Clin Med
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Infliximab is a biological agent that is licensed for the treatment of severe Crohn's disease. The annual cost of infliximab treatment is approximately pound 16,456 (excl VAT). In May 2010, the National Institute for Health and Clinical Excellence (NICE) recommended that patients should receive biological agents as a planned course of treatment only until treatment failure or until 12 months after the start of treatment, whichever is shorter. ⋯ Four patients were in deep clinical remission and discontinued infliximab. Implementation of the NICE recommendations on the use of infliximab in Crohn's disease is likely to be challenging in the face of significant resistance from patients who have an understandable fear of relapse. It might be more appropriate to discuss treatment withdrawal when high-quality evidence is available to support this management option.
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The role of cardiac computed tomography (CT) in the assessment and management of patients with suspected cardiac chest pain has been formally recognised in NICE guidance 95. When the technique and patient selection are appropriate, cardiac CT is a valuable diagnostic tool, particularly for patients with a low to intermediate pre-test probability of coronary artery disease. The physician must be aware of the implications of the recent guidelines; hence, we present an illustrated synopsis on the current technique and the indications for the use of calcium scoring and cardiac CT in the assessment and management of patients with suspected cardiac chest pain.
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Medical training is a complex endeavour and analysing its quality is not a simple task. The accuracy of information, particularly of data gathered from trainees, will depend greatly on its source, on perceptions relating to confidentiality and on the uses to which the data are put. These factors should guide our choice of feedback instrument. ⋯ Administrative support is needed but the workload should not be onerous, especially if an on-line process can be developed. Strong evidence to support the validity of this instrument has been collected. The next step is the development and evaluation of the approach as an online process.