This month, 33 care pathways have been updated with the latest evidence.
Twenty seven pathways have received updates in line with the new National Institute of Health and Care Excellence (NICE) cancer recognition and referral guideline to include updated recommendations on urgent referral and direct access tests – the ‘Abnormal vaginal bleeding’, ‘Abnormal vaginal discharge’, ‘Bacterial vaginosis’ and ‘Vulvovaginal candidiasis’ pathways have been updated regarding urgent referral and direct access tests for suspected cancer for patients with symptoms or signs of gynaecological cancers. The ‘Colorectal cancer’ and ‘Irritable bowel syndrome (IBS)’ pathways have been updated regarding the use of faecal occult blood testing to assess for colorectal cancer.
The ‘Lymphoma’ pathway has been updated to incorporate new guidance from NICE regarding urgent referral and very urgent tests for suspected cancer for patients with lymphadenopathy or splenomegaly accompanied by unexplained symptoms. Updated recommendations on the management of Hodgkin’s B-cell lymphoma have been included. New recommendations on the use of pixantrone monotherapy for multiply relapsed or refractory aggressive non-Hodgkin’s B-cell lymphoma have been added.
The ‘Diabetes in pregnancy’ pathway has undergone an extensive update to include new recommendations on the diagnosis and management of gestation diabetes, preconception advice and continuing treatment of pre-existing diabetes in pregnancy and postnatal considerations.
The ‘Sodium and potassium imbalance’ pathway has been updated to include new and updated recommendations on clinical presentation and investigations for hyperkalaemia, as well as urgent referral criteria for confirmation and emergency management of hyperkalaemia. A reminder on referral for suspected cancer has also been added.
The full list of pathways receiving an update is:
- Abnormal vaginal bleeding
- Abnormal vaginal discharge
- Acute leukaemia
- Assessment of jaundice
- Bacterial vaginosis
- Bone sarcoma
- Breast cancer
- Chronic fatigue syndrome and myalgic encephalopathy (CFS/ME)
- Colorectal cancer
- Constipation in adults and the elderly
- Cough in adults
- Deep vein thrombosis
- Diabetes in pregnancy
- Diarrhoea in adults
- Endometrial cancer
- Headache in adults
- Hepatocellular cancer
- Head and neck cancer
- Irritable bowel syndrome (IBS)
- Lung cancer
- Pancreatic cancer
- Postpartum haemorrhage
- Sodium and potassium imbalance
- Stable angina
- Testicular cancer
- Thyroid disorders
- Upper gastrointestinal (GI) cancer
- Vulvovaginal candidiasis
Changes in the information landscape can be identified by different sources, including regular searches for national clinical guidelines, recently published quality-appraised secondary literature, and user feedback. The impact of new information is assessed to determine a timeframe for updating the care map. Practice-based knowledge from clinical experts is then added where appropriate.
Download the report below for a brief summary of changes for all care maps updated in this publication.