My name is Fernando Florido and I am a GP in the United Kingdom. With this episode I continue with the series on the monthly “NICE News” bulletin, which includes new guidance published in that month as well as any updates, also in that particular month, to already published guidelines. However, I will only address guidance which is relevant to Primary Care.

In today’s episode, I go through the NICE Guidance and advice published in February 2023.  

There is a YouTube version of this and other episodes that you can access here: 

NICEGP YouTube channel:  

·      NICE GP - YouTube

The Full NICE News bulleting for February 2023 can be found at:  

·      https://www.nice.org.uk/guidance/published?from=2023-02-01&to=2023-02-28

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Transcript

Hello everyone and welcome. My name is Fernando Florido and I am a GP in the United Kingdom.

With today’s episode I am continuing with the series on the monthly “NICE News” bulletin, which includes any new guidance published in that month as well as any updates, also in that particular month, to already published guidelines, also updated in that month. However, I will only address guidance which is relevant to Primary Care. In today’s episode, I go through the NICE Guidance and advice published in February 2023. 

Remember that there is also a Youtube version of these episodes so have a look in the episode description.

The first guideline update that we are looking at refers to Urinary tract infections in adults 

And the new quality statements are:

Statement 1 Women aged under 65 years are diagnosed with a urinary tract infection (UTI) if they have 2 or more key urinary symptoms and no other excluding causes or warning signs.

This means that according to the updated quality standard on urinary tract infections (UTI) in adults, healthcare professionals should diagnose women under 65 with a UTI if they have 2 or more key urinary symptoms. Therefore, women who present with 2 or more key symptoms should not require a dipstick test. Professionals should however exclude any other causes of urinary symptoms and consider warning signs of other conditions such as sepsis and cancer when diagnosing a UTI. We also need to ensure that vaginal and urethral causes of urinary symptoms are excluded by asking about vaginal discharge and irritation, and other possible urethral causes of urinary symptoms.  

Statement 2 Adult patients with indwelling urinary catheters do not have dipstick testing to diagnose UTIs. Therefore, instead, we need to assess signs and symptoms to diagnose a UTI and use urine culture and sensitivity testing to support the diagnosis. 

Statement 3 Men and non-pregnant women are not prescribed antibiotics to treat asymptomatic bacteriuria. Instead, we need to assess symptoms to determine if a urine sample should be sent for culture and if antibiotics should be prescribed when a urine culture identifies bacteriuria. 

Statement 4 non-pregnant women with an uncomplicated lower UTI are prescribed a 3-day course of antibiotics, and men and pregnant women with an uncomplicated lower UTI are prescribed a 7-day course of antibiotics. We also need to reassess if a person's symptoms worsen or do not start to improve within 48 hours of taking the antibiotic.

Statement 5 Men with a recurrent UTI, and women with a recurrent lower UTI where the cause is unknown or a recurrent upper UTI are referred for specialist advice.

The next section refers to an update to the antenatal care guidelines.

The new quality statements are:

Statement 1 Pregnant women are seen by antenatal care by 10 weeks of pregnancy.

Statement 2 Pregnant women have a risk assessment at routine antenatal appointments.

Statement 3 Pregnant women have coordinated care from a small team of midwives.

Statement 4 Pregnant women are offered vaccinations at routine antenatal appointments, including flu, pertussis and COVID-19 vaccinations. 

Statement 5 Pregnant women and partners who smoke are referred for stop-smoking support and treatment at routine antenatal appointments.  

The next guideline update refers to cardiovascular disease: risk assessment and reduction, including lipid modification 

And in February 2023, a new recommendation on aspirin for primary prevention of CVD has been added. This is based on a 2023 surveillance decision. The results of this evidence strongly suggests that the benefit from aspirin for primary prevention is very closely balanced or outweighed by the increased risk of bleeds. So, the overall decision is that we should not routinely offer the use aspirin for primary prevention of CVD. 

And finally, there was a brand-new guideline published for the first time this month in respect of the monitoring and management of Barrett's oesophagus and stage 1 oesophageal adenocarcinoma.

The recommendations are that:  

1.   We will Follow the recommendations for gastro-oesophageal reflux disease to achieve symptom control 

2.   We will not offer aspirin to patients with Barrett's oesophagus to prevent progression to oesophageal dysplasia and cancer. 

3.   We will discuss the benefits and risks of endoscopic surveillance with the person diagnosed with Barrett's oesophagus. 

4.   We will offer endoscopic surveillance with Seattle protocol biopsies:

a.   every 2 to 3 years to people with long-segment (3 cm or longer) Barrett's oesophagus

b.   every 3 to 5 years to people with short-segment (less than 3 cm) Barrett's oesophagus with intestinal metaplasia.  

5.   We will assess a person's risk of cancer based on their age, sex, family history of oesophageal cancer and smoking history and tailor the frequency of endoscopic surveillance accordingly.

6.   We will not offer endoscopic surveillance to people with short-segment (less than 3 cm) Barrett's oesophagus without intestinal metaplasia provided the diagnosis has been confirmed at 2 endoscopies

7.   We will not offer anti-reflux surgery to people with Barrett's oesophagus to prevent progression to dysplasia or cancer.

The rest of the guideline refers to the management of Barrett's oesophagus with dysplasia and management of oesophageal adenocarcinoma, which I will not go into because it is a specialist area.

We have come to the end of this episode. I hope that you have found it useful. Thank you for listening and good-bye