Clinical Guidelines

Overview

The clinical guidelines section offers physicians access to the most recent good practice guidelines in the management of patients. These are based on the best available scientific evidence and a broad consensus from panels of experts. Find information about diagnosis, drug prescribing, disease management and other data that will support clinical practice and gaining the best outcomes for patients.

The regularly updated guidelines can be sorted by disease/condition, publisher or year of publication. They can also be accessed within the relevant epgonline.org disease topic areas, via the collapsible menu at the top of each page of the epgonline.org website.

Guidelines Image

Association for Clinical Biochemistry & Laboratary medicine (ACB)

Best Practice when providing interpretative comments on laboratory medicine reports

Association for Clinical Biochemistry & Laboratary medicine (ACB) (Sep 2014)

This Best Practice document is intended as a guide for those providing interpretative comments. It is self-evident that comments must add clinical value and it is anticipated that many of the recommendations will be second nature to those already involved with this task but others may not yet be routinely practised by all laboratories.

Top Tips for the measurement 25 Hydroxy Vitamin D Metabolites

Association for Clinical Biochemistry & Laboratary medicine (ACB) (Aug 2013)

This document provides tips for the measurement 25 Hydroxy Vitamin D Metabolites

Recommendations as a result of the ACB national audit on tumour marker service provision

Association for Clinical Biochemistry & Laboratary medicine (ACB) (May 2013)

This document provides recommandations on the use of tumour markers

National Minimum Re‐testing Interval Project: A final report detailing consensus recommendations for minimum re‐testing intervals for use in Clinical Biochemistry

Association for Clinical Biochemistry & Laboratary medicine (ACB) (Jan 2013)

There is currently a drive in pathology to harmonise processes and remove unnecessary waste, thereby saving money. At a time when many trusts are implementing electronic requesting of laboratory tests, which allows the requestor and the laboratory to manage what is requested, there needs to be a solution to support this process based on the best available evidence. Similar type initiatives have been reported including the work of the Pathology Harmony Group and the recent proposal to standardise test profiles. How often a test should be repeated, if at all, should be based upon a number of criteria: the physiological properties, biological half‐life, analytical aspects, treatment and monitoring requirements, and established guidance. This report proposes a set of consensus recommendations from the laboratory medicine perspective.

Top Tips for the measurement of Immunosuppressive Drugs by LC‐MS/MS

Association for Clinical Biochemistry & Laboratary medicine (ACB) (Dec 2012)

This document provides tips for the measurement of Immunosuppressive drugs by LC-MS/MS

Association of Anaesthetists of Great Britain and Ireland

Arterial line blood sampling: preventing hypoglycaemic brain injury

Association of Anaesthetists of Great Britain and Ireland (Sep 2014)

This guideline makes detailed recommendations on the prescription, checking and administration of arterial line infusions in adult practice. We also make recommendations about storage, arterial pressure monitoring and sampling systems and techniques. Finally, we make recommendations about glucose monitoring and insulin administration. It is intended that adherence to these guidelines will reduce the frequency of sample contamination errors in arterial line use and capture events, when they do occur, before they cause patient harm.

Safety guideline: skin antisepsis for central neuraxial blockade

Association of Anaesthetists of Great Britain and Ireland (Sep 2014)

Concise guidelines are presented that recommend the method of choice for skin antisepsis before central neuraxial blockade. The Working Party specifically considered the concentration of antiseptic agent to use and its method of application. The advice presented is based on previously published guidelines, laboratory and clinical studies, case reports, and on the known properties of antiseptic agents.

Peri-operative care of the elderly 2014

Association of Anaesthetists of Great Britain and Ireland (Jan 2014)

This guideline is specific to the role of anaesthesia within the multidisciplinary peri-operative care given to elderly surgical patients.

Regional Anaesthesia and Patients with Abnormalities of Coagulation

Association of Anaesthetists of Great Britain and Ireland (Nov 2013)

Concise guidelines are presented that relate abnormalities of coagulation, whether the result of the administration of drugs or that of pathological processes, to the consequent haemorrhagic risks associated with neuraxial and peripheral nerve blocks. The advice presented is based on published guidelines and on the known properties of anticoagulant drugs. Four separate Tables address risks associated with anticoagulant drugs, neuraxial and peripheral nerve blocks, obstetric anaesthesia and special circumstances such as trauma, sepsis and massive transfusion.

Immediate Post-anaesthesia Recovery 2013

Association of Anaesthetists of Great Britain and Ireland (Mar 2013)

The guideline uses the widely used term ‘post-anaesthesia care unit’ (PACU) to refer to all areas that would formerly have been called ‘recovery rooms’ . The guideline recommends that all PACU staff should be trained to nationally recognised standards and be familiar with relevant safeguarding/child protection procedures as appropriate, and that all patients with tracheal tubes in place in PACUs should be monitored with continuous capnography. These recommendations align this guideline with other recent guidance on these and related topics.

Immediate Post-anaesthesia Recovery 2013 supplement

Association of Anaesthetists of Great Britain and Ireland (Mar 2013)

This supplement complements the Immediate Post-anaesthesia Recovery 2013

Checking Anaesthetic Equipment 2012

Association of Anaesthetists of Great Britain and Ireland (Jun 2012)

A pre-use check to ensure the correct functioning of anaesthetic equipment is essential to patient safety. The anaesthetist has a primary responsibility to understand the function of the anaesthetic equipment and to check it before use. Anaesthetists must not use equipment unless they have been trained to use it and are competent to do so.

Management of proximal femoral fractures 2011

Association of Anaesthetists of Great Britain and Ireland (Sep 2011)

Proximal femoral fractures present unique challenges for anaesthetic departments throughout Great Britain and Ireland, involving the perioperative care of large numbers of older patients with significant comorbidities. Despite guidance since the early 1990s concerning best practice management for these vulnerable patients, there remains considerable variation in models of peri-operative care, rehabilitation and orthogeriatric input.

Best practice in the management of epidural analgesia in the hospital setting

Association of Anaesthetists of Great Britain and Ireland (Nov 2010)

These guidelines are concerned with the management of epidural analgesia in the hospital setting, including continuous infusions, patient-controlled epidural analgesia (PCEA) and intermittent top-up injections. They are not concerned with the management of epidural analgesia for obstetrics, palliative care or management of persistent non-cancer pain.

Blood Transfusion and the Anaesthetist Management of Massive Haemorrhage

Association of Anaesthetists of Great Britain and Ireland (Nov 2010)

The management of massive haemorrhage is usually only one component of the management of a critically unwell patient. These guidelines are intended to supplement current resuscitation guidelines and are specifically directed at improving management of massive haemorrhage. The guidance is intended to provide a better understanding of the priorities in specific situations. Effective teamwork and communication are an essential part of this process.

Association of Breast Surgery

Oncoplastic Breast Reconstruction - Guidelines for Best Practice

Association of Breast Surgery (Nov 2012)

Oncoplastic techniques for breast reconstruction (BR) are becoming a new standard of care in the management of breast cancer patients. The recently completed National Mastectomy and Breast Reconstruction Audit (NMBRA) involving more than 18,000 women examined a broad range of clinical and patient-reported outcomes. The Audit also looked at important factors such as information and access to reconstructive services, as well as the level of pain, complications, quality of life and well-being experienced by women following a variety of procedures.

Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons

Acellular dermal matrix (ADM) assisted breast reconstruction procedures: Joint guidelines from the Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons

Association of Breast Surgery and the British Association of Plastic, Reconstructive and Aesthetic Surgeons (Jan 2013)

Tissue expansion with delayed insertion of a definitive prosthesis is the most common form of immediate breast reconstruction performed in the United Kingdom. However, achieving total muscle coverage of the implant and natural ptosis is a key technical challenge. The use of acellular dermal matrices (ADM) to supplement the pectoralis major muscle at the lower and lateral aspects of the breast has been widely adopted in the UK, potentially allowing for a single stage procedure. There is however little published data on the clinical and quality criteria for its use, and no long term follow-up.

Association of British Neurologists and British Infection Association National Guidelines

Management of suspected viral encephalitis in adults

Association of British Neurologists and British Infection Association National Guidelines (Nov 2011)

The scope of the guideline is to cover the initial management of all patients with suspected encephalitis, up to the point of diagnosis, in an acute care setting such as acute medical unit or emergency department. They are thus intended as a ready reference for clinicians encountering the more common causes of encephalitis, rather than specialists managing rarer causes.

Association of British Neurologists and British Paediatric Allergy, Immunology and Infection Group National Guidelines

Management of suspected viral encephalitis in children

Association of British Neurologists and British Paediatric Allergy, Immunology and Infection Group National Guidelines (Nov 2011)

The scope of the guideline is to cover the initial management of all patients with suspected encephalitis, up to the point of diagnosis and early treatment, in an acute care setting such as acute medical unit or emergency room. They are thus intended as a ready reference for clinicians encountering the more common causes of encephalitis, rather than specialists managing rarer causes.

Association of Paediatric Anaesthetists of Great Britain and Ireland

Pediatric Anesthesia: Good Practice in Postoperative and Procedural Pain Management 2nd Edition, 2012

Association of Paediatric Anaesthetists of Great Britain and Ireland (Jul 2012)

This guidance was developed by a committee of health professionals with the assistance of a patient representative. It was published following a period of open public consultation, including advice from representatives from patient groups and professional organisations. It is intended for use by qualified heath professionals who are involved in the management of acute pain in children. In its present form, it is not suitable for use by other groups. At the present time, and largely because of resource limitations, no consumer guide is planned to enable the recommendations to be easily interpreted by those who do not already possess knowledge and training in the field of children’s acute pain management.

Bariatric Scientific Collaborative Group (BSCG)

Interdisciplinary European Guidelines on Surgery of Severe Obesity

Bariatric Scientific Collaborative Group (BSCG) (Feb 2007)

This joint BSCG expert panel convened several meetings which were entirely focused on guidelines creation, during the past 2 years. There was a specific effort to develop clinical guidelines, which will reflect current knowledge, expertise and evidence based data on morbid obesity treatment.

British Association for Psychopharmacology

Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines

British Association for Psychopharmacology (May 2015)

A revision of the 2008 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken in order to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in September 2012. Key areas in treating depression were reviewed and the strength of evidence and clinical implications were considered. The guidelines were then revised after extensive feedback from participants and interested parties. A literature review is provided which identifies the quality of evidence upon which the recommendations are made. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse and stopping treatment. Significant changes since the last guidelines were published in 2008 include the availability of new antidepressant treatment options, improved evidence supporting certain augmentation strategies (drug and non-drug), management of potential long-term side effects, updated guidance for prescribing in elderly and adolescent populations and updated guidance for optimal prescribing. Suggestions for future research priorities are also made.

Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: A revision of the 2005 guidelines from the British Association for Psychopharmacology

British Association for Psychopharmacology (Apr 2014)

This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions.

Evidence-based guidelines for the pharmacological management of attention deficit hyperactivity disorder: Update on recommendations from the British Association for Psychopharmacology

British Association for Psychopharmacology (Feb 2014)

In line with the general aims of the BAP guideline series, these guidelines are intended to translate recent research in the field of ADHD to promote improvements in diagnosis and treatment of this disorder. These guidelines are aimed at all those who deliver clinical care, commission treatment or are otherwise involved in the diagnosis and treatment of children, adolescents and adults with ADHD, including psychiatrists, general practitioners, psychologists, paediatricians, pharmacists, commissioners and user representatives. The guidelines encompass a comprehensive assessment of current literature on ADHD, ranging from aetiological research and neuroimaging to current trends in the development of treatment and services.

BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP

British Association for Psychopharmacology (May 2012)

The British Association for Psychopharmacology guidelines for the treatment of substance abuse, harmful use, addiction and comorbidity with psychiatric disorders primarily focus on their pharmacological management. They are based explicitly on the available evidence and presented as recommendations to aid clinical decision making for practitioners alongside a detailed review of the evidence. A consensus meeting, involving experts in the treatment of these disorders, reviewed key areas and considered the strength of the evidence and clinical implications. The guidelines were drawn up after feedback from participants. The guidelines primarily cover the pharmacological management of withdrawal, short- and long-term substitution, maintenance of abstinence and prevention of complications, where appropriate, for substance abuse or harmful use or addiction as well management in pregnancy, comorbidity with psychiatric disorders and in younger and older people.

Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology

British Association for Psychopharmacology (Feb 2011)

These guidelines from the British Association for Psychopharmacology address the scope and targets of pharmacological treatment for schizophrenia. A consensus meeting, involving experts in schizophrenia and its treatment, reviewed key areas and considered the strength of evidence and clinical implications. The guidelines were drawn up after extensive feedback from the participants and interested parties, and cover the pharmacological management and treatment of schizophrenia across the various stages of the illness, including first-episode, relapse prevention, and illness that has proved refractory to standard treatment. The practice recommendations presented are based on the available evidence to date, and seek to clarify which interventions are of proven benefit. It is hoped that the recommendations will help to inform clinical decision making for practitioners, and perhaps also serve as a source of information for patients and carers. They are accompanied by a more detailed qualitative review of the available evidence. The strength of supporting evidence for each recommendation is rated.

Clinical practice with anti-dementia drugs: a revised (second) consensus statement from the British Association for Psychopharmacology

British Association for Psychopharmacology (Nov 2010)

The British Association for Psychopharmacology (BAP) coordinated a meeting of experts to review and revise its first (2006) Guidelines for clinical practice with anti-dementia drugs. As before, levels of evidence were rated using accepted standards which were then translated into grades of recommendation A to D, with A having the strongest evidence base (from randomized controlled trials) and D the weakest (case studies or expert opinion).

British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders

British Association for Psychopharmacology (Sep 2010)

These British Association for Psychopharmacology guidelines are designed to address this problem by providing an accessible up-to-date and evidence-based outline of the major issues, especially those relating to reliable diagnosis and appropriate treatment.

British Association for Sexual Health and HIV (BASHH)

2014 UK National Guideline on the Management of Non-gonococcal Urethritis

British Association for Sexual Health and HIV (BASHH) (Dec 2014)

We present the updated British Association for Sexual Health and HIV (BASHH) guideline for the management of non-gonococcal urethritis in men. This document includes a review of the current literature on its aetiology, diagnosis and management. In particular it highlights the emerging evidence that azithromycin 1 g may result in the development of antimicrobial resistance in Mycoplasma genitalium and that neither azithromycin 1 g nor doxycycline 100mgs bd for 7 days achieves a cure rate of >90% for this micro-organism. Evidence based diagnostic and management strategies for men presenting with symptoms suggestive of urethritis, those confirmed to have non-gonococcal urethritis and those with persistent symptoms following 1st line treatment are detailed.

United Kingdom National Guideline on the Management of Trichomonas vaginalis 2014

British Association for Sexual Health and HIV (BASHH) (Jul 2014)

The main objective is to assist practitioners in managing men and women diagnosed with Trichomonas vaginalis. This guideline offers recommendations on the diagnostic tests, treatment regimens and health promotion principles needed for the effective management of TV, covering, the management of the initial presentation, as well as how to prevent transmission and future infection.
It is aimed primarily at people aged 16 years or older (see specific guidelines for those under 16) presenting to health care professionals, working in departments offering specialist care in sexually transmitted infection (STI) management within the United Kingdom. However, the principles of the recommendations should be adopted across all levels (non specialist services may need to develop, where appropriate, local care pathways).

UK national guideline for the management of Genital Molluscum in adults 2014

British Association for Sexual Health and HIV (BASHH) (Jul 2014)

This guideline offers recommendations on diagnosis, treatment regimens and health promotion principles needed for the effective management of genital molluscum, including management of the initial presentation and recurrences. It primarily focuses on infection which affects the genital area and has a sexual mode of transmission.

UK National Guideline for the Management of Chancroid 2014

British Association for Sexual Health and HIV (BASHH) (Mar 2014)

The main purpose of this guideline is to offer recommendations on the diagnosis, treatment and health promotion principles for the effective management of chancroid. It is aimed primarily to assist in the management of people aged 16 years and older presenting to services offering Level 3 care in sexually transmitted infection (STI) management within the UK. However, the principles of the recommendations could be adopted at all levels.

2014 UK National Guideline on the Management of Vulval Conditions

British Association for Sexual Health and HIV (BASHH) (Feb 2014)

This guideline offers recommendation on the management of a range of vulval disorders who may present to Genitourinary Medicine clinics. Vulval disorders represent a disparate group of conditions with a variety of causes, affecting a particular anatomical site and may affect women of any age.

British Association for Sexual Health and HIV (BASHH) and British HIV Association (BHIVA)

UK National Guidelines on safer sex advice

British Association for Sexual Health and HIV (BASHH) and British HIV Association (BHIVA) (Jul 2012)

This guideline provides evidence based guidance on the content of safer sex advice and the format and delivery of brief behaviour change interventions deliverable in GUM clinics. Much of the advice is applicable to other healthcare settings including general practice and clinics providing HIV care. Advice on condom use and effectiveness, oral sex and other sexual practices and advice specific to the transmission of HIV infection is included. A review of the evidence supporting the guideline, complete reference list and evidence and consensus-based advice statements are published electronically. A patient information leaflet based on the advice statements developed is also available through the BASHH website.

British Association of Dermatologists

British Association of Dermatologists’ guidelines for the management of onychomycosis 2014

British Association of Dermatologists (Jul 2014)

The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of onychomycosis. The document aims to (i) offer an appraisal of all relevant literature since January 2002, focusing on any key developments; (ii) address important, practical clinical questions relating to the primary guideline objective, for example accurate diagnosis and identification of cases, and suitable treatment to minimize the duration of disease and discomfort; (iii) provide guideline recommendations and, where appropriate, with some health economic implications; and (iv) discuss potential developments and future directions.
The guideline is presented as a detailed review with highlighted recommendations for practical use in the clinic, in addition to an updated patient information leaflet.

British Association of Dermatologists’ guidelines for the management of tinea capitis 2014

British Association of Dermatologists (Jun 2014)

The overall objective of this guideline is to provide up-todate, evidence-based recommendations for the management of tinea capitis. This document aims to update and expand on the previous guidelines by (i) offering an appraisal of all relevant literature since January 1999, focusing on any key developments; (ii) addressing important, practical clinical questions relating to the primary guideline objective, i.e. accurate diagnosis and identification of cases; suitable treatment to minimize duration of disease, discomfort and scarring; and limiting spread among other members of the community; (iii) providing guideline recommendations and, where appropriate, some health economic implications (tinea capitis is a common problem in resource-poor settings and therefore treatments that are more easily and cheaply available and applicable to these settings have been factored in); and (iv) discussing potential developments and future directions.
This guideline is presented as a detailed review with highlighted recommendations for practical use in the clinic, in addition to the production of a patient information leaflet.

British Association of Dermatologists’ guidelines for the management of squamous cell carcinoma in situ (Bowen’s disease) 2014

British Association of Dermatologists (Feb 2014)

The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of squamous cell carcinoma (SCC) in situ (Bowen’s disease). The document aims to update and expand on the previous guidelines by (i) offering an appraisal of all relevant literature since January 2006, focusing on any key developments; (ii) addressing important, practical clinical questions relating to the primary guideline objective, i.e. accurate diagnosis and identification of cases and suitable treatment; (iii) providing guideline recommendations and, where appropriate, some health economic considerations; and (iv) discussing potential developments and future directions.
The guideline is presented as a detailed review with highlighted recommendations for practical use in the clinic, in addition to an updated patient information leaflet.

British Association of Dermatologists’ guidelines for the management of bullous pemphigoid 2012

British Association of Dermatologists (Sep 2012)

The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of bullous pemphigoid (BP). The document aims to update and expand on the previous guidelines by: (i) offering an appraisal of all relevant literature since January 2002, focusing on any key developments; (ii) addressing important, practical clinical questions relating to the primary guideline objective; (iii) providing guideline recommendations and, where appropriate, with some health economic implications discussing potential developments and future directions.

British Association of Dermatologists’ guidelines for the management of alopecia areata 2012

British Association of Dermatologists (Feb 2012)

The objectives of the guidelines are to provide up-to-date recommendations for the management of alopecia areata in adults and children and a summary of the evidence base.

British Association of Dermatologists’ guidelines for the safe and effective prescribing of azathioprine 2011

British Association of Dermatologists (Jul 2011)

The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the safe and effective use of azathioprine.

Advice on the safe introduction and continued use of isotretinoin in acne in the U.K. 2010

British Association of Dermatologists (Mar 2010)

The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the safe and effective use of isotretinoin.

British Association of Dermatologists' guidelines on the efficacy and use of acitretin in dermatology

British Association of Dermatologists (Feb 2010)

Although available for 20 years there have not been any published guidelines on the use of acitretin. Its clinical use is almost completely restricted to dermatology and it has important metabolic, skeletal and teratogenic side-effects. We felt it important to produce evidence-based guidelines on its use in dermatology.

British Association of Dermatologists’ guidelines for biologic interventions for psoriasis 2009

British Association of Dermatologists (Aug 2009)

The overall objective of these guidelines is to provide up-to-date, evidence-based recommendations on use of biologic therapies (infliximab, adalimumab, etanercept, ustekinumab) in adults and children with all types of psoriasis and, where relevant, psoriatic arthritis, for clinical staff involved in the care of patients treated with biologic therapies. Efalizumab remains in the scope of the guideline in relation to safety only, given that the European Medicines Agency has withdrawn the marketing authorization of this drug because of concerns over the development of progressive multifocal leukoencephalopathy (PML).

Guidelines for the management of contact dermatitis: an update

British Association of Dermatologists (Dec 2008)

These guidelines for management of contact dermatitis have been prepared for dermatologists on behalf of the British Association of Dermatologists. They present evidence-based guidance for investigation and treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, including details of relevant epidemiological aspects, diagnosis and investigation.

Guidelines for the management of basal cell carcinoma

British Association of Dermatologists (Mar 2008)

This article represents a planned regular updating of the previous British Association of Dermatologists guidelines for the management of basal cell carcinoma. These guidelines present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.

British Committee for Standards in Haematology (BCSH)

Guidelines for the Management of Tumour Lysis Syndrome in Adults and Children with Haematological Malignancies on Behalf of the British Committee for Standards in Haematology

British Committee for Standards in Haematology (BCSH) (Mar 2015)

The objective of this guideline is to provide healthcare professionals with clear guidance on the management of patients with tumour lysis syndrome (TLS). The guidance may not be appropriate to every patient and in all cases individual patient circumstances may dictate an alternative approach.

Guidelines on the management of AL amyloidosis

British Committee for Standards in Haematology (BCSH) (Oct 2014)

The purpose of this guideline is to provide guidance on the management of patients with AL amyloidosis.

Guidelines for the diagnosis and treatment of cobalamin and folate disorders

British Committee for Standards in Haematology (BCSH) (Jun 2014)

These guidelines aim to provide an evidence-based approach to the diagnosis and management of cobalamin and folate disorders. However, such evidence, particularly in the form of randomized controlled trials, is lacking. As a result, these guidelines provide a pragmatic approach to the testing and treatment of cobalamin and folate disorders, with recommendations based, as far as possible, on the GRADE system.

Measurement of non-coumarin anticoagulants and their effects on tests of Haemostasis: Guidance from the British Committee for Standards in Haematology

British Committee for Standards in Haematology (BCSH) (Jun 2014)

The objective of this guideline is to provide healthcare professionals with clear guidance on the clinically important issues regarding the laboratory assessment of currently used non-coumarin anticoagulants and their impact on laboratory tests of haemostasis.

Guidelines for the first line management of classical Hodgkin lymphoma

British Committee for Standards in Haematology (BCSH) (Apr 2014)

The objective of this guideline is to provide healthcare professionals with clear guidance on the management of patients with classical Hodgkin Lymphoma (HL). The guidance may not be appropriate for all patients with HL and in all cases individual patient circumstances may dictate an alternative approach.

Guidelines on the use of multicolour flow cytometry in the diagnosis of haematological neoplasms

British Committee for Standards in Haematology (BCSH) (Mar 2014)

The aim of this document is to provide healthcare professionals with clear guidance on the use of MFC for leukaemia and lymphoma immunophenotyping of peripheral blood (PB), bone marrow (BM), body fluids and tissue specimens.

Guidelines on the diagnosis and management of Waldenström macroglobulinaemia

British Committee for Standards in Haematology (BCSH) (Feb 2014)

This guideline offers best practice advice on the care of patients with Waldenström macroglobulinaemia.

Guidelines for the diagnosis and management of Multiple Myeloma 2014

British Committee for Standards in Haematology (BCSH) (Feb 2014)

The objective of this guideline is to provide healthcare professionals with clear guidance on the diagnosis and management of patients with multiple myeloma

Guidelines for the diagnosis and management of adult myelodysplastic syndromes

British Committee for Standards in Haematology (BCSH) (Dec 2013)

The objective of this guideline is to provide healthcare professionals with recommandations on the diagnosis and managament of patients with Myelodysplastic syndrome

BCSH guideline for the use of anti-D immunoglobulin for the prevention of haemolytic disease of the fetus and newborn

British Committee for Standards in Haematology (BCSH) (Nov 2013)

The objective of this guideline is to provide healthcare professionals with practical guidance on the use of anti-D Ig as immunoprophylaxis to prevent sensitisation to the D antigen during pregnancy or at delivery for the prevention of HDN.

Guideline on the management of primary resistant and relapsed classical Hodgkin lymphoma

British Committee for Standards in Haematology (BCSH) (Oct 2013)

The objective of this guideline is to aid clinicians in deciding which patients with primary refractory or relapsed Hodgkin lymphoma (HL) should receive salvage therapy with a view to autologous stem cell transplantation (ASCT); what response is adequate to allow ASCT and how to determine this; what is the role of radiotherapy in patient management; and what is the best management of patients unsuitable for autologous transplantation.

Guideline on the prevention of secondary central nervous system lymphoma: British Committee for Standards in Haematology

British Committee for Standards in Haematology (BCSH) (Aug 2013)

The objective of this guideline is to provide healthcare professionals with clear guidance on the optimal prevention of secondary central nervous system (CNS) lymphoma. The guidance may not be appropriate to patients of all lymphoma sub-types and in all cases individual patient circumstances may dictate an alternative approach. Acronyms are defined at time of first use.

Guidelines for the Management of Mature T-cell and NK-cell Neoplasms (Excluding cutaneous T-cell Lymphoma)

British Committee for Standards in Haematology (BCSH) (Aug 2013)

The objective of this guideline is to provide healthcare professionals with clear guidance on the management of patients with mature T-cell and NK-cell neoplasms. It should be recognised that limited evidence was available. and that no grade A recommendations could be made because of lack of data from randomised controlled trials. Historically, most information regarding management of T-cell lymphomas has been derived retrospectively from studies conducted predominately in B-cell non-Hodgkin lymphoma (NHL) which included small numbers of peripheral T-cell lymphomas (PTCL) which were of differing histological types, further confusing interpretation. It is only more recently, following the advent of B-cell directed antibody therapy that T-cell lymphomas have been singled out for separate clinical studies. As yet these are largely phase II studies or small case series. The guidance may not be appropriate to all patients in this disease group and in all cases individual patient circumstances may dictate an alternative approach.

Management of cytomegalovirus infection in haemopoietic stem cell transplantation

British Committee for Standards in Haematology (BCSH) (May 2013)

These evidence-based guidelines expand and adapt previous guidance (Tomblyn et al, 2009; Andrews et al, 2011). While specifically focusing on allogeneic haemopoietic stem cell transplantation (HSCT), they are relevant to other areas of haematological oncology where there is an increased risk of cytomegalovirus (CMV) infection, such as haematological cancers where intense anti-T-cell therapy has been deployed (O’Brien et al, 2006).

Guideline for the laboratory diagnosis of functional iron deficiency

British Committee for Standards in Haematology (BCSH) (Apr 2013)

The guideline group was selected to be representative of UK-based experts in the clinical and laboratory fields of iron metabolism, CKD, quality control and method evaluation.

Guidelines on the management of anaemia and red cell transfusion in adult critically ill patients

British Committee for Standards in Haematology (BCSH) (Dec 2012)

This document aims to summarize the current literature guiding the use of red cell transfusion in critically ill patients and provides recommendations to support clinicians in their day-to-day practice. Critically ill patients differ in their age, diagnosis, co-morbidities, and severity of illness. These factors influence their tolerance of anaemia and alter the risk to benefit ratio of transfusion. The optimal management for an individual may not fall clearly within our recommendations and each decision requires a synthesis of the available evidence and the clinical judgment of the treating physician

Guidelines on the diagnosis and management of heparin induced thrombocytopenia: second edition

British Committee for Standards in Haematology (BCSH) (Oct 2012)

The objective of this guideline is to provide healthcare professionals with clear guidance on the clinical features of heparin-induced thrombocytopenia (HIT), the indications for monitoring of patients on heparins for HIT, the investigation of suspected HIT and the treatment of HIT.

Guidelines for the investigation and management of mantle cell lymphoma

British Committee for Standards in Haematology (BCSH) (Sep 2012)

This guideline is the first BCSH guideline on the topic of mantle cell lymphoma, and therefore, does not supersede any previous guidance.

Guidelines on the investigation and management of venous thrombosis at unusual sites

British Committee for Standards in Haematology (BCSH) (Aug 2012)

Deep vein thrombosis (DVT) of the lower limb veins and pulmonary embolism (PE) are the most commonly encountered manifestations of venous thrombosis in routine clinical practice. Consequently, they have a strong evidence base supporting their optimal management. Venous thrombosis at other ‘unusual sites’ is well documented, but given the paucity of robust studies its management has often been extrapolated from experience of lower limb DVT and PE. The objective of this guideline is to provide healthcare professionals with guidance, based on contemporary evidence, on the appropriate investigation and treatment of venous thrombosis at these other sites.

Guidelines on the laboratory aspects of assays used in haemostasis and thrombosis

British Committee for Standards in Haematology (BCSH) (Aug 2012)

This guideline is intended to help clinical laboratories perform valid and reliable assays of pro- and anticoagulant factors in blood.

Guidelines on the diagnosis, investigation and management of Chronic Lymphocytic Leukaemia

British Committee for Standards in Haematology (BCSH) (Jul 2012)

The objective of this guideline is to provide healthcare professionals with clear guidance on the management of patients with chronic lymphocytic leukaemia. In all cases individual patient circumstances may dictate an alternative approach.

Guideline for the diagnosis and management of myelofibrosis

British Committee for Standards in Haematology (BCSH) (Jun 2012)

The objective of this guideline is to provide healthcare professionals with clear guidance on the investigation and management of primary myelofibrosis, as well as post-polycythaemic myelofibrosis (post-PV MF) and post-thrombocythemic myelofibrosis (post-ET MF) in both adult and paediatric patients.

Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies

British Committee for Standards in Haematology (BCSH) (May 2012)

The objective of this guideline is to provide healthcare professionals with clear, up-to-date, and practical guidance on the management of TTP and related thrombotic microangiopathies, defined by thrombocytopenia, microangiopathic haemolytic anaemia (MAHA) and small vessel thrombosis.

Diagnosis and management of acute graft-versus-host disease

British Committee for Standards in Haematology (BCSH) (Apr 2012)

A joint working group established by the Haemato-oncology subgroup of the British Committee for Standards in Haematology (BCSH) and the British Society for Bone Marrow Transplantation (BSBMT) has reviewed the available literature and made recommendations for the diagnosis and management of acute graft-versus-host disease. This guideline includes recommendations for the diagnosis and grading of acute graft-versus-host disease as well as primary treatment and options for patients with steroid-refractory disease. The goal of treatment should be effective control of graft-versus-host disease while minimizing risk of toxicity and relapse.

Diagnosis and management of chronic graft-versus-host disease

British Committee for Standards in Haematology (BCSH) (Apr 2012)

A joint working group established by the Haemato-oncology subgroup of the British Committee for Standards in Haematology (BCSH) and the British Society for Bone Marrow Transplantation (BSBMT) has reviewed the available literature and made recommendations for the diagnosis and management of chronic graft-versus-host disease (GvHD). This guideline includes recommendations for the diagnosis and staging of chronic GvHD as well as primary treatment and options for patients with steroid-refractory disease. The goal of treatment should be the effective control of GvHD while minimizing the risk of toxicity and relapse.

Guidelines on the investigation and management of antiphospholipid syndrome

British Committee for Standards in Haematology (BCSH) (Feb 2012)

The objective of this guideline is to provide healthcare professionals with clear guidance on the diagnosis and management of patients with antiphospholipid syndrome (autoimmune condition) though individual patient circumstances may dictate an alternative approach.

Guidelines on the investigation and management of follicular lymphoma

British Committee for Standards in Haematology (BCSH) (Sep 2011)

The objective of this guideline is to provide healthcare professionals with clear guidance on the management of patients with follicular lymphoma. The guidance is not appropriate for patients with other lymphoma subtypes and in all cases individual patient circumstances may dictate an alternative approach

Revised Guidelines for the Diagnosis and Management of Hairy Cell Leukaemia and Hairy cell Leukaemia Variant

British Committee for Standards in Haematology (BCSH) (Aug 2011)

The objective of this guideline is to provide healthcare professionals with clear guidance on the management of patients with hairy cell leukaemia. The guidance may not be appropriate to every patient with hairy cell leukaemia and in all cases individual patient circumstances may dictate an alternative approach.

Guideline on the management of haemophilia in the fetus and neonate

British Committee for Standards in Haematology (BCSH) (May 2011)

Evidence-based guidelines are presented for the management of haemophilia in the fetus and neonate. This includes information regarding the management of pregnancy and delivery as well as aspects of management during the early neonatal period. Specific issues regarding the mode of delivery and the risk of intra-cranial and extra-cranial haemorrhage are discussed.

British HIV Association

Position statement on the use of antiretroviral therapy to reduce HIV transmission

British HIV Association (Sep 2014)

This statement refers to the use of antiretroviral therapy (ART) by HIV-positive individuals to reduce the risk of transmission of HIV.

British HIV Association guidelines for the management of HIV infection in pregnant women 2012 (2014 interim review)

British HIV Association (Jun 2014)

The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of human immunodeficiency virus (HIV)-positive pregnant women in the UK. The scope includes guidance on the use of antiretroviral therapy (ART) both to prevent HIV mother-to-child transmission (MTCT) and for the welfare of the mother herself, guidance on mode of delivery and recommendations in specific patient populations where other factors need to be taken into consideration, such as co-infection with other agents. The guidelines are aimed at clinical professionals directly involved with, and responsible for, the care of pregnant women with HIV infection. The purpose of the 2014 interim review is to identify significant developments that would either lead to a change in recommendation or a change in the strength of recommendation. These changes and the supporting evidence are highlighted. More detail has been added in areas of controversy. New data that simply support the existing data have not routinely been included in this revision.

British HIV Association guidelines for HIV-associated malignancies 2014

British HIV Association (Feb 2014)

The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of adults with HIV infection and malignancy. The scope includes the management of diagnosed malignancies in people living with HIV but does not address screening for malignancies in this population. This is covered elsewhere in other BHIVA guidance where evidence is available to support it

British HIV Association guidelines for the management of hepatitis viruses in adults infected with HIV 2013

British HIV Association (Nov 2013)

The purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of adults with HIV and viral hepatitis coinfection. The scope includes: i) guidance on diagnostic and fibrosis screening; ii) preventative measures including immunisation and behavioural intervention; iii) ARV therapy and toxicity; iv) management of acute and chronic HBV/HIV and HCV/HIV; v) monitoring and management of coinfection-related endstage liver disease (ESLD) including transplantation; and vi) discussion on HDV/HIV and HEV/HIV infection. The guidelines are aimed at clinical professionals involved in and responsible for the care of adults with HIV and viral hepatitis coinfection, and at community advocates responsible for promoting the best interests and care of adults with coinfection.

British HIV Association guidelines for the treatment of HIV-1-positive adults with antiretroviral therapy 2012 (Updated November 2013)

British HIV Association (Nov 2013)

The overall purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of adults with HIV infection with antiretroviral therapy (ART). The scope includes: (i) guidance on the initiation of ART in those previously naïve to therapy; (ii) support of patients on treatment; (iii) management of patients experiencing virological failure; and (iv) recommendations in specific patient populations where other factors need to be taken into consideration. The guidelines are aimed at clinical professionals directly involved with and responsible for the care of adults with HIV infection and at community advocates responsible for promoting the best interests and care of HIV-positive adults.

British HIV Association guidelines for the management of hepatitis viruses in adults infected with HIV 2013

British HIV Association (Nov 2013)

The purpose of these guidelines is to provide guidance on best clinical practice in the treatment and management of adults with HIV and viral hepatitis coinfection. The scope includes: i) guidance on diagnostic and fibrosis screening; ii) preventative measures including immunisation and behavioural intervention; iii) ARV therapy and toxicity; iv) management of acute and chronic HBV/HIV and HCV/HIV; v) monitoring and management of coinfection-related endstage liver disease (ESLD) including transplantation; and vi) discussion on HDV/HIV and HEV/HIV infection. The guidelines are aimed at clinical professionals involved in and responsible for the care of adults with HIV and viral hepatitis coinfection, and at community advocates responsible for promoting the best interests and care of adults with coinfection.

UK guideline for the use of post-exposure prophylaxis for HIV following sexual exposure (2011)

British HIV Association (Dec 2011)

This guideline offers recommendations on the potential use of PEPSE, the circumstances in which it may be recommended, the treatment regimens that may be recommended and the appropriate use of subsequent diagnostic tests to measure individual outcomes.

British HIV Association guidelines for the routine investigation and monitoring of adult HIV-1-infected individuals 2011

British HIV Association (Sep 2011)

The aim is to present a consensus regarding the standard assessment and investigation at diagnosis of HIV infection and to describe the appropriate monitoring of HIV-positive individuals both on and off ART.

Guidelines for the treatment of opportunistic infection in HIV-seropositive individuals 2011

British HIV Association (Sep 2011)

These guidelines have been drawn up to help physicians investigate and manage HIV-seropositive patients suspected of, or having an opportunistic infection (OI). They are primarily intended to guide practice in the UK and related health systems.

British HIV Association and British Infection Association Guidelines for the Treatment of Opportunistic Infection in HIV-seropositive Individuals 2011

British HIV Association (Sep 2011)

These guidelines have been drawn up to help physicians investigate and manage HIV-seropositive patients suspected of, or having an opportunistic infection. They are primarily intended to guide practice in the UK and related health systems.

British HIV Association guidelines for the treatment of TB/HIV coinfection 2011

British HIV Association (May 2011)

These guidelines have been drawn up to help physicians manage adults with HIV/TB co-infection.

Guidelines for antiretroviral treatment of HIV-2-positive individuals

British HIV Association (Aug 2010)

HIV-2, which is closely related to SIV from sooty mangabeys, was first identified in 1986 in patients with AIDS in Guinea-Bissau and Cape Verde, West Africa. Like HIV-1, HIV-2 is an immunodeficiency virus that causes AIDS in humans. However, although HIV-1 and HIV-2 are related, there are important structural differences between them which influence pathogenicity, natural history and therapy.

Guidelines for the management of coinfection with HIV-1 and hepatitis B or C virus

British HIV Association (Aug 2009)

The 2010 guidelines have been updated to incorporate all new relevant information that has become available since the previous versions were published in 2005. The 2005 versions came as separate hepatitis B and C guidelines but for 2010 we have decided to amalgamate them into a single document.

Guidelines for the management of the sexual and reproductive health of people living with HIV infection

British HIV Association (Oct 2008)

The guidelines have been developed for use by healthcare staff in various disciplines including, gynaecologists, staff in primary care, fertility experts and all those involved in the care of HIV positive individuals. They will also be of use to a wider audience including commissioners, public health specialists and communities or individuals living with and affected by HIV.

Guidelines for immunization of HIV-infected adults 2008

British HIV Association (Aug 2008)

These guidelines provide evidence-graded recommendations on the appropriate use of active and passive immunization in HIV-infected adults. There are several factors that make the formulation of HIV-specific immunization guidelines important at a time when highly active antiretroviral therapy (HAART) is modifying the natural history of HIV infection, vaccination practices are changing and new vaccines are becoming available in clinical care.

Guidelines for the management of HIV infection in pregnant women 2008

British HIV Association (Aug 2008)

The success of antenatal testing for HIV means that more clinicians than ever are involved in the care of women with HIV who are pregnant. Despite very few recent randomized controlled trials regarding the use of antiretroviral therapy (ART) in pregnancy or obstetric interventions, practice is changing. This is informed largely by observational data and theoretical considerations and these guidelines reflect this.

British Society for Allergy and Clinical Immunology (BSACI)

BSACI guideline for the management of chronic urticaria and angioedema

British Society for Allergy and Clinical Immunology (BSACI) (Feb 2015)

This guidance for the management of patients with chronic urticaria and angioedema has been prepared by the Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is aimed at both adult physicians and paediatricians practising in allergy. The recommendations are evidence graded. During the development of these guidelines, all BSACI members were included in the consultation process using a Web-based system. Their comments and suggestions were carefully considered by the Standards of Care Committee. Where evidence was lacking, a consensus was reached by the experts on the committee. Included in this management guideline are clinical classification, aetiology, diagnosis, investigations, treatment guidance with special sections on children with urticaria and the use of antihistamines in women who are pregnant or breastfeeding.

Management of allergy to penicillins and other beta-lactams

British Society for Allergy and Clinical Immunology (BSACI) (Jan 2015)

The Standards of Care Committee of the British Society for Allergy and Clinical Immunology (BSACI) and an expert panel have prepared this guidance for the management of immediate and non-immediate allergic reactions to penicillins and other beta-lactams. The guideline is intended for UK specialists in both adult and paediatric allergy and for other clinicians practising allergy in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking, the panel reached consensus. During the development of the guideline, all BSACI members were consulted using a Web-based process and all comments carefully considered. Included in the guideline are epidemiology of allergic reactions to beta-lactams, molecular structure, formulations available in the UK and a description of known beta-lactam antigenic determinants. Sections on the value and limitations of clinical history, skin testing and laboratory investigations for both penicillins and cephalosporins are included. Cross-reactivity between penicillins and cephalosporins is discussed in detail. Recommendations on oral provocation and desensitization procedures have been made. Guidance for beta-lactam allergy in children is given in a separate section. An algorithm to help the clinician in the diagnosis of patients with a history of penicillin allergy has also been included.

BSACI guideline for the diagnosis and management of cow’s milk allergy

British Society for Allergy and Clinical Immunology (BSACI) (Apr 2014)

This guideline advises on the management of patients with cow’s milk allergy. Cow’s milk allergy presents in the first year of life with estimated population prevalence between 2% and 3%. The clinical manifestations of cow’s milk allergy are very variable in type and severity making it the most difficult food allergy to diagnose. A careful age- and diseasespecific history with relevant allergy tests including detection of milk-specific IgE (by skin prick test or serum assay), diagnostic elimination diet, and oral challenge will aid in diagnosis in most cases. Treatment is advice on cow’s milk avoidance and suitable substitute milks. Cow’s milk allergy often resolves. Reintroduction can be achieved by the graded exposure, either at home or supervised in hospital depending on severity, using a milk ladder. Where cow’s milk allergy persists, novel treatment options may include oral tolerance induction, although most authors do not currently recommend it for routine clinical practice. Cow’s milk allergy must be distinguished from primary lactose intolerance. This guideline was prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI) and is intended for clinicians in secondary and tertiary care. The recommendations are evidence based, but where evidence is lacking the panel of experts in the committee reached consensus. Grades of recommendation are shown throughout. The document encompasses epidemiology, natural history, clinical presentations, diagnosis, and treatment.

BSACI guidelines: Immunotherapy for allergic rhinitis

British Society for Allergy and Clinical Immunology (BSACI) (Aug 2011)

This guidance is for the management of AR in patients that have failed to achieve adequate relief of symptoms despite treatment with intranasal corticosteroids and/or antihistamines. The guideline is based on evidence and is for use by both adult physicians and paediatricians practising allergy.

Diagnosis and management of hymenoptera venom allergy: British Society for Allergy and Clinical Immunology (BSACI) guidelines

British Society for Allergy and Clinical Immunology (BSACI) (Aug 2011)

The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and pediatricians practising allergy. During the development of these guidelines, all BSACI members were included in the consultation process using a web-based system. Included in this guideline are epidemiology, risk factors, clinical features, diagnostic tests, natural history of hymenoptera venom allergy and guidance on undertaking venom immunotherapy (VIT). There are also separate sections on children, elevated baseline tryptase and mastocytosis and mechanisms underlying VIT. Finally, we have made recommendations for potential areas of future research.

BSACI guidelines for the management of egg allergy

British Society for Allergy and Clinical Immunology (BSACI) (Jul 2010)

This guideline advises on the management of patients with egg allergy. Most commonly, egg allergy presents in infancy, with a prevalence of approximately 2% in children and 0.1% in adults.

BSACI guidelines for the investigation of suspected anaphylaxis during general anaesthesia

British Society for Allergy and Clinical Immunology (BSACI) (Dec 2009)

Investigation of anaphylaxis during general anaesthesia requires an accurate record of events including information on timing of drug administration provided by the anaesthetist, as well as timed acute tryptase measurements. Referrals should be made to a centre with the experience and ability to investigate reactions to a range of drug classes/substances including neuromuscular blocking agents (NMBAs) intravenous (i.v.) anaesthetics, antibiotics, opioid analgesics, non-steroidal anti-inflammatory drugs (NSAIDs), local anaesthetics, colloids, latex and other agents. About a third of cases are due to allergy to NMBAs.

BSACI guidelines for the management of drug allergy

British Society for Allergy and Clinical Immunology (BSACI) (Dec 2008)

As routine or validated tests are not available for the majority of drugs, considerable experience is required for the investigation of allergic drug reactions and to undertake specific drug challenge. A missed or incorrect diagnosis of drug allergy can have serious consequences. Therefore, investigation and management of drug allergy is best carried out in specialist centres with large patient numbers and adequate competence and resources to manage complex cases. The recommendations are evidencebased but where evidence was lacking consensus was reached by the panel of specialists on the committee. The document encompasses epidemiology, risk factors, clinical patterns of drug allergy, diagnosis and treatment procedures.

BSACI guidelines for the management of allergic and non-allergic rhinitis

British Society for Allergy and Clinical Immunology (BSACI) (Dec 2007)

This guidance for the management of patients with allergic and non-allergic rhinitis has been prepared by the Standards of Care Committee (SOCC) of the British Society for Allergy and Clinical Immunology (BSACI). The guideline is based on evidence as well as on expert opinion and is for use by both adult physicians and paediatricians practicing in allergy. The recommendations are evidence graded.

British Society for Paediatric Endocrinology and Diabetes (BSPED)

Shared Care Guidelines: Paediatric use of Recombinant human Growth Hormone (r-hGH, Somatropin)

British Society for Paediatric Endocrinology and Diabetes (BSPED) (May 2012)

r-hGH is administered by subcutaneous injection or needle free transjection, once daily. Depending on the brand, injections may be prepared from multi-dose ampoules or by using cartridges in a multi-dose pen injection device or other disposable devices. r-hGH has a role in protein, lipid and carbohydrate metabolism, in addition to increasing linear growth in children.

Shared Care Guidelines: Use of Gonadotrophin Releasing Hormone (GnRH) Agonists - Triptorelin

British Society for Paediatric Endocrinology and Diabetes (BSPED) (May 2012)

Treatment with GnRH agonists should always be initiated and monitored by a specialist (Consultant Paediatric Endocrinologist or Consultant Paediatrician with expertise in growth disorders) as recognised by the British Society for Paediatric Endocrinology and Diabetes (BSPED).

British Society for Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR)

BSR and BHPR guideline for the management of adults with ANCA-associated vasculitis

British Society for Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) (Apr 2014)

The aim of this document is to provide a guideline for the management of adults with AAV, especially the induction and maintenance of remission.

The 2012 BSR and BHPR guideline for the treatment of psoriatic arthritis with biologics

British Society for Rheumatology (BSR) and British Health Professionals in Rheumatology (BHPR) (Apr 2013)

These guidelines offer systematic and evidence-based recommendations for the prescription of anti-TNF therapies in adult PsA patients to support UK clinicians in their use. The guidelines cover adult patients with PsA affecting all domains of psoriatic disease. They provide a stepwise management plan giving clear advice on treatment, including inclusion/exclusion criteria for treatment, monitoring requirements and how to quantify response to biologics. They provide evidence-based advice for the use of anti-TNF therapies in difficult situations, including pregnancy and significant comorbidities. A review on the use of conventional DMARDs prior to the use of anti-TNF therapies was not undertaken.

British Society for Sexual Medicine

Guidelines on the management of erectile dysfunction

British Society for Sexual Medicine (Sep 2013)

The objective of this guideline is to provide healthcare professionals with recommandations on the management of patients with erectile dysfunction.

Guidelines on the management of sexual problems in men: the role of androgens

British Society for Sexual Medicine (Dec 2010)

Reduced androgen levels (a feature of ageing in both sexes) may have somatic, psychological and sexual effects, sometimes severe enough to compromise a patient's general well-being or sex life in particluar.

Guidelines on the management of sexual problems in women: the role of androgens

British Society for Sexual Medicine (Dec 2010)

Reduced androgen levels (a feature of ageing in both sexes) may have somatic, psychological and sexual effects, sometimes severe enough to compromise a patient's general well-being or sex life in particluar.

British Society of Gastroenterology

Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology

British Society of Gastroenterology (Jun 2014)

The aim was to create updated guidelines for the management of adult coeliac disease (CD), but non-coeliac gluten sensitivity (NCGS) was not considered.

British Society of Gastroenterology guidelines on the diagnosis and management of Barrett's oesophagus

British Society of Gastroenterology (Sep 2013)

The purpose of this guideline is to provide a practical and evidence-based resource for the management of patients with Barrett’s oesophagus and related early neoplasia. This document is therefore aimed at gastroenterologists, physicians and nurse practitioners, as well as members of multidisciplinary teams (MDTs; surgeons, radiologists, pathologists), who take decisions on the management of such patients.

Inflammatory bowel disease biopsies: updated British Society of Gastroenterology reporting guidelines

British Society of Gastroenterology (Jul 2013)

These revised guidelines aim to optimise the quality and consistency of reporting of biopsies taken for the initial diagnosis of IBD by summarising the literature and making recommendations based on the available evidence.

Guidelines for the diagnosis and treatment of cholangiocarcinoma: an update

British Society of Gastroenterology (Aug 2012)

CC is the second commonest primary liver tumour worldwide, after hepatocellular carcinoma (HCC). These guidelines are intended to bring consistency and improvement in the management from first suspicion of CC through to diagnosis and subsequent treatment.

Guidelines for Liver Transplantation for Patients with Non-Alcoholic Steatohepatitis

British Society of Gastroenterology (Dec 2011)

Non-alcoholic steatohepatitis (NASH) is an increasing cause of liver disease necessitating liver transplantation. In patients with advanced NASH, there are often coexistent clinical issues that impact on the outcome of liver transplantation. There are no guidelines for the assessment and management of patients with NASH undergoing liver transplantation. A group was therefore invited by the Council of the British Transplant Society (BTS) to prepare guidelines for the management of NASH before and after liver transplantation. The guideline is approved by the British Society of Gastroenterology, the British Association for the Study of Liver and NHS Blood and Transplant.

Practice guidance on the management of acute and chronic gastrointestinal problems arising as a result of treatment for cancer

British Society of Gastroenterology (Nov 2011)

The number of patients with chronic gastrointestinal (GI) symptoms after cancer therapies which have a moderate or severe impact on quality of life is similar to the number diagnosed with inflammatory bowel disease annually. However, in contrast to patients with inflammatory bowel disease, most of these patients are not referred for gastroenterological assessment. Clinicians who do see these patients are often unaware of the benefits of targeted investigation (which differ from those required to exclude recurrent cancer), the range of available treatments and how the pathological processes underlying side effects of cancer treatment differ from those in benign GI disorders. This paper aims to help clinicians become aware of the problem and suggests ways in which the panoply of syndromes can be managed.

Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours (NETs)

British Society of Gastroenterology (Nov 2011)

These guidelines update previous guidance published in 2005. They have been revised by a group who are members of the UK and Ireland Neuroendocrine Tumour Society with endorsement from the clinical committees of the British Society of Gastroenterology, the Society for Endocrinology, the Association of Surgeons of Great Britain and Ireland (and its Surgical Specialty Associations), the British Society of Gastrointestinal and Abdominal Radiology and others. The authorship represents leaders of the various groups in the UK and Ireland Neuroendocrine Tumour Society, but a large amount of work has been carried out by other specialists, many of whom attended a guidelines conference in May 2009. We have attempted to represent this work in the acknowledgements section. Over the past few years, there have been advances in the management of neuroendocrine tumours, which have included clearer characterisation, more specific and therapeutically relevant diagnosis, and improved treatments. However, there remain few randomised trials in the field and the disease is uncommon, hence all evidence must be considered weak in comparison with other more common cancers.

Guidelines for the management of oesophageal and gastric cancer

British Society of Gastroenterology (Jun 2011)

The original guidelines described the management of oesophageal and gastric cancer within existing practice. This paper updates the guidance to include new evidence and to embed it within the framework of the current UK National Health Service (NHS) Cancer Plan. The revised guidelines are informed by reviews of the literature and collation of evidence by expert contributors. The key recommendations are listed. The sections of the guidelines are broadly the same layout as the earlier version, with some evidence provided in detail to describe areas of development and to support the changes to the recommendations.

Guidelines for the Management of Autoimmune Hepatitis

British Society of Gastroenterology (May 2011)

These guidelines describe the optimal management strategies in adults based on available published evidence, including the American Association for the Study of Liver Diseases practice guidelines for the diagnosis and treatment of AIH published in 2002 and recently updated.

Guidelines for the management of iron deficiency anaemia

British Society of Gastroenterology (Mar 2011)

These guidelines are primarily intended for gastroenterologists and GI surgeons but are applicable for other doctors seeing patients with IDA. The investigation of overt blood loss is not considered in these guidelines.

Guidelines for the management of inflammatory bowel disease in adults

British Society of Gastroenterology (Dec 2010)

The management of inflammatory bowel disease represents a key component of clinical practice for members of the British Society of Gastroenterology. There has been considerable progress in management strategies affecting all aspects of clinical care since the publication of previous BSG guidelines in 2004, necessitating the present revision.

The provision of a percutaneously placed enteral tube feeding service

British Society of Gastroenterology (Aug 2010)

This guideline, relating to the provision of a percutaneously placed enteral tube feeding service, is focused upon a specific area of nutrition provision that has not been previously targeted.

The Management of Gastric Polyps

British Society of Gastroenterology (Feb 2010)

This guideline aims to characterise gastric polyps and provide a framework for management. However, recommendations for diagnosis and treatment of these polyps remain controversial, as there is no consensus. Specifically, these guidelines do not cover the management of early gastric cancer.

Guidelines for colorectal cancer screening and surveillance in moderate and high risk groups

British Society of Gastroenterology (Dec 2009)

The aim, as before, is to provide guidance on the appropriateness, method and frequency of screening for people at moderate and high risk from colorectal cancer. This guidance provides some new recommendations for those with inflammatory bowel disease and for those at moderate risk resulting from a family history of colorectal cancer. In other areas guidance is relatively unchanged, but the recent literature was reviewed and is included where appropriate.

Antibiotic Prophylaxis in Gastrointestinal Endoscopy

British Society of Gastroenterology (Jan 2009)

The revised BSG guidelines recommending a marked reduction of pre-procedure antibiotic usage are available for download below. The practice of administering antibiotics to prevent endocarditis is no longer recommended. Prophylaxis remains indicated prior to endoscopic gastrostomy/jejunostomy procedures.

Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures - Updated Flowchart

British Society of Gastroenterology (Sep 2008)

Updated flowchart for the document entitled: Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures

Guidelines for the management of anticoagulant and antiplatelet therapy in patients undergoing endoscopic procedures

British Society of Gastroenterology (Apr 2008)

Acute gastro-intestinal haemorrhage in patients on anticoagulant or antiplatelet agents is a high-risk situation. The immediate risk to the patient from haemorrhage may outweigh the risk of thrombosis as a result of stopping anticoagulant or antiplatelet therapy. Patients need to be assessed on an individual basis, and it is not possible to give unequivocal guidance to cover all situations.

Guidance for Obtaining a Valid Consent for Elective Endoscopic Procedures

British Society of Gastroenterology (Apr 2008)

This document sets out the standards and procedures that are appropriate for elective endoscopic procedures in adults. It is based upon current guidance from the Department of Health, the General Medical Council and other relevant sources.

Guidelines on the Management of Common Bile Duct Stones (CBDS)

British Society of Gastroenterology (Jan 2008)

Clinicians are now faced with a number of potentially valid options for managing patients with suspected CBDS. It is with this in mind that the following guidelines have been written.

British Thoracic Society

British Thoracic Society guideline for advanced diagnostic and therapeutic flexible bronchoscopy in adults

British Thoracic Society (Nov 2011)

This guideline was formulated following consultation with stakeholders from the medical and nursing professions, patient groups and healthcare management. Advanced diagnostic and therapeutic procedures in adults using a flexible bronchoscope are included in the guideline.

Managing passengers with stable respiratory disease planning air travel: British Thoracic Society recommendations

British Thoracic Society (Sep 2011)

The 2011 recommendations are an expert consensus view based on literature reviews and have as their main aim to give practical advice for respiratory specialists in secondary care.

Guidelines for the management of community acquired pneumonia in children: update 2011

British Thoracic Society (Jun 2011)

These updated guidelines represent a review of new evidence since then and consensus clinical opinion where evidence was not found. This document incorporates material from the 2002 guidelines and supersedes the previous guideline document.

BTS Pleural Disease Guideline 2010 A Quick Reference Guide

British Thoracic Society (Aug 2010)

The guideline addresses the investigation and medical management of pleural disease in adults.

Guidelines for the prevention and management of Mycobacterium tuberculosis infection and disease in adult patients with chronic kidney disease

British Thoracic Society (Jan 2010)

The objectives of these guidelines are to quantify the risks of developing active disease and to give advice where possible on the management of TB infection

British Thyroid Association

Guidelines for the management of thyroid cancer

British Thyroid Association (Jul 2014)

The intention is to provide guidance for all those involved in the management of patients with differentiated thyroid cancer (DTC) and some of the rarer thyroid cancers. This document is not intended as guidelines for management of thyroid nodules, though the role of ultrasound (US) in assessing thyroid nodules is included. A summary of the key recommendations for the management of adult differentiated thyroid cancer, medullary thyroid cancer (MTC) and anaplastic thyroid cancer is provided.

The three main aims of the guidelines are:
- to improve the referral pattern and management of patients with thyroid cancer;
- to improve the long-term overall and disease-free survival of patients with thyroid cancer;
- to enhance the health-related quality of life of patients with thyroid cancer.

These guidelines do not address thyroid lymphomas or metastases to the thyroid.

CHEST Journal

Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines

CHEST Journal (Feb 2012)

The Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines differs substantially from the prior versions both in process and in content. In this introduction, we describe some of the differences and the rationale for the changes.

We would like to begin by acknowledging the contributions of the visionaries whose work on past editions of these guidelines have allowed the current panel to develop this edition using the changes noted herein. First, James E. Dalen, respected clinician and researcher, while President of the American College of Chest Physicians (ACCP), had the foresight not only to propose the original consensus conference on the controversial issues of the indications for antithrombotics, antiplatelet agents, and thrombolytics for the prevention and treatment of cardiovascular disorders but also to invite Jack Hirsh, an extremely productive scientist and leader in the field of thrombosis, to join him in leading this important project. Drs Hirsh and Dalen brought a panel of leading experts together for the first antithrombotic guideline1 in 1986. Dr Dalen was co-editor of the first six guidelines from 1986 to 2001.

College of Emergency Medicine (CEM)

Caring for adult patients suspected of having concealed illicit drugs

College of Emergency Medicine (CEM) (Jun 2014)

This guideline deals with adult patients presenting to the Emergency Department (ED) having ingested or concealed illicit drugs in body cavities. It covers our legal responsibilities, interactions with the police and provides clinical guidance. This document provides more detailed guidance for the ED regarding the management of patients who are suspected of having concealed illicit drugs. The

Intravenous Regional Anaesthesia for Distal Forearm Fractures (Bier’s Block)

College of Emergency Medicine (CEM) (Mar 2014)

These guidelines aim to assist emergency physician using intravenous regional anaesthesia (Bier’s Block) for adults in the Emergency Department requiring manipulation for distal forearm fractures.

Consent, Capacity and Restraint of Adults, Adolescents and Children in Emergency Departments

College of Emergency Medicine (CEM) (Jul 2013)

This guideline offers guidance for clinicians working in Emergency Departments in the United Kingdom about obtaining consent. The guideline is mainly written for clinicians working in England and Scotland. Legislation in the other devolved nations and the Republic of Ireland differs, though the principles of autonomy and capacity are broadly similar and the clinical practice of obtaining consent varies little between these nations. This guideline does not consider consent to participation in research studies, retention of human tissue or sharing of information.

Management of Pain in Children

College of Emergency Medicine (CEM) (Jul 2013)

This guideline has been developed and reviewed in order to provide clear guidance on the standards for timeliness of provision of analgesia, and to provide an approach to the delivery of analgesia based on available evidence and consensus of the CEM CEC. It is applicable to all children presenting to Emergency Departments in the UK.

The patient who absconds

College of Emergency Medicine (CEM) (May 2013)

This guideline has been developed to assist Emergency Physicians and healthcare managers in the management of patients who abscond from the Emergency Department (ED). The guideline offers recommendations for the prevention and management of absconders in the Emergency Department setting. In this document ‘absconding’ is defined as a patient who has left the department unexpectedly with their assessment or treatment only partially completed, without the knowledge of clinical staff. Some patients who abscond may present a risk to themselves whilst others may not. This guideline does not refer to those patients who ‘Did Not Wait’ or ‘Left Without Being Seen’ or who take their own ‘self-discharge’.

HIV Testing in the Emergency Department

College of Emergency Medicine (CEM) (Oct 2012)

This guideline has been developed to assist Emergency Physicians and healthcare managers in the establishment of human immunodeficiency virus (HIV) testing in Emergency Departments. The guideline offers recommendations regarding the principles and safeguards required for the implementation of HIV testing in the Emergency Department setting.

End of life care for adults in the Emergency Department

College of Emergency Medicine (CEM) (Feb 2012)

This guideline defines best practice in all areas of end life care for adults. It covers both patient and relative care in the Emergency Department.

Department of Health

Guidance for the pharmacological management of substance misuse among young people

Department of Health (Mar 2009)

A prerequisite of pharmacological management is a comprehensive assessment of the young person’s needs and risks to that young person, and the establishment of a care plan. Pharmacological management should be provided in conjunction with psychosocial interventions and support, including risk management tailored to the individual. Aftercare provision needs to be put in place, which includes psychosocial interventions to prevent relapse.

Diabetes UK

Good clinical practice guidelines for care home residents with diabetes

Diabetes UK (Jan 2010)

These guidelines summarise the evidence base of published studies in the area, and reviews documents and other material relevant to care within residential and nursing homes. In addition, this document embodies the views and comments of a multidisciplinary expert panel established as the original Working Party to deliver a series of recommendations relating to the provision and delivery of diabetes care practices primarily for adults within care settings in the UK.

Enhanced Recovery After Surgery (ERAS) Society

Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS ) Society recommendations

Enhanced Recovery After Surgery (ERAS) Society (Aug 2012)

Protocols for enhanced recovery provide comprehensive and evidence-based guidelines for best perioperative care. Protocol implementation may reduce complication rates and enhance functional recovery and, as a result of this, also reduce length-of-stay in hospital. There is no comprehensive framework available for pancreaticoduodenectomy.

Guidelines for Perioperative Care in Elective Colonic Surgery: Enhanced Recovery After Surgery (ERAS ) Society Recommendations

Enhanced Recovery After Surgery (ERAS) Society (Aug 2012)

This review aims to present a consensus for optimal perioperative care in colonic surgery and to provide graded recommendations for items for an evidenced-based enhanced perioperative protocol.

Guidelines for Perioperative Care in Elective Rectal/Pelvic Surgery: Enhanced Recovery After Surgery (ERAS ) Society Recommendations

Enhanced Recovery After Surgery (ERAS) Society (Aug 2012)

This review aims to present a consensus for optimal perioperative care in rectal/pelvic surgery, and to provide graded recommendations for items for an evidenced-based enhanced recovery protocol.

European Academy of Allergy and Clinical Immunology (EAACI)

EAACI Food Allergy and Anaphylaxis Guidelines: diagnosis and management of food allergy

European Academy of Allergy and Clinical Immunology (EAACI) (Jun 2014)

Food allergy can result in considerable morbidity, impact negatively on quality of life, and prove costly in terms of medical care. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology’s (EAACI) Guidelines for Food Allergy and Anaphylaxis Group, building on previous EAACI position papers on adverse reaction to foods and three recent systematic reviews on the epidemiology, diagnosis, and management of food allergy, and provide evidence-based recommendations for the diagnosis and management of food allergy. While the primary audience is allergists, this document is relevant for all other healthcare professionals, including primary care physicians, and pediatric and adult specialists, dieticians, pharmacists and paramedics.
Our current understanding of the manifestations of food allergy, the role of diagnostic tests, and the effective management of patients of all ages with food allergy is presented. The acute management of non-life-threatening reactions is covered in these guidelines, but for guidance on the emergency management of anaphylaxis, readers are referred to the related EAACI Anaphylaxis Guidelines.

Anaphylaxis: guidelines from the European Academy of Allergy and Clinical Immunology

European Academy of Allergy and Clinical Immunology (EAACI) (Jun 2014)

Anaphylaxis is a clinical emergency, and all healthcare professionals should be familiar with its recognition and acute and ongoing management. These guidelines have been prepared by the European Academy of Allergy and Clinical Immunology (EAACI) Taskforce on Anaphylaxis. They aim to provide evidencebased recommendations for the recognition, risk factor assessment, and the management of patients who are at risk of, are experiencing, or have experienced anaphylaxis. While the primary audience is allergists, these guidelines are also relevant to all other healthcare professionals. The development of these guidelines has been underpinned by two systematic reviews of the literature, both on the epidemiology and on clinical management of anaphylaxis.

European AIDS Clinical Society (EACS)

EACS Guidelines

European AIDS Clinical Society (EACS) (Dec 2014)

EACS produces the European Guidelines for treatment of HIV-infected adults in Europe. The English version is regularly updated by the guideline panels. A major update is published once per year in autumn and translated into additional languages.

European Association for the Study of Obesity (EASO)

Prevalence, Pathophysiology, Health Consequences and Treatment Options of Obesity in the Elderly: A Guideline

European Association for the Study of Obesity (EASO) (Jun 2012)

This guideline provides recommendations based on current evidence for best practice in the management of obesity in the elderly

Evaluation of the Overweight/Obese Child – Practical Tips for the Primary Health Care Provider: Recommendations from the Childhood Obesity Task Force of the European Association for the Study of Obesity

European Association for the Study of Obesity (EASO) (Apr 2010)

This text is aimed at providing simple and practical tools for the identification and management of children with or at risk of overweight and obesity in the primary care setting. The tips and tools provided are based on data from the recent body of work that has been published in this field, official statements of several scientific societies along with expert opinion provided by the members of the Childhood Obesity Task Force (COTF) of the European Association for the Study of Obesity (EASO).

Management of Obesity in Adults: European Clinical Practice Guidelines

European Association for the Study of Obesity (EASO) (Apr 2008)

These European guidelines on the management of obesity in adults were developed to address the need for evidence-based recommendations for the management of obesity at the individual level and to establish a basis for a more uniform approach in obesity management across Europe. Our aim is to provide physicians, health-care policy makers and health-care carriers with essential elements of good clinical practice in the management of obesity.

European Association for the Study of Obesity (EASO) and the European Society of Hypertension (ESH)

Joint statement of the European Association for the Study of Obesity and the European Society of Hypertension: obesity and difficult to treat arterial hypertension

European Association for the Study of Obesity (EASO) and the European Society of Hypertension (ESH) (Mar 2012)

The present joint scientific statement provides an overview on the interaction between obesity and arterial hypertension from a pathophysiological, epidemiological, and clinical point of view. An important goal of this joint effort is to identify areas of uncertainty that ought to be studied in more detail. In particular, a focus is made on difficulties in treating hypertension in these patients.

European Association for the Study of the Liver (EASL)

EASL Recommendations on Treatment of Hepatitis C 2015

European Association for the Study of the Liver (EASL) (Apr 2015)

These EASL Recommendations on Treatment of Hepatitis C are intended to assist physicians and other healthcare providers, as well as patients and other interested individuals, in the clinical decision-making process by describing the current optimal management of patients with acute and chronic HCV infections. These recommendations apply to therapies that have been approved in the European Union at the time of their publication.

EASL Clinical Practice Guidelines: Management of hepatitis C virus infection

European Association for the Study of the Liver (EASL) (Feb 2014)

These EASL Clinical Practice Guidelines (CPGs) are intended to assist physicians and other healthcare providers, as well as patients and other interested individuals, in the clinical decision-making process by describing the optimal management of patients with acute and chronic HCV infections. These guidelines apply to therapies that are approved at the time of their publication.

EASL Clinical Practical Guidelines: Management of Alcoholic Liver Disease

European Association for the Study of the Liver (EASL) (Apr 2012)

Alcoholic liver disease (ALD) is the most prevalent cause of advanced liver disease in Europe. However, there has been limited research investment into ALD despite its significant burden on the health of Europeans. In recent years however, the mechanisms driving disease progression and the natural history of ALD have been better defined and novel targets for therapy have been identified. In addition, significant clinical research has produced a clear framework for the evaluation of new therapies in particular in patients with alcoholic steatohepatitis (ASH). ALD is a complex disease, the successful management of which hinges on the integration of all the competences in public health, epidemiology, addiction behavior and alcohol-induced organ injury. Both primary intervention to reduce alcohol abuse and secondary intervention to prevent alcohol-associated morbidity and mortality rely on the coordinated action of multidisciplinary teams established at local, national, and international levels.

EASL Clinical Practice Guidelines: Management of chronic hepatitis B virus infection

European Association for the Study of the Liver (EASL) (Apr 2012)

Our understanding of the natural history of hepatitis B virus (HBV) infection and the potential for therapy of the resultant disease is continuously improving. New data have become available since the previous EASL Clinical Practice Guidelines (CPGs) prepared in 2008 and published in early 2009. The objective of this manuscript is to update the recommendations for the optimal management of chronic HBV infection. The CPGs do not fully address prevention including vaccination. In addition, despite the increasing knowledge, areas of uncertainty still exist and therefore clinicians, patients, and public health authorities must continue to make choices on the basis of the evolving evidence.

EASL Clinical Practice Guidelines: Wilson’s disease

European Association for the Study of the Liver (EASL) (Feb 2012)

This Clinical Practice Guideline (CPG) has been developed to assist physicians and other healthcare providers in the diagnosis and management of patients with Wilson’s disease. The goal is to describe a number of generally accepted approaches for diagnosis, prevention, and treatment of Wilson’s disease.

EASL Clinical Practice Guidelines for HFE Hemochromatosis

European Association for the Study of the Liver (EASL) (Apr 2010)

Iron overload in humans is associated with a variety of genetic and acquired conditions. Of these, HFE hemochromatosis (HFE-HC) is by far the most frequent and most well-defined inherited cause when considering epidemiological aspects and risks for iron-related morbidity and mortality. The majority of patients with HFE-HC are homozygotes for the C282Y polymorphism. Without therapeutic intervention, there is a risk that iron overload will occur, with the potential for tissue damage and disease. While a specific genetic test now allows for the diagnosis of HFE-HC, the uncertainty in defining cases and disease burden, as well as the low phenotypic penetrance of C282Y homozygosity poses a number of clinical problems in the management of patients with HC. This Clinical Practice Guideline will therefore focus on HFE-HC, while rarer forms of genetic iron overload recently attributed to pathogenic mutations of transferrin receptor 2, (TFR2), hepcidin (HAMP), hemojuvelin (HJV), or to a sub-type of ferroportin (FPN) mutations, on which limited and sparse clinical and epidemiologic data are available, will not be discussed. We have developed recommendations for the screening, diagnosis, and management of HFE-HC.

European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Diseases (AASLD)

Hepatic Encephalopathy in Chronic Liver Disease: 2014 Practice Guideline by the European Association for the Study of the Liver and the American Association for the Study of Liver Diseases

European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Diseases (AASLD) (May 2014)

These recommendations provide a data-supported approach. They are based on the following: (1) formal review and analysis of the recently published world literature on the topic; (2) guideline policies covered by the American Association for the Study of Liver Diseases/European Association for the Study of the Liver (AASLD/EASL) Policy on the Joint Development and Use of Practice Guidelines; and (3) the experience of the authors in the specified topic.

European Association for the Study of the Liver (EASL) and Asociación Latinoamericana para el Estudio del Hígado (ALEH)

EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis

European Association for the Study of the Liver (EASL) and Asociación Latinoamericana para el Estudio del Hígado (ALEH) (Apr 2015)

These Clinical Practice Guidelines (CPGs) have been developed by a panel of experts chosen by the EASL and ALEH Governing Boards. The recommendations were peer-reviewed by external expert reviewers and approved by EASL and ALEH Governing Boards.

European Association for the Study of the Liver (EASL) and European Organisation for Research and Treatment of Cancer (EORTC)

Erratum to: EASL–EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma

European Association for the Study of the Liver (EASL) and European Organisation for Research and Treatment of Cancer (EORTC) (Jun 2012)

Fig. 3 was incomplete for BCLC stage A, and it has been corrected as per below. Patients at BCLC stage A and single tumors can be evaluated for surgical resection.

EASL–EORTC Clinical Practice Guidelines: Management of hepatocellular carcinoma

European Association for the Study of the Liver (EASL) and European Organisation for Research and Treatment of Cancer (EORTC) (Jan 2012)

EASL–EORTC Clinical Practice Guidelines (CPG) on the management of hepatocellular carcinoma (HCC) define the use of surveillance, diagnosis, and therapeutic strategies recommended for patients with this type of cancer. This is the first European joint effort by the European Association for the Study of the Liver (EASL) and the European Organization for Research and Treatment of Cancer (EORTC) to provide common guidelines for the management of hepatocellular carcinoma.

European Association for the Study of the Liver (EASL) and European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)

Management of chronic hepatitis B in childhood: ESPGHAN clinical practice guidelines

European Association for the Study of the Liver (EASL) and European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) (Oct 2013)

Treatment of CHB in childhood has been hampered by the chronic delay in licensing new drugs for pediatric use. Safe and effective antiviral therapies are available in adults, but few are labeled for the use in children, and an accurate selection of whom to treat and the identification of the right timing for treatment are needed to optimize response and reduce the risk of antiviral resistance. Although several guidelines on the management of adult patients with CHB have been published by major international societies, the clinical approach to infected children is still evolving, and is mostly based on consensus of expert opinion.

European Association of Urology (EAU)

Guidelines on Muscle-invasive and Metastatic Bladder Cancer

European Association of Urology (EAU) (Apr 2015)

The European Association of Urology (EAU) Guidelines Panel for Muscle-invasive and Metastatic Bladder Cancer (MIBC) has prepared these guidelines to help urologists assess the evidence-based management of MIBC and to incorporate guideline recommendations into their clinical practice.

Guidelines on Urological Infections

European Association of Urology (EAU) (Mar 2015)

Due to the increasing threat of resistant pathogens worldwide, it has become imperative to limit the use of antibiotics, and consequently, to monitor established treatment strategies closely. It is the ambition of the present guidelines to provide both the urologist and the physician from other medical specialties with advices in their daily practice. The guidelines cover male and female UTIs, male genital infections, and special fields such as UTIs in paediatric urology, immunosuppression, renal insufficiency and kidney transplant recipients. Much attention is given to antibiotic prophylaxis, with the aim of reducing the misuse of antibiotics in conjunction with surgery. High quality clinical research is strongly encouraged.

Guidelines on Testicular Cancer

European Association of Urology (EAU) (Mar 2015)

The aim of these guidelines is to present the current evidence for the diagnosis and treatment of patients with cancer of the testis. Testicular cancer represents 5% of urological tumours affecting mostly younger males. This document addresses germ-cell tumours and sex cord/gonadal stromal tumours.

Guidelines on Primary Urethral Carcinoma

European Association of Urology (EAU) (Mar 2015)

The European Association of Urology (EAU) Guidelines Group on Muscle-invasive and Metastatic Bladder Cancer has prepared these guidelines to deliver current evidence-based information on the diagnosis and treatment of patients with primary urethral carcinoma (UC). When the first carcinoma in the urinary tract is detected in the urethra, this is defined as primary UC, in contrast to secondary UC, which presents as recurrent carcinoma in the urethra after prior diagnosis and treatment of carcinoma elsewhere in the urinary tract.

Guidelines on Urinary Incontinence

European Association of Urology (EAU) (Mar 2015)

These Guidelines from the European Association of Urology (EAU) Working Panel on Urinary Incontinence are written by urologists primarily for urologists, though we recognise that they are likely to be referred to by other professional groups. They aim to provide sensible and practical evidence-based guidance on the clinical problem of UI rather than an exhaustive narrative review.

Guidelines on Non-muscle-invasive Bladder Cancer (Ta, T1 and CIS)

European Association of Urology (EAU) (Mar 2015)

This overview represents the updated European Association of Urology (EAU) guidelines for Non-muscle-invasive Bladder Cancer (CIS, Ta, T1). The information presented is limited to urothelial carcinoma, if not specified otherwise. Aim is to provide practical guidance on the clinical management of non-muscle-invasive bladder cancer with a focus on clinical presentation and recommendations.

Guidelines on Renal Cell Carcinoma

European Association of Urology (EAU) (Mar 2015)

The European Association of Urology (EAU) Renal Cell Cancer (RCC) Guidelines Panel has compiled these clinical guidelines to provide urologists with evidence-based information and recommendations for the management of renal cell cancer. The RCC panel is an international group consisting of clinicians with particular expertise in this field of urological care.

Guidelines on Urothelial Carcinomas of the Upper Urinary Tract

European Association of Urology (EAU) (Mar 2015)

The first EAU guidelines on UTUC were published in 2011. The current 2015 EAU guidelines on UTUC present an update of the 2014 version, and provide evidence-based information for clinical management of UTUC.

Guidelines on Male Sexual Dysfunction: Erectile dysfunction and premature ejaculation

European Association of Urology (EAU) (Mar 2015)

Erectile dysfunction (ED, impotence) and premature ejaculation (PE) are the two main complaints in male sexual medicine. New oral therapies have completely changed the diagnostic and therapeutic approach to ED and the Guidelines Office of The European Association of Urology (EAU) has appointed an Expert Panel to update previously published EAU guidelines for ED or impotence. The update is based on a review of available scientific information, current research, and clinical practice in the field. The Expert Panel has also identified critical problems and knowledge gaps, setting priorities for future clinical research.

Guidelines on Priapism

European Association of Urology (EAU) (Mar 2015)

The aim of these guidelines is to present the current evidence for the diagnosis and treatment of patients suffering from priapism.

Guidelines on the Management of Non-Neurogenic Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO)

European Association of Urology (EAU) (Mar 2015)

Recommendations apply to men aged 40 years or older who seek professional help for various non-neurogenic benign forms of LUTS for example, LUTS/BPO, detrusor overactivity/overactive bladder (OAB), or nocturnal polyuria. Men with lower urinary tract disease who do not fall into this category (e.g. concomitant neurological diseases, young age, prior lower urinary tract disease or surgery) usually require a more extensive work-up, which is not covered in these Guidelines, but may include several tests mentioned in the following section.

Guidelines on Urolithiasis

European Association of Urology (EAU) (Mar 2015)

The European Association of Urology (EAU) Urolithiasis Guidelines Panel have prepared these guidelines to help urologists assess evidence-based management of stones/calculi and incorporate recommendations into clinical practice. The document covers most aspects of the disease, which is still a cause of significant morbidity despite technological and scientific advances. The Panel is aware of the geographical variations in healthcare provision.

Guidelines on Urological Trauma

European Association of Urology (EAU) (Mar 2015)

The European Association of Urology (EAU) Guidelines Group for Urological Trauma prepared these guidelines in order to assist medical professionals in the management of urological trauma in adults.

Guidelines on Neuro-Urology

European Association of Urology (EAU) (Mar 2015)

The purpose of these clinical guidelines is to provide information for clinical practitioners on the incidence, definitions, diagnosis, therapy, and follow-up of neuro-urological disorders. These guidelines reflect the current opinion of experts in this specific pathology and thus represent a state-of-the-art reference for all clinicians, as of the date of its presentation to the European Association of Urology (EAU).

EAU Guidelines on Prostate Cancer

European Association of Urology (EAU) (Mar 2015)

The European Association of Urology (EAU) Guidelines Group for Prostate Cancer have prepared this guidelines document to assist medical professionals assess the evidence-based management of prostate cancer (PCa). The multidisciplinary guidelines panel includes urologists, radiation oncologists, a medical oncologist, a radiologist and a pathologist.

Guidelines on Paediatric Urology

European Association of Urology (EAU) (Mar 2015)

A collaborative working group consisting of members representing the European Society for Paediatric Urology (ESPU) and the European Association of Urology (EAU) has prepared these guidelines to make a document available that may help to increase the quality of care for children with urological problems. This compilation document addresses a number of common clinical pathologies in paediatric urological practice, but covering the entire field of paediatric urology in a single guideline document is unattainable, nor practical. The majority of urological clinical problems in children are distinct and in many ways different to those in adults. This publication intends to outline a practical and preliminary approach to paediatric urological problems.

Guidelines on Male Hypogonadism

European Association of Urology (EAU) (Mar 2015)

Androgens play a crucial role in the development and maintenance of male reproductive and sexual functions. Low levels of circulating androgens can cause disturbances in male sexual development, resulting in congenital abnormalities of the male reproductive tract. Later in life, this may cause reduced fertility, sexual dysfunction, decreased muscle formation and bone mineralisation, disturbances of fat metabolism, and cognitive dysfunction. Testosterone levels decrease as a process of ageing: signs and symptoms caused by this decline can be considered a normal part of ageing. However, low testosterone levels are also associated with several chronic diseases, and symptomatic patients may benefit from testosterone treatment. This document presents the European Association of Urology (EAU) guidelines on diagnosis and treatment of male hypogonadism. This guideline aims to provide practical recommendations on how to deal with primary low testosterone and ageing-related decline in testosterone in male patients, as well as the treatment of testosterone disruption and deficiencies caused by other illnesses.

Guidelines on Chronic Pelvic Pain

European Association of Urology (EAU) (Mar 2015)

The European Association of Urology (EAU) Guidelines Working Group for Chronic Pelvic Pain prepared this guidelines document to assist urologists and medical professionals from associated specialties, such as gynaecologists, psychologists, gastroenterologists and sexologists, in assessing the evidence-based management of CPP and to incorporate evidence-based recommendations into their every-day clinical practice.

Guidelines on Penile Cancer

European Association of Urology (EAU) (Apr 2014)

The European Association of Urology (EAU) Guidelines Group on Penile Cancer has prepared this guidelines document to assist medical professionals in the management of penile cancer. The guidelines aim to provide detailed, up-to-date information, based on recent developments in our understanding and management of penile squamous cell carcinoma (SCC). However, it must be emphasised that these guidelines provide an updated, but not yet standardised general approach to treatment and that they provide guidance and recommendations without legal implications.

Guidelines on Male Infertility

European Association of Urology (EAU) (Mar 2014)

The European Association of Urology (EAU) Guideline Panel on Male Infertility has prepared these guidelines to assist urologists and healthcare professionals from related specialities in the treatment of male infertility. Urologists are usually the specialists who are initially responsible for assessing the male partner when male infertility is suspected. However, infertility can be a multifactorial condition requiring multidisciplinary involvement. The Male Infertility Guidelines Panel consists of urologists and endocrinologists with special training in andrology and experience in the diagnosis and treatment of male infertility.

Guidelines on Upper Urinary Tract Urothelial Cell Carcinomas

European Association of Urology (EAU) (Mar 2013)

To provide evidence-based information for the clinical management of these rare tumours and to help clinicians incorporate these recommendations into their practice. The current update is based on a structured literature search.

Guidelines on Robotic- and Single-site Surgery in Urology

European Association of Urology (EAU) (Mar 2013)

In 2011, the EAU Guidelines Office formed a working group to evaluate the current literature and the level of evidence (LE) of keyhole and robotic assisted surgery in urological procedures. The panel members are surgeons with particular expertise in performing the procedures discussed in this document. All have been trained in traditional open and laparoscopic surgical approaches. Robotic assisted surgery is performed as a routine procedure by two expert panel members on a daily basis

Guidelines on Pain Management & Palliative Care

European Association of Urology (EAU) (Mar 2013)

The new European Association of Urology (EAU) Guidelines expert panel for Pain Management and Palliative Care have prepared this guidelines document to assist medical professionals in appraising the evidence-based management of pain and palliation in urological practice. These guidelines include general advice on pain assessment and palliation, with a focus on treatment strategies relating to common medical conditions and painful procedures.

Guidelines on Penile Curvature

European Association of Urology (EAU) (Feb 2012)

The aim of this guideline is to provide the practising urologist with the most recent evidence on the diagnosis and management of penile curvature in order to assist in his/her decision-making process.

Penile curvature is a common urological disorder which can be congenital or acquired. Congenital curvature is briefly discussed in these guidelines as a distinct pathology in the adult population without any other concomitant abnormality present (such as urethral abnormalities). For paediatric congenital penile curvature, please refer to the EAU Guidelines on Paediatric Urology, Chapter on Congenital Penile Curvature.

Acquired curvature is mainly secondary due to La Peyronie’s disease (referred to as Peyronie’s disease in this text), but can also be due to the healing process of a penile fracture.

Guidelines on the Management of Male Lower Urinary Tract Symptoms (LUTS), incl. Benign Prostatic Obstruction (BPO)

European Association of Urology (EAU) (Feb 2012)

Because patients seek help for LUTS and not an underlying attribute of the prostate such as BPH or BPE, this updated guideline has been written from the perspective of men who complain about a variety of bladder storage, voiding and/or post-micturition symptoms. The recommendations made within the guideline are based on the best available evidence. The guideline panel consisted of urologists, a pharmacologist, and an epidemiologist and statistician who have been working on the topic for the last 4 years. The guideline is primarily written for urologists but can also be used by general practitioners, patients, or other stakeholders.

Guidelines on Reporting and Grading of Complications after Urologic Surgical Procedures

European Association of Urology (EAU) (Feb 2012)

The aim of our work was to review the available reporting systems used for urologic surgical complications, to establish a possible change in attitude towards reporting of complications using standardised systems, to assess systematically the Clavien-Dindo system (currently widely used for the reporting of complications related to urologic surgical interventions), to identify shortcomings in reporting complications, and to present recommendations for the development and implementation of future reporting systems that focus on patientcentred outcomes. The panel did not take intraoperative complications into consideration, which may be addressed in a follow-up project.

Guidelines on Neurogenic Lower Urinary Tract Dysfunction

European Association of Urology (EAU) (Mar 2011)

The purpose of these clinical guidelines is to provide useful information for clinical practitioners on the incidence, definitions, diagnosis, therapy, and follow-up observation of the condition of neurogenic lower urinary tract dysfunction (NLUTD). These guidelines reflect the current opinion of the experts in this specific pathology and thus represent a state-of-the-art reference for all clinicians, as of the date of its presentation to the European Association of Urology (EAU).

European Atherosclerosis Society (EAS)

Familial hypercholesterolaemia in children and adolescents: gaining decades of life by optimizing detection and treatment

European Atherosclerosis Society (EAS) (May 2015)

Familial hypercholesterolaemia (FH) is a common genetic cause of premature coronary heart disease (CHD). Globally, one baby is born with FH every minute. If diagnosed and treated early in childhood, individuals with FH can have normal life expectancy. This consensus paper aims to improve awareness of the need for early detection and management of FH children. Familial hypercholesterolaemia is diagnosed either on phenotypic criteria, i.e. an elevated low-density lipoprotein cholesterol (LDL-C) level plus a family history of elevated LDL-C, premature coronary artery disease and/or genetic diagnosis, or positive genetic testing. Childhood is the optimal period for discrimination between FH and non-FH using LDL-C screening. An LDL-C ≥5 mmol/L (190 mg/dL), or an LDL-C ≥4 mmol/L (160 mg/dL) with family history of premature CHD and/or high baseline cholesterol in one parent, make the phenotypic diagnosis. If a parent has a genetic defect, the LDL-C cut-off for the child is ≥3.5 mmol/L (130 mg/dL). We recommend cascade screening of families using a combined phenotypic and genotypic strategy. In children, testing is recommended from age 5 years, or earlier if homozygous FH is suspected. A healthy lifestyle and statin treatment (from age 8 to 10 years) are the cornerstones of management of heterozygous FH. Target LDL-C is <3.5 mmol/L (130 mg/dL) if >10 years, or ideally 50% reduction from baseline if 8–10 years, especially with very high LDL-C, elevated lipoprotein(a), a family history of premature CHD or other cardiovascular risk factors, balanced against the long-term risk of treatment side effects. Identifying FH early and optimally lowering LDL-C over the lifespan reduces cumulative LDL-C burden and offers health and socioeconomic benefits. To drive policy change for timely detection and management, we call for further studies in the young. Increased awareness, early identification, and optimal treatment from childhood are critical to adding decades of healthy life for children and adolescents with FH.

Statin-associated muscle symptoms: impact on statin therapy—European Atherosclerosis Society Consensus Panel Statement on Assessment, Aetiology and Management

European Atherosclerosis Society (EAS) (Feb 2015)

Statin-associated muscle symptoms (SAMS) are one of the principal reasons for statin non-adherence and/or discontinuation, contributing to adverse cardiovascular outcomes. This European Atherosclerosis Society (EAS) Consensus Panel overviews current understanding of the pathophysiology of statin-associated myopathy, and provides guidance for diagnosis and management of SAMS.

Homozygous familial hypercholesterolaemia: new insights and guidance for clinicians to improve detection and clinical management. A position paper from the Consensus Panel on Familial Hypercholesterolaemia of the European Atherosclerosis Society

European Atherosclerosis Society (EAS) (Jul 2014)

Homozygous familial hypercholesterolaemia (HoFH) is a rare life-threatening condition characterized by markedly elevated circulating levels of low-density lipoprotein cholesterol (LDL-C) and accelerated, premature atherosclerotic cardiovascular disease (ACVD). Given recent insights into the heterogeneity of genetic defects and clinical phenotype of HoFH, and the availability of new therapeutic options, this Consensus Panel on Familial Hypercholesterolaemia of the European Atherosclerosis Society (EAS) critically reviewed available data with the aim of providing clinical guidance for the recognition and management of HoFH.

Plant sterols and plant stanols in the management of dyslipidaemia and prevention of cardiovascular disease

European Atherosclerosis Society (EAS) (Nov 2013)

This EAS Consensus Panel critically appraised evidence relevant to the benefit to risk relationship of functional foods with added plant sterols and/or plant stanols, as components of a healthy lifestyle, to reduce plasma low-density lipoprotein-cholesterol (LDL-C) levels, and thereby lower cardiovascular risk.

European Crohn's and Colitis Organization (ECCO) and European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)

Consensus guidelines of ECCO/ESPGHAN on the medical management of pediatric Crohn's disease

European Crohn's and Colitis Organization (ECCO) and European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) (Oct 2014)

The objective of these guidelines is to provide state of the art guidance for medical treatment and long term management of children and adolescents with CD, while individualizing therapy based on risk and benefit, based on a thorough review of the existing evidence. The guidelines are intended to help and support (pediatric) gastroenterologists who are experienced in the care of children and adolescents.

European Crohn’s and Colitis Organisation (ECCO)

The Second European Evidenced-Based Consensus on Reproduction and Pregnancy in Inflammatory Bowel Disease

European Crohn’s and Colitis Organisation (ECCO) (Mar 2015)

Trying to conceive and being pregnant is an emotional period for those involved. In the majority of patients suffering from inflammatory bowel disease, maintenance therapy is required during pregnancy to control the disease, and disease control might necessitate introduction of new drugs during a vulnerable period. In this updated consensus on the reproduction and pregnancy in inflammatory bowel disease reproductive issues including fertility, the safety of drugs during pregnancy and lactation are discussed.

European Consensus on the Diagnosis and Management of Iron Deficiency and Anaemia in Inflammatory Bowel Diseases

European Crohn’s and Colitis Organisation (ECCO) (Jan 2015)

The goal of this consensus initiated by the European Crohn’s and Colitis Organisation [ECCO] was to establish European consensus guidelines for the diagnosis, treatment and prevention of iron deficiency and iron deficiency anaemia [IDA], but also for non-iron deficiency anaemia and associated conditions.

European evidence based consensus on surgery for ulcerative colitis

European Crohn’s and Colitis Organisation (ECCO) (Jan 2015)

The goal of this consensus initiated by the European Crohn's and Colitis Organisation (ECCO) was to establish European consensus guidelines for the surgical treatment of ulcerative colitis.

European evidence based consensus for endoscopy in inflammatory bowel disease

European Crohn’s and Colitis Organisation (ECCO) (Sep 2013)

The aim of this new consensus is to establish standards for the diagnosis, follow-up and surveillance in IBD, including the differential diagnosis of other colitides.

European Crohn’s and Colitis Organisation (ECCO) and European Society of Pathology (ESP)

Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease

European Crohn’s and Colitis Organisation (ECCO) and European Society of Pathology (ESP) (Dec 2013)

This paper is the product of work by gastroenterologists, infectious disease experts and pediatricians. It provides guidance on the prevention, detection and management of opportunistic infections in patients of all age categories with IBD. After a section on definitions and risk factors for developing opportunistic infection, there are five sections on different infectious agents, followed by a section on information and guidance for patients with IBD travelling frequently or to less economically developed countries. In the final section, a systematic work up and vaccination programme is proposed for consideration in patients exposed to immunomodulator therapies.

European consensus on the histopathology of inflammatory bowel disease

European Crohn’s and Colitis Organisation (ECCO) and European Society of Pathology (ESP) (Jun 2013)

The aim of this new consensus is to establish standards for diagnosis and pathological procedures in IBD and other colitides, such as lymphocytic and collagenous Colitis and variants, indeterminate, unclassified Colitis and infectious Colitis related to IBD.

European Cystic Fibrosis Society

European Cystic Fibrosis Society Standards of Care: Best Practice guidelines

European Cystic Fibrosis Society (May 2014)

Specialised CF care has led to a dramatic improvement in survival in CF: in the last four decades, well above what was seen in the general population over the same period. With the implementation of newborn screening in many European countries, centres are increasingly caring for a cohort of patients who have minimal lung disease at diagnosis and therefore have the potential to enjoy an excellent quality of life and an even greater life expectancy than was seen previously. To allow high quality care to be delivered throughout Europe, a landmark document was published in 2005 that sets standards of care. Our current document builds on this work, setting standards for best practice in key aspects of CF care. The objective of our document is to give a broad overview of the standards expected for screening, diagnosis, pre-emptive treatment of lung disease, nutrition, complications, transplant/end of life care and psychological support. For comprehensive details of clinical care of CF, references to the most up to date European Consensus Statements, Guidelines or Position Papers are provided in Table 1. We hope that this best practice document will be useful to clinical teams both in countries where CF care is developing and those with established CF centres.

© 2014 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

Culture-based diagnostic microbiology in cystic fibrosis: Can we simplify the complexity?

European Cystic Fibrosis Society (Sep 2013)

This review summarizes state-of-the art culture methods and makes recommendations for addition of non-culture based methods in the diagnostic laboratory.

Best practice guidance for the diagnosis and management of cystic fibrosis-associated liver disease

European Cystic Fibrosis Society (Jun 2011)

Approximately 5–10% of cystic fibrosis (CF) patients develop multilobular cirrhosis during the first decade of life. Most CF patients later develop signs of portal hypertension with complications, mainly variceal bleeding. Liver failure usually occurs later, after the paediatric age. Annual screening for liver disease is recommended to detect pre-symptomatic signs and initiate ursodeoxycholic acid therapy, which might halt disease progression. Liver disease should be considered if at least two of the following variables are present: abnormal physical examination, persistently abnormal liver function tests and pathological ultrasonography. If there is diagnostic doubt, a liver biopsy is indicated. All CF patients with liver disease need annual follow-up to evaluate the development of cirrhosis, portal hypertension or liver failure. Management should focus on nutrition, prevention of bleeding and variceal decompression. Deterioration of pulmonary function is an important consideration for liver transplantation, particularly in children with hepatic dysfunction or advanced portal hypertension.

End of life care for patients with cystic fibrosis

European Cystic Fibrosis Society (Jun 2011)

Palliative care is an approach that improves quality of life for patients and their families facing problems associated with a life-threatening illness. Care planning is particularly important in CF, where predicting a time of death is extremely difficult. The patient and family should receive realistic information about health status and further options of care. Particularly important is the explanation that treatment does not stop during the terminal phase of the disease, instead the primary aim is to alleviate unpleasant symptoms. More invasive end of life care is becoming the norm in patients awaiting lung transplantation. Terminal care should be organised in the place chosen by the patient and their family. Ideally terminal care should not end when the patient dies, instead psychological and spiritual support should continue to bereaved families.

Best practice guidance for the diagnosis and management of cystic fibrosis-associated liver disease

European Cystic Fibrosis Society (Jun 2011)

Approximately 5–10% of cystic fibrosis (CF) patients develop multilobular cirrhosis during the first decade of life. Most CF patients later develop signs of portal hypertension with complications, mainly variceal bleeding. Liver failure usually occurs later, after the paediatric age. Annual screening for liver disease is recommended to detect pre-symptomatic signs and initiate ursodeoxycholic acid therapy, which might halt disease progression. Liver disease should be considered if at least two of the following variables are present: abnormal physical examination, persistently abnormal liver function tests and pathological ultrasonography. If there is diagnostic doubt, a liver biopsy is indicated. All CF patients with liver disease need annual follow-up to evaluate the development of cirrhosis, portal hypertension or liver failure. Management should focus on nutrition, prevention of bleeding and variceal decompression. Deterioration of pulmonary function is an important consideration for liver transplantation, particularly in children with hepatic dysfunction or advanced portal hypertension.

End of life care for patients with cystic fibrosis

European Cystic Fibrosis Society (Jun 2011)

Palliative care is an approach that improves quality of life for patients and their families facing problems associated with a life-threatening illness. Care planning is particularly important in CF, where predicting a time of death is extremely difficult. The patient and family should receive realistic information about health status and further options of care. Particularly important is the explanation that treatment does not stop during the terminal phase of the disease, instead the primary aim is to alleviate unpleasant symptoms. More invasive end of life care is becoming the norm in patients awaiting lung transplantation. Terminal care should be organised in the place chosen by the patient and their family. Ideally terminal care should not end when the patient dies, instead psychological and spiritual support should continue to bereaved families.

European cystic fibrosis bone mineralisation guidelines

European Cystic Fibrosis Society (Jun 2011)

Patients with cystic fibrosis (CF) are at risk of developing low bone mineral density (BMD) and fragility fractures. This paper presents consensus statements that summarise current knowledge of the epidemiology and pathophysiology of CF-related skeletal deficits and provides guidance on its assessment, prevention and treatment. The statements were validated using a modified Delphi methodology.

Guidelines for the diagnosis and management of distal intestinal obstruction syndrome in cystic fibrosis patients

European Cystic Fibrosis Society (Jun 2011)

Complete or incomplete intestinal obstruction by viscid faecal material in the terminal ileum and proximal colon – distal intestinal obstruction syndrome (DIOS) – is a common complication in cystic fibrosis. Estimates of prevalence range from 5 to 12 episodes per 1000 patients per year in children, with higher rates reported in adults. DIOS is mainly seen in patients with pancreatic insufficiency, positive history of meconium ileus and previous episodes of DIOS. DIOS is being described with increasing frequency following organ transplantation. Diagnosis is based on suggestive symptoms with a right lower quadrant mass confirmed on X-ray. The main differential is chronic constipation. Treatment consists of rehydration combined with stool softening laxatives or gut lavage with balanced electrolyte solutions. Rapid fluid shifts have been described following osmotic agents. Avoiding dehydration and optimizing pancreatic enzyme dosage may reduce the chance of further episodes. Prophylactic laxative therapy is widely used, but is not evidence-based.

European cystic fibrosis bone mineralisation guidelines

European Cystic Fibrosis Society (Jun 2011)

Patients with cystic fibrosis (CF) are at risk of developing low bone mineral density (BMD) and fragility fractures. This paper presents consensus statements that summarise current knowledge of the epidemiology and pathophysiology of CF-related skeletal deficits and provides guidance on its assessment, prevention and treatment. The statements were validated using a modified Delphi methodology.

Guidelines for the diagnosis and management of distal intestinal obstruction syndrome in cystic fibrosis patients

European Cystic Fibrosis Society (Jun 2011)

Complete or incomplete intestinal obstruction by viscid faecal material in the terminal ileum and proximal colon – distal intestinal obstruction syndrome (DIOS) – is a common complication in cystic fibrosis. Estimates of prevalence range from 5 to 12 episodes per 1000 patients per year in children, with higher rates reported in adults. DIOS is mainly seen in patients with pancreatic insufficiency, positive history of meconium ileus and previous episodes of DIOS. DIOS is being described with increasing frequency following organ transplantation. Diagnosis is based on suggestive symptoms with a right lower quadrant mass confirmed on X-ray. The main differential is chronic constipation. Treatment consists of rehydration combined with stool softening laxatives or gut lavage with balanced electrolyte solutions. Rapid fluid shifts have been described following osmotic agents. Avoiding dehydration and optimizing pancreatic enzyme dosage may reduce the chance of further episodes. Prophylactic laxative therapy is widely used, but is not evidence-based.

European Federation of Neurological Societies (EFNS)

Brain metastases

European Federation of Neurological Societies (EFNS) (Oct 2011)

The primary objective has been to establish evidence - based guidelines in regard to the management of patients with brain metastases. The secondary objective has been to identify areas where there are still controversies and clinical trials are needed.

Alcohol - related seizures

European Federation of Neurological Societies (EFNS) (Sep 2011)

These guidelines summarize the current evidence for the diagnosis and management of alcohol - related seizures.

EFNS guidelines on the Clinical Management of Amyotrophic Lateral Sclerosis (MALS) – revised report of an EFNS task force

European Federation of Neurological Societies (EFNS) (Jul 2011)

This systematic review is an objective appraisal of the evidence regarding the diagnosis and clinical management of patients with amyotrophic lateral sclerosis (ALS). Advances in the knowledge and care of ALS warrant an updating of the 2005 EFNS guidelines with the primary aim of establishing evidence-based and patient- and carer-centred guidelines for diagnosing and managing patients with ALS for clinicians, with the secondary aim of identifying areas where further research is needed.

Post-polio syndrome

European Federation of Neurological Societies (EFNS) (Jun 2011)

The aim was to revise the existing EFNS task force document, with regard to a common defi nition of PPS, and evaluation of the existing evidence for the effectiveness and safety of therapeutic interventions. By this revision, clinical guidelines for management of PPS are provided.

Use of anti - interferon beta antibody measurements in multiple sclerosis

European Federation of Neurological Societies (EFNS) (Jun 2011)

The objectives of our task force were to: (i) evaluate differences in immunogenicity of IFN β products; (ii) evaluate the reliability and give recommendations on BABs and NABs assays; (iii) evaluate the impact of NABs on clinical effi cacy and give recommendations on the clinical use of measurement of IFN β antibodies; and (iv) review the evidence on prevention of NAB development and the management of patients with NABs.

Use of imaging in multiple sclerosis

European Federation of Neurological Societies (EFNS) (Jun 2011)

Conventional magnetic resonance imaging (cMRI) has proven to be sensitive for detecting multiple sclerosis (MS) lesions and their changes over time. This exquisite sensitivity has made cMRI the most important paraclinical tool in supporting a diagnosis of MS and establishing a prognosis at the clinical onset of the disease.

Cognitive rehabilitation

European Federation of Neurological Societies (EFNS) (Jun 2011)

The aim was to evaluate the existing evidence for the clinical effectiveness of cognitive rehabilitation in stroke and TBI, and provide recommendations for neurological practice. The results were published in 2003 in the European Journal of Neurology and updated in 2005. The present chapter is an update and a revision of these guidelines.

Management of narcolepsy in adults

European Federation of Neurological Societies (EFNS) (Jun 2011)

The treatments used for narcolepsy, either pharmacological or behavioural, are diverse. However, the quality of the published pieces of clinical evidence supporting them varies widely, and studies comparing the efficacy of different substances are lacking.

Use of antibody testing in nervous system disorders

European Federation of Neurological Societies (EFNS) (Jun 2011)

To evaluate service provision and quality assurance schemes for clinically useful autoantibody tests in neurology.

Early (uncomplicated) Parkinson’s disease

European Federation of Neurological Societies (EFNS) (Jun 2011)

This chapter provides these scientifically supported treatment recommendations.

Late (complicated) Parkinson’s disease

European Federation of Neurological Societies (EFNS) (Jun 2011)

Patients with advanced Parkinson’s disease (PD) may suffer from any combination of motor and non - motor problems. Doctors and patients must make choices and decide which therapeutic strategies should prevail for each particular instance.

Cluster headache and other trigemino- autonomic cephalgias

European Federation of Neurological Societies (EFNS) (Jun 2011)

These guidelines aim to give evidence - based recommendations for the treatment of cluster headache attacks, for the prophylaxis of cluster headache, for the treatment of paroxysmal hemicranias, and for the treatment of SUNCT syndrome. A brief clinical description of the headache disorders is included. The defi nition of the headache disorders follows the diagnostic criteria of the International Headache Society (IHS).

Treatment of medication overuse headache – guideline of the EFNS headache panel

European Federation of Neurological Societies (EFNS) (Jun 2011)

This guideline aims to give recommendations for the treatment of medication overuse headache (MOH) as classified by the International Headache Society (IHS). Although this headache disorder is frequent and a major problem in the treatment of patients with chronic headache, placebo- or sham-controlled double-blind trials for a specific treatment of this condition are almost completely missing.

Neurological problems in liver transplantation

European Federation of Neurological Societies (EFNS) (Jun 2011)

The recommendation section includes statements classifi ed in levels A – C derived from Classes I – III of evidence according to EFNS guidelines when feasible. For those clinical areas exhibiting Class IV scientifi c evidence, recommendations were based on the agreement obtained and indicated in the text as Good Practice Points (GPP).

Cerebral vasculitis

European Federation of Neurological Societies (EFNS) (Jun 2011)

Cerebral vasculitis is an uncommon disorder that offers unusual problems for the neurologist. It is notoriously difficult to recognize, producing a wide range of possible neurological symptoms and signs with no typical or characteristic features. Potential clinical patterns that might facilitate recognition have been proposed but have not been tested prospectively on large numbers of patients, and their value in consequence remains to be substantiated.

Treatment of miscellaneous idiopathic headache disorders (group 4 of the IHS classification) – Report of an EFNS task force

European Federation of Neurological Societies (EFNS) (Feb 2011)

To give expert recommendations for the different drug and non-drug treatment procedures of these different headache disorders based on a literature search and on consensus of an expert panel.

EFNS guidelines for the diagnosis and management of Alzheimer's disease

European Federation of Neurological Societies (EFNS) (Mar 2010)

The aim of this revised international guideline was to present a peer-reviewed evidence-based statement for the guidance of practice for clinical neurologists, geriatricians, psychiatrists, and other specialist physicians responsible for the care of patients with AD. Mild cognitive impairment and non-Alzheimer dementias are not included in this guideline.

EFNS guidelines on diagnosis and treatment of primary dystonias

European Federation of Neurological Societies (EFNS) (Mar 2010)

This guideline makes evidence-based recommendations on the diagnosis and treatment of primary dystonias

Guidelines for treatment of autoimmune neuromuscular transmission disorders

European Federation of Neurological Societies (EFNS) (Feb 2010)

Important progress has been made in our understanding of the autoimmune neuromuscular transmission (NMT) disorders; myasthenia gravis (MG), Lambert–Eaton myasthenic syndrome (LEMS) and neuromyotonia (Isaacs syndrome).

EFNS guideline on the treatment of cerebral venous and sinus thrombosis in adult patients

European Federation of Neurological Societies (EFNS) (Feb 2010)

The aim of the present Task Force was to review the strength of evidence to support these interventions and the preparation of recommendations on the therapy of CVST based on the best available evidence for the efficacy and safety of anticoagulant therapy, thrombolysis and symptomatic therapy.

EFNS guidelines on neuropathic pain assessment

European Federation of Neurological Societies (EFNS) (Jan 2010)

We have revised the previous EFNS guidelines on neuropathic pain (NP) assessment, which aimed to provide recommendations for the diagnostic process, screening tools and questionnaires, quantitative sensory testing (QST), microneurography, pain-related reflexes and evoked potentials, functional neuroimaging and skin biopsy.

Guideline on management of chronic inflammatory demyelinating polyradiculoneuropathy

European Federation of Neurological Societies (EFNS) (Dec 2009)

The EFNS/PNS consensus guideline was designed to offer diagnostic criteria to balance more evenly specificity, which needs to be higher in research than clinical practice, and sensitivity which might miss disease if set too high.

EFNS guideline on the management of status epilepticus in adults

European Federation of Neurological Societies (EFNS) (Nov 2009)

Recommendations are based on this literature and on our judgement of the relevance of the references to the subject. Recommendations were reached by informative consensus approach.

European Federation of Neurological Societies/Movement Disorder Society–European Section

EFNS/MDS-ES recommendations for the diagnosis of Parkinson’s disease

European Federation of Neurological Societies/Movement Disorder Society–European Section (Sep 2012)

A Task Force was convened by the EFNS/MDS-ES Scientist Panel on Parkinson’s disease (PD) and other movement disorders to systemically review relevant publications on the diagnosis of PD.

European League against Rheumatism (EULAR)

EULAR recommendations for the use of imaging in the diagnosis and management of spondyloarthritis in clinical practice

European League against Rheumatism (EULAR) (Apr 2015)

A taskforce comprised of an expert group of 21 rheumatologists, radiologists and methodologists from 11 countries developed evidence-based recommendations on the use of imaging in the clinical management of both axial and peripheral spondyloarthritis (SpA). Twelve key questions on the role of imaging in SpA were generated using a process of discussion and consensus. Imaging modalities included conventional radiography, ultrasound, magnetic resonance imaging, computed tomography (CT), positron emission tomography, single photon emission CT, dual emission x-ray absorptiometry and scintigraphy.

EULAR recommendations for patient education for people with inflammatory arthritis

European League against Rheumatism (EULAR) (Mar 2015)

The task force aimed to: (1) develop evidence-based recommendations for patient education (PE) for people with inflammatory arthritis, (2) identify the need for further research on PE and (3) determine health professionals’ educational needs in order to provide evidence-based PE.

EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update

European League against Rheumatism (EULAR) (Oct 2013)

In this article, the 2010 European League against Rheumatism (EULAR) recommendations for the management of rheumatoid arthritis (RA) with synthetic and biological disease-modifying antirheumatic drugs (sDMARDs and bDMARDs, respectively) have been updated. The 2013 update has been developed by an international task force, which based its decisions mostly on evidence from three systematic literature reviews (one each on sDMARDs, including glucocorticoids, bDMARDs and safety aspects of DMARD therapy); treatment strategies were also covered by the searches.

EULAR evidence-based and consensus-based recommendations on the management of medium to high-dose glucocorticoid therapy in rheumatic diseases

European League against Rheumatism (EULAR) (Jun 2013)

Proper advice on balancing advantages and disadvantages of medium/high-dose GC therapy is lacking. Therefore, this task force set out to develop recommendations for the use and management of systemic medium/high-dose GC therapy in rheumatic diseases.

EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis

European League against Rheumatism (EULAR) (Mar 2013)

The objective was to develop evidence -based recommendations and a research and educational agenda for the non-pharmacological management of hip and knee osteoarthritis (OA).

EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis

European League against Rheumatism (EULAR) (Feb 2013)

The objective is to develop evidence-based recommendations on the use of imaging of the joints in the clinical management of rheumatoid arthritis (RA).

European LeukemiaNet

Diagnosis and treatment of primary myelodysplastic syndromes in adults: recommendations from the European LeukemiaNet

European LeukemiaNet (Aug 2013)

This guideline aims to provide clinical practice recommendations that can support the diagnosis and the appropriate choice of therapeutic interventions in adult patients with primary MDS.

European LeukemiaNet recommendations for the management of chronic myeloid leukemia: 2013

European LeukemiaNet (Jun 2013)

European LeukemiaNet (ELN) had proposed recommendations for the management of CML in 2006 and 2009. These were the third version of these recommendations based on data gained from new studies as well as from the update of the most relevant previous studies. We discuss and make recommendations about which tyrosine kinase inhibitor (TKI) should be used as first-line and as second-line therapy, the important end points of treatment, the best approach of evaluating and monitoring response, the reporting and interpretation of molecular and cytogenetic tests, the information provided by mutational analysis, the importance of side effects, and the role of allogeneic stem cell transplantation (alloSCT).

European Psychiatric Association (EPA)

EPA guidance on the early detection of clinical high risk states of psychoses

European Psychiatric Association (EPA) (Mar 2015)

The aim of this guidance paper of the European Psychiatric Association is to provide evidence-based recommendations on the early detection of a clinical high risk (CHR) for psychosis in patients with mental problems. To this aim, we conducted a meta-analysis of studies reporting on conversion rates to psychosis in non-overlapping samples meeting any at least any one of the main CHR criteria: ultra-high risk (UHR) and/or basic symptoms criteria. Further, effects of potential moderators (different UHR criteria definitions, single UHR criteria and age) on conversion rates were examined. Conversion rates in the identified 42 samples with altogether more than 4000 CHR patients who had mainly been identified by UHR criteria and/or the basic symptom criterion ‘cognitive disturbances’ (COGDIS) showed considerable heterogeneity. While UHR criteria and COGDIS were related to similar conversion rates until 2-year follow-up, conversion rates of COGDIS were significantly higher thereafter. Differences in onset and frequency requirements of symptomatic UHR criteria or in their different consideration of functional decline, substance use and co-morbidity did not seem to impact on conversion rates. The ‘genetic risk and functional decline’ UHR criterion was rarely met and only showed an insignificant pooled sample effect. However, age significantly affected UHR conversion rates with lower rates in children and adolescents. Although more research into potential sources of heterogeneity in conversion rates is needed to facilitate improvement of CHR criteria, six evidence-based recommendations for an early detection of psychosis were developed as a basis for the EPA guidance on early intervention in CHR states.

© 2015 Elsevier Masson SAS. All rights reserved.

EPA guidance on the early intervention in clinical high risk states of psychoses

European Psychiatric Association (EPA) (Mar 2015)

This guidance paper from the European Psychiatric Association (EPA) aims to provide evidence-based recommendations on early intervention in clinical high risk (CHR) states of psychosis, assessed according to the EPA guidance on early detection. The recommendations were derived from a meta-analysis of current empirical evidence on the efficacy of psychological and pharmacological interventions in CHR samples. Eligible studies had to investigate conversion rate and/or functioning as a treatment outcome in CHR patients defined by the ultra-high risk and/or basic symptom criteria. Besides analyses on treatment effects on conversion rate and functional outcome, age and type of intervention were examined as potential moderators. Based on data from 15 studies (n = 1394), early intervention generally produced significantly reduced conversion rates at 6- to 48-month follow-up compared to control conditions. However, early intervention failed to achieve significantly greater functional improvements because both early intervention and control conditions produced similar positive effects. With regard to the type of intervention, both psychological and pharmacological interventions produced significant effects on conversion rates, but not on functional outcome relative to the control conditions. Early intervention in youth samples was generally less effective than in predominantly adult samples. Seven evidence-based recommendations for early intervention in CHR samples could have been formulated, although more studies are needed to investigate the specificity of treatment effects and potential age effects in order to tailor interventions to the individual treatment needs and risk status.

© 2015 Elsevier Masson SAS. All rights reserved.

EPA Guidance mental health care of migrants

European Psychiatric Association (EPA) (Jan 2014)

The present document provides guidance towards managing psychiatric and mental health needs of the migrant groups. This is not and does not purport to be a systematic review of the literature.

European Psychiatric Association (EPA) guidance on post-graduate psychiatric training in Europe

European Psychiatric Association (EPA) (Jan 2014)

The European Union Free Movement Directive gives professionals the opportunity to work and live within the European Union, but does not give specific requirements regarding how the specialists in medicine have to be trained, with the exception of a required minimum of 4 years of education. Efforts have been undertaken to harmonize post-graduate training in psychiatry in Europe since the Treaty of Rome 1957, with the founding of the European Union of Medical Specialists (UEMS) and establishment of a charter outlining how psychiatrists should be trained. However, the different curricula for postgraduate training were only compared by surveys, never through a systematic review of the official national requirements. The published survey data still shows great differences between European countries and unlike other UEMS Boards, the Board of Psychiatry did not introduce a certification for specialists willing to practice in a foreign country within Europe. Such a European certification could help to keep a high qualification level for post-graduate training in psychiatry all over Europe. Moreover, it would make it easier for employers to assess the educational level of European psychiatrists applying for a job in their field.

EPA Guidance on tobacco dependence and strategies for smoking cessation in people with mental illness

European Psychiatric Association (EPA) (Nov 2013)

This statement from the European Psychiatric Association (EPA) systematically reviews the current evidence on tobacco dependence and withdrawal in patients with mental illness and their treatment. It provides seven recommendations for the core components of diagnostics and treatment in this patient group. These recommendations concern: (1) the recording process, (2) the timing of the intervention, (3) counselling specificities, (4) proposed treatments, (5) frequency of contact after stopping, (6) follow-up visits and (7) relapse prevention. They aim to help clinicians improve the care, health and well-being of patients suffering from mental illness.

European Psychiatric Association (EPA) guidance on prevention of mental disorders

European Psychiatric Association (EPA) (Oct 2011)

There is considerable evidence that various psychiatric conditions can be prevented through the implementation of effective evidence-based interventions. Since a large proportion of lifetime mental illness starts before adulthood, such interventions are particularly important during childhood and adolescence. Prevention is important for the sustainable reduction of the burden of mental disorder since once it has arisen, treatment can only reduce a relatively small proportion of such burden. The challenge for clinicians is to incorporate such interventions into non-clinical and clinical practice as well as engaging with a range of other service providers including public health. Similar strategies can be employed in both the European and global contexts. Promotion of mental well-being can prevent mental disorder but is also important in the recovery from mental disorder. This guidance should be read in conjunction with the EPA Guidance on Mental Health Promotion. This guidance draws on preparatory work for the development of England policy on prevention of mental disorder which used a wide range of sources.

Mental health promotion: Guidance and strategies

European Psychiatric Association (EPA) (Oct 2011)

Public mental health incorporates a number of strategies from mental well-being promotion to primary prevention and other forms of prevention. There is considerable evidence in the literature to suggest that early interventions and public education can work well for reducing psychiatric morbidity and resulting burden of disease. Educational strategies need to focus on individual, societal and environmental aspects. Targeted interventions at individuals will also need to focus on the whole population. A nested approach with the individual at the heart of it surrounded by family surrounded by society at large is the most suitable way to approach this. This Guidance should be read along with the European Psychiatric Association (EPA) Guidance on Prevention. Those at risk of developing psychiatric disorders also require adequate interventions as well as those who may have already developed illness. However, on the model of triage, mental health and well-being promotion need to be prioritized to ensure that, with the limited resources available, these activities do not get forgotten. One possibility is to have separate programmes for addressing concerns of a particular population group, another that is relevant for the broader general population. Mental health promotion as a concept is important and this will allow prevention of some psychiatric disorders and, by improving coping strategies, is likely to reduce the burden and stress induced by mental illness.

Position statement of the European Psychiatric Association (EPA) on the value of antidepressants in the treatment of unipolar depression

European Psychiatric Association (EPA) (Aug 2011)

This position statement will address in an evidence-based approach some of the important issues and controversies of current drug treatment of depression such as the efficacy of antidepressants, their effect on suicidality and their place in a complex psychiatric treatment strategy including psychotherapy.

European Respiratory Society (ERS)

Guidelines for the management of work-related asthma

European Respiratory Society (ERS) (Mar 2012)

Work-related asthma, which includes occupational asthma and work-aggravated asthma, has become one of the most prevalent occupational lung diseases. These guidelines aim to upgrade occupational health standards, contribute importantly to transnational legal harmonisation and reduce the high socio-economic burden caused by this disorder.

Non-continuous positive airway pressure (CPAP) therapies in obstructive sleep apnoea

European Respiratory Society (ERS) (Dec 2010)

In view of the high prevalence and the relevant impairment of patients with obstructive sleep apnoea syndrome (OSAS) lots of methods are offered which promise definitive cures for or relevant improvement of OSAS. This report summarises the efficacy of alternative treatment options in OSAS. An interdisciplinary European Respiratory Society task force evaluated the scientific literature according to the standards of evidence-based medicine.

European Respiratory Society (ERS) and American Thoracic Society (ATS)

International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma

European Respiratory Society (ERS) and American Thoracic Society (ATS) (Feb 2014)

The purpose of this document is to revise the definition of severe asthma, discuss the possible phenotypes and provide guidance about the management of patients with severe asthma. The target audience of these guidelines is specialists in respiratory medicine and allergy managing adults and children with severe asthma. General internists, paediatricians, primary care physicians, other healthcare professionals and policy makers may also benefit from these guidelines. This document may also serve as the basis for development and implementation of locally adapted guidelines.

An Official American Thoracic Society/European Respiratory Society Statement: Key Concepts and Advances in Pulmonary Rehabilitation

European Respiratory Society (ERS) and American Thoracic Society (ATS) (Oct 2013)

The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field.

Consensus statement for inert gas washout measurement using multiple- and single-breath tests

European Respiratory Society (ERS) and American Thoracic Society (ATS) (Sep 2012)

Inert gas washout tests, performed using the single- or multiple-breath washout technique, were first described over 60 years ago. As measures of ventilation distribution inhomogeneity, they offer complementary information to standard lung function tests, such as spirometry, as well as improved feasibility across wider age ranges and improved sensitivity in the detection of early lung damage. These benefits have led to a resurgence of interest in these techniques from manufacturers, clinicians and researchers, yet detailed guidelines for washout equipment specifications, test performance and analysis are lacking. This manuscript provides recommendations about these aspects, applicable to both the paediatric and adult testing environment, whilst outlining the important principles that are essential for the reader to understand. These recommendations are evidence based, where possible, but in many places represent expert opinion from a working group with a large collective experience in the techniques discussed.

European Respiratory Society (ERS) and European Society for Clinical Microbiology and Infectious Diseases (ESCMID)

Guidelines for the management of adult lower respiratory tract infections

European Respiratory Society (ERS) and European Society for Clinical Microbiology and Infectious Diseases (ESCMID) (Jun 2011)

These guidelines provide evidence-based recommendations for the most common management questions occurring in routine clinical practice in the management of adult patients with LRTI. Topics include management outside hospital, management inside hospital (including community-acquired pneumonia (CAP), acute exacerbations of COPD (AECOPD), acute exacerbations of bronchiectasis) and prevention. Background sections and graded evidence tables are also included. The target audience for the Guideline is thus all those whose routine practice includes the management of adult LRTI.

European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and International Osteoporosis Foundation (IOF)

European guidance for the diagnosis and management of osteoporosis in postmenopausal women

European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) and International Osteoporosis Foundation (IOF) (Jun 2012)

Guidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk of fractures due to osteoporosis.

European Society for Clinical Microbiology and Infectious Diseases (ESCMID)

ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients

European Society for Clinical Microbiology and Infectious Diseases (ESCMID) (Dec 2013)

Healthcare-associated infections due to multidrug-resistant Gram-negative bacteria (MDR-GNB) are a leading cause of morbidity and mortality worldwide. These evidence-based guidelines have been produced after a systematic review of published studies on infection prevention and control interventions aimed at reducing the transmission of MDR-GNB. The recommendations are stratified by type of infection prevention and control intervention and species of MDR-GNB and are presented in the form of ‘basic’ practices, recommended for all acute care facilities, and ‘additional special approaches’ to be considered when there is still clinical and/or epidemiological and/or molecular evidence of ongoing transmission, despite the application of the basic measures. The level of evidence for and strength of each recommendation, were defined according to the GRADE approach.

European Society of Clinical Microbiology and Infectious Diseases: Update of the Treatment Guidance Document for Clostridium difficile Infection

European Society for Clinical Microbiology and Infectious Diseases (ESCMID) (Sep 2013)

The previous European Society of Clinical Microbiology and Infection (ESCMID) guidance document, which has been applied widely in clinical practice, dates from 2009. Meanwhile, new treatments for Clostridium difficile infection (CDI) have been developed and limitations of the currently recommended treatment options of CDI are considered. As the current ESCMID treatment guidance document is already implemented in clinical practice, an update of this widely applied guidance document is essential to further improve uniformity of national hospital infection treatment policies for CDI in Europe. In particular, after the recent development of new alternative drugs for the treatment of CDI (e.g. fidaxomicin) in the USA and Europe, there has been an increasing need for an update on the comparative effectiveness of the currently available antibiotic agents in the treatment of CDI, thereby providing evidence-based recommendations on this issue.

ESCMID guideline for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT)

European Society for Clinical Microbiology and Infectious Diseases (ESCMID) (Dec 2012)

Fungal diseases still play a major role in morbidity and mortality in patients with haematological malignancies, including those undergoing haematopoietic stem cell transplantation. Although Aspergillus and other filamentous fungal diseases remain a major concern, Candida infections are still a major cause of mortality. This part of the ESCMID guidelines focuses on this patient population and reviews pertaining to prophylaxis, empirical/pre-emptive and targeted therapy of Candida diseases. AntiCandida prophylaxis is only recommended for patients receiving allogeneic stem cell transplantation.

ESCMID guideline for the diagnosis and management of Candida diseases 2012: diagnostic procedures

European Society for Clinical Microbiology and Infectious Diseases (ESCMID) (Dec 2012)

As the mortality associated with invasive Candida infections remains high, it is important to make optimal use of available diagnostic tools to initiate antifungal therapy as early as possible and to select the most appropriate antifungal drug. A panel of experts of the European Fungal Infection Study Group (EFISG) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) undertook a data review and compiled guidelines for the clinical utility and accuracy of different diagnostic tests and procedures for detection of Candida infections.

ESCMID guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients

European Society for Clinical Microbiology and Infectious Diseases (ESCMID) (Dec 2012)

This part of the European Fungal Infection Study Group (EFISG) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines focuses on non-neutropenic adult patients. Only a few of the numerous recommendations can be summarized in the abstract. Prophylactic usage of fluconazole is supported in patients with recent abdominal surgery and recurrent gastrointestinal perforations or anastomotic leakages. Candida isolation from respiratory secretions alone should never prompt treatment.

ESCMID guideline for the diagnosis and management of Candida diseases 2012: patients with HIV infection or AIDS

European Society for Clinical Microbiology and Infectious Diseases (ESCMID) (Dec 2012)

Mucosal candidiasis is frequent in immunocompromised HIV-infected highly active antiretroviral (HAART) naive patients or those who have failed therapy. Mucosal candidiasis is a marker of progressive immune deficiency. Because of the frequently marked and prompt immune reconstitution induced by HAART, there is no recommendation for primary antifungal prophylaxis of mucosal candidiasis in the HIV setting in Europe, although it has been evidenced as effective in the pre-HAART era.

ESCMID guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp.

European Society for Clinical Microbiology and Infectious Diseases (ESCMID) (Dec 2012)

Invasive candidiasis (IC) is a relatively common syndrome in neonates and children and is associated with significant morbidity and mortality. These guidelines provide recommendations for the prevention and treatment of IC in neonates and children. Appropriate agents for the prevention of IC in neonates at high risk include fluconazole (A-I), nystatin (B-II) or lactoferrin ± Lactobacillus (B-II). The treatment of IC in neonates is complicated by the high likelihood of disseminated disease, including the possibility of infection within the central nervous system.

ESCMID Guideline for the Management of Acute Sore Throat

European Society for Clinical Microbiology and Infectious Diseases (ESCMID) (Apr 2012)

Acute sore throat is a symptom often caused by an inflammatory process in the pharynx, tonsils or nasopharynx. Most of these cases are of viral origin and occur as a part of the common cold. The European Society for Clinical Microbiology and Infectious Diseases established the Sore Throat Guideline Group to write an updated guideline to diagnose and treat patients with acute sore throat.

Guidelines for the management of adult lower respiratory tract infections - Summary

European Society for Clinical Microbiology and Infectious Diseases (ESCMID) (Jun 2011)

This document is an update of Guidelines published in 2005 and now includes scientific publications through to May 2010. It provides evidence-based recommendations for the most common management questions occurring in routine clinical practice in the management of adult patients with LRTI. Topics include management outside hospital, management inside hospital (including community-acquired pneumonia (CAP), acute exacerbations of COPD (AECOPD), acute exacerbations of bronchiectasis) and prevention. The target audience for the Guideline is thus all those whose routine practice includes the management of adult LRTI.

European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and European Confederation of Medical Mycology (ECMM)

ESCMID and ECMM joint guidelines on diagnosis and management of hyalohyphomycosis: Fusarium spp., Scedosporium spp. and others

European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and European Confederation of Medical Mycology (ECMM) (Feb 2014)

The overall aim of this guidance is to address the difficulties in managing and diagnosing invasive fungal infections due to hyalohyphomycetes. The objectives of the guidelines are to: - Recommend approaches and practical tools for education and training of healthcare professionals in managing invasive fungal infections due to hyalophyphomycetes. - Present practical considerations that should be taken into account when dealing with fungal infections. The guideline covers epidemiology, clinical spectrum, diagnosis and therapy, mainly for species associated with the genera Fusarium and Scedosporium. The guidelines presented herein are limited to invasive infections caused by these fungi. For diagnosis and treatment recommendations, tables list the scientific evidence. Recommendations for various patients at risk are weighted differently based on available literature.

ESCMID and ECMM joint clinical guidelines for the diagnosis and management of mucormycosis 2013

European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and European Confederation of Medical Mycology (ECMM) (Jan 2014)

These European Society for Clinical Microbiology and Infectious Diseases and European Confederation of Medical Mycology Joint Clinical Guidelines focus on the diagnosis and management of mucormycosis.

ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: diseases caused by black fungi

European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and European Confederation of Medical Mycology (ECMM) (Dec 2013)

A panel of experts of the European Fungal Infection Study Group (EFISG) of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) undertook a data review and compiled guidelines for the diagnosis and management of infections caused by melanized (black) fungi.

ESCMID and ECMM joint clinical guidelines for the diagnosis and management of rare invasive yeast infections

European Society for Clinical Microbiology and Infectious Diseases (ESCMID) and European Confederation of Medical Mycology (ECMM) (Sep 2013)

A panel of experts of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Fungal Infection Study Group (EFISG) and the European Confederation of Medical Mycology (ECMM) undertook a data review and compiled guidelines for the diagnostic tests and procedures for detection and management of rare invasive yeast infections.

European Society for Clinical Nutrition and Metabolism (ESPEN)

ESPEN endorsed recommendations: Nutritional therapy in major burns

European Society for Clinical Nutrition and Metabolism (ESPEN) (Feb 2013)

Nutrition therapy is a cornerstone of burn care from the early resuscitation phase until the end of rehabilitation. While several aspects of nutrition therapy are similar in major burns and other critical care conditions, the patho-physiology of burn injury with its major endocrine, inflammatory, metabolic and immune alterations requires somespecific nutritional interventions. The present text developed by the French speaking societies, is updated to provide evidenced-based recommendations for clinical practice.

European Society for Medical Oncology (ESMO)

Metastatic colorectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Sep 2014)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine.

They include information on incidence, diagnosis, staging and risk assessment, treatment and response evaluation and follow-up.

ESMO Clinical Practice Guidelines on palliative care: advanced care planning

European Society for Medical Oncology (ESMO) (Sep 2014)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine.

ESMO Clinical Practice Guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation

European Society for Medical Oncology (ESMO) (Sep 2014)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine.

Bladder cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Aug 2014)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Metastatic non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Aug 2014)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine.
Primary lung cancer is the most common malignancy after non-melanocytic skin cancer, and the leading cause of human cancer deaths worldwide. This guidelines focuses on diagnosis, staging and risk assessment, treatment of stage IV NSCLC, treatment of oligometastatic NSCLC, and follow-up.

Newly diagnosed and relapsed mantle cell lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Aug 2014)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine.
They include information on incidence, diagnosis, staging and risk assessment, treatment, response evaluation and follow-up.

Newly diagnosed and relapsed follicular lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Aug 2014)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine.
ESMO Clinical Practice Guidelines on Follicular Lymphoma: chapters cover staging and risk assessment, first line therapy including consolidation/maintenance, treatment for relapsed disease and recommendations for response evaluation and follow-up.

Renal cell carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2014)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Bone sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2014)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine.
ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of bone sarcomas includes chapters on incidence, diagnosis, stage classification and risk assessment, treatment of osteosarcoma, Ewing sarcoma, high-grade undifferentiated pleomorphic sarcomas of bone, chondrosarcoma, chordoma, giant cell tumour of bone, and follow-up.

Gastrointestinal Stromal Tumours: ESMO Clinical Practice Guidelines

European Society for Medical Oncology (ESMO) (Jul 2014)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine.
Gastrointestinal stromal tumours (GISTs) are rare tumours, with an estimated unadjusted incidence of around 1/100 000/year. This only covers clinically relevant GISTs, since it is likely that a much higher number of microscopic lesions could be found pathologically, if looked for.

Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2014)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine.
Adult soft tissue and visceral sarcomas (excluding gastrointestinal stromal tumor, GIST) are rare tumors, with an estimated incidence averaging 4–5/100 000/year in Europe. This guideline focuses on diagnosis, stage classification and risk assessment, staging, treatment, follow-up and special presentations and entities.

Hodgkin’s lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2014)

The 2014 update elaborates on two histologically distinguished entities: classical Hodgkin's lymphoma that accounts about 95% of cases and nodular lymphocyte-predominant Hodgkin's lymphoma, which represents the remainder of cases. The text provides clinical practice recommendations for diagnosis, staging and risk assessment; treatment of limited-, intermediate- and advanced-stage classical Hodgkin lymphoma and relapsed disease; treatment of nodular lymphocyte-predominant Hodgkin lymphoma; and response evaluation, prognosis and follow-up.

Myelodysplastic syndromes: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2014)

Myelodysplastic syndromes (MDS) are clonal haematopoietic stem cell (HSC) disorders predominating in the elderly, with a median age at diagnosis of ~70 years. The aetiology of MDS is known in only 15% of cases. The first clinical practice guidelines from ESMO cover the diagnosis and management of these rare syndromes and also include information on cytomorphology, cytogenetics, prognosis and risk assessment and supportive care.

High-grade glioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Apr 2014)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Second ESMO consensus conference on lung cancer: pathology and molecular biomarkers for non-small-cell lung cancer

European Society for Medical Oncology (ESMO) (Apr 2014)

This report from the 2nd ESMO Consensus Conference on Lung Cancer complements existing guidelines and provides recommendations by international experts on guidance on tissue handling, small biopsy/cytology diagnostic setting, testing for EGFR somatic mutations & ALK rearrangements, when to consider KRAS, BRAF, HER2, ROS1 fusion, RET fusion testing, if there is a role for ERCC1, RRM1, TS testing, the role of emerging technologies, why laboratories should participate in quality assurance programmes, and reporting data from pathological, molecular & other biomarker testing.

ESMO Consensus Guidelines: Non-small-cell lung cancer first-line/second and further lines in advanced disease

European Society for Medical Oncology (ESMO) (Mar 2014)

This report from the 2nd ESMO Consensus Conference on Lung Cancer covers all patients (regardless of NSCLC mutational status): chemotherapy in asymptomatic patients, anti-angiogenic treatment, to switch or to continue maintenance treatment, elderly patients, and systemic treatment for bone metastases, NSCLC aberrations: first-line treatment for EGFR mutated and ALK rearranged NSCLC, optimal management of brain metastases at diagnosis, and recommendations for later lines, and emerging biomarkers and secondary resistance: re-biopsy and treatment options for patients with ROS1, RET, BRAF or HER2 alterations after standard treatment.

Bone health in cancer patients: ESMO Clinical Practice Guidelines

European Society for Medical Oncology (ESMO) (Mar 2014)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

2nd ESMO Consensus Conference on Lung Cancer: early-stage non-small-cell lung cancer consensus on diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Feb 2014)

Written to complement the ESMO Clinical Practice Guidelines, this manuscript focuses on stage I and II disease. The publication discusses LDCT Screening in non-clinical trial patients, whether or not tissue based diagnosis is necessary before surgery or radiation, functional cardiopulmonary evaluation before resection, when sub-lobular resection is an acceptable therapeutic choice, optimal management of multifocal lung cancer, and beyond staging: which factors to consider when selecting adjuvant treatment.

Penile cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Testicular seminoma and non-seminoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Primary breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Early colon cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Oesophageal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Gestational trophoblastic disease: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Newly diagnosed and relapsed epithelial ovarian carcinoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Acute myeloblastic leukaemias in adult patients: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Gastric marginal zone lymphoma of MALT type: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Waldenström’s macroglobulinaemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Primary cutaneous lymphomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jun 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Early and locally advanced non-small-cell lung cancer (NSCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (May 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Small-cell lung cancer (SCLC): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (May 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Prostate cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (May 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

ESMO Consensus Guidelines: Prostate Cancer

European Society for Medical Oncology (ESMO) (May 2013)

This report focuses on clinically relevant questions about prostate cancer in four areas as follows: diagnosis and staging, management of early localised disease, management of advanced localised disease and systemic disease.

Familial risk-colorectal cancer: ESMO Clinical Practice Guidelines

European Society for Medical Oncology (ESMO) (May 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (May 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Cancer, pregnancy and fertility: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (May 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Neuroendocrine bronchial and thymic tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2012)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Neuroendocrine gastro-entero-pancreatic tumors: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2012)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Cervical cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2012)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Diffuse large B-cell lymphoma (DLBCL): ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2012)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Cardiovascular toxicity induced by chemotherapy, targeted agents and radiotherapy: ESMO Clinical Practice Guidelines

European Society for Medical Oncology (ESMO) (Jul 2012)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Management of chemotherapy extravasation: ESMO – EONS Clinical Practice Guidelines

European Society for Medical Oncology (ESMO) (Jul 2012)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Locally recurrent or metastatic breast cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jun 2012)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Adrenal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jun 2012)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jun 2012)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Non-epithelial ovarian cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jun 2012)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Chronic myeloid leukemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jun 2012)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Cutaneous melanoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jun 2012)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Management of cancer pain: ESMO Clinical Practice Guidelines

European Society for Medical Oncology (ESMO) (Jun 2012)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Chronic lymphocytic leukemia: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Jul 2011)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Management of oral and gastrointestinal mucositis: ESMO Clinical Practice Guidelines

European Society for Medical Oncology (ESMO) (Jul 2011)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Cancers of unknown primary site: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (May 2011)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Biliary cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Mar 2011)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Management of venous thromboembolism (VTE) in cancer patients: ESMO Clinical Practice Guidelines

European Society for Medical Oncology (ESMO) (Mar 2011)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

BRCA in breast cancer: ESMO Clinical Practice Guidelines

European Society for Medical Oncology (ESMO) (Jan 2011)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Malignant pleural mesothelioma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) (Mar 2010)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Advanced colorectal cancer: ESMO Clinical Practice Guidelines for treatment

European Society for Medical Oncology (ESMO) (Mar 2010)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Guideline update for MASCC and ESMO in the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting: results of the Perugia consensus conference

European Society for Medical Oncology (ESMO) (Feb 2010)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Hematopoietic growth factors: ESMO Clinical Practice Guidelines for the applications

European Society for Medical Oncology (ESMO) (Feb 2010)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Management of febrile neutropenia: ESMO Clinical Practice Guidelines

European Society for Medical Oncology (ESMO) (Jan 2010)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Erythropoiesis-stimulating agents in the treatment of anaemia in cancer patients: ESMO Clinical Practice Guidelines for use

European Society for Medical Oncology (ESMO) (Nov 2009)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

European Society for Medical Oncology (ESMO) and European School of Oncology (ESO)

ESO-ESMO 2nd international consensus guidelines for advanced breast cancer (ABC2)

European Society for Medical Oncology (ESMO) and European School of Oncology (ESO) (Sep 2014)

The ESMO Clinical Practice Guidelines on Breast Cancer cover both primary and locally recurrent/metastatic breast cancer and include information on staging and diagnosis, treatment and follow-up.

European Society for Medical Oncology (ESMO) and European Society of Digestive Oncology (ESDO)

Hepatocellular carcinoma: ESMO–ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) and European Society of Digestive Oncology (ESDO) (Jun 2012)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Pancreatic adenocarcinoma: ESMO–ESDO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO) and European Society of Digestive Oncology (ESDO) (Jun 2012)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

European Society for Medical Oncology (ESMO), European Head & Neck Society (EHNS) and European Society for Radiotherapy & Oncology (ESTRO)

Nasopharyngeal cancer: EHNS – ESMO – ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO), European Head & Neck Society (EHNS) and European Society for Radiotherapy & Oncology (ESTRO) (Jun 2012)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

Squamous cell carcinoma of the head and neck: EHNS–ESMO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO), European Head & Neck Society (EHNS) and European Society for Radiotherapy & Oncology (ESTRO) (Feb 2010)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

European Society for Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO) and European Society for Radiotherapy & Oncology (ESTRO)

Anal cancer: ESMO-ESSO-ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO) and European Society for Radiotherapy & Oncology (ESTRO) (Jul 2014)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

European Society for Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO) and European Society of Radiotherapy and Oncology (ESTRO)

Gastric cancer: ESMO–ESSO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up

European Society for Medical Oncology (ESMO), European Society of Surgical Oncology (ESSO) and European Society of Radiotherapy and Oncology (ESTRO) (Oct 2013)

The ESMO Clinical Practice Guidelines (CPG) are intended to provide the user with a set of recommendations for the best standards of cancer care, based on the findings of evidence-based medicine. Each Clinical Practice Guideline includes information about: the incidence of the malignancy, diagnostic criteria, staging of disease and risk assessment, treatment plans, response evaluation and follow-up.

European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN)

Management Guidelines of Eosinophilic Esophagitis in Childhood

European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) (Jan 2014)

This position paper of the Eosinophilic Esophagitis Working Group and the Gastroenterology Committee of ESPGHAN aims at providing practical guidelines for the management of children and adolescents with EoE, based on available evidence where possible. If sufficient evidence is lacking, our recommendations are based on expert opinion and personal practice.

Diagnostic Approach and Management of Cow’s-Milk Protein Allergy in Infants and Children: ESPGHAN GI Committee Practical Guidelines

European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) (Apr 2012)

This guideline provides recommendations for the diagnosis and management of suspected cow’s-milk protein allergy (CMPA) in Europe. It presents a practical approach with a diagnostic algorithm and is based on recently published evidence-based guidelines on CMPA.

Indications, Methodology, and Interpretation of Combined Esophageal Impedance-pH Monitoring in Children: ESPGHAN EURO-PIG Standard Protocol

European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) (Mar 2012)

The aim of the study was to provide an updated position statement from the ESPGHAN European Pediatric Impedance Working Group on different technical aspects such as indications, methodology, and interpretation of multichannel intraluminal impedance-pH monitoring (MII-pH).

European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and European Crohn’s and Colitis Organization (ECCO)

Management of Pediatric Ulcerative Colitis: Joint ECCO and ESPGHAN Evidence-based Consensus Guidelines

European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and European Crohn’s and Colitis Organization (ECCO) (Jun 2012)

These guidelines provide clinically useful points to guide the management of UC in children. Taken together, the recommendations offer a standardized protocol that allows effective, timely management and monitoring of the disease course, while acknowledging that each patient is unique.

European Society of Cardiology (ESC)

2014 ESC Guidelines on the diagnosis and treatment of aortic diseases

European Society of Cardiology (ESC) (Aug 2014)

The ESC decided to publish updated guidelines on the diagnosis and treatment of aortic diseases related to the thoracic and abdominal aorta. Emphasis is made on rapid and efficacious diagnostic strategies and therapeutic management, including the medical, endovascular, and surgical approaches, which are often combined. In addition, genetic disorders, congenital abnormalities, aortic aneurysms, and AD are discussed in more detail.

Guidelines on the diagnosis and management of acute pulmonary embolism

European Society of Cardiology (ESC) (Aug 2014)

This document follows the two previous ESC Guidelines focussing on clinical management of pulmonary embolism, published in 2000 and 2008.Many recommendations have retained or reinforced their validity; however, new data has extended or modified our knowledge in respect of optimal diagnosis, assessment and treatment of patients with PE.

2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy

European Society of Cardiology (ESC) (Aug 2014)

The aim is to provide healthcare professionals with a practical diagnostic and treatment framework for patients of all ages and, as the majority of patients have a genetic cause for their disease, the Guidelines also consider the implications of a diagnosis for families and provide specific advice on reproduction and contraception.
Adoption of a purely morphological disease definition means that the number of possible aetiologies is considerable, particularly in young children. As it is impractical to provide an exhaustive compendium of all possible causes of HCM, the Guidelines focus on the most common genetic and non-genetic subtypes, but additional references for less common disorders are provided. Similarly, treatment recommendations focus largely on generic management issues but make reference to rare diseases when appropriate.

2013 ESC guidelines on the management of stable coronary artery disease

European Society of Cardiology (ESC) (Aug 2013)

These guidelines should be applied to patients with stable known or suspected coronary artery disease (SCAD). This condition encompasses several groups of patients: (i) those having stable angina pectoris or other symptoms felt to be related to coronary artery disease (CAD) such as dyspnoea; (ii) those previously symptomatic with known obstructive or non-obstructive CAD, who have become asymptomatic with treatment and need regular follow-up; (iii) those who report symptoms for the first time and are judged to already be in a chronic stable condition (for instance because history-taking reveals that similar symptoms were already present for several months). Hence, SCAD defines the different evolutionary phases of CAD, excluding the situations in, which coronary artery thrombosis dominates clinical presentation (acute coronary syndromes).

2012 focused update of the ESC Guidelines for the management of atrial fibrillation

European Society of Cardiology (ESC) (Aug 2012)

The current estimate of the prevalence of atrial fibrillation (AF) in the developed world is approximately 1.5–2% of the general population, with the average age of patients with this condition steadily rising, such that it now averages between 75 and 85 years. The arrhythmia is associated with a five-fold risk of stroke and a three-fold incidence of congestive heart failure, and higher mortality. Hospitalization of patients with AF is also very common. This arrhythmia is a major cardiovascular challenge in modern society and its medical, social and economic aspects are all set to worsen over the coming decades. Fortunately a number of valuable treatments have been devised in recent years that may offer some solution to this problem.

Guidelines on the management of valvular heart disease (version 2012)

European Society of Cardiology (ESC) (Aug 2012)

Although valvular heart disease (VHD) is less common in industrialized countries than coronary artery disease (CAD), heart failure (HF), or hypertension, guidelines are of interest in this field because VHD is frequent and often requires intervention. Decision-making for intervention is complex, since VHD is often seen at an older age and, as a consequence, there is a higher frequency of comorbidity, contributing to increased risk of intervention. Another important aspect of contemporary VHD is the growing proportion of previously-operated patients who present with further problems. Conversely, rheumatic valve disease still remains a major public health problem in developing countries, where it predominantly affects young adults.

ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

European Society of Cardiology (ESC) (Aug 2012)

The management of acute myocardial infarction continues to undergo major changes. Good practice should be based on sound evidence, derived from well-conducted clinical trials. Because of the great number of trials on new treatments performed in recent years, and in view of new diagnostic tests, the ESC decided that it was opportune to upgrade the previous guidelines and appointed a Task Force. It must be recognized that, even when excellent clinical trials have been undertaken, their results are open to interpretation and that treatment options may be limited by resources. Indeed, cost-effectiveness is becoming an increasingly important issue when deciding upon therapeutic strategies.

Third universal definition of myocardial infarction

European Society of Cardiology (ESC) (Aug 2012)

Myocardial infarction (MI) can be recognised by clinical features, including electrocardiographic (ECG) findings, elevated values of biochemical markers (biomarkers) of myocardial necrosis, and by imaging, or may be defined by pathology. It is a major cause of death and disability worldwide. MI may be the first manifestation of coronary artery disease (CAD) or it may occur, repeatedly, in patients with established disease. Information on MI rates can provide useful information regarding the burden of CAD within and across populations, especially if standardized data are collected in a manner that distinguishes between incident and recurrent events. From the epidemiological point of view, the incidence of MI in a population can be used as a proxy for the prevalence of CAD in that population. The term ‘myocardial infarction’ may have major psychological and legal implications for the individual and society. It is an indicator of one of the leading health problems in the world and it is an outcome measure in clinical trials, observational studies and quality assurance programmes. These studies and programmes require a precise and consistent definition of MI.

ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012

European Society of Cardiology (ESC) (May 2012)

The aim of this document is to provide practical, evidence-based guidelines for the diagnosis and treatment of heart failure (HF). The principal changes from the 2008 guidelines relate to:
(i) an expansion of the indication for mineralocorticoid (aldosterone) receptor antagonists (MRAs);
(ii) a new indication for the sinus node inhibitor ivabradine;
(iii) an expanded indication for cardiac resynchronization therapy (CRT);
(iv) new information on the role of coronary revascularization in HF;
(v) recognition of the growing use of ventricular assist devices; and (vi) the emergence of transcatheter valve interventions.

European Guidelines on cardiovascular disease prevention in clinical practice (version 2012)

European Society of Cardiology (ESC) (Mar 2012)

The aim of the 2012 guidelines from the Fifth Joint Task Force (JTF) of the European Societies on Cardiovascular Disease Prevention in Clinical Practice is to give an update of the present knowledge in preventive cardiology for physicians and other health workers. The document differs from 2007 guidelines in several ways: there is a greater focus on new scientific knowledge. The use of grading systems [European Society of Cardiology (ESC) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE)] allows more evidence-based recommendations to be adapted to the needs of clinical practice. The reader will find answers to the key questions of CVD prevention in the five sections: what is CVD prevention, why is it needed, who should benefit from it, how can CVD prevention be applied, and when is the right moment to act, and finally where prevention programmes should be provided.

European Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

European Society of Cardiology (ESC) (Aug 2011)

The present document deals with the management of patients with suspected NSTE-ACS, replacing the document first published in 2000 and updated in 2002 and 2007. It includes all scientific evidence fully published as peer-reviewed papers, before May 2011.

ESC Guidelines on the management of cardiovascular diseases during pregnancy

European Society of Cardiology (ESC) (Aug 2011)

Knowledge of the risks associated with CVD during pregnancy and their management are of pivotal importance for advising patients before pregnancy. Therefore, guidelines on disease management in pregnancy are of great relevance. Such guidelines have to give special consideration to the fact that all measures concern not only the mother, but the fetus as well.

ESC Guidelines on the diagnosis and treatment of peripheral artery diseases

European Society of Cardiology (ESC) (Aug 2011)

This is the first document produced by the ESC addressing different aspects of peripheral artery diseases (PAD). This task has been undertaken because an increasing proportion of patients with heart disease need to be assessed for vascular problems in other territories, both symptomatic and asymptomatic, that may affect their prognosis and treatment strategy. It is also recognized that patients with PAD will probably die from CAD.
In this document the term PAD is used to include all vascular sites, including carotid, vertebral, upper extremity, mesenteric, renal, and lower extremity vessels. Diseases of the aorta are not covered.

ESC Guidelines on Myocardial Revascularization

European Society of Cardiology (ESC) (Aug 2010)

Formulation of the best possible revascularization approach, taking into consideration the social and cultural context also, will often require interaction between cardiologists and cardiac surgeons, referring physicians or other specialists as desirable. Patients need help in taking informed decisions about their treatment, and the most valuable advice will likely be provided to them by the Heart Team.

ESC Guidelines for the management of grown-up congenital heart disease

European Society of Cardiology (ESC) (Aug 2010)

The aim of practice guidelines is to be evidence based, but, in a relatively young specialty dealing with a variety of diseases and frequently small patient numbers, there is a lack of robust data. It is therefore difficult to use categories of strength of endorsement as have been used in other guidelines documents. The vast majority of recommendations must unfortunately remain based on expert consensus rather than on solid data (level of evidence C).

ESC Guidelines on device therapy in heart failure

European Society of Cardiology (ESC) (Aug 2010)

This Focused Update on the use of devices in heart failure 2010 is the first publication of its kind from the CPG.
In contrast to previous guidelines, this focused update considers the characteristics of the patients included in the trials and contains several examples.

ESC Guidelines on the prevention, diagnosis, and treatment of infective endocarditis

European Society of Cardiology (ESC) (Aug 2009)

The main objective of the current Task Force was to provide clear and simple recommendations, assisting health care providers in clinical decision making. These recommendations were obtained by expert consensus after thorough review of the available literature. An evidence-based scoring system was used, based on a classification of the strength of recommendation and the levels of evidence.

ESC Guidelines for the diagnosis and treatment of pulmonary hypertension

European Society of Cardiology (ESC) (Aug 2009)

The Guidelines on the diagnosis and treatment of pulmonary hypertension (PH) are intended to provide the medical community with updated theoretical and practical information on the management of patients with PH.

ESC Guidelines for the diagnosis and management of syncope

European Society of Cardiology (ESC) (Aug 2009)

There are two main aspects of this document that differentiate it from its predecessors.
The first is to stress the concept that there are two distinct reasons for evaluating patients with syncope: one is to identify the precise cause in order to address an effective mechanismspecific treatment; the other is to identify the specific risk to the patient, which frequently depends on the underlying disease rather than on the mechanism of syncope itself. The background is provided for physicians to avoid confounding these two concepts.
The second aspect is to produce a comprehensive document which is addressed not only to cardiologists but to all physicians who are interested in the field. In order to achieve this aim a great number of other specialists were involved, as either full members, external contributors, or reviewers nominated by international societies of neurology, autonomic disease, internal medicine, emergency medicine, geriatrics, and general medicine. In total 76 specialists from different disciplines participated in this project.

European Society of Cardiology (ESC) and European Association for the Study of Diabetes (EASD)

ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD

European Society of Cardiology (ESC) and European Association for the Study of Diabetes (EASD) (Aug 2013)

The emphasis in these Guidelines is to provide information on the current state of the art in how to prevent and manage the diverse problems associated with the effects of DM (Diabetes Mellitus) on the heart and vasculature in a holistic manner. In describing the mechanisms of disease,we hope to provide an educational tool and, in describing the latest management approaches, an algorithm for achieving the best care for patients in an individualized setting. It should be noted that these guidelines are written for the management of the combination of CVD (or risk of CVD) and DM, not as a separate guideline for each condition.

European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS)

ESC/EAS Guidelines for the management of dyslipidaemias

European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) (Jun 2011)

These guidelines deal with the management of dyslipidaemias as an essential and integral part of CVD prevention.

European Society of Cardiology (ESC) and European Heart Rhythm Association (EHRA)

2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy

European Society of Cardiology (ESC) and European Heart Rhythm Association (EHRA) (Jun 2013)

The purpose of this document is to provide guidance on cardiac pacing and cardiac resynchronization therapy.

European Society of Cardiology (ESC) and European Society of Anaesthesiology (ESA)

ESC Guidelines for pre-operative cardiac risk assessment and perioperative cardiac management in non-cardiac surgery

European Society of Cardiology (ESC) and European Society of Anaesthesiology (ESA) (Aug 2014)

These Guidelines are intended for physicians and collaborators involved in the pre-operative, operative, and post-operative care of patients undergoing non-cardiac surgery.
The objective is to endorse a standardized and evidence-based approach to perioperative cardiac management. The Guidelines recommend a practical, stepwise evaluation of the patient that integrates clinical risk factors and test results with the estimated stress of the planned surgical procedure. This results in an individualized cardiac risk assessment, with the opportunity of initiating medical therapy, coronary interventions, and specific surgical and anaesthetic techniques in order to optimize the patient’s perioperative condition.

European Society of Cardiology (ESC) and European Society of Hypertension (ESH)

2013 ESH/ESC Guidelines for the management of arterial hypertension

European Society of Cardiology (ESC) and European Society of Hypertension (ESH) (Jun 2013)

The 2013 guidelines on hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) follow the guidelines jointly issued by the two societies in 2003 and 2007. Publication of a new document 6 years after the previous one was felt to be timely because, over this period, important studies have been conducted and many new results have been published on both the diagnosis and treatment of individuals with an elevated blood pressure (BP), making refinements, modifications and expansion of the previous recommendations necessary.

European Society of Digestive Oncology (ESDO) and European Society for Medical Oncology (ESMO)

The management of locally advanced pancreatic cancer: European Society of Digestive Oncology (ESDO) expert discussion and recommendations from the 14th ESMO/ World Congress on Gastrointestinal Cancer, Barcelona

European Society of Digestive Oncology (ESDO) and European Society for Medical Oncology (ESMO) (Jun 2014)

This article focuses on the management of locally advanced pancreatic cancer and summarizes the expert discussion, which was organized by the European Society of Digestive Oncology (ESDO) during the 14th European Society of Medical Oncology (ESMO)/World Congress on Gastrointestinal Cancer (WCGIC) in June 2012 in Barcelona, Spain.

European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and European Society of Gastrointestinal Endoscopy (ESGE)

Clinical indications for computed tomographic colonography: European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastrointestinal and Abdominal Radiology (ESGAR) Guideline

European Society of Gastrointestinal and Abdominal Radiology (ESGAR) and European Society of Gastrointestinal Endoscopy (ESGE) (Sep 2014)

This is an official guideline of the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society of Gastrointestinal and Abdominal Radiology (ESGAR). It addresses the clinical indications for the use of computed tomographic colonography (CTC). A targeted literature search was performed to evaluate the evidence supporting the use of CTC. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) system was adopted to define the strength of recommendations and the quality of evidence.

European Society of Gastrointestinal Endoscopy (ESGE)

Small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline

European Society of Gastrointestinal Endoscopy (ESGE) (Mar 2015)

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The Guideline was also reviewed and endorsed by the British Society of Gastroenterology (BSG). It addresses the roles of small-bowel capsule endoscopy and device-assisted enteroscopy for diagnosis and treatment of small-bowel disorders.

Live endoscopy events (LEEs): European Society of Gastrointestinal Endoscopy Position Statement – Update 2014

European Society of Gastrointestinal Endoscopy (ESGE) (Oct 2014)

The European Society of Gastrointestinal Endoscopy (ESGE) is dedicated to improving the quality of gastrointestinal endoscopy through educational activities such as live endoscopy events (LEEs). The primary utility of LEEs is the educational value for the audience, and patients should not expect additional benefit from being treated during a LEE compared to a routine setting. Although there is no evidence that LEEs entail additional risks for patients, neither can possible unknown risks be excluded as the evidence available is limited. Therefore, necessary measures should be taken to assure patient safety. Patients must be adequately informed that the standard of care will be assured and that their identity will not be revealed. ESGE recommends that an endoscopist not belonging to the hosting unit is named as patient advocate. Clinical indications for the LEE procedures and the educational outputs must be clear and agreed between host and demonstrator teams. ESGE will ensure that in all ESGE-organized LEEs the indications, procedural descriptions, and adverse events will be registered, and that organizers requesting ESGE endorsement can demonstrate such a registry.

Advanced imaging for detection and differentiation of colorectal neoplasia: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

European Society of Gastrointestinal Endoscopy (ESGE) (Jan 2014)

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the role of advanced endoscopic imaging for the detection and differentiation of colorectal neoplasia.

Post-polypectomy colonoscopy surveillance: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

European Society of Gastrointestinal Endoscopy (ESGE) (Sep 2013)

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). The following recommendations for post-polypectomy endoscopic surveillance should be applied only after a high quality baseline colonoscopy with complete removal of all detected neoplastic lesions.

Bowel preparation for colonoscopy: European Society of Gastrointestinal Endoscopy (ESGE) Guideline

European Society of Gastrointestinal Endoscopy (ESGE) (Jan 2013)

This Guideline is an official statement of the European Society of Gastrointestinal Endoscopy (ESGE). It addresses the choice amongst regimens available for cleansing the colon in preparation for colonoscopy.

Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Clinical Guideline

European Society of Gastrointestinal Endoscopy (ESGE) (Mar 2012)

Clarification of the position of the European Society of Gastrointestinal Endoscopy (ESGE) regarding the interventional options available for treating patients with chronic pancreatitis.

Biliary stenting: Indications, choice of stents and results: European Society of Gastrointestinal Endoscopy (ESGE) clinical guideline

European Society of Gastrointestinal Endoscopy (ESGE) (Oct 2011)

This article is part of a combined publication that expresses the current view of the European Society of Gastrointestinal Endoscopy (ESGE) about endoscopic biliary stenting for benign and malignant conditions; the other part of the publication describes the models of biliary stents available and the techniques used for stenting.

European Society of Intensive Care Medicine (ESICM)

Consensus on circulatory shock and hemodynamic monitoring

European Society of Intensive Care Medicine (ESICM) (Nov 2014)

Circulatory shock is a life-threatening syndrome resulting in multiorgan failure and a high mortality rate. The aim of this consensus is to provide support to the bedside clinician regarding the diagnosis, management and monitoring of shock.

Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic Shock, 2012

European Society of Intensive Care Medicine (ESICM) (Nov 2012)

The recommendations in this document are intended to provide guidance for the clinician caring for a patient with severe sepsis or septic shock. Recommendations from these guidelines cannot replace the clinician’s decision-making capability when he or she is presented with a patient’s unique set of clinical variables. Most of these recommendations are appropriate for the severe sepsis patient in the intensive care unit (ICU) and non-ICU settings.

European Society of Intensive Care Medicine (ESICM), European Society of Endocrinology (ESE) and European Renal Association–European Dialysis and Transplant Association (ERA–EDTA)

Clinical practice guideline on diagnosis and treatment of hyponatraemia

European Society of Intensive Care Medicine (ESICM), European Society of Endocrinology (ESE) and European Renal Association–European Dialysis and Transplant Association (ERA–EDTA) (Feb 2014)

The European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association–European Dialysis and Transplant Association (ERA–EDTA), represented by European Renal Best Practice (ERBP) have developed this Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure the document focused on patient-important outcomes and had utility for clinicians involved in every-day practice

European Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)

ESPGHAN Revised Porto Criteria for the Diagnosis of Inflammatory Bowel Disease in Children and Adolescents

European Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) (Nov 2013)

These revised Porto criteria for the diagnosis of PIBD have been developed to meet present challenges and developments in PIBD and provide up-to-date guidelines for the definition and diagnosis of the IBD spectrum.

Pediatric Celiac Disease, Cryptogenic Hypertransaminasemia, and Autoimmune Hepatitis

European Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) (Feb 2013)

The association between celiac disease (CD) and liver disease in pediatrics is widely recognized, but its prevalence is unknown. This study aims to conduct a systematic review and meta-analysis to evaluate the prevalence of CD in children with cryptogenic persistent hypertransaminasemia (HTS) or autoimmune hepatitis (AIH), and vice versa.

European Society of Radiology (ESR) and European Respiratory Society (ERS)

ESR/ERS white paper on lung cancer screening

European Society of Radiology (ESR) and European Respiratory Society (ERS) (Apr 2015)

Lung cancer is the most frequently fatal cancer, with poor survival once the disease is advanced. Annual low-dose computed tomography has shown a survival benefit in screening individuals at high risk for lung cancer. Based on the available evidence, the European Society of Radiology and the European Respiratory Society recommend lung cancer screening in comprehensive, quality-assured, longitudinal programmes within a clinical trial or in routine clinical practice at certified multidisciplinary medical centres.

European Stroke Organisation (ESO)

European Stroke Organisation (ESO) guidelines for the management of temperature in patients with acute ischemic stroke

European Stroke Organisation (ESO) (Jul 2015)

Hyperthermia is a frequent complication in up to 50% of patients with acute ischemic stroke, and it was shown to be associated with a poor outcome. On the other end, therapeutically induced hypothermia has shown promising potential in patients with hypoxic encephalopathy and in animal models of focal cerebral ischemia. This document presents the ESO guidelines on temperature management in patients with acute ischemic stroke. The aim of this Guideline document is to assist physicians treating patients with acute ischemic stroke in their clinical decisions with regard to the management of temperature.

European Stroke Organisation (ESO) guidelines for the management of spontaneous intracerebral hemorrhage

European Stroke Organisation (ESO) (Oct 2014)

These guidelines inform the management of Intracerebral hemorrhage (ICH) based on evidence for the effects of treatments in randomized controlled trials (RCTs). Outcome after ICH remains poor, prioritizing further RCTs of interventions to improve outcome.

European Stroke Organization Guidelines for the Management of Intracranial Aneurysms and Subarachnoid Haemorrhage

European Stroke Organisation (ESO) (Feb 2013)

The aim of these guidelines is to provide comprehensive recommendations on the management of subarachnoid haemorrhage (SAH) with and without aneurysm as well as on unruptured intracranial aneurysm.

European Thyroid Association (ETA)

2014 European Thyroid Association Guidelines for the Management of Subclinical Hypothyroidism in Pregnancy and in Children

European Thyroid Association (ETA) (Jun 2014)

This guideline has been produced as the official statement of the European Thyroid Association guideline committee. Subclinical hypothyroidism (SCH) in pregnancy is defined as a thyroid-stimulating hormone (TSH) level above the pregnancy-related reference range with a normal serum thyroxine concentration.

2013 ETA Guideline: Management of Subclinical Hypothyroidism

European Thyroid Association (ETA) (Oct 2013)

The consequences of Subclinical Hypothyroidism (SCH) are variable at several levels and may depend on the duration and the degree of elevation of the serum TSH. However, a number of important questions about SCH remain, including whether it increases cardiovascular (CV) risk or mortality, whether it negatively influences metabolic parameters and whether it should be treated with L -thyroxine. These open questions have prompted the European Thyroid Association (ETA) to form a task force with the aim of drawing up guidelines on the management of SCH in adults. A specific guideline on the management of SCH in children and in pregnancy will be prepared separately and these subjects are not covered in this guidance. Similarly, interpretation of elevated serum TSH while taking amiodarone is not covered in this guideline. Population screening for hypothyroidism was also considered a separate issue and is not covered by this guideline.

2013 European Thyroid Association Guidelines for Cervical Ultrasound Scan and Ultrasound-Guided Techniques in the Postoperative Management of Patients with Thyroid Cancer

European Thyroid Association (ETA) (Jul 2013)

Because of the pivotal role of ultrasound scanning (US) in the care of thyroid cancer patients, the European Thyroid Association convened a panel of international experts to review technical aspects, indications, results, and limitations of cervical US in the initial staging and follow-up of thyroid cancer patients. The main aim is to establish guidelines for both a cervical US scanning protocol and US-guided diagnostic and therapeutic procedures in patients with thyroid cancer.

2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism

European Thyroid Association (ETA) (Jul 2012)

Treatment of hypothyroidism is today predominantly with L-T4: its long half-life of 1 week is advantageous allowing one daily dose and it generates stable T3 levels by conversion of T4 into T3 in peripheral tissues. In contrast, the half-life of T3 is short (about 1 day), and treatment with L-T3 would require several doses per day with wide variation in serum T3 levels along the 24-hour period. In recognition of these developments and existing controversies regarding the value of L-T4 + L-T3 combination therapy of hypothyroidism, the ETA appointed a task force to systematically approach this issue and establish guidelines according to the principles of evidence-based medicine.

2012 European Thyroid Association Guidelines for Metastatic Medullary Thyroid Cancer

European Thyroid Association (ETA) (Apr 2012)

Distant metastases are the main cause of death in patients with medullary thyroid cancer (MTC). These 21 recommendations focus on MTC patients with distant metastases and a detailed follow-up protocol of patients with biochemical or imaging evidence of disease, selection criteria for treatment, and treatment modalities, including local and systemic treatments based on the results of recent trials.

Global Initiative for Chronic Obstructive Lung Disease (GOLD)

Global strategy for the diagnosis, management, and prevention of Chronic Obstructive Pulmonary Disease - Updated 2015

Global Initiative for Chronic Obstructive Lung Disease (GOLD) (Jan 2015)

The GOLD report is presented as a “strategy document” for health care professionals to use as a tool to implement effective management programs based on available health care systems. The quadrant management strategy tool is designed to be used in any clinical setting; it draws together a measure of the impact of the patient’s symptoms and an assessment of the patient’s risk of having a serious adverse health event in the future. Many studies have assessed the utility/relevance of this new tool. Evidence will continue to be evaluated by the GOLD committees and management strategy recommendations modified as required.

HIV in Europe

HIV Indicator Conditions: Guidance for Implementing HIV Testing in Adults in Health Care Settings

HIV in Europe (Nov 2012)

Written by the HIV in Europe initiative that is directed by an independent group of experts which has come together to work for optimal testing and earlier care for HIV in Europe. ESCMID endorses this guidance. The objectives of the guidance are to: - Encourage and support the inclusion of indicator condition-guided HIV testing in national HIV testing strategies, taking into account the local HIV prevalence, ongoing testing programmes and the local healthcare setting; - Recommend approaches and practical tools for education and training of healthcare professionals on overcoming barriers to recommending an HIV test.

HM Government

Multi-Agency Practice Guidelines: Female Genital Mutilation

HM Government (Nov 2014)

This document seeks to provide advice and support to frontline professionals who have responsibilities to safeguard children and protect adults from the abuses associated with female genital mutilation (FGM). As it is unlikely that any single agency will be able to meet the multiple needs of someone affected by FGM, this document sets out a multi-agency response and strategies to encourage agencies to cooperate and work together. This guidance provides information on: - identifying when a girl (including an unborn girl) or young woman may be at risk of being subjected to FGM and responding appropriately to protect them; - identifying when a girl or young woman has been subjected to FGM and responding appropriately to support them; and - measures that can be implemented to prevent and ultimately eradicate the practice of FGM. FGM is a form of child abuse and violence against women and girls, and therefore should be dealt with as part of existing child and adult protection structures, policies and procedures.

International Diabetes Federation (IDF)

Managing older people with type 2 Diabetes

International Diabetes Federation (IDF) (Jan 2013)

This Guideline has been structured into main chapter headings dealing with expected areas such as cardiovascular risk, education, renal impairment, diabetic foot disease and so on, but also includes less commonly addressed areas such as seen such as sexual health. Also included is a section of ‘special considerations’ where areas such as pain and end of life care are addressed.

Global Guideline for Type 2 Diabetes

International Diabetes Federation (IDF) (Jan 2012)

In 2005 the first IDF Global Guideline for type 2 diabetes was developed. This presented a unique challenge as we tried to develop a guideline that is sensitive to resource and cost-effectiveness issues. Many national guidelines address one group of people with diabetes in the context of one health-care system, with one level of national and health-care resources. This is not true in the global context where, although every health-care system seems to be short of resources, the funding and expertise available for health-care vary widely between countries and even between localities. Despite the challenges, we feel that we found an approach which is at least partially successful in addressing this issue which we termed ‘Levels of care’. This guideline represents an update of the first guideline and extends the evidence base by including new studies and treatments which have emerged since the original guideline was produced in 2005.

2011 Guideline for Management of PostMeal Glucose in Diabetes

International Diabetes Federation (IDF) (May 2011)

The purpose of this guideline is to consider the evidence on the relationship between postmeal glucose and glycaemic control (HbA1c), and with diabetes outcomes. Based on this information, recommendations for the appropriate management and monitoring of postmeal glucose in type 1 and type 2 diabetes have been developed. Management of postmeal glucose in pregnancy has not been addressed in this guideline. The recommendations are intended to assist clinicians and organizations in developing strategies to consider and effectively manage postmeal glucose in people with type 1 and type 2 diabetes, taking into consideration locally available therapies and resources. Although the literature provides valuable information and evidence regarding this area of diabetes management, uncertainties remain about a causal association between postmeal plasma glucose and complications and additional research is needed to clarify our understanding in this area. Logic and clinical judgment remain critical components of diabetes care and implementation of any guideline recommendations.

Pregnancy and diabetes

International Diabetes Federation (IDF) (Sep 2009)

Pregnancy is associated with changes in insulin sensitivity which may lead to changes in plasma glucose levels. For women with known diabetes or for women who develop diabetes during the pregnancy, these changes can put outcomes at risk. This guideline deals with the means of identifying women for whom such problems are new, and helping them, as well as women already known to have diabetes, to achieve the desired outcome of a healthy mother and baby.

Self-Monitoring of Blood Glucose in Non-Insulin Treated Type 2 Diabetes

International Diabetes Federation (IDF) (Jan 2009)

In October 2008, the International Diabetes Federation Clinical Guidelines Task Force, in conjunction with the SMBG International Working Group, convened a workshop in Amsterdam to address the issue of SMBG utilization in people with type 2 diabetes (T2M) that is not treated with insulin. Workshop participants included clinical investigators actively engaged in self-monitoring of blood glucose (SMBG) research and research translation activities. The IDF Guideline on Self-monitoring of Blood Glucose in Non-Insulin Treated Type 2 Diabetes presents a summary of the findings and recommendations of the workshop, related to the use of the SMBG in non-insulin treated people with T2M.

International Diabetes Federation (IDF) and International Society for Pediatric and Adolescent Diabetes (ISPAD)

Global IDF/ ISPAD Guideline for Diabetes in Childhood and Adolescence

International Diabetes Federation (IDF) and International Society for Pediatric and Adolescent Diabetes (ISPAD) (Jan 2011)

We hope the guidelines will be widely consulted and will be used to: - improve awareness among governments, state health care providers and the general public of the serious long-term implications of poorly managed diabetes and of the essential resources needed for optimal care. - assist individual care givers in managing children and adolescents with diabetes in a prompt, safe, consistent, equitable, standardised manner in accordance with the current views of experts in the field.

International Federation for the Surgery of Obesity – European Chapter (IFSO-EC) and European Association for the Study of Obesity (EASO)

Interdisciplinary European Guidelines on Metabolic and Bariatric Surgery

International Federation for the Surgery of Obesity – European Chapter (IFSO-EC) and European Association for the Study of Obesity (EASO) (Sep 2013)

The expert panel composition allowed the coverage of key disciplines in the comprehensive management of obesity and obesity-associated diseases, aimed specifically at updating the clinical guidelines to reflect current knowledge, expertise and evidence-based data on metabolic and bariatric surgery.

International Parkinson and Movement Disorder Society

Time to Redefine PD? Introductory Statement of the MDS Task Force on the Definition of Parkinson’s Disease

International Parkinson and Movement Disorder Society (Dec 2013)

This review is intended as an introductory discussion article; it is not the final word on disease definition, but rather an opening of dialog. Each section will start by presenting conversational-style informal minivignettes (in italics) that summarize what clinicians or researchers often mention when pointing out problems with the current PD definition. Both sides of each issue are then discussed, followed by proposals for moving forward. Finally, we will discuss the need for new diagnostic criteria for PD.

International Society for Pediatric and Adolescent Diabetes (ISPAD)

International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines 2014

International Society for Pediatric and Adolescent Diabetes (ISPAD) (Sep 2014)

This supplement of Pediatric Diabetes  is an update of the guideline chapters that were originally individually published in the journal between 2006 and 2008, and as a single compendium edition in 2009. The chapters have been modified and updated to reflect the significant advances in scientific knowledge and clinical care that have occurred since then.

Joint British Diabetes Societies

Management of Hyperglycaemia and Steroid (Glucocorticoid) Therapy

Joint British Diabetes Societies (Oct 2014)

This document aims to guide the management of hyperglycaemia in people given steroids as a hospital inpatient, and following discharge.

The use of variable rate intravenous insulin infusion (VRIII) in medical inpatients

Joint British Diabetes Societies (Oct 2014)

This guideline is for the use of a variable rate intravenous insulin infusion (VRIII) in adult inpatients with medical conditions and diabetes/hyperglycaemia, who require intravenous administration of insulin to keep their blood glucose within the recommended target range during an acute illness or a period of starvation.

The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus

Joint British Diabetes Societies (Sep 2013)

This guideline has been written by practicing clinicians and draws from their experiences of managing hypoglycaemia in UK hospitals. It outlines the risk factors for, and causes of hypoglycaemia in hospital, recognising that these are often quite different from those in the community e.g. a dislodged enteral feeding tube in a patient receiving insulin. It gives comprehensive and detailed advice on the management of hypoglycaemia in a variety of clinical situations from the fully conscious, to the conscious but confused, through to the unconscious patient.

The Management of Diabetic Ketoacidosis in Adults

Joint British Diabetes Societies (Sep 2013)

Diabetic ketoacidosis (DKA) though preventable remains a frequent and life threatening complication of type 1 diabetes. Unfortunately, errors in its management are not uncommon and importantly are associated with significant morbidity and mortality. Most acute hospitals have guidelines for the management of DKA but it is not unusual to find these out of date and at variance to those of other hospitals. Even when specific hospital guidelines are available audits have shown that adherence to and indeed the use of these is variable amongst the admitting teams. These teams infrequently refer early to the diabetes specialist team and it is not uncommon for the most junior member of the admitting team, who is least likely to be aware of the hospital guidance, to be given responsibility for the initial management of this complex and challenging condition.

Kidney Disease: Improving Global Outcomes (KDIGO)

KDIGO Clinical Practice Guideline for Lipid Management in Chronic Kidney Disease

Kidney Disease: Improving Global Outcomes (KDIGO) (Nov 2013)

This guideline contains chapters on the assessment of lipid status and treatment for dyslipidemia in adults and children. Development of the guideline followed an explicit process of evidence review and appraisal. Treatment approaches are addressed in each chapter and guideline recommendations are based on systematic reviews of relevant trials.

KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease

Kidney Disease: Improving Global Outcomes (KDIGO) (Jan 2013)

The document aims to provide state-of-the-art guidance on the evaluation, management and treatment for all patients with CKD. Specifically, the guideline retains the definition of CKD but presents an enhanced classification framework for CKD; elaborates on the identification and prognosis of CKD; discusses the management of progression and complications of CKD; and expands on the continuum of CKD care: timing of specialist referral, ongoing management of people with progressive CKD, timing of the initiation of dialysis, and finally the implementation of a treatment program which includes comprehensive conservative management.

KDIGO Clinical Practice Guideline for the Management of Blood Pressure in Chronic Kidney Disease

Kidney Disease: Improving Global Outcomes (KDIGO) (Dec 2012)

This Guideline has been developed to provide advice on the management of BP in patients with non–dialysis-dependent CKD (CKD ND)

KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease

Kidney Disease: Improving Global Outcomes (KDIGO) (Aug 2012)

The 2012 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for Anemia in Chronic Kidney Disease aims to provide guidance on diagnosis, evaluation, management and treatment for all CKD patients (non-dialysis, dialysis, kidney transplant recipients and children) at risk of or with anemia. Guideline development followed an explicit process of evidence review and appraisal. The guideline contains chapters addressing diagnosis and evaluation of anemia in CKD and the use of various therapeutic agents (iron, ESAs and other agents) and red cell transfusion as means of treatment. Treatment approaches are addressed in each chapter and guideline recommendations are based on systematic reviews of relevant trials.

KDIGO Clinical Practice Guideline for Glomerulonephritis

Kidney Disease: Improving Global Outcomes (KDIGO) (Jun 2012)

The guideline contains chapters on various glomerular diseases: steroid-sensitive nephrotic syndrome in children; steroid-resistant nephrotic syndrome in children; minimal-change disease; idiopathic focal segmental glomerulosclerosis; idiopathic membranous nephropathy; membranoproliferative glomerulonephritis; infection-related glomerulonephritis; IgA nephropathy; Henoch-Scho¨nlein purpura nephritis; lupus nephritis; pauci-immune focal and segmental necrotizing glomerulonephritis; and anti–glomerular basement membrane antibody glomerulonephritis. Treatment approaches are addressed in each chapter and guideline recommendations are based on systematic reviews of relevant trials.

KDIGO Clinical Practice Guideline for Acute Kidney Injury

Kidney Disease: Improving Global Outcomes (KDIGO) (Mar 2012)

The guideline contains chapters on definition, risk assessment, evaluation, prevention, and treatment. Definition and staging of AKI are based on the Risk, Injury, Failure; Loss, End-Stage Renal Disease (RIFLE) and Acute Kidney Injury Network (AKIN) criteria and studies on risk relationships. The treatment chapters cover pharmacological approaches to prevent or treat AKI, and management of renal replacement for kidney failure from AKI.

National Institute for Health and Care Excellence (NICE)

Anaemia management in people with chronic kidney disease

National Institute for Health and Care Excellence (NICE) (Jun 2015)

This guideline covers the management of anaemia in adults, children and young people with a clinical diagnosis of anaemia associated with CKD. It does not cover people with anaemia not principally caused by CKD. All parts of the care pathway are covered in the guideline.

Lower urinary tract symptoms: The management of lower urinary tract symptoms in men

National Institute for Health and Care Excellence (NICE) (Jun 2015)

Lower urinary tract symptoms (LUTS) in men are best categorised into voiding, storage or post-micturition symptoms to help define the source of the problem. Voiding symptoms include weak or intermittent urinary stream, straining, hesitancy, terminal dribbling and incomplete emptying. Storage symptoms include urgency, frequency, urgency incontinence and nocturia. The major post-micturition symptom is post-micturition dribbling, which is common and bothersome. Although LUTS do not usually cause severe illness, they can considerably reduce men's quality of life, and may point to serious pathology of the urogenital tract.

LUTS are a major burden for the ageing male population. Age is an important risk factor for LUTS and the prevalence of LUTS increases as men get older. Bothersome LUTS can occur in up to 30% of men older than 65 years. This is a large group potentially requiring treatment.

Because uncertainty and variation exist in clinical practice, this guideline gives clear recommendations on diagnosing, monitoring and treating LUTS.

Suspected cancer: recognition and referral

National Institute for Health and Care Excellence (NICE) (Jun 2015)

This guideline updates and replaces NICE clinical guideline CG27 (published June 2005). It offers evidence-based advice on the recognition of and referral for suspected cancer in children, young people and adults.

This guideline covers the recognition and selection for referral or investigation in primary care of people of all ages, including children and young people, who may have cancer. Although we have used the terms 'men' and 'women' for recommendations on gender-related cancers, these recommendations also extend to people who have changed or are in the process of changing gender, and who retain the relevant organs.

The guideline aims to help people understand what to expect if they have symptoms that may suggest cancer. It should also help those in secondary care to understand which services should be provided for people with suspected cancer. Finally, these recommendations are recommendations, not requirements, and they are not intended to override clinical judgement.

The recommendations in this guideline have been organised into 3 separate sections to help clinicians find the relevant information easily. In the first, the recommendations are organised by cancer site. There is a section covering patient support, safety netting and the diagnostic process. Then, for those wanting to find recommendations on specific symptoms and primary care investigations, the recommendations are in a section organised by symptoms and investigation findings.

Diagnosing prostate cancer: PROGENSA PCA3 assay and Prostate Health Index

National Institute for Health and Care Excellence (NICE) (Jun 2015)

NICE has not recommended the PROGENSA PCA3 assay and the Prostate Health Index for use in people having investigations for suspected prostate cancer, who have had a negative or inconclusive transrectal ultrasound prostate biopsy. The PCA3 assay is diagnostic test that detects the level of prostate cancer gene 3 (PCA3) in urine, and the PHI is a diagnostic test that detects the level of prostate-specific antigen (PSA) in blood.

Bronchiolitis in children

National Institute for Health and Care Excellence (NICE) (May 2015)

Bronchiolitis is the most common disease of the lower respiratory tract during the first year of life. It usually presents with cough with increased work of breathing, and it often affects a child's ability to feed. In primary care, the condition may often be confused with a common cold, though the presence of lower respiratory tract signs (wheeze and/or crackles on auscultation) in an infant in mid-winter would be consistent with this clinical diagnosis. The symptoms are usually mild and may only last for a few days, but in some cases the disease can cause severe illness.

The guideline covers children with bronchiolitis but not those with other respiratory conditions, such as recurrent viral induced wheeze or asthma.

Challenging behaviour and learning disabilities: prevention and interventions for people with learning disabilities whose behaviour challenges

National Institute for Health and Care Excellence (NICE) (May 2015)

A learning disability is defined by 3 core criteria: lower intellectual ability (usually an IQ of less than 70), significant impairment of social or adaptive functioning, and onset in childhood. Learning disabilities are different from specific learning difficulties such as dyslexia, which do not affect intellectual ability. Although the term 'intellectual disability' is becoming accepted internationally, 'learning disability' is the most widely used and accepted term in the UK and is therefore used in this guideline. The amount of everyday support a person with a learning disability needs will depend mostly on the severity of the disability. It is important to treat each person as an individual, with specific strengths and abilities as well as needs, and a broad and detailed assessment may be needed.

This guideline offers best practice advice on the care of children, young people and adults with a learning disability and behaviour that challenges.

Violence and aggression: short-term management in mental health, health and community settings

National Institute for Health and Care Excellence (NICE) (May 2015)

Violence and aggression refer to a range of behaviours or actions that can result in harm, hurt or injury to another person, regardless of whether the violence or aggression is physically or verbally expressed, physical harm is sustained or the intention is clear.

This guideline covers the short-term management of violence and physically threatening behaviour in mental health, health and community settings. This includes inpatient psychiatric care, emergency and urgent care, secondary mental health care (such as care provided by assertive community teams, community mental health teams, early intervention teams and crisis resolution and home treatment teams), community healthcare, primary care, social care and care provided in people's homes. The guideline covers anticipating and reducing the risk of violence and aggression, prevention methods (such as searching, de-escalation and pharmacological strategies, including p.r.n. medication), restrictive interventions (for example, restraint, rapid tranquillisation and seclusion), staff training, and post-incident debrief and review.

This guideline includes adults (aged 18 and over), children (aged 12 and under) and young people (aged 13 to 17) with a mental health problem who are currently service users within mental health, health and community settings. It also covers carers of service users with mental health problems in these settings.

This guideline does not cover but may be relevant to practice regarding people who do not have mental health problems, those who are not carers of people with mental health problems, people in whom the primary behaviour is self-harm and people with a primary diagnosis of learning disability.

Depression in children and young people: Identification and management in primary, community and secondary care

National Institute for Health and Care Excellence (NICE) (Mar 2015)

This guideline covers the identification and treatment of depression in children (5–11 years) and young people (12–18 years) in primary, community and secondary care. Depression is a broad diagnosis that can include different symptoms in different people. However, depressed mood or loss of pleasure in most activities, are key signs of depression. Depressive symptoms are frequently accompanied by symptoms of anxiety, but may also occur on their own. The International Statistical Classification of Diseases (ICD-10) uses an agreed list of 10 depressive symptoms, and divides depression into 4 categories: not depressed (fewer than 4 symptoms), mild depression (4 symptoms), moderate depression (5 to 6 symptoms), and severe depression (7 or more symptoms, with or without psychotic symptoms). For a diagnosis of depression, symptoms should be present for at least 2 weeks and every symptom should be present for most of the day.

Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children

National Institute for Health and Care Excellence (NICE) (Mar 2015)

Preventing and managing overweight and obesity are complex problems, with no easy answers. This guidance offers practical recommendations based on the evidence. But staff working directly with the public also need to be aware of the many factors that could be affecting a person's ability to stay at a healthy weight or succeed in losing weight.

Diabetes in pregnancy: management of diabetes and its complications from preconception to the postnatal period

National Institute for Health and Care Excellence (NICE) (Feb 2015)

This guideline contains recommendations for managing diabetes and its complications in women who are planning pregnancy and those who are already pregnant. The guideline focuses on areas where additional or different care should be offered to women with diabetes and their newborn babies. Where the evidence supports it, the guideline makes separate recommendations for women with pre-existing diabetes and women with gestational diabetes. The term 'women' is used in the guideline to refer to all females of childbearing age, including young women who have not yet transferred from paediatric to adult services.

Bladder cancer: diagnosis and management

National Institute for Health and Care Excellence (NICE) (Feb 2015)

This guideline covers adults (18 years and older) referred from primary care with suspected bladder cancer and those with newly diagnosed or recurrent bladder (urothelial carcinoma, adenocarcinoma, squamous-cell carcinoma or small-cell carcinoma) or urethral cancer. There was insufficient high-quality evidence on which to make specific recommendations for non-urothelial bladder cancer (adenocarcinoma, squamous-cell carcinoma or small-cell carcinoma).

It does not cover people aged under 18 or adults with bladder sarcoma, urothelial cancer of the upper urinary tract, or secondary bladder or urethral cancer (for example, bowel or cervix cancer spreading into the bladder).

Postnatal care

National Institute for Health and Care Excellence (NICE) (Feb 2015)

This guideline aims to identify the essential core (routine) care that every woman and her baby should receive in the first 6–8 weeks after birth, based on the best evidence available. The recommendations on co-sleeping and sudden infant death syndrome cover the first year of an infant's life.

Although for most women and babies the postnatal period is uncomplicated, care during this period needs to address any deviation from expected recovery after birth. This guideline gives advice on when additional care may be needed and these recommendations have been given a status level.

Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care

National Institute for Health and Care Excellence (NICE) (Feb 2015)

Key aspects of this guideline include establishing a diagnosis; referral into secondary care only after identification of 'red flags' (symptoms and/or features that may be caused by another condition that needs investigation); providing lifestyle advice; drug and psychological interventions; and referral and follow-up.

Gastro-oesophageal reflflux disease: recognition, diagnosis and management in children and young people

National Institute for Health and Care Excellence (NICE) (Jan 2015)

This guideline focuses on signs and symptoms and interventions for GORD. Commonly observed events, such as infant regurgitation, are covered as well as much rarer but potentially more serious problems, such as apnoea. Where appropriate, clear recommendations are given as to when and how reassurance should be offered. The guideline also advises healthcare professionals about when to think about investigations, and what treatments to offer. Finally, it is emphasised that other, and on occasion more serious, conditions that need different management can be confused with some of the relatively common manifestations of GOR or GORD. These warning signs are defined under the headings of 'red flags' along with recommended initial actions.

Bipolar disorder: the assessment and management of bipolar disorder in adults, children and young people in primary and secondary care

National Institute for Health and Care Excellence (NICE) (Jan 2015)

This guideline covers the recognition, assessment and management of bipolar disorder in children, young people and adults. It includes specific recommendations for diagnosis in children and young people because presentation in these age groups can be complicated by other conditions such as ADHD. The recommendations apply to people with bipolar I, bipolar II, mixed affective and rapid cycling disorders. Non-bipolar affective disorders are not covered because these are addressed by other guidelines, and this guideline does not make specific recommendations about other mental disorders that commonly coexist with bipolar disorder.

Pneumonia: Diagnosis and management of community- and hospital-acquired pneumonia in adults

National Institute for Health and Care Excellence (NICE) (Dec 2014)

This guideline provides recommendations for the management of suspected and confirmed community- and hospital-acquired pneumonia in adults. However, it does not provide recommendations on areas of care where best practice is already established, such as diagnosis using chest X-ray. This guideline does not cover bronchiectasis complicated by pneumonia, people younger than 18 years, or patients who acquire pneumonia while intubated or in an intensive care unit, who are immunocompromised, or in whom management of pneumonia is an expected part of end-of-life care.

Intrapartum care: care of healthy women and their babies during childbirth

National Institute for Health and Care Excellence (NICE) (Dec 2014)

The guideline is intended to cover the care of healthy women with uncomplicated pregnancies entering labour at low risk of developing intrapartum complications. In addition, recommendations are included that address the care of women who start labour as 'low risk' but who go on to develop complications. These include the care of women with prelabour rupture of membranes at term, care of the woman and baby when meconium is present, indications for continuous cardiotocography, interpretation of cardiotocograph traces, and management of retained placenta and postpartum haemorrhage. Aspects of intrapartum care for women at risk of developing intrapartum complications are covered by a range of guidelines on specific conditions and a further guideline is planned on the intrapartum care of women at high risk of complications during pregnancy and the intrapartum period.

Antenatal and postnatal mental health: Clinical management and service guidance

National Institute for Health and Care Excellence (NICE) (Dec 2014)

This guideline makes recommendations for the recognition, assessment, care and treatment of mental health problems in women during pregnancy and the postnatal period (up to 1 year after childbirth) and in women who are planning a pregnancy. The guideline covers depression, anxiety disorders, eating disorders, drug and alcohol-use disorders and severe mental illness (such as psychosis, bipolar disorder, schizophrenia and severe depression). It covers subthreshold symptoms as well as mild, moderate and severe mental health problems. However, the guideline focuses on aspects of expression, risks and management that are of special relevance in pregnancy and the postnatal period.

Colorectal cancer: The diagnosis and management of colorectal cancer

National Institute for Health and Care Excellence (NICE) (Dec 2014)

This guideline offers best practice advice on the care of patients with colorectal cancer.

Dyspepsia and gastro-oesophageal reflux disease: Investigation and management of dyspepsia, symptoms suggestive of gastro-oesophageal reflux disease, or both

National Institute for Health and Care Excellence (NICE) (Nov 2014)

This guideline update covers adults (18 years and older) with symptoms of dyspepsia, symptoms suggestive of GORD, or both. It also covers endoscopic surveillance for adults with a diagnosis of Barrett's oesophagus, but it does not cover the management of Barrett's oesophagus. It is important to note that children and young people (younger than 18 years) and people with a diagnosis of oesophagogastric cancer are not covered in this guideline update.

Obesity: identification, assessment and management of overweight and obesity in children, young people and adults

National Institute for Health and Care Excellence (NICE) (Nov 2014)

This guideline updates and replaces section 1.2 in 'Obesity' (NICE clinical guideline 43: Obesity - Guidance on the prevention of overweight and obesity in adults and children).

NICE's clinical guideline on obesity was reviewed in 2011, leading to this update. This guideline addresses three main areas: follow-up care packages after bariatric surgery; the role of bariatric surgery in the management of recent-onset type 2 diabetes; and very-low-calorie diets including their effectiveness, and safety and effective management strategies for maintaining weight loss after such diets.

Gallstone disease

National Institute for Health and Care Excellence (NICE) (Oct 2014)

There is variation in how gallstone disease is managed. Some people with symptomless gallstone disease are offered treatment to prevent symptoms developing in the future, whereas others are offered a watch-and-wait approach. When people experience symptoms of gallstone disease they often need surgery to remove their gallbladder. There is uncertainty about the best way of treating gallstone disease. In addition, if surgery is appropriate there is uncertainty about whether it should be performed as soon as possible after a gallstones attack or delayed until any infection and inflammation has subsided.

This guideline addresses some of these uncertainties and provides recommendations about how gallstone disease should be identified, diagnosed and managed in adults.

Acute heart failure: diagnosing and managing acute heart failure in adults

National Institute for Health and Care Excellence (NICE) (Oct 2014)

This guideline includes important aspects of the diagnosis and management of acute heart failure that are not addressed by the NICE guideline on chronic heart failure (NICE clinical guideline 108). The guideline on chronic heart failure focused on long-term management rather than on the immediate care of someone who is acutely unwell as a result of heart failure.

This guideline covers the care of adults (aged 18 years or older) who have a diagnosis of acute heart failure, have possible acute heart failure, or are being investigated for acute heart failure. It includes the following key clinical areas:
- the role of early natriuretic peptide testing and echocardiography
- the role of specialist management units
- the use of ventilatory support, pharmacological therapy and ultrafiltration
- treatment after stabilisation, including selected surgical interventions and initiation of the pharmacological therapies that are used in the management of chronic heart failure.

Multiple sclerosis: management of multiple sclerosis in primary and secondary care

National Institute for Health and Care Excellence (NICE) (Oct 2014)

This guideline replaces NICE clinical guideline 8 (2003) and covers diagnosis, information and support, treatment of relapse and management of MS-related symptoms. The guideline does not address all symptoms and problems associated with MS. Some areas are addressed in other NICE guidance for example urinary symptoms and swallowing, and these are referenced where appropriate. Many of the interventions used in a rehabilitation setting to alleviate symptoms such as tremor, weakness, cardiorespiratory fitness, sensory loss, visual problems (apart from oscillopsia), and secondary complications of immobility such as deconditioning and contractures have not been covered because these are beyond the scope of the guideline. Many of these problems are complex and need individual assessment and management strategies. These assessments and treatments need to be carried out by healthcare professionals with appropriate expertise in rehabilitation and MS.

The guideline does not address the use of disease-modifying treatments; there are NICE technology appraisals about these treatments.

The guideline is aimed primarily at services provided in primary and secondary care. It does not map out a model of service delivery. Many people with MS may also attend specialised tertiary services, often established particularly to provide and monitor disease-modifying therapies.

Drug allergy: diagnosis and management of drug allergy in adults, children and young people

National Institute for Health and Care Excellence (NICE) (Sep 2014)

In view of the variation in provision of care for people with drug allergy, the scope of this guideline identified a need for guidance to improve clinical management for people affected by drug allergy. This guideline has been developed for use by healthcare professionals at all levelsof healthcare and offers best practice advice on the diagnosis, documentation and communication of drug allergy in adults, children and young people.

Long-acting reversible contraception

National Institute for Health and Care Excellence (NICE) (Sep 2014)

The guideline offers the best-practice advice for all women of reproductive age who may wish to regulate their fertility by using LARC methods. It covers specific issues for the use of these methods during the menarche and before the menopause, and by particular groups, including women who have HIV, learning disabilities or physical disabilities, or are younger than 16 years.

Early and locally advanced breast cancer: Diagnosis and treatment

National Institute for Health and Care Excellence (NICE) (Jul 2014)

This guideline offers best practice advice on the care of patients with early or locally advanced breast cancer.

Advanced breast cancer (update): Diagnosis and treatment

National Institute for Health and Care Excellence (NICE) (Jul 2014)

This guideline offers best practice advice on the care of patients with advanced breast cancer.

Lipid modification: Cardiovascular risk assessment and the modification of blood lipids for the primary and secondary prevention of cardiovascular disease

National Institute for Health and Care Excellence (NICE) (Jul 2014)

This guideline offers best practice advice on the care of adults at high risk of developing CVD or with established CVD.

Chronic kidney disease: Early identification and management of chronic kidney disease in adults in primary and secondary care

National Institute for Health and Care Excellence (NICE) (Jul 2014)

This guideline offers best practice advice on the care of adults with chronic kidney disease.

Type 2 diabetes: The management of type 2 diabetes

National Institute for Health and Care Excellence (NICE) (Jul 2014)

This guideline offers best practice advice on the care of people with type 2 diabetes. It does not address care in or before pregnancy, or care by specialist services for specific advanced organ damage (cardiac, renal, eye, vascular, stroke and other services).

Atrial fibrillation: the management of atrial fibrillation

National Institute for Health and Care Excellence (NICE) (Jun 2014)

This guideline offers best practice advice on the care of adults (aged 18 and over) with suspected or diagnosed atrial fibrillation.

Pressure ulcers: prevention and management of pressure ulcers

National Institute for Health and Care Excellence (NICE) (Apr 2014)

This guideline offers best practice advice on the care of people with pressure ulcers.

Psychosis and schizophrenia in adults: treatment and management

National Institute for Health and Care Excellence (NICE) (Mar 2014)

This guideline covers the treatment and management of psychosis and schizophrenia and related disorders in adults (18 years and older) with onset before 60 years. The term 'psychosis' is used in this guideline to refer to the group of psychotic disorders that includes schizophrenia, schizoaffective disorder, schizophreniform disorder and delusional disorder.

Osteoarthritis: Care and management in adults

National Institute for Health and Care Excellence (NICE) (Feb 2014)

The current update addresses issues around decision-making and referral thresholds for surgery, and includes new recommendations about diagnosis and follow-up. The update also contains recommendations based on new evidence about the use of nutraceuticals, hyaluronans and acupuncture in the management of osteoarthritis.

Prostate cancer: diagnosis and treatment (NICE)

National Institute for Health and Care Excellence (NICE) (Jan 2014)

This updated guidance includes several treatments that have been licensed for the management of hormone-relapsed metastatic prostate cancer since the publication of NICE clinical guideline 58 (2008). It also aims to reduce the uncertainty and variations in practice that remain in some areas of prostate cancer diagnosis and management. Updated recommendations are provided on: - pre-biopsy imaging - management after an initial negative biopsy - imaging for T and N staging - groups for whom active surveillance is suitable and a protocol for active surveillance - the most effective radical prostatectomy method - the combination of external beam radiotherapy and brachytherapy in non-metastatic prostate cancer - management of radiation-induced enteropathy - the combination of hormone therapy and external beam radiotherapy in non-metastatic prostate cancer - intermittent compared with continuous hormone therapy for men having long-term hormone therapy - management of side effects resulting from long-term androgen deprivation therapy. This guideline covers the care of men referred to secondary care with suspected or diagnosed prostate cancer, including follow-up in primary care for men with diagnosed prostate cancer. The guideline does not cover men with an abnormal PSA (prostate-specific antigen) level detected in primary care who have no symptoms and are not referred for subsequent investigation.

Head injury: Triage, assessment, investigation and early management of head injury in children, young people and adults

National Institute for Health and Care Excellence (NICE) (Jan 2014)

This guideline offers best practice advice on the care of people with head injury. This update addresses these areas, including in particular: - indications for transporting patients with a head injury from the scene of injury directly to the nearest neuroscience centre, bypassing the nearest emergency department - indications for and timing of CT head scans in the emergency department, with particular reference to anticoagulant therapy and levels of circulating brain injury biomarkers - the relative cost effectiveness of different strategies for initial imaging of the cervical spine - information that should be provided to patients, family members and carers on discharge from the emergency department or observation ward.

The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care

National Institute for Health and Care Excellence (NICE) (Dec 2013)

This guideline offers best practice advice on the care of children, young people and adults with epilepsy.

Neuropathic pain – pharmacological management: The pharmacological management of neuropathic pain in adults in non-specialist settings

National Institute for Health and Care Excellence (NICE) (Nov 2013)

This short clinical guideline aims to improve the care of adults with neuropathic pain by making evidence-based recommendations on the pharmacological management of neuropathic pain outside of specialist pain management services. A further aim is to ensure that people who require specialist assessment and interventions are referred appropriately and in a timely fashion to a specialist pain management service and/or other condition-specific services.

Unstable angina and NSTEMI: The early management of unstable angina and non-ST-segment-elevation myocardial infarction

National Institute for Health and Care Excellence (NICE) (Nov 2013)

The term ‘acute coronary syndromes’ encompasses a range of conditions from unstable angina to ST-segment-elevation myocardial infarction (STEMI), arising from thrombus formation on an atheromatous plaque. This guideline addresses the early management of unstable angina and non-ST-segment-elevation myocardial infarction (NSTEMI) once a firm diagnosis has been made and before discharge from hospital. If untreated, the prognosis is poor and mortality high, particularly in people who have had myocardial damage. Appropriate triage, risk assessment and timely use of acute pharmacological or invasive interventions are critical for the prevention of future adverse cardiovascular events (myocardial infarction, stroke, repeat revascularisation or death).

MI – secondary prevention: Secondary prevention in primary and secondary care for patients following a myocardial infarction

National Institute for Health and Care Excellence (NICE) (Nov 2013)

This guideline offers best practice advice on the care of adults who have had a myocardial infarction.

Urinary incontinence: The management of urinary incontinence in women

National Institute for Health and Care Excellence (NICE) (Sep 2013)

Since the publication of the 2006 guideline, new methods of managing urinary incontinence have become available on the NHS. Botulinum toxin A and sacral nerve stimulation are also now more commonly used for treating OAB symptoms. Synthetic tape procedures have become increasingly popular for the treatment of stress urinary incontinence, and there have been reported improvements in the effectiveness and advances in the types of procedure offered since 2006. Updated guidance is needed to reflect these changes. New recommendations for 2013 sit alongside the original recommendations from the 2006 guideline. It is important to emphasise that all of the 2006 recommendations are just as relevant and important now as they were when they were originally published. Urinary incontinence in neurological disease is outside the scope of this guideline.

Antisocial personality disorder: treatment, management and prevention

National Institute for Health and Care Excellence (NICE) (Sep 2013)

Antisocial personality disorder is the name given to a condition that affects a person's thoughts, emotions and behaviour. Antisocial means behaving in a way that is disruptive to, and may be harmful to, other people.

Autism: The management and support of children and young people on the autism spectrum

National Institute for Health and Care Excellence (NICE) (Aug 2013)

This guideline covers children and young people with autism (across the full range of intellectual ability) from birth until their 19th birthday, and their parents and carers.

Acute kidney injury: Prevention, detection and management of acute kidney injury up to the point of renal replacement therapy

National Institute for Health and Care Excellence (NICE) (Aug 2013)

This guideline emphasises early intervention and stresses the importance of risk assessment and prevention, early recognition and treatment. It is primarily aimed at the non-specialist clinician, who will care for most patients with acute kidney injury in a variety of settings. The recommendations aim to address known and unacceptable variations in recognition, assessment, initial treatment and referral for renal replacement therapy.

Rheumatoid arthritis: the management of rheumatoid arthritis in adults

National Institute for Health and Care Excellence (NICE) (Aug 2013)

This guideline offers best practice advice on the care of adults with RA

Varicose veins in the legs: The diagnosis and management of varicose veins

National Institute for Health and Care Excellence (NICE) (Jul 2013)

This guideline offers best practice advice on the care of adults aged 18 years and over with varicose veins in the legs.

Myocardial infarction with ST-segment elevation: The acute management of myocardial infarction with ST-segment elevation

National Institute for Health and Care Excellence (NICE) (Jul 2013)

Primary PCI 'timeliness' is a key part of this guideline. This is addressed in detail, so commissioners and professionals delivering services for people with STEMI can plan their configuration in such a way that outcomes are optimal. This guideline also covers procedural primary PCI issues, the use of antiplatelet and antithrombin agents, and improving outcomes for the minority of people still receiving fibrinolysis.

Falls: assessment and prevention of falls in older people

National Institute for Health and Care Excellence (NICE) (Jun 2013)

This clinical guideline offers evidence-based advice on preventing falls in older people. New recommendations have been added about preventing falls in older people during a hospital stay. All people aged 65 or older are covered by all guideline recommendations. People aged 50 to 64 who are admitted to hospital and are judged by a clinician to be at higher risk of falling because of an underlying condition are also covered by the guideline recommendations about assessing and preventing falls in older people during a hospital stay.

Idiopathic pulmonary fibrosis: the diagnosis and management of suspected idiopathic pulmonary fibrosis

National Institute for Health and Care Excellence (NICE) (Jun 2013)

This clinical guideline offers evidence-based advice on the diagnosis and management of suspected idiopathic pulmonary fibrosis in adults. Idiopathic pulmonary fibrosis is a chronic, progressive disease in which the lungs become scarred.

Stroke rehabilitation: Long-term rehabilitation after stroke

National Institute for Health and Care Excellence (NICE) (Jun 2013)

This guideline offers evidence-based advice on the care of adults and young people aged 16 years and older who have had a stroke with continuing impairment, activity limitation or participation restriction.

Feverish illness in children: Assessment and initial management in children younger than 5 years

National Institute for Health and Care Excellence (NICE) (May 2013)

This clinical guideline updates and replaces NICE clinical guideline 47 ‘Feverish illness in children’ (published May 2007). It offers evidence-based advice on the care of young children with feverish illness. New and updated recommendations have been included in areas relating to assessment and initial management in children younger than 5 years with no obvious cause of feverish illness.

Social anxiety disorder: recognition, assessment and treatment

National Institute for Health and Care Excellence (NICE) (May 2013)

This clinical guideline offers evidence-based advice on the recognition, assessment and treatment of social anxiety disorder in children and young people (from school age to 17 years) and adults (aged 18 years and older). It includes a recommendation on the treatment of specific phobias that updates and replaces the section of NICE technology appraisal guidance 97 that deals with phobia.

Hyperphosphataemia in chronic kidney disease: Management of hyperphosphataemia in patients with stage 4 or 5 chronic kidney disease

National Institute for Health and Care Excellence (NICE) (Mar 2013)

This clinical guideline offers best practice advice on the care of adults, children and young people with stage 4 or 5 chronic kidney disease (CKD) who have, or are at risk of, hyperphosphataemia. People with stage 4 or 5 CKD often have high levels of phosphate in their blood; this is called hyperphosphataemia. When the kidneys are not working as well as they should, phosphate is not passed out of the body in the urine. Instead, it builds up in the blood and hyperphosphataemia develops.

Antisocial behaviour and conduct disorders in children and young people: recognition, intervention and management

National Institute for Health and Care Excellence (NICE) (Mar 2013)

This guideline updates and replaces 'Parent-training/education programmes in the management of children with conduct disorder' (NICE technology appraisal guidance 102, published June 2006). It offers evidence-based advice on the recognition and management of conduct disorders in children and young people.

Attention deficit hyperactivity disorder: Diagnosis and management of ADHD in children, young people and adults

National Institute for Health and Care Excellence (NICE) (Mar 2013)

This guideline makes recommendations for the diagnosis and management of attention deficit hyperactivity disorder (ADHD) in children, young people and adults. The guideline does not cover the management of ADHD in children younger than 3 years. The term ‘children’ refers to those aged 11 years and younger; ‘young people’ refers to those between 12 and 18 years. However, these categories are flexible and clinicians should use their judgement about a child or young person’s developmental, as opposed to their chronological, age.

Fertility: Assessment and treatment for people with fertility problems

National Institute for Health and Care Excellence (NICE) (Feb 2013)

This clinical guideline updates and replaces NICE clinical guideline 11 ‘Fertility’ (published February 2004). It offers evidence-based advice on the care and treatment of people with fertility problems. New and updated recommendations have been included in areas of diagnosis and treatment for fertility problems.

Psychosis and schizophrenia in children and young people: Recognition and management

National Institute for Health and Care Excellence (NICE) (Jan 2013)

This clinical guideline offers evidence-based advice on the recognition and management of psychosis and schizophrenia in children and young people under 18.

Management of stable angina

National Institute for Health and Care Excellence (NICE) (Dec 2012)

This guideline offers best practice advice on the care of people with stable angina.

Ectopic pregnancy and miscarriage: Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage

National Institute for Health and Care Excellence (NICE) (Dec 2012)

This clinical guideline offers evidence-based advice on the diagnosis and management of ectopic pregnancy and miscarriage in early pregnancy (that is, up to 13 completed weeks of pregnancy).

Psoriasis: Assessment and management of psoriasis

National Institute for Health and Care Excellence (NICE) (Oct 2012)

This guideline aims to provide clear recommendations on the assessment and management of psoriasis for all people with psoriasis. The diagnosis of psoriasis has not been included within the scope, partly for pragmatic reasons given that to cover psoriasis management itself is a considerable task, but also because there are no agreed diagnostic criteria or tests available and accurate diagnosis remains primarily a clinical one. In considering which specific aspects of psoriasis management to address, the guideline development group have focussed on areas most likely to improve the management and delivery of care for a majority of people affected, where practice is very varied and/or where clear consensus or guidelines on treatments are lacking.

Crohn's disease: Management in adults, children and young people

National Institute for Health and Care Excellence (NICE) (Oct 2012)

This guideline intends to show the place of both new and established treatments in the wider care pathway for Crohn’s disease. This will be useful for clinicians and people with Crohn’s disease because new drugs have been licensed for Crohn’s disease in the last decade. The guideline also deals with those medications which are unlicensed for treatment of the condition, but which have been used in this way (off-label) for many years and their role is recognised in other NICE documents as well as the British National Formulary.They include azathioprine, mercaptopurine and methotrexate. The guideline aims to help improve the care offered to people with Crohn’s disease and provide information about the clinical and cost effectiveness of potential care pathways. Management of Crohn’s disease in specific populations (for example, in pregnancy) may require special consideration.

Headaches: Diagnosis and management of headaches in young people and adults

National Institute for Health and Care Excellence (NICE) (Sep 2012)

Headaches are one of the most common neurological problems presented to GPs and neurologists. They are painful and debilitating for individuals, an important cause of absence from work or school and a substantial burden on society. Headache disorders are classified as primary or secondary. The aetiology of primary headaches is not well understood and they are classified according to their clinical pattern. The most common primary headache disorders are tension-type headache, migraine and cluster headache. Secondary headaches are attributed to underlying disorders and include, for example, headaches associated with medication overuse, giant cell arteritis, raised intracranial pressure and infection. Medication overuse headache most commonly occurs in those taking medication for a primary headache disorder. The major health and social burden of headaches is caused by primary headache disorders and medication overuse headache. This guideline makes recommendations on the diagnosis and management of the most common primary headache disorders in young people (aged 12 years and older) and adults.

Neutropenic sepsis: prevention and management of neutropenic sepsis in cancer patients

National Institute for Health and Care Excellence (NICE) (Sep 2012)

Neutropenic sepsis is a potentially fatal complication of anticancer treatment (particularly chemotherapy). Mortality rates ranging between 2% and 21% have been reported in adults. Aggressive use of inpatient intravenous antibiotic therapy has reduced morbidity and mortality rates and intensive care management is now needed in fewer than 5% of cases in England. Systemic therapies to treat cancer can suppress the ability of bone marrow to respond to infection. This is particularly the case with systemic chemotherapy, although radiotherapy can also cause such suppression. Chemotherapy is most commonly given in a day-case or outpatient setting so most episodes of obvious sepsis, and fever in a person with potential sepsis, present in the community. People receiving chemotherapy and their carers need to be told about the risk of neutropenic sepsis and the warning signs and symptoms. Neutropenic sepsis is a medical emergency that requires immediate hospital investigation and treatment.

Urinary incontinence in neurological disease: Management of lower urinary tract dysfunction in neurological disease

National Institute for Health and Care Excellence (NICE) (Aug 2012)

The lower urinary tract consists of the urinary bladder and the urethra. Its function is to store and expel urine in a coordinated and controlled manner. The central and peripheral nervous systems regulate this activity. Urinary symptoms can arise due to neurological disease in the brain, the suprasacral spinal cord, the sacral spinal cord or the peripheral nervous system. Damage within each of these areas tends to produce characteristic patterns of bladder and sphincter dysfunction. The nature of the damage to the nervous system is also important.

Antibiotics for early-onset neonatal infection: Antibiotics for the prevention and treatment of early-onset neonatal infection

National Institute for Health and Care Excellence (NICE) (Aug 2012)

Early-onset neonatal bacterial infection (infection with onset within 72 hours of birth) is a significant cause of mortality and morbidity in newborn babies. Parent organisations and the scientific literature report that there can be unnecessary delays in recognising and treating sick babies. In addition, concern about the possibility of early-onset neonatal infection is common. This concern is an important influence on the care given to pregnant women and newborn babies. There is wide variation in how the risk of early-onset neonatal infection is managed in healthy babies.

Caesarean section

National Institute for Health and Care Excellence (NICE) (Aug 2012)

This guideline offers best practice advice on the care of pregnant women who may require a CS.

Lower limb peripheral arterial disease: diagnosis and management

National Institute for Health and Care Excellence (NICE) (Aug 2012)

Lower limb peripheral arterial disease (called peripheral arterial disease throughout this document) is a marker for increased risk of cardiovascular events even when it is asymptomatic. The most common initial symptom of peripheral arterial disease is leg pain while walking, known as intermittent claudication. Critical limb ischaemia is a severe manifestation of peripheral arterial disease, and is characterised by severely diminished circulation, ischaemic pain, ulceration, tissue loss and/or gangrene.

Osteoporosis: assessing the risk of fragility fracture

National Institute for Health and Care Excellence (NICE) (Aug 2012)

Osteoporosis is a disease characterised by low bone mass and structural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. Osteoporosis leads to nearly 9 million fractures annually worldwide, and over 300,000 patients present with fragility fractures to hospitals in the UK each year.

Spasticity in children and young people with non-progressive brain disorders: Management of spasticity and co-existing motor disorders and their early musculoskeletal complications

National Institute for Health and Care Excellence (NICE) (Jul 2012)

This guideline covers the management of spasticity and co-existing motor disorders and their early musculoskeletal complications in children and young people (from birth up to their 19th birthday) with non-progressive brain disorders. Cerebral palsy is the most common condition associated with spasticity in children and young people. The incidence of cerebral palsy is not known, but its prevalence in the UK is 186 per 100,000 population, with a total of 110,000 people affected. The guideline covers the management of spasticity associated with cerebral palsy, but not all aspects of the management of cerebral palsy.

Autism: recognition, referral, diagnosis and management of adults on the autism spectrum

National Institute for Health and Care Excellence (NICE) (Jun 2012)

Autism is a lifelong neurodevelopmental condition, the core features of which are persistent difficulties in social interaction and communication and the presence of stereotypic (rigid and repetitive) behaviours, resistance to change or restricted interests. The way that autism is expressed in individual people differs at different stages of life, in response to interventions, and with the presence of coexisting conditions such as learning disabilities (also called 'intellectual disabilities'). People with autism also commonly experience difficulty with cognitive and behavioural flexibility, altered sensory sensitivity, sensory processing difficulties and emotional regulation difficulties. The features of autism may range from mild to severe and may fluctuate over time or in response to changes in circumstances.

Venous thromboembolic diseases: the management of venous thromboembolic diseases and the role of thrombophilia testing

National Institute for Health and Care Excellence (NICE) (Jun 2012)

The current standard practice for the treatment of VTE is anticoagulation. These drugs “thin” the blood and prevent further clotting. There is a wide variation in practice, but patients are usually given a brief course of heparin treatment initially while they start on a 3–6 month course of warfarin. Patients who have had recurrent VTE or who are at high risk of recurrence may be given indefinite treatment with anticoagulants to prevent further VTE episodes. However, anticoagulation treatment is not without risk, for example, the risk of bleeding, and requires the patient to have regular monitoring blood tests. There is a need for guidance about which patients should have such prolonged treatment and how the monitoring should be performed. In addition, there is a wide variation in practice regarding when to test for thrombophilia after VTE and controversy as to how thrombophilia should be managed if it is found on testing.

Acute upper gastrointestinal bleeding: management

National Institute for Health and Care Excellence (NICE) (Jun 2012)

Acute upper gastrointestinal bleeding is a common medical emergency that has a 10% hospital mortality rate. Despite changes in management, mortality has not significantly improved over the past 50 years. Elderly patients and people with chronic medical diseases withstand acute upper gastrointestinal bleeding less well than younger, fitter patients, and have a higher risk of death. Almost all people who develop acute upper gastrointestinal bleeding are treated in hospital and the guideline therefore focuses on hospital care. The most common causes are peptic ulcer and oesophagogastric varices.

Sickle cell acute painful episode: management of an acute painful sickle cell episode in hospital

National Institute for Health and Care Excellence (NICE) (Jun 2012)

Acute painful sickle cell episodes (also known as painful crises) are caused by blockage of the small blood vessels. The red blood cells in people with sickle cell disease behave differently under a variety of conditions, including dehydration, low oxygen levels and elevated temperature. Changes in any of these conditions may cause the cells to block small blood vessels and cause tissue infarction. Repeated episodes may result in organ damage. Acute painful sickle cell episodes occur unpredictably, often without clear precipitating factors. Their frequency may vary from less than one episode a year to severe pain at least once a week. Pain can fluctuate in both intensity and duration, and may be excruciating. The majority of painful episodes are managed at home, with patients usually seeking hospital care only if the pain is uncontrolled or they have no access to analgesia. Patients who require admission may remain in hospital for several days. The primary goal in the management of an acute painful sickle cell episode is to achieve effective pain control both promptly and safely.

Opioids in palliative care: safe and effective prescribing of strong opioids for pain in palliative care of adults

National Institute for Health and Care Excellence (NICE) (May 2012)

Pain is common in advanced and progressive disease. Up to two-thirds of people with cancer experience pain that needs a strong opioid. This proportion is similar or higher in many other advanced and progressive conditions. Despite the increased availability of strong opioids, published evidence suggests that pain which results from advanced disease, especially cancer, remains under-treated. The guideline will address first-line treatment with strong opioids for patients who have been assessed as requiring pain relief at the third level of the WHO pain ladder. It will not cover second-line treatment with strong opioids where a change in strong opioid treatment is required because of inadequate pain control or significant toxicity.

Infection: Prevention and control of healthcare-associated infections in primary and community care

National Institute for Health and Care Excellence (NICE) (Mar 2012)

This guideline offers best practice advice on the prevention and control of healthcare-associated infections in primary and community care.

Organ donation for transplantation: improving donor identification and consent rates for deceased organ donation

National Institute for Health and Care Excellence (NICE) (Dec 2011)

This guideline offers best practice advice on improving donor identification and consent rates.

Anaphylaxis: assessment to confirm an anaphylactic episode and the decision to refer after emergency treatment for a suspected anaphylactic episode

National Institute for Health and Care Excellence (NICE) (Dec 2011)

This guideline offers best practice advice on the care of adults, young people and children following emergency treatment for suspected anaphylaxis.

Service user experience in adult mental health: improving the experience of care for people using adult NHS mental health services

National Institute for Health and Care Excellence (NICE) (Dec 2011)

This guidance aims to promote person-centred care that takes into account service users' needs, preferences and strengths. People who use mental health services should have the opportunity to make informed decisions about their care and treatment, in partnership with their health and social care practitioners

Hyperglycaemia in acute coronary syndromes: Management of hyperglycaemia in acute coronary syndromes

National Institute for Health and Care Excellence (NICE) (Oct 2011)

This guideline covers the role of intensive insulin therapy in managing hyperglycaemia within the first 48 hours in people admitted to hospital for acute coronary syndromes

Autism diagnosis in children and young people: Recognition, referral and diagnosis of children and young people on the autism spectrum

National Institute for Health and Care Excellence (NICE) (Sep 2011)

This guideline does not cover management of autism but aims to improve recognition, referral and diagnosis, and the experience of children, young people and those who care for them.

Multiple pregnancy: The management of twin and triplet pregnancies in the antenatal period

National Institute for Health and Care Excellence (NICE) (Sep 2011)

This guideline offers best practice advice on the care of women with twin and triplet pregnancies

Hypertension: management of hypertension in adults in primary care

National Institute for Health and Care Excellence (NICE) (Aug 2011)

This clinical guideline (published August 2011) updates and replaces NICE clinical guideline 34 (published June 2006). It offers evidence-based advice on the care and treatment of adults with primary hypertension. New and updated recommendations on diagnosis, antihypertensive drug treatment and treatment monitoring were included in 2011.

Common mental health disorders: Identification and pathways to care

National Institute for Health and Care Excellence (NICE) (May 2011)

The intention of this guideline, which is focused on primary care, is to improve access to services (including primary care services themselves), improve identification and recognition, and provide advice on the principles that need to be adopted to develop appropriate referral and local care pathways. It brings together advice from existing guidelines and combines it with new recommendations concerning access, assessment and local care pathways for common mental health disorders.

Lung cancer: The diagnosis and treatment of lung cancer

National Institute for Health and Care Excellence (NICE) (Apr 2011)

This clinical guideline (published April 2011) updates and replaces NICE clinical guideline 24 (published February 2005). It offers evidence-based advice on the care and treatment of people with lung cancer. New and updated recommendations are included on communication, diagnosis and staging, selection of patients with non-small-cell lung cancer (NSCLC) for treatment with curative intent, surgery with curative intent for NSCLC, smoking cessation, combination treatment for NSCLC, treatment for small-cell lung cancer (SCLC), managing endobronchial obstruction, managing brain metastases, and follow-up and patient perspectives.

Diabetic foot problems: Inpatient management of diabetic foot problems

National Institute for Health and Care Excellence (NICE) (Mar 2011)

This short clinical guideline aims to provide guidance on the key components of inpatient care of people with diabetic foot problems from hospital admission onwards.

Psychosis with coexisting substance misuse: Assessment and management in adults and young people

National Institute for Health and Care Excellence (NICE) (Mar 2011)

This guideline covers the assessment and management of adults and young people (aged 14 years and older) who have a clinical diagnosis of psychosis with coexisting substance misuse.

Colonoscopic surveillance for prevention of colorectal cancer in people with ulcerative colitis, Crohn's disease or adenomas

National Institute for Health and Care Excellence (NICE) (Mar 2011)

This guideline offers best practice advice on the use of colonoscopic surveillance in adults with inflammatory bowel disease (IBD, which covers ulcerative colitis and Crohn's disease) or adenomas

Tuberculosis: Clinical diagnosis and management of tuberculosis, and measures for its prevention and control

National Institute for Health and Care Excellence (NICE) (Mar 2011)

The guideline offers evidence-based advice on the diagnosis and treatment of active and latent tuberculosis in adults and children, and on preventing the spread of tuberculosis, for example by offering tests to people at high risk, and by vaccination. The guideline does not explain tuberculosis or its treatments in detail.

Alcohol-use disorders: Diagnosis, assessment and management of harmful drinking and alcohol dependence

National Institute for Health and Care Excellence (NICE) (Feb 2011)

This guideline makes recommendations on the diagnosis, assessment and management of harmful drinking and alcohol dependence in adults and in young people aged 10–17 years.

Food allergy in children and young people: Diagnosis and assessment of food allergy in children and young people in primary care and community settings

National Institute for Health and Care Excellence (NICE) (Feb 2011)

This guideline offers best practice advice on the care of children and young people with suspected food allergies.

Hypertension in pregnancy. The management of hypertensive disorders during pregnancy

National Institute for Health and Care Excellence (NICE) (Jan 2011)

This clinical guideline offers evidence-based advice on the care and treatment of women who have or are at risk of developing hypertension (high blood pressure) in pregnancy. It contains advice on the diagnosis and management of hypertension during pregnancy, birth and the postnatal period. It also includes advice for women with chronic hypertension who wish to conceive and for women who have had a pregnancy complicated by hypertension.

Generalised anxiety disorder and panic disorder (with or without agoraphobia) in adults: Management in primary, secondary and community care

National Institute for Health and Care Excellence (NICE) (Jan 2011)

This clinical guideline (published January 2011) updates and replaces NICE clinical guideline 22 (published December 2004; amended April 2007). It offers evidence-based advice on the care and treatment of adults with generalised anxiety disorder or panic disorder (with or without agoraphobia. New and updated recommendations on the management of generalised anxiety disorder were included in 2011.

Nocturnal enuresis - the management of bedwetting in children and young people

National Institute for Health and Care Excellence (NICE) (Oct 2010)

This clinical guideline offers evidence-based advice on the assessment, care and treatment of children and young people up to the age of 19 with bedwetting.

Pregnancy and complex social factors - A model for service provision for pregnant women with complex social factors

National Institute for Health and Care Excellence (NICE) (Sep 2010)

The guideline has been developed in collaboration with the Social Care Institute for Excellence. It is for professional groups who are routinely involved in the care of pregnant women, including midwives, GPs and primary care professionals who may encounter pregnant women with complex social factors in the course of their professional duties. It is also for those who are responsible for commissioning and planning healthcare and social services. In addition, the guideline will be of relevance to professionals working in social services and education/childcare settings, for example school nurses, substance misuse service workers, reception centre workers and domestic abuse support workers.

Bacterial meningitis and meningococcal septicaemia: Management of bacterial meningitis and meningococcal septicaemia in children and young people younger than 16 years in primary and secondary care

National Institute for Health and Care Excellence (NICE) (Sep 2010)

This guideline offers best practice advice on the care of children and young people younger than 16 years with bacterial meningitis and meningococcal septicaemia.

Chronic heart failure: Management of chronic heart failure in adults in primary and secondary care

National Institute for Health and Care Excellence (NICE) (Aug 2010)

This clinical guideline (published August 2010) updates and replaces NICE clinical guideline 5 (published July 2003). It offers evidence-based advice on the care and treatment of people with chronic heart failure. New and updated recommendations are included on diagnosis, pharmacological treatment, monitoring and rehabilitation.

Alcohol use disorders: diagnosis and clinical management of alcohol-related physical complications

National Institute for Health and Care Excellence (NICE) (Jun 2010)

The care of adults and young people (aged 10 years and older) who have any health problems that are completely or partly caused by alcohol use

Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults in primary and secondary care (partial update)

National Institute for Health and Care Excellence (NICE) (Jun 2010)

This guidance is for the care and treatment of people with chronic obstructive pulmonary disease (which is usually shortened to COPD) in the NHS in England and Wales. It explains guidance (advice) from NICE (the National Institute for Health and Clinical Excellence). It is written for people with COPD but it may also be useful for their families or carers or for anyone with an interest in the condition.

Antenatal care

National Institute for Health and Care Excellence (NICE) (Jun 2010)

The advice in the NICE guideline covers : the routine care that all healthy women can expect to receive during their pregnancy.

Neonatal jaundice

National Institute for Health and Care Excellence (NICE) (May 2010)

This guideline provides guidance regarding the recognition, assessment and treatment of neonatal jaundice. The advice is based on evidence where this is available and on consensus-based practice where it is not.

Chest pain of recent onset: assessment and diagnosis of recent onset chest pain or discomfort of suspected cardiac origin

National Institute for Health and Care Excellence (NICE) (Mar 2010)

It offers evidence-based advice on the care and support of adults with chest pain thought to be related to the heart. The guideline covers the tests and treatment that should be offered to people while their condition is being diagnosed.

School-based interventions to prevent the uptake of smoking among children

National Institute for Health and Care Excellence (NICE) (Feb 2010)

This guidance is for all those responsible for preventing the uptake of smoking by children and young people aged under 19. This includes those working in the NHS, local authorities, education and the wider public, private, voluntary and community sectors. It may also be of interest to children and young people, their parents or carers and other members of the public. For the purposes of this guidance, ‘schools’ includes ‘extended schools’ (where childcare or informal education is provided outside school hours), pupil referral units, secure training and local authority secure units. It also includes further education colleges.

Venous thromboembolism: reducing the risk

National Institute for Health and Care Excellence (NICE) (Jan 2010)

This guideline examines the risk of venous thromboembolism and assesses the evidence for the effectiveness of primary preventative measures. It provides recommendations on the most clinically and cost effective measures to reduce the risk of venous thromboembolism, whilst considering the potential risks of the various VTE prophylaxis options and patient preferences.

Depression in adults: The treatment and management of depression in adults

National Institute for Health and Care Excellence (NICE) (Oct 2009)

This guideline was first published in December 2004 (NICE, 2004a; NCCMH, 2004) (referred to as the ‘previous guideline’). The present guideline (referred to as the ‘update’) updates many areas of the previous guideline. There are also new chapters on the experience of depression for people with depression and their carers (Chapter 4), and on the treatment and management of subthreshold depressive symptoms (including dysthymia symptoms) (Chapter 13), which were not part of the scope of the previous guideline. Recommendations categorised as ‘good practice points’ in the previous guideline were reviewed for their current relevance (including issues around consent and advance directives). Further details of what has been updated and what is left unchanged can be found at the beginning of each evidence chapter. The scope for the update also included updating two National Institute for Health and Clinical Excellence (NICE) technology appraisals (TAs) on the use of electroconvulsive therapy (ECT) (TA59) and on computerised cognitive behaviour therapy.

Depression with a chronic physical health problem: Treatment and management

National Institute for Health and Care Excellence (NICE) (Oct 2009)

This guideline makes recommendations on the identification, treatment and management of depression in adults aged 18 years and older who also have a chronic physical health problem (such as cancer, heart disease, diabetes, or a musculoskeletal, respiratory or neurological disorder).

Low back pain: Early management of persistent non-specific low back pain

National Institute for Health and Care Excellence (NICE) (May 2009)

This guideline is about the care and treatment that people who have persistent non-specific low back pain can expect from the NHS in England and Wales to help them manage their pain.

Glaucoma: Diagnosis and management of chronic open angle glaucoma and ocular hypertension

National Institute for Health and Care Excellence (NICE) (Apr 2009)

This guideline offers best practice advice on the diagnosis and management of COAG and OHT.

Diarrhoea and vomiting diagnosis, assessment and management in children younger than 5 years caused by gastroenteritis

National Institute for Health and Care Excellence (NICE) (Apr 2009)

This guideline is intended to apply to children younger than 5 years in England and Wales who present to a healthcare professional for advice in any setting. Importantly, it differs from other guidelines in that it was developed using a set of important principles employed for all NICE clinical guidelines. At the outset there was a process of national consultation to determine the key areas of management that should be addressed and to define the exact ‘scope’ of the guideline. Recommendations were based on the best available evidence whenever possible.

Rehabilitation after Critical Illness

National Institute for Health and Care Excellence (NICE) (Mar 2009)

The advice in the NICE guideline covers the care of adults who, as a result of critical illness, have stayed in critical care and need rehabilitation.

Borderline personality disorder: treatment and management

National Institute for Health and Care Excellence (NICE) (Jan 2009)

This guideline covers the care, treatment and support that people with borderline personality disorder should be offered.

Surgical site infection: Prevention and treatment of surgical site infection

National Institute for Health and Care Excellence (NICE) (Oct 2008)

The advice in the NICE guideline covers adults and children who are going to have a cut through the skin for an operation.

Induction of labour

National Institute for Health and Care Excellence (NICE) (Jul 2008)

The purpose of this guideline is to review all aspects of the methodology of induction of labour and the appropriateness of different approaches in the various clinical circumstances that may call for such an intervention.

Inadvertent perioperative hypothermia: The management of inadvertent perioperative hypothermia in adults

National Institute for Health and Care Excellence (NICE) (Apr 2008)

This guidance covers the care and treatment of people who are having an operation in hospital, in the NHS in England and Wales, to reduce their risk of getting cold before, during or after their operation.

Prophylaxis against infective endocarditis - Antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures

National Institute for Health and Care Excellence (NICE) (Mar 2008)

The advice in this NICE guideline covers Patients who are at risk of infective endocarditis.

Surgical management of otitis media with effusion in children

National Institute for Health and Care Excellence (NICE) (Feb 2008)

The guideline has been developed with the aim of providing guidance on the appropriate criteria for referral, assessment and optimum surgical management of children younger than 12 years with a suspected diagnosis of OME’ for use in the NHS in England, Wales and Northern Ireland.

Atopic eczema in children: Management of atopic eczema in children from birth up to the age of 12 years

National Institute for Health and Care Excellence (NICE) (Dec 2007)

Clinical guidelines have been defined as ‘systematically developed statements which assist clinicians and patients in making decisions about appropriate treatment for specific conditions’. This clinical guideline concerns the management of atopic eczema in children from birth up to the age of 12 years. It has been developed with the aim of providing guidance on: • diagnosis and assessment of the impact of the condition • management during and between flares • information and education to children and their families/caregivers about the condition.

Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy): Diagnosis and management of CFS/ME in adults and children

National Institute for Health and Care Excellence (NICE) (Aug 2007)

The guideline covers care provided by healthcare professionals who have direct contact with and make decisions about the care of people with chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy) (CFS/ME). It covers care provided in primary and secondary care, and in specialist centres/teams.

Drug misuse: opioid detoxification

National Institute for Health and Care Excellence (NICE) (Jul 2007)

This guideline has been developed to advise on opioid detoxification for drug misuse. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, service users, a carer and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning high-quality care for people who misuse drugs while also emphasising the importance of the experience of care for people who misuse drugs and their carers (see Appendix 1 for more details on the scope of the guideline).

Drug misuse: psychosocial interventions

National Institute for Health and Care Excellence (NICE) (Jul 2007)

This guideline makes recommendations for the use of psychosocial interventions in the treatment of people who misuse opioids, stimulants and cannabis in the healthcare and criminal justice systems. The patterns of use vary for these drugs, with cannabis the most likely to be used in the UK. Cocaine is the next most commonly used drug in the UK, followed by other stimulants such as amphetamine. Opioids, although presenting the most significant health problem, are used less commonly. A large proportion of people who misuse drugs are polydrug users and do not limit their use to one particular drug. This guideline will not deal with recreational drug use, although opportunistic brief interventions for people who misuse drugs but who are not in formal drug treatment are included. The guideline also does not specifically address drug misuse in pregnancy.

Faecal incontinence: the management of faecal incontinence in adults

National Institute for Health and Care Excellence (NICE) (Jun 2007)

The task of producing a guideline on the management of faecal incontinence in adults has presented challenges, the greatest of which has been the almost complete absence of high quality evidence for most assessment and treatment methods. The guideline development group was therefore faced with a choice: recommending nothing in the absence of good evidence, or doing the best that we could on lesser quality evidence and expert opinion. We chose the latter as we felt that the needs of patients demanded that we at least provide a starting point. But we urge the reader to remember that little of what is contained in this guideline is based on incontrovertible evidence.

Heavy menstrual bleeding

National Institute for Health and Care Excellence (NICE) (Jan 2007)

Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss which interferes with a woman's physical, social, emotional and/or material quality of life. It can occur alone or in combination with other symptoms.

Parkinson’s disease: Diagnosis and management in primary and secondary care

National Institute for Health and Care Excellence (NICE) (Jun 2006)

The NICE clinical guideline on Parkinson's disease covers: - the diagnosis of Parkinson's disease and checking the diagnosis regularly - the way people with Parkinson's disease should receive information - the medicines that can be used - other ways of helping with symptoms - how to care for people whose mental health is affected - the care people with Parkinson's disease should receive at the end of their life

Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition

National Institute for Health and Care Excellence (NICE) (Feb 2006)

The NICE clinical guideline on nutrition support in adults covers the care of patients with malnutrition or at risk of malnutrition, whether they are in hospital or at home. It doesn't cover malnutrition or its treatments in detail.

Neurocritical Care Society

Critical Care Management of Patients Following Aneurysmal Subarachnoid Hemorrhage: Recommendations from the Neurocritical Care Society’s Multidisciplinary Consensus Conference

Neurocritical Care Society (Jul 2011)

The purpose of the consensus conference was to develop recommendations for the critical care management of patients following acute SAH. The complex multi-organ pathophysiology of SAH presents a multitude of clinical challenges which demand attention. For each situation decisions must be made about if, when, and how to intervene. Ideally, each decision would be made based on high quality data; yet the reality is that such data rarely exist. Still, decisions about management must be made. Recommendations were developed based on the literature, a robust discussion regarding the interpretation of the literature, the collective experience of the members of the group and review by an impartial jury.

Neurocritical Care Society (NCS), European Society of Intensive Care Medicine (ESICM), Society for Critical Care Medicine (SCCM), and the Latin America Brain Injury Consortium (LABIC)

Consensus summary statement of the International Multidisciplinary Consensus Conference on Multimodality Monitoring in Neurocritical Care

Neurocritical Care Society (NCS), European Society of Intensive Care Medicine (ESICM), Society for Critical Care Medicine (SCCM), and the Latin America Brain Injury Consortium (LABIC) (Aug 2014)

The Neurocritical Care Society (NCS) in collaboration with the European Society of Intensive Care Medicine (ESICM), the Society for Critical Care Medicine (SCCM), and the Latin America Brain Injury Consortium (LABIC) commissioned a consensus conference on monitoring patients with acute neurological disorders that require intensive care management.

Nurses-European Crohn’s and Colitis Organisation (N-ECCO)

N-ECCO Consensus statements on the European nursing roles in caring for patients with Crohn's disease or ulcerative colitis

Nurses-European Crohn’s and Colitis Organisation (N-ECCO) (Jun 2013)

The N-ECCO Consensus provides clarity on the different nursing roles in caring for patients with Crohn’s disease and ulcerative colitis within Europe. The intention is to identify the position of IBD nurses and provide a consensus on the ideal standard of nursing care that patients with IBD can expect, irrespective of level of training or title.

Primary Care Dermatology Society (PCDS)

Guidance in Dermatology

Primary Care Dermatology Society (PCDS) (Mar 2015)

The Primary Care Dermatology Society (PCDS) has published more than 200 clinical chapters providing pictures and concise guidance about dermatological conditions and their management. These are all available on their website and address many conditions including: Acne, Eczema, Becker's Naevus, Bowen's disease, Chronic Actinic Dermatitis, Fibrous Papule, Kerion, Lichen Planopilaris, Porphyria and Vitiligo..

Royal College of Anaesthetists (RCoA) and College of Emergency Medicine (CEM)

Safe Sedation of Adults in the Emergency Department

Royal College of Anaesthetists (RCoA) and College of Emergency Medicine (CEM) (Nov 2012)

The aim of this document is to set standards for the safe practice of adult sedation in the Emergency Department (ED). This document applies only to sedation within the Emergency Department, and is not intended to be used in any other setting. It is intended to promote collaborative and safe working between specialties to achieve the best possible patient outcomes whilst acknowledging the complexities and risks of providing care to individuals with serious illness and injury. It relates to sedation undertaken by doctors; if other professionals are engaged in the delivery and management of sedation in the Emergency Department, additional local guidance should be provided.

Royal College of Anaesthetists and Royal College of Ophthalmologists

Local anaesthesia for ophthalmic surgery

Royal College of Anaesthetists and Royal College of Ophthalmologists (Feb 2012)

The purpose of these guidelines is to provide information for all members of the ophthalmic team in order to promote safe and effective local anaesthesia for ophthalmic patients. They are intended to apply to practice in the United Kingdom.

Royal College of Obstetricians and Gynaecologists (RCOG)

Reducing the Risk of Venous Thromboembolism during Pregnancy and the Puerperium

Royal College of Obstetricians and Gynaecologists (RCOG) (Apr 2015)

The aim of this guideline is to provide advice, based on clinical evidence where available, regarding the prevention of venous thromboembolism (VTE) during pregnancy, birth and following delivery.

Thromboembolic Disease in Pregnancy and the Puerperium: Acute Management

Royal College of Obstetricians and Gynaecologists (RCOG) (Apr 2015)

The aim of this guideline is to provide information, based on clinical evidence where available, regarding the immediate investigation and management of women in whom venous thromboembolism is suspected during pregnancy or the puerperium.

Chickenpox in Pregnancy

Royal College of Obstetricians and Gynaecologists (RCOG) (Jan 2015)

Varicella, the primary infection with varicella-zoster virus (VZV; human herpesvirus 3), in pregnancy may cause maternal mortality or serious morbidity. It may also cause fetal varicella syndrome (FVS) and varicella infection of the newborn, which includes congenital varicella syndrome (CVS) and neonatal varicella. This guideline addresses the role of varicella vaccination in susceptible women of reproductive age. The guideline also assesses the evidence regarding the maternal and fetal risks of VZV infection in pregnancy and whether or not these complications can be prevented or modified beneficially by the administration of varicella-zoster immunoglobulin (VZIG) or by treatment of infected individuals with aciclovir. This information should guide the prudent use of VZIG, which is manufactured from the plasma of human blood donors and hence is a limited and expensive resource. The management of neonates is outside the scope of this guideline.

Long-term Consequences of Polycystic Ovary Syndrome

Royal College of Obstetricians and Gynaecologists (RCOG) (Nov 2014)

This guideline aims to provide information, based on clinical evidence, to assist clinicians who manage women with polycystic ovary syndrome (PCOS) in advising these women about the long-term health consequences of the syndrome. The advice should be targeted to the individual and the presenting complaints. The delivery of the advice in this document to the patient will need to be done sensitively within the framework of the patient presentation that will differ for each individual. This guideline does not cover infertility associated with PCOS, which has been extensively reviewed elsewhere.

Umbilical Cord Prolapse

Royal College of Obstetricians and Gynaecologists (RCOG) (Nov 2014)

The purpose of this guideline is to describe the prevention, diagnosis and management of cord prolapse. It addresses those women who are pregnant and at high risk or with a diagnosis of cord prolapse in both hospital and community settings. Pregnancies with cord prolapse before 23+0 weeks are not covered by this guideline. All later gestations are covered by the guidance, including those pregnancies at the threshold of viability.

The Management of Women with Red Cell Antibodies during Pregnancy

Royal College of Obstetricians and Gynaecologists (RCOG) (May 2014)

The purpose of this guideline is to provide guidance on the management of pregnant women with red cell antibodies predating the pregnancy or those developing antibodies during pregnancy. The guideline also includes the management of fetal anaemia caused by red cell antibodies, as well as the early management of the neonate at risk of anaemia and/or hyperbilirubinaemia. It does not address the management of the pregnant woman with anti-platelet antibodies or other autoimmune or alloimmune antibodies.

Management of Beta Thalassaemia in Pregnancy

Royal College of Obstetricians and Gynaecologists (RCOG) (Mar 2014)

The purpose of this guideline is to produce evidence-based guidance on the management of women with beta (β) thalassaemia major and intermedia in pregnancy. In this guideline, thalassaemia major women are those who require more than seven transfusion episodes per year and thalassaemia intermedia women are those needing seven or fewer transfusion episodes per year or those who are not transfused. Women who are thalassaemia carriers do not require transfusion. It will include preconceptual, antenatal, intrapartum and postnatal management and contraception in both primary and secondary care settings. It will not cover screening as the British Committee for Standards in Haematology has published guidelines for screening and diagnosis of thalassaemias.

The Investigation and Management of the Small–for–Gestational–Age Fetus

Royal College of Obstetricians and Gynaecologists (RCOG) (Feb 2013)

This guideline identifies risk factors – both major and minor – for a SGA fetus, and presents appropriate screening for a SGA fetus. An algorithm displaying the clinical procedures appropriate for identifying and managing these risk factors for SGA is available. Doppler as a method of SGA screening has now been introduced as a new recommendation. This guideline does not address multiple pregnancies or pregnancies with fetal abnormalities

The Prevention of Early-onset Neonatal Group B Streptococcal Disease

Royal College of Obstetricians and Gynaecologists (RCOG) (Jul 2012)

The purpose of this guideline is to provide guidance for obstetricians, midwives and neonatologists on the prevention of early-onset neonatal group B streptococcal (EOGBS) disease. Prevention of late-onset GBS and treatment of established GBS disease is not considered beyond initial antibiotic therapy.

The Initial Management of Chronic Pelvic Pain

Royal College of Obstetricians and Gynaecologists (RCOG) (May 2012)

The purpose of this guideline is to provide an evidence-based summary for the generalist to facilitate appropriate investigation and management of women presenting for the first time with chronic pelvic pain.

Bacterial Sepsis following Pregnancy

Royal College of Obstetricians and Gynaecologists (RCOG) (Apr 2012)

The purpose of this guideline is to provide guidance on the management of sepsis in the puerperium (i.e. sepsis developing after birth until 6 weeks postnatally), in response to the findings of the Centre for Maternal and Child Enquiries (CMACE) Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom.1 This topic is particularly relevant as there has been a dramatic rise in maternal deaths attributable to group A beta-haemolytic streptococci (GAS) (three in 2000–20022 and 13 in 2006–2008). The most common site of sepsis in the puerperium is the genital tract and in particular the uterus, resulting in endometritis. This guideline covers the recognition of febrile bacterial illness in the postpartum period – including postabortion sepsis – arising in the genital tract or elsewhere, investigations to identify and characterise sepsis in the puerperium, and management strategies. The population covered includes women in the puerperium (i.e. within 6 weeks of giving birth) with suspected or diagnosed bacterial sepsis in primary or secondary care. Sepsis in pregnancy is covered by a parallel guideline. Sepsis arising owing to viral or parasitic agents is outside the scope of this guideline. This guideline excludes mild to moderate illness in primary care.

Bacterial Sepsis in Pregnancy

Royal College of Obstetricians and Gynaecologists (RCOG) (Apr 2012)

The need for a guideline on the management of sepsis in pregnancy was identified by the 2007 Confidential Enquiry into Maternal Deaths.1 The scope of this guideline covers the recognition and management of serious bacterial illness in the antenatal and intrapartum periods, arising in the genital tract or elsewhere, and its management in secondary care. Sepsis arising due to viral, fungal or other infectious agents is outside the scope of this guideline. Bacterial sepsis following pregnancy in the puerperium is the subject of a separate Green-top Guideline. The population covered by this guideline includes pregnant women suspected of, or diagnosed with, serious bacterial sepsis in primary or secondary healthcare.

Shoulder Dystocia

Royal College of Obstetricians and Gynaecologists (RCOG) (Mar 2012)

The purpose of this guideline is to review the current evidence regarding the possible prediction, prevention and management of shoulder dystocia; it does not cover primary prevention of fetal macrosomia associated with gestational diabetes mellitus. The guideline provides guidance for skills training for the management of shoulder dystocia, but the practical manoeuvres are not described in detail.

Antepartum Haemorrhage

Royal College of Obstetricians and Gynaecologists (RCOG) (Nov 2011)

Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby. The most important causes of APH are placenta praevia and placental abruption, although these are not the most common. APH complicates 3–5% of pregnancies and is a leading cause of perinatal and maternal mortality worldwide.1 Up to one-fifth of very preterm babies are born in association with APH, and the known association of APH with cerebral palsy can be explained by preterm delivery.

Management of Suspected Ovarian Masses in Premenopausal Women

Royal College of Obstetricians and Gynaecologists (RCOG) (Nov 2011)

This guideline has been produced to provide information, based on clinical evidence, to assist clinicians with the initial assessment and appropriate management of suspected ovarian masses in the premenopausal woman. It aims to clarify when ovarian masses can be managed within a ‘benign’ gynaecological service and when referral into a gynaecological oncological service should occur. The ongoing management of borderline ovarian tumours is outside the remit of this guideline. The laparoscopic management of highly suspicious or known ovarian malignancies is also outside the scope of this guideline. In addition, the guideline does not specifically address the acute presentation of ovarian cysts or the management of ovarian cysts in pregnant women.

Management of Sickle Cell Disease in Pregnancy

Royal College of Obstetricians and Gynaecologists (RCOG) (Jul 2011)

The purpose of this guideline is to describe the management of pregnant women with sickle cell disease (SCD). It will include preconceptual screening and antenatal, intrapartum and postnatal management. It will not cover the management of women with sickle cell trait.

The Investigation and Treatment of Couples with Recurrent First-trimester and Second-trimester Miscarriage

Royal College of Obstetricians and Gynaecologists (RCOG) (May 2011)

The purpose of this guideline is to provide guidance on the investigation and treatment of couples with three or more first-trimester miscarriages, or one or more second-trimester miscarriages.

Cervical Cerclage

Royal College of Obstetricians and Gynaecologists (RCOG) (May 2011)

Since the 1960s, the use of cerclage has expanded to include the management of women considered to be at high risk of mid-trimester loss and spontaneous preterm birth by virtue of factors such as multiple pregnancy, uterine anomalies, a history of cervical trauma (e.g. conisation or operations requiring forced dilatation of the cervical canal) and cervical shortening seen on sonographic examination. However, the use and efficacy of cerclage in these different groups is highly controversial since there is contradiction in the results of individual studies and meta-analyses. Cerclage remains a commonly performed prophylactic intervention used by most obstetricians despite the absence of a well-defined population for whom there is clear evidence of benefit. Furthermore, there is little consensus on the optimal cerclage technique and timing of suture placement. The role of amniocentesis before emergency (rescue) cerclage insertion and the optimal management following insertion are also poorly defined. Complications are not well documented and often difficult to separate from risks inherent to the underlying condition. The purpose of this guideline is to review the literature and provide evidence-based guidance on the use of cerclage.

Obstetric Cholestasis

Royal College of Obstetricians and Gynaecologists (RCOG) (Apr 2011)

This guideline summarises the evidence for the fetal risks associated with obstetric cholestasis and provides guidance on the different management choices and the options available for its treatment.The wide range of definitions of obstetric cholestasis and the absence of agreed diagnostic criteria make comparisons of the published literature challenging and limit the ability to provide detailed recommendations for specific aspects of care.Areas of uncertainty are highlighted along with recommendations for future research in this field.

Pregnancy and Breast Cancer

Royal College of Obstetricians and Gynaecologists (RCOG) (Mar 2011)

This document aims to provide clinical guidance to health professionals caring for women of childbearing age with a diagnosis or history of breast cancer. The management of pregnancy in relation to breast cancer is multidisciplinary. The guideline will be of value to obstetricians and gynaecologists, fertility specialists and midwives as well as oncologists and breast care nurses.

Royal College of Obstetricians and Gynaecologists (RCOG) and British Gynaecological Cancer Society

Guidelines for the Diagnosis and Management of Vulval Carcinoma

Royal College of Obstetricians and Gynaecologists (RCOG) and British Gynaecological Cancer Society (May 2014)

This document is intended to fulfil several objectives: - To promote a uniformly high standard of care for women with vulval cancer - To define standard approaches to treatment - To encourage gynaecological oncologists to develop and participate in clinical trials involving new approaches to management - To establish auditable standards.

Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Radiologists (RCR)

Clinical recommendations on the use of uterine artery embolisation (UAE) in the management of fibroids

Royal College of Obstetricians and Gynaecologists (RCOG) and Royal College of Radiologists (RCR) (Dec 2013)

This guideline provides guidance on the on the use of uterine artery embolisation (UAE) in the management of fibroids.

Royal College of Obstetricians and Gynaecologists (RCOG)and British Association for Sexual Health and HIV (BASHH)

Management of Genital Herpes in Pregnancy

Royal College of Obstetricians and Gynaecologists (RCOG)and British Association for Sexual Health and HIV (BASHH) (Oct 2014)

This is a joint guideline with the British Association for Sexual Health and HIV (BASHH). It updates existing RCOG guidance on the management of genital herpes in pregnancy.

As the risk of herpes simplex virus (HSV) infection in pregnancy concerns the neonate rather than the mother, the focus of this guideline is on managing maternal infection to reduce the risk of vertical transmission at birth. Guidance is provided according to the type of maternal infection (primary or recurrent) and the gestational age at which infection occurred. The subsequent management of the neonate also reflects the mode of delivery and their condition. New to this guideline are sections on preterm prelabour rupture of membranes (PPROM) and the management of women who are HIV positive, and a clinical algorithm. In addition, a stronger recommendation to offer vaginal birth to women with a recurrent infection has been made.

Royal College of Ophtalmologists

Age-Related Macular Degeneration: Guidelines for Management

Royal College of Ophtalmologists (Sep 2013)

The guidelines are intended to set the standards for best practice in the NHS and in the private sector. They will be useful for education of ophthalmic trainees and those in other disciplines. The guidelines are also intended to give patients, carers and consumer organisations a resource with improved current information.

Diabetic Retinopathy Guidelines

Royal College of Ophtalmologists (Jul 2013)

Diabetic retinopathy is a chronic progressive, potentially sight-threatening disease of the retinal microvasculature associated with the prolonged hyperglycaemia and other conditions linked to diabetes mellitus such as hypertension. The scope of the guidelines is limited to management of diabetic retinopathy with special focus on sight threatening retinopathy.

Abusive Head Trauma and the Eye in Infancy Guidelines 2013

Royal College of Ophtalmologists (Jun 2013)

Non accidental injury (NAI) or non-accidental head injury (NAHI) and shaken baby syndrome (SBS) are terms that have been used synonymously in previous college publications to describe the forms of physical abuse most relevant to the ophthalmologist. Abusive head trauma (AHT) is the currently accepted term and will be used in addition to the previously accepted terminology. This guidance deals with the new literature in the field of abusive head trauma to supplement and update the previous publications produced by the College.

Guidelines for the Management of Strabismus in Childhood

Royal College of Ophtalmologists (Mar 2012)

The aim of strabismus management is to achieve good visual acuity in each eye, restore normal ocular alignment (as near as possible, which may be a small under or over correction) and maximise the potential for sensory cooperation between the two eyes (the development of binocular single vision, which includes 3D vision, or stereopsis). While normal binocular single vision is the goal, sub-normal levels may be useful and may prevent later recurrences.

Cataract Surgery Guidelines

Royal College of Ophtalmologists (Sep 2010)

The aim of these guidelines is to identify good clinical practice, set standards of patient care and safety and provide a benchmark for outcomes within which high quality cataract surgery can be practised. They represent the current understanding of the guideline development group but will not necessarily all remain applicable until the next review in 2015.

Royal College of Paediatrics and Child Health (RCPCH)

Palate examination: Identification of cleft palate in the newborn

Royal College of Paediatrics and Child Health (RCPCH) (Oct 2014)

This guide provides recommendations to health care professionals for optimal examination of the palate during the routine newborn examination to ensure early detection of a cleft palate.

The Differential Diagnosis of Hypernatraemia in Children, with Particular Reference to Salt Poisoning

Royal College of Paediatrics and Child Health (RCPCH) (Sep 2009)

As well as the causes of excessive sodium intake there are a number of other causes of significant hypernatraemia, all due to water depletion. Although hypernatraemia may occur with mineralocorticoid excess, this is mild and it is rarely, if ever, severe enough to constitute a clinical problem.

Royal College of Physicians

National Clinical Guideline for Stroke, fourth edition

Royal College of Physicians (Sep 2012)

This guideline offers evidence-based advice on the management of adults with Stroke, Transient Ischaemic Attack (TIA) or Subarachnoid Haemorrage (SAH)

Diagnosis, management and prevention of occupational contact dermatitis

Royal College of Physicians (Apr 2011)

This guideline aims to provide physicians who work in primary and secondary medical care with a standardised approach to managing CD in patients of working age.

Royal College of Physicians and Royal College of Radiologists

Evidence-based indications for the use of PET-CT in the UK 2013

Royal College of Physicians and Royal College of Radiologists (Feb 2013)

This guidance comprises an up-to-date summary of relevant indications for the use of positron emission tomography – computed tomography (PET-CT), where there is good evidence that patients will benefit from improved disease assessment resulting in altered management and improved outcomes.

Royal College of Physicians and the Faculty of Occupational Medicine

Pregnancy: occupational aspects of management: concise guidance

Royal College of Physicians and the Faculty of Occupational Medicine (Feb 2013)

This Concise Guidance is aimed at clinicians advising healthy women with uncomplicated singleton pregnancies about the relative safety of physical factors at work. Women with comorbidities, a previous adverse obstetric history or complications in the present pregnancy, including multiple pregnancies, should seek specialist advice from their obstetrician or midwife.

Royal College of Psychiatrists and British Association for Psychopharmacology

Benzodiazepines: Risks and benefits. A reconsideration

Royal College of Psychiatrists and British Association for Psychopharmacology (Sep 2013)

Over the last decade there have been further developments in our knowledge of the risks and benefits of benzodiazepines, and of the risks and benefits of alternatives to benzodiazepines. Representatives drawn from the Psychopharmacology Special Interest Group of the Royal College of Psychiatrists and the British Association for Psychopharmacology together examined these developments, and have provided this joint statement with recommendations for clinical practice. The working group was mindful of widespread concerns about benzodiazepines and related anxiolytic and hypnotic drugs. The group believes that whenever benzodiazepines are prescribed, the potential for dependence or other harmful effects must be considered. However, the group also believes that the risks of dependence associated with long-term use should be balanced against the benefits that in many cases follow from the short or intermittent use of benzodiazepines and the risk of the underlying conditions for which treatment is being provided.

Royal College of Radiologists

Standards for intravascular contrast administration to adult patients, Third edition

Royal College of Radiologists (Feb 2015)

The use of intravascular contrast in radiology continues to increase. The potential risks of intravascular administration of contrast must be weighed against the potential benefits. This document aims to provide guidance on how intravascular contrast may be used as safely as possible. These revised guidelines are necessary because of the ever-changing literature about both iodinated contrast media and gadolinium-based contrast agents (GBCAs).

A review of the use of radiotherapy in the UK for the treatment of benign clinical conditions and benign tumours

Royal College of Radiologists (Feb 2015)

In response to the varying numbers of patients in some UK radiotherapy departments being treated for benign conditions, the RCR has undertaken an evidence review with the aim of providing clinicians with a handbook to consult when a patient is referred with a benign condition and to help to raise awareness of the wider potential uses of radiotherapy beyond treating cancer.

Guidelines for nursing care in interventional radiology, Second edition

Royal College of Radiologists (Aug 2014)

This document outlines the issues surrounding interventional radiology nursing support, sets out models for nursing staff and describes the role of the interventional radiology nurse in the management of patients who are undergoing interventional radiology treatment. It has been created to emphasise the importance of nursing support in departments of clinical radiology and to be used by clinical radiologists in discussion with their hospital nurse managers and executive boards, to ensure that they understand the need for proper nursing support availability within individual departments.

Molecular radiotherapy: guidance for clinicians

Royal College of Radiologists (Aug 2014)

The Intercollegiate Standing Committee on Nuclear Medicine (ICSCNM) is committed to the continuing development of molecular radiotherapy. Close liaison between clinicians from a number of different specialties is essential to ensure high-quality service delivery in radionuclide therapy across a range of clinical indications. This document sets out the roles and responsibilities of those who may be involved. It covers the licensing and organisational aspects of handling radioactive isotopes, as well as issues that relate to clinical practice, delegation and team working.

This document aims to:
- Provide guidance for clinical teams delivering molecular radiotherapy and focuses on medical staff
- Define the roles and key responsibilities of specialists involved in delivering molecular radiotherapy
- Emphasise the importance of training, skills and maintenance of competence for all staff involved in caring for patients receiving molecular radiotherapy
- Describe the requirement for close liaison within a skilled multiprofessional team and appropriate infrastructure to ensure high-quality molecular radiotherapy service provision
- Identify the specialists required in multidisciplinary teams delivering specific molecular radiotherapy treatments.

Guidelines for the use of PET-CT in children, Second edition

Royal College of Radiologists (Apr 2014)

The use of positron emission tomography co-registered with computed tomography (PET-CT) in adult oncology, neurology and cardiology is well established. The most common tracer used in clinical PET-CT is 18Fluorine fluorodeoxyglucose (FDG). However, experience with PET-CT in the field of paediatric imaging is limited. In the face of limited published data and experience, this report was compiled by individuals with experience in scanning children with PET-CT in the UK and paediatricians involved in clinical management of the type of conditions for which PET-CT is likely to be used. It represents a consensus reached between the authors of what is desirable ‘best’ practice.

Guidance on screening and symptomatic breast imaging, Third edition

Royal College of Radiologists (Jun 2013)

The document is provided for radiologists and other members of breast teams providing diagnostic, treatment and follow-up services for patients with symptomatic breast problems. Guidance on the role of imaging in breast cancer screening is also included.

Meningioma as a late effect of cancer treatment

Royal College of Radiologists (Apr 2013)

New cranial neoplasms following exposure of the brain to radiation were first recorded over 40 years ago and of these neoplasms, meningiomas are the most common. The risk of meningiomas appears to be highest in those exposed in childhood and ascertainment of meningiomas in this group increases with both time since treatment and radiation dose.

This guidance reviews the late effects of cancer treatment from which survivors of childhood cancer are at particular risk.

Although there is an increased risk of developing meningiomas (and to a lesser extent gliomas) several years after cranial radiotherapy in childhood, routine imaging surveillance for the detection of radiation induced meningiomas is not indicated based on current evidence. Depending on the indication for the radiotherapy, some of these patients will already be on long-term imaging surveillance for their original tumour.

Clinicians and radiologists should have a low threshold for imaging if a patient develops symptoms that may point to a radiation induced intracranial tumour.

Gadolinium enhanced MRI is the imaging modality of choice for detecting radiation induced intracranial tumours including meningiomas.

Royal College of Radiologists and British Society of Gastrointestinal and Abdominal Radiology (BSGAR)

Guidance on the use of CT colonography for suspected colorectal cancer

Royal College of Radiologists and British Society of Gastrointestinal and Abdominal Radiology (BSGAR) (Sep 2014)

The number of CT colonography examinations is increasing in the UK for suspected colon cancer, having now replaced the barium enema as the alternative imaging investigation of choice when colonoscopy is incomplete or the patient is considered unsuitable for colonoscopy. The British Society of Gastrointestinal and Abdominal Radiology (BSGAR) and The Royal College of Radiologists have produced this document to set out the key considerations in using CT colonography for suspected colorectal cancer as well as important guidance on all aspects of establishing a high-quality CT colonography service.

However, there are hurdles in instituting a change in UK practice from BE to CTC, not least that a BE service is largely delivered by radiographers, while CTC places additional pressure on CT workload and consultant reporting time. The purpose of this guidance is to set out some of the key considerations in the use of CTC for suspected colorectal cancer.

Royal College of Radiologists and Society and College of Radiographers

Standards for the provision of an ultrasound service

Royal College of Radiologists and Society and College of Radiographers (Dec 2014)

Ultrasound, if carried out correctly in the appropriate clinical situation, is one of the most effective diagnostic tools in healthcare. It is therefore not surprising that the use of ultrasound has increased markedly over the last ten years and continues to do so. The fact that it is safe to carry out, relatively inexpensive and can be provided in most clinical facilities makes ultrasound one of the most commonly requested examinations in the field of diagnostic imaging.

The RCR and the Society and College of Radiographers have produced this document which sets standards in key areas that are seen as essential for the delivery of high-quality and effective ultrasound imaging services and examinations. The aim is to clarify the components of a clinically safe and efficient ultrasound service. It is relevant to all services that carry out ultrasound and to those individuals responsible for the commissioning of such services.

Royal College of Radiologists, Royal College of Physicians (RCP) and British Society of Cardiovascular Imaging (BSCI)

Standards of practice of computed tomography coronary angiography (CTCA) in adult patients

Royal College of Radiologists, Royal College of Physicians (RCP) and British Society of Cardiovascular Imaging (BSCI) (Dec 2014)

CTCA has become a well recognised imaging technique in the investigation of patients with chest pain. The indications for CTCA are also established and it is part of nationally and internationally recognised imaging pathways. Its clinical utility means that increasing numbers of UK centres are establishing CTCA imaging programmes.

Together with the Royal College of Physicians (RCP) and the British Society of Cardiovascular Imaging (BSCI), The Royal College of Radiologists (RCR) has produced this document, which brings together the latest guidance on departmental standards of practice required to deliver safe computed tomography coronary angiography (CTCA) to adult patients.

Scottish Intercollegiate Guidelines Network (SIGN)

Diagnosis and management of epilepsy in adults

Scottish Intercollegiate Guidelines Network (SIGN) (May 2015)

This guideline provides recommendations based on current evidence for best practice in the diagnosis and management of epilepsy in adults. It does not include patients with a non-epileptic attack disorder.

Management of osteoporosis and the prevention of fragility fractures

Scottish Intercollegiate Guidelines Network (SIGN) (Mar 2015)

This guideline provides recommendations based on current evidence for best practice in the management of osteoporosis and prevention of fractures. It addresses risk factors for fracture, commonly-used tools for assessment of fracture risk, approaches to targeting therapy, pharmacological, and non-pharmacological treatments to reduce fracture risk, treatment of painful vertebral fractures and systems of care. The assessment and prevention of falls is excluded as it was covered by a national resource published by NHS Quality Improvement Scotland in 2010, which aimed to prevent fractures in older people by raising the profile of falls,1and also a clinical guideline published by the National Institute for Health and Care Excellence (NICE) in 2013.2 The guideline also excludes issues surrounding the surgical management of fractures and postoperative care of patients with fractures.

This guideline will be of interest to rheumatologists, endocrinologists, general practitioners (GPs), physicians involved in care of the elderly, orthopaedic surgeons, gynaecologists, specialist nurses involved in the care of patients with osteoporosis and pharmacists.

Management of primary cutaneous squamous cell carcinoma

Scottish Intercollegiate Guidelines Network (SIGN) (Jun 2014)

This evidence based guideline for management of primary cutaneous SCC will: - help practitioners to more reliably identify the high-risk tumours which are most likely to metastasise - help to direct available resources to the management of patients with high-risk SCC, thus reducing the incidence of metastatic SCC. The guideline recommendations will also help address the following concerns: - treatment variability amongst practitioners currently managing SCC - that patients with high-risk SCC are not always referred to MDT meetings - the limitations of the current TNM classification in identifying those SCC most likely to metastasise.

Management of lung cancer

Scottish Intercollegiate Guidelines Network (SIGN) (Feb 2014)

The guideline covers all aspects of the management of patients with small cell lung cancer (SCLC) and nonsmall cell lung cancer (NSCLC), and provides information for discussion with patients and carers.

Management of chronic pain

Scottish Intercollegiate Guidelines Network (SIGN) (Dec 2013)

This guideline provides recommendations based on current evidence for best practice in the assessment and management of adults with chronic non-malignant pain in non-specialist settings. It does not cover: - interventions which are only delivered in secondary care. - treatment of patients with headache - children. While chronic pain occurs in children, some of their treatment options are different to those of adults, and evidence on the paediatric population has not been included in this remit. - underlying conditions. Chronic pain is caused by many underlying conditions. The treatment of these conditions is not the focus of this guideline so the search strategies were restricted to the treatment of chronic pain, not specific conditions.

Management of epithelial ovarian cancer

Scottish Intercollegiate Guidelines Network (SIGN) (Nov 2013)

This guideline provides recommendations based on current evidence for best practice in the management of epithelial ovarian cancer. It excludes the management of borderline tumours.

Treatment of primary breast cancer

Scottish Intercollegiate Guidelines Network (SIGN) (Sep 2013)

This guideline provides recommendations based on current evidence for best practice in the treatment of patients with operable early breast cancer. It includes recommendations on surgery, chemotherapy, radiotherapy, endocrine therapy and other therapies, for example biological therapy. It excludes diagnosis, staging, follow up, and management of patients with metastatic disease. The use of complementary therapies and lifestyle management, including diet are not addressed.

Management of hepatitis C

Scottish Intercollegiate Guidelines Network (SIGN) (Jul 2013)

The guideline provides evidence based recommendations covering all stages of the patient care pathway; screening, testing, diagnosis, referral, treatment, care and follow up of infants, children and adults with, or exposed to, HCV infection. The remit encompasses prevention of secondary transmission of the virus but specifically excludes primary prevention of HCV infection. Primary prevention of hepatitis C infection is an important public health concern but is outwith the remit of this guideline. The principles and evidence for the prevention of blood borne viruses are generalisable and while reviewing this large body of evidence would have been beyond the capacity of the guideline development group, reviewing the HCV evidence alone would have produced a distorted view.

Antithrombotics: indications and management

Scottish Intercollegiate Guidelines Network (SIGN) (Jun 2013)

This update (June 2013) provides a new recommendation for the use of novel oral anticoagulant medication in patients with atrial fibrillation who are at risk of stroke. The full guideline provides recommendations based on current evidence for best practice in the management of adult patients on antithrombotic therapy

Brain injury rehabilitation in adults

Scottish Intercollegiate Guidelines Network (SIGN) (Mar 2013)

The guideline will provide recommendations, where possible, about post-acute assessment for adults over 16 years of age with brain injuries and interventions for cognitive, communicative, emotional, behavioural and physical rehabilitation. Evidence is also presented on important questions relevant to patient outcomes such as optimal models and settings of care, the benefits of discharge planning and the applicability of telemedicine.

Long term follow up of survivors of childhood cancer

Scottish Intercollegiate Guidelines Network (SIGN) (Mar 2013)

This guideline is applicable to all people who have survived cancer in childhood, and who may experience late effects that are related to the treatment received. It is aimed at primary care staff who provide health care for cancer survivors, as well as secondary care and long term follow-up clinic staff.

Management of Schizophrenia

Scottish Intercollegiate Guidelines Network (SIGN) (Mar 2013)

This guideline provides evidence based recommendations for the care and treatment of adults with schizophrenia. Topics include: dual diagnosis, access and engagement, pharmacological interventions, psychological therapies, perinatal issues.

Guidelines on Management of perinatal mood disorders

Scottish Intercollegiate Guidelines Network (SIGN) (Mar 2012)

This guideline provides recommendations based on current evidence for best practice in the management of antenatal and postnatal mood and anxiety disorders. The guideline covers prediction, detection and prevention as well as management in both primary and secondary care. It also outlines the evidence in relation to the use of psychotropic medications in pregnancy and during breastfeeding. This guideline will assist in the development of local evidence based integrated care pathways and networks. The guideline does not cover the management of other disorders which pose particular risks for women, their pregnancies and infants such as schizophrenia, emotionally unstable personality disorder, eating disorders and substance misuse disorders.

Diagnosis and management of colorectal cancer

Scottish Intercollegiate Guidelines Network (SIGN) (Dec 2011)

This guideline updates SIGN 67 and reflects the most recent evidence available

Management of adult testicular germ cell tumours

Scottish Intercollegiate Guidelines Network (SIGN) (Mar 2011)

This guideline provides recommendations based on current evidence for best practice in the management of testicular cancer. It excludes the management of germ cell testicular tumours in children, germ cell tumours in women and extragonadal tumours.

Management of atopic eczema in primary care

Scottish Intercollegiate Guidelines Network (SIGN) (Mar 2011)

This guideline focuses on providing recommendations for the management of atopic eczema in children and adults in primary care, based on current evidence for best practice. It includes advice on the various topical treatments for atopic eczema (including emollients (moisturisers), topical corticosteroids, topical calcineurin inhibitors and dressings), anti-infective treatments (such as antibiotics and antiseptics), antihistamines, complementary therapies and the roles of diet and environmental factors. It excludes treatments that are usually carried out in secondary care, such as phototherapy and systemic immunosuppressant drugs.

Management of early rheumatoid arthritis

Scottish Intercollegiate Guidelines Network (SIGN) (Feb 2011)

This guideline addresses the diagnosis of early RA, its pharmacological treatment including symptom relief and disease modification, and the role of the multidisciplinary team in improving the care of patients with RA. The guideline does not address the treatment of comorbidities (eg anaemia, osteoporosis), complications of drug therapy and their management, or treatment of extra-articular disease (eg vasculitis, ocular complications, amyloid).

Prevention and management of venous thromboembolism

Scottish Intercollegiate Guidelines Network (SIGN) (Dec 2010)

The guideline identifies adult patient groups at risk of VTE and describes the available methods of prophylaxis. Appropriate methods of prophylaxis for specific patient groups are considered in subsequent sections. Important advances in the diagnosis of DVT and PE are described, including the use of diagnostic algorithms incorporating D-dimer assay. Finally, recommendations are made on treatment options for thrombosis in various anatomical regions, including choice of anticoagulant and duration of use, taking account of evidence of risks and benefits of anticoagulant use.

Diagnosis and management of psoriasis and psoriatic arthritis in adults

Scottish Intercollegiate Guidelines Network (SIGN) (Oct 2010)

This guideline provides recommendations based on current evidence for best practice in the diagnosis and management of psoriasis and PsA in adults. It covers early diagnosis of PsA, screening for comorbidities, assessment of disease severity, non-pharmacological treatment, psychological interventions, occupational health, topical treatment, phototherapy, systemic therapy, biologic treatment, referral pathways and the provision of patient information. It excludes psoriasis and PsA in children. Pregnancy and pre-conception care (eg for patients on systemic therapies) are not addressed. Other inflammatory conditions sometimes associated with psoriasis such as palmoplantar pustulosis are not addressed.

Management of chronic venous leg ulcers

Scottish Intercollegiate Guidelines Network (SIGN) (Aug 2010)

This guideline provides evidence based recommendations on the management of venous leg ulcers and examines assessment, treatment and the prevention of recurrence. Evidence on provision of care is also presented. The guideline does not cover detailed management of patients with chronic leg ulcer in the specialist fields of diabetes, vascular surgery or rheumatoid disease, although indications for referral are considered.

Management of patients with stroke: identification and management of dysphagia

Scottish Intercollegiate Guidelines Network (SIGN) (Jun 2010)

This guideline provides recommendations based on current evidence for best practice in the identification and management of dysphagia after stroke. The guideline does not apply to people with neurological conditions other than stroke, or to people with subarachnoid haemorrhage.

Management of patients with stroke: Rehabilitation, prevention and management of complications, and discharge planning

Scottish Intercollegiate Guidelines Network (SIGN) (Jun 2010)

The aim of this national guideline is to assist individual clinicians, primary care teams and hospital departments to optimise their management of stroke patients. The focus is on general management, rehabilitation, the prevention and management of complications and discharge planning, with an emphasis on the first 12 months after stroke.

Management of sore throat and indications for tonsillectomy

Scottish Intercollegiate Guidelines Network (SIGN) (Apr 2010)

This guideline covers diagnosis, pain management, antibiotic use, indications for surgical management and postoperative care for acute and recurrent sore throat in children and adults.

Management of diabetes

Scottish Intercollegiate Guidelines Network (SIGN) (Mar 2010)

This guideline provides recommendations based on current evidence for best practice in the management of diabetes. For people with type 1 and type 2 diabetes recommendations for lifestyle interventions are included, as are recommendations for the management of cardiovascular, kidney and foot diseases

Management of Obesity

Scottish Intercollegiate Guidelines Network (SIGN) (Feb 2010)

This guideline provides evidence based recommendations on the prevention and treatment of obesity within the clinical setting, in children, young people and adults. The focus of prevention is on primary prevention, defined here as intervention when individuals are at a healthy weight and/or overweight to prevent or delay the onset of obesity.

Diagnosis and pharmacological management of Parkinson’s disease

Scottish Intercollegiate Guidelines Network (SIGN) (Jan 2010)

This guideline provides recommendations based on current evidence for best practice in the diagnosis and pharmacological management of PD. It includes comparisons of the accuracy of diagnoses carried out by different healthcare professionals, and the value of different diagnostic tests for differentiating PD from other associated conditions. It includes a comprehensive assessment of pharmacological management of motor and non-motor symptoms associated with PD. It also includes a narrative review of qualitative evidence describing the attitudes, beliefs and opinions of patients with PD across six themes.

Non-pharmaceutical management of depression in adults

Scottish Intercollegiate Guidelines Network (SIGN) (Jan 2010)

The focus of the guideline is to examine the evidence for depression treatments which may be used as alternatives to prescribed pharmacological therapies. Interventions were prioritised for inclusion by the guideline development group if they were known to be delivered, or be under consideration for delivery, by NHS services in Scotland or if, based on the experience of group members, they were interventions which patients asked about or sought outside of the health service.

Management of attention deficit and hyperkinetic disorders in children and young people

Scottish Intercollegiate Guidelines Network (SIGN) (Oct 2009)

The overall aim of this national guideline update is to provide a framework for evidence based assessment and management of ADHD/HKD, from which multidisciplinary and multiagency approaches can be developed locally.

Early management of patients with a head injury

Scottish Intercollegiate Guidelines Network (SIGN) (May 2009)

One aim of the guideline is to determine which patients are at risk of intracranial complications. Another is how to identify which patients are likely to benefit from transfer to neurosurgical care, and who should be followed up after discharge.

Management of genital Chlamydia trachomatis infection

Scottish Intercollegiate Guidelines Network (SIGN) (Mar 2009)

This guideline covers chlamydial infection of the genital tract and rectum. It excludes other sites of infection, eg ocular.

Management of patients with stroke or TIA: assessment, investigation, immediate management and secondary prevention

Scottish Intercollegiate Guidelines Network (SIGN) (Dec 2008)

This guideline replaces SIGN 13 Management of patients with stroke I: Assessment, investigation, immediate management and secondary prevention and SIGN 14 Management of patients with stroke II: Management of carotid stenosis and carotid endarterectomy, which were published in 1997

Control of pain in adults with cancer

Scottish Intercollegiate Guidelines Network (SIGN) (Nov 2008)

This guideline provides recommendations based on current evidence for best practice in the management of pain in adult patients who have cancer. The guideline includes advice mainly concerning pain secondary to the cancer, but many of the principles outlined are applicable to coexisting painful conditions and pain secondary to treatment of the cancer. It excludes the treatment of pain in children under the age of 12.

Diagnosis and management of headache in adults. A national clinical guideline

Scottish Intercollegiate Guidelines Network (SIGN) (Nov 2008)

This guideline provides recommendations based on evidence for best practice in the diagnosis and management of headache in adults. The International Classification of Headache Disorders lists over 200 headache types and a comprehensive review of all headaches is beyond the scope of these guidelines.16 This guideline focuses on the more common primary headaches such as migraine and tension-type headache, and addresses some of the rarer primary headaches which have recognisable features with specific treatments. Secondary headache due to medication overuse is addressed, as the overuse of headache medication can compromise the management of primary headache. “Red flags” for secondary headache are highlighted. A guide to the main investigations used in headache is provided.

Management of acute upper and lower gastrointestinal bleeding

Scottish Intercollegiate Guidelines Network (SIGN) (Sep 2008)

The BSG guidelines for acute variceal and non-variceal haemorrhage were written 8 and 6 years ago and have become dated. Acute upper gastrointestinal bleeding is a major emergency and the recent National, UK-wide audit demonstrated significant deficiencies in service provision and care, and it is therefore appropriate to update the evidence base for managing acutely bleeding patients. The Scottish Inter-collegiate Guideline Network (SIGN) have, this year, published their guideline ‘Management of Acute Upper and Lower GI Bleeding’.

Antibiotic prophylaxis in surgery

Scottish Intercollegiate Guidelines Network (SIGN) (Jul 2008)

The goals of prophylactic administration of antibiotics to surgical patients are to: - reduce the incidence of surgical site infection - use antibiotics in a manner that is supported by evidence of effectiveness - minimise the effect of antibiotics on the patient’s normal bacterial flora - minimise adverse effects - cause minimal change to the patient’s host defences.

Diagnosis and management of chronic kidney disease

Scottish Intercollegiate Guidelines Network (SIGN) (Jun 2008)

This guideline covers three main areas. Firstly, the evidence for the association of specific risk factors with CKD is presented to help identify which individuals are more likely to develop CKD. Secondly, guidance is provided on how to diagnose CKD principally using blood and urine tests. Thirdly, the guideline contains recommendations on how to slow the progression of CKD and how to reduce the risk of cardiovascular disease.

Management of invasive meningococcal disease in children and young people

Scottish Intercollegiate Guidelines Network (SIGN) (May 2008)

This guideline makes recommendations on best practice in the recognition and management of meningococcal disease in children and young people up to 16 years of age. It addresses the patient journey through pre-hospital care, referral, diagnostic testing, disease management, follow-up care and rehabilitation and considers public health issues.

Scottish Intercollegiate Guidelines Network (SIGN) and British Thoracic Society

British Guideline on the Management of Asthma

Scottish Intercollegiate Guidelines Network (SIGN) and British Thoracic Society (Oct 2014)

This guideline provides recommendations based on current evidence for best practice in the management of asthma. It makes recommendations on management of adults, including pregnant women, adolescents, and children with asthma.
The guideline does not cover patients whose primary diagnosis is not asthma, for example those with chronic obstructive pulmonary disease or cystic fibrosis, but patients with these conditions can also have asthma. Under these circumstances many of the principles set out in this guideline will apply to the management of their asthma symptoms.

Society for Endocrinology

Acute Hypercalcaemia - for use in adult patients

Society for Endocrinology (Feb 2013)

Under physiological conditions, serum calcium concentration is tightly regulated. Abnormalities of parathyroid function, bone resorption, renal calcium reabsorption or dihydroxylation of vitamin D may cause regulatory mechanisms to fail and serum calcium may rise. Serum calcium is bound to albumin, and measurements should be adjusted for serum albumin. This guideline aims to take the non-specialist through the initial phase of assessment and management.

Acute Hypocalcaemia - for use in adult patients

Society for Endocrinology (Feb 2013)

Acute hypocalcaemia can be life threatening, necessitating urgent treatment. In severe cases, intravenous calcium forms the mainstay of initial therapy but it is essential to ascertain the underlying cause and commence specific therapy as early as possible. This guideline aims to take the non-specialist through the initial phase of assessment and management.

Pituitary Apoplexy

Society for Endocrinology (Feb 2013)

Classical pituitary apoplexy is a medical emergency and rapid replacement with hydrocortisone maybe life saving. It is caused by haemorrhage and/or infarction of a tumour within the pituitary gland. A high index of clinical suspicion is essential to diagnose this condition as prompt management may be life and vision saving. This guideline aims to take the non-specialist through the initial phase of assessment and management.

UK guidance on the initial evaluation of an infant or an adolescent with a suspected disorder of sex development

Society for Endocrinology (Apr 2011)

The aim of this guidance is to support clinical professionals in the initial evaluation and diagnosis of children with suspected disorders of sex development and to provide a framework to standardise clinical practice throughout the UK. The guidance does not provide information on the clinical management of a condition once a diagnosis has been confirmed. It is of paramount importance that a child with a suspected disorder of sex development is assessed by an experienced multidisciplinary team.

UK Guidelines for the Management of Pituitary Apoplexy

Society for Endocrinology (Oct 2010)

It is hoped that the document will provide guidance for physicians, endocrinologists, neurosurgeons and ophthalmologists. The purpose of the guidelines is to encourage the widespread adoption of harmonized good practice in the diagnosis and management of patients with pituitary apoplexy. The guidelines are also intended to provide a basis for local and national audit and recommendations that are suitable for the audit process have been included in section 9. The document should be considered as guidelines only; it is not intended to serve as a standard of medical care. The doctors concerned must make the management plan for an individual patient.

United Kingdom Haemophilia Centre Doctors’ Organization (UKHCDO)

The diagnosis and management of von Willebrand disease: a United Kingdom Haemophilia Centre Doctors Organization guideline approved by the British Committee for Standards in Haematology

United Kingdom Haemophilia Centre Doctors’ Organization (UKHCDO) (Aug 2014)

The objective of this guideline is to provide healthcare professionals with clear guidance on the diagnosis and management of patients with von Willebrand disease.

Guideline for the diagnosis and management of the rare coagulation disorders

United Kingdom Haemophilia Centre Doctors’ Organization (UKHCDO) (Aug 2014)

The objective of this document is to guide diagnosis and management of patients with rare coagulation disorders (RCD).

Diagnosis and management of acquired coagulation inhibitors: a guideline from UKHCDO

United Kingdom Haemophilia Centre Doctors’ Organization (UKHCDO) (Jul 2013)

Acquired coagulation inhibitors result from immune-mediated depletion or inhibition of a coagulation factor. Inhibitors are most commonly directed against factor VIII (FVIII) and von Willebrand factor (VWF) and inhibitors against other coagulation factors are only occasionally reported. Since the publication of previous guidelines (Laffan et al,2004; Pasi et al, 2004; Hay et al, 2006) substantial new data has been published on acquired FVIII inhibitors, necessitating updated guidelines. The rarity of acquired inhibitors to other coagulation factors means that limited information is available to guide management and the treatment strategies suggested are necessarily by consensus and often extrapolated from data derived from FVIII inhibitors. Inhibitors to VWF will not be covered because a revised von willebrand disease (VWD) guideline is in preparation (Laffan et al, 2004; Pasi et al, 2004).

Diagnosis and treatment of factor VIII and IX inhibitors in congenital haemophilia: (4th edition)

United Kingdom Haemophilia Centre Doctors’ Organization (UKHCDO) (Nov 2012)

This document updates UK Haemophilia Centre Doctors Organization (UKHCDO) guidelines on the management of factor VIII/IX (FVIII/IX) inhibitors in congenital haemophilia (Hay et al, 2000, 2006). Acquired haemophilia is excluded and will be covered separately. Most data apply to FVIII inhibitors and the recommendations for FIX inhibitors are sometimes extrapolated from this. Low titre inhibitors are defined as <5 Bethesda units (BU)/ml and high titre 5 ≥ BU/ml. These guidelines are targeted towards haemophilia treaters in the UK. Not all recommendations may be appropriate for other countries with different health care arrangements and resources.

World Federation of Societies of Biological Psychiatry (WFSBP)

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia. Part 3: Update 2015 Management of special circumstances: Depression, Suicidality, substance use disorders and pregnancy and lactation

World Federation of Societies of Biological Psychiatry (WFSBP) (Apr 2015)

For this 2015 revision, all available publications pertaining to the biological treatment of schizophrenia were reviewed systematically to allow for an evidence-based update. These guidelines provide evidence-based practice recommendations which are clinically and scientifically relevant. They are intended to be used by all physicians diagnosing and treating patients with schizophrenia.

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders. Part 2: Maintenance Treatment of Major Depressive Disorder-Update 2015

World Federation of Societies of Biological Psychiatry (WFSBP) (Feb 2015)

These guidelines for the treatment of unipolar depressive disorders systematically review available evidence pertaining to the biological treatment of patients with major depression and produce a series of practice recommendations that are clinically and scientifi cally meaningful based on the available evidence. These guidelines are intended for use by all physicians assessing and treating patients with these conditions.

Consensus paper of the WFSBP task force on biological markers: Biological markers for alcoholism

World Federation of Societies of Biological Psychiatry (WFSBP) (Aug 2013)

This article presents an overview of the current literature on biological markers for alcoholism, including markers associated with the pharmacological effects of alcohol and markers related to the clinical course and treatment of alcohol-related problems. Many of these studies are well known, while other studies cited are new and still being evaluated.

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Unipolar Depressive Disorders, Part 1: Update 2013 on the acute and continuation treatment of unipolar depressive disorders

World Federation of Societies of Biological Psychiatry (WFSBP) (May 2013)

This 2013 update of the practice guidelines for the biological treatment of unipolar depressive disorders was developed by an international Task Force of the World Federation of Societies of Biological Psychiatry (WFSBP). The goal has been to systematically review all available evidence pertaining to the treatment of unipolar depressive disorders, and to produce a series of practice recommendations that are clinically and scientifi cally meaningful based on the available evidence. The guidelines are intended for use by all physicians seeing and treating patients with these conditions.

The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar Disorders: Update 2012 on the long-term treatment of bipolar disorder

World Federation of Societies of Biological Psychiatry (WFSBP) (Jan 2013)

These guidelines are based on a fi rst edition that was published in 2004, and have been edited and updated with the available scientifi c evidence up to October 2012. Their purpose is to supply a systematic overview of all scientific evidence pertaining to the long-term treatment of bipolar disorder in adults.

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 2: Update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side effects

World Federation of Societies of Biological Psychiatry (WFSBP) (Oct 2012)

These updated guidelines are based on a fi rst edition of the World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia published in 2006. For this 2012 revision, all available publications pertaining to the biological treatment of schizophrenia were reviewed systematically to allow for an evidencebased update. These guidelines provide evidence-based practice recommendations that are clinically and scientifically meaningful. They are intended to be used by all physicians diagnosing and treating people suffering from schizophrenia. Based on the first version of these guidelines, a systematic review of the MEDLINE/PUBMED database and the Cochrane Library, in addition to data extraction from national treatment guidelines, has been performed for this update. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into six levels of evidence (A – F) and fi ve levels of recommendation (1 – 5) (Bandelow et al. 2008a,b, World J Biol Psychiatry 9:242,see Table 1). This second part of the updated guidelines covers long-term treatment as well as the management of relevant side effects. These guidelines are primarily concerned with the biological treatment (including antipsychotic medication and other pharmacological treatment options) of adults suffering from schizophrenia.

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 1: Update 2012 on the acute treatment of schizophrenia and the management of treatment resistance

World Federation of Societies of Biological Psychiatry (WFSBP) (May 2012)

These updated guidelines are based on a fi rst edition of the World Federation of Societies of Biological Psychiatry Guidelines for Biological Treatment of Schizophrenia published in 2005. For this 2012 revision, all available publications pertaining to the biological treatment of schizophrenia were reviewed systematically to allow for an evidence-based update. These guidelines provide evidence-based practice recommendations that are clinically and scientifi cally meaningful and these guidelines are intended to be used by all physicians diagnosing and treating people suffering from schizophrenia. Based on the first version of these guidelines, a systematic review of the MEDLINE/PUBMED database and the Cochrane Library, in addition to data extraction from national treatment guidelines, has been performed for this update. The identified literature was evaluated with respect to the strength of evidence for its efficacy and then categorised into six levels of evidence (A–F; Bandelow et al. 2008b, World J Biol Psychiatry 9:242). This first part of the updated guidelines covers the general. descriptions of antipsychotics and their side effects, the biological treatment of acute schizophrenia and the management of treatment-resistant schizophrenia.

Guidelines for the pharmacological treatment of anxiety disorders, obsessive – compulsive disorder and posttraumatic stress disorder in primary care

World Federation of Societies of Biological Psychiatry (WFSBP) (Jan 2012)

Anxiety disorders are frequently under-diagnosed conditions in primary care, although they can be managed effectively by general practitioners. The World Health Organization (WHO) and American Psychiatric Association (APA) developed specific diagnostic guidelines for the mental disorders in primary care. This publication is a complementary tool – a brief and user friendly diagnostic guideline, developed for general practitioners. It is a short and practical summary of the WFSBP guidelines for the anxiety disorders, obsessive – compulsive disorder (OCD) and posttraumatic stress disorder (PTSD), aiming at providing information about how to use modern medications for managing anxiety disorders in a busy primary care setting.

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Eating Disorders

World Federation of Societies of Biological Psychiatry (WFSBP) (Jun 2011)

The treatment of eating disorders is a complex process that relies not only on the use of psychotropic drugs but should include also nutritional counselling, psychotherapy and the treatment of the medical complications, where they are present. These guidelines make recommendations on the pharmacological treatment of the main 3 eating disorders (EDs): Anorexia nervosa (AN), Bulimia nervosa (BN) and Binge Eating Disorder (BED). Most of the drugs studied have not been approved for the treatment of eating disorders, so their clinical use is, at present, mostly off-label.

The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Substance Use and Related Disorders. Part 2: Opioid dependence

World Federation of Societies of Biological Psychiatry (WFSBP) (Apr 2011)

These practice guidelines for the biological – mainly pharmacological – treatment of opioid dependence were developed by an international task force of the World Federation of Societies of Biological Psychiatry (WFSBP).

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Alzheimer ’s disease and other dementias

World Federation of Societies of Biological Psychiatry (WFSBP) (Feb 2011)

Like with the preceding guidelines of this series (Bauer et al. 2002, Bandelow et al. 2008b), these practice guidelines for the pharmacological treatment of Alzheimer’s disease and other dementias(AD) were developed by an international Task force of the World Federation of Societies of Biological Psychiatry (WFSBP). Their purpose is to provide expert guidance on the pharmacological treatment of dementia based on a systematic overview of all available scientific evidence pertaining to the pharmacologic treatment of AD and other disorders associated with dementia. These guidelines are intended for use by all physicians seeing and treating patients with dementia. Some medications recommended in the present guideline may not be available in all countries.

World Health Organization

Nutritional care and support for patients with tuberculosis

World Health Organization (Jan 2013)

This guideline provides guidance on the principles and recommendations for nutritional care and support of patients with TB as part of their regular TB care. However, it does not consider the provision of food as part of a package of enablers to improve TB treatment adherence or as means to mitigate the negative financial consequences of TB. Member States have requested guidance from the World Health Organization (WHO) on nutritional care and support for patients with TB, in support of their efforts to achieve the Millennium Development Goals. The primary audience for the guideline is health workers providing care to people with TB.

Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus: Abbreviated Report of a WHO Consultation

World Health Organization (Mar 2011)

This report is an addendum to the diagnostic criteria published in the 2006 WHO/IDF report “Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia” , and addresses the use of HbA1c in diagnosing diabetes mellitus. This report does not invalidate the 2006 recommendations on the use of plasma glucose measurements to diagnose diabetes.

Good Clinical Laboratory Practice (GCLP)

World Health Organization (Mar 2009)

It is recommended that the framework outlined in this document be adopted by any organisation that analyses samples generated by a clinical trial. The principles defined in this framework are intended to be applied equally to the analysis of a blood sample for routine safety screening of volunteers (haematology/biochemistry) as to pharmacokinetics or even the process for the analysis of ECG traces. The types of facilities undertaking analyses of clinical samples may include pharmaceutical company laboratories, contract research organisations (CROs), central laboratories, pharmacogenetic laboratories, hospital laboratories, clinics, Investigator sites and specialized analytical services

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