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Constipation in Children and Young People: Diagnosis and Management of Idiopathic Childhood Constipation in Primary and Secondary Care

Without early diagnosis and treatment, an acute episode of constipation can lead to anal fissure and become chronic. By the time the child or young person is seen they may be in a vicious cycle. Children and young people and their families are often given conflicting advice and practice is inconsistent, making treatment potentially less effective and frustrating for all concerned. Early identification of constipation and effective treatment can improve outcomes for children and young people. This guideline provides strategies based on the best available evidence to support early identification, positive diagnosis and timely, effective management. Implementation of this guideline will provide a consistent, coordinated approach and will improve outcomes for children and young people.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: 2010
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Topical haemostatic agents for skin wounds: a systematic review

This review evaluated the effectiveness of haemostatic agents in patients with donor site split-skin graft wounds. The authors concluded that epinephrine and fibrin sealant appeared superior agents for stopping bleeding in patients with skin wounds from burns. Limited data means that the results warrant cautious interpretation; this reflects the emphasis of the authors' conclusion.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

Laxatives for the management of childhood constipation

Constipation within childhood is an extremely common problem. Despite the widespread use of laxatives by health professionals to manage constipation in children, there has been a long standing lack of evidence to support this practice.This review included eighteen studies with a total of 1643 patients that compared nine different agents to either placebo (inactive medications) or each other. The results of this review suggest that polyethylene glycol preparations may increase the frequency of bowel motions in constipated children. Polyethylene glycol was generally safe, with lower rates of minor side effects compared to other agents. Common side effects included flatulence, abdominal pain, nausea, diarrhoea and headache. There was also some evidence that liquid paraffin (mineral oil) increased the frequency of bowel motions in constipated children and was also safe. Common side effects with liquid paraffin included abdominal pain, distention and watery stools. There was no evidence to suggest that lactulose is superior to the other agents studied, although there were no trials comparing it to placebo. The results of the review should be interpreted with caution due to methodological quality and statistical issues in the included studies. In addition, these studies were relatively short in duration and so it is difficult to assess the long term effectiveness of these agents for the treatment of childhood constipation. Long term effectiveness is important, given the often chronic nature of this problem in children.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Atopic Eczema in Children: Management of Atopic Eczema in Children from Birth up to the Age of 12 Years

Atopic eczema (atopic dermatitis) is a chronic inflammatory itchy skin condition that develops in early childhood in the majority of cases. It is typically an episodic disease of exacerbation (flares, which may occur as frequently as two or three per month) and remissions, except for severe cases where it may be continuous. Certain patterns of atopic eczema are recognised. In infants, atopic eczema usually involves the face and extensor surfaces of the limbs and, while it may involve the trunk, the napkin area is usually spared. A few infants may exhibit a discoid pattern (circular patches). In older children flexural involvement predominates, as in adults. Diagnostic criteria are discussed in Chapter 3. As with other atopic conditions, such as asthma and allergic rhinitis (hay fever), atopic eczema often has a genetic component. In atopic eczema, inherited factors affect the development of the skin barrier, which can lead to exacerbation of the disease by a large number of trigger factors, including irritants and allergens. Many cases of atopic eczema clear or improve during childhood while others persist into adulthood, and some children who have atopic eczema `will go on to develop asthma and/or allergic rhinitis; this sequence of events is sometimes referred to as the ‘atopic march’. The epidemiology of atopic eczema is considered in Chapter 5, and the impact of the condition on children and their families/caregivers is considered in Sections 4.2 and 4.3.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: December 2007
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Surgical Site Infection: Prevention and Treatment of Surgical Site Infection

Infections that occur in the wound created by an invasive surgical procedure are generally referred to as surgical site infections (SSIs). SSIs are one of the most important causes of healthcare-associated infections (HCAIs). A prevalence survey undertaken in 2006 suggested that approximately 8% of patients in hospital in the UK have an HCAI. SSIs accounted for 14% of these infections and nearly 5% of patients who had undergone a surgical procedure were found to have developed an SSI. However, prevalence studies tend to underestimate SSI because many of these infections occur after the patient has been discharged from hospital.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: October 2008
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Wireless Motility Capsule Versus Other Diagnostic Technologies for Evaluating Gastroparesis and Constipation: A Comparative Effectiveness Review [Internet]

To systematically review the evidence comparing wireless motility capsule (WMC) with other diagnostic tests used for the evaluation of gastroparesis and slow-transit constipation, in terms of diagnostic accuracy, accuracy of motility assessment, effect on treatment decisions, effect on patient-centered outcomes, harms, and effect on resource utilization.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: May 2013
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Pressure Ulcer Risk Assessment and Prevention: Comparative Effectiveness [Internet]

While pressure ulcers commonly occur and are associated with significant health burdens, they are potentially preventable. This report systematically reviews the evidence on (1) risk-assessment scales for identifying people at higher risk of pressure ulcers and (2) preventive interventions to decrease incidence or severity of pressure ulcers. The Agency for Healthcare Research and Quality also commissioned a separate report on effectiveness of interventions to treat pressure ulcers.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: May 2013
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Oral Mechanical Bowel Preparation for Colorectal Surgery [Internet]

Oral mechanical bowel preparation (OMBP) is often prescribed preoperatively for patients undergoing elective colorectal surgery.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: April 2014
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Borderline Personality Disorder: Treatment and Management

The guideline on Borderline Personality Disorder, commissioned by NICE and developed by the National Collaborating Centre for Mental Health, sets out clear, evidence- and consensus-based recommendations for healthcare staff on how to treat and manage borderline personality disorder.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2009
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Natural health products in the prevention and treatment of osteoporosis: systematic review of randomized controlled trials

BACKGROUND: Consumers are increasingly looking to natural health products to manage specific diseases such as osteoporosis. As a result, healthcare providers need evidence-based information on which to base recommendations regarding use and efficacy.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Palm olein in the fat blend of infant formulas: effect on the intestinal absorption of calcium and fat, and bone mineralization

OBJECTIVE: To evaluate the published clinical data on the physiologic effects of using palm oil and its low melting fraction, palm olein (PO) as a dominant lipid source in the fat blend in infant formulas.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2006

Lactose Intolerance and Health

We systematically reviewed evidence to determine lactose intolerance (LI) prevalence, bone health after dairy-exclusion diets, tolerable dose of lactose in subjects with diagnosed LI, and management.

Evidence Reports/Technology Assessments - Agency for Healthcare Research and Quality (US).

Version: February 2010
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Effects of Eicosapentanoic Acid and Docosahexanoic Acid on Mortality Across Diverse Settings: Systematic Review and Meta-Analysis of Randomized Trials and Prospective Cohorts: Nutritional Research Series, Vol. 4

Eicosapentanoic acid (EPA) and docosahexanoic acid (DHA) intake may protect from cardiovascular or all-cause mortality.

Technical Reviews - Agency for Healthcare Research and Quality (US).

Version: February 2012

Nutrition Support for Adults: Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition

These guidelines cover most aspects of nutrition support in adult patients (>18 years) who are either malnourished or are at ‘risk’ of malnutrition. In some cases specific guidance related to patients in specific care settings or with specific diseases has been provided but in general the guidance is applicable to patients whatever their setting (hospital or community) or disease. The guideline therefore includes: information on the prevalence of malnutrition and the benefits of good nutrition; guidance on the appropriate forums for the organisation of nutrition support in all settings; guidance on who should be screened for malnutrition and when, along with the criteria for consideration when assessing patients’ nutritional status; the general indications for nutrition support together with ethical and legal considerations that may arise; guidance on the process and special considerations required to prescribe nutrition support and details information on the important parameters to monitor for patients receiving nutrition support; detailed guidance on the administration of oral, enteral and parenteral nutrition including; the appropriate types of access for enteral and parenteral nutrition and the optimum mode of delivering these; specific guidance on the management of providing nutrition support to patients with dysphagia; issues to consider for patients receiving enteral and parenteral nutrition support in the community; issues arising for patients and their carers.

NICE Clinical Guidelines - National Collaborating Centre for Acute Care (UK).

Version: February 2006
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Type 1 Diabetes in Adults: National Clinical Guideline for Diagnosis and Management in Primary and Secondary Care

Type 1 diabetes can, if poorly controlled, produce devastating problems in both the short and the long term. Good control of blood glucose levels reduces the risk of these problems arising, but can be very difficult for patients and carers to achieve. This guideline emphasises that the NHS should provide all patients with the means – and the necessary understanding – to control their diabetes, and that it should help patients integrate the disease management with their other activities and goals. It argues that every person with diabetes should be able to develop their own care plan and utilise effective treatment in a way agreeable to them. The input of various health professionals may be needed to achieve this, and should be readily available. A system of regular monitoring, so that any complications which do develop are picked up at an early stage and treated appropriately, should also be provided.

NICE Clinical Guidelines - National Collaborating Centre for Chronic Conditions (UK).

Version: 2004
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Diarrhoea and Vomiting Caused by Gastroenteritis: Diagnosis, Assessment and Management in Children Younger than 5 Years

When young children suddenly experience the onset of diarrhoea, with or without vomiting, infective gastroenteritis is by far the most common explanation. A range of enteric viruses, bacteria and protozoal pathogens may be responsible. Viral infections account for most cases in the developed world. Gastroenteritis is very common, with many infants and young children experiencing more than one episode in a year.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: April 2009
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Screening for Lipid Disorders in Children and Adolescents [Internet]

Dyslipidemias, disorders of lipid metabolism, are important risk factors for coronary heart disease (CHD). Identification of children with dyslipidemias could lead to interventions aimed at decreasing their risk of CHD as adults.

Evidence Syntheses - Agency for Healthcare Research and Quality (US).

Version: July 2007
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Irritable Bowel Syndrome in Adults: Diagnosis and Management of Irritable Bowel Syndrome in Primary Care [Internet]

This guideline covers areas relevant to the diagnosis and management of irritable bowel syndrome (IBS) reflecting the complete patient journey, from the person presenting with IBS symptoms, positive diagnosis and management, targeted at symptom control. The guideline incorporates Cochrane reviews, published NICE clinical and public health guidance, Health Technology Assessment reports, systematic and health economic reviews produced by the National Collaborating Centre for Nursing and Supportive Care. Recommendations are based on clinical and cost effectiveness evidence, and where this is insufficient, the GDG used all available information sources and experience to make consensus recommendations using nominal group technique.

NICE Clinical Guidelines - National Collaborating Centre for Nursing and Supportive Care (UK).

Version: February 2008

Long-acting Reversible Contraception: The Effective and Appropriate Use of Long-Acting Reversible Contraception

Contraception can be divided into two broad categories: hormonal and nonhormonal. There are two categories of hormonal contraception: combined oestrogen and progestogen and progestogen-only. Long-acting reversible contraception (LARC) is defined in this guideline as methods that require administering less than once per cycle or month.

NICE Clinical Guidelines - National Collaborating Centre for Women’s and Children’s Health (UK).

Version: October 2005
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Rheumatoid Arthritis: National Clinical Guideline for Management and Treatment in Adults

There are over 400,000 people with rheumatoid arthritis (RA) in the UK. Although this makes it a common disorder, there are numerous other conditions ahead of it in terms of numbers, and indeed as causes of excess mortality. What this does not capture however, is the dreadful morbidity associated with the disease. The synovitis of RA affects multiple sites causing widespread pain, and the subsequent destruction of the joints can lead to severe disability affecting all aspects of motor function from walking to fine movements of the hand. Furthermore, RA is not simply a disease of the joints but can affect many other organs causing, for example, widespread vasculitis or severe lung fibrosis. More recently it has become apparent that RA is associated with an increased prevalence of coronary artery disease and significant increased risk of premature mortality.

NICE Clinical Guidelines - National Collaborating Centre for Chronic Conditions (UK).

Version: February 2009
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Medical Encyclopedia

  • Mineral oil overdose
    Mineral oil is a liquid oil produced from petroleum. Mineral oil overdose occurs when someone accidentally or intentionally takes more than the normal or recommended amount of this substance.
  • Encopresis
    If a child over the age of 4 has been toilet trained and then passes stool and soils clothes again, this is called encopresis. The child may or may not be doing this on purpose.
  • Laxative overdose
    A laxative is a medication used to produce bowel movements. Laxative overdose occurs when someone accidentally or intentionally takes more than the normal or recommended amount of this medication.
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Systematic Reviews in PubMed

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