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Agilio: Diagnosis and Treatment Guidance July 2024 Update

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.