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1721. Guidelines for the management and diagnosis of vitiligo

of evidence 4 What is the natural history of vitiligo? Introduction Despite being a common condition that may cause severe and long-lasting disability, the epidemiology of vitiligo has not been established with clarity. Table 4 Skin types (from http://www.dermnetnz.org) Skin type Typical features Tanning ability I Pale white skin, blue/ hazel eyes, blond/ red hair Always burns, does not tan II Fair skin, blue eyes Burns easily, tans poorly III Darker white skin Tans after initial burn IV Light brown skin

2008 British Association of Dermatologists

1722. Intermediate care - Hospital at Home in COPD

with pharmacological and non-pharma- cological approaches; – knowledge of current guidelines in COPD manage- ment; – excellent communication skills; – excellent team working skills. [Grade D] N (R26) Useful but non-essential team member skills include: – ability to perform chest auscultation; – venous and arterial blood sampling; – performance of and basic interpretation of an ECG; – interpretation of a chest radiograph; – performance of spirometry; – understanding of airway clearance techniques. [Grade D (...) of nurse led management inter- ventions for COPD, but the data are too sparse to exclude any clinically relevant benefit or harm arising from such interven- tions’’. 64 A recent ATS statement concurs: ‘‘Many home health interventions are based on empirical recommendations rather than research data’’. 65 Components of the interventions The components of home care/chronic disease management interventions for stable COPD patients may include: N An education programme with information on the following

2007 British Thoracic Society

1723. Paediatric - convulsions in children

Paediatric - convulsions in children Convulsions in Children Paediatric Guidelines INTRODUCTION A convulsion is a period of involuntary muscular contraction, often followed by a period of profound lethargy and confusion and sometimes profound sleep. Most convulsions in children under the age of 5 years will be due to febrile convulsions. The ?rst convulsion can be very frightening for the parents. Children with learning disabilities or congenital syndromes may have epilepsy as part

2007 Joint Royal Colleges Ambulance Liaison Committee

1724. Ethical Issues - consent

the option not to treat and the likely consequences ? explanation of likely bene?ts of treatment ? a reminder that the patient can change their mind about consent at any time. In practice, patients also need to be able to communicate their decision. Care should be taken not to underestimate the ability of a patient to communicate, whatever their condition. 8,9 Many people with learning disabilities have the capacity to consent if time is spent explaining the issues in simple language, using visual aids

2007 Joint Royal Colleges Ambulance Liaison Committee

1725. Assault/Abuse - safeguarding children

-injury ? running away and ?re-setting ? environmental factors and situation of parents (e.g. domestic violence, drug or alcohol abuse, learning disabilities). These notes have been developed for training purposes and should be read in conjunction with the ambulance service’s operational procedure – Suspected Cases of Child Abuse and Report Forms for the Protection of Children and Vulnerable Adults. Safeguarding Children Page 10 of 14 October 2006 Treatment and Management of Assault Treatment (...) include neglect of, or unresponsiveness to, a child’s basic emotional needs. Safeguarding Children Treatment and Management of Assault October 2006 Page 5 of 14 Treatment & Management of AssaultWHO IS VULNERABLE TO ABUSE? Although any child can potentially be a victim of abuse, there are some groups of children who may be particularly vulnerable. These include children with learning disabilities, severe physical illnesses or sensory impairments. Sources of stress within families may have a negative

2007 Joint Royal Colleges Ambulance Liaison Committee

1726. Workplace interventions for people with common mental health problems

as is reasonably practicable, safe and without risks to health. The Management Regulations place a ‘duty of care’ on employers to assess the nature and scale of risks to health in the workplace and risks to health include risks to mental health. The Disability Discrimination Act 1995 (DDA) creates a duty on employers and makes discrimination against those disabled by mental health problems illegal. The DDA applies to all employment matters including recruitment, training, performance management, protection (...) position and common mental disorders found that prevalence was more marked amongst socially disadvantaged populations. More consistent associations were with unemployment, less education and low income or material standard of living. Occupational social class was the least consistent marker. (Fryers et al 2003) Mental and neurological disorders account for 13% of the total Disability Adjusted Life Years (DALYs) lost due to all diseases and injuries in the world (WHO 2004). Five of the ten leading 1011

2005 British Occupational Health Research Foundation

1727. Trauma - trauma emergencies in adults (overview)

the principles of the Pre- Hospital Trauma Life Support (PHTLS RCS Ed)1, and Advanced Trauma Life Support (ATLS) training courses. BASIC TRAUMA INCIDENT PROCEDURE Safety: 1. SELF – personal protective equipment is mandatory 2. SCENE 3. CASUALTY. Remember, safety is dynamic and needs to be continually re-assessed throughout. Scene Assessment: ? consider resources required ? consider possibility of major incident/chemical, biological, radiological or nuclear (CBRN) (refer to CBRN guideline) ? early situation (...) that may result, but mechanism of injury alone cannot exclude injury. PATIENT ASSESSMENT The primary survey should be used to assess and detect any TIME CRITICAL/POTENTIALLY TIME CRITICAL problems Primary Survey – (60 – 90 seconds for assessment) ? AIRWAY with spine control ? BREATHING ? CIRCULATION ? DISABILITY (mini neurological examination) ? EXPOSURE and ENVIRONMENT Stepwise Patient Assessment and Management In ABCDE management, problems should be dealt with as they are encountered, i.e. do

2007 Joint Royal Colleges Ambulance Liaison Committee

1728. Assault/Abuse - suspected abuse of vulnerable adults/recognition of abuse

to take risks and may choose to live at risk if they have the capacity to make such a decision. Their wishes should not be overruled lightly. For example, most older people are not ‘confused’. Similarly, people with learning disabilities or mental health problems may have the capacity to make some decisions about their lives, but not others. All Local Authorities should have Inter-Agency Adult Protection Procedures which comply with the ‘No Secrets’ guidance 1 and many authorities will also have (...) other special needs themselves. Who is vulnerable to abuse? Particular groups of people may be more vulnerable to abuse. These include people from minority ethnic groups, people with physical disabilities, people with learning disabilities, mental health problems, severe physical illnesses, older people, the homeless, people with sensory impairments or those diagnosed as HIV positive. Some people with special needs (e.g. sensory impairment or learning disabilities) may demonstrate challenging

2007 Joint Royal Colleges Ambulance Liaison Committee

1729. Paediatric - trauma emergencies in children (overview)

? Disability ? Exposure, Examine and Evaluate The management of a child suffering a traumatic injury requires a careful approach, with an emphasis on explanation, reassurance and honesty. Trust of the carer by the child makes management much easier. If possible, it is helpful to keep the child’s parents/carers close by for reassurance, although their distress can exacerbate that of the child! Stepwise Primary Survey Assessment As for all trauma care, a systematic approach, managing problems (...) (refer to burns and scalds in children guideline). Looking for soot in the nostrils and mouth, erythema and blistering of the lips with a hoarse voice may indicate potential airway injury. There may be a need to progress to endotracheal (ET) intubation, but only if trained and airway re?exes are absent. If airway re?exes are present then rapid sequence intubation will be required; either initiate emergency transfer to further care or bring such skills to the scene e.g. immediate care Doctor (refer

2007 Joint Royal Colleges Ambulance Liaison Committee

1730. Adjuvant therapy

Adjuvant therapy Adjuvant therapy | CMAJ Main menu User menu Search Search for this keyword Search for this keyword Article Adjuvant therapy Nonsteroidal inhaled anti-inflammatory agents (anti-allergic agents) Disodium cromoglycate There is excellent evidence that disodium cromoglycate (DSCG) therapy can reduce symptoms,[ , ] disability and costly emergency room visits and admissions to hospital for asthma. The associated improvement in pulmonary function is relatively small or nil (...) compromising clinical benefit by aiming for serum concentrations of 28-55 μmol/L, rather than the previously recommended 55-110 μmol/L. Some studies have suggested that theophylline could cause behavioural changes and learning difficulties in children, but these findings have not been confirmed elsewhere.[ , ] Concomitant use of theophylline and the new leukotriene antagonists may lower the serum concentration of certain of the leukotriene antagonists, but not the theophylline concentration. In chronic

1999 CPG Infobase

1731. Use of back belts to prevent occupational low-back pain

, Montgomery JF. An evaluation of a weightlifting belt and back injury prevention training class for airline baggage handlers. Appl Ergon 1992 ; 23 : 319 -29. 11. Van Poppel MN, Koes BW, van der Ploeg T, Smid T, Boutar LM. Lumbar supports and education for the prevention of low back pain in industry: a randomized controlled trial. JAMA 1998 ; 279 : 1789 -94. 12. Alexander A, Woolley SM, Bisesi M, Schaub E. The effectiveness of back belts on occupational back injuries and worker perception. Prof Saf 1995 (...) a recommendation for or against the use of back belts to either prevent occupational low-back pain or to reduce lost work time due to occupational low-back pain (grade C recommendation). In Canada, back injuries account for over 25% of all lost time claims, the largest single claims category in most workers' compensation jurisdictions. Low-back pain (LBP), which is often seen initially in primary care practice, is estimated to be the most costly ailment in working-age adults. Disability resulting from LBP

2003 CPG Infobase

1732. Intimate Partner Violence During the Perinatal Period

Henderson, RN, PhD Associate Professor, School of Nursing, University of British Columbia Patricia Janssen, BSN, MPH, PhD Department of Health Care and Epidemiology University of British Columbia Patty Keith, RN, RM, Perinatal Nurse Consultant M.A.(Educ.), PhD(c) Outreach Education Coordinator, BCRCP Katheen Mackay, BSc, MSW Social Worker and Program Planner Domestic Violence Programs, VGH and Providence Health Care; Clinical Instructor, Division of Emergency Medicine, Department of Surgery, University (...) of British Columbia Joan Reiter, BSN, MBA Perinatal Nurse Consultant Conference Coordinator, BCRCP Colleen Varcoe, RN, PhD Associate Professor University of Victoria Ad Hoc Members Betty Braund, RN Nurse Educator, Woman Abuse Response Team BC Women’s Hospital and Health Centre Jan Christilaw, MD, FRCSC Department Head, Specialized Woman’s Health, BC Women’s Hospital and Health Centre Clinical Professor, Obstetrics and Gynecology, University of British Columbia Sarah Payne, RN Clinical Manager, Fir Square

2003 British Columbia Perinatal Health Program

1733. Principles of Perinatal Care for Substance Using Women

in 1993. Two provincial documents: the FAS Strategic Plan (1993) and the FAS Community Action Guide (1998) were utilized, along with other resources. GUIDELINE PRINCIPLES 1) All individuals, from a variety of social, economic, educational, racial and cultural backgrounds are at-risk for substance use during pregnancy. Principles of Perinatal Care for Substance Using Women and their Newborns * BCRCP * November, 1999 Page 2 of 8 2) It is important that women who are pregnant and using substances (...) , and the duty of every person to report to a Ministry for Children and Families child protection social worker knowledge of a child in those circumstances. Section 13 states that a child needs protection when (s)he has been or is likely to be subject to: 1) Physical harm 2) Sexual abuse 3) Sexual exploitation 4) Emotional harm 5) Deprivation of required health care 6) Parental refusal of needed treatment for the child 7) Inadequate provision for the child’s care 8) Child’s prolonged absence from home

1999 British Columbia Perinatal Health Program

1734. Principles on Intervention for People Unable to Comply with Routine Dental Care

of the legal protection available to all as well as knowledge of the laws that may be infringed by the use of physical intervention. The British Institute for Learning Disability (B.I.L.D.) in its document – Physical Interventions, A Policy Framework 1 quotes from Ashton and Ward: 'a duty of care exists when duties or responsibilities are placed on paid carers 10 .’ This is defined further as ‘taking reasonable care to avoid acts or omissions, which are likely to cause harm to another person.’ Judgements (...) process has been undertaken should be recorded in the records with regard to both the treatment and the physical intervention. (After Shuman and Bebeau, 1994) 20 12 A Pilot Study Case Scenario 4 A study carried out in an institution for people with a learning disability arose as a result of increasing reluctance of care staff to provide oral hygiene for dependent residents. This was associated with a staff training programme to deal with aggression and provide safe restraint. Some of the techniques

2004 British Society for Disability and Oral Health

1735. Resources for Coloproctology

37The Association of Coloproctology of Great Britain and Ireland, is a multi-professional organisation, committed to setting, developing and maintaining the highest standards of care of patients with colorectal disease including bowel cancer by audit, training, research and education. The Association recognises that increased funding has been directed towards the NHS and cancer care welcomes the Government’s initiative in directing more resource to cancer services and supports the multidisciplinary (...) and omissions have been excluded. Supported in part by an educational grant from Tyco Healthcare f fo or re ew wo or rd d It gives me great pleasure to introduce this timely update of the Resources for Coloproctology document published in 2001 under the guidance of Professor Christopher Marks. That document has been an invaluable reference source which has helped enormously in the development of colorectal units as specialisation has become established. The present updated report summarises exactly what

2006 Association of Coloproctology of Great Britain and Ireland

1736. Guidelines on the acoustics of sound field audiometry in clinical audiological applications

- like, or speech-feature stimuli. It is not intended as a “recommended procedure”, but does provide suggestions on a range of issues in order to encourage consistent practice and reporting that is comparable between test centres. There are two main areas of application of sound field audiometry in clinical audiology: 2.1 Unaided hearing assessments In most cases sound field assessment of hearing is applicable to young children and clinics in which learning disabled adults are tested. It is generally (...) . These include: • training young children to respond to tonal or narrow-band noise signals, prior to measuring their thresholds with earphones or static loudspeakers. For this purpose calibration is obviously not critical. • distraction testing in clinics (e.g. community) where VRA facilities are not available. This also includes “modified” distraction testing, where a child will not remain at the reference point of a dedicated paediatric test room but opportunistic distraction testing may provide limited

2008 British Society of Audiology

1737. Guidance on the use of real ear measurement to verify the fitting of digital signal processing hearing aids

In-situ REAR approach 6.4.2.1 General 6.4.2.2 REUR measurement 6.4.2.3 REAR measurement 6.5 Modify the programming in the aid 6.6 Check output does not exceed uncomfortable loudness levels 7 Notes on other types of patients 8 Glossary 9 Useful references 3 1. Scope This document provides guidance for clinical audiologists 1 who are fitting digital signal processing (DSP) hearing aids. It assumes prior knowledge, and it aims to provide a starting position from which audiologists may develop (...) the patient, make sure they know how to communicate any discomfort, and be ready to act immediately if distress is apparent. It may be appropriate to start at lower levels and increase the intensity if it causes no discomfort. The document does not address staff training for conducting REMs, however, this type of work does require an experienced audiologist, or audiologist under supervision, (as deemed appropriate by Head of Department). The document is in two parts. The first, described in section 6

2008 British Society of Audiology

1738. Vertigo part 2 - management in general practice

and these programs should be considered. A simple program including patient education and home based exercises can be sufficient. Vertigo – Part 2 – management in general practice clinicAl PRActice Reprinted from AustRAliAn F Amily PhysiciAn Vol. 37, No. 6, June 2008 411 neuritis describes an inflammation of the vestibular nerve which results in severe vertigo that usually lasts for days, whereas in labyrinthitis hearing loss is an additional feature. Viruses such as mumps and influenza are thought (...) . It is recommended that patients be educated in how to perform the program at home, either a modified Epley manoeuvre, Brandt-Daroff exercises (see Patient education) or the Semont manoeuvre (see Resources). Two small trials have shown that a modified Epley manoeuvre performed at home is the most effective among the three exercises, with up to 95% response rate 1 week post-treatment. 10,11 In particular, if the side of labyrinth affected can be clearly identified, the modified Epley manoeuvre is the treatment

2008 The Royal Australian College of General Practitioners

1739. Elder Abuse - Revision of original paper

is pivotal, and the general practitioner should therefore be part of the referral and decision making process. 5. All health professionals dealing with older people need appropriate education and training programs to enable them to identify cases of elder abuse. 6. Staff of agencies, who may encounter cases of elder abuse, need training in recognition of abuse. Policies and procedures need to be developed by these agencies for management of these cases, and referral of such cases to regional geriatric (...) into elder abuse needs to be encouraged and supported. 12. Current community education programs to raise awareness and knowledge of elder abuse need to be expanded. This Position Statement represents the views of the Australian Society for Geriatric Medicine. This Statement was approved by the Federal Council of the ASGM on 5 September 2003. The revision of this paper was coordinated by Dr Susan Kurrle 2 BACKGROUND PAPER Introduction Elder abuse is not a new phenomenon, however until recently it has gone

2003 Australian and New Zealand Society for Geriatric Medicine

1740. Clinical practice guidelines for the psychosocial care of adults with cancer

WITH C ANCER These guidelines have been developed to promote awareness of the psychosocial needs of patients and inform health professionals of those evidence-based interventions that may improve adjustment and outcome for patients. However, the psychosocial care of patients is not conducted in a vacuum, and the training, skills, attitudes and beliefs of health professionals will affect clinical care, often in subtle ways. Furthermore, the clinical care of patients with severe, disabling or life (...) support – Chapter 3.3 Level Evidence Appropriate counselling improves the well-being of people with cancer I 15 The opportunity to discuss feelings with a member of the treatment team I 15 or counsellor decreases psychosocial distress Participation in psycho-educational programs decreases anxiety and II 477,478 depression and increases knowledge 479 Participation in peer support programs is beneficial for patients with II 559 poor perceived social support Successful strategies for meeting psychosocial

2002 Cancer Australia

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