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121. Weakness / Fatigue

disease. The severity and impact of fatigue may change in the course of the disease trajectory. It is frequently regarded as more distressing than pain by patients. It is often under-recognised by professionals. Fatigue may be unrelated to level of activity and not fully alleviated by rest or sleep. It is multidimensional affecting physical function, cognitive ability, social, emotional and spiritual wellbeing. Reduced physical function limits participation in preferred activities and activities (...) conservation/restoration consider a self-management plan set priorities, delegate tasks pace activities and attend to one activity at a time schedule activities at times of peak energy and conserve energy for valued activities eliminate non-essential activities occupational therapy referral for advice on minimising energy expenditure and appropriate aids/equipment. Physical activity and exercise An appropriate level of exercise can reduce fatigue and should be recommended. Consider physiotherapy referral

2015 Scottish Palliative Care Guidelines

122. Hiccups

, hypercalcaemia, magnesium deficiency) infection irritation of diaphragm or phrenic nerve hepatic disease/hepatomegaly cerebral causes (eg tumour, metastases). Damage to phrenic nerve over its course from skull to diaphragm, eg shingles, pressure from mediastinal tumour. Management Treat reversible causes. Hiccups often stop spontaneously. Treatment is only required if hiccups are persistent. Try simple physical manoeuvres initially and those that have worked previously. Non-pharmacological management Simple (...) this use is off licence Indicates this medication is associated with QT prolongation Colour codes: Red – For medicines normally initiated and used under specialist guidance Amber – For medicines normally initiated by a specialist but may be used by generalists Green – For medicines routinely initiated and used by generalists

2015 Scottish Palliative Care Guidelines

123. Nausea and Vomiting

are distinct entities, principally representing behavioural adaptive mechanisms to avoid the ingestion of toxins. However, there are clearly other physical (eg vestibular upset) and psychological (eg fear, anticipation) triggers that can lead to the experience of nausea, vomiting or both. As there may be several potential contributory factors to consider in any one individual, it may be useful to parallel the approach taken with pain management in palliative care and consider the concept of ‘total nausea (...) , and diuretics which may require to be temporarily discontinued until vomiting is controlled. The effect on family and carers of looking after someone with nausea and / or vomiting can be profound. The patient and their family will therefore usually require emotional and spiritual care as well as physical support. Regurgitation Obstruction of the oesophagus and consequent regurgitation can be reported as vomiting. It is important to differentiate regurgitation from vomiting to avoid delay in seeking

2015 Scottish Palliative Care Guidelines

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

information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding. 1.1 Information and support 1.1.1 Offer all people with oesophago-gastric cancer access to an oesophago-gastric clinical nurse specialist through the person's multidisciplinary team. 1.1.2 Make sure the person with oesophago-gastric cancer is given information, in a format that is appropriate for them, to take away and review (...) are important to them (as appropriate), at a pace that is suitable for them. This could include information on: life expectancy, if the person has said they would like to know about this the treatment and care available, and how to access this both now and for future symptoms holistic issues (such as physical, emotional, social, financial and spiritual issues), and how they can get support and help dietary changes, and how to manage these and access specialist dietetic support which sources of information

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

125. Age-related macular degeneration

People have the right to be involved in discussions and make informed decisions about their care, as described in your care. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding. 1.1 Classifying age-related macular degeneration 1.1.1 Classify age (...) with late AMD (wet active) if there are practical reasons for doing so (for example, if a different medicine can be given in a regimen the person prefers), but be aware that clinical benefits are likely to be limited. 1.5.16 Consider observation without giving anti-VEGF treatment if the disease appears stable (in this event, see section 1.7 for recommendations on monitoring and self-monitoring). 1.5.17 Consider stopping anti-VEGF treatment if the eye develops severe, progressive loss of visual acuity

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

126. Naloxone

Omit next regular dose of opioid; review analgesia. Monitor the patient closely; maintain hydration, oxygenation. Cautions Naloxone is not indicated for opioid induced drowsiness and/or that are not life threatening. Naloxone is not indicated for patients on opioids who are dying. Patients on regular opioids for pain and symptom control are physically dependent; naloxone given in too large a dose or too quickly can cause an acute withdrawal reaction and an abrupt return of pain that is difficult (...) to control. Patients with pre-existing cardiovascular disease are at more risk of side effects. Side effects Total antagonism will result in severe pain with hyperalgesia and, if physically dependent, severe physical withdrawal symptoms and marked agitation. Opioid withdrawal syndrome: anxiety, irritability, muscle aches; ; can include life-threatening tachycardia and hypertension. Cardiac arrhythmias, pulmonary oedema and cardiac arrest have been described. Dose and Administration Where intravenous

2015 Scottish Palliative Care Guidelines

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

a positive childbirth experience for women and their babies, the recommendations in this guideline should be implemented as a package of care in all settings, by kind, competent and motivated health care professionals working where essential physical resources are available. Health systems should aim to implement this WHO model of intrapartum care to empower all women to access the type of woman-centred care that they want and need, and to provide a sound foundation for such care, in accordance (...) Working Group (TWG) comprised guideline methodologists and systematic review teams. An independent consultant from the Evidence-Based Medicine Consultancy in Bath, United Kingdom, and technical experts from Centro Rosarino de Estudios Perinatales (CREP) in Rosario, Argentina, served as guideline methodologists. In relation to quantitative evidence on the effects of different prioritized interventions, the Cochrane Pregnancy and Childbirth Group (PCG) provided input on the scoping of the guideline

2018 World Health Organisation Guidelines

128. Deprescribing benzodiazepine receptor agonists

., S.S.], 1 family physician [L.M.B.], 1 geriatric psychiatrist [A.W.], and 1 family physician spe- cializing in LTC [L.G.]) and a Cochrane methodologist (V.W.). Expertise, role descriptions, and conflict of inter- est statements are available at CFPlus.* We selected a guideline chair (L.M.B.) based on expertise in pharma- coepidemiology and in primary care clinical medicine. A Canadian Library of Family Medicine librarian conducted searches in collaboration with 1 staff member (M.H.). We used (...) baseline BPSD • Tapering may not be needed if low dose for insomnia only • Consider interventions such as: relaxation, social contact, sensory (music or aroma-therapy), structured activities and behavioural therapy • Address physical and other disease factors: e.g. pain, infection, constipation, depression • Consider environment: e.g. light, noise • Review medications that might be worsening symptoms T apering doses BPSD management Primary care: 1. Go to bed only when sleepy 2. Do not use your bed

2018 CPG Infobase

129. Guideline on the management of women with endometriosis

, others have no symptoms at all. The exact prevalence of endometriosis is unknown but estimates range from 2 to 10% within the general female population but up to 50% in infertile women (Eskenazi and Warner, 1997, Meuleman, et al., 2009). Endometriosis diagnosis is based on the women's history, symptoms and signs; the diagnosis is corroborated by physical examination and imaging techniques, and finally proven by histology of either a directly biopsied vaginal lesion, from a scar, or of tissue (...) in deep infiltrating disease, where sometimes endometriosis is hidden beneath the peritoneal surface. Laparoscopy also allows direct surgical treatment and disease staging, which could for example be performed according to the ASRM classification system (Revised American Society for Reproductive Medicine classification of endometriosis: 1996, 1997). This classification system assigns points to the different locations of the disease thus resulting in four stages: minimal, mild, moderate and severe

2013 European Society of Human Reproduction and Embryology

130. Pharmacological management of migraine

Health Technologies Group, the Scottish Intercollegiate Guidelines Network (SIGN) and the Scottish Medicines Consortium are key components of our organisation. KEY TO EVIDENCE STATEMENTS AND RECOMMENDATIONS LEVELS OF EVIDENCE 1 ++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias 1 + Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias 1 - Meta-analyses, systematic reviews, or RCTs with a high risk of bias 2 ++ High-quality (...) 8 Implementing the guideline 27 8.1 Implementation strategy 27 8.2 Resource implications of key recommendations 27 8.3 Auditing current practice 27 8.4 Advice for NHSScotland from the Scottish Medicines Consortium 27 9 The evidence base 29 9.1 Systematic literature review 29 9.2 Recommendations for research 29 9.3 Review and updating 30 10 Development of the guideline 31 10.1 Introduction 31 10.2 The guideline development group 31 10.3 Acknowledgements 32 10.4 Consultation and peer review 32

2018 SIGN

131. Menopause

information about managing menopausal symptoms can be found here.ROYAL COLLEGE OF NURSING 11 Confidence and sexuality Some women view the menopause with confidence as an end to periods, pre-menstrual syndrome and contraceptive worries, and the start of the next enjoyable phase of their lives. Others can be less positive as they struggle to deal with the impact of the loss of fertility and other physical symptoms, alongside the coincidental problems which arise in later middle age such as: • children (...) is important as obesity is a major risk factor for CHD and is associated with high blood pressure, heart attacks, heart failure and diabetes. Women should aim for a health body mass index (BMI) of 20–25. Exercise The following key points relate to the importance and benefits of exercise: • regular exercise is necessary to remain active, healthy and independent • physical activity reduces both the risk of developing CHD and of having a stroke by lowering blood pressure • exercise increases energy levels

2018 Royal College of Nursing

132. ESMO Consensus Conference on malignant lymphoma: general perspectives and recommendations for the clinical management of the elderly patient with malignant lymphoma

of Internal Medicine III, Institute of Experimental Cancer Research, University Hospital, Ulm, Germany Correspondence to : Prof. Christian Buske, ESMO Guidelines Committee, ESMO Head Office, Via L. Taddei 4, CH-6962 Viganello-Lugano, Switzerland. E-mail: Search for other works by this author on: M Hutchings Department of Haematology, Rigshospitalet, Copenhagen, Denmark Search for other works by this author on: M Ladetto Hematology Division, Azienda Ospedaliera Santi Antonio e Biagio e Cesare Arrigo (...) , Alessandria, Italy Search for other works by this author on: V Goede Department of Internal Medicine, University Hospital Cologne, Cologne, Germany Search for other works by this author on: U Mey Department of Oncology and Haematology, Kantonsspital Graubünden, Chur, Switzerland Search for other works by this author on: P Soubeyran Department of Medical Oncology, Institut Bergonié, Comprehensive Cancer Centre, Bordeaux, France Search for other works by this author on: M Spina Division of Medical Oncology

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2018 European Society for Medical Oncology

134. Mental health care in the perinatal period: Australian clinical practice guideline

of a woman’s physical and mental health should be central to every aspect of maternity care. As well as affecting a woman’s emotional welfare and happiness, mental health conditions affect her experience of pregnancy and parenting, are associated with a degree of increased risk of obstetric and neonatal complications and can profoundly affect a woman’s ability to bond with her baby and the infant’s psychological adaptation over the longer term. Fetal exposure to an untreated maternal mental health (...) General Assembly 1948; UN General Assembly 2007). While many Australian women experience economic security, educational attainment and good health, there are still many women living in poverty, subsisting on pensions or low-income occupations, restricted by under-employment and experiencing poor health outcomes (AWHN 2008). Gender inequalities persist, with women economically less secure, maintaining the primary carer role, and subject to violence (including physical and sexual assault, as well

2018 Clinical Practice Guidelines Portal

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

2Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham3Birmingham and Midland Eye Centre, City Hospital NHS Trust, Birmingham Search for other works by this author on: Anwar R. Tappuni 4Institute of Dentistry, Queen Mary University of London Search for other works by this author on: Nurhan Sutcliffe 5Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Barts Health NHS Trust, London Search for other works by this author (...) on: Katie L. Hackett 6Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University & Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne7Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne Search for other works by this author on: Francesca Barone 8Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham9Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK Search for other

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2017 British Society for Rheumatology

136. Air pollution: outdoor air quality and health

prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding. 1.1 Planning 1.1.1 Include air pollution in 'plan making' by all tiers of local government, in line with the Department for Communities and Local Government's National Planning Policy Framework. This includes county, district and unitary authorities, as well as regional bodies and transport authorities. The Local Plan and other strategic planning (...) processes (such as the core strategy, local transport plan, environment and health and wellbeing strategies) should include zero- and low-emission travel, for example cycling and walking (see section 1.6 and NICE's guideline on physical activity: walking and cycling). Other strategies for zero- and low- emission travel could include: Providing charge points for electric vehicles in workplaces, commercial developments and residential areas. Supporting car sharing schemes or car clubs. 1.1.2 When 'plan

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

137. Guidelines for the Management of Evolving Airway Obstruction: Transition to the Can't Intubate Can't Oxygenate Airway Emergency

through them and to follow best practice at high risk points (See Appendix 1). Page 4 PS61 2017 ? Self-awareness by clinicians of their vulnerability to errors, and self- monitoring to detect and rectify errors, unproductive cognitive processes, or factors such as stress fatigue and high task workload that reduce cognitive resources and lead to errors. ? Encouragement of other team members to speak up to provide input or raise concerns where these exist. ? Real-time optimisation of the physical (...) errors. 5.4.2. Prevent and detect cognitive failure ? Use a cognitive aid which is available to all members of the team. ? Activate pre-rehearsed emergency responses and problem-solving practices ? Be self-aware of vulnerability to errors and self-monitor to detect and rectify errors or unproductive cognitive processes that lead to fixation errors or that reduce cognitive resources ? Manage stress ? Invite team members to provide input and raise concerns ? Optimise the physical environment to promote

2017 Australian and New Zealand College of Anaesthetists

138. Guidelines for the Management of Evolving Airway Obstruction: Transition to the Can't Intubate Can't Oxygenate Airway Emergency Background Paper

based locally relevant guidelines, resources, equipment and communications systems with which they have been trained. They should have access to other experts. Ideally they should train in teams but at a minimum should adhere to a common set of guidelines and procedures. The physical environment of the operating theatre or setting in which airway management occurs should be optimised to promote team coordination and situation awareness through display of cognitive aids, layout of relevant equipment (...) ), Dr Reny Segal, FANZCA (Vic), A/Prof Leonie Watterson, FANZC (NSW) REFERENCESProfessional documents of the Australian and New Zealand College of Anaesthetists (ANZCA) are intended to apply wherever anaesthesia is administered and perioperative medicine practised within Australia and New Zealand. It is the responsibility of each practitioner to have express regard to the particular circumstances of each case, and the application of these ANZCA documents in each case. It is recognised that there may

2017 Australian and New Zealand College of Anaesthetists

139. Guidelines for the Safe Management and Use of Medications in Anaesthesia

have a significant impact on availability of essential medications when there are interruptions to supply. 5.1.2 If feasible, a designated pharmacist should liaise with a designated (clinical) drug safety officer in the department of anaesthesia or pain medicine over all decisions on relevant drug purchasing and presentation. In the absence of an anaesthesia department an anaesthetist should be nominated/designated to undertake such liaison. 5.1.3 The labelling and packaging of drugs should (...) be clear segregation of drugs of different concentrations but similar physical presentation (e.g. local anaesthetics, heparin). Page 3 PS51 2018 5.1.6 Wherever practicable drugs should be purchased or supplied in concentrations that minimise the need for dilution prior to administration. Certain drugs are particularly dangerous when undiluted and these should ideally be supplied in bags of fluid, pre- diluted to concentrations suitable for safe administration. 5.1.7 Consideration should be given

2017 Australian and New Zealand College of Anaesthetists

140. Guidelines on Monitoring During Anaesthesia Background Paper

from “Recommendations” to “Guidelines”. “Guidelines” offer advice on clinical and non- clinical aspects of the practice of anaesthesia and perioperative medicine, reflecting expert consensus and supported by other evidence when available. SCOPE PS18 is intended to apply wherever anaesthesia is administered and includes general anaesthesia, sedation, and major regional analgesia. While general anaesthesia and major regional analgesia is performed by anaesthetists, conscious sedation is administered (...) necessitated the anaesthetist to be in close physical contact to the patient, with constant observation, palpation of peripheral pulses, continual auscultation with precordial stethoscopes, and visualisation of pupils, amongst other things. Increasing sophistication of equipment has allowed the anaesthetist to be removed from direct physical contact and has provided the opportunity for improved quantification of parameters, as well as enabling alarm parameters to be set, and recording of data. This in turn

2017 Australian and New Zealand College of Anaesthetists

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