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81. Rehabilitation after critical illness in adults

' clinical stories. Research on the longer-term consequences of critical illness has shown that significant numbers of patients surviving critical illness have important continuing problems. For many, discharge from critical care is the start of an uncertain journey to recovery characterised by, among other problems, weakness, loss of energy and physical difficulties, anxiety, depression, post-traumatic stress (PTS) phenomena and, for some, a loss of mental faculty (termed cognitive function). Family (...) of developing physical and non-physical morbidity. Functional assessment: an assessment to examine the patient's daily functional ability. Short-term rehabilitation goals: goals for the patient to reach before they are discharged from hospital. Medium-term rehabilitation goals: goals to help the patient return to their normal activities of daily living after they are discharged from hospital. Physical morbidity: problems such as muscle loss, muscle weakness, musculoskeletal problems including contractures

2009 National Institute for Health and Clinical Excellence - Clinical Guidelines

83. Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence

It is thought that between a third and a half of all medicines [1] prescribed for long-term conditions are not taken as recommended. If the prescription is appropriate, then this may represent a loss to patients, the healthcare system and society. The costs are both personal and economic. Adherence presumes an agreement between prescriber and patient about the prescriber's recommendations. Adherence to medicines is defined as the extent to which the patient's action matches the agreed recommendations. Non (...) to communicate with their healthcare professional than others. 1.1.1 Healthcare professionals should adapt their consultation style to the needs of individual patients so that all patients have the opportunity to be involved in decisions about their medicines at the level they wish. 1.1.2 Consider any factors such as physical or learning disabilities, sight or hearing problems and difficulties with reading or speaking English, which may affect the patient's involvement in the consultation. 1.1.3 Establish

2009 National Institute for Health and Clinical Excellence - Clinical Guidelines

84. Child maltreatment: when to suspect maltreatment in under 16s

maltreatment the level of concern may change and lead to exclude or suspect maltreatment. When hearing about or observing an alerting feature in the guidance: look for other alerting features of maltreatment in the child or young person's history, presentation or parent– or carer–interaction with the child or young person now or in the past. Then do one or more of the following: Discuss your concerns with a more experienced colleague, a community paediatrician, child and adolescent mental health service (...) . There is a history of events that is biologically unlikely (for example, infants with a history of very large blood losses who do not become unwell or anaemic). Despite a definitive clinical opinion being reached, multiple opinions from both primary and secondary care are sought and disputed by the parent or carer and the child continues to be presented for investigation and treatment with a range of signs and symptoms. The child's normal daily activities (for example, school attendance) are being compromised

2009 National Institute for Health and Clinical Excellence - Clinical Guidelines

85. Workplace health: management practices

services are also available to younger age groups and it would be important to ensure that all employees are helped to access appropriate services. The committee considered comments on the importance of communication issues relating to sight and hearing loss. These can have a significant impact on people, both at work and in other areas of their lives. However, no evidence was found relating specifically to sight or hearing issues. The committee noted that equalities legislation requires employers (...) of their employees on the basis of likely performance benefits (Does worker wellbeing affect workplace performance, Department for Business, Innovation & Skills). During 2013/14, 1.2 million working people had a work-related illness. Half a million of these were new illnesses (Health and Safety Statistics Annual report for Great Britain 2013/14 Health and Safety Executive). Work-related illness and workplace injury led to the loss of an estimated 28.2 million working days in 2013/14. Injuries and new cases

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

86. Older people: independence and mental wellbeing

Release'). By 2035 the number is expected to reach 3.5 million and account for 5% of the population (Population ageing in the United Kingdom, its constituent countries and the European Union Office for National Statistics). Older people may experience an age-related disability. For example, 71% of people aged 70 and over have hearing loss (Hearing matters Action on Hearing Loss). One in 5 people aged 75 and older and 1 in 2 aged 90 and older have sight loss (Sight loss statistics postcard RNIB). Older (...) to overcome the barriers to getting involved. This could include: Providing help and advocacy for people with specific needs. For example: carers; people with mental health problems; people who have difficulties seeing or hearing; and people who have problems with their flexibility, balance or mobility. Use of existing services. For example, using concessionary fares and encouraging transport services to coordinate their timetables and stops to help people get to the activities. This also includes

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

87. Older people with social care needs and multiple long-term conditions

use words to show the strength of our recommendations, and has information about safeguarding, consent and prescribing medicines. Making information accessible Making information accessible Information provided to both people using services and their families and carers should be in a format that suits their needs and preferences. In particular, practitioners must identify, record and meet the information and communication needs of people who have hearing loss, sight loss or learning disabilities (...) , hearing and sight loss, and and common care needs, such as nutrition, hydration, chronic pain, falls and skin integrity, and and common support needs, such as dealing with bereavement and end-of-life, and and deterioration in someone's health or circumstances [5] . 1.7.3 Make provision for more specialist support to be available to people who need it – for example, in response to complex long-term health conditions – either by training practitioners directly involved in supporting people

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

88. Excess winter deaths and illness and the health risks associated with cold homes

health and housing referral service for people living in cold homes Health and wellbeing boards and their partners (see who should take action?) should ensure the local single-point-of-contact health and housing referral service provides access to tailored solutions to address identified needs, rather than an off-the-shelf approach. Solutions should take into account the language and reading ability of recipients, including any vision or hearing problems. Solutions should include: Housing insulation (...) . Usually, most health sector costs come from identifying and engaging with people who are most at risk of health problems from the cold and helping to ensure they have access to, and receive, the necessary support. The Committee did hear of examples where, for example, insulation or boiler replacements were funded directly by health bodies. But this was unusual. 4.7 The Committee noted the importance of considering cold-related illnesses (as well as deaths from the cold). There is a lack of evidence

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

89. Otitis media with effusion in under 12s: surgery

#notice-of-rights). Page 5 of 28Introduction Introduction Otitis media with effusion (OME) is a common condition of early childhood in which an accumulation of fluid within the middle ear space causes hearing impairment. The hearing loss is usually transient and self-limiting over several weeks, but may be more persistent and lead to educational, language and behavioural problems. OME may be overlooked because of the insidious nature of the condition, and suspicion of hearing loss in children must (...) be acted upon effectively. In most instances of uncomplicated OME, no intervention is required because the fluid clears spontaneously and the hearing recovers. A period of observation of the hearing loss over 3 months (with accurate audiometry), and its impact on the child's development, is recommended in order to determine whether resolution occurs or if further treatment is needed. This may require better and more timely access to paediatric audiology services than is currently available in some

2008 National Institute for Health and Clinical Excellence - Clinical Guidelines

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

://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 15 of 54significant weight loss sleep apnoea clinically significant lymphadenopathy. 1.2.2 1.2.2 History History, e , examinations and in xaminations and inv vestigations estigations 1.2.2.1 A full history (including exacerbating and alleviating factors, sleep disturbance and intercurrent stressors) should be taken, and a physical examination and assessment of psychological wellbeing should be carried out. 1.2.2.2 A child or young person who has (...) and other haematological indices suggest iron deficiency. 1.2.2.5 T ests for vitamin B 12 deficiency and folate levels should not be carried out unless a full blood count and mean cell volume show a macrocytosis. 1.2.2.6 The following tests should not be done routinely to aid diagnosis: the head-up tilt test auditory brainstem responses electrodermal conductivity. 1.2.2.7 Serological testing should not be carried out unless the history is indicative of an infection. Depending on the history, tests

2007 National Institute for Health and Clinical Excellence - Clinical Guidelines

92. Caesarean section

individual CS. [new 2011] [new 2011] 1.4.4 1.4.4 Preoper Preoperativ ative testing and prepar e testing and preparation for CS ation for CS 1.4.4.1 Pregnant women should be offered a haemoglobin assessment before CS to identify those who have anaemia. Although blood loss of more than 1000 ml is infrequent after CS (it occurs in 4–8% of CS) it is a potentially serious complication. [2004] [2004] 1.4.4.2 Pregnant women having CS for antepartum haemorrhage, abruption, uterine rupture and placenta praevia (...) are at increased risk of blood loss of more than 1000 ml and should have the CS carried out at a maternity unit with on-site blood transfusion services. [2004] [2004] 1.4.4.3 Pregnant women who are healthy and who have otherwise uncomplicated pregnancies should not routinely be offered the following tests before CS: grouping and saving of serum cross-matching of blood a clotting screen preoperative ultrasound for localisation of the placenta, because this does not improve CS morbidity outcomes (such as blood

2011 National Institute for Health and Clinical Excellence - Clinical Guidelines

93. Autism in under 19s: recognition, referral and diagnosis

team should either have the skills (or have access to professionals that have the skills) needed to carry out an autism diagnostic assessment, for children and young people with special circumstances including: coexisting conditions such as severe visual and hearing impairments, motor disorders including cerebral palsy, severe learning (intellectual) disabilities, complex language disorders or complex mental health disorders looked-after children and young people. [2011] [2011] 1.1.10 If young (...) of cultural variation, but do not assume that language delay is accounted for because English is not the family's first language or by early hearing difficulties autism may be missed in children or young people with a learning (intellectual) disability autism may be missed in children or young people who are verbally able autism may be under-diagnosed in girls important information about early development may not be readily available for some children and young people, for example looked-after children

2011 National Institute for Health and Clinical Excellence - Clinical Guidelines

97. Contraceptive services for under 25s

, colleges, youth clubs and other places that young people visit have up-to-date and accessible information on contraceptive methods and local services. Ensure information is available in a range of formats. For example, it should be available in languages other than English, in large print, or text relay (for those who are deaf or hard of hearing). It should also be distributed via a range of media, for example, via mobile phones (text messaging or calls) or emails. (Practitioners should be mindful

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

98. Stroke rehabilitation in adults

resulted in further significant improvements in mortality and morbidity from stroke (as documented in the National sentinel stroke audit [2] ). However, the burden of stroke may increase in the future as a consequence of the ageing population. Despite improvements in mortality and morbidity, people with stroke need access to effective rehabilitation services. Stroke rehabilitation is a multidimensional process, which is designed to facilitate restoration of, or adaptation to the loss of, physiological (...) also be given the information and support they need. Stroke rehabilitation in adults (CG162) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 7 of 43T T erms used in this guideline erms used in this guideline Aphasia Aphasia Loss or impairment of the ability to use and comprehend language, usually resulting from brain damage. Apr Apraxia ( axia (of speech) of speech) Difficulty in initiating and executing

2013 National Institute for Health and Clinical Excellence - Clinical Guidelines

99. Diabetes (type 1 and type 2) in children and young people: diagnosis and management

-and- conditions#notice-of-rights). Page 10 of 85diabetes who have increased thirst, polyuria, recent unexplained weight loss or excessive tiredness and any of the following: nausea or vomiting abdominal pain hyperventilation dehydration reduced level of consciousness. [new 2015] [new 2015] [2] Level 3 carbohydrate counting is defined as carbohydrate counting with adjustment of insulin dosage according to an insulin:carbohydrate ratio. Diabetes (type 1 and type 2) in children and young people: diagnosis (...) monitoring' is in very common use, so in this guideline we use the term 'blood glucose' , except when referring to specific concentration values. 1.1 Diagnosis 1.1.1 Be aware that the characteristics of type 1 diabetes in children and young people include: hyperglycaemia (random plasma glucose more than 11 mmol/litre) polyuria polydipsia weight loss excessive tiredness. [2004, amended 2015] [2004, amended 2015] 1.1.2 Refer children and young people with suspected type 1 diabetes immediately (on the same

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

100. Dementia, disability and frailty in later life - mid-life approaches to delay or prevent onset

or environmental factors. People often think of disability as difficulty walking, but problems using your hands, hearing loss, sight loss and speech impairment are just a few of the many issues people may experience which contribute to disabilities. The impact of these functional restrictions can be made worse by poor environments, but can made easier to cope with in good environments. For example, physical mobility can be made easier by improvements to the environment. Conditions such as type 2 diabetes (...) ://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 22 of 62Sensory disability, including hearing loss and visual impairment, is estimated to be responsible for 7–10% of all years lived with disability among those aged 70 or over in the UK (Annual report of the Chief Medical Officer: Surveillance volume 2012, On the state of the public's health Department of Health). Some form of hearing loss is reported by 42% of people over 50 in the UK (Hearing matters Action on Hearing Loss). An estimated 80,000

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

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