Practical clinical guidance for common conditions and symptoms

Covering over 370 clinical topics for use in primary care, Clarity’s Diagnosis and Treatment Guidance supports confident decision-making at the point of care.

Referenced and linked to source evidence and covering over 1,200 clinical presentations or patient scenarios, this guidance helps healthcare professionals:

  • Reach a diagnosis
  • Prescribe safely
  • Offer safe and effective treatment options or referral for specialist care
  • Create local protocols and guidance

This resource is only available to customers outside of the UK.

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Clinical topics commissioned by National Institute for Health and Care Excellence (NICE) for use in the NHS

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Evidence-based and rigorous content development process

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Continually reviewed and updated, with new topics introduced regularly

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Easily accessible at the point of care

370 +

clinical topics

1,200 +

clinical presentations or patient scenarios

65 +

updates a year

Up to 10

new topics each year

Publication Updates

12 Oct
Clarity’s Diagnosis and Treatment Guidance October 2021 Update

This update contains 7 significant changes, and 3 minor changes.

Significant changes:
• Sickle cell disease — reviewed. A literature search was conducted in July 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Chest pain — reviewed. A literature search was conducted in May 2021 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.

• Temporomandibular disorders (TMJs) — reviewed. A literature search was conducted in July 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.

• Pruritus ani — reviewed. A literature search was conducted in July 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Minor changes to clinical recommendations have been made.

• Bunions — reviewed. A literature search was conducted in July 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials (RCTs) published since the last revision of the topic. The section on Assessment has been moved to the Diagnosis section to improve clarity and navigation. An additional section on Surgical management has been added to the Management section. The basis for recommendation sections have been updated with current evidence in the literature. No major changes to clinical recommendations have been made.

• Breast pain – cyclical — reviewed. A literature search was conducted in June 2021 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. A new section on the differential diagnosis of breast pain has been added.

• Constipation — minor update. Broken links to two external resources have been updated.

Minor changes:
• Heart failure – chronic — minor update. The advice to add iron studies as part of the assessment of a person with heart failure and to manage comorbidity of hypertension was added based on the European Society for Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure.

• Angio-oedema and anaphylaxis — minor update. The topic has been updated to align with the Resuscitation Council UK guideline Emergency treatment of anaphylaxis. Guidelines for healthcare providers [Resuscitation Council UK, 2021]. Recommendations to routinely administer IV or IM chlorphenamine and hydrocortisone have been removed from this topic.

• Smoking cessation — minor update. History of epilepsy added to the cautions section for nicotine replacement therapy in line with updated manufacturer’s SPC.

14 Sep
Clarity’s Diagnosis and Treatment Guidance September 2021 Update

This update contains 6 significant changes and 17 minor changes.

Significant Changes
• Pancreatitis – chronic — reviewed. A literature search was conducted in April 2021 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 been updated in line with current evidence in the literature including the National Institute for Health and Care Excellence (NICE) guideline Pancreatitis (NICE, 2020). The topic has undergone minor restructuring to improve clarity and navigation. No major changes to recommendations have been made.

• Cholecystitis – acute — reviewed. A literature search was conducted in June 2021 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 clinical recommendations have been made.

• Angina — reviewed. A literature search was conducted in April 2021 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.

• Red eye — reviewed. A literature search was conducted in May 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Carpal tunnel syndrome — reviewed. A literature search was conducted in May 2021 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. The recommendations on follow up in primary care have been amended to reflect pragmatic clinical practice. A new section on specialist assessment and management has been created to provide additional information. The basis for recommendation sections have been updated with current evidence in the literature.

• Haemorrhoids — reviewed. A literature search was conducted in June 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Updated advice on topical preparations for haemorrhoids which should be purchased over the counter in line with NHS Clinical Commissioners (2018). Re-positioning of the role of haemorrhoidal artery ligation in the treatment algorithm was also revised as repeat procedures are often needed.

Minor Changes
• Sciatica (lumbar radiculopathy) — minor update. Text has been updated to clarify that the link to the neuropathic pain topic has been included to provide information on suitable neuropathic pain treatments other than those which should not be offered.

• Scrotal pain and swelling — minor update. Change of wording to apply gender neutral descriptions.

• Cervical cancer and HPV — minor update. National policy on a change from the quadrivalent vaccine to the nine valent Gardasil® 9 based on Public Health England advice in Annex A: HPV vaccine information and guidance for healthcare professionals.

• Whooping cough — minor update. Adverse effects of co-trimoxazole updated in line with revised manufacturer’s SPC relating to the rare problem of severe respiratory toxicity with the potential to progress to Adult Respiratory Distress Syndrome.

• Bites – human and animal — minor update. Adverse effects of co-trimoxazole updated in line with revised manufacturer’s SPC relating to the rare problem of severe respiratory toxicity with the potential to progress to Adult Respiratory Distress Syndrome.

• Leg ulcer – venous — minor update. Adverse effects of co-trimoxazole updated in line with revised manufacturer’s SPC relating to the rare problem of severe respiratory toxicity with the potential to progress to Adult Respiratory Distress Syndrome.

• Prostatitis – acute — minor update. Adverse effects of co-trimoxazole updated in line with revised manufacturer’s SPC relating to the rare problem of severe respiratory toxicity with the potential to progress to Adult Respiratory Distress Syndrome.

• Allergic rhinitis — minor update. Recommendations on use of cetirizine in people with renal impairment have been updated in line with the updated manufacturer’s Summary of Product Characteristics.

• Urticaria — minor update. Recommendations on use of cetirizine in people with renal impairment have been updated in line with the updated manufacturer’s Summary of Product Characteristics.

• Itch – widespread — minor update. Recommendations on use of cetirizine in people with renal impairment have been updated in line with the updated manufacturer’s Summary of Product Characteristics.

• Cow’s milk allergy in children — minor update. Recommendations on use of cetirizine in people with renal impairment have been updated in line with the updated manufacturer’s Summary of Product Characteristics.

• Chronic kidney disease — minor update. New recommendations and advice from NICE Chronic kidney disease guideline August 2021 were included.

• Acute kidney injury — minor update. The recommendation to monitor people for the development or progression of chronic kidney disease for at least 3 years after acute kidney injury (longer for people with acute kidney injury stage 3) even if eGFR has returned to baseline was added in order to align with NICE Chronic kidney disease guideline update August 2021.

• Anticoagulation – oral — minor update. A minor typographical error has been corrected.

• Shingles — minor update. Information relating to the use of the non-live Shingrix® vaccine for immunocompromised individuals from 1st September 2021 was added.

• Obstructive sleep apnoea syndrome — minor update. New information from the NICE Guideline [NG202] Obstructive sleep apnoea/hypopnoea syndrome and obesity hypoventilation syndrome in over 16s has been incorporated. New information added on not using the Epworth sleepiness scale solely for referral and new criteria for urgent referral to specialist care.

• Cough – acute with chest signs in children — minor update. Threshold for immediate admission to hospital for children with bronchiolitis changed from 92% oxygen saturation to 90% as a response to the partial update of the NICE Bronchiolitis in children guideline [NG9].

10 Aug
Clarity’s Diagnosis and Treatment Guidance August 2021 Update

This update contains 8 significant changes and 9 minor changes.

Significant Changes:
• Pancreatitis – acute — reviewed. A literature search was conducted in April 2021 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 been updated in line with current evidence in the literature including the National Institute for Health and Care Excellence (NICE) guideline Pancreatitis (NICE, 2020). No major changes to recommendations have been made. A new section on the Follow up of confirmed acute pancreatitis has been added to the Scenario on Management.

• Contraception – barrier methods and spermicides — reviewed. A literature search was conducted in April 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.

• Contraception – natural family planning — reviewed. A literature search was conducted in May 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.

• Head injury — reviewed. A literature search was conducted in April 2021 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.

• Boils, carbuncles, and staphylococcal carriage — reviewed. A literature search was conducted in March 2021 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.

• Olecranon bursitis — reviewed. A literature search was conducted in May 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. No significant changes have been made to the recommendations.

• Osteoporosis – prevention of fragility fractures — reviewed. A literature search was conducted in May 2021 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.

• Otitis media with effusion — reviewed. A literature search was conducted in June 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The standard observation period was updated to 3 months. Adjuvant adenoidectomy is now offered with insertion of ventilation tubes for children over 4 years.

Minor Changes:
• Scrotal pain and swelling — minor update. Additional information on managing possible adverse effects of fluoroquinolones have been added to this topic in line with the MHRA drug safety update Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects.

• Chest infections – adults — minor update. Pulse oximetry thresholds for severity in COVID-19 revised from 92% to 91% in line with an update to the NICE COVID-19 rapid guideline.

• Glandular fever (infectious mononucleosis) — minor update. Information that given mononucleosis-like illness is an HIV indicator condition the recommendation on HIV testing has been revised, when two negative monospots are reported.

• Immunizations – childhood — minor update. The detail on managing missed doses of meningococcal B vaccination has been updated in line with PHE advice.

• Chronic obstructive pulmonary disorder — minor update. Contraindications and cautions for carbocisteine have been updated.

• Immunizations – seasonal influenza — minor update. Information added to update the eligibility criteria for the immunization which has been extended to those children in secondary school from years 7–11.

• Coronavirus – COVID-19 — minor update. Added capillary leak syndrome as a contraindication, special warning, and an adverse effect of the Astra Zeneca COVID-19 vaccine. Myocarditis has also been added as a rare adverse effect of mRNA COVID-19 vaccines. Added eligibility for COVID-19 vaccines to children aged 12–15 years with severe neurodisabilities.

• Diarrhoea – antibiotic associated — minor update. Treatment of C. difficile updated to align with Clostridioides difficile infection: antimicrobial prescribing NICE guideline [NG199]. This has meant removing the recommendation to use metronidazole as the first-line treatment for mild to moderation infection. The most recent recommendation advises vancomycin after consultation with local microbiologists or infectious disease specialists.

• Acne vulgaris — minor update. Recommendations have been updated to align with the new NICE guideline Acne vulgaris: management. Sections on referral, follow up, and relapse have been added.

13 Jul
Clarity’s Diagnosis and Treatment Guidance July 2021 Update

This update contains 7 significant changes and 9 minor changes.

Significant Changes:
• Vitamin D deficiency in adults — reviewed. A literature search was conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. The topic title has been shortened to ‘Vitamin D deficiency in adults’. The recommendations have been updated in line with current evidence in the literature. The recommendation on who should take year-round vitamin D supplementation for the prevention of vitamin D deficiency has been amended, in line with Public Health England (PHE) guidance PHE, 2016 PHE, 2020. The section on Calcium and vitamin D combination products has been removed from the Prescribing information section to avoid repetition with text in the Management section.

• Vitamin D deficiency in children — reviewed. A literature search was conducted in February 2021 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 recommended dose for vitamin D supplementation for prevention of vitamin D deficiency has been amended in line with the Royal Osteoporosis Society (ROS) publication Vitamin D and bone health: a practical clinical guideline for patient management in children and young people ROS, 2018.

• Contraception – assessment — reviewed. A literature search was conducted in March 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The structure of the topic has been changed. No major changes to the recommendations have been made.

• Contraception – sterilization — reviewed. A literature search was conducted in April 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic.

• Whitlow (staphylococcal and herpetic) — reviewed. A literature search was conducted in March 2021 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.

• Anal fissure — reviewed. A literature search was conducted in March 2021 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 recommendations have been made.

• Greater trochanteric pain syndrome — reviewed. A literature search was conducted in April 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

Minor Changes:
• Coronavirus – COVID-19 — minor update. Storage details for Pfizer BioNtech vaccine has been updated in line with the revised Summary of Product Characteristics, prevalence data have been updated, information on arranging PCR tests and self-isolation has been updated, information about rare thromboembolic events after AstraZeneca COVID-19 vaccine, information about variants of concern, and details of signs and symptoms of the Delta variant have also been added. The section on the Public health response has been removed as well as the information on administering the Pfizer BioNtech vaccine.

• Prostate cancer — minor update. Links to Prostate Cancer UK patient resources updated.

• Irritable bowel syndrome — minor update. Adverse effects for linaclotide have been updated in line with the revised manufacturer’s SPC and a link to the Ovarian cancer topic has been added to the section on differential diagnosis.

• Urinary tract infection (lower) – women — minor update. A typographical error has been corrected.

• Polymyalgia rheumatica — minor update. Hyperlinks to a charity organization have been updated.

• Antenatal care – uncomplicated pregnancy — minor update. Information on the European Health Insurance Card (EHIC) has been replaced with information on the Global Health Insurance Card (GHIC).

• Diabetes – type 2 — minor update. Adverse effects of GLP-1 receptor agonists updated in line with revised manufacturer’s SPC.

• Shingles — minor update. Prescribing information for aciclovir has been clarified.

• Platelets – abnormal counts and cancer — minor update. Family history of cancer added to the assessment of people with thrombocytosis.

08 Jun
Clarity’s Diagnosis and Treatment Guidance June 2021 Update

This update contains 6 significant changes and 31 minor changes.

Significant Changes:
• Palliative care – oral — reviewed. Literature searches were conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. Minor restructuring of the topic was undertaken and recommendations updated in line with new evidence and guidelines.

• Palliative care – secretions — reviewed. Literature searches were conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Palliative care – nausea and vomiting — reviewed. Literature searches were conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Palliative care – malignant skin ulcer — reviewed. Literature searches were conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Palliative cancer care – pain — reviewed. Literature searches were conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Dementia — reviewed. A literature search was conducted in March 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. Some minor structural changes have been made to this topic, but no major changes to clinical recommendations.

Minor Changes:
• Nausea/vomiting in pregnancy — minor update. Domperidone has been added as a second-line treatment option and prescribing information has been added.

• Lipid modification – CVD prevention — minor update. Rosuvastatin added as a drug interaction with gemfibrozil in line with the updated Summary of Product Characteristics.

• Conjunctivitis – infective — minor update. The recommendation that use of chloramphenicol eyes drops is contraindicated in children aged under 2 years has been added.

• Atrial fibrillation — minor update. The topic has been updated to align with the updated NICE guideline Atrial fibrillation: diagnosis and management and includes the recommendation to use the ORBIT bleeding risk assessment tool when considering starting anticoagulation in people with atrial fibrillation, and that a direct oral anticoagulant should be used first-line in people considered to be at risk of stroke.

• Cervical screening — minor update. Information that cervical dysplasia is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Cervical cancer and HPV — minor update. Information that cervical dysplasia is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Shingles — minor update. Information that herpes zoster is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Hepatitis B — minor update. Information that hepatitis B is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Glandular fever (infectious mononucleosis) — minor update. Information that mononucleosis-like illness is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Chest infections – adult — minor update. Information that community-acquired pneumonia is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Platelets – abnormal counts and cancer — minor update. Information that thrombocytopenia lasting for over 4 weeks is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Seborrhoeic dermatitis — minor update. Information that seborrhoeic dermatitis/exanthema is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Psoriasis — minor update. Information that severe or atypical psoriasis is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Candida – oral — minor update. Information that unexplained oral candidiasis is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Diarrhoea – adult’s assessment — minor update. Information that unexplained chronic diarrhoea is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Chronic kidney disease — minor update. Information that unexplained chronic renal impairment is an HIV indicator condition has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• HIV infection and AIDs — minor update. Information on non-AIDS-defining indicator conditions and a recommendation to offer HIV screening to people with these conditions has been added to this topic in line with the British HIV Association/British Association for Sexual Health and HIV/British Infection Association Adult HIV testing guidelines 2020.

• Immunizations – travel — minor update. Recommendations that Revaxis and Avaxim should be used with caution in people with phenylketonuria have been added to this topic in line with the manufacturers’ Summary of Product Characteristics.

• Hepatitis A — minor update. A recommendation that Avaxim should be used with caution in people with phenylketonuria has been added to this topic in line with the manufacturer’s Summary of Product Characteristics.

• Immunizations – childhood — minor update. A recommendation that Revaxis should be used with caution in people with phenylketonuria has been added to this topic in line with the manufacturer’s Summary of Product Characteristics.

• Appendicitis — minor update. A typographical error has been corrected.

• Diabetes – type 2 — minor update. Adverse effects of SGLT-2 inhibitors updated in line with revised manufacturer’s SPC.

• Cough — minor update. Links have been added within the section on management of sub-acute and chronic cough to the assessment and diagnosis sections.

• DMARDs — minor update. Clarification added on frequency of pneumococcal vaccination where a single pneumococcal vaccine is now recommended unless the person on DMARDs also has asplenic, splenic dysfunction or chronic renal disease.

• Contraception – emergency — minor update. A typographical error has been corrected.

• Hypothyroidism — minor update. Prescribing advice about patients who experience symptoms on switching between different levothyroxine products has been added to this topic in line with MHRA advice.

• Migraine — minor update. A recommendation that a discussion of the potential benefits and risks, and the importance of effective contraception for women and girls of childbearing potential when taking topiramate has been added to this topic in line with the updated NICE guideline Headaches in over 12s: diagnosis and management.

• Epilepsy — minor update. A recommendation to urgently refer women for specialist advice if they are taking antiepileptic drugs and planning to become pregnant has been added to this topic in line with the Medicines and Healthcare products Agency (MHRA) Drug Safety Update Antiepileptic drugs in pregnancy: updated advice following comprehensive safety review.

• Uveitis — minor update. Endophthalmitis was added as a sight-threatening differential diagnosis.

• Asthma — minor update. A typographical error has been corrected.

• Chronic obstructive pulmonary disease — minor update. A typographical error has been corrected.

11 May
Clarity’s Diagnosis and Treatment Guidance May 2021 Update

This update contains 6 significant changes, 11 minor changes and 1 new topic.

Significant Changes:
• Palliative care – constipation — reviewed. Literature searches were conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Palliative care – cough — reviewed. Literature searches were conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Palliative care – dyspnoea — reviewed. Literature searches were conducted in February 2021 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Palliative care – general issues — reviewed. A literature search was conducted in February 2021 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 recommendations have been made.

• Delirium — reviewed. Literature searches were conducted to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic.

• Immunizations – pneumococcal — reviewed. A literature search was conducted in March 2021 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 aligned with the Public Health England publication Immunisation against infectious disease — The Green Book Chapter 25: Pneumococcal, and some minor structural changes have been made.

Minor Changes:
• Anaemia – iron deficiency — minor update. Diagnostic level of ferritin level was changed from 15 micrograms/L to 30 micrograms/L. Clarification of wording on volume dilution in pregnancy. Symptoms clarified to outline that pre-existing cardiac conditions can result in worsening angina, tachycardia, or heart failure. Changes were made to the threshold for ferritin levels in chronic kidney disease and inflammatory conditions.

• Aphthous ulcer — minor update. A typographical error has been corrected.

• Hypertension – minor update. Title of topic has been changed from ‘Hypertension – not diabetic’ to ‘Hypertension’.

• Lipid modification – CVD prevention — minor update. The scope of the topic has been clarified.

• Psychosis and schizophrenia — minor update. Some additional information on monitoring antipsychotics has been added to this topic.

• Bipolar disorder — minor update. Some additional information on monitoring antipsychotics has been added to this topic.

• Anticoagulation – oral — minor update. Information about reducing the dose of apixaban in renal impairment has been clarified. Erythema multiforme has also been added as an adverse effect of apixaban.

• Molluscum contagiosum — minor update. Information that the use of podophyllotoxin in people with anogenital molluscum contagiosum is off-label has been added to this topic.

• Conjunctivitis – infective — minor update. Contraindications for chloramphenicol eye drops have been updated in line with revised manufacturer’s SPC.

• Angina — minor update. Adverse effects of nicorandil updated in line with revised manufacturer’s SPC.

• Diabetes – type 2 — minor update. Adverse effects of DPP-4 inhibitors updated in line with revised manufacturer’s SPC.

New Topic:
• Chronic pain – this is a new topic. A literature search was conducted in April 2021 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.

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