, Embase and PsycINFO (where appropriate) to test the impact of additional search techniques: focused subject headings, subheadings, frequency operators and title only searches. Modified searches were compared to original search results to determine: the retrieval of included studies, the precision of the search and the number needed to read. Studies not retrieved by the modified search were checked to determine if the surveillance decision would have been affected. Results The additional search techniques tested indicated that a combination of focused subject headings and frequency operators could improve the precision of surveillance searches. The modified search retrieved all the original studies included in the surveillance review for three of the reviews tested. Some of the original included studies were not retrieved for two reviews but the missing studies would not have affected the surveillance decision. Conclusions Combining focused subject headings and frequency operators is a viable option for improving the precision of surveillance searches without compromising recall and without impacting the surveillance decision.

In December 2020, the National Institute for Health and Care Excellence (NICE) reviewed the evidence and updated their recommendations on intermittently scanned (commonly known as Flash) and Continuous Glucose Monitoring (CGM) during pregnancy for women with type 1 diabetes (1). The NICE guidelines now recommend offering CGM to all pregnant women with type 1 diabetes to help them meet their pregnancy glucose targets and improve neonatal outcomes. Their evidence review, based on the CONCEPTT randomised trial (2) and a Swedish observational study (3) found that, compared to capillary glucose monitoring, CGM resulted in more women achieving their blood glucose targets, fewer caesarean sections and fewer neonatal intensive care admissions.

Objectives (1) To derive a simple risk score for preterm pre-eclampsia based on the model used in the ASPRE trial, and (2) to compare it (i) with the original ASPRE algorithm, (ii) with the NICE Guideline score, and (iii) with and without biochemical and ultrasonic predictors. Design Prospective cohort study. Setting Cambridge, UK. Population or sample 4184 nulliparous women from the Pregnancy Outcome Prediction study. Methods Maternal history model coefficients from the ASPRE algorithm were translated into a risk score, preserving the relative weight of each coefficient. Main outcome measures Preterm delivery with a diagnosis of pre-eclampsia. Results The area under the ROC curve (AUC) for preterm pre-eclampsia was 0.846 (95% CI 0.787-0.906) for the risk score and 0.854 (95% CI 0.795-0.914) for the original ASPRE algorithm (P = 0.14). In all, 9.1% of women had a risk score of ≥30 and their risk ratio for preterm pre-eclampsia was 13.3 (95% CI 6.3-27.8), sensitivity 57.1% (37.5-74.8%), false-positive rate (1-specificity) 8.8% (8.0-9.7%), and LR+ 6.5 (4.6-9.1). The score had higher specificity than the NICE Guideline criteria. First trimester levels of PAPP-A and PlGF were not predictive when included in a model with the risk score. In contrast, mean arterial pressure at booking and 20-week uterine artery Doppler were independently associated with preterm pre-eclampsia and the latter modestly increased the AUC (by ~0.02). Conclusions A simple risk score derived from the ASPRE screening study predictive model provided clinically useful prediction of the risk of preterm pre-eclampsia. Tweetable abstract A simple risk score derived from the ASPRE screening study provided clinically useful prediction of the risk of preterm pre-eclampsia.

The new NICE guideline on the menopause published in November provides information on diagnosis and the risks and benefits of HRT to enable shared decision making between women and healthcare professionals. Steve Chaplin provides an overview of the guidance.

As part of our series of articles highlighting the recommendations made in the NICE guideline on Medicines Optimisation,1 this month we discuss the section of the guidance concerning medicines-related models of organisational and crosssector working.

The author summarises the recommendations of the NICE clinical guideline on ‘Lower urinary tract symptoms in men’ – the first national guideline to address this umbrella concept rather than focusing on benign prostatic hyperplasia alone. Copyright © 2010 Wiley Interface Ltd

The NICE guideline on the management of faecal incontinence calls for healthcare professionals to ask people in high-risk groups, such as the frail and elderly, and women who have recently given birth, about whether they have any symptoms of the condition. In this article, Dr Ismail highlights the main features of this guideline, exploring how it could be implemented in primary care, and provides a simplified care algorithm of patient assessment and management. Copyright © 2008 Wiley Interface Ltd.

The NICE guideline on the management of hypertension in primary care has recently been updated. Here, the author discusses the major impact this will have on prescribing practice. Copyright © 2006 Wiley Interface Ltd

Background There is variation in the literature concerning optimum weekly weight gain for inpatient treatment of anorexia nervosa. The recently published UK National Institute for Clinical Excellence guidelines recommend 0.5–1.0 kg. Methods Weight gain was retrospectively compared for 53 inpatients admitted consecutively to an NHS adolescent anorexia nervosa unit. Results Mean weekly weight gain achieved was 0.82 kg, with no significant differences between patients who did or did not reach a target weight range, nor those who had or had not had previous inpatient treatment. Variation in mean weekly weight gain between patients approximated to a normal distribution. Patients admitted with a lower per cent expected BMI gained weight significantly faster. Weight gain was initially low, corresponding to low caloric intake, then faster, but tailed off as patients approached target weight range. Discussion Rate of weight gain was within NICE guideline recommendations. This still leaves questions as to optimum rate of weight gain. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.

OBJECTIVES: In several Western European countries guidelines regarding urinary incontinence (UI) management in general practice have been drawn up. The aim of this study was to evaluate guideline adherence with feedback in general practice in order to improve UI management. METHODS: First, a retrospective audit of female patient records was performed with Egton Medical Information System compared with the NICE Guideline regarding UI. Between 1 January 2000 and 31 December 2006 patients, 18-65 years of age, with newly diagnosed UI (ICPC U04) were included in two general practices in Nottingham, UK. Second, results were presented to the general practitioners (GPs) in a feedback session. RESULTS: Sixty-five patients were identified to have newly reported UI. Gynaecological examination was performed in 51% of cases. Additionally, in 40% of patients a urine sample was obtained for dipstick. Follow-up was performed in 34% of the 65 cases. During a feedback session GPs became aware they do not adhere to these guideline items consistently. Patients often report UI as final after several other problems during one single consultation. CONCLUSION: Most women with UI were not managed according to the NICE Guideline. Audit feedback created awareness of current UI management in general practice and can therefore be used in improving UI management.

Dr Ismail summarises recent NICE guidance on how to provide consistent clinically and cost-effective practice for the diagnosis, treatment and long-term management of urinary tract infection in childhood. Copyright © 2008 Wiley Interface Ltd

Steve Chaplin summarises the recently updated NICE guideline on the management of hypertension in primary care. Copyright © 2006 Wiley Interface Ltd