From treating people to a target of 140/150 to a much higher target of 170 would be a massive shift. I wonder what the biological basis of this is? It can't just be a reduction in falls as surely they'd have reported that.
Obviously we await bigger trials, but I will certainly be taking this into account for my 85 pluses.
An interesting article - but I have several things which make little sense to me.
Spending £10 to work out if a £2 trial of medication will be effective is not a sensible use of resources. Why not just give the inhaler to everyone?
I also think a lot of the costs of follow up can be mediated with sensible communication. For example I always tell the patient - for a trial of treatment - to start on a high dose to control the symptoms and wean down to the minimum effective dose on their own at home.
If it isn't asthma they will either wean down to nothing, stop and not see me again, or come back because it didn't work.
If it is asthma they will wean down (As I explain to them in detail) and stay at the lowest dose that controls their symptoms.
I don't see how FENO fits into that?
That said some of the other indications in monitoring and complex patients are interesting, and I'm sure it will be used more. I'm not convinced yet though.
Great article - which made me think more about the evidence for permissive pyrexia. I found this very interesting paper for those who want to read more.
The long and short of it is - Pyrexia increases inflammation but decreases viral/bacterial load.
So if you let it ride its course you will likely get better faster/be less likely to be overrun by infection - but feel worse in the meantime.
Caveat: In severe sepsis - it is the inflammation which kills you - so aggressive pyrexia management is essential.
(Not my paper!)
I think the only thing I disagree with in the guidelines is the lack of extended release metformin (though it is significant).
As far as repaglinide goes, from a glance at NICE's statistics it does seem like there is compelling evidence to use it (I. e. The best medication at reducing HbA1c without as high a risk of hypos/weight gain as sulphonylureas).
And of course NICE are taking into account costs here, if we don't do this collectively then the NHS is going down the pan. We don't have the money for expensive treatments anymore unfortunately.
I'm all for good guidance but this is massively flawed (i just read it) in it's estimates for cost effectiveness.
NICEs price estimate per test:
Full blood count (eosinophils) = £82.33
2 week home PEFR monitoring = £21.08
FENO test = £10.01
Sometimes they include "doctor time" in the pricing and sometimes they don't. There is no mention of acquisition or training costs, and this is the data they use to decide what is cost effective...
Some of these new technologies will be very useful but for me, seeing the quality of data they put into their calculations means that i cannot trust their conclusions.
And that's putting it nicely
This is all very very sad to read. I had no idea it was this bad... Good Luck and thanks for sharing.
Fantastic to hear that studies are starting to be interpreted in terms of "amount of life gained". After all statins/aspirins don't prevent death/MI/stoke forever, they just delay it. It would be nice to know by how long.
Very interesting thank you!