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41. Menstrual Suppression in Special Circumstances

Library using appropriate controlled vocabulary and key words (heavy menstrual bleeding, menstrual suppression, chemotherapy/radiation, cognitive disability, physical disability, learning disability). Results were restricted to systematic reviews, randomized controlled trials, observation studies, and pilot studies. There were no language or date restrictions. Searches were updated on a regular basis and new material was incorporated into the guideline until September 2013. Grey (unpublished (...) specific indications, contraindications, and side effects, both immediate and long-term, and the investigations and monitoring necessary throughout suppression. Outcomes Clinicians will be better informed about the options and indications for menstrual suppression in patients with cognitive and/or physical disabilities and patients undergoing chemotherapy, radiation, or other treatments for cancer. Evidence Published literature was retrieved through searches of Medline, EMBASE, OVID, and the Cochrane

2019 Society of Obstetricians and Gynaecologists of Canada

42. Monitoring Progress of Neurological and Functional Outcomes in the Paediatric HIV Cohort in the UK

educational or social care support, should be referred to a local Learning Disability (LD) and/or child development services at the earliest opportunity. On-going liaison with LD health and social care organisations is crucial to support the young person’s health, education and transition through education and to adult health services in the future. The health team should support young people to gain age appropriate levels of understanding and independence in their health care, through joint working (...) care is to enhance wellbeing and quality of life outcomes as well as improve the management of the condition and treatment demands. To achieve these, careful attention needs to be given to monitoring all aspects of progress (physical, cognitive, behavioural, learning, social and emotional) and address the changing demands of daily life as a child moves through childhood and adolescence. Background The developing brain is known to be particularly vulnerable to the effects of early biological

2019 The Children's HIV Association

43. Valproate Use In Women and Girls Of Childbearing Years

approach, considering issues through life stages. 1. Girls with epilepsy Our consensus is that the current guidance requires clarity with regard to the age and developmental stage of girls/young people as it is not appropriate for all children/young people in the paediatric population. In order to provide a framework for clinical management, the prescribing needs of children/young people should be considered by age and learning ability (13). The prescribing needs of girls with intellectual disability (...) 14 5.4 Emergency contraception 14 5.5 Adverse effects of contraception 15 5.6 Discontinuation or exchanging of valproate 15 5.7 Women choosing to remain on valproate, but without a PPP 15 5.8 Intellectual Disability (ID) 16 5.8.1 With lack of mental capacity 17 5.8.2 With mental capacity 17 5.9 Women who fail to attend their specialist appointment 17 5.10 Prescribing responsibility: consider shared care 18 5.11 Particular situations that may arise 18 5.11.1 Status epilepticus 18 5.11.2 Women

2019 Royal College of Obstetricians and Gynaecologists

44. Follow-Up Model of Care for Cancer Survivors: Recommendations for the Delivery of Follow-up Care for Cancer Survivors in Ontario

to employment and work re-entry, finances, and disability). These consequences may be temporary or chronic, or they may appear long after treatment was completed. Supportive care is needed to address social, psychological, emotional, spiritual, quality-of-life, and functional aspects of cancer to ensure high quality follow-up care. 7 Primary care providers have reported willingness to provide supportive care for cancer survivors, if clinical guidance, education/training, support from and communication (...) and confidence in managing their health and well-being. Self-management support is underpinned by effective communication skills of health care providers and is augmented by patient education resources and tools that reinforce learning and behaviours. 42,43,44 Survivorship Phase of the cancer continuum following diagnosis and treatment, prior to recurrence of subsequent cancers or death. 7 Follow-Up Model of Care for Cancer Survivors 14 Term Definition Telehealth The delivery of services by healthcare

2019 Cancer Care Ontario

45. Simplified guideline for prescribing medical cannabinoids in primary care

(such as anxiety), sleep disorders, and spasticity in MS. 3 Surveys of medical marijuana users find 70% or more believe medical mari- juana use results in moderate or better improvement in their symptoms. 3 A Canadian study found that functional status among medical marijuana users was worse than among the general population, reporting scores of 28 versus 7 on functional assessment, respectively (using the World Health Organization Disability Assessment Schedule for which possible scores range from 0 to 100 (...) recommend long-term monitoring of medical cannabinoids to further assess potential individual and societal benefits and harms. Dr Allan is Professor of Evidence-Based Medicine in the Department of Family Medicine at the University of Alberta in Edmonton. Mr Ramji, Ms Perry, and Dr Ton are Knowledge Translation Experts in the Physician Learning Program with the Alberta Medical Association and in Lifelong Learning and the Department of Family Medicine at the University of Alberta. Dr Beahm is Research

2018 CPG Infobase

46. Pharmacological management of migraine

produced using the processes described in SIGN 50: a guideline developer’s handbook, 2015 edition (www.sign.ac.uk/guidelines/fulltext/50/ index.html). More information on accreditation can be viewed at www.nice.org.uk/ accreditation 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 (...) headache with a global prevalence of around one in seven people. 8 The Global Burden of Disease study ranks migraine as the seventh most common cause of disability worldwide, rising to the third most common cause in the under 50s. 9 It is estimated that migraine costs the UK around £3 billion a year in direct and indirect costs, taking into consideration the costs of healthcare, lost productivity and disability. 10 Twice as many women as men are affected. 11 This is considered to be due to changes

2018 SIGN

47. Practice guideline: joint CCMG-SOGC recommendations for the use of chromosomal microarray analysis for prenatal diagnosis and assessment of fetal loss in Canada

of specialty genetics centres across Canada, please refer to the Canadian Association of Genetic Counsellors website at www. cagc- accg. ca. Discussion around approaches to incidental findings follows later in this document, but centres that choose to report such findings should ensure that patients receive counselling by quali- fied health professionals, focusing on both the risks and benefits of learning about this type of result. Counselling must include recognition of and discussion of possible adverse (...) outcomes, including parents’ learning about secondary findings that they did not wish to know, such as identification of an adult onset disorder. r ecommendation 4 Given the varied contexts in which prenatal chromosomal microarray analysis may be offered, it is essential that pretest counselling be undertaken by a professional with expertise in the utilisation of CMA in the prenatal setting. The counsel- ling content should be documented in the medical record. This pretest counselling should include

2018 CPG Infobase

48. Diagnosis and management of epilepsy in adults

epilepticus 23 4.11 Patients with recurrent prolonged or serial seizures in the community 26 4.12 Drugs which exacerbate epileptic seizures 27 4.13 Management of patients with epilepsy in the perioperative period 27 4.14 Management of older people with epilepsy 27 4.15 Management of people with learning disability and epilepsy 29 5 Epilepsy and women’s health 31 5.1 Contraception 31 5.2 Preconceptual counselling 35 5.3 Risks of inheriting epilepsy 36 5.4 Pregnancy 38 5.5 Labour and birth 40 (...) after a seizure, and by recordings during sleep or following sleep deprivation. 16, 37, 38 Incidental epileptiform abnormalities are found in 0.5% of healthy young adults, but are more likely in people with learning disability and psychiatric disorders, patients with previous neurological insult (for example head injury, meningitis, stroke, cerebral palsy), and patients who have undergone neurosurgery. 39-41 Diagnosis and management of epilepsy in adults 3 • Diagnosis 2 +10 | In a patient in whom

2018 SIGN

49. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU

Tumors Penis Retroperitoneum Cytology Online Learning For Medical Students Exams/LLL/Certifications Exam Prep Research Research Funding AUA Funding Research Education & Events Online Research Education Courses Research Resources Biorepositories and Other Resources Research Publications Research Career Opportunities Advocacy Scholar & Fellowship Programs Comment Letters & Resources International International Opportunities Annual Meeting Membership Collaborations Academic Exchanges Giving Back

2019 Canadian Urological Association

50. End of life care for infants, children and young people with life-limiting conditions: planning and management

, coping, and building resilience. 1.2.24 Be aware that children and young people may experience rapid changes in their condition and so might need emergency interventions and urgent access to psychological services. 1.2.25 Be aware of the specific emotional and psychological difficulties that may affect children and young people who have learning difficulties or problems with communication. 1.2.26 Provide information to children and young people and their parents or carers about the emotional (...) of 44bone pain (for example associated with metabolic diseases) pressure ulcers headache (for example caused by raised intracranial pressure) musculoskeletal pain (particularly if they have neurological disabilities) dental pain. 1.3.23 Be aware that pain, discomfort and distress may be caused by a combination of factors, which will need an individualised management approach. 1.3.24 For children and young people who have pain or have had it before, regularly reassess for its presence and severity even

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

51. Coexisting severe mental illness and substance misuse: community health and social care services

and employment services. 1.3.2 Ensure the care plan includes an assessment of the person's physical health, social care and other support needs, and make provision to meet those needs. This could include: personal care and hygiene family and personal relationships housing learning new skills for future employment or while in employment (including those administering social security benefits) education Coexisting severe mental illness and substance misuse: community health and social care services (NG58) © (...) that can help to improve wellbeing and create a sense of belonging or purpose. For example, encourage sport or recreation activities, or attendance at community groups that support their physical health or social needs. Ensure activities take account of a range of different abilities. Consider, for example: the gym education opportunities volunteering use of personal budgets (if applicable) for learning new skills, such as those that might support a return to employment. 1.3.6 Consider the following

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

52. Physical health of people in prison

of injury'). No: record no action needed. Other health conditions 4. Does the person have any of the following: allergies, asthma, diabetes, epilepsy or history of seizures chest pain, heart disease chronic obstructive pulmonary disease tuberculosis, sickle cell disease hepatitis B or C virus, HIV, other sexually transmitted infections learning disabilities neurodevelopmental disorders physical disabilities? Ask about each condition listed. Yes: make short notes on any details of the person's condition (...) and they need immediate support. No: record response. Mental health Physical health of people in prison (NG57) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 10 of 3616. Has the person ever seen a healthcare professional or service about a mental health problem (including a psychiatrist, GP , psychologist, counsellor, community mental health services, alcohol or substance misuse services or learning disability services

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

53. Multimorbidity: clinical assessment and management

or schizophrenia ongoing conditions such as learning disability symptom complexes such as frailty or chronic pain sensory impairment such as sight or hearing loss alcohol and substance misuse. 1.1.2 Be aware that the management of risk factors for future disease can be a major treatment burden for people with multimorbidity and should be carefully considered when optimising care. 1.1.3 Be aware that the evidence for recommendations in NICE guidance on single health conditions is regularly drawn from people (...) for adults with social care needs.] T erms used in this guideline Multimorbidity Multimorbidity Multimorbidity refers to the presence of 2 or more long-term health conditions, which can include: defined physical and mental health conditions such as diabetes or schizophrenia ongoing conditions such as learning disability symptom complexes such as frailty or chronic pain sensory impairment such as sight or hearing loss alcohol and substance misuse. The management of risk factors for future disease can

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

54. Harmful sexual behaviour among children and young people

on transition from child to adult services. 1.1.3 Ensure multi-agency, multidisciplinary teams: have links to clinical and non-clinical services and can make prompt referrals collaborate with specialists when children and young people have difficult or complex needs (for example, those with neurodevelopmental or learning disabilities or conduct disorders) establish relationships with statutory, community and voluntary organisations that work with at-risk children and young people, to provide a broad range (...) and adulthood and distinguishes between 3 levels, using a traffic light system to indicate the level of seriousness. Models that place a child or young person's sexual behaviour on a continuum indicating various levels of seriousness, such as Hackett's model [2] . 1.3.5 T ake account of the child or young person's age, developmental status and gender and, if relevant, any neurodevelopmental or learning disabilities. 1.3.6 Recognise that inappropriate sexualised behaviour is often an expression of a range

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

55. Community engagement: improving health and wellbeing and reducing health inequalities

as possible for people to get involved 10 T erms used in this guideline 11 Implementation: getting started 13 Identifying the resources needed 13 Learning and training 13 Evaluation and feedback 15 Need more help? 16 Context 17 Statutory obligations 17 More information 18 The committee's discussion 19 Background 19 Community engagement activities and approaches 20 Health and social inequalities 21 Evidence 21 Health economics 24 Evidence reviews 26 Gaps in the evidence 28 Recommendations for research 30 (...) and wellbeing initiatives (see sections 1.2 and 1.3). Do this by: Using evidence-based approaches to community engagement (see collaborations and partnerships and peer and lay roles). Being clear about which decisions people in local communities can influence and how this will happen. Recognising, valuing and sharing the knowledge, skills and experiences of all partners, particularly those from the local community (see learning and training). Making each partner's goals for community engagement clear

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

56. Transition from children's to adults' services for young people using health or social care services

] . 1.5.5 Consider establishing local, integrated youth forums for transition to provide feedback on existing service quality and to highlight any gaps. These forums should: meet regularly link with existing structures where these exist involve people with a range of care and support needs, such as: people with physical and mental health needs people with learning disabilities people who use social care services. 1.5.6 Ensure that data from education, health and care plans is used to inform service (...) : support the young person for the time defined in relevant legislation, or a minimum of 6 months before and after transfer (the exact length of time should be negotiated with the young person) hand over their responsibilities as named worker to someone in adults' services, if they are based in children's services. 1.2.10 For disabled young people in education, the named worker should liaise with education practitioners to ensure comprehensive student-focused transition planning is provided. This should

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

57. Sunlight exposure: risks and benefits

days absence because of sunburn or other adverse effects (Sun protection: advice for employers of outdoor workers Health and Safety Executive). Cover the needs of all at-risk groups (see recommendation 1.1.1). T ailor advice according to skin type and age. T ailor advice according to needs and circumstances. This includes people for whom English is not a first language, from lower socioeconomic groups, with specific cultural needs, or with a disability. Encourage people to manage their own risk (...) to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 17 of 40Be clearly displayed in communal locations including pharmacies, airports, schools, travel vaccination clinics and appropriate leisure and sporting events. Be available in a variety of formats, including formats that are suitable for people with a disability. Use skin-type charts. A range of charts are available, such as those produced by Cancer Research UK and the British Association of Dermatologists

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

58. Oral health for adults in care homes

they may be home to around 30,000 younger adults with learning disabilities (Emerson et al. 2013 [2] ). The Alzheimer's Society estimates 80% of residents have dementia or severe memory problems (Low expectations). Research with adults in care homes with moderate to severe dementia has reported poor oral health (Preston 2006 [3] ). A 2012 British Dental Association survey (Dentistry in care homes research – UK) found inconsistent oral health care in care homes. It found many residents had oral health (...) , Hatton C, Robertson J et al. (2013) People with learning disabilities in England 2012. Learning Disabilities Observatory: Lancaster. [3] Preston A (2006) The oral health of individuals with dementia in nursing homes. Gerodontology 23 (2): 99–105 Oral health for adults in care homes (NG48) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 15 of 37The committee The committee's discussion 's discussion Evidence statement

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

59. Transition between inpatient mental health settings and community or care home settings

admission Planning and assessment Planning and assessment 1.2.1 Mental health practitioners supporting transition should respond quickly to requests for assessment of mental health from: people with mental health problems family members carers primary care practitioners (including GPs) specialist community teams (for example, learning disability teams) staff such as hostel, housing and community support workers. Assessments for people in crisis should be prioritised. 1.2.2 If admission is being planned (...) people with dementia, cognitive or sensory impairment people on the autistic spectrum Transition between inpatient mental health settings and community or care home settings (NG53) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 7 of 34people with learning disabilities and other additional needs people placed outside the area in which they live. 1.2.5 For planned admissions, offer people an opportunity to visit

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

60. Pain Assessment - Cognitive Impairment

and inadequately managed in people with dementia, learning disabilities or a stroke– seek specialist advice . Actions If the pain is severe and overwhelming immediate treatment may be required before further assessment . Adjust the dose according to current analgesic use seek specialist advice . Assessment Involve the patient as much as possible in the assessment of their pain. Use a team approach: Is there a carer, friend or staff member who knows the patient and can help with the assessment? How (...) and carers. A trial of analgesics, non-pharmacological treatments or both may be appropriate. If opioids are required, discuss any concerns regarding their use. Agree goals for pain relief and a monitoring plan. If pain has not settled within 24 hours seek specialist advice. Agree arrangements for regular review. Practice Points Consider having a pain chart at the patient’s home. Provide written explanations about opioids. Resources DisDAT tool and information on pain assessment for people with learning

2018 Scottish Palliative Care Guidelines

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