Primary Care Clinical Effectiveness Bulletin

Edition No. 16: June 2012

Welcome to your South West London digest of Act 1995). PCTs will fund circumcisions for the best practice relevant to primary care. This following indications: information is collated each month from national and local sources, with hyperlinks to Phimosis seriously interfering with urine flow the more detailed guidance – simply [control + and/or associated with significant recurrent click] to follow the link to the website. infections OR Suspected cancer or balanitis xerotica obliterans Contents (Ctrl+Click on section titles) OR 1. South West London Effective Congenital urological abnormalities when skin Commissioning Initiative (SWLECI) - is required for grafting OR  Circumcision Interference with normal sexual activity in 2. NICE Clinical Guidelines adult males OR  Autism in Adults Symptomatic cases of paraphimosis  Venous Thromboembolic Disease OR Symptomatic cases of minor hypospadias  Preventing Type 2 Diabetes 3. NICE Technology Appraisals and IPGs Circumcisions for social, religious or cultural reasons will not be funded on  Breast cancer, Lung cancer and the NHS. Prostate Cancer  Migraine- botulinum toxin 2. NICE Clinical Guidelines  NICE Interventional Procedure Autism in adults (CG142) Guidance. 4. Other news This guideline covers the care provided by primary, community, secondary, tertiary and other health and social care professionals who 1. South West London Effective have direct contact with, and make decisions concerning the care of, adults with autism. The guideline makes recommendations for the support and management of adults with The SW London Effective Commissioning autism. It aims to: Initiative (ECI), is driven by the need to ensure that NHS funded treatments are  Improve access and engagement with effective and evidence-based and provide interventions and services for adults with value for money, and that access to them is autism equitable across the cluster. This months  Evaluate the role of specific psychological, featured criteria are from the recently finalised psychosocial and pharmacological 2012/13 ECI list. interventions in the management of autism Circumcision  Evaluate the role of psychological and Circumcision is an effective operative psychosocial interventions in combination procedure with a range of medical indications. with pharmacological interventions in the This statement refers to circumcision (the management of autism in adults surgical removal of the penile foreskin) in  Evaluate the role of specific service-level males only. Female circumcision is prohibited interventions for adults with autism by law (The Prohibition of Female Circumcision

Edition No. 16: June 2012

 Integrate the above to provide best- 1.2 Trastuzumab in combination with an practice advice on the care of adults with aromatase inhibitor is not recommended autism for first-line treatment in postmenopausal  promote the implementation of best women with metastatic hormone-receptor- clinical practice through the development positive breast cancer that overexpresses of recommendations tailored to the HER2. requirements of the NHS in England and 1.3 Postmenopausal women currently Wales. receiving lapatinib or trastuzumab in Venous thromboembolic diseases (CG144) combination with an aromatase inhibitor that is not recommended according to 1.1 This guideline includes advice on the Wells or 1.2 should have the option to continue score, D-dimer measurement, ultrasound and treatment until they and their clinicians radiological imaging. It also offers guidance consider it appropriate to stop. on the management of VTE, investigations for Lung cancer (non small cell, EGFR-TK cancer in patients with VTE and thrombophilia mutation positive) - erlotinib (1st line) (TA258) testing. The guideline covers adults with suspected or confirmed DVT or PE. It does Erlotinib is recommended as an option for the not cover children or young people aged first-line treatment of people with locally under 18, or women who are pregnant. advanced or metastatic non-small-cell lung cancer (NSCLC) if: Preventing type 2 diabetes - risk identification  They test positive for the epidermal and interventions for individuals at high risk growth factor receptor tyrosine kinase (PH38) (EGFR-TK) mutation and  The manufacturer provides erlotinib at the The guidance reminds practitioners that age is discounted price agreed under the patient no barrier to being at high risk of, or access scheme (as revised in 2012). developing, type 2 diabetes. The Prostate cancer (metastatic, castration recommendations can be used alongside the resistant) - abiraterone (following cytotoxic NHS Health Check programme. They include: therapy) (TA259)

 Risk identification (stages 1 and 2) 1.1 Abiraterone in combination with  Intensive lifestyle-change programmes prednisone or prednisolone is recommended  Physical activity as an option for the treatment of castration-  Weight management and dietary advice resistant metastatic prostate cancer in adults,  Vulnerable groups only if:  Training and professional development  Their disease has progressed on or after  Use of metformin and orlistat one docetaxel-containing chemotherapy regimen, and 3. NICE Technology Appraisals and IPGs  The manufacturer provides abiraterone with the discount agreed in the patient Breast cancer (metastatic hormone-receptor) - access scheme. lapatinib and trastuzumab (with aromatase 1.2 People currently receiving abiraterone in inhibitor) (TA257) combination with prednisone or prednisolone whose disease does not meet the criteria in 1.1 Lapatinib in combination with an 1.1 should be able to continue therapy until aromatase inhibitor is not recommended they and their clinician consider it appropriate for first-line treatment in postmenopausal to stop. women with metastatic hormone-receptor- Migraine (chronic) - botulinum toxin type A positive breast cancer that overexpresses human epidermal growth factor receptor 2 1.1 Botulinum toxin type A is recommended as (HER2). an option for the prophylaxis of headaches in

Edition No. 16: June 2012 adults with chronic migraine (defined as Is a reliable source of evidence-based headaches on at least 15 days per month of information and practical 'know how' about the which at least 8 days are with migraine): common conditions managed in primary care.  That has not responded to at least three prior pharmacological prophylaxis See new and updated topics therapies and ’Eyes on Evidence’ (NHS Evidence)  Whose condition is appropriately managed for medication overuse. This monthly newsletter covers major new evidence as it emerges, with an explanation 1.2 Treatment with botulinum toxin type A about what it means for current practice. that is recommended according to 1.1 should New Evidence Updates on NICE guidance be stopped in people whose condition:  Is not adequately responding to treatment Guidance is continually under review in the (defined as less than a 30% reduction in light of new scientific evidence. Topics from headache days per month after two COPD to Depression have been reviewed, and treatment cycles) or the implications for current guidance assessed.  Has changed to episodic migraine (defined as fewer than 15 headache days per Practical support for general practice month) for three consecutive months. NICE provide a collection of resources to 1.3 People currently receiving botulinum toxin enable general practice professionals to type A that is not recommended according to improve outcomes for their patients by 1.1 and 1.2 should have the option to continue ensuring that their practice is up to date with treatment until they and their clinician current recommendations from NICE on consider it appropriate to stop. clinical practice, public health, social care and support for GP led commissioning. Interventional Procedure Guidance Editorial team If you are interested in seeing the latest NICE IPGs these can be accessed directly from the Thank you to those who have fed back on the NICE Website. usefulness of this bulletin and made suggestions for improvement. All comments 4. Other News are helpful to continually improve it. Contact details for your borough leads are: Healthcare-associated infections quality improvement guide - Prevention and control Dr. Usman Khan, Richmond Borough Team, of healthcare-associated infections (PH36) [email protected] Tracy Steadman, Croydon Borough Team, The guide consists of 11 quality improvement [email protected] statements which provide clear markers of Alastair Johnston, Wandsworth Borough Team, excellence in infection prevention and control [email protected] at a management or organisational level. Each Livia Royle, Kingston Borough Team, statement is supported by examples of the [email protected] type of evidence that could be used to prove Jacqueline Lindo, Sutton & Merton Borough the organisation has achieved excellence, and Team, [email protected] examples of what this would mean in practice on a day-to-day basis.

PRODIGY (formerly CKS)