Lyme disease [NG95]

New: Guidance


This guideline covers diagnosing and managing Lyme disease. It aims to raise awareness of when Lyme disease should be suspected and ensure that people have prompt and consistent diagnosis and treatment. It does not cover preventing Lyme disease.


https://www.nice.org.uk/guidance/ng95

Sore throat (acute): antimicrobial prescribing [NG 84]

New:  NICE guideline


acute sore throat (including pharyngitis and tonsillitis) is self‑limiting and often triggered by a viral infection of the upper respiratory tract

symptoms can last for around 1 week, but most people will get better within this time without antibiotics, regardless of cause (bacteria or virus).

Assess and manage children under 5 who present with fever as outlined in the NICE guideline on fever in under 5s.

Use FeverPAIN or Centor criteria to identify people who are more likely to benefit from an antibiotic and manage in line with recommendations 1.1.4 to 1.1.13.

Age-related macular degeneration [NG 82]

New:  NICE guideline

1.1 Classifying age-related macular degeneration

1.2 Information and support

1.3 Risk factors

1.4 Diagnosis and referral

1.5 Pharmacological management of AMD

1.6 Non-pharmacological management of AMD

1.7 Monitoring AMD

Terms used in this guideline

Intensive case management for severe mental illness

Intensive Case Management (ICM) is a community-based package of care aiming to provide long-term care for severely mentally ill people who do not require immediate admission. Intensive Case Management evolved from two original community models of care, Assertive Community Treatment (ACT) and Case Management (CM), where ICM emphasises the importance of small caseload (fewer than 20) and high-intensity input.

Read more about the effectiveness of ICM in the Cochrane Database of Systematic Reviews. 

Understanding the distribution of A&E attendances and hospital admissions for the case managed population: A single case cross sectional study

Applied Nursing Research.  http://dx.doi.org/10.1016/j.apnr.2016.10.005

Aim: To describe the characteristics of case-managed patients presenting at accident and emergency (A & E) and to explore the distribution of their attendances and admissions.

Conclusion: The high level of A&E conversion could indicate case-managed patients are presenting appropriately with acute clinical need. However, inadequate provision in primary-care could drive decisions for admitting vulnerable patients.

UHCW Research: Mark Radford

“Case management” can prevent people with heart failure being admitted again

Case management that is initiated in hospital and led by specialist nurses may reduce unplanned hospital readmissions and length of hospital stay for adults with heart failure.

This NIHR review of organisational type research found quite a lot of studies: 17 trials and five other studies, including three from the UK. The interventions used by the individual studies in this review varied widely, which highlights some need for caution in interpreting the pooled findings. There was limited evidence that hospital-initiated case management is cost effective – particularly in relation to the NHS. A few studies examined case management that was started in the community.

The findings are promising and may lead to further studies that confirm these findings in the UK setting. Commissioners would also need to know other things too, such as the components of case management that are most beneficial and the costs.

From the NIHR Dissemination Centre