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21. End of life care for adults: service delivery

reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 8 of 351.4 1.4 Pro Providing information viding information 1.4.1 For advice on communication, information and shared decision making, see the NICE guidelines on patient experience in adult NHS services and people's experience in adult social care services. Apply the same principles for communication and information giving to carers of all ages. 1.4.2 For people with learning disabilities, use (...) this guideline alongside the recommendations on end of life care in the NICE guideline on care and support of people growing older with learning disabilities. 1.4.3 Support and enable adults approaching the end of their life to actively participate in decision making by having in place: processes to establish the amount and type of information they would prefer systems to provide information in a way that meets their communication needs and preferences, for example, how it is given (verbally, on paper

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

22. Crohn’s disease: management

and Harvey-Bradshaw Index, healthcare professionals should take into account any physical, sensory or learning disabilities, or communication difficulties that could affect the scores and make any adjustments they consider appropriate. [2010] [2010] 1.2.20 Treatment with infliximab or adalimumab should only be started and reviewed by clinicians with experience of TNF inhibitors and of managing Crohn's disease. [2010] [2010] Ustekinumab and v Ustekinumab and vedolizumab edolizumab 1.2.21 For guidance

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

23. Suspected neurological conditions: recognition and referral

of the thigh (meralgia paraesthetica) that the condition is benign and might improve spontaneously. Consider referring for pain management only if the symptoms are severe. Cervical or lumbar r Cervical or lumbar radiculopath adiculopathy y 1.10.11 Do not routinely refer adults with symptoms of cervical radiculopathy that have remained stable for 6 weeks or more unless: pain is not controlled with analgesics or or the symptoms are disabling or or Suspected neurological conditions: recognition and referral (...) unless pain is not controlled with analgesics or symptoms are disabling, in line with the NICE guideline on low back pain and sciatica in over 16s. Tingling or sensory disturbances on waking from sleep Tingling or sensory disturbances on waking from sleep 1.10.13 Do not routinely refer adults with recurrent episodes of tingling or sensory disturbance in the limbs that are present on waking from sleep and last less than 10 minutes. T o find out why the committee made the recommendations on sensory

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

24. Attention deficit hyperactivity disorder: diagnosis and management

://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 6 of 62The size and time commitment of these teams should depend on local circumstances (for example, the size of the trust, the population covered and the estimated referral rate for people with ADHD). [2008, amended 2018] [2008, amended 2018] 1.1.3 Every locality should develop a multi-agency group, with representatives from multidisciplinary specialist ADHD teams, paediatrics, mental health and learning disability trusts, forensic services (...) of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 8 of 62disorders, learning disability [intellectual disability] and specific learning difficulties) adults with a mental health condition people with a history of substance misuse people known to the Youth Justice System or Adult Criminal Justice System people with acquired brain injury. [2018] [2018] 1.2.2 Be aware that ADHD is thought to be under-recognised in girls and women and that: they are less likely to be referred

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

25. Physical activity and the environment

, for example by providing safe areas in which children can play and picnic facilities lighting and other measures to prevent or reduce antisocial behaviour, such as maintaining vegetation clear signs that can be understood by everyone, including people with visual impairments and learning disabilities seats with arms and backrests, sited at frequent intervals shelter and shade accessible toilets that are clean, well maintained and unlocked during daylight hours footpaths with even, non-reflective, anti (...) their needs. Examples may include: some disabled people, including people with sensory impairments or learning disabilities people using wheelchairs, cycles or other mobility aids, or those supporting people using these aids Physical activity and the environment (NG90) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 14 of 57some older or frail people people using buggies, prams or cargo cycles for transporting children

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

26. Hearing loss in adults: assessment and management

, or recurs abnormal appearance of the outer ear or the eardrum, such as: inflammation polyp formation perforated eardrum abnormal bony or skin growths swelling of the outer ear blood in the ear canal a middle ear effusion in the absence of, or that persists after, an acute upper respiratory tract infection. Adults with suspected or diagnosed dementia, mild cognitiv Adults with suspected or diagnosed dementia, mild cognitive impairment or a e impairment or a learning disability learning disability 1.1.8 (...) Consider referring adults with diagnosed or suspected dementia or mild cognitive impairment to an audiology service for a hearing assessment because hearing loss may be a comorbid condition. 1.1.9 Consider referring adults with diagnosed dementia or mild cognitive impairment to an audiology service for a hearing assessment every 2 years if they have not previously been diagnosed with hearing loss. 1.1.10 Consider referring people with a diagnosed learning disability to an audiology service

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

27. Dementia: assessment, management and support for people living with dementia and their carers

with learning disabilities, see the NICE guideline on mental health problems in people with learning disabilities. Diagnosis in specialist dementia diagnostic services Diagnosis in specialist dementia diagnostic services 1.2.9 Diagnose a dementia subtype (if possible) if initial specialist assessment (including an appropriate neurological examination and cognitive testing) confirms cognitive decline and reversible causes have been ruled out. 1.2.10 If Alzheimer's disease is suspected, include a test (...) accessible Making services accessible 1.3.6 Service providers should design services to be accessible to as many people living with dementia as possible, including: people who do not have a carer or whose carer cannot support them on their own people who do not have access to affordable transport, or find transport difficult to use people who have other responsibilities (such as work, children or being a carer themselves) people with learning disabilities, sensory impairment (such as sight or hearing

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

28. Flu vaccination: increasing uptake

such as oncology or antenatal. Social care staff who may have contact with carers and other eligible groups, such as people with learning disabilities. This may include during home visits, individual needs assessments and carers' assessments. Flu vaccination: increasing uptake (NG103) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 6 of 731.2.2 Provide information on the following as part of an education programme on flu (...) an undiagnosed clinical condition) access health services attend healthcare appointments. The groups classified as underserved in this guideline are: Flu vaccination: increasing uptake (NG103) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 19 of 73people who are homeless or sleep rough people who misuse substances asylum seekers Gypsy, Traveller and Roma people people with learning disabilities young people leaving long

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

29. Preventing suicide in community and custodial settings

on the management of prisoners at risk of harm to self, to others and from others). 1.5.3 T ake into account socioeconomic deprivation, disability, physical and mental health status, and cultural, religious and social norms about suicide and help- seeking behaviour, particularly among groups at high suicide risk. 1.5.4 Ensure the language and content of any awareness-raising materials is: appropriate for the target group sensitive and compliant with media reporting guidelines, such as the Samaritans' Media (...) suicide in community and custodial settings (NG105) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 13 of 32In custodial settings, for example, provide safer cells (see the Ministry of Justice's Quick-time learning bulletin: safer cells). In the community, for example, restrict access to painkillers (see NHS England's Items which should not be routinely prescribed in primary care: guidance for CCGs, Medicines

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

30. Decision-making and mental capacity

decisions, for example, about their personal welfare, medical treatment, property or affairs facilitating their involvement in decisions that may be made, or are being made under the Mental Capacity Act 2005. 1.1.8 As a minimum, independent advocacy must be offered by local authorities as described in the Care Act 2014, Mental Capacity Act 2005 and Mental Health Act 2007. [This recommendation is adapted from the NICE guideline on learning disabilities and behaviour that challenges: service design (...) to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 4 of 41Conte Context xt The Care Quality Commission (CQC) estimates that around 2 million people in England and Wales may lack the capacity to make certain decisions for themselves at some point because of illness, injury or disability. The Mental Capacity Act 2005 was designed to empower and protect individuals in these circumstances. However, the CQC identified serious issues with the practical implementation

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

31. Children and young people exposed prenatally to alcohol

at risk of FASD, including child development specialists, clinical and educational psychologists, clinical geneticists, general practitioners (GPs) and members of the primary care team, health visitors, members of the judicial system, midwives, neonatologists, nurses (eg school, learning disability and others), obstetricians, occupational therapists, paediatricians, physicians, physiotherapists, psychiatrists, social workers and speech and language therapists. It will also be of interest to people (...) includes a section for recording of sentinel facial features is available for download from the SIGN website. 3.4 Neurodevelopmental assessment 3.4.1 Areas of assessment The neurodevelopmental deficits associated with FASD are complex and multifaceted. It is well established that learning disabilities, 77 inattention, 78 social 79 and executive function deficits 80 can occur regardless of facial dysmorphology. There is no single neuropsychological measure, nor pattern of neuropsychological profiles

2019 SIGN

32. British guideline on the management of asthma

; or Extrapolated evidence from studies rated as 2 + Good-practice points ? Recommended best practice based on the clinical experience of the guideline development group. Healthcare Improvement Scotland (HIS) is committed to equality and diversity and assesses all its publications for likely impact on the six equality groups defined by age, disability, gender, race, religion/belief and sexual orientation. SIGN guidelines are produced using a standard methodology that has been equality impact assessed to ensure

2019 SIGN

33. Guidelines for diagnosing and managing pediatric concussion

. B On Discharge (what do we tell parents and/or caregivers?) Number Evidence 3.1 Provide verbal information and written handouts to the child/adolescent and the parents and/or caregivers. A/B 3.1a Inform on the expected course of recovery and return-to-learn/play. B 3.1b Advise on the risks and complications of re-injury, especially of persistent symptoms. B 3.1c Advise on managing sleep proactively. C 3.1d Advise on managing headaches. B 3.1e Advise on coping with fatigue. B 3.1f Advise (...) /adolescent return to learn/play?) Number Evidence 4.1 Recommend that the child/adolescent follow a stepwise return-to-learn plan. B/C 4.2 Develop a return-to-learn program after acute symptoms have improved. B/C 4.3 Recommend additional assessment and accommodations if symptoms worsen or fail to improve. B/C 4.4 Develop a return-to-play program only after the child/adolescent has started his/her return-to-learn program. B 4.5 Refer any child/adolescent who has sustained multiple concussions to an expert

2019 CPG Infobase

34. Child abuse and neglect

Working with children and y orking with children and young people oung people 1.1.1 T ake a child-centred approach to all work with children and young people. Involve them in decision-making to the fullest extent possible depending on their age and developmental stage. 1.1.2 Use a range of methods (for example, drawing, books or activities if appropriate) for communicating with children and young people. T ailor communication to: their age and developmental stage any disabilities, for example learning (...) solutions avoiding blame, even if they may be responsible for the child abuse or neglect inviting, recognising and discussing any worries they have about specific interventions they will be offered identifying what they are currently doing well, and building on this making adjustments for any factors which may make it harder for them to get support, such as refugee status, long-term illness, neurodevelopmental disorders, mental health problems, disability or learning disability being sensitive

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

35. Glaucoma: diagnosis and management

circumstances rule out gonioscopy (for example, when people with physical or learning disabilities are unable to participate in the examination). [2009] [2009] 1.2.4 Obtain an optic nerve head image at diagnosis for baseline documentation (for example, a stereoscopic optic nerve head image or OCT). [2009, amended 2017] [2009, amended 2017] 1.2.5 After referral, consider an early assessment appointment when there is clinical concern based on the information provided. [2017] [2017] 1.2.6 At the time (...) choice current systemic and topical medication glaucoma medication record drug allergies and intolerances. [2009] [2009] 1.3.2 Use alternative methods of assessment if clinical circumstances rule out Glaucoma: diagnosis and management (NG81) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 7 of 41standard methods (for example, when people with physical or learning disabilities are unable to participate

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

36. Cataracts in adults: management

of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 21 of 23The development and validation of suitable vision-specific, quality-of-life measures would aid the decision-making process for cataract surgery, and help to accurately quantify the quality of life gains that may be expected from surgery. Particular consideration should be given to people with learning disabilities/cognitive impairment, or any other groups who may find it more difficult to self-report their own (...) the anterior and posterior corneal curvature. Do not use standard biometry techniques or historical data alone. 1.3.8 Surgeons should think about modifying a manufacturer's recommended intraocular lens constant, guided by learning gained from their previous deviations from predicted refractive outcomes. Second-e Second-ey ye prediction e prediction 1.3.9 Consider using 50% of the first-eye prediction error in observed refractive outcome to guide calculations for the intraocular lens power for second-eye

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

37. Intermediate care including reablement

-and- conditions#notice-of-rights). Page 14 of 28positive risk taking. 1.8.2 Ensure that intermediate care staff are able to recognise and respond to: common conditions, such as diabetes; mental health and neurological conditions, including dementia; frailty; stroke; physical and learning disabilities; sensory loss; and multi-morbidity common support needs, such as nutrition, hydration, continence, and issues related to overall skin integrity common support needs, such as dealing with bereavement and end (...) of assessment and delivery, ensure good communication between intermediate care practitioners and: other agencies people using the service and their families and carers. 1.1.3 Intermediate care practitioners should: work in partnership with the person to find out what they want to achieve and understand what motivates them focus on the person's own strengths and help them realise their potential to regain independence build the person's knowledge, skills, resilience and confidence learn to observe and guide

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

38. Developmental follow-up of children and young people born preterm

enterocolitis that needed surgery neonatal sepsis severe retinopathy of prematurity. 1.2.5 Be aware that there is an increased prevalence of developmental coordination disorder in children born preterm compared with the general population. L Learning disability (intellectual disability) earning disability (intellectual disability) 1.2.6 Be aware that children born preterm are at increased risk of learning disability (intellectual disability), and that: the following are independent risk factors: grade 3 (...) investigation or referral if a developmental problem or disorder is suspected or present refer the child to the appropriate local pathway if needed. 1.3.8 At each face-to-face follow-up visit and developmental assessment for a child born preterm who is having enhanced developmental surveillance, check for signs and symptoms of developmental problems and disorders as appropriate, such as: cerebral palsy (see recommendation 1.3.9) global developmental delay and learning disability (intellectual disability

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

39. Eating disorders: recognition and treatment

/terms-and- conditions#notice-of-rights). Page 5 of 40any physical or other mental health problems or disabilities. 1.1.3 Healthcare professionals assessing people with an eating disorder (especially children and young people) should be alert throughout assessment and treatment to signs of bullying, teasing, abuse (emotional, physical and sexual) and neglect. For guidance on when to suspect child maltreatment, see the NICE guideline on child maltreatment. Communication and information Communication (...) the person practice in their daily life what they have learned. 1.3.6 MANTRA for adults with anorexia nervosa should: typically consist of 20 sessions, with: weekly sessions for the first 10 weeks, and a flexible schedule after this up to 10 extra sessions for people with complex problems base treatment on the MANTRA workbook motivate the person and encourage them to work with the practitioner be flexible in how the modules of MANTRA are delivered and emphasised when the person is ready, cover nutrition

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

40. Mental health of adults in contact with the criminal justice system

this guideline with the NICE guidelines on service user experience in adult mental health and patient experience in adult NHS services to improve the experience of care for people with mental health problems including those with neurodevelopmental disorders. 1.1.2 Use this guideline with any NICE guidelines on specific mental health problems [1] . T ake into account: the nature and severity of any mental health problem the presence of a learning disability or any acquired cognitive impairment other (...) learning disabilities), cognitive impairments, or physical health problems or disabilities. Seek advice or involve specialists if needed. 1.3 Identification and assessment throughout the care pathway 1.3.1 Be vigilant for the possibility of unidentified or emerging mental health problems in people in contact with the criminal justice system, and review available records for any indications of a mental health problem. 1.3.2 Ensure all staff working in criminal justice settings are aware of the potential

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

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