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Assessment of Physical Function

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141. WHO Guidelines on Integrated Care for Older People (ICOPE)

, is “the composite of all of the physical and mental capacities that an individual can draw on”. The WHO public health framework for Healthy Ageing focuses on the goal of maintaining intrinsic capacity and functional ability across the life course. Health care professionals in clinical settings can detect declines in physical and mental capacities (clinically expressed as impairments) and deliver effective interventions to prevent and delay progression. Yet early markers of declines in intrinsic capacity (...) to the present guidance is an ICOPE implementation guide, which addresses how to set person-centred care goals, develop an integrated care plan, and provide self-management support. This will also include guidance to lead the practitioner through the process of assessing, classifying and managing declining physical and mental capacities in older age in an integrated way. The present guidelines and the supplementary implementation guide are both organized into three modules. • Module I: Declines in intrinsic

2017 World Health Organisation Guidelines

142. Preventive chemotherapy to control soil-transmitted helminth infections in at-risk population groups

38 Systematic review teams 38 Management of conflicts of interests 38 Identification of priority questions and outcomes 40 Evidence identification and retrieval 40 Quality assessment and grading of evidence 41 Formulation of recommendations 41 Decision-making during the guideline development group meeting 42 Document preparation and peer review 43 DISSEMINATION AND PLANS FOR UPDATING 43 Dissemination 43 Plans for updating the guideline 43 REFERENCES 44 ANNEX 1. QUESTION IN POPULATION (...) helminthiases as a public health problem in children: progress report 2001–2010 and strategic plan 2011–2020. 3 Guideline development methodology WHO developed the present evidence-informed recommendations 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 recommendations, including research

2017 World Health Organisation Guidelines

143. Faltering growth: recognition and management of faltering growth in children

inequalities. Nothing in this guideline should be interpreted in a way that would 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. Faltering growth: recognition and management of faltering growth in children (NG75) © NICE 2019. All rights reserved. Subject to Notice of rights (https (...) of neonatal weight loss 21 3 Behavioural interventions 21 4 Frequency of monitoring 22 5 Support needs of parents 22 Faltering growth: recognition and management of faltering growth in children (NG75) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 23Ov Overview erview This guideline covers recognition, assessment and monitoring of faltering growth in infants and children. It includes a definition of growth

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

144. Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline

1.97, 95% CI 0.18–21.29). Benefits Oral corticosteroids improved lung function in ambulatory patients having a COPD exacerbation. There was also a trend toward fewer hospitalisations. Harms Various adverse effects were reported in the studies, including seizures, insomnia, weight gain, anxiety, depressive symptoms and hyperglycaemia. However, it is unclear whether the methods used to assess harms were similar across the studies and there were too few serious adverse events reported to adequately (...) obstructive pulmonary disease (COPD) exacerbations. Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts. After considering

2017 European Respiratory Society

145. Canadian guidelines for controlled pediatric donation after circulatory determination of death-summary report

and pediatric centers performing DCD use 5-minute hands-off period. During this 5-minute period, also sometimes referred to as a “no touch” period, no healthcare professional should have any physical contact with the patient, and the physicians determining death should be constantly observing the method used to confirm absent circulation. The period of time commences when no visible pulsatility is observable on a well-functioning arterial catheter waveform or after the last evidence of anterograde (...) Manager Save my selection Pediatric Critical Care Medicine: doi: 10.1097/PCC.0000000000001320 Special Article Open Objectives: Create trustworthy, rigorous, national clinical practice guidelines for the practice of pediatric donation after circulatory determination of death in Canada. Methods: We followed a process of clinical practice guideline development based on World Health Organization and Canadian Medical Association methods. This included application of Grading of Recommendations Assessment

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2017 CPG Infobase

146. A Practical Approach to the Management of Continuous Glucose Monitoring (CGM) / Real-Time Flash Glucose Scanning (FGS) in Type 1 Diabetes Mellitus in Children and Young People Under 18 Years

Started with the CGM or FGS System 22 Appendix A: Literature Search – Evidence for CGM or Sensor Augmented Pump Therapy 22 Appendix B: Review of Evidence and Limitations of Evidence Underpinning NICE Recommendations .. 24 Appendix C: Criteria Used to Assess Levels of Evidence and Strength of Recommendations 42 Appendix D: Scores to Assess Hypoglycaemia 43 Appendix E: Scales That Can Be Used to Assess Hypoglycaemia 44 References 48 Clinical Guideline A Practical Approach to the Management of Continuous (...) hypoglycaemia or ? impaired awareness of hypoglycaemia associated with adverse consequences (for example, seizures or anxiety) or ? inability to recognise, or communicate about, symptoms of hypoglycaemia (for example, because of cognitive or neurological disabilities). 1.2.63 Consider ongoing real-time continuous glucose monitoring for: ? neonates, infants and pre-school children ? children and young people who undertake high levels of physical activity (for example, sport at a regional, national

2017 British Society for Paediatric Endocrinology and Diabetes

147. Commissioning guide: Faecal incontinence

and overflow and assess anal tone and squeeze Initial bowel management ? Dietary modification ? Medication ? Advice on use of continence products (see appendix 2) Offer all patients: ? reassurance and lifestyle advice ? access to help with relevant physical, emotional, psychological and social issues ? advice about relevant support groups ? advice on self-management of symptoms Commissioning guide 2017 Faecal Incontinence 4 All individuals who continue to experience symptoms of faecal incontinence should (...) (neurological disease) ? Patient request Level 2: At this level the majority of patients will need anorectal physiological testing and an endoanal ultrasound to assess sphincter function and anatomy. The majority can then go straight to a nurse- or therapist-led specialised bowel management clinic. A minority of patients will go directly to a colorectal clinic to discuss surgery. Indications for this are: ? Full thickness rectal prolapse. These patients will usually have anorectal physiological testing

2017 Association of Coloproctology of Great Britain and Ireland

148. Child abuse and neglect

brings them into contact with children and young people to spot signs of abuse and neglect and to know how to respond. It also supports practitioners who carry out assessments and provide early help and interventions to children, young people, parents and carers. Clinical features of abuse and neglect (including physical injury) are covered in NICE's guideline on child maltreatment. Recommendations relevant to both health and social care practitioners appear in both guidelines. NICE has also produced (...) problems and physical ill health. Recognising and responding to child abuse and neglect, or its early signs, is complex. Key challenges practitioners face may include: Knowing 'when to be worried' that a child or young person is being abused or neglected, and how serious a cause for concern different indicators may be. Assessing levels of risk and need in relation to child abuse and neglect. Knowing what early help interventions are effective when there are early signs of child abuse and neglect

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

149. Counter-terrorism and psychiatry

://www.rcpsych.ac.uk those found to carry out such acts may have experienced physical and mental health problems. Current tools and methodologies should be viewed with considerable caution. There is a temptation to misuse them, and they should be used primarily to structure assessments in the context of the Vulnerability Assessment Framework (HM Government, 2012). Methodologies that aim to forecast rare events, such as acts of terror, yield consistently poor results. We do not know what the base-rates (...) . In making these decisions, psychiatrists consult with peers and seek organisational advice and guidance on breaching confidentiality in accordance with professional and ethical principles. Like other professionals, psychiatrists have a duty to safeguard both their patients and the public. If a psychiatrist is asked to see an individual with a serious mental health problem and assesses them as being a significant risk to themselves or to others, they will act to provide appropriate care and to minimise

2016 Royal College of Psychiatrists

150. Psychiatric reports: preparation and use in cases involving asylum, removal from the UK or immigration detention

concerned and can change over time. Capacity must also be kept under review by both the psychiatrist and the instructing legal representative. If it is the psychi- atrist’s opinion that a person lacks capacity, they might consider recommending that the position should be reviewed in a certain period of time. Specific evidence must be provided to substanti - ate any statement about lack of capacity. It might be helpful to include an overall assessment of cognitive function as well as assessment (...) if there were none. Where discrepancies arise, they should be noted and described. Trying to resolve the discrepancy is not generally the function of the psychiatrist’s report, but if noted and explored it provides an opportunity to discuss the impact 2 ‘… it was not for the doctor to reach an overall conclusion on the credibility or otherwise of the victim’s account. The most that any doctor could say was the physical and psychological condition of an appellant was consistent with her story.’ HH (Ethiopia

2016 Royal College of Psychiatrists

151. WHO recommendation on duration of bladder catheterization after surgical repair of simple obstetric urinary fistula

differences between the research reported and the context for which the recommendation was being prepared. Such differences were related, for instance, to populations, interventions, comparators or outcomes of interest. Imprecision: This assessed the degree of uncertainty around the estimate of effect. As this is often a function of sample size and number of events, studies with relatively few participants or events – and thus wide confidence intervals around effect estimates – were downgraded (...) by the surgeon after repair surgery. Nardos et al., 2012, included women with simple obstetric urinary fistula assessed at physical exam before surgery. • Barone et al. excluded women who were pregnant, any fistula was not simple or was multiple, and any fistula that was radiation induced, associated with cancer , WHO recommendation on duration of bladder catheterization after surgical repair of simple obstetric urinary fistula 13 or due to lymphogranuloma venereum. Nardos et al. excluded women

2018 World Health Organisation Guidelines

152. Guidelines on the management of abnormal liver blood tests

syndrome, malabsorption and gastrointestinal protein loss. Prothrombin time (PT) and INR are assessments of blood clot- ting, which are used to measure liver function, as the underlying protein clotting factors (II, V , VII, IX and X) are made in the liver. If there is significant liver injury (usually loss of >70% of synthetic function), this results in a reduction in clotting factor production and subsequent coagulopathy, as confirmed by a prolonged PT or INR. While a prolonged PT/INR can indicate (...) that in some patients with autoimmune hepatitis their fibrosis stage progresses despite apparent control of their inflammatory process via perceived normal aminotransferase levels. This is compounded by the knowledge that many patients with signifi- cant liver fibrosis may have liver enzymes in the normal reference range and normal synthetic function, increasing the difficulty of their early identification. Thus, the clinical assessment of such individuals is critical in determining what the question

2017 British Society of Gastroenterology

153. Cancer Australia Annual Report 2016-17

approved by the Joint Committee of Public Accounts and Audit under sections 63(2) and 70(2) of the Public Service Act 1999. The Report has also been prepared to be consistent with the requirements for annual reporting of the Cancer Australia Act 2006. In compliance with section 10 of the Public Governance Performance and Accountability Rule 2014, I certify that: i. a fraud risk assessment and fraud control plan has been prepared for Cancer Australia; ii. appropriate mechanisms for preventing, detecting (...) Cancer Australia 12 Purpose 14 Functions and role 14 Organisational structure 14 The Cancer Australia Advisory Council 15 Audit Committee 15 Advisory Groups 15 Outcome and program structure 15 Report on Performance 16 Annual Performance Statement 18 2016–2017 Highlights 24 Report on financial performance 26 Management & accountability 28 Management and accountability 30 Corporate governance 31 Financial overview 32 Management of human resources 32 Cancer Australia Staffing statistics 33 Ministerial

2017 Cancer Australia

154. Guidelines on autopsy practice: Autopsy in sickle cell disease and persons with sickle trait

in the interests of specific patients and special circumstances. The medicolegal risk of departing from the guidelines should be assessed by the autopsy pathologist; just as adherence to the guidelines may not constitute defence against a claim of negligence, so a decision to deviate from them should not necessarily be deemed negligent. There is a general requirement from the General Medical Council to have continuing professional development (CPD) in all practice areas and this will naturally encompass (...) in the tiny (5 gm or less) non-functioning splenic remnant. · Splenic sequestration: expansion of the red pulp, with aggregates of tightly packed sickled red cells. Liver · Hepatic sequestration manifests as severe congestion and expansion of the sinusoids, packed with sickle red cells. · Haemphagocytosis by Kupffer cells. Circle of Willis 11,26 · Chronic sickle cell arteriopathy is the major cause of stroke and haemorrhage; histologically it is a combination of non-atherosclerotic intimal thickening

2017 Royal College of Pathologists

155. Screening for disruptive behaviour problems in preschool children in primary health care settings

of disruptive symptoms and their triggers, especially noting what makes problem behaviours worse or better. lists the domains that require assessment. Evaluating the child’s adaptive functioning across settings will clarify pervasiveness and severity of impairment. It is also important to note protective factors—child and family strengths—such as cognition, stable employment or a supportive family network. Table 2. Factors to evaluate during assessment Child Family Environment Cognitive levels Parent*–child (...) an understanding of etiology and indicate where best to intervene. However, even after a systematic assessment is completed, some children are difficult to categorize as having the symptomology or degree of functional impairment necessary to establish with certainty that a disorder is present. The best approach in these situations may be to contract with the family for a series of regular visits to monitor the child’s behavioural trajectory over several months. From a practical standpoint, the timing

2017 Canadian Paediatric Society

156. Summary of the development process and methodology for the investigation of a new breast symptom GP card

concerning physical examination, begin with mammography. US is useful if mammography is inconclusive or suspicious. University of Michigan 2013 19 Men – Diagnose and treat enlargement or pain. Breast mass is rare, but suspicious for cancer UK DoH 2010 12 History & clinical assessment to be performed (note testicles also to be examined) Imaging: “Mammography and/or ultrasound should be performed in men with unexplained or suspicious unilateral breast enlargement” Biopsy: “Needle core biopsy should (...) systematic approach to the assessment of a new breast symptom. A second edition of the INBS guide was published in 2006, incorporating evidence published to 2004. In 2016-17 Cancer Australia has undertaken an update of the INBS guide to ensure currency with contemporary practice and latest evidence. Establishment of a multidisciplinary Working Group A multidisciplinary Working Group, chaired by Dr Julie Thompson, General Practitioner, was convened to provide Cancer Australia with expert input

2017 Cancer Australia

157. Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis

• Baseline evaluation of individuals beginning nPEP should include laboratory assessment of hepatic and renal function and evaluation for sexually transmitted infection (STI) and hepatitis infection, with appropriate subsequent management (Table 6). • Ongoing laboratory monitoring of biochemistry and hematology during nPEP is advised only for those with baseline laboratory abnormalities, or in those who develop signs or symptoms of organ dysfunction or medication-related adverse effects during therapy (...) of Health Research and in- kind support from the CIHR Canadian HIV Trials Network. We fol- lowed the GRADE (Grading of Recommendation, Assessment, Development and Evaluation) system, a rigorous and widely accepted methodology for the development of clinical practice guidelines (Box 1). We first assembled a panel of 25 experts from across Canada who represent diverse disciplines (infectious diseases, primary care, emergency medicine, public health, pharmacy, nursing, community), with invitations from

2017 CPG Infobase

158. Frailty in Older Adults - Early Identification and Management

health authorities. Areas of Assessment There are number of common problems associated with frailty such as falls, weight loss, poor nutrition, physical inactivity, cognitive impairment and polypharmacy—many of which may be reversible or preventable—that should be addressed to improve outcomes. Conduct a review of the medical, functional, psychological and social/environmental needs of the patient. 7 The areas of geriatric assessment outlined in Table 3 in the section below and the may help guide (...) problems Functional Review Mobility Consider use of mobility assessment tools: see Associated Documents: and . Consider referral to physical therapist. Gait and speed Balance Mobility aids Foot care/footwear Fall Risk Direct patient to , including . Consider a medical review for factors that increase fall risk. Consider arranging for an alert device or recommending using a hip protector. See and and . Fall history Fall prevention Osteoporosis Drugs that increase fall risk Physical Activity Assess

2017 Clinical Practice Guidelines and Protocols in British Columbia

159. Ileoanal Pouch Report

of ulcerative colitis and familial adenomatous polyposis. At the beginning surgeons were concerned with the assessment of the initial clinical results. During the next few years technical modifications were made to the type of pouch and the ileoanal anastomosis. Pouchitis was defined and as time went on the late results including function and failure rates were reported. In the last ten years minimally invasive surgery has been increasingly applied to pouch surgery with no difference in morbidity or failure (...) a routine procedure with reliable outcomes. The pouch operation has also gone through a similar period of development and today’s pouch patients deserve even more reassurance in a changed world with social media and access to many sources of information and advice. Someone considering a pouch operation needs to know what they can really expect, from complications to outcomes and bowel function, and we hope this report will help drive up success rates and create increasing transparency for both

2017 Association of Coloproctology of Great Britain and Ireland

160. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock

: Reassessment should include a thorough clinical examination and evaluation of available physiologic variables (heart rate, blood pressure, arterial oxygen saturation, respiratory rate, temperature, urine output, and others, as available) as well as other noninvasive or invasive monitoring, as available. 4. We recommend further hemodynamic assessment (such as assessing cardiac function) to determine the type of shock if the clinical examination does not lead to a clear diagnosis (BPS). 5. We suggest (...) ( , ). The average volume of fluid pre-randomization given in the PROCESS and ARISE trials was approximately 30mL/kg, and approximately 2 liters in the PROMISE trial ( ). Many patients will require more fluid than this, and for this group we advocate that further fluid be given in accordance with functional hemodynamic measurements. One of the most important principles to understand in the management of these complex patients is the need for a detailed initial assessment and ongoing reevaluation of the response

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2016 European Respiratory Society

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