Quality standards supporting care for conditions.

Prostate cancer
Prostate cancer is the most common cancer in men, with 35,567 diagnosed in England in 2011. It is more common in men aged over 65 and as the population ages, more cases are expected to occur.

NICE published a quality standard to help the NHS provide high quality care to men with prostate cancer. It highlights key areas of care that if addressed, can contribute to:

• improving patient quality of life;
• reduce premature death from disease;
• patients have better hospital care experience
• improve need for care and support.

Osteoarthritis is a common condition affecting joints, most commonly knees, hips and smaller joints of the hand. It is a leading cause of pain and disability worldwide and in the UK about 2 million people see their GP annually with the large majority of hip and knee replacements caused by osteoarthritis.

The NICE quality standard for osteoarthritis has 8 statements covering diagnosis, assessment, management, ongoing review and referral for joint surgery of adults with osteoarthritis. It highlights need to reduce unnecessary diagnostic investigations while providing advice and support to exercise and (as appropriate) losing weight.

Personality disorders: borderline and antisocial
Borderline and antisocial personality disorders are distinctive conditions that affect people differently and each have different care pathways. Diagnosis affects how condition is managed and interventions and services that are appropriate.

Symptoms of BPD include having emotions that are up and down, unstable sense of identity, self-image and mood with fear of abandonment, rejection, and a strong tendency towards suicidal thinking and self-harm. As a result, people with BPD can have difficulties making and maintaining relationships.

Traits of ASPD include impulsivity, anger and associated behaviours including recklessness and deceitfulness. As a result, people with ASPD may experience unstable interpersonal relationships and may disregard consequences of their behaviour and feelings of others.

The NICE quality standard on personality disorders: borderline and antisocial consists of 7 statements that highlight different aspects of high quality care that should be available to people with these disorders. These include ensuring that people with possible borderline or antisocial personality disorder have a structured assessment by a specialist in mental health before they are given a diagnosis. The quality standard also states that people with borderline or antisocial personality disorder are only prescribed antipsychotic or sedative medication for a short time if they have a crisis or if they have another condition that needs that medication.

Pressure ulcers
A pressure ulcer, also known as a pressure sore or bed sore, occurs when pressure is placed on the skin for a considerable amount of time, restricting blood supply. Typically, they occur in a person confined to a bed or chair most of the time by an illness. They affect people of all ages, but people over 70 are particularly at risk because they are more likely to have mobility problems, and because of their skin being more fragile.

The new NICE quality standard on pressure ulcers covers the prevention, assessment and management of pressure ulcers in all settings, including hospitals, care homes with and without nursing, and people’s own homes. It covers people of all ages, from neonates to older people.

Urinary tract infections in adults
Urinary tract infection (UTIs) in adults is common : about 10–20% of women experience a symptomatic UTI – and its the second most common reason for treating with antibiotics. There is high evidence of variation in use of diagnostic tests, interpretation of signs or symptoms and initiation of antibiotic treatment.

Drawing on Scottish Intercollegiate Guidelines Network 2012 guideline on managing suspected bacterial urinary tract infection in adults, the new NICE quality standard on UTI in adults consists of 7 statements focusing on the assessment, diagnosis and treatment of UTI in adults.

These include highlighting that men with symptoms of an upper urinary tract infection are referred to a specialist for urological tests, and that adults with catheters and non-pregnant women who have bacteria in their urine but no symptoms of urinary tract infection should not be prescribed antibiotics.

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