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1641. Cardiovascular disease: identifying and supporting people most at risk of dying early

Adults who are disadvantaged include (but are not limited to): those on a low income (or who are members of a low-income family) those on benefits those living in public or social housing some members of black and minority ethnic groups those with a mental health problem those with a learning disability those who are institutionalised (including those serving a custodial sentence) those who are homeless. Local agencies (such as local authorities and primary care trusts [PCTs]) define disadvantaged (...) 5: training and capacity 14 2 Public health need and practice 16 Factors linked to health inequalities 16 T ackling health inequalities 17 Challenges to preventing cancer and CVD 18 3 Considerations 19 4 Implementation 22 5 Recommendations for research 23 6 Updating the recommendations 24 7 Related NICE guidance 25 8 References 26 Appendix A: Membership of the Public Health Interventions Advisory Committee (PHIAC), the NICE project team and external contractors 28 Public Health Interventions

2008 National Institute for Health and Clinical Excellence - Clinical Guidelines

1642. Antenatal care for uncomplicated pregnancies

the Welsh Government. Good communication between healthcare professionals and women is essential. It should be supported by evidence-based, written information tailored to the woman's needs. Care and information should be culturally appropriate. All information should also be accessible to women with additional needs such as physical, sensory or learning disabilities, and to women who do not speak or read English. Every opportunity should be taken to provide the woman and her partner or other relevant (...) (CG62) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 10 of 471.1.1.2 Information should be given in a form that is easy to understand and accessible to pregnant women with additional needs, such as physical, sensory or learning disabilities, and to pregnant women who do not speak or read English. [2008] [2008] 1.1.1.3 Information can also be given in other forms such as audiovisual or touch-screen technology

2008 National Institute for Health and Clinical Excellence - Clinical Guidelines

1643. Mental wellbeing in over 65s: occupational therapy and physical activity interventions

therapy aims to enable people who have physical, mental and/or social needs, either from birth or as a result of accident, illness or ageing, to achieve as much as they can to get the most out of life (College of Occupational Therapists 2008). If need exceeds the resources available, there should be a focus on the most disadvantaged older people, for example, those with physical or learning disabilities, those on very low incomes or living in social or rural isolation, including older people from (...) and setting competencies, standards and continuing professional development schemes. NHS and local authority senior managers, human resources and training providers and employers of residential and domiciliary care staff in the private and voluntary sector. What action should they tak What action should they take? e? Involve occupational therapists in the design and development of locally relevant training schemes for those working with older people. Training schemes should include: essential knowledge

2008 National Institute for Health and Clinical Excellence - Clinical Guidelines

1644. Familial hypercholesterolaemia: identification and management

Drug treatment Drug treatment Adults Adults 1.3.1.1 When offering lipid-modifying drug therapy to adults with FH, healthcare professionals should inform the person that this treatment should be lifelong. [2008] [2008]. 1.3.1.2 Offer a high-intensity statin with the lowest acquisition cost as the initial treatment for all adults with FH and aim for at least a 50% reduction in LDL -C concentration from the baseline measurement. [2017] [2017] 1.3.1.3 The dose of statin should be increased (...) of initial statin therapy or because dose titration is limited by intolerance to the initial statin therapy (as defined in recommendation 1.3.1.9) and and a change from initial statin therapy to an alternative statin is being considered. [2016] [2016] 1.3.1.7 When prescribing ezetimibe co-administered with a statin, ezetimibe should be prescribed on the basis of lowest acquisition cost [2] . [2016] [2016] Familial hypercholesterolaemia: identification and management (CG71) © NICE 2018. All rights

2008 National Institute for Health and Clinical Excellence - Clinical Guidelines

1645. Atopic eczema in under 12s: diagnosis and management

be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. Parents or carers should also be given the information and support they need. Atopic eczema in under 12s: diagnosis and management (CG57) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 7 of 40K Ke ey priorities for implementation y priorities for implementation Assessment of se (...) Contents Overview 5 Who is it for? 5 Introduction 6 Child-centred care 7 Key priorities for implementation 8 1 Guidance 13 1.1 Diagnosis 13 1.2 Assessment of severity, psychological and psychosocial wellbeing and quality of life 14 1.3 Epidemiology 15 1.4 Identification and management of trigger factors 16 1.5 Treatment 17 1.6 Education and adherence to therapy 26 1.7 Indications for referral 27 2 Notes on the scope of the guidance 29 3 Implementation in the NHS 30 4 Research recommendations 31 4.1

2007 National Institute for Health and Clinical Excellence - Clinical Guidelines

1646. Faecal incontinence in adults: management

Introduction 5 Key priorities for implementation 6 1 Guidance 10 1.1 Good practice in managing faecal incontinence 10 1.2 Baseline assessment 12 1.3 Initial management 13 1.4 Specialised management 17 1.5 Specialist assessment 18 1.6 Long-term management 18 1.7 Management of specific groups 19 1.8 Surgery 22 More information 24 2 Research recommendations 25 2.1 Pelvic floor muscle training 25 2.2 Patient-rated outcomes 25 2.3 Self-care educational programmes 26 2.4 Bowel management programme 26 2.5 (...) with neurological or spinal disease/injury (for example, spina bifida, stroke, multiple sclerosis, spinal cord injury) people with severe cognitive impairment people with urinary incontinence people with pelvic organ prolapse and/or rectal prolapse people who have had colonic resection or anal surgery people who have undergone pelvic radiotherapy people with perianal soreness, itching or pain people with learning disabilities When assessing faecal incontinence healthcare professionals should: be aware

2007 National Institute for Health and Clinical Excellence - Clinical Guidelines

1647. Drug misuse in over 16s: psychosocial interventions

with additional needs, such as physical, sensory or learning disabilities, and to people who do not speak or read English. If the service user agrees, families and carers should have the opportunity to be involved in decisions about treatment and care. Families and carers should also be given the information and support they need. Drug misuse in over 16s: psychosocial interventions (CG51) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice (...) Sarah Hopkins ah Hopkins Project Manager, National Collaborating Centre for Mental Health (2006–2007) Ms Rebecca King Ms Rebecca King Project Manager, National Collaborating Centre for Mental Health (2005–2006) Drug misuse in over 16s: psychosocial interventions (CG51) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 28 of 38Mr Tim L Mr Tim Leighton eighton Head of Professional Education, Training and Research

2007 National Institute for Health and Clinical Excellence - Clinical Guidelines

1648. Acute illness in adults in hospital: recognising and responding to deterioration

to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. If the patient agrees, families and carers should have the opportunity to be involved in decisions about treatment and care. Families and carers should also be given the information and support they need. Acutely ill adults in hospital: recognising and responding to deterioration (CG50) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk (...) this frequency for an individual patient. The frequency of monitoring should increase if abnormal physiology is detected, as outlined in the recommendation on graded response strategy. Staff caring for patients in acute hospital settings should have competencies in monitoring, measurement, interpretation and prompt response to the acutely ill patient appropriate to the level of care they are providing. Education and training should be provided to ensure staff have these competencies, and they should

2007 National Institute for Health and Clinical Excellence - Clinical Guidelines

1649. Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): diagnosis and management

, and the information people with CFS/ME (and their families and carers as appropriate) are given about it, should be culturally appropriate. It should also be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. Carers and relatives should have the opportunity to be involved in decisions about the patient's care and treatment, unless the patient specifically excludes them. Carers and relatives should also be given (...) to help people with CFS/ ME to return to them when they are ready and fit enough. This may include, with the informed consent of the person with CFS/ME, liaising with employers, education providers and support services, such as: occupational health services disability services through Jobcentre Plus schools, home education services and local education authorities disability advisers in universities and colleges. Specialist CFS/ME care Specialist CFS/ME care Any decision to refer a person to specialist

2007 National Institute for Health and Clinical Excellence - Clinical Guidelines

1650. Long-acting reversible contraception

Counselling about contraception should be sensitive to cultural differences and religious beliefs. [2005] 1.1.2.3 Healthcare professionals should have access to trained interpreters for women who are not English speaking, and to advocates for women with sensory impairments or learning disabilities. [2005] 1.1.3 1.1.3 Contr Contraceptiv aceptive prescribing e prescribing 1.1.3.1 A medical history – including relevant family, menstrual, contraceptive and sexual history – should be taken as part (...) and before the menopause, and by particular groups, including women who have HIV, learning disabilities or physical disabilities, or are younger than 16 years. Drug recommendations The guideline will assume that prescribers will use a drug's summary of product characteristics to inform decisions made with individual patients. Long-acting reversible contraception (CG30) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 5

2005 National Institute for Health and Clinical Excellence - Clinical Guidelines

1651. Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition

be supported by evidence-based written information tailored to the patient's needs. Treatment and care, and the information patients are given about it, should be culturally appropriate. It should also be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. Carers and relatives should have the opportunity to be involved in decisions about the patient's care and treatment, if the patient agrees to this. Carers (...) -and- conditions#notice-of-rights). Page 8 of 37Key organisational priorities All healthcare professionals who are directly involved in patient care should receive education and training, relevant to their post, on the importance of providing adequate nutrition. Healthcare professionals should ensure that all people who need nutrition support receive coordinated care from a multidisciplinary team. [1] All acute hospital trusts should employ at least one specialist nutrition support nurse. All hospital trusts

2006 National Institute for Health and Clinical Excellence - Clinical Guidelines

1652. Obesity prevention

also be accessible to people with additional needs such as physical, sensory or learning disabilities, and to people who do not speak or read English. For older children who are overweight or obese, a balance needs to be found between the importance of involving parents and the right of the child to be cared for independently. If people do not have the capacity to make decisions, healthcare professionals should follow the Department of Health's advice on consent and the code of practice (...) building regulations and policies, particularly in relation to access for disabled people. Section 3 has links to tools to help with implementing the recommendations, meeting training needs, evaluating the impact of action and working in partnership with other organisations. Ov Over erar arching r ching recommendation ecommendation 1.1.3.1 As part of their roles in regulation, enforcement and promoting wellbeing, local authorities, primary care trusts (PCTs) or local health boards and local strategic

2006 National Institute for Health and Clinical Excellence - Clinical Guidelines

1653. Improving outcomes in children and young people with cancer

for Health and Clinical Excellence Improving Outcomes in Children and Young People with Cancer Background 1Guidance on cancer services: cancer in children and young people 11 Improving Outcomes in Children and Young People with Cancer Background 1 Treatment settings Psychological services Communication Continuity of care Staff training Child protection Research Patient information Data protection Social and family support Education services Ethics Epidemiological information Audit Presentation Referral (...) Institute for Health and Clinical Excellence, August 2005. All rights reserved. This material may be freely reproduced for educational and not-for-profit purposes within the NHS. No reproduction by or for commercial organisations is permitted without the express written permission of the Institute.Guidance on Cancer Services Improving Outcomes in Children and Young People with Cancer The Manual August 2005 Developed by the National Collaborating Centre for CancerGuidance on cancer services: cancer

2005 National Institute for Health and Clinical Excellence - Clinical Guidelines

1654. Improving outcomes in head and neck cancers

for educational and not-for-profit purposes within the NHS. No reproduction by or for commercial organisations is permitted without the express written permission of the Institute. This guidance is written in the following context: This Guidance is a part of the Institute’s inherited work programme. It was commissioned by the Department of Health before the Institute was formed in April 1999. The developers have worked with the Institute to ensure that the guidance has been subjected to validation (...) to this heterogeneity by adopting the view that the key issue in assembling specialist services for head and neck cancer patients is that those involved should have the necessary training, skills, experience and expertise. It is this, rather than the specialty as such, that influences outcomes. We have also recognised another important trend in complex surgery. This is the increasing involvement of several surgeons, working together during the course of operations and sharing the operative tasks. Such arrangements

2004 National Institute for Health and Clinical Excellence - Clinical Guidelines

1655. Improving outcomes for people with skin tumours including melanoma

about it, should be culturally appropriate. It should also be accessible to patients with additional needs such as physical, sensory or learning disabilities, and to patients who do not speak or read English. . If the patient agrees, families and carers should have the opportunity to be involved in decisions about treatment and care. Families and carers should also be given the information and support they need. Training and accreditation It is recognised that the training of healthcare (...) Contents Foreword 4 Methodology 5 Background 5 Algorithms 14 The management of low-risk basal cell carcinomas in the community 16 Types of BCC 18 Burden of disease 19 Management options 19 Patient perspective 20 Patient-centred care 21 Training and accreditation 21 Existing guidance 22 Definition of low- and high-risk basal cell carcinoma 23 Recommendations 25 Training, education and accreditation 25 Commissioning 25 Superficial BCCs 26 Models of care 26 Quality assurance 33 Clinical governance 35

2006 National Institute for Health and Clinical Excellence - Clinical Guidelines

1656. Improving supportive and palliative care for adults with cancer

Development Steering Group in Wales) to determine and meet workforce requirements and to ensure education and training programmes are available.14 Key Recommendation 20: Provider organisations should identify staff who may benefit from training and should facilitate their participation in training and ongoing development. Individual practitioners should ensure they have the knowledge and skills required for the roles they undertake. References 1. Department of Health. National Surveys of NHS Patients (...) and the enhancement of knowledge and skills of existing staff. Front-line staff require enhanced training in the assessment of patients’ problems, concerns and needs; in information giving; and in communication skills. Additional specialist staff will be needed in roles related to information delivery, psychological support, rehabilitation, palliative care and support for families and carers. Key Recommendation 19: Cancer Networks should work closely with Workforce Development Confederations (the Workforce

2004 National Institute for Health and Clinical Excellence - Clinical Guidelines

1657. Obsessive-compulsive disorder and body dysmorphic disorder: treatment

and people with OCD or BDD is essential. Provision of information, treatment and care should be tailored to the needs of the individual, culturally appropriate, and provided in a form that is accessible to people who have additional needs, such as learning difficulties, physical or sensory disabilities, or limited competence in speaking or reading English. 1.1.3.3 Healthcare professionals should consider informing people with OCD or BDD and their family or carers about local self-help and support groups (...) professionals should sensitively explore the hidden distress and disability commonly associated with the disorders, providing explanation and information wherever necessary. In particular, people with OCD who are distressed by their obsessive thoughts should be informed that such thoughts are occasionally experienced by almost everybody, and when frequent and distressing are a typical feature of OCD. 1.1.2 1.1.2 Continuity of care Continuity of care 1.1.2.1 OCD and BDD are frequently recurring or chronic

2005 National Institute for Health and Clinical Excellence - Clinical Guidelines

1658. Improving outcomes in colorectal cancer

be obtained from the NHS Response Line by telephoning 0870 1555 455 and quoting reference N0555. Bilingual information for the public has been published, reference N0557, and a CD with all documentation including the research evidence on which the guidance is based is also available, reference N0556. Published by the National Institute for Clinical Excellence May 2004 © National Institute for Clinical Excellence, May 2004. All rights reserved. This material may be freely reproduced for educational (...) obstruction) should be managed by colorectal cancer MDTs. This may require the development of emergency teams and transfers of patients between neighbouring hospitals. • Patients with rectal cancer should be managed by teams trained in all aspects of total mesorectal excision (TME), including pre- and post-operative assessment, surgical technique, and the role of clinical oncology. 6• All aspects of patient-centred care should be re-assessed in the light of recommendations in this manual update

2004 National Institute for Health and Clinical Excellence - Clinical Guidelines

1659. Improving outcomes for people with brain and other central nervous system tumours

2006 © National Institute for Health and Clinical Excellence, June 2006. All rights reserved. This material may be freely reproduced for educational and not-for-profit purposes. No reproduction by or for commercial organisations, or for commercial purposes, is allowed without the express written permission of the Institute.Guidance on Cancer Services Improving Outcomes for People with Brain and Other CNS Tumours The Manual June 2006 Developed by the National Collaborating Centre for CancerGuidance (...) are shown in Table 1. Survival of those with brain tumours classed as ‘malignant’ (ICD-10 C71) is poor, and is shown in Table 3. Relative survival has decreased in the past 20 years. The increased incidence in elderly people does not explain the decrease in relative survival, but an increased tendency to investigate severe disability in elderly people and hence diagnose tumours with poor prognosis may be a contributing factor. The European cancer registries study on cancer patients’ survival and care

2006 National Institute for Health and Clinical Excellence - Clinical Guidelines

1660. Improving outcomes for people with sarcoma

be carried out at designated centres by appropriate specialists as recommended by a sarcoma MDT. • Patients should be informed about relevant clinical trials and supported to enter them. • All sarcoma MDTs should participate in national audit, data collection and training. • Patients with functional disabilities as a consequence of their sarcoma should have timely access to appropriate support and rehabilitation services. • The National Specialist Commissioning Advisory Group should consider (...) of the rarity of sarcomas, most patients and non-specialist clinicians will have no background knowledge of the condition. This can lead to a sense of frustration and isolation for the patient. The problem is not helped by fragmented information and few reliable information sources. There are also specific long-term healthcare support issues that must be addressed. Sarcoma surgery is frequently disabling or disfiguring, and although fewer patients face amputation than in the past they require lifetime

2006 National Institute for Health and Clinical Excellence - Clinical Guidelines

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