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Archive for the ‘NICE’ Category

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Many GP’s and other healthcare professionals don’t know much about ME. (Myalgic Encephalomyelitis [WHO ICD-10:G93.3])

They think it is the same as tiredness and that impression is further reinforced by the recent NICE guidelines that proclaim that tiredness and a sore throat or headache equals ME. Nothing is further from the truth. Here is a quick guideline for BUSY GP’s about ME.

“Many GPs believe ME doesn’t exist or is a form of hysteria. But this is very wrong, just as we were with MS, when we called it hysteria, and with many other medical conditions. So here are some usefull tips when dealing with patients who might have ME.

Tip ONE: if a patient comes to the surgery, have a look at the size of his docs, if he has never been, or only rarely, with real problems, than he is not a malingerer or a hypochondriac.

Tip TWO: there are a lot of differences between hysteria and ME but two easy ones are: Belle indifference and shallowness of affect.

Tip THREE: hysteria has been binned from the DSM when they realised they made a big mistake naming MS hysteria. If you encounter a psychiatrist who still uses the term hysteria you have to be careful because in that version of the DSM homosexuality is still a psychiatric illness.

Tip FOUR: ask how long someone with fatigue needs to recover from even a simple task. Patients with ME don’t recover from simple tasks like healthy people, something you don’t see with (most) other forms of fatigue.

Tip FIVE: discuss CBT, if it cures the patient your diagnosis of ME was wrong.

Tip SIX: ME patients have the so called threshold phenomenon, meaning that they can’t increase their stamina like healthy people. If they can or if GET helps to improve their stamina then again, the diagnosis of ME was wrong.

Tip SEVEN: ask about muscle pain. If they have it, it is so extreme and completely different from a bit of pain after a strenuous run that NSAIDs look like smarties and have the same effect.

Tip EIGHT: have a look at page SIX of the South Australian guidelines where you can find an easy to use tick chart of symptoms to distinguish ME from other illnesses with fatigue. This will help a lot because there is no cure at present for ME but for many other illnesses with fatigue there is. And the patient will be cured and grateful. Print it to have it ready when needed; or >>>>> CLICK HERE FOR PROPER AND UP TO DATE GUIDELINES……….

Tip NINE: take a proper history, examine the patient and do lab tests. This might sound obvious but very often this doesn’t happen and the sooner you diagnose the problem, like with any other (serious) medical problem, the easier it is to cure or deal with. Might also give you a happier patient and one who is less likely to sue you.

Tip TEN: diagnose ME (if so), explain that the body will cure itself in many patients but that it is difficult to say how long that will take, and you have answered all important questions, and your patient will not only be grateful for that, but you won’t have a difficult patient, because he knows what is what. So help him and yourself by using this simple guide.

Last TIP: remember, even if you don’t believe ME exists, you might still get it yourself.

There are studies suggesting that teachers and healthcare workers/doctors are more at risk.

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BMJ 2007;335:275 (11 August).

Anaesthetists get new guidelines for morbidly obese patients
BY: Toby Reynolds

The rising number of morbidly obese people in the UK population has prompted anaesthetists to write new guidelines for managing these higher risk patients, emphasising the need for training and suitable equipment.

In England nearly 3% of women and 1% of men are morbidly obese (with a body mass index (BMI) of >40), and well over a fifth of the population are obese (BMI >30).
We do know that these patients suffer a higher incidence of anaesthetic complications, but we don’t have hard data to quantify this.

Every major hospital is likely to encounter patients weighing more than 150 kg.

Morbidly obese patients have a greater risk of developing deep vein thrombosis, wound infection, and respiratory complications. They are also more likely to need intensive care after an operation.

In such patients intubation is often more difficult, low oxygen saturation during general anaesthesia is more common, and regional anaesthesia is harder where landmarks are obscured.

Staff were also at risk, highlighting back pain as a potential consequence of unsafe lifting.

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Janice Hopkins Tanne; BMJ  2007;335:226 (4 August).

Patients with severe Alzheimer’s disease who are living at home with family care givers and are treated with donepezil stabilise or decline more slowly than patients given placebo, according to a multinational, randomised, placebo controlled trial published in Neurology (2007;69:459-69).

North American researchers were suspicious of the decision by the UK National Institute for Health and Clinical Excellence (NICE) not to fund donepezil for patients with mild Alzheimer’s disease.

They said donepezil might SLOW decline in these patients.

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New guidance from the National Institute for Health and Clinical Excellence recommends Herceptin in early breast cancer, but it provides no additional funding or any suggestion of which services to cut. This leaves medical staff with difficult decisions to make.

The media have made little mention of the restricted categories of patients for whom Herceptin may be appropriate, or of the lack of long term toxicity data, especially concerning effects on the heart. Although the three published trials showed a statistically significant improvement in rates of recurrence, as yet, only one has shown a benefit in survival (4.8% at four years). 

On the face of it, the answer to our question is simple—Herceptin will cost our trust £2.3m—but the real cost lies in the services that will be cut to provide this money. This is an important element currently missing from the debate.

Guidance from the National Institute for Health and Clinical Excellence on new treatments does not have additional funding attached, and does not recommend which services should be cut to pay for new treatments.

BY: Ann Barrett, lead clinician for oncology, Department of Oncology, Norfolk and Norwich University Hospital;

BMJ  2006;333:1118-1120 (25 November);

http://www.bmj.com/cgi/content/full/333/7578/1118

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