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NICE guidance: the latest in evidence-based practice

The National Institute for Health and Clinical Excellence (NICE) regularly adds to its advice on the management of a range of conditions in primary care. Here, NiP brings you the latest publications …

Alcohol misuse
The guideline on alcohol dependence and harmful alcohol misuse calls for practice nurses to be able to identify patients who could be abusing alcohol through clinical interviews and assessment tools, such as the AUDIT and SADQ. These help healthcare professionals make accurate diagnoses and measure the severity of their patients' dependence. Other key recommendations from NICE include:
•• Harmful drinkers and people who are mildly dependent should be offered psychological interventions, such as cognitive behavioural therapy, behavioural couples therapy or social network and environment-based therapies.
•• People who drink more than 15 units a day or who score 20 or more on the AUDIT should be offered a structured assisted withdrawal programme. In some circumstances,
people should be offered an inpatient or residential assisted withdrawal programme. People who drink 15-20 units of alcohol a day and have significant mental or physical problems, or a significant learning disability or cognitive impairment, should also be offered inpatient or residential assisted withdrawal.
•• A person's alcohol misuse should be treated before any co-existing mental health conditions. This is because symptoms can often improve once alcohol misuse has been effectively treated. However, if a person with a mental health condition hasn't experienced significant improvements after abstaining from alcohol for around three to four weeks, then referral for specific treatment of this should be considered.

Ovarian cancer
Women who present with persistent symptoms that could suggest ovarian cancer should be offered a blood test
to measure CA125 levels. Although ovarian cancer is often dubbed 'the silent killer', it is increasingly recognised
that the majority of women with the cancer will present with symptoms.

But if all women with symptoms were referred to secondary care, only one in every 500 women would turn out to have ovarian cancer.

NICE recommends that CA125 testing, which measures levels of the cancer antigen-125 found in ovarian cancer cells, is carried out in primary care to help make a more accurate diagnosis.

The test should be offered to any woman who reports having any of the following symptoms persistently or frequently, especially if they are over the age of 50:
•• Persistent abdominal distension.
•• Pelvic or abdominal pain.
•• An increased urinary urgency and/or frequency.
•• Feeling full and/or loss of appetite.
If the serum CA125 level is 35 IU/ml or greater, then the patient should have an ultrasound scan of the abdomen and pelvis. If the ultrasound is suggestive of ovarian
cancer, then the patient should be referred urgently to a gynaecological cancer service.

The guidance aims to increase HIV testing to help
reduce undiagnosed infection and prevent transmission
among men who have sex with men and people from black African communities by recommending healthcare professionals offer regular, routine testing to all men in high prevalence areas. "HIV is still a serious problem in this country, with a large proportion of people unaware they are infected" explains Dr Matt Kearney, GP and Primary
Care Adviser to the Department of Health. "In areas
where levels of HIV are high, testing needs to be offered
routinely when registering new patients in GP practices,
regardless of ethnic background or sexual orientation. This
system is already in place in many practices, but not all.
With around a quarter of people with HIV in this country
unaware that they are infected, we need to ensure that
people know that testing is simple, fast, reliable, accurate
and confidential."

Dr Kearney continues, "This new guidance offers clear recommendations to help healthcare professionals
who work in primary care offer HIV testing routinely and ensure that those who test positive are offered the treatment they need as soon as possible. For those whose results are negative, testing can also provide an opportunity to identify people who are most likely to be
infected and help them remain infection free."
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Food allergy
Food allergies are among the most common allergic disorders and are recognised as a major paediatric health
problem. Reactions can be extremely severe and hospital admissions in the UK have increased by 500% since
1990. The most common foods to which children and young people are allergic include cow's milk; fish and shellfish;
hen's eggs; peanuts and wheat.

The first evidence-based guideline on food allergy in children and young people aims to support GPs, nurses, healthcare professionals working in community/primary
care and patients. It gives clear recommendations and warns against the use of some alternative and highstreet

If a food allergy is suspected, the healthcare
professional should take an allergy-focused clinical history, tailored to the presenting symptoms and age of the patient. This should include a family history of allergies,
an assessment of the symptoms, details of foods that are avoided and reasons why, and feeding history as an
infant. A physical examination should pay particular attention to growth, and physical signs of malnutrition.
The guideline also recommends offering the patient information on the type of allergy suspected, the risk of severe allergic reaction, and the diagnostic process. This may include excluding specific foods from the diet and reintroducing these foods with reoccurrence of the allergic reaction confirming diagnosis. Diagnosis may also include skin prick and/or blood tests for immunoglobulin antibodies.