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121. Weakness / Fatigue

-rated assessment on a 0 - 10 scale Impact on function and quality of life, eg everyday activities can seem impossible Impact on family or carers Contributing factors: General factors: patient/family roles and responsibilities sleep disturbance nutrition – diet, absorption deconditioning due to reduced activity levels, fitness and/or muscle wasting over-exertion psychological factors, eg anxiety, fear depression. Condition-related factors: metabolic abnormalities – consider checking sodium, potassium

2015 Scottish Palliative Care Guidelines

122. Nausea and Vomiting

with appropriate antibiotics, antifungals or antivirals nebulised saline to aid clearance of thick respiratory secretions nausea associated with the use of NSAIDs or frank gastritis or peptic ulcer may require treatment with a PPI. nausea associated with anticipation or anxiety may respond to benzodiazepines Practice Points For persistent vomiting, attention to hydration and nutritional status is essential ( see ‘ ’ guidance). Nausea may be the cause of lack of efficacy of anti-emetics and other oral drugs

2015 Scottish Palliative Care Guidelines

123. Delirium

for , urinary retention or catheter problems. Management Treat underlying causes. If terminal delirium, see guideline. Maintain hydration, oral nutrition and mobility. If nicotine dependent, consider using replacement patches. Non-pharmacological management Explain cause and likely course to patient, relatives and carers Address anxiety; patients with delirium are often frightened Quiet area or side room; limit staff changes Ensure glasses, hearing aids etc. are accessible Adequate lighting, minimise noise

2015 Scottish Palliative Care Guidelines

124. Pancreatic cancer in adults: diagnosis and management

Contents Overview 4 Who is it for? 4 Recommendations 5 1.1 Diagnosis 5 1.2 Specialist pancreatic multidisciplinary teams 7 1.3 Staging 7 1.4 Psychological support 8 1.5 Pain management 8 1.6 Nutritional management 9 1.7 Relieving biliary and duodenal obstruction 9 1.8 Managing resectable and borderline resectable pancreatic cancer 10 1.9 Managing unresectable pancreatic cancer 11 Putting this guideline into practice 14 Context 16 More information 16 Recommendations for research 17 1 Neoadjuvant therapy (...) care should be agreed and delivered. 1.4 Psychological support 1.4.1 Throughout the person's pancreatic cancer care pathway, specifically assess the psychological impact of: fatigue pain gastrointestinal symptoms (including changes to appetite) nutrition anxiety depression. 1.4.2 Provide people and their family members or carers (as appropriate) with information and support to help them manage the psychological impact of pancreatic cancer on their lives and daily activities. This should

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

125. Oesophago-gastric cancer: assessment and management in adults

of 20Contents Contents Overview 4 Who is it for? 4 Recommendations 5 1.1 Information and support 5 1.2 Organisation of services 7 1.3 Assessment after diagnosis 7 1.4 Radical treatment 8 1.5 Palliative management 10 1.6 Nutritional support 12 1.7 Follow-up 13 Putting this guideline into practice 15 Context 17 More information 17 Recommendations for research 18 1 Radical treatment of squamous cell carcinoma of the oesophagus 18 2 Radical treatment of T1bN0 adenocarcinoma of the oesophagus 18 3 Nutritional (...) and palliative treatment and nutritional support. It aims to reduce variation in practice through better organisation of care and support, and improve quality of life and survival by giving advice on the most suitable treatments depending on cancer type, stage and location. Who is it for? Healthcare professionals involved in the care of people with oesophago-gastric cancer Commissioners of oesophago-gastric cancer services People with oesophago-gastric cancer, their family members and carers, and the public

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

126. Bowel Obstruction

, likely benefits/ risks and patient preferences. Factors to take into consideration prior to surgery Diffuse intra-abdominal cancer seen at previous surgery, or shown radiologically. Diffuse, palpable intra-abdominal masses. Massive ascites which recurs rapidly after drainage. High obstruction involving the proximal stomach. Non-symptomatic but extensive metastatic disease outside the abdomen. Frail or elderly patient with poor performance status or nutritional status. Previous radiotherapy

2015 Scottish Palliative Care Guidelines

127. Anorexia/Cachexia

for carers. Assessment The assessment is much more than the patient’s calorific intake versus their body weight. It is worth considering if recording the patient’s weight is necessary as this may result in increasing anxiety regarding their weight loss. Be aware that the ongoing loss of lean body mass may occur with or without loss of fat mass. A nutritional assessment needs to be holistic and acknowledge the emotional, social, cognitive and biochemical aspects of nutrition and diet. Each assessment (...) satiety and vomiting of undigested foods that relieve nausea. is commonly associated with anorexia/cachexia syndrome Ask the patient and the carer about their perspectives on weight, body image, nutrition and dietary intake. Management The aims are prevention or early identification as well as the treatment of contributory symptoms. This includes acknowledging the psychological impact on the patient and carer, together with providing information and supportive care. In nutritional support

2015 Scottish Palliative Care Guidelines

128. WHO recommendations: intrapartum care for a positive childbirth experience

and ergometrine) or oral misoprostol (600 µg) is recommended. a Recommended Recommended Recommended Delayed umbilical cord clamping 44. Delayed umbilical cord clamping (not earlier than 1 minute after birth) is recommended for improved maternal and infant health and nutrition outcomes. b Recommended Controlled cord traction (CCT) 45. In settings where skilled birth attendants are available, controlled cord traction (CCT) is recommended for vaginal births if the care provider and the parturient woman regard (...) of the baby for ambient temperature is recommended. This means one to two layers of clothes more than adults, and use of hats/caps. The mother and baby should not be separated and should stay in the same room 24 hours a day. f Recommended a Integrated from WHO recommendations for the prevention and treatment of postpartum haemorrhage. b Integrated from the WHO Guideline: delayed cord clamping for improved maternal and infant health and nutrition outcomes. c Integrated from WHO Guidelines on basic newborn

2018 World Health Organisation Guidelines

130. Menopause

-to- date information, and an explanation of normal menopausal changes. General health advice is the same throughout a woman’s life, but there is a particular emphasis on certain factors for menopausal woman, primarily the effects that the menopause has on cardiovascular and bone health as well as the day-to-day symptoms of menopause. The key areas to cover are: • smoking status • diet and nutrition • exercise • alcohol consumption • weight control • psychological aspects of the menopause • reinforcing (...) levels and adversely effects the HDL/LDL ratio • smokers have an increased level of atherosclerosis in their coronary arteries • smoking leads to an earlier menopause – up to two years earlier when compared with non-smokers • smokers are at greater risk of developing osteoporosis • smokers are more likely to experience vasomotor symptoms. Make yourself aware of smoking cessation initiatives, so that you can make these resources available to support women who want to stop smoking. Diet and nutrition

2018 Royal College of Nursing

132. BSR guideline Management of Adults with Primary Sjögren's Syndrome

to replace tear film oil layer Punctal plugging—punctal or intracanalicular plugs (ophthalmology only) Nutritional tear substitutes Secretagogues Autologous or allogeneic serum eye drops (available via specialist commissioned centres only) Oral pilocarpine max 5 mg 4× per day (start with 2.5 mg od and build up) Permanent punctal occlusion via cautery of all four puncta Pilocarpine 4% (3 drops = 5 mg) for those who are unable to swallow (palliative care pathway [ ]) Periorbital botulinum toxin (...) ) Higher strength topical steroids for short term use, e.g. dexamethasone 0.1% Lid hygiene For blepharitis consider metallomatrix proteinase inhibitors, e.g. doxycycline 50 mg od (ophthalmology only) Ciclosporin-containing drops or ointment Liposomal sprays available over the counter to replace tear film oil layer Punctal plugging—punctal or intracanalicular plugs (ophthalmology only) Nutritional tear substitutes Secretagogues Autologous or allogeneic serum eye drops (available via specialist

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2017 British Society for Rheumatology

133. Cardiac rehabilitation

telephone follow up, educational tools, contracts, nutritional tools and feedback should be considered for patients in cardiac rehabilitation to enhance adherence to dietary advice. 2.3 LONG-TERM MAINTENANCE OF BEHAVIOUR CHANGE R P sy choeduca tion (goal setting, self monitoring) should be considered for patients in cardiac rehabilitation to facilitate adherence to physical activity. 2.4 PSYCHOSOCIAL HEALTH R Cardiac rehabilitation should incorporate a stepped-care pathway to meet the psychological

2017 SIGN

134. Lifestyle risk factors and the primary prevention of cancer

prevention of cancer page 3 of 31Methodology and scope This position statement was developed by Cancer Australia, based on existing high level evidence and evidence reviews. Information was primarily sourced from: the 2012 International Agency for Research on Cancer (IARC) Monographs on tobacco, alcohol, UV radiation and infectious agents, 5-7 the 2007 World Cancer Research Fund (WCRF) and American Institute for Cancer Research (AICR) report Food, Nutrition, Physical Activity and the Prevention of Cancer (...) status areas are more likely to have higher levels of cancer and lifestyle risk factors, such as smoking, poor diet and physical inactivity. 20 Although cancer incidence varies across geographical regions for different cancers, people living in remote areas of Australia are more likely to have higher rates of risky health behaviours, such as smoking, heavy alcohol use and poor nutrition. 20 Position Statement - Lifestyle risk factors and the primary prevention of cancer page 5 of 31Primary prevention

2015 Cancer Australia

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

mean the place of care and place of death need to be changed. 1.3.52 If a child or young person is given enteral or intravenous fluids, review this decision regularly to make sure it continues to be in their best interests. Managing nutrition Managing nutrition 1.3.53 If a child or young person is approaching the end of life or is dying, discuss how to manage their nutritional needs with them and their parents or carers. 1.3.54 If a child or young person with a life-limiting condition is dying (...) , encourage and support them to eat if they want to and are able. 1.3.55 If a child or young person is dying and they are receiving enteral tube feeding or intravenous nutrition: discuss with them (as appropriate) and their parents or carers whether continuing this is in their best interest and and review this decision regularly. Recognising that a child or y Recognising that a child or young person is lik oung person is likely to die within hours or da ely to die within hours or days ys 1.3.56

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

137. Hypertension Canada's 2016 Canadian Hypertension Education Program guidelines for pharmacists: an update

, Naugler C. Fasting time and lipid levels in a community-based population: a cross-sectional study. Arch Intern Med. 2012;172:1707-10. 38. Doran B, Guo Y, Xu J, et al. Prognostic value of fasting versus nonfasting low-density lipoprotein cholesterol levels on long-term mortality: insight from the National Health and Nutrition Examination Survey III (NHANES-III). Cir - culation 2014;130:546-53. 39. Langsted A, Freiberg JJ, Nordestgaard BG. Fasting and nonfasting lipid levels: influence of normal food

2016 CPG Infobase

138. Use of multiple micronutrient powders for point-of-use fortification of foods consumed by infants and young children aged 6?23 months and children aged 2?12 years

of the considerations of the members of the guideline development group for determining the strength of the recommendations for use of multiple micronutrient powders for point-of-use fortification of foods consumed by infants and young children aged 6–23 months and children aged 2–12 years 43 ANNEX 6. WHO Steering Committee for Nutrition Guidelines Development 44 ANNEX 7. WHO guideline development group – nutrition actions 2013–2014 46 ANNEX 8. WHO Secretariat 48 WHO headquarters 48 WHO regional offices 48 ANNEX 9 (...) Thomas Bosco and the peer-reviewers. Ms Jennifer Volonnino from the Evidence and Programme Guidance Unit, Department of Nutrition for Health and Development, provided logistic support. WHO gratefully acknowledges the technical input of the members of the Nutrition Steering Committee and the WHO guidelines development group – nutrition actions 2013–2014, especially the chairs of the meetings, Dr Rebecca Stoltzfus and Ms Rusidah Selamat. WHO is also grateful to the staff of the Cochrane Developmental

2017 World Health Organisation Guidelines

139. Consent for anaesthesia

for the treatment of chronic pain, epidural blood patch for the treatment of post-dural puncture headache or placement of a central line for chemother- apy or parenteral nutrition. In these circumstances, and Table 2 Broad summary of information appropriate for patients during the consenting process (n.b. the anaesthetist should be guided by what each particular patient wants to know, rather than a proforma list, and with consideration of what the incidence of risks might be in that patient). Common components

2017 Association of Anaesthetists of GB and Ireland

140. Selected practice recommendations for contraceptive use

Britain and Northern Ireland [United Kingdom]), Tsungai Chipato (University of Zimbabwe, Zimbabwe), Roger Chou (Oregon Health & Science University, United States of America [USA]), Jacqueline Conard (Hôpital Universitaire de Paris – Hôtel Dieu, France), Maria del Carmen Cravioto (National Institute of Nutrition Salvador Zubiran, Mexico), Marc Dhont (Ghent University Hospital, Belgium), Alison Edelman (Oregon Health & Science University, USA), Faysel El-Kak (American University of Beirut, Lebanon

2017 World Health Organisation Guidelines

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