Agilio: Diagnosis and Treatment Guidance

10th December 2024

Agilio: Diagnosis and Treatment Guidance

This update contains 8 significant changes, 15 minor changes and 1 new topic.

Significant changes:

• Bedwetting (enuresis) — reviewed and updated. A literature search was conducted in November 2024 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.
• Blepharitis — reviewed. A literature search was conducted in July 2024 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.
• Hirsutism — reviewed and updated. A literature search was conducted in October 2024 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.
• Infectious mononucleosis (glandular fever) — reviewed. A literature search was conducted in October 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The topic title has been changed from Glandular fever (infectious mononucleosis) to Infectious mononucleosis (glandular fever), to reflect common terminology in the literature. The age cut-off below which to arrange Epstein-Barr virus (EBV) serology testing in children has been changed from 12 years to 4 years, in line with the Public Health England publication UK Standards for microbiology investigations. Epstein-Barr virus serology(PHE 2019). The information on treatments which are not recommended have been removed from the Management section.
• Psychosis and schizophrenia — reviewed. A literature search was conducted in October 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. There were no major changes to the recommendations.
• Raynaud’s phenomenon — reviewed. A literature search was conducted in September 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The recommended dose of sustained-release nifedipine for drug prophylaxis has been amended, in line with the consensus best practice pathway of the UK Scleroderma Study Group (2015). The prescribing information section has been updated and expanded, in line with current Prodigy style. No major changes to recommendations have been made.
• Trichomoniasis — reviewed. A literature search was conducted in September 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. There have been minor structural changes to the topic. Information on the risk factors, prognosis, and differential diagnosis have been added. There have been changes to the recommendation on the diagnosis of trichomoniasis to include information on sampling using nucleic acid amplification testing. There have been no major changes to recommendations on management.
• Styes (hordeola) — reviewed. A literature search was conducted in July 2024 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 the recommendations have been made.

Minor updates:

• Cellulitis — minor update. A recommendation to advise people to use emollients to prevent dry and cracking skin has been added to the management section.
• Contraception – progestogen-only methods— minor update. Information that the depot medroxyprogesterone acetate (DMPA) intramuscular injection can be given every 13 weeks, but this dosing interval is off-label, has been added to the Summary, in line with the FSRH guideline Progestogen-only injectables. Information on follow-up for people taking drospirenone with mild/moderate renal insufficiency or with treated hypoaldosteronism has been added in line with the FSRH guideline Progestogen-only pills.
• Constipation — minor update. Information that naldemedine is an option for people with opioid-induced constipation has been added in line with the NICE technology appraisal Naldemedine for treating opioid-induced constipation.
• Diabetes – type 2— minor update.  Added information regarding the need for further evaluation of black people with known or potential sickle cell trait and the interpretation of HbA1c results, which may underestimate past glycaemia.
• Endometriosis — minor update. The diagnosis section has been updated in line with the updated NICE guideline Endometriosis: diagnosis and management.
• Epilepsy — minor update. Clarification of use of copper intrauterine devices to be preferred for women of childbearing age receiving enzyme-inducing antiepileptic drugs.
• Immunizations – seasonal influenza — minor update. Minor typographical error corrected in the summary section.
• Menopause— minor update. Updated to reflect the new guidance in NICE Menopause: identification and management [NG23], November 2024. Specifically relating to the risk and benefits of HRT.
• Menorrhagia (heavy menstrual bleeding) — minor update. The drug interactions section for tranexamic acid has been updated.
• Migraine— minor update. Wording update to information regarding atogepant to align with NICE technology appraisal.
• Osteoporosis – prevention of fragility fractures — minor update. Recommendations from the updated National Osteoporosis Guideline Group (NOGG) Clinical guideline for the prevention and treatment of osteoporosishave been incorporated into this topic.
• Palliative care – constipation — minor update. Information that naldemedine is an option for people with opioid-induced constipation has been added in line with the NICE technology appraisal Naldemedine for treating opioid-induced constipation.
• Seborrhoeic dermatitis — minor update. Revised advice on the potency of topical steroids to use when treating seborrhoeic dermatitis.
• Shingles — minor update. Added further link to management of people with shingles of the head and neck advising specialist management or admission to hospital.
• Urinary tract infection (lower) – women — minor update. Added information on MSU screening at booking appointments in intermediate and high-risk pregnancies to align with the NHS England document Saving babies’ lives: version 3 A care bundle for reducing perinatal mortality.

New Topic:

• Functional neurological disorder — new topic. A literature search was conducted in August 2024 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.

12th November 2024

Agilio: Diagnosis and Treatment Guidance

8th October 2024

Agilio: Diagnosis and Treatment Guidance

This update contains 9 significant changes and 20 minor changes.

Significant Changes:

• Bipolar disorder — reviewed and updated. A literature search was conducted in July 2024 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.
• Cholesteatoma — reviewed. A literature search was conducted in July 2024 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 minor restructuring, to improve clarity and navigation. No major changes to recommendations have been made.
• Healthcare-associated infections — reviewed. A literature search was conducted in June 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic.
• Hypercalcaemia — reviewed. A literature search was conducted in July 2024 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 undergone minor restructuring. The definitions of severity have been slightly amended in line with current literature. This is a condition which usually involves referral to secondary care, and an attempt has been made to clarify recommendations for primary care clinicians based on or extrapolated from available guidelines and expert opinion.
• Leg ulcer – venous — reviewed. A literature search was conducted in July 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. There have been minor structural changes to align the topic with recommendations provided in updated literature sources.
• Neutropenic sepsis — reviewed. A literature search was conducted in June to August 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. There have been no major changes to the recommendations. Quality statements temporarily removed from this topic due to ongoing updates to NICE guidelines on sepsis, which underpin the quality statements.
• Roundworm — reviewed. A literature search was conducted in July 2024 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.
• Scarlet fever — reviewed. A literature search was conducted in September 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic.
• Self-harm — reviewed. A literature search was conducted in July 2024 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.

Minor Changes:

• Addison’s disease — minor update. Information about the interpretation of cortisol levels from the NICE guideline Adrenal insufficiency: identification and management has been incorporated into the diagnosis section of this topic.
• Attention deficit hyperactivity disorder — minor update. Minor text changes have been made in the section on Definitions.
• Alopecia areata — minor update. Ritlecitinib added to the specialist management options for severe alopecia areata.
• Atrial fibrillation — minor update. Minor typographical error corrected in the QOF indicators section.
• Chlamydia – uncomplicated genital — minor update. Information on asymptomatic screening in people aged under 25 years has been updated in line with the National Chlamydia Screening Programme.
• Chronic kidney disease — minor update. A minor typographical error has been corrected.
• Common musculoskeletal presentations in children — minor update. The name of the topic changed to ‘common musculoskeletal presentations in children’ from ‘developmental rheumatology in children’.
• Corticosteroids – topical (skin), nose, and eyes — minor update. Information relating to the potency of topical corticosteroids has been updated to reflect the new MHRA potency labeling system for topical corticosteroids.
• CVD risk assessment and management — minor update. Recommendations on physical activity have been clarified.
• Epilepsy — minor update. A new section about contraceptive advice to give men with epilepsy has been added in line with the MHRA drug safety update Valproate use in men: as a precaution, men and their partners should use effective contraception.
• Hand, foot, and mouth disease — minor update. Typographical error was corrected.
• Immunizations – seasonal influenza — minor update. Topic has been updated to reflect August updates made in the UKHSA publication National protocol for inactivated influenza vaccine.
• Lipid modification – CVD prevention — minor update. Added recommendation on adding icosapent ethyl.
• Measles — minor update. Revised information on management and contacts to align with the NHS England guidance Measles guidance for primary, community care, emergency departments and hospital.
• Migraine — minor update. Revised wording on typical migraine symptoms.
• Polycythaemia/erythrocytosis — minor update. Revised advice on management of apparent erythrocytosis to advise that these people need no further investigations.
• Prostate cancer — minor update. Added AoMRC reference to the assessment table for PSA level.
• Seborrhoeic dermatitis — minor update. Information relating to the potency of topical corticosteroids has been updated to reflect the new MHRA potency labeling system for topical corticosteroids.
• Sepsis — minor update. Quality statements temporarily removed from this topic due to ongoing updates to NICE guidelines on sepsis, which underpin the quality statements.
• Shingles — minor update. Information about severely immunosuppressed individuals who received Zostavax prior to becoming immunosuppressed has been added in line with an update to the UKHSA Shingles vaccination guidance.

10th September 2024

Agilio: Diagnosis and Treatment Guidance

This update contains 7 significant changes and 30 minor changes.

Significant Changes:

• Cerebral palsy — reviewed. A literature search was conducted in June 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. There have been no major changes to the recommendations.
• Cow’s milk protein allergy in children — reviewed. A literature search was conducted in July 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic.
• Gallstones — reviewed. A literature search was conducted in April 2024 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.
• Hepatitis A — reviewed. A literature search was conducted in May 2024 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.
• Prostatitis – chronic — reviewed. A literature search was conducted in June 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.
• Retinal detachment — reviewed. A literature search was conducted in July 2024 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 undergone minor restructuring, and the recommendations on the diagnosis, assessment and management of suspected retinal detachment have been updated to align with current evidence.
• Superficial vein thrombosis (superficial thrombophlebitis) — reviewed. A literature search was conducted in June 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The recommendations have been updated in line with current evidence in the literature, including to consider arranging urgent duplex ultrasound scan if there is suspected superficial vein thrombosis of the lower limb. Minor structural changes have been made to improve clarity and navigation.

Minor Changes:     

• Anaemia – iron deficiency — minor update. The summary updated to include FIT testing referral criteria and to align with the management section on referral.
• Angio-oedema and anaphylaxis— minor update. Details of updated NICE quality standards have been added to this topic.
• Bites – human and animal — minor update. An adverse effect of co-amoxiclav has been added as per the manufacturer’s SPC.
• Bronchiectasis — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
• Cellulitis – acute — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
• Chronic kidney disease — minor update. Examples of structural abnormalities, and other abnormalities due to tubular disorders have been added to the bullet point on markers of kidney damage in the section on Definition.
• Chronic obstructive pulmonary disease — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
• Contraception – combined hormonal methods — minor update. Added information on drug interaction between tirzepatide and oral contraceptives in line with advice from the MHRA and an update to the manufacturer’s summary of product characteristics.
• Contraception – emergency— minor update. Removed information about IUS expiry after 6 years for Mirena® as this is licensed for 8 years of contraception.
• Contraception – IUC — minor update. Length of use of LNG-IUD revised to 8 years maximum for Levosert® in line with an update to the manufacturer’s summary of product characteristics.
• Contraception – progestogen-only methods — minor update. Added information on drug interaction between tirzepatide and oral contraceptives in line with advice from the MHRA and an update to the manufacturer’s summary of product characteristics.
• Cough – acute with chest signs in children — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
• Diabetes – type 2— minor update. Added information on drug interaction between tirzepatide and oral contraceptives in line with advice from the MHRA and an update to the manufacturer’s summary of product characteristics. Information that HbA1c may be used to diagnose type 2 diabetes in children and young people has been added to this topic in line with the updated International Society for Pediatric and Adolescent Diabetes (ISPAD) guideline.
• Epilepsy — minor update. Broken links updated to MHRA information on topiramate in pregnancy.
• Heart failure – chronic — minor update. Update in wording on monitoring eGFR and creatinine after starting or titrating of renin-angiotensin system antagonists.
• Hypothyroidism — minor update. Minor typographical error corrected.
• Immunizations – seasonal influenza — minor update. Topic has been updated to reflect August updates made in the UKHSA publication National protocol for inactivated influenza vaccine.
• Mastitis and breast abscess — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC. Added information about considering the use of cold compresses for retroareolar inflammation.
• Migraine — minor update. A typographical error has been corrected.
• Neuropathic pain – drug treatment— minor update. Removed information regarding capsaicin cream as it is currently unavailable.
• Obesity — minor update. Added information about endoscopic sleeve gastroplasty as an option for people who may be high risk for bariatric surgery, who decline bariatric surgery because of the associated risk, or where this procedure may prevent progression of obesity and associated comorbidities. Added information about tirzepatide (Mounjaro®) and risks of interaction with oral contraception in individuals who are overweight or obese.
• Otitis media – acute — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
• Post-herpetic neuralgia — minor update. Removed capsaicin cream recommendation, as this is currently unavailable.
• Prostate cancer — minor update. Following communication from an expert reviewer the topic has been updated to include recent research specifically on the asymptomatic nature of the presentation of prostate cancer, mortality and ethincity, prognostic models, change of terminology from Gleason score to Grade Group, additional information about PSA testing in men over the age of 79, and refinements to the outline of the active surveillance approach and applicability to different Cambridge Prognostic Groups.
• Pyelonephritis – acute — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
• Restless legs syndrome — minor update. Adverse effects of pramipexole updated in line with updated manufacturer’s SPC.
• Scrotal pain and swelling — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
• Sepsis — minor update. A minor typographical error has been corrected.
• Sinusitis — minor update. Adverse effects of co-amoxiclav updated in line with manufacturer’s SPC.
• Smoking cessation — minor update. Alopecia added as an adverse effect of bupropion, in line with the manufacturer’s updated SPC.

13th August 2024

Agilio: Diagnosis and Treatment Guidance

This update contains 8 significant changes and 14 minor changes.

Significant Changes:

•Developmental rheumatology in children — reviewed. A literature search was conducted in May 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic. A section on assessment has been added. Additional detail has been added in the management section for situations where GP reassurance and advice may be sufficient and no referral is necessary. Although there is no nationally agreed guidance for this area, the recommendations made have been linked to the supporting evidence, including local NHS referral guidance and expert opinion in review articles.
•Eating disorders — reviewed. A literature search was conducted in June 2024 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.
•Endometriosis — A literature search was conducted in May 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic. The topic is in line with the 2024 updated National Institute for Health and Care Excellence (NICE) guideline Endometriosis: diagnosis and management. No significant changes to recommendations for primary care have been made.
•GORD in children — reviewed. A literature search was conducted in May 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The recommendations have been updated in line with current evidence in the literature. The topic structure has been amended to improve clarity and navigation. A link to the First Steps Nutrition Trust resources has been provided, which gives information about infant formula milk requirements and different anti-reflux infant formula milk available.
•Lipid modification – CVD prevention — reviewed. A literature search was conducted in May 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The scope of the topic has been clarified, and prescribing information sections have been added for bempedoic acid, inclisiran, alirocumab, evolocumab, and icosapent ethyl. No major changes to clinical recommendations have been made.
•Migraine — reviewed. A literature search was conducted in June 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. There have been minor structural changes to the topic. Changes to the recommendations include an update regarding the topiramate pregnancy prevention programme in alignment with guidance from the Medicines and Healthcare products Regulatory Agency, the addition of candesartan or sodium valproate as alternative preventative treatment options (including the relevant restrictions regarding pregnancy/reproduction), and a recommendation to seek specialist advice about anti-emetic use in pregnant and breastfeeding women.
•Prostatitis – acute — reviewed. A literature search was conducted in April 2024 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 the recommendations have been made.
•Shingles — reviewed. A literature search was conducted in June 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of this topic.

Minor Changes:

•Asthma — minor update. Updated prevalence data and replaced broken links.
•Breathlessness — minor update. Added information from the NHS England Adult breathlessness pathway (pre-diagnosis): diagnostic pathway support tool relating to referral of people with uncertain cause of breathlessness.
•Chronic kidney disease — minor update. Minor formatting issue corrected. Minor change to the management of people with persistent proteinuria to revise a recommendation to titrate the dose of ARB or ACE inhibitor to the maximum tolerated dose.
•Corticosteroids – topical — minor update. New link to the SPS document Using inhaled and topical corticosteroids in breastfeeding added in the pregnancy and breastfeeding section.
•Eczema – atopic — minor update. Removed Calmurid cream as an option in emollients as this is no longer manufactured.
•Food allergy — minor update. A minor typographical error was corrected.
•Generalized anxiety disorder — minor update. Adverse effects of neuroleptic malignant syndrome (NMS) and stress cardiomyopathy relating to Duloxetine has been added in line with an update to the manufacturer’s SPC.
•Giant cell arteritis — minor update. Additional emphasis placed on the need to initiate glucocorticoids in primary care if GCA is ‘strongly suspected’ aligned with the British Society of Rheumatology guideline on diagnosis and treatment of giant cell arteritis wording.
•Immunizations – childhood — minor update. The use of MenQuadfi® has been added as an option for immunization against Meningococcal groups A, C, W and Y in line with the UKHSA updated guidance Meningococcal ACWY programme: information for healthcare professionals.
•Immunizations – seasonal influenza — minor update. The vaccines available and the age brackets in the vaccine choice section have been updated to reflect updates made in the UKHSA publication National protocol for inactivated influenza vaccine.
•Impetigo — minor update. Prescribing section on hydrogen peroxide changed from 2% to 1% cream.
•Incontinence – urinary, in women — minor update. Adverse effects of neuroleptic malignant syndrome (NMS) and stress cardiomyopathy relating to Duloxetine has been added in line with an update to the manufacturer’s SPC.
•LUTS in men — minor update. Minor typographical error corrected in the prescribing section for furosemide.
•Whooping cough — minor update. Minor typographical error corrected in the prescribing section. Updated information on exclusion periods for cases and recommendations concerning the window of eligibility for antibiotics to align with the UKHSA national guidance on public health management of pertussis, June 2024.

9th July 2024

Agilio: Diagnosis and Treatment Guidance

This update contains 8 significant changes and 12 minor changes.

Significant Changes:

• Atrial fibrillation — reviewed. A literature search was conducted in April 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The recommendations have been updated in line with current evidence in the literature. The topic structure has been amended to improve clarity and navigation. Information about the further assessment of device-detected atrial fibrillation (AF), including use of patient-initiated mobile or wearable devices has been added, in line with the European Society of Cardiology (ESC) joint guideline (2021). The management section has been split into two scenarios covering new-onset or acute AF, and the routine review of paroxysmal, persistent, or permanent AF.
• Autism in adults — reviewed. A literature search was conducted in May 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Minor structural changes have been applied to the topic, with the basis for recommendation sections updated to align with current guidance and evidence. The term, “People with autism” has been updated to “Autistic people” to align with changes in the NICE guidance from 2021.
• Contraception – combined hormonal methods — reviewed. A literature search was conducted in April 2024 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.
• Crohn’s disease — reviewed. A literature search was conducted in May 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Recent epidemiology figures have been added and detail added on the management of a flare-up of Crohn’s disease.
• CVD risk assessment and management — reviewed. A literature search was conducted in March 2024 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Minor structural changes have been applied to the topic, with the basis for recommendation sections updated to align with current guidance from the National Institute for Health and Care Excellence (NICE) on Cardiovascular disease: risk assessment and reduction, including lipid modification and the European Society of Cardiology (ESC) guidelines on Cardiovascular disease prevention in clinical practice.
• End of life care in children — reviewed. A literature search was conducted in April 2024 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 the recommendations have been made, but the topic has been restructured.
• Opioid dependence — reviewed. A literature search was conducted in February 2024 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 and restructured with a focus on the generalist management of opioid dependency in primary care. Information on what to expect from specialist drug services following referral from primary care is included.
• Urethritis – male — reviewed. A literature search was conducted in April 2024 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 minor restructuring with a section added on Assessment and Clinical features. No major changes to the recommendations have been made.

Minor Changes:

• Appendicitis — minor update. A typographical error has been corrected.
• Breast cancer – recognition and referral — minor update. Updated prevalence figures.
• Depression — minor update. An adverse effect of hypoglycaemia relating to venlafaxine has been added in line with an update to the manufacturer’s SPC.
• Dyspepsia – pregnancy-associated — minor update. Further revision of content in the regarding the specific use of antacids and alginates in pregnancy in the basis of recommendation section.
• Epilepsy — minor update. Information that topiramate is now contraindicated in pregnancy and in women of childbearing potential unless the conditions of a Pregnancy Prevention Programme are fulfilled has been added to this topic in line with the MHRA drug safety update Topiramate (Topamax): introduction of new safety measures, including a Pregnancy Prevention Programme.
• Erectile dysfunction — minor update. A typographical error has been corrected.
• Insomnia — minor update. Further clarification on wording regarding the use of Sleepio as recommended by NICE.
• Pelvic inflammatory disease — minor update. Information on adverse effects of moxifloxacin updated in line with manufacturer’s SPC.
• Prostate cancer — minor update. Meningioma added as an adverse effect of medroxyprogesterone acetate and caution is advised when prescribing medroxyprogesterone acetate to people with a history of meningioma, as per the manufacturer’s updated SPC.
• Post-traumatic stress disorder — minor update. An adverse effect of hypoglycaemia relating to venlafaxine has been added in line with an update to the manufacturer’s SPC.
• Scabies — minor update. Information that ivermectin 3 mg is unlicensed for treatment of scabies has been removed from this topic.
• Scrotal pain and swelling — minor update. The recommendation on management of people with suspected inguinal hernia who do not need emergency hospital admission has been clarified.