This month, 30 care pathways have been updated with the latest evidence.

Seventeen pathways including ‘Anaemia’, ‘Cervical dysplasia and cancer’, and ‘Ovarian cancer’ 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 ‘Contraception’ pathway has undergone an update to include new and updated guidance on the use of all contraceptive methods; including progestogen-only pills, injectable contraceptives, and intrauterine methods. Safety warnings about the risk of perforation following insertion of intrauterine contraception and the risk of VTE associated with combined hormonal contraceptives have been added. Advice on the use of DMPA and the risk of HIV acquisition has also been included.

The ‘Depression in adults’ pathway has been extensively updated to include new guidance on assessment, management, and referral considerations for patients with depression. Special considerations for the management of depression in older patients, patients with a chronic physical health problem, women of childbearing potential, and depression in the postnatal period have been added. Drug safety information for the use of antidepressants in patients with coronary heart disease have been added. Information on prescribing considerations including the risks associated with SSRIs and SNRIs and their discontinuation symptoms has been incorporated.

The ‘Obesity in adults’ pathway has undergone content changes to reflect the new NICE guidelines on maintaining a healthy weight, obesity prevention, and managing overweight and obese adults. Additional recommendations for the prevention and management of adult obesity have been included. Updated information on the surgical management of obesity, including surgical techniques, new information on follow-up body contouring surgery, and the primary care management of patients post-bariatric surgery has also been added.

The full list of pathways receiving an update is:

• Anaemia
• Ano-genital warts
• Assessment of acute chest pain
• Bacterial meningitis in adults
• Bacterial meningitis in children and adolescents
• Bladder cancer
• Breast cancer
• Bronchiectasis
• Cervical dysplasia and cancer
• Contraception
• Crohn’s disease
• Depression in adults
• Diabetes
• Dyslipidaemia
• Early childhood assessment
• Epicondylitis
• Gallstones (and associated conditions)
• Headache in adults
• Interstitial lung disease
• Knee pain
• Melanoma
• Obesity in adults
• Osteoarthritis
• Ovarian cancer
• Proteinuria in adults
• Pruritus
• Psoriasis
• Shoulder pain
• Ulcerative colitis
• Urticaria and angio-oedema

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.

Map of Medicine: Update to Map Pathways [October 2015]