Clinical Knowledge Summaries Updates

The CKS provide primary care practitioners with a readily accessible summary of the evidence base and best practice guidance for over 370 topics. These cover 1,000 clinical presentations or patient scenarios, free to access in the UK.  These are circulated regularly by email, we will collate them under this tab for ease of reference.  

New topics and updates shared since:

November 2021

Angio-oedema and anaphylaxis. Updated in line with the Resuscitation Council UK’s guideline on the emergency treatment of anaphylactic reactions. Recommendations to routinely administer intravenous or intramuscular chlorphenamine and hydrocortisone have been removed.

Bunions. The section on assessment has been moved to the diagnosis section to improve clarity and navigation. An extra section on surgical management has been added to the management section.

Heart failure – chronic. Advice to add iron studies as part of the assessment of a person with heart failure and to manage comorbidity of hypertension has been added. This is based on the European Society for Cardiology guideline on the diagnosis and treatment of acute and chronic heart failure.

Smoking cessation. History of epilepsy has been added to the contraindications and cautions section for nicotine replacement therapy in line with updated manufacturer's summary of product characteristics.

October 2021

Anaemia – iron deficiency. The topic has been updated in line with the British Society of Gastroenterology guidelines for the management of iron deficiency anaemia in adults 2021.

Candida – female genital. The treatment regimens for acute vulvovaginal candidiasis and for women with uncontrolled diabetes or other causes of immunocompromise have been updated, in line with the British Association for Sexual Health and HIV national guideline on vulvovaginal candidiasis 2019. The scenarios on 'severe infection' and 'uncontrolled diabetes or immunocompromised' have been deleted, and their content incorporated into other scenarios, for clarity and ease of navigation.

Immunisations – seasonal influenza. A new recommendation has been added to this topic. Children aged over 2 years, with a history of severe anaphylaxis to egg, who have previously required intensive care management in hospital, can be offered the egg-free cell-based quadrivalent influenza vaccine. This is an alternative to referral to a specialist for immunisation in hospital.

Non-alcoholic fatty liver disease. Content has been updated on prevalence, aetiology, complications, diagnosis, and management.

Tiredness/fatigue in adults. Updated to include recommendations from the NICE guideline on myalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome (ME/CFS): diagnosis and management 2021. Changes include the range of blood tests that are recommended in assessing a person with suspected CFS, the timescale for referral, the range of supportive measures that should be considered, and the follow up recommended in primary care.

September 2021

Allergic rhinitisCow’s milk allergy in childrenItch - widespread and Urticaria. Recommendations on use of cetirizine in people with renal impairment have been updated in line with the updated manufacturer's supplementary protection certificates (SPCs).

Bites – human and animalLeg ulcer – venousProstatitis – acute and Whooping cough. Adverse effects of co-trimoxazole updated in line with revised manufacturer's SPCs relating to the rare problem of severe respiratory toxicity with the potential to progress to Adult respiratory distress syndrome.

Carpal tunnel syndrome. A new section on specialist assessment and management has been created to provide additional information.

Chronic kidney disease. New recommendations and advice from NICE Chronic kidney disease guideline August 2021 were included.

Haemorrhoids. Updated advice on topical preparations for haemorrhoids and re-positioned the role of haemorrhoidal artery ligation in the treatment algorithm.

Obstructive sleep apnoea syndrome. New information from the NICE Obstructive sleep apnoea/hypopnoea syndrome, and obesity hypoventilation syndrome in over 16s, has been incorporated.