This site has been compiled as an aide-mémoire for all staff concerned with the management of general medical adult inpatients, especially those who present as emergencies.
GUIDELINES ON THE MANAGEMENT OF COMMON MEDICAL CONDITIONS
These have been drafted with reference to published medical literature and amended after extensive consultation. For ease of reference, the layout adopts a standard format, covering Recognition and assessment, Immediate treatment, Subsequent management, Monitoring treatment, and Discharge and follow-up.
Wherever possible, recommendations made are evidence based. Where no clear evidence has been identified from published literature, the advice given represents a consensus of the expert authors and their peers and is based on their practical experience.
No guideline will apply to every patient, even where the diagnosis is clear-cut; there will always be exceptions. These guidelines are not intended as a substitute for logical thought and must be tempered by clinical judgement in the individual patient.
PRESCRIBING REGIMENS AND NOMOGRAMS
The administration of certain drugs, especially those given intravenously, requires great care if hazardous errors are to be avoided. This section includes guidance on the Indications, Contraindications, Dosage and Administration (including Preparation and Diluents) for all drugs in this category referred to in the Guidelines. For some, there are Tables or Nomograms to assist dose selection or adjustment.
PRACTICAL PROCEDURES
This section includes advice on how to perform most forms of clinical intervention feasible at the bedside. Drafted with reference to published recommendations, they have also been subject to wide consultation with local experts and put to the test to check their reliability. The layout adopts a standard format, covering Indications, Contraindications, Equipment, Procedure, Specimens, and Aftercare. The recommendations should not be applied rigidly to every patient, and must be tempered by clinical judgement.
The illustrations in this section are reproduced with the permission of the BMJ Publishing Group and New England Journal of Medicine
ADDITIONS AND REVISIONS
The editors acknowledge the infinite time and trouble taken by numerous colleagues in the drafting and amendment of the text. The accuracy of the detailed advice given has been subject to exhaustive checks. However, any errors or omissions that become apparent should be brought to the attention of the Clinical Guidelines Developer/Co-ordinator (Telephone 01782 676697 or [email protected]), so that these can be amended in the next review, or, if necessary, brought to the urgent attention of users. Constructive comments or suggestions would also be welcome.
SUPPORTING INFORMATION
Where possible, the guidelines are based on evidence from published literature. It is intended that evidence relating to statements made in the guidelines - and its quality - will be made explicit.
Where supporting evidence has been identified, it is graded 1 to 5 according to standard criteria of validity and methodological quality as detailed in the table below. A summary of the evidence supporting each statement where available can be found at the bottom of the respective guideline. The evidence summaries are developed on a rolling programme, which are updated as each guideline is reviewed.
| Level | Treatment benefits | Treatment harms | Prognosis | Diagnosis |
| 1 | Systematic review of randomized trials or n-of-1 trials | Systematic review of randomized trials, systematic review of nested case-control studies, n-of-1 trial with the patient you are raising the question about, or observational study with dramatic effect | Systematic review of inception cohort studies | Systematic review of cross sectional studies with consistently applied reference standard and blinding |
| 2 | Randomized trial or observational study with dramatic effect | Individual randomized trial or (exceptionally) observational study with dramatic effect | Inception cohort studies | Individual cross sectional studies with consistently applied reference standard and blinding |
| 3 | Non-randomized controlled cohort/follow-up study | Non-randomized controlled cohort/follow-up study provided there are sufficient numbers to rule out a common harm | Cohort study or control arm of randomized trial | Non-consecutive studies, or studies without consistently applied reference standards |
| 4 | Case-series, case-control studies, or historically controlled studies | Case-series, case-control, or historically controlled studies | Case-series or case-control studies, or poor quality prognostic cohort study | Case-control studies, or poor or non-independent reference standard |
| 5 |
Mechanism-based reasoning |
Mechanism-based reasoning |
n/a |
Mechanism-based reasoning |
Excerpt from: OCEBM Levels of Evidence Working Group. The Oxford Levels of Evidence 2. Oxford Centre for Evidence-Based Medicine. 2011. http://www.cebm.net/index.aspx?o=5653
Evaluating the evidence base of these guidelines involves continuous review of both new and existing literature. The editors encourage you to challenge the evidence provided in this document. If you know of evidence that contradicts, or additional evidence in support of, the advice given in these guidelines, please forward it to the Clinical Guidelines Developer/Co-ordinator, Room D17, Ground Floor, West Building, University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Newcastle Road, Stoke-on-Trent, ST4 6QG (Telephone 01782 676697 or e-mail: [email protected])
EVIDENCE-BASED DEVELOPMENTS FOR WHICH FUNDING IS BEING SOUGHT
As new treatments prove themselves more effective than existing ones, the onus falls upon those practising evidence-based healthcare to adopt best practice. New treatments are usually more expensive than older ones. Within the finite resources of the Trust and the NHS as a whole, the adoption of these treatments has to be justified in terms of the improvements they will bring to the quality or cost-effectiveness of care. The priorities for funding new areas of treatment and patient care will be determined at Trust level.