Practical clinical guidance for common conditions and symptoms

Covering over 370 clinical topics for use in primary care, Clarity’s Diagnosis and Treatment Guidance supports confident decision-making at the point of care.

Referenced and linked to source evidence and covering over 1,200 clinical presentations or patient scenarios, this guidance helps healthcare professionals:

  • Reach a diagnosis
  • Prescribe safely
  • Offer safe and effective treatment options or referral for specialist care
  • Create local protocols and guidance

This resource is only available to customers outside of the UK.

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Clinical topics commissioned by National Institute for Health and Care Excellence (NICE) for use in the NHS

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Evidence-based and rigorous content development process

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Continually reviewed and updated, with new topics introduced regularly

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Easily accessible at the point of care

370 +

clinical topics

1,200 +

clinical presentations or patient scenarios

65 +

updates a year

Up to 10

new topics each year

Publication Updates

10 May
Clarity’s Diagnosis and Treatment Guidance May 2022 Update

This update contains 8 significant changes and 18 minor changes.

Significant Changes:
• Trigeminal neuralgia — reviewed. A literature search was conducted in November 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. Updated literature has been incorporated to provide supporting evidence for the guidance. Addition of a differential diagnosis section. Minor changes to prescribing advice in line with manufacturer’s guidance (SmPC for Tegretol). No major changes to the clinical recommendations have been made.

• Headache – assessment — reviewed. A literature search was conducted in February 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The topic has been updated in line with current available literature. The sections on Prognosis, Complications, and Differential diagnosis have been deleted, as content is included elsewhere in this topic or in other Clarity’s DTG topics. No major changes to the clinical recommendations have been made.

• Headache – tension-type — reviewed. A literature search was conducted in February 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The recommendations have been updated in line with current evidence in the literature. The section on QIPP – options for local implementation for nonsteroidal anti-inflammatory drugs (NSAIDs) has been deleted. The recommendations on management in primary care have been updated to include the option of physiotherapy, regular exercise, cognitive behavioural therapy, and/or relaxation techniques for some people.

• Aphthous ulcer — reviewed. A literature search was conducted in March 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made.

• Venous eczema and lipodermatosclerosis — reviewed. A literature search was conducted in March 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of the topic.

• Adverse drug reactions — reviewed. A literature search was conducted in February 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of the topic. No major changes were made to the recommendations.

• Parvovirus B19 infection — reviewed. A literature search was conducted in February 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.

• Post-herpetic neuralgia — reviewed. A literature search was conducted in March 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made.

Minor Changes:
• Multiple myeloma — minor update. Aligned the parameters of levels of moderate hypercalcaemia with the Hypercalcaemia Clarity DTG topic.• Learning disabilities — minor update. New wording added and statement of educational needs has been replaced by education, health and care plan.
• Bronchiectasis — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Whooping cough — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Gonorrhoea — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Asthma — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Lyme disease — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Scarlet fever — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Prostatitis – chronic — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Urethritis – male — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Pelvic inflammatory disease — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Chlamydia – uncomplicated genital — minor update. Drug interactions with azithromycin to include hydroxychloroquine and chloroquine added in line with the manufacturer’s summary of product characteristics.
• Cervical screening — minor update. The section on follow-up screening after hysterectomy has been updated to align with the Public Health England 2021 guidance in Colposcopic diagnosis, treatment and follow up.
• Depression – antenatal and postnatal — minor update. Telephone number for UKTIS has been updated.
• Antiplatelet treatment — minor update. Added adverse effect of bradyarrhythmia and AV block for people taking ticagrelor in line with revised manufacturer’s SPC.
• Neuropathic pain – drug treatment — minor update. Further information about assessment prior to initiation of medication and risk of dependence added in line with NICE [NG215] 2022 Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults.
• Benzodiazepines and Z-drugs — minor update. Further information about assessment prior to initiation of medication and risk of dependence added in line with NICE [NG215] 2022 Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults.
• Opioid dependence — minor update. Further information about assessment prior to initiation of medication and risk of dependence added in line with NICE [NG215] 2022 Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults.

11 Apr
Clarity’s Diagnosis and Treatment Guidance April 2022 Update

This update contains 7 significant changes, 20 minor changes and 1 new topic.

Significant Changes:
• Molloscum contagiosum – reviewed. A literature search was conducted in March 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No changes to clinical recommendations have been made. A section on Risk factors has been added to Background information.

• Breathlessness – reviewed. A literature search was conducted in February 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The topic has undergone some structural changes, but there have been no major changes to the recommendations.

• Cough – acute with chest signs in children – reviewed. A literature search was conducted in February 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The topic has undergone restructuring. No major changes to the recommendations have been made.

• Haematospermia – reviewed. Literature searches were conducted in February 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to recommendations have been made.

• Breastfeeding problems – reviewed. A literature search was conducted in November 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Changes have been made to the section on management of suspected ductal infection to reflect a lack of evidence of the role of bacteria and yeast and to support the judicious use of antimicrobials.

• Hiccups – reviewed. A literature search was conducted in January 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to recommendations have been made.

• Cervical cancer and HPV – reviewed. A literature search was conducted in January 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Some minor structural changes have been made to the topic. The recommendations on assessment and management have been updated in line with current evidence in the literature. A new section on Assessment has been added to the Diagnosis section.

Minor Changes:
• Insomnia – minor update. Link to Mental Health Foundation has been updated.

• Otitis externa – minor update. Cetraxal® (ciprofloxacin 2 mg/mL ear drops solution in a single-dose container) and Cetraxal plus® added to the topical preparations table. Cilodex® removed and generic combined preparation ciprofloxacin and dexamethasone added.

• Sciatica (lumbar radiculopathy) – minor update. The results of a systematic review to determine the accuracy of digital rectal examination (DRE) in people with suspected cauda equina syndrome have been added to the basis for recommendation in the section on diagnosis.

• Immunizations – childhood – minor update. Information that the severe combined immunodeficiency (SCID) screening result should be checked before giving BCG or rotavirus vaccines has been added to this topic in line with UK Health Security Agency (UKHSA) guideline The complete routine immunisation schedule February 2022. A recommendation that people who have not had their first dose of HPV vaccine by the time they are 15 years old should be offered two doses given at least 6 months apart has been added in line with the UK Health Security Agency letter Changing to a 2 dose NHS HPV vaccination schedule for eligible adolescents and adults starting the course after they turn 15 years old, including men who have sex with men (MSM).

• Colic – infantile – minor update. A link to a patient information leaflet has been removed from this topic.

• Otitis media – acute – minor update to incorporate new advice provided in NICE [NG91] Otitis media (acute): antimicrobial prescribing, March 2022. Added advice to follow up people and review treatment if symptoms do not improve within 7 days or worsen at any time. A further recommendation added for children and young people to prescribe ear drops containing an anaesthetic and an analgesic for up to 7 days if an immediate oral antibiotic prescription is not given, and there is no ear drum perforation or otorrhoea. A new prescribing section on phenazone and lidocaine drops, Otigo® has been added.

• Generalized anxiety disorder – minor update. Contraindication to pregabalin use in pregnancy unless the benefits to the mother outweigh the risks to the foetus in line with the manufacturers summary of product characteristics.

• Anticoagulation – oral – minor update. Recommendations on managing people who are undergoing dental treatment and taking DOAC anticoagulants have been added and recommendations on people taking warfarin have been updated in line with the NHS Education for Scotland guidance Management of dental patients taking anticoagulants or antiplatelet drugs.

• Hypertension – minor update to align with the update in NICE [NG136] Hypertension in adults: diagnosis and management. Acute respiratory toxicity has been added as a very rare adverse effect of hydrochlorothiazide in line with the updated manufacturer’s Summary of Product Characteristics.

• Menopause – minor update. Added detail to recommendation regarding progestogen regimes in non-hysterectomised women taking sequential HRT.

• Multiple myeloma – minor update. The basis of recommendation section in management of suspected myeloma has been updated to add evidence to the recommendation that a serum-free light chain assay should be arranged for people with suspected multiple myeloma.

• Hypercholesterolaemia – familial – minor update. Minor text changes have been made to clarify the recommendation to offer a lipid-lowering drug.

• Palliative care – general issues – minor update. Reference to Mari Curie in this topic has been updated to reflect a change in the charity’s name.

• Anaemia – B12 and folate deficiency – minor update. Update to the management of neurological complications added the recommendation to seek advice from a neurologist.

• Giant cell arthritis – minor update. Wegener’s granulomatosis is now known as granulomatosis with polyangiitis.

• Pulmonary embolism – minor update. A typographical error has been corrected.

• Neuropathic pain drug treatment – minor update. Information about the use of pregabalin in pregnancy has been updated in line with the manufacturer’s Summary of Product Characteristics.

• Neck pain – cervical radiculopathy – minor update. The section on red flags has been clarified and updated.

• Neck pain – non-specific – minor update. The section on red flags has been clarified and updated.

• Diabetes type 2 – minor update. Updated renal thresholds for prescribing empagliflozin in line with updated manufacturers summary of product characteristics.

New Topic:
• Rehabilitation after traumatic injury – new topic – this is a new Clarity’s DTG topic. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.

08 Mar
Clarity’s Diagnosis and Treatment Guidance March 2022 Update

This update contains 6 significant changes, 21 minor changes and 1 new topic.

Significant Changes:
• Gingivitis and periodontitis — reviewed. A literature search was conducted in December 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made.

• Scrotal pain and swelling — reviewed. A literature search was conducted in December 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Some minor structural changes have been made to the topic. The recommendations on assessment and management have been updated in line with current evidence in the literature. A prescribing information section has been added to the topic, to include antibiotic treatment options for suspected acute epididymo-orchitis if not managed by a specialist sexual health clinic.

• Prostate cancer — reviewed. A literature search was conducted in January 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.

• Heart failure – chronic — reviewed. A literature search was conducted in January 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Chickenpox — reviewed. A literature search was conducted in September 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to clinical recommendations have been made. Additional information on when to consider admission to hospital for pregnant women with chickenpox has been added in line with updated guidance from Public Health England (Guidance on the investigation, diagnosis and management of viral illness, or exposure to viral rash illness, in pregnancy).

• Cervical cancer and HPV — reviewed. A literature search was conducted in January 2022 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Some minor structural changes have been made to the topic. The recommendations on assessment and management have been updated in line with current evidence in the literature. A new section on Assessment has been added to the Diagnosis section.

Minor Changes:
• Male pattern hair loss (male androgenetic alopecia) — minor update. Information added that while some manufacturers’ patient information leaflets may advise against combination treatment with minoxidil and finasteride, that this combination may be used by specialists.

• Immunizations – childhood — minor update. Information that Gardasil®9 vaccine will replace Gardasil® vaccine from 2022 has been added to this topic. Information added about avoiding live vaccines for children up to 12 months after birth exposed to infliximab during pregnancy.

• Neuropathic pain – drug treatment — minor update. Parkinsonism added as an adverse effect of pregabalin in line with updated manufacturer’s SPC.

• Generalized anxiety disorder — minor update. Parkinsonism added as an adverse effect of pregabalin in line with updated manufacturer’s SPC.

• Opioid dependence — minor update. Information on awareness of signs and symptoms of overdose added in line with revised manufacturer’s SPC.

• Gonorrhoea — minor update. A hyperlink to a patient information leaflet was updated.

• Common cold — minor update. Removed mention of delta variant COVID-19 symptoms in the differential diagnosis section, as this has now been broadened to include other variants.

• Restless legs syndrome — minor update. Added information relating to monitoring people taking ropinirole for the possibility of mania as symptoms have been reported with or without the symptoms of impulse control disorders.

• Deep vein thrombosis — minor update. Information added on a potential adverse effect of enoxaparin, acute generalized exanthematous pustulosis.

• Pulmonary embolism — minor update. Information added on a potential adverse effect of enoxaparin, acute generalized exanthematous pustulosis.

• Hepatitis B — minor update. Added information about the hexavalent hepatitis B vaccine.

• Osteoarthritis — minor update. Removed wording relating to glucosamine status as an over the counter medication.

• Polycystic ovary syndrome — minor update. Removed the information about metformin being contraindicated in pregnancy. The manufacturer’s summary of product characteristics advises that metformin can be taken in pregnancy and the periconception phase if clinically needed.

• Diabetes type 2 — minor update. Added information relating to the use of SGLT-2 inhibitors as an adjunct to treatment for adults with type 2 diabetes and chronic heart failure, atherosclerotic cardiovascular disease based on the updated NICE guideline Type 2 diabetes in adults: management [NG28].

• Seborrhoeic dermatitis — minor update. Information that olive oil may act as a growth medium for Malassezia yeasts has been added.

• Amenorrhoea — minor update. A recommendation that the combined oral contraceptive (COC) pill is an option if amenorrhoea persists for more than 12 months to help manage the risk of osteoporosis has been removed from this topic in line with the Endocrine Society guideline Functional hypothalamic amenorrhea: an Endocrine Society clinical practice guideline.

• Whooping cough — minor update. Links to key therapeutic topic guidance removed as service has been retired.

• Back pain – low (without radiculopathy) — minor update. Links to key therapeutic topic guidance removed as service has been retired.

• Boils, carbuncles, and staphylococcal carriage — minor update. Links to key therapeutic topic guidance removed as service has been retired.

• Depression — minor update. Links to key therapeutic topic guidance removed as service has been retired.

• Post-herpetic neuralgia — minor update. Links to key therapeutic topic guidance removed as service has been retired.

New Topic:
• Faecal incontinence in adults — this is a new Clarity’s DTG topic. The evidence base has been reviewed in detail and recommendations are clearly justified and transparently linked to the supporting evidence.

08 Feb
Clarity’s Diagnosis and Treatment Guidance February 2022 Update

This update contains 9 significant changes and 15 minor changes.

Significant Changes:
• Constipation — reviewed. A literature search was conducted in December 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to recommendations have been made.

• Diverticular disease — reviewed. A literature search was conducted in December 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.

• DMARDs — reviewed. A literature search was conducted in November 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.

• Head lice — reviewed. A literature search was conducted in October 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made.

• Insect bites and stings — reviewed. A literature search was conducted in November 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made.

• Nausea/vomiting in pregnancy — reviewed. A literature search was conducted in November 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of the topic. The recommendations have been updated in line with the National Institute for Health and Care Excellence (NICE) guidance Antenatal care (NICE 2021) and other current evidence in the literature. The definition of hyperemesis gravidarum has been amended, as ketonuria is no longer required to make the diagnosis, in line with the Royal College of Obstetricians and Gynaecologists (RCOG) Green-top guideline The management of nausea and vomiting of pregnancy and hyperemesis gravidarum (2016). In the Management Scenario, the Drug treatments section has been amended to include chlorpromazine as an option in line with NICE 2021 and RCOG 2016 guidance, and doxylamine with pyridoxine as an option, in line with NICE 2021 guidance. The Prescribing information section has been amended accordingly.

• Postnatal care — this is a new topic. A literature search was conducted in September 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials. The evidence-base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.

• Pre-patellar bursitis — reviewed. A literature search was conducted in October 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to clinical recommendations have been made.

• Safeguarding adults in care homes — this is a new topic. A literature search was conducted in October 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials. The evidence-base has been reviewed in detail, and recommendations clearly justified and transparently linked to the supporting evidence.

Minor Changes:
• Analgesia – mild to moderate pain — minor update. Clarified the basis for recommending paracetamol dose reduction in people with risk factors for hepatotoxicity and paracetamol overdose, including those who weigh less than 50 kg.

• Angina — minor update. QT-interval prolongation and elevated creatinine levels have been added as uncommon adverse effects of ivabradine.

• Atrial fibrillation — minor update. A minor typographical error has been corrected.

• Candida – female genital — minor update. Information that topical imidazole preparations may damage latex condoms and diaphragms has been added to the management section of this topic.

• Cervical screening — minor update. The section on follow-up screening after CIN treatment has been updated to align with the Public Health England (PHE) guidance Cervical screening: programme and colposcopy management to incorporate details of primary HPV screening.

• Chronic kidney disease — minor update. A typographical error has been corrected.

• Dental abscess — minor update. The dose of amoxicillin has been updated in line with the Public Health England document Summary of antimicrobial prescribing guidance – managing common infections.

• Depression — minor update. A minor typographical error has been corrected.

• Lipid modification – CVD prevention — minor update. Information that ezetimibe with bempedoic acid can be considered for people taking ezetimibe monotherapy if it alone does not control low-density lipoprotein cholesterol well enough has been added to this topic in line with the NHS England Summary of National Guidance for Lipid Management for Primary and Secondary Prevention of CVD.

• Male pattern hair loss — minor update. Added a reference to a patient leaflet which advises against concomitant prescribing of minoxidil and finasteride.

• Parkinson’s disease — minor update. Clarification on the provenance of the information relating to the fact that oral monoamine oxidase-B (MAO-B) inhibitors (selegiline, rasagiline, or safinamide) — do not cause an interaction after consumption of tyramine-rich foods. Links to the manufacturers SPC and a textbook of neurology have been added.

• Prostatitis – chronic — minor update. A broken hyperlink has been updated.

• Stroke and TIA — minor update. Typographical error in spelling corrected.

• Varicocele — minor update. New evidence demonstrates no laterality of increased risk of retroperitoneal cancer with varicocele.

• Glaucoma — minor update. Revised and updated to include first line therapeutic changes in secondary care management of glaucoma. If people have an intraocular pressure of 24mmHg or more and are at risk of visual impairment first line treatment is 360° selective laser trabeculoplasty. This recommendation is based on the NICE guideline [NG 81] Glaucoma: diagnosis and management.

07 Dec
Clarity’s Diagnosis and Treatment Guidance December 2021 Update

This update contains 9 significant changes and 7 minor changes.

Significant Changes:
• Herpes simplex – ocular — reviewed. A literature search was conducted in October 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made.

• Herpes simplex – oral — reviewed. A literature search was conducted in September 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made.

• Otitis externa — reviewed. A literature search was conducted in August 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The Scenario on Localized otitis externa has been removed, as content is covered in the Clarity’s DTG topic on Boils, carbuncles, and staphylococcal carriage. The recommendations have been updated in line with current evidence in the literature. The Prescribing information section has been updated, and information on oral flucloxacillin and clarithromycin has been removed, as oral antibiotics are not routinely needed in primary care for the management of uncomplicated acute otitis externa, in line with current evidence in the literature.

• Stroke and TIA — reviewed. A literature search was conducted in September 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.

• Malaria — reviewed. A literature search was conducted in October 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to clinical recommendations have been made.

• Sciatica (lumbar radiculopathy) — reviewed. A literature search was conducted in October 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to clinical recommendations have been made.

• Male pattern hair loss (male androgenetic alopecia) — reviewed. A literature search was conducted in July 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to clinical recommendations have been made, but the title of the topic has been changed from ‘Alopecia, androgenetic – male’ to ‘Male pattern hair loss (male androgenetic alopecia)’.

• Antenatal care – uncomplicated pregnancy — reviewed. A literature search was conducted in July 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. This topic has been updated in line with new NICE guidance on Antenatal care [NG201] which replaces the previous NICE guideline Antenatal care for uncomplicated pregnancies [CG62].

• Morton’s neuroma — reviewed. A literature search was conducted in October 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to recommendations have been made.

Minor Changes:
• Chronic obstructive pulmonary disease — minor update. Dosage recommendations for salbutamol dry powder inhalers have been clarified.

• Anaemia – iron deficiency — minor update. Recommendations for people who experience adverse effects of iron supplements have been clarified.

• Palliative care – cough — minor update. Adverse effect of pholcodine added relating to the possibility of a severe skin reaction, including acute generalized exanthematous pustulosis.

• Coronavirus – COVID-19 — minor update. The section on managing the long-term effects has been updated in line with the recently updated NICE guideline COVID-19 rapid guideline: managing the long-term effects of COVID-19.

• Female pattern hair loss (female androgenetic alopecia) — minor update. Title of the topic has been changed from ‘Alopecia, androgenetic – female’ to ‘Female pattern hair loss (female androgenetic alopecia)’.

• Obstructive sleep apnoea syndrome — minor update. Broken link updated.

• Delirium — minor update. The status of haloperidol has been updated as previously it was designated as an off-label indication for the treatment of delirium but this has been revised as haloperidol is now licensed for the treatment of acute delirium when non-pharmacological treatments have failed.

09 Nov
Clarity’s Diagnosis and Treatment Guidance November 2021 Update

This update contains 6 significant changes and 4 minor changes.

Significant Changes:
• Alopecia, androgenic – female — reviewed. A literature search was conducted in June 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No major changes to clinical recommendations have been made.

• Candida – female genital — reviewed. A literature search was conducted in June 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of the topic. The terms ‘uncomplicated’ and ‘complicated’ vulvovaginal candidiasis are no longer recommended in the British Association for Sexual Health and HIV (BASHH) national guideline on vulvovaginal candidiasis (2019), and the definition section has been amended accordingly.
The recommended treatment regimens for acute vulvovaginal candidiasis and for women with uncontrolled diabetes or other causes of immunocompromise have been updated, in line with the BASHH national guideline on vulvovaginal candidiasis (2019). The Scenarios on ‘Severe infection’ and ‘Uncontrolled diabetes or immunocompromised’ have been deleted, and their content incorporated into other Scenarios, for clarity and ease of navigation. The Prescribing Information section has been updated.

• Common cold — reviewed. A literature search was conducted in June 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made.

• Immunizations – seasonal influenza — reviewed. A literature search was conducted in October 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. A recommendation that children aged over 2 years with a history of severe anaphylaxis to egg who have previously required intensive care management in hospital can be offered the egg-free cell-based quadrivalent influenza vaccine (QIVc) as an alternative to referral to a specialist for immunization in hospital has been added to this topic. A section has been added summarising the preferred vaccines by age range and other relevant characteristics.

• Non-alcoholic fatty liver disease (NAFLD) — reviewed. Updated evidence on prevalence, aetiology, complications, diagnosis, and management.

• Tiredness/fatigue in adults — reviewed. Updated to include the recommendations from the NICE guideline Myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management [NG206]. Changes include the range of blood tests which are recommended in assessing a person with suspected CFS, the timescale for referral, the range of supportive measures which should be considered and the follow up recommended in primary care.

Minor Changes:
• Vitamin D deficiency in adults — minor update. The dose of vitamin D required for maintenance therapy has been repeated for clarity in the recommendations for people not requiring a loading dose.

• Anaemia – iron deficiency — minor update. The topic has been updated in line with the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults [Snook, 2021].

• Contraception – assessment — minor update. Information that a progestogen-only injectable can be considered a highly effective method of contraception for women taking known teratogenic drugs if repeat injections are documented as having been administered on schedule by a healthcare professional has been added for clarity.

• Atrial fibrillation — minor update. A minor typographical error has been corrected.

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