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Assessment of Physical Function

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181. Integrating collaborative TB and HIV services within a comprehensive package of care for people who inject drugs

Integrating collaborative TB and HIV services within a comprehensive package of care for people who inject drugs | Consolidated Guidelines Box 1.2 Compulsory drug detention and rehabilitation centres In some contexts, people who use or inject drugs are detained in compulsory drug detention centres or rehabilitation centres where they are typically supervised by custodial staff and have limited access to health services. Detainees can be subject to physical punishment and treatment that is neither evidence (...) a coordinating body for the integrated delivery of services for PWID, with representation from key stakeholders. Recommendations 1. The ministry of health should create and strengthen a joint national multisectoral coordinating body of key governmental and nongovernmental stakeholders, including PWID networks and their advocates. 2. This body should function at regional, district, local and facility levels, and be responsible for the governance, planning, coordination, implementation, monitoring and resource

2016 World Health Organisation HIV Guidelines

182. Diabetes Care

modifications alone. For more information: . Canadian Agency for Drugs and Technologies in Health reviews of second and third - line pharmacotherapy, at website: . , 5. Preventing complications and comorbidities Global Cardiovascular Management People with diabetes are at significantly increased risk of cardiovascular disease. The – Cardiovascular Disease: Primary Prevention recommends using a risk assessment tool, medical history, physical examination, and full fasting lipid profile. See about use of risk (...) . [Level 5, new 2015] Glycosylated hemoglobin (A1C; $12.69*) or glucose testing (e.g., fasting plasma glucose (FPG; $1.46) or 2-hour plasma glucose (2hPG; $12.94)) can be used for diagnosis and screening. Best choice of test will depend on clinical circumstances. [Level 2, new 2015] Individualized glycemic targets are based on patient’s age, duration of diabetes, risk of hypoglycemia, cardiovascular disease presence, and life expectancy. [Level 5, new 2015] Measure A1C every 3 months to assess glycemic

2015 Clinical Practice Guidelines and Protocols in British Columbia

183. Stoma care guidelines for Clinical nurse specialists

Consultancy in action 18 Management 19 Consultancy in action 19 Summary 21 Patient story 21 References and further reading 22 Contents 4 Clinical nurse specialists Stoma care5 Stoma nurse specialists are pathfinders who help guide patients on their journey to a new life that should be free from disease and of a better quality. However, adapting to life with a stoma involves a number of physical and psychological challenges, and the partnership formed between a patient and a stoma nurse specialist (...) of the bowel and bladder can affect people of any age, from babies through to the elderly. The surgical treatment of these conditions – which include bowel and bladder cancer, inflammatory bowel disease and diverticulosis, functional problems or trauma – often requires the formation of a stoma. A stoma is an artificial opening on the abdomen to divert the flow of faeces or urine into an external pouch located outside of the body. This procedure may be temporary or permanent. It is estimated

2016 Association of Coloproctology of Great Britain and Ireland

184. Asthma in Children - Diagnosis and Management

there is underestimation of asthma in 0-5 years olds due to variable diagnostic labels used. Diagnosis Clinical History Patients < 6 years old Diagnosing children < 6 years is difficult due to: lack of pulmonary function testing (as children < 6 typically cannot do the test reliably), and overlap of viral symptoms with asthma symptoms. Diagnosis is based on: a compatible history (recurrent episodes of wheezing, cough, difficulty breathing and chest tightness) (see ), a physical exam confirming airway obstruction (e.g (...) history (recurrent episodes of wheezing, cough, difficulty breathing and chest tightness) (see ), documented evidence of reversible obstruction or bronchial hyperreactivity with lung function testing (see ), and if lung function testing is not available, a physical exam finding of wheezing or signs of increased work of breathing that definitively improves with SABA can be used as a surrogate marker of reversible airway obstruction although lung function testing should be done when available. Table 1

2016 Clinical Practice Guidelines and Protocols in British Columbia

185. Asthma in Adults - Recognition, Diagnosis and Management

leads to increased health care costs it also results in productivity and work losses. , Diagnosis Due to the high prevalence of asthma, assess all patients for asthma who present with common asthma respiratory symptoms (see Figure 1). Take a history and perform a physical examination to determine if the pattern of respiratory symptoms supports the diagnosis of asthma (see . Adult clinical features to assess the probability of asthma). A diagnosis of asthma is based on documenting a pattern of common (...) to treatment, assuming adherence, inhaler technique and co-morbidities are being treated, reconsider the diagnosis of asthma. Table 1. Adult clinical features to assess the probability of asthma , NOTE: 30% of patients with a physician diagnosis of asthma are misdiagnosed . Thus, even in cases where the clinical diagnosis seems certain, it is still recommended that objective evidence of variable airflow obstruction be obtained. Investigation or Tests 1. Spirometry Spirometry (pre and post bronchodilator

2016 Clinical Practice Guidelines and Protocols in British Columbia

186. Clinical practice guidelines and principles of care for people with dementia

the person well, if possible - cognitive and mental state examination with a validated instrument - physical examination - a review of medication in order to identify and minimise use of medications, including over-the-counter products, that may adversely affect cognitive functioning and to simplify medication dosing - consideration of other causes (including delirium or depression). EXECUTIVE SUMMARY x 29 PP At the time of diagnosis of dementia, and at regular intervals subsequently, assessment should (...) of functioning, aphasia, hearing or visual impairments, psychiatric illness or physical/neurological problems when interpreting scores. 39 EBR Low 1 The Kimberley Indigenous Cognitive Assessment (KICA-Cog) or KICA-Screen tool is recommended for use with remote living Indigenous Australians for whom the use of alternative cognitive assessment tools is not considered appropriate. 40 EBR Low The modified KICA (mKICA) is recommended as an alternative to the Mini Mental State Exam (MMSE) in urban and rural

2016 Clinical Practice Guidelines Portal

187. National Evidence Based Guideline on Secondary Prevention of Cardiovascular Disease in Type 2 Diabetes

and platelet function. This guideline addresses the main pharmacological approaches to controlling these risk factors. Lifestyle interventions are also important, but the levels of evidence for such interventions are generally lower, and they are comprehensively discussed elsewhere. The guideline generally promotes an aggressive approach to management of risk factors, in recognition of the high risk of the target population. Nevertheless, it also advises caution in regard to contra-indications and adverse (...) other fibrates combined with statins. ** HDL 2 g alpha linolenic acid (ALA) daily •limiting salt intake to =4 g/day (1550 mg sodium). * National Heart Foundation of Australia. Position statement: Dietary fats and dietary sterols for cardiovascular health. Melbourne: National Heart Foundation of Australia, 2009. Alcohol Goal: Patients with coronary heart disease consume a low-risk amount of alcohol. Physical Activity Goals: Patients with coronary heart disease do at least 30 minutes of moderate

2015 Clinical Practice Guidelines Portal

188. Management of chronic heart failure

a diagnosis of HF, an ECG should be done (if it has not already been done) to help identify the underlying cause of the heart failure. Pulmonary-function tests should be considered in selected patients, ie in those whom HF is excluded and also in those with HF and comorbid lung disease which may contribute to dyspnoea. 3.1.3 ELECTROCARDIOGRAPHY The ECG can be used firstly as a screening test to assess the likelihood of HF and the need for subsequent echocardiography to confirm or refute a diagnosis (...) the processes described SIGN 50: a guideline developer’s handbook, 2015 edition (www.sign.ac.uk/guidelines/fulltext/50/ index.html). More information on accreditation can be viewed at www.nice.org.uk/ accreditation Healthcare Improvement Scotland (HIS) is committed to equality and diversity and assesses all its publications for likely impact on the six equality groups defined by age, disability, gender, race, religion/belief and sexual orientation. SIGN guidelines are produced using a standard methodology

2016 SIGN

189. British Association of Dermatologists and British Photodermatology Group guidelines for the safe and effective use of psoralen ultraviolet A (PUVA) therapy

+) PUVA should usually be offered before oral systemic therapy for patients with chronic plaque psoriasis that has not responded adequately to other therapies, including NB-UVB. 9.1.3 Is psoralen–ultraviolet A therapy more ef?cacious than biologics in patients with chronic plaque psoriasis? This has not been assessed in any head-to-head comparative studies. However, a retrospective database comparison showed PUVA in the short term to be more effective than most bio- logicals in improving psoriasis (...) than NB-UVB for psoriasis. It may work better in those with more severe psoriasis, although only one study showed this to be a signi?cant ?nding. PUVA can work when NB-UVB has not worked, as found in at least one of the paired comparison studies. The experience of all members of the GDG is that fail- ure to respond adequately (either in initial clearance or main- tenance of improvement after a course) to NB-UVB does not mean that PUVA will not prove adequate. An assessment of one region’s data

2016 British Association of Dermatologists

190. Sepsis: recognition, diagnosis and early management

significant. 1.4.19 Be aware that changes in cognitive function may be subtle and assessment should include history from patient and family or carers. 1.4.20 T ake into account that changes in cognitive function may present as changes in behaviour or irritability in both children and in adults with dementia. 1.4.21 T ake into account that changes in cognitive function in older people may present as acute changes in functional abilities. Oxygen satur Oxygen saturation in suspected sepsis ation in suspected (...) be inconsistent with complying with those duties. Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Sepsis: recognition, diagnosis and early management (NG51) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 50Contents Contents Overview 4 Who

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

191. Oral health for adults in care homes

. Of particular concern were circumstances in which vulnerable people may not be able to tell anyone that they have pain or discomfort in their mouth. Oral health assessments and mouth care plans The discussion below explains how we made recommendations 1.2.1–1.2.4. The committee recognised that poor oral health may occur before people move into care. For example, as someone's dementia or physical illness worsens, they often find it increasingly difficult Oral health for adults in care homes (NG48) © NICE (...) . Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Oral health for adults in care homes (NG48) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 37Contents Contents Overview 5 Who is it for? 5 Recommendations 6 1.1 Care home policies on oral health

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

192. Routine preoperative tests for elective surgery

resection radical neck dissection ASA gr ASA grades ades The ASA (American Society of Anesthesiologists) Physical Status Classification System is a simple scale describing fitness to undergo an anaesthetic. The ASA states that it does not endorse any elaboration of these definitions. However, anaesthetists in the UK often qualify (or interpret) these grades as relating to functional capacity – that is, comorbidity that does not (ASA 2) or that does (ASA 3) limit a person's activity. ASA 1 A normal (...) (NG45) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 11 of 17ECG ECG Consider for people aged over 65 if no ECG results available from past 12 months Yes Yes Lung Lung function/ function/ arterial arterial blood gas blood gas Not routinely Not routinely Consider seeking advice from a senior anaesthetist as soon as possible after assessment for people who are ASA grade 3 or 4 due to known or suspected respiratory

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

193. Use of multiple micronutrient powders for point-of-use fortification of foods consumed by pregnant women

included: (i) identification of priority questions and outcomes; (ii) retrieval of the evidence; (iii) assessment and synthesis of the evidence; (iv) formulation of recommendations, including research priorities; and (v) planning for dissemination implementation, impact evaluation and updating of the guideline. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was followed (6), to prepare evidence profiles related to prioritized questions, based on up-to-date (...) systematic reviews. The guideline development group – nutrition actions 2013–2014 consisted of content experts, methodologists, and representatives of potential stakeholders and beneficiaries. The first meeting to scope the guideline was held on 18–21 February 2013, Geneva, Switzerland. The second meeting on 23–26 June 2014, Geneva, Switzerland, aimed to examine the evidence and assess the results of the systematic review. The third and final meeting on 3–6 November 2014, Cancun, Mexico, was held

2016 World Health Organisation Guidelines

194. Daily iron supplementation in infants and children

deficiency anaemia from annual physical productivity losses have been calculated to be around US$ 2.32 per capita, or 0.57% of gross domestic product in low- and middle-income countries. The WHO has consistently recommended oral iron supplementation as one of the interventions that can reduce the prevalence of anaemia. Iron is required for the survival and virulence of many pathogens. Concerns have been expressed on a possible increased risk of malaria with iron interventions in malaria-endemic areas (...) , particularly among iron-replete children. On the other hand, screening to identify iron deficiency in children prior to iron supplementation is not feasible in many malaria-endemic settings. Given the importance and magnitude of anaemia globally, particularly in areas where malaria transmission is intense, an assessment of all available evidence has been carried out, to examine the safety and effectiveness of iron supplementation in children, including in malaria- endemic areas. Purpose of the guideline

2016 World Health Organisation Guidelines

195. Daily iron supplementation in adult women and adolescent girls

menstruating adult women and adolescent girls. Guideline development methodology WHO developed the present evidence-informed recommendation using the procedures outlined in the WHO handbook for guideline development (4). The steps in this process included: (i) identification of priority questions and outcomes; (ii) retrieval of the evidence; (iii) assessment and synthesis of the evidence; (iv) formulation of recommendation, including research priorities; and planning for (v) dissemination; (vi (...) ) implementation, equity and ethical considerations; and (vii) impact evaluation and updating of the guideline. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was followed (5), to prepare evidence profiles related to preselected topics, based on up-to-date systematic reviews. The guideline development group consisted of content experts, methodologists and representatives of potential stakeholders and beneficiaries. One guideline group participated in a meeting

2016 World Health Organisation Guidelines

196. Esophageal cancer

of regional and non-regional lymph nodes); o Pulmonary function testing (required prior to surgical resection and may be necessary prior to chemoradiotherapy); and/or o F-fluorodeoxy-D-glucose (FDG) PET scan can complement an augmented CT scan and help to identify radiologically-occult metastatic disease. 4-6 In certain cases, FDG-PET can provide an assessment of response. 7-12 Page 3 of 12 CLINICAL PRACTICE GUIDELINE GI-009 Version 4 Stage Information Table 1. AJCC Staging System for Esophageal Cancer (...) • Complete a work-up (as described above) and review the patient’s case with the multidisciplinary team. Early referral to a surgeon trained in esophageal surgery is important to assess for resectability. • Assess the degree of dysphagia and consult with a dietician to optimize the patient’s nutritional status. Consider placement of a nasogastic (NG) feeding tube. If the NG feeding tube insertion is technically difficult, placement should be performed radiographically. In a curative situation, avoid

2016 CPG Infobase

197. Lymphoma

-%20Canadian%20Cancer%20Statistics%20- %20English/Canadian%20Cancer%20Statistics%202011%20-%20English.ashx. Accessed October 17, 2011. CLINICAL PRACTICE GUIDELINE LYHE-002 Version 11 I. Diagnosis and Pathologic Classification Page 1 of 5 DISCUSSION I. DIAGNOSIS AND PATHOLOGIC CLASSIFICATION 1-6 An excisional lymph node biopsy of the largest regionally involved lymph node is the optimal specimen for initial diagnostic assessment. Similarly, a sizable biopsy from the organ of origin in extranodal lymphomas (...) , clarification of staging at questionable sites and as a source of additional specimen where required for further special testing or research. Occasionally,a generous core needle biopsy comprising many core samples with sufficient material to perform the appropriate ancillary techniques required for diagnostic assessment (immunohistochemistry, flow cytometry, PCR for IgH and TCR gene rearrangements, and FISH for major translocations) may supply adequate tissue, in cases when a lymph node is not easily

2016 CPG Infobase

198. BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment

National Health Service (NHS) in its document ‘No Health Without Mental Health: A Cross-Government Mental Health Outcomes Strategy for People of All Ages’ (Department of Health, 2011: paragraphs 3.26–3.30) and through the institution of a specific set of standards for the annual assessment of the quality of physical health care provided by mental health trusts to people with psychosis, delivered through the national commis- sioning for quality and innovation (CQUIN) programme (NHS England, 2015 (...) be supplanted by a risk score specifically developed for people with psychosis on antipsychotic medications. Current risk scores for the general population may underes- timate cardiovascular risk for people with psychosis. Monitoring for physical health risk factors (these are all category S) • The measurements below should be assessed before start- ing an antipsychotic, or as soon as possible afterwards, and then at the intervals indicated. • Body mass index (BMI) should be used to monitor whether

2016 British Association for Psychopharmacology

199. WHO guidelines on the management of health complications from female genital mutilation

of interests by external contributors 12 2.3 Identification of priority research questions and outcomes – scoping exercise . . . . . . . . . . . . . . . . . . . 12 2.4 Evidence retrieval 13 2.5 Quality assessment, synthesis and grading of the evidence 13 2.6 Qualitative research and human rights evidence 13 2.7 Formulation of recommendations 14 2.8 Document preparation and peer review 15 3. Guidance 16 3.1 Guiding principles 16 3.2 Recommendations and best practice statements 16 3.2.1 Deinfibulation (...) of Recommendations Assessment, Development and Evaluation HRP UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction IEC information, education and communication NGO nongovernmental organization OHCHR Office of the United Nations High Commissioner for Human Rights PICO population, intervention, comparator, outcome PTSD post-traumatic stress disorder UN United Nations UNAIDS Joint United Nations Programme on AIDS UNDP United Nations Development

2016 World Health Organisation Guidelines

200. Management of Suspected Spinal Injury

the limbs (paralysis) • nausea • headache or dizziness • altered or absent skin sensation. 2.2 Signs Signs of spinal injury include: • head or neck in an abnormal position • signs of an associated head injury • altered conscious state • breathing difficulties • shock • change in muscle tone, either flaccid or stiff • loss of function in limbs • loss of bladder or bowel control • priapism (erection in males). ANZCOR Guideline 9.1.6 January 2016 Page 3 of 6 3 Management The priorities of management (...) of a suspected spinal injury are: 1. calling for an ambulance 2. management of airway, breathing and circulation 3. spinal care. An awareness of potential spinal injury and careful victim handling, with attention to spinal alignment, is the key to harm minimisation. 3.1 The Conscious Victim Tell the victim to remain still but do not physically restrain if unco-operative. Those with significant spinal pain will likely have muscle spasm which acts to splint their injury. Keep victim comfortable until help

2016 Australian Resuscitation Council

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