Nice foam or NICE and FOAM

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Nice foam or NICE and FOAM:

Nice foam or NICE and FOAM Mr.Mohamed Omar El- Farok , M.SC, FRCSENG,FRCSED

Where I do stand:

Where I do stand I do not agree with duplex guided foam sclerotherapy for venous telangiectasia in my country and these situations I do not agree with duplex guided foam sclerotherapy for venous ulcerations as there are other equally effective alternatives in my country in these situations

Documents on Foam:

Documents on Foam IPG217 at year 2007 and not available anymore IPG314 August 2009 IPG440 updated nov 2012 IP244 Dec 2012 Equality impact assessment IPG440 Jan 2013 IPG440 Feb 2013 Information for the public on UGFS feb 2013

Coding of guidelines :

Coding of guidelines Yes , in favour of UGFS Against the UGFS Equivocal

2- IPG314 August 2009 :

2- IPG314 August 2009

What does it say:

What does it say 4 pages , It replaces IPG217 It mentions procedure , efficacy and safety And comments

PowerPoint Presentation:

2.5.1 The Committee noted that there was considerable variability in foam preparation such that there was insufficient evidence to draw conclusions on the relative safety of different types and strengths of sclerosing agents, volume of foam and foam -producing techniques.

PowerPoint Presentation:

2.5.2 The Committee also noted that some recent publications addressed the systemic events following foam sclerotherapy , indicating evolving techniques and postprocedural care to reduce side effects.

PowerPoint Presentation:

3.2 The National Patient Safety Agency runs the National Reporting and Learning System (NRLS), and clinicians should report any serious adverse events relating to the use of this procedure to the NRLS (www.npsa.nhs.uk/nrls).

PowerPoint Presentation:

3.1 This guidance requires that clinicians undertaking the procedure make special arrangements for audit. NICE has identified relevant audit criteria and developed an audit tool (which is for use at local discretion) available from www.nice.org.uk/IPG314

PowerPoint Presentation:

Interventional procedures guidance makes recommendations on the safety and efficacy of a procedure. The guidance does not cover whether or not the NHS should fund a procedure. Decisions about funding are taken by local NHS bodies (primary care trusts and hospital trusts) after considering the clinical effectiveness of the procedure and whether it represents value for money for the NHS. Interventional procedures guidance is for healthcare professionals and people using the NHS in England, Wales,Scotland and Northern Ireland. This guidance is endorsed by NHS QIS for implementation by NHSScotland .

PowerPoint Presentation:

1.1 Current evidence on ultrasound-guided foam sclerotherapy for varicose veins shows that it is efficacious in the short term. The evidence on safety includes systemic side effects in some patients. Therefore, this procedure should only be used with special arrangements for clinical governance, consent and audit

PowerPoint Presentation:

1.3 The procedure should only be undertaken using sclerosants licensed for varicose veins. The practice of mixing liquid sclerosant with air or other gas constitutes off-label use.

3- IPG440 updated nov 2012 :

3- IPG440 updated nov 2012 40 pages prepared in August 2012 and updated in November 2012 Analyse all papers published with views of surgeons and radiologists doing this procedure There was no recommendations of this work

4- IP244 Dec 2012 :

4- IP244 Dec 2012 Consultants comments table It is 7 pages Mostly were in favor of using foam

5 -Equality impact assessment IPG440 Jan 2013 :

5 -Equality impact assessment IPG440 Jan 2013

PowerPoint Presentation:

It is 4 pages Because there are more VVs in females than males There was no unequality issues that has been described Documet approved to have no unequality issues

6- IPG440 Feb 2013 :

6- IPG440 Feb 2013

PowerPoint Presentation:

7 pages Issued feb 2013 Replaces previous IPG314

PowerPoint Presentation:

NICE interventional procedure guidance makes recommendations on the safety and efficacy of the procedure. It does not cover whether or not the NHS should fund a procedure. Funding decisions are taken by local NHS bodies after considering the clinical effectiveness of the procedure and whether it represents value for money for the NHS. It is for healthcare professionals and people using the NHS in England, Wales, Scotland and Northern Ireland, and is endorsed by Healthcare Improvement Scotland for implementation by NHSScotland .

PowerPoint Presentation:

Your responsibility This guidance represents the views of NICE and was arrived at after careful consideration of the available evidence. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement . This guidance does not, however, override the individual responsibility of healthcare professionals to make appropriate decisions in the circumstances of the individual patient, in consultation with the patient and/or guardian or carer .

PowerPoint Presentation:

1.1 Current evidence on the efficacy of ultrasound-guided foam sclerotherapy for varicose veins is adequate. The evidence on safety is adequate, and provided that patients are warned of the small but significant risks of foam embolization ( see section 1.2), this procedure may be used with normal arrangements for clinical governance, consent and audit.

PowerPoint Presentation:

1.2 During the consent process, clinicians should inform patients that there are reports of temporary chest tightness, dry cough, headaches and visual disturbance, and rare but significant complications including myocardial infarction, seizures, transient ischaemic attacks and stroke.

7- Information for the public on UGFS feb 2013 :

7- Information for the public on UGFS feb 2013

PowerPoint Presentation:

What has NICE said? This procedure can be offered routinely as a treatment option for people with varicose veins provided that doctors are sure that: • the patient understands the risks of the treatment, what is involved and agrees to the treatment, and • the results of the procedure are monitored. The risks of the treatment include temporary chest tightness, dry cough, headaches, problems with vision, and rare but serious problems such as heart attack, fits and stroke (including transient ischaemic attacks, known as ‘mini-strokes’).

PowerPoint Presentation:

What does this mean for me? NICE has said that this procedure is safe enough and works well enough for use in the NHS. If your doctor thinks that treating varicose veins with foam injections using ultrasound guidance is a suitable treatment option for you, he or she should still make sure you understand the benefits and risks before asking you to agree to it.

My conclusion :

My conclusion In EGYPT 2013 with the current circumstanes I do not recommend to give UGFS for venous telegiectasia for sure and for most cases of venous ulcer unless there is no other alternative

PowerPoint Presentation:

Thank you

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