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Diagnosis and Management of Suspected Idiopathic Pulmonary Fibrosis: Idiopathic Pulmonary Fibrosis [Internet]

Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrotic interstitial lung disease (ILD) of unknown origin. It is a difficult disease to diagnose and often requires the collaborative expertise of a chest physician, radiologist and histopathologist to reach a consensus diagnosis. Most people with idiopathic pulmonary fibrosis experience symptoms of breathlessness, which may initially be only on exertion. Cough, with or without sputum is a common symptom. Over time, these symptoms are associated with a decline in lung function, reduced quality of life and ultimately death. Specific pharmacological therapies for IPF are limited but the last decade has seen more trials of new drugs which have had a variable impact on clinical practice. A number of difficulties arise when undertaking clinical trials in IPF in terms of defining precise, diagnostic inclusion criteria and clinically meaningful end-points. However, such trials are the only way by which promising new treatments will come to benefit patients. Furthermore, it is only by performing rigorous clinical trials, we have learned that drugs once widely used to treat IPF may in fact have been harmful. The limitations of current pharmacological therapies for IPF highlight the importance of other forms of treatment including lung transplantation and best supportive care such as oxygen therapy, pulmonary rehabilitation and palliation of symptoms. These are interventions which justifiably require scrutiny in the context of healthcare delivery by the modern NHS. Despite the significant burden of disease caused by IPF, there is currently no established framework within the NHS for its diagnosis and management thus creating an environment in which significant variations in clinical care may occur. In recognition of this, the Department of Health commissioned the National Institute of Health and Care Excellence (NICE) to produce a guideline aimed at improving the care of people with IPF.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: June 2013
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Mechanical ventilation for newborn infants with respiratory failure due to pulmonary disease

Mechanical ventilation of newborn infants with severe lung disease results in reduced mortality. Mechanical ventilation with intermittent positive or negative pressure was introduced in the 1960s. It was compared with standard treatment in five trials for infants with very severe lung disease and resulted in a reduction in mortality. This effect was observed principally in infants with birth weights over two kilograms. Mechanical ventilation has become standard therapy for severe respiratory failure. There have been no trials in modern neonatal intensive care units so the magnitude of the benefits and harms in current practice are not known.

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

Version: 2013

Infant position in neonates receiving mechanical ventilation

We found no clear evidence that particular body positions in newborn babies who need assisted ventilation are effective in producing relevant and sustained improvement. However, putting infants on assisted ventilation in the face down position for a short time slightly improves their oxygenation and infants in the prone position undergo fewer episodes of poor oxygenation. No trials were considered to have a low risk of bias and, in other words, results in which we could put some confidence. Approximately one third of the studies had a high risk of bias, which means we cannot be completely confident with their results.

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

Version: 2013

Mechanical ventilation at night for people with nerve, muscle or chest wall disease who have persistent breathing problems

We reviewed the evidence about the effect of mechanical ventilation at night in people with chronic (i.e. persistent) difficulties with breathing spontaneously due to diseases of the nerves, muscles or chest wall.

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

Version: 2014

Continuous distending pressure for respiratory distress in preterm infants

Background: Respiratory distress syndrome (RDS) is the most common cause of disease and death in babies born before 34 weeks' gestation. Intermittent positive pressure ventilation (IPPV) has been the standard way of helping these babies breathe. A simpler method of assisting breathing is to provide continuous distending pressure of the lung, either as continuous positive pressure to the airway or as continuous negative pressure (partial vacuum).

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

Version: 2015

Motor Neurone Disease: The Use of Non-Invasive Ventilation in the Management of Motor Neurone Disease [Internet]

Motor neurone disease (MND) is a fatal neurodegenerative disease. It is characterised by the onset of symptoms and signs of degeneration of primarily the upper and lower motor neurones. This leads to progressive weakness of the bulbar, limb, thoracic and abdominal muscles. Respiratory muscle weakness resulting in respiratory impairment is a major feature of MND, and is a strong predictor of quality of life and survival. Non-invasive ventilation can improve symptoms and signs related to respiratory impairment and hence survival.

NICE Clinical Guidelines - National Institute for Health and Clinical Excellence (UK).

Version: July 2010
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Motor Neurone Disease: Assessment and Management

Motor neurone disease (MND) is a neurodegenerative condition that affects the brain and spinal cord. MND is characterised by the degeneration of primarily motor neurones, leading to muscle weakness.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: February 2016
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Continuous negative extrathoracic pressure or continuous positive airway pressure for children with acute respiratory failure and shortage of oxygen

Children develop respiratory failure and shortage of oxygen when they have infectious or non‐infectious respiratory illnesses. Continuous negative extrathoracic pressure (CNEP) which keeps lungs open by creating negative pressure on the chest or continuous positive airway pressure (CPAP) which keeps lungs open by delivering positive pressure in the lungs during all phases of breathing are used to help increase blood oxygen levels in respiratory failure and thereby reduce organ damage and risk of death. However, the safety and efficacy of these methods of respiratory support are uncertain. The searches for this review were updated in July 2013.

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

Version: 2013

The Prevention and Management of Pressure Ulcers in Primary and Secondary Care

Prevention of pressure ulcers usually involves an assessment to identify people most at risk of pressure ulcers, such as elderly, immobile people or those with spinal cord injury. Assessments are most commonly carried out using specific pressure area risk scores (for example, the Braden or Waterlow scales for predicting pressure sore risk or the, Glamorgan scale for paediatric pressure ulcers).

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: April 2014

Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices

To review important patient safety practices for evidence of effectiveness, implementation, and adoption.

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

Version: March 2013
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Effect of non-invasive positive pressure ventilation (NIPPV) on mortality in patients with acute cardiogenic pulmonary oedema: a meta-analysis

The review investigated the effects of noninvasive positive pressure ventilation in patients with acute cardiogenic pulmonary oedema. The authors concluded that, compared with standard therapy, continuous positive airway pressure (CPAP) and bilevel ventilation reduce the need for subsequent mechanical ventilation and that CPAP reduces mortality. The conclusions appear reliable.

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

Version: 2006

Positive expiratory pressure in patients with chronic obstructive pulmonary disease: a systematic review

The authors concluded that the findings on the effects of positive expiratory pressure treatment in patients with chronic obstructive pulmonary disease were inconclusive and that further research is needed. This was a generally well-conducted review and the authors' conclusions are likely to be reliable.

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

Version: 2009

Capnography for Monitoring End-Tidal CO2 in Hospital and Pre-hospital Settings: A Health Technology Assessment [Internet]

Anesthesiologists have been using capnography for decades to monitor end-tidal carbon dioxide (ETCO2) in patients receiving general anesthesia. ETCO2 monitoring using capnography devices has application across several hospital and pre-hospital settings, including monitoring the effectiveness of cardiopulmonary resuscitation (CPR), continuous monitoring of patients in the emergency room or intensive care unit (ICU), during ambulatory transport, to confirm the correct placement of an endotracheal tube (ETT), and monitoring post-operative patients with a history of sleep apnea or who have received high doses of opioids. Depending on the clinical area, the technology is at various stages of adoption.

CADTH Health Technology Assessment - Canadian Agency for Drugs and Technologies in Health.

Version: March 2016
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Hypertension in Pregnancy: The Management of Hypertensive Disorders During Pregnancy

This clinical guideline concerns the management of hypertensive disorders in pregnancy and their complications from preconception to the postnatal period. For the purpose of this guideline, ‘pregnancy’ includes the antenatal, intrapartum and postpartum (6 weeks after birth) periods. The guideline has been developed with the aim of providing guidance in the following areas: information and advice for women who have chronic hypertension and are pregnant or planning to become pregnant; information and advice for women who are pregnant and at increased risk of developing hypertensive disorders of pregnancy; management of pregnancy with chronic hypertension; management of pregnancy in women with gestational hypertension; management of pregnancy for women with pre-eclampsia before admission to critical care level 2 setting; management of pre-eclampsia and its complications in a critical care setting; information, advice and support for women and healthcare professionals after discharge to primary care following a pregnancy complicated by hypertension; care of the fetus during pregnancy complicated by a hypertensive disorder.

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

Version: August 2010
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The Management of Inadvertent Perioperative Hypothermia in Adults [Internet]

Inadvertent perioperative hypothermia is a common but preventable complication of perioperative procedures, which is associated with poor outcomes for patients. Inadvertent perioperative hypothermia should be distinguished from the deliberate induction of hypothermia for medical reasons, which is not covered by this guideline.

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

Version: April 2008
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Pneumonia: Diagnosis and Management of Community- and Hospital-Acquired Pneumonia in Adults

The microbial causes of pneumonia vary according to its origin and the immune constitution of the patient. Pneumonia is classified into community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP) and pneumonia in the immunocompromised. The guideline development process is guided by its scope - published after stakeholder consultation. This guideline does not cover all aspects of pneumonia, but focuses on areas of uncertainty or variable practice and those considered of greatest clinical importance. Best practice guidance on the diagnosis and management of CAP and HAP is offered, based on systematic analysis of clinical and economic evidence with the aim of reducing mortality and morbidity from pneumonia and maximising resources.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: December 2014
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Bacterial Meningitis and Meningococcal Septicaemia: Management of Bacterial Meningitis and Meningococcal Septicaemia in Children and Young People Younger than 16 Years in Primary and Secondary Care

This guideline covers bacterial meningitis and meningococcal septicaemia, focusing on management of these conditions in children and young people aged younger than 16 years in primary and secondary care, and using evidence of direct relevance to these age groups where available.

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

Version: 2010
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Fractures (Complex): Assessment and Management

Two of the five guidelines in the NICE Trauma Suite relate to fractures. These are titled non-complex and complex fractures. In broad terms the non-complex fractures are those likely to be treated at the receiving hospital, whereas the complex fractures require transfer or the consideration of transfer of the injured person to a specialist centre.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: February 2016
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Major Trauma: Assessment and Initial Management

This guideline provides guidance on the assessment and management of major trauma, including resuscitation following major blood loss associated with trauma. For the purposes of this guideline, major trauma is defined as an injury or a combination of injuries that are life-threatening and could be life changing because it may result in long-term disability. This guideline covers both the pre-hospital and immediate hospital care of major trauma patients but does not include any management after definitive lifesaving intervention. It has been developed for health practitioners and professionals, patients and carers and commissioners of health services.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: February 2016
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Spinal Injury: Assessment and Initial Management

The scope of this guideline is the assessment, imaging and early management of spinal injury and does not address rehabilitation. It is important to recognise that early management is intrinsically connected to rehabilitation and some later complications may be avoided with changes in early care. Early and ongoing collaborative multidisciplinary care across a trauma network is vital in ensuring that the patient with a spinal injury receives the best possible care.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: February 2016
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