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2921. Otitis media - acute

been introduced by the Medicines and Healthcare products Regulatory Agency. Prescriptions have been updated to reflect the revised dosing. Issued in July 2011. May 2011 — minor update. The 2010/2011 QIPP options for local implementation have been added to this topic. Issued in June 2011. April to July 2009 — converted from CKS guidance to CKS topic structure. The evidence-base has been reviewed in detail, and recommendations are more clearly justified and transparently linked to the supporting (...) implementation QIPP - Options for local implementation Non-steroidal anti-inflammatory drugs (NSAIDs) Review the appropriateness of non-steroidal anti-inflammatory drug (NSAID) prescribing widely and on a routine basis, especially in people who are at higher risk of gastrointestinal, renal and cardiovascular morbidity and mortality (for example, older people). If an NSAID is needed, use ibuprofen (1200 mg a day or less) or naproxen (1000 mg a day or less). Use the lowest effective dose and the shortest

2018 NICE Clinical Knowledge Summaries

2922. Deep vein thrombosis

of DVT are: Pain and swelling in one leg, although both legs may be affected. Tenderness, changes to skin colour and temperature, and vein distension. Carry out a physical examination and review the person's general medical history to exclude an for the symptoms and signs. Use the to assess the likelihood of DVT and inform further management. Basis for recommendation Basis for recommendation These recommendations are based mainly on a National Clinical Guideline Centre guideline (commissioned (...) -marketing surveillance by the Medicines and Healthcare products Regulatory Agency (MHRA). Following a technology appraisal, NICE recommends rivaroxaban as an option for treating DVT after a diagnosis of acute DVT in adults [ ]. The Regional Drug and Therapeutic Centre state that rivaroxaban may be considered if warfarin is contraindicated or not tolerated, or if monitoring of the international normalized ratio (INR) is impractical [ ]. Investigations for undiagnosed cancer This recommendation is based

2018 NICE Clinical Knowledge Summaries

2923. Infertility

with normal history, examination, and investigations in both partners, referral should usually be considered if the couple have not conceived after 1 year. Earlier referral may be considered in women older than 35 years, or if the history, examination, and investigations of either partner suggest an underlying cause. There are three main types of fertility treatment: Medical treatment includes the use of drugs (such as clomifene) to induce ovulation. Surgical treatment includes tubal microsurgery in women (...) with impaired ovulatory and tubal function [ ]. Other drugs — a case control study reported that women who had ever used thyroid replacement hormones, asthma medication, tranquillizers, or antidepressants had an increased risk of anovulatory infertility [ ]. Age — natural female fertility declines with age, and this is more noticeable after 35 years of age [ ; ; ]. Occupational and environmental factors, including exposure to pesticides, nitrous oxide, metals (lead, cadmium, manganese), solvents

2018 NICE Clinical Knowledge Summaries

2924. Autism in children

. Statement 5. People with autism have a documented discussion with a member of the autism team about opportunities to take part in age-appropriate psychosocial interventions to help address the core features of autism. Statement 6. People with autism are not prescribed medication to address the core features of autism. Statement 7. People with autism who develop behaviour that challenges are assessed for possible triggers, including physical health conditions, mental health problems and environmental (...) in detail, and recommendations are clearly justified and transparently linked to the supporting evidence. Update Update New evidence New evidence Evidence-based guidelines PHE (2019) Psychotropic drugs and people with learning disabilities or autism. Public Health England. [ ] HTAs (Health Technology Assessments) No new HTAs since 1 October 2018. Economic appraisals No new economic appraisals relevant to England since 1 October 2018. Systematic reviews and meta-analyses No new systematic reviews

2018 NICE Clinical Knowledge Summaries

2925. MRSA in primary care

are strains of MRSA identified in people who have had contact with healthcare services — they can present in hospital or in the community. CA-MRSA are strains of MRSA identified in the community setting or within 48 hours of hospital admission typically in people with no significant past medical history or healthcare contact. Definition of MRSA based on where infection is likely to have been acquired is becoming less relevant as cross-over in strain types identified in hospital and the community becomes (...) a cut or wound) and causes harm. is usually acquired following direct or indirect contact with healthcare services and is more likely to occur in older age groups. Risk factors include: Admission to hospital or other contact with healthcare services such as for acute or chronic disease management (including use of invasive devices, for example, urinary catheters). Residence in long term care facilities (such as care homes) or crowded conditions. Previous exposure to antibiotics. Past medical history

2018 NICE Clinical Knowledge Summaries

2926. Rosacea - acne

: Initial management includes lifestyle advice (such as avoidance of triggers), medication review (some drugs can aggravate acne rosacea), and management of any psychosocial problems. For mild or moderate papulopustular rosacea, treatment options include topical metronidazole or topical azelaic acid. For moderate to severe papulopustular rosacea, an oral tetracycline or erythromycin is recommended. Brimonidine 0.5% gel is an option if erythema (without prominent telangiectasia) is the predominant (...) the management of acne rosacea in primary care. Scenario: acne rosacea Scenario: acne rosacea Managing acne rosacea How should I manage a person with acne rosacea? If acne rosacea is suspected, initial management in primary care includes: Lifestyle advice — see the section on . Reviewing the person’s medication — some drugs can aggravate flushing symptoms (such as calcium-channel blockers) and flare-ups of acne rosacea (such as topical corticosteroids). Reduce and stop these if possible. Assessing the impact

2018 NICE Clinical Knowledge Summaries

2927. Palliative care - oral

cancer receiving radiotherapy with or without chemotherapy found that the mean incidence of mucositis was 80% [ ]. Risk factors Risk factors for oral problems The risk factors for oral problems are [ ] : Debility. Dry mouth. Poor oral intake. Dehydration. Chemotherapy: mucositis occurs about 5–7 days after drug administration. Radiotherapy: mucositis occurs about 2 weeks after the initiation of therapy. Oral tumours. Bisphosphonate: may cause osteonecrosis of the jaws. The most significant risk (...) Diagnosis of oral problems in palliative care History History Enquiry into symptoms and problems with the oral cavity should be part of a full history and examination that includes physical, psychological, social, and spiritual issues: Enquire about dry mouth, oral pain, halitosis, alteration in taste, excessive salivation, bad breath, difficulty chewing, difficulty speaking, dysphagia and bleeding. Be particularly alert if the person has any for oral problems or is using medication that may cause

2018 NICE Clinical Knowledge Summaries

2928. Palliative care - malignant skin ulcer

. Ensuring a professional with expertise in wound management is involved in the person's care (such as a district nurse, palliative care or tissue viability nurse). This professional can advise on the need for cleansing, debridement, and the correct selection and use of dressings. Referral where appropriate to an oncologist or palliative care specialist for advice if further cancer treatment is possible (such as radiotherapy, chemotherapy, hormone therapy, or surgical intervention). Principles (...) criteria No audit criteria were found during the review of this topic. QOF indicators QOF indicators Table 1 . Indicators related to palliative care in the Quality and Outcomes Framework of the General Medical Services contract. Indicator Points Payment stages PC001 The contractor establishes and maintains a register of all patients in need of palliative care/support irrespective of age 3 — PC002 The contractor has regular (at least 3 monthly) multidisciplinary case review meetings where all patients

2018 NICE Clinical Knowledge Summaries

2929. Miscarriage

. Referral should be arranged if there is doubt about the viability of a pregnancy. Transvaginal ultrasound is the diagnostic tool of choice to assess the location and viability of the pregnancy. Secondary care treatments options include expectant management (watchful waiting), medical management (with vaginal or oral misoprostol), or surgery. Following a miscarriage, the woman should be followed up in primary care and offered appropriate support, information, and advice. Referral should be offered (...) [ ; ]. There is no evidence that intercourse during pregnancy can cause an early pregnancy loss [ ]. There is no evidence that using illicit drugs (such as cannabis) is a risk factor for pregnancy loss in women with recurrent miscarriage. However, avoiding illicit drugs is generally recommended, especially during pregnancy [ ]. Prevalence How common is it? Miscarriage is a common complication of pregnancy. About 10–24% of clinically recognized pregnancies end in miscarriage [ ; ; ; ; ]. Most miscarriages occur

2018 NICE Clinical Knowledge Summaries

2930. Alopecia, androgenetic - male

to their doctor any changes in their breast tissue (such as lumps, pain, or nipple discharge). The Medicines and Healthcare products Regulatory Agency (MHRA) has reported three cases of breast cancer in men taking finasteride 1 mg. Overall incidence is not increased but in view of these reports, a connection cannot be excluded. Depression, anxiety and suicidal thoughts with treatment have been observed. Men are advised to stop therapy if they develop depression. [ ; ; ; ] Drug interactions What are the drug (...) hypotension caused by antihypertensive drugs. Topical drugs — application of other topical drugs, such as corticosteroids, tretinoin, or dithranol, may increase absorption of minoxidil. [ ; ; ] Finasteride Finasteride Finasteride 1 mg tablets (Propecia®) are not available to prescribe on the NHS, but can be prescribed on a private prescription. Finasteride 1 mg tablets are a prescription-only medicine and cannot be purchased over-the-counter. However, in some areas, they are available to purchase from

2018 NICE Clinical Knowledge Summaries

2931. Domestic violence and abuse

(including any injuries) and do not need the person's permission to do this. Enter in the medical record any health complaints, symptoms, and signs, as you would for any other person, including a description of any injuries. It may be helpful to note the cause or suspected cause of these injuries or other conditions, including the person who caused the injury. Consider taking photographs of physical injuries as pictures will convey the severity of injuries more effectively than a verbal description (...) Domestic violence and abuse Domestic violence and abuse - NICE CKS Share Domestic violence and abuse: Summary Domestic violence and abuse is defined as any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence, or abuse between people aged 16 years or over who are, or have been, intimate partners or are family members regardless of gender or sexuality. It includes psychological, physical, sexual, emotional, and financial abuse, forced marriage, and 'honour

2018 NICE Clinical Knowledge Summaries

2932. Depression - antenatal and postnatal

Institute for Health and Care Excellence (NICE) that advises considering seeking advice, preferably from a specialist perinatal mental health service, when more detailed advice about risks of mental health problems or the benefits and harms of treatment in pregnancy is needed, or when psychotropic medication is started in pregnancy [ ]. It is also extrapolated from an evidence review commissioned by NICE that noted that considerable caution should be used when changing or stopping antidepressant drugs (...) and wants to stop her medication, consider her previous response to treatment, stage of pregnancy, preferences for treatment, risk of relapse, and risks of medication and discuss the options of: Switching to a high intensity psychological intervention (for example CBT). Changing medication if there is a drug effective for her with a lower risk of adverse effects. If the woman is taking a TCA, SSRI, or (S)NRI for severe depression, take into account her previous response to treatment, stage of pregnancy

2018 NICE Clinical Knowledge Summaries

2933. Psoriasis

forms of psoriasis include: Guttate psoriasis. Nail psoriasis. Erythrodermic and generalized pustular psoriasis (rare medical emergencies, may be life-threatening). Psoriasis is common, with about 1.3–2.2% of the UK population affected. Several factors are associated with the onset or exacerbation of psoriasis, including infection, drugs (including corticosteroid withdrawal), ultraviolet light exposure, trauma, hormonal changes, stress, smoking, and alcohol. Psoriasis may be associated with other (...) . There is nail disease which is severe and having a major functional or cosmetic impact. There is a significant impact on the person's physical, psychological, or social wellbeing. Additional information or education for self-use is needed (for example about application of topical treatments). Specialist treatments may include topical calcineurin inhibitors, phototherapy, systemic or biologic therapy. Have I got the right topic? Have I got the right topic? From age 18 years onwards. This CKS topic covers

2018 NICE Clinical Knowledge Summaries

2934. ASCIA Position Paper - Hereditary Angioedema (HAE)

hereditary angioedema HRT hormone replacement therapy NBA National Blood Authority OCP oral contraceptive pill PBS Pharmaceutical Benefits Scheme PID primary immunodeficiency TA tranexamic acid TGA Therapeutic Goods Administration SAS Special Access Scheme ASCIA Position Paper - Hereditary Angioedema 2 © ASCIA 2017 CONTENTS Page 1.0 Introduction 4 1.1 Classification and definitions 1.2 Historical facts 1.3 Epidemiology 1.3.1 HAE in Australia 2.0 Pathogenesis 6 3.0 Clinical Presentation 7 3.1 The acute (...) although one must investigate the legality of carrying certain medications if unregistered in the destination country. 7.2.2 Pregnancy and delivery Danazol needs to be ceased prior to conception. Tranexamic acid may be used with caution if frequent attacks occur. C1-INH ncentrate on demand, as individual replacement therapy, or at scheduled regular intervals if frequent attacks are occurring is now considered optimal therapy in the pregnant woman with HAE. There is no data on the use of icatibant

2017 Australasian Society of Clinical Immunology and Allergy

2935. Supporting Clients on Methadone Maintenance Treatment

and other opioid substitution therapies. Detoxification from opioids is a method of treatment aimed at eliminating the use of opioids. Detoxification may include the use of methadone or other pharmaceutical therapies to treat symptoms of withdrawal while the client elimi- nates the dependent opioid from his or her body. The main goal of detoxification is to reduce withdrawal symptoms until the client adjusts to living drug-free. Substitution programs are designed to change a patient’s opioid of choice (...) and physiological dependence (opioid) or solely as a psychologi- cal dependence (cocaine) disorder. Physical dependence occurs when a person’s body has developed a tolerance to the drug so that more is needed to achieve the same effect (see Figure 1), which often includes feeling “normal”. It is also char- acterized by the presence of withdrawal symptoms if there is a sudden discontinuation in the use of the drug. These symptoms can be very debilitating. Persons who are addicted to opioids often take them

2009 Registered Nurses' Association of Ontario

2936. Oral Health: Nursing Assessment and Intervention

working in diverse practice settings provide evidence-based oral health care to adults with special needs. Within the scope of this guideline, those with special needs may include older adults, those who are medically compromised, intellectually challenged, physically challenged, and/or have severe and persistent mental illness. Many may be frail or dependent upon caregivers to help with their activities of daily living. These adults may live in the community or may be in institutions. It should (...) population groups, both in developing, and developed countries (Petersen et al., 2005). Loeppeky and Sigal (2007) have identified people with special needs who are in most need of meticulous oral hygiene: “physical, developmental, mental, sensory, behavioural, cognitive or emotional impairment or a condition that requires medical management, health care interventions or use of specialized services or programs” (p.915). Residents of Long-Term Care Homes and/or Persons with Dementia Canada’ s population

2008 Registered Nurses' Association of Ontario

2937. Woman Abuse: Screening, Identification and Initial Response

to report physical injury (40% vs. 13%) and five times more likely to require medical attention as a result of a violent incident; n more likely to fear for their lives (38% vs. 7%); and n more likely to be killed by someone with whom they had an intimate relationship (52% vs. 8%). Estimates of woman abuse in Ontario are equally compelling. Findings from The Women’s Safety Project (Randall & Haskell, 1995) revealed that, depending on the particular type of violence measured, between 27% and 51% of women (...) and Reproductive Gynecological disorders Infertility Pelvic inflammatory disease Sexual dysfunction Unsafe abortion Pregnancy complications Unwanted pregnancy Sexually transmitted infections, including HIV/AIDS Psychological and Behavioural Alcohol and drug abuse Depression and anxiety Smoking Eating and sleep disorders Feelings of shame and guilt Poor self-esteem Phobias and panic disorders Physical inactivity Psychosomatic disorders Post-traumatic stress disorder Suicidal behaviour and self harm Unsafe

2005 Registered Nurses' Association of Ontario

2938. Prevention of Constipation in the Older Adult Population

, depression, dementia or acute confusion. 3.0 Review the client’s medications to identify those associated with an increased III risk for developing constipation, including chronic laxative use and history of laxative use. 3.1 Screen for risks of polypharmacy, including duplication of both prescription III and over-the-counter drugs and their adverse effects. 4.0 Identify the client’s functional abilities related to mobility, eating and drinking, III and cognitive status related to abilities (...) categories of medications, which are therefore a risk factor for constipation. The effects of drugs on the intestinal tract have been primarily identified through clinical drug trials on the various medications (Hert & Huseboe, 1996). These medications include the following categories: ¦ Anticholinergics ¦ Antidepressants ¦ Anti-emetics ¦ Anti-histamines ¦ Anti-hypertensives ¦ Anti-Parkinson agents ¦ Anti-psychotics ¦ Antacids containing aluminum ¦ Analgesics ¦ NSAIDs ¦ Histamine-2 blockers ¦ Hypnotics

2005 Registered Nurses' Association of Ontario

2939. Nursing Management of Hypertension

, Kingston General CCN(C), PhD(cand) Hospital, Kingston, Ontario Joy Parsons-Nicota, RN(EC), BScN, MScN Nurse Practitioner, Family Medicine Centre, The Ottawa Hospital, Ottawa, Ontario Wendy L. Pomponio, RN, BScN Medical/Rehabilitation Nurse Clinician, Brant Community Healthcare System, Brantford, Ontario Tara Poselwhite, RN Registered Nurse, Thunder Bay Regional Health Science Centre, Thunder Bay, Ontario Sandra Rice, RN Registered Nurse, Merrickville District Community Health Centre, Merrickville (...) status and implement Brief Ia Tobacco Interventions at each appropriate visit, in order to facilitate smoking cessation. Stress 2.13 Nurses will assist clients diagnosed with hypertension to understand how IV they react to stressful events and to learn how to cope with and manage stress effectively. Medications 3.1 Nurses will obtain clients’ medication history, which will include prescribed, IV over-the-counter, herbal and illicit drug use. 3.2 Nurses will be knowledgeable about the classes

2005 Registered Nurses' Association of Ontario

2940. Embracing Cultural Diversity in Health Care: Developing Cultural Competence

, there are physical/structural policy components, cognitive/psycho/social/cultural components and professional/occupational components; and ¦ the professional/occupational factors are unique to each profession, while the remaining factors are generic for all professions/occupations. Embracing Cultural Diversity in Health Care i Adapted from DeJoy, D.M. & Southern, D.J. (1993). An Integrative perspective on work-site health promotion. Journal of Medicine, 35(12): December, 1221-1230; modified by Laschinger (...) Community Care Program Coordinator N.B. and P.E.I. Past President, Aboriginal Nurses Association Fredericton, New Brunswick Ginette Lazure, inf., MScinf., PhD Professeure agrégée, Directrice des programmes de premier cycle Responsable académique pour la formation à l'international Faculté des sciences infirmières, Université Laval, Québec Healthy Work Environments Best Practice Guidelines3 Ruth Lee, RN, BScN, MScN, PhD Chief of Nursing Practice, Professional Affairs McMaster University Medical Centre

2007 Registered Nurses' Association of Ontario

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