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Agilio Diagnosis and Treatment Guidance May 2023 Update

This update contains 4 significant changes and 16 minor changes.

Significant Changes:

  • Alopecia areata — reviewed. A literature search was conducted in February 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No significant changes have been made to the recommendations. The advice linking treatment to a more than 50% scalp involvement has been removed as no basis for this could be found. Assessing for the need for referral for psychological support in adults and children has been clarified. The option of offering specialist referral for any person wishing to have treatment for alopecia areata has been added, with a rationale.
  • B12 and folate deficiency — reviewed. A literature search was conducted in March 2023 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. Update to the prevalence data for B12 deficiency added.
  • Blackouts — reviewed. A literature search was conducted in January 2023 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomised controlled trials published since the last revision of the topic. The name of the topic has been changed from ‘Blackouts’ to ‘Blackouts and syncope’, to reflect current definitions in the literature. The topic has undergone minor restructuring to improve clarity and navigation. The recommendations have been updated in line with current evidence in the literature.
  • Ectopic pregnancy — reviewed. A literature search was conducted in January 2023 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 some minor structural changes to this topic, but no changes to recommendations.Minor Changes:
  • Anticoagulation – oral — minor update. Recommendations on management of missed doses of DOACs has been updated in line with manufacturers’ summaries of product characteristics. Typographical error corrected.
  • Chilblains — minor update. Added juvenile spring eruption as a differential diagnosis.
  • Depression — minor update. Added more detailed information about stopping antidepressants based on the NICE [NG215] Medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults NICE, 2022. Also added an additional patient resource provided by the Royal College of Psychiatrists, Stopping antidepressants RCPsych, 2022. Revised the wording on timing of the review for people after starting antidepressant medication in line with an update the NICE guideline [NG222] Depression in adults: treatment and management NICE, 2022.
  • Dyspepsia – pregnancy associated — minor update. Typographical error corrected.
  • Eczema – atopic — minor update. A link to an online resource about eczema has been added to this topic.
  • Erythrocytosis — minor update. Typographical error corrected.
  • Hypercholesterolaemia — minor update. Adverse effects of statins were updated in line with the manufacturer’s SPC as they have been found to induce de novo or aggravate pre-existing myasthenia gravis or ocular myasthenia. Treatment should be discontinued in case of aggravation or development of these symptoms.
  • Insulin therapy diabetes type 1— minor update. Information about continuous glucose monitoring was revised to align with the Diabetes type 1 topic and the National Institute for Health and Care Excellence (NICE) guideline, 2022 Type 1 diabetes in adults: diagnosis and management.
  • Lipid modification — minor update. Added adverse effect that statins can induce de novo or aggravate pre-existing myasthenia gravis or ocular myasthenia, and that treatment should be discontinued in case of aggravation or development of these symptoms.
  • Neck pain – cervical radiculopathy — minor update. Removed recommendation on the use of diazepam to align with NICE guidance on back pain.
  • Neck pain – non-specific — minor update. Removed the recommendation on the use of diazepam to align with NICE guidance on the management of back pain.
  • Osteoporosis — minor updates. Revised information about dental review prior to initiation of bisphosphonates aligned with BNF advice. Recommendations on prescribing bisphosphonates in people with renal impairment updated in line with manufacturers’ summaries of product characteristics.
  • Pre-conception – advice and management — minor update. Revised the advice for women with epilepsy and linked to the Agilio DTG epilepsy topic.
  • Scarlet fever — minor update. Antibiotic recommendations updated in line with the UKHSA guideline Scarlet fever: managing outbreaks in schools and nurseries.
  • Stroke and TIA — minor update. Information on blood pressure targets has been removed and a link to the section on monitoring and treatment targets in the CKS topic on Hypertension has been added.
  • UTI in children — minor update. Typographical error corrected in the section on prophylaxis treatment for amoxicillin age range.