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3961. Contraception - assessment

conditions — cardiovascular disease (CVD) risk factors; diabetes mellitus; epilepsy; headache or migraine; hypertension; menorrhagia; fibroids; previous ectopic pregnancy; obesity; sexually transmitted infections (STIs) or pelvic inflammatory disease (PID); smoking; and venous thromboembolism (VTE). Concurrent medication — liver enzyme-inducing drugs (such as medicines for epilepsy, anti-retrovirals and St John’s Wort) can affect some forms of contraception. If the woman is taking teratogenic drugs (...) Contraception - assessment Contraception - assessment | Topics A to Z | CKS | NICE Search CKS… Menu Contraception - assessment Contraception - assessment Last revised in September 2019 An assessment should be carried out on all women requesting contraception to identify any relevant medical conditions or medication Management Background information Contraception - assessment: Summary An assessment should be carried out on all women requesting contraception to identify any relevant medical

2020 NICE Clinical Knowledge Summaries

3962. Constipation: Scenario: Constipation in adults

prescribing different laxatives. If there is uncertainty about the use or safety of laxatives during breastfeeding, contact the UK Drugs in Lactation Advisory Service (UKDILAS) provided by the UK Medicines Information Network: To discuss with a specialist pharmacist, telephone 0116 2586491 or 0121 4247298. For information on the safety of specific laxatives, see the website at . Basis for recommendation The recommendations on the management of constipation in pregnancy are largely based on expert opinion (...) by increasing fluid intake unless there is evidence of dehydration, and cites evidence that increasing physical activity can improve constipation symptoms [ ]. The ACG monograph found low-quality evidence that dietary fibre supplements increase stool frequency in people with chronic idiopathic constipation [ ]. In addition, a meta-analysis of five randomized controlled trials (RCTs) found that dietary fibre increased stool frequency compared with placebo, but there was no significant difference in stool

2020 NICE Clinical Knowledge Summaries

3963. Constipation in children: What clinical features are suggestive of idiopathic constipation in a child?

. Use of drug treatments such as sedating antihistamines or opiates. Timing of potty or toilet training. Psychosocial factors such as difficulty accessing a toilet, moving house, starting nursery or school, other major change in family circumstances, and fears and phobias. Perform a physical examination. In a child with idiopathic constipation: There is normal appearance of the anus and surrounding area. Digital rectal examination is not routinely required to make the diagnosis. The abdomen is soft (...) that plain abdominal X-ray should not be routinely requested to diagnose idiopathic constipation, and should only be performed if absolutely necessary and if requested by specialist services [ ]. Similarly, NICE evaluated the evidence for using abdominal ultrasound in children with chronic constipation and concluded that there is no evidence that abdominal ultrasound is a useful addition to thorough history-taking and physical examination. NICE recognized that emerging evidence indicates that measuring

2017 NICE Clinical Knowledge Summaries

3964. Constipation in children: Scenario: Management of constipation in children

physical activity that is tailored to the child or young person's stage of development and ability. Physical activity guidelines are available from the Chief Medical Officer for different age groups including , , and . [ ] Recommended fluid intake Encourage children with a poor fluid intake to increase fluids to a recommended level. Approximately three-quarters of the daily fluid requirement in children is obtained from water in drinks. Higher intakes of total water will be required for children who (...) . Secondary care management Specialist management of constipation that does not respond to optimal treatment in primary care may include: Manual evacuation of the bowel under anaesthesia (if all oral and rectal medications have failed). Use of polyethylene glycol solutions for whole-gut lavage (often via nasogastric tube). Antegrade colonic enema (a surgical procedure). Psychological and behavioural interventions, ranging from toilet training to family therapy. Referral to child and adolescent mental

2017 NICE Clinical Knowledge Summaries

3965. Chest pain: What are the signs and symptoms of other causes of chest pain?

(mild tenderness in the upper abdomen to generalized peritonitis), abdominal distension, Cullen's sign (a bluish discolouration around the umbilicus), or Grey–Turner's sign (bluish discolouration around the flank), and low blood pressure. There may be a low-grade fever. To confirm a diagnosis of acute pancreatitis, see the CKS topic on . Oesophageal rupture History — a recent history of a medical procedure, foreign body ingestion, or oesophageal cancer. Symptoms — thoracic oesophageal perforation (...) of sensation or muscle strength. To confirm a diagnosis of neck pain, see the scenario in the prodigy topic . Other causes of chest pain include: Psychogenic or non-specific chest pain History — the person has no identifiable risk factors for a physical cause of chest pain. Anxiety disorders are common, especially panic disorders. The episode is often preceded by a stressful event. Symptoms — chest pain is usually in the left sub-mammary position (without radiation). The pain is sharp and continuous

2017 NICE Clinical Knowledge Summaries

3966. Chest pain: Scenario: Management

into account discussion in several review papers, as there is no evidence from controlled trials for paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), codeine, or opioid analgesics for treating the pain of acute shingles [ ; ; ]. Managing Bornholm's disease This recommendation is based on expert opinion from a review article Assessment of chest pain in primary care [ ], and a primary care medical textbook John Murtagh's general practice [ ]. Managing psychogenic or non-specific chest pain (...) [ ], the National Institute for Health and Care Excellence (NICE) guideline Chest pain of recent onset: assessment and diagnosis [ ], the Scottish Intercollegiate Guidelines Network (SIGN) and BTS British guideline on the management of asthma [ ], and expert opinion in review articles [ ; ; ] and a primary care medical textbook John Murtagh's general practice [ ]. Clinical features of a serious cause of chest pain If there is any suspicion of a serious cause, or any concern regarding the person's general well

2017 NICE Clinical Knowledge Summaries

3967. Chest pain: How should I examine a person with chest pain?

Chest pain: How should I examine a person with chest pain? Examination | Diagnosis | Chest pain | CKS | NICE Search CKS… Menu Examination Chest pain: How should I examine a person with chest pain? Last revised in April 2020 How should I examine a person with chest pain? Carry out a physical examination for people with chest pain. This should include: A cardiovascular examination. Heart sounds (for murmurs and pericardial rub). Blood pressure in both arms (possible aortic dissection). Pulse (...) (NICE) guideline Chest pain of recent onset: assessment and diagnosis [ ], expert opinion in review articles Assessment of chest pain in primary care [ ], Outpatient diagnosis of acute chest pain in adults [ ], and a primary care medical textbook John Murtagh's general practice [ ]. © .

2017 NICE Clinical Knowledge Summaries

3968. Conduct disorders in children and young people: When to suspect a conduct disorder

). Current functioning at home, at school or college, and with peers. Parenting ability. History of any past or current mental or physical health problems. Note: consider the possibility of in any child with behavioural problems, especially if there is a marked change in the child's behaviour or emotional state in the absence of a plausible explanation. Suspect a conduct disorder , if maltreatment is not considered likely, and the child or young person presents with persistent , marked antisocial (...) with general defiance of adults’ wishes, disobedience of instructions, angry outbursts with temper tantrums, physical aggression (especially towards siblings and peers), destruction of property, arguing, blaming others for things that have gone wrong, annoying and provoking others. Children aged 8 to 11 years — may present with any of the above, as well as other behaviours such as swearing, lying, stealing outside the home, persistent breaking of rules, physical fights, bullying, cruelty to animals

2019 NICE Clinical Knowledge Summaries

3969. Conduct disorders in children and young people

. If antisocial behaviours occurs: Before 10 years of age this is referred to as 'early onset'. After 10 years of age this is referred to as 'adolescent onset'. Conduct disorder should be suspected, if maltreatment is not considered likely, and the child or young person presents with persistent, marked antisocial behaviours such as: Children aged 3 to 7 years — general defiance of adults’ wishes, disobedience, angry outbursts with temper tantrums, physical aggression to other people (especially siblings (...) and peers), destruction of property, arguing, blaming others for things that have gone wrong, annoying and provoking others. Children aged 8 to 11 years — may present with any of the above as well as swearing, lying, stealing outside the home, persistent rule breaking, physical fights, bullying other children, cruelty to animals, and setting fires. Young people aged 12 to 17 years — may present with any of the above behaviours as well as more antisocial behaviours such as being cruel to and hurting

2019 NICE Clinical Knowledge Summaries

3970. Colic - infantile: How should I assess an infant with suspected colic?

[ ]. The recommendations on assessing infant feeding have also been extrapolated from the US Academy of Breastfeeding Medicine clinical protocol Persistent pain with breastfeeding [ ]. Expert opinion in a review article on troublesome crying in infants notes that crying is the commonest trigger for physical maltreatment of an infant [ ]. © . (...) : Infant history: The onset, duration, frequency, and timing of crying episodes; change in tone or pitch of crying; and any alleviating or exacerbating factors. Birth gestation, any birth trauma or known medical conditions or congenital abnormalities, such as ankyloglossia (tongue-tie) or cleft lip and/or palate which may affect breastfeeding. Birth weight, weight gain or faltering growth, general health and behaviour. Associated red flag symptoms such as apnoeic episodes, cyanosis, respiratory

2019 NICE Clinical Knowledge Summaries

3971. Palliative cancer care - pain: Scenario: Assessment of pain

in review articles [ ; ; ] and expert opinion in a palliative care guideline [ ]. How should I assess factors affecting treatment? Enquire about: Response to previous analgesia (including allergies or sensitivities). The use of over-the-counter or complementary therapies and other prescribed medication. The person's treatment preferences (for example, preferred route of administration, a wish not to experience sedative effects from medication so that they can remain mobile). Concerns of the person (...) is difficult because of complex or multiple pains. Assess pain regularly, particularly if it is not adequately controlled. Review the medical history and medical records to determine the known site and extent of the cancer. Pain occurring distant from the previously known sites of cancer may indicate either a non-malignant cause or secondary spread of the cancer. Assess the influence of psychological, social, and spiritual factors on the person's experience of pain. Basis for recommendation

2019 NICE Clinical Knowledge Summaries

3972. Palliative cancer care - pain

Palliative cancer care - pain Palliative cancer care - pain | Topics A to Z | CKS | NICE Search CKS… Menu Palliative cancer care - pain Palliative cancer care - pain Last revised in October 2016 Cancer-related pain may be persistent or breakthrough (episodic), and influenced by physical, psychological, social and spiritual factors. Management Prescribing information Background information Palliative cancer care - pain: Summary Cancer-related pain may be persistent or breakthrough (episodic (...) ), and influenced by physical, psychological, social and spiritual factors. Breakthrough pain may be: Unpredictable (spontaneous). Predictable (incident) and related to movement or activity. The type of pain experienced depends on the underlying cause, and may be somatic, visceral or neuropathic pain. It can be caused by direct effects of a tumour, cancer treatment, related to procedures such as dressing changes, or unrelated to the underlying cancer. When assessing pain for a person in palliative care

2018 NICE Clinical Knowledge Summaries

3973. Parkinson's disease: Scenario: Confirmed Parkinson's disease

service if needed. See the CKS topic on for more information. The Parkinson's UK information sheet may be helpful. Look for and treat any acute illness (such as infection or constipation) that may exacerbate motor symptoms. Check adherence with anti-parkinsonian medication, including the correct doses and timings. Antiparkinsonian medicines should not be withdrawn abruptly to avoid the potential for acute akinesia or . Do not offer anticholinergic drug treatment to people who have developed dyskinesia (...) specialist advice regarding reducing or stopping relevant medication. The person's specialist may consider modafinil drug treatment for excessive daytime sleepiness, if a detailed sleep history has excluded reversible drug and physical causes. Sedating medication (such as antihistamines, antipsychotics, and some antidepressants) — reduce, stop, or use an alternative medication; seek specialist advice if necessary. Inadequate rest at night — see the CKS topic on for more information. Dementia — see

2016 NICE Clinical Knowledge Summaries

3974. Palliative care - nausea and vomiting: Prescribing dexamethasone

or silent perforation) is markedly increased in people who are also taking nonsteroidal anti-inflammatory drugs (NSAIDs). Gastrointestinal prophylaxis with a proton pump inhibitor or misoprostol should be considered for people receiving concurrent NSAIDs or those with a history of peptic ulcer disease. Dexamethasone should only be used in people with active peptic ulcer disease if the benefits are likely to outweigh the risks. Stopping use of dexamethasone in the terminal phase lacks expert consensus (...) : If the oral route is no longer available, dexamethasone can be given as a single slow subcutaneous dose, once a day. If treatment is not given the person may become agitated and distressed because of corticosteroid withdrawal. The onset of withdrawal symptoms is highly variable, depending on the risk of adrenal suppression, the length of time that the person lives after their last treatment, and their degree of physical stress; it is highly unlikely within the first 24 hours. The clinician must balance

2020 NICE Clinical Knowledge Summaries

3975. Palliative care - general issues: Scenario: Management approach

(such as sleep disturbance). Even if cancer is the underlying cause, different mechanisms may be responsible for the symptom (for example vomiting due to hypercalcaemia or gastric outflow obstruction). Bear in mind that all symptoms may be made worse by insomnia, exhaustion, anxiety, and depression. Ensure that any prescribed drug treatment is as pragmatic and straightforward as possible, avoiding medication which is no longer required, for example statins. Do not delay starting treatment as symptoms become (...) Palliative care - general issues: Scenario: Management approach Scenario: Management approach | Management | Palliative care - general issues | CKS | NICE Search CKS… Menu Scenario: Management approach Palliative care - general issues: Scenario: Management approach Last revised in April 2020 Scenario: Management approach From age 16 years onwards. How should I assess and manage the person's physical symptoms? Assess the person's physical needs at key points during the course of the illness

2020 NICE Clinical Knowledge Summaries

3976. Palliative care - dyspnoea: Scenario: Symptomatic treatment

obstruction, see in . Basis for recommendation These recommendations are pragmatic advice, based on expert opinion from palliative care and medical specialist reviewers of this CKS topic. When should I consider oxygen therapy? Consider oxygen therapy in people with dyspnoea who are known or clinically suspected to have symptomatic hypoxaemia. Consider non-pharmacological management of breathlessness in a person in the last days of life. Do not routinely start oxygen to manage breathlessness. Only offer (...) capabilities. Exertion to the point of breathlessness can increase tolerance and maintain fitness. The level of physical activity that is realistically achievable will vary from person to person. For example, people with very limited mobility may be able to stand up only once every hour or move their feet a few times an hour. Discuss adaptations in activities of daily living and lifestyle expectations and involve other professionals to identify where additional support is required : Help the person adapt

2020 NICE Clinical Knowledge Summaries

3977. Palliative care - oral: Scenario: Prevention

, and/or those undergoing advanced treatment). Every hour in people at high risk or who have severe problems (for example oral infections, coma, severe mucositis, dehydration, immunosuppressed, diabetes, or needing oxygen therapy). Dentures should be removed at night and cleaned with a soft toothbrush and unperfumed soap or denture toothpaste. Seek the advice of a dentist regarding how to soak dentures overnight. Different strategies are used to soak dentures overnight. Some experts recommend the following (...) and chemotherapy. Preventing oral candidiasis Oral candidiasis is a potential adverse effect of cancer treatment, and complications may result in a further deterioration of the physical state. Prevention of superficial infection is important because of its possible role in the development of systemic fungal infection. Systemic infection is difficult to diagnose early and consequently cure because it rapidly becomes advanced and disseminated, leading to considerable morbidity and mortality. Seek specialist

2020 NICE Clinical Knowledge Summaries

3978. Palliative care - dyspnoea

obstructive pulmonary disease, heart failure, and anxiety. Assessment of someone with dyspnoea in a palliative care setting involves asking about: Features of the dyspnoea (for example severity, timing, onset, and precipitating and exacerbating factors). Associated physical symptoms (for example cough, sputum, haemoptysis, wheeze, stridor, pleuritic pain, fatigue, and panic). Effect on the person’s quality of life. An appropriate examination for the stage of the person's illness should be carried out (...) involves adopting a stepwise approach, depending on the underlying cause of the dyspnoea and the stage of illness. The following approach should be considered: Simple measures, such as keeping the room cool, the use of a fan, opening a window, relaxation and breathing techniques. Encouraging exercise within the person's capabilities. Adaptations in activities of daily living and lifestyle expectations. Strategies to manage other physical symptoms, and the psychological, social, and spiritual needs

2020 NICE Clinical Knowledge Summaries

3979. Palliative care - cough: Scenario: Known cause of cough

relief and improved quality of life. For further information, see . Manage dyspnoea if present. See the CKS topic on . Provide holistic care of the person by considering management of other physical symptoms, and the psychological, social, and spiritual needs of the person and their family. For more information, see the CKS topic on . Basis for recommendation These recommendations are based on palliative care guidelines [ ] and expert opinion from medical and palliative care literature [ ; ; ]. How (...) of cough (such as a tumour or tracheo-oesophageal fistula) — involve a specialist in view of the need to tailor treatment to the person's underlying malignancy and co-existing problems, and the large variety of treatments available. These include radiotherapy, stenting of tracheo-oesophageal fistulae, aspiration of a pleural effusion, or corticosteroids. Drug-related cough (such as angiotensin-converting enzyme inhibitors) — review the person's medication, as it may be appropriate to stop certain drugs

2020 NICE Clinical Knowledge Summaries

3980. Palliative care - dyspnoea: Scenario: Assessment

, sputum, haemoptysis, wheeze, stridor, pleuritic pain, fatigue, and panic). Associated psychological symptoms (such as anxiety). Precipitating or exacerbating factors (for example physical activity, posture, environmental factors [such as pollen], and emotional factors [such as anxiety, excitement, fear]). Drug history (for example nonsteroidal anti-inflammatory drugs, beta-blockers, chemotherapy). Quality of life issues (for example effect of the dyspnoea on the person's mobility, usual role, coping (...) Palliative care - dyspnoea: Scenario: Assessment Scenario: Assessment | Management | Palliative care - dyspnoea | CKS | NICE Search CKS… Menu Scenario: Assessment Palliative care - dyspnoea: Scenario: Assessment Last revised in April 2020 Scenario: Assessment From age 16 years onwards. What questions should I ask about dyspnoea? Ask about: Features of the dyspnoea (for example severity, timing, onset, and precipitating and exacerbating factors). Associated physical symptoms (for example cough

2015 NICE Clinical Knowledge Summaries

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