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Clinical digest - top stories in January

A round-up of the top clinical news from the past month

NHS to trial twice-yearly cholesterol-lowering injection

A twice-yearly injection that lowers cholesterol levels could become available on the NHS by 2021.

Inclisiran, an as-yet unlicensed injection that uses gene silencing to reduce LDL-C levels, will be made available to patients in a large-scale clinical trial later this year. Results from previous studies suggest it can halve LDL-C levels in just two weeks.

The trial, a collaboration between the Government and pharmaceutical company Novartis, will provide the drug to NHS patients in England in advance of a cost-effectiveness assessment by NICE.

If approved by NICE, inclisiran could be available to NHS patients next year, the Department for Health and Social Care said. The DHSC said around 40,000

patients who are at risk of heart disease but do not respond to statins will be eligible to participate in the trial. It estimates that if given to 300,000 people annually, inclisiran could prevent 55,000 heart attacks and strokes and save 30,000 lives.

90,000 complete NHS diabetes prevention programme

A total of 89,604 people have completed the NHS diabetes prevention programme, losing an average of just under 3kg each.

The programme, launched in 2016, educates patients on diet, exercise and weight loss. It lasts for nine to 12 months and aims to stop or delay onset of diabetes.

The programme was given the green light for a national rollout in April last year, with the aim of treating 200,000 people annually - although no time scale was set for meeting the goal.

NHS national clinical director for obesity and diabetes Professor Jonathan Valabhji said: ‘Helping people avoid diabetes is potentially life-saving, so these results are encouraging, but ultimately the NHS cannot win the fight against obesity alone, which is why we are providing people with the tools to help themselves – changing lives and freeing up vital NHS resources.’

Smokers ‘less likely to attempt to quit than 10 years ago’

Smokers in England are showing fewer signs of dependence on cigarettes but are less inclined to try to quit than a decade ago, according to data from a 10-year trial.

Researchers from University College London analysed data from 41,610 smokers in England and found that in 2017 smokers were consuming fewer cigarettes a day compared with 2008 and were less likely to smoke within an hour of waking. But the results also showed the proportion of smokers who tried to quit fell from 37% to just under 30%.

Study lead Dr Claire Garnett said: ‘The decline in the proportion of smokers trying to quit or cut down is a worrying trend and may reflect budget cuts on tobacco control, including mass media expenditure and stop smoking services.

‘These are known to be effective and it is a false economy to cut back on these.’

Addiction, Jan 2020

Avoid out-of-area rehab for complex psychosis, says NICE

Out-of-area rehabilitation placements for people with complex psychosis should only be used in exceptional circumstances, draft NICE guidance has suggested.

The draft recommendations, for which consultation ended last month, say exceptions may be made for patients who need highly specialised services, for example those with psychosis with brain injury. Patients moved outside their local area should be told the reason for this and what steps will be taken to return them nearer to home, the guidelines state.

They also highlight the need to review the physical health needs of those with severe mental health conditions, likely to be greater than in the general population.

Director of NICE’s centre for guidelines Paul Chrisp said reducing out-of-area placements would improve patients’ quality of life and cut costs to the NHS.

Wide variation in GPs’ perceptions of emotional distress

There is wide variation in how GPs differentiate between emotional distress. Interviews with 21 GPs revealed a range of opinions on whether or not it is possible to distinguish between the two.

While there was some consensus around ‘biological symptoms’, such as loss of appetite and poor sleep, views varied on whether depression had to be independent of other adverse life events.

Most of those interviewed believed a patient’s circumstances were key when considering symptoms, which the researchers said was at odds with the guideline-promoted approach of using only a validated measure of symptoms and functioning.

They said the findings highlight the complexity of dealing with depression in primary care and echo a wider debate about how to diagnose depression if current criteria are not sophisticated enough.

BMJ Open, Dec 2019

GP-designed AF tool rolled out to UK practices

A new NICE-endorsed tool to improve the care of patients with atrial fibrillation (AF) is being rolled out to more than 4,000 GP practices in the UK.

The tool, designed by GPs and developed by EMIS, uses data from patients’ medical records in real time to spot potential dosage errors, risks of bleeding or stroke, or patients who should be prescribed anticoagulants.

As well as giving personalised information for each stage of the condition, the tool alerts healthcare staff to potential issues, prompting them to open the anticoagulation care pathway, which is based on NICE guidance.

GPs can also use the system to identify patients who are not on treatment, or whose treatment is suboptimal.

Bromsgrove GP and project lead Dr Nic Boeckx said: ‘Uptake of AF tools outside clinical IT systems has been low because they are too time-consuming. Integrating decision support within EMIS Web will, I believe, make relevant guidance instantly accessible and far more impactful.’

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