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1741. Neuroprotective strategies and alternative therapies for parkinson disease

treatments for the management of Parkinson disease (PD). These recommendations are meant to address the needs of specialists and nonspecialists caring for people with PD. Background and justification. PD is a neurodegenerative disorder characterized by the classic symptoms of bradykinesia, rigidity, and rest tremor. Although symptomatic therapy can provide benefit for many years, the disorder slowly progresses, eventually resulting in significant disability. Strategies to delay onset or slow progression (...) –August 2004, followed by a secondary search using the bibliographies of retrieved articles and knowledge from the expert panel extending to January 2005. The majority of articles were reviewed by the full panel. If a panelist was an author of one of the articles, at least two other panelists reviewed that article. If a disagreement was identified, consensus was reached by discussion with the whole group. The risk of bias for each study was determined using the classification of evidence scheme

2006 American Academy of Neurology

1742. Prediction of outcome in comatose survivors after cardiopulmonary resuscitation

, G. B. Young , C. L. Bassetti , S. Wiebe Neurology Jul 2006, 67 (2) 203-210; DOI: 10.1212/01.wnl.0000227183.21314.cd Citation Manager Formats Make Comment See Comments Downloads 68584 Share Abstract Objective: To systematically review outcomes in comatose survivors after cardiac arrest and cardiopulmonary resuscitation (CPR). Methods: The authors analyzed studies (1966 to 2006) that explored predictors of death or unconsciousness after 1 month or unconsciousness or severe disability after 6 (...) . Awakening generally takes place within 3 days after CPR, and neurologic impairment is expected if a patient fails to do so. These patients are often left in a severely cognitively disabled and fully dependent state; some remain in a minimally conscious or vegetative state, and very few awaken neurologically intact. The financial implications of caring for patients in a vegetative state or prolonged impaired consciousness are substantial. Health systems and family members directly are burdened

2006 American Academy of Neurology

1743. Diagnosis and prognosis of new onset parkinson disease

being the UK PD Society Brain Bank criteria (see appendix E-1 on the Neurology Web site at ). However, it has been suggested that an accuracy of 90% is the best that can be achieved with clinical assessment and clinical diagnostic criteria. Although symptomatic therapy can provide benefit for many years, PD is a progressive disorder that will eventually result in significant morbidity. Knowledge of the features that predict the rate of progression would empower clinicians to better counsel patients (...) . A second MEDLINE search covered 1966 through August 2004, followed by another search using the bibliographies of retrieved articles and knowledge from the expert panel extending to January 2005. At least two panel members reviewed each article. If a panelist was an author of one of the articles, at least two other panelists reviewed that article. If a disagreement was identified, consensus was reached by discussion with the whole group. The risk of bias for each study was determined using

2006 American Academy of Neurology

1744. Consent for anaesthesia 2 revised edition 2006

and training 27 Section 11 References 30 1 Consent A5 10/1/06 15:49 Page 1Section 1 Recommendations • Information about anaesthesia, preferably in the form of a patient- friendly leaflet, should be provided to patients undergoing elective surgery before they meet their anaesthetist. • The anaesthetic room immediately before induction is not an acceptable place or time to provide elective patients with new information other than in exceptional circumstances. • The amount and the nature of information (...) Consent A5 10/1/06 15:49 Page 2• The MCA places a duty upon carers to treat incapable patients in their best interests, to use the minimum necessary intervention when doing so, and to make efforts to reverse or minimise temporary incapacity to enable patients to make autonomous decisions. • When planning to allow trainees or others to use an opportunity presented by a patient for training in practical procedures, the anaesthetist should make every effort to minimise risk and maximise benefits

2006 Association of Anaesthetists of GB and Ireland

1745. Controlled drugs in perioperative care

Section 3 The Consultant Contract -Practical application Section 4 Direct Clinical Care Section 5 Supporting Activities Section 6 Additional NHS responsibilities Section 7 External Duties Section 8 On-Call Section 9 Leave Section 10 Pay and pensions Section 11 Clinical Excellence Awards Section 12 Appraisal and Continuing Medical Education Section 13 Work Diaries Section 14 Part time working Section 15 Job Plan Review and Appeal Section 16 Private Practice Section 17 Academic and Honorary Contracts (...) circumstances a consultant may wish to contract for fewer than 2.5 SPAs - but beware of the effect on appraisal and revalidation and on quality of care given to patients. Examples of SPA • Training (e.g. of trainees, medical students) • Continuing professional development (i.e. all regular activity such as reading journals, attending regular professional or academic meetings etc.) • Formal teaching (e.g. giving lectures, seminars) • Audit • Job planning • Appraisal • Research • Clinical management • Local

2006 Association of Anaesthetists of GB and Ireland

1746. Guidelines on Consent for Anaesthesia or Sedation

Professional Documents are progressively being coded as follows: TE Training and Educational EX Examinations PS Professional Standards T Technical POLICY – defined as ‘a course of action adopted and pursued by the College’. These are matters coming within the authority and control of the College. RECOMMENDATIONS – defined as ‘advisable courses of action’. GUIDELINES – defined as ‘a document offering advice’. These may be clinical (in which case they will eventually be evidence-based), or non-clinical (...) be of concern. GENERAL PRINCIPLES The standard for consent in Australia is established by the common law. In New Zealand it is embodied in the Code of Health and Disability Services Consumers’ Rights. Consent for treatment provided by an anaesthetist is different from a statement as to the necessity for anaesthesia (which may form part of the consent for an operative procedure). Although legal processes that test the validity of consent differ, both Australian and New Zealand law state that the provision

2005 Australian and New Zealand College of Anaesthetists

1747. Recommendations for the Pre-Anaesthesia Consultation

: A Guide for Clinicians, and PS26 Guidelines on Consent for Anaesthesia or Sedation). These requirements are also reflected in the New Zealand Code of Health and Disability Consumers’ Rights 6 issued by the New Zealand Health and Disability Commissioner, and the Australian Charter of Healthcare Rights 7 (endorsed July 2008). 2. PURPOSE The purpose of this document is to assist practitioners to ensure that patients are adequately assessed, prepared, and have given consent for the recommended treatment (...) of the anaesthetist’s role in health advocacy, as well as in optimal preparation or surgery, the pre-anaesthesia consultation is a valuable opportunity to encourage and educate patients regarding modifiable health factors such as encouraging smokers to quit (see PS12 Guidelines on Smoking as Related to the Perioperative Period). 5.13 The pre-anaesthesia consultation should identify and take note of any advanced care directives. In their absence the consultation may represent an appropriate opportunity to recommend

2008 Australian and New Zealand College of Anaesthetists

1748. A controlled comparison study to evaluate different management strategies for workplace trauma

85184 366 3 Printed in Great Britain v The Institute for Employment Studies The Institute for Employment Studies is an independent, apolitical, international centre of research and consultancy in human resource issues. It works closely with employers in the manufacturing, service and public sectors, government departments, agencies, and professional and employee bodies. For over 35 years the Institute has been a focus of knowledge and practical experience in employment and training policy (...) , Rick J, Fergusson E HSE Research Report RR170, 2004. ISBN 0 7176 2770 5 Best Practice in Rehabilitating Employees Following Absence Due to Work-Related Stress Thomson L, Rick J, Neathey F HSE Research Report RR138, 2003. ISBN 0 7176 2715 2 Review of Existing Supporting Scientific Knowledge to Underpin Standards of Good Practice for Key Work-Related Stressors, Phase 1 Rick J, Thomson L, Briner R, O'Regan S, Daniels K HSE Research Report RR024, 2002. ISBN 0 7176 2568 0 A catalogue of these and all

2006 Publication 1430

1749. Hand-Arm Vibration Syndrome: an evidence based review and summary for managers and workers

of the symptoms of someone with HAVS. Exposure to HTV should therefore be reduced as low as is reasonably practicable. Health surveillance has an important role to play in monitoring the effectiveness of exposure levels. How do we find out if someone has HAVS? A clinical assessment by an appropriately trained health professional is required and this may need to be supplemented by special investigations. The assessment should include: • Record of past exposure to vibration, including that from previous (...) trained health professional. This advice will largely be based on the stage the worker has reached on the Stockholm Workshop Scale. Can affected workers recover? After reducing or ceasing exposure to HTV vascular symptoms reduce in some, but not all, people over a number of years. There is evidence that smoking impedes recovery. What is the best way of managing someone with HAVS? Removal from or reduction of further HTV exposure is the key and medical treatment is largely unproven. Stopping smoking

2004 Publication 1430

1750. Convulsions in children

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 of the condition

2006 Joint Royal Colleges Ambulance Liaison Committee

1751. Trauma emergencies in children ? overview

differences. BASIC TRAUMA APPROACH Scene: ? triage if more than one casualty. Situation: ? observe and note mechanisms of injury (MOI) ? always look for evidence of children such as toys or child seats that may indicate that a child has been ejected from a vehicle or wandered off from the scene but may still require medical attention. ASSESSMENT Primary Survey – Rapid In-depth primary survey (60- 90 seconds) ? Airway with cervical spine control (see C-spine collar) ? Breathing ? Circulation ? Disability (...) 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

2006 Joint Royal Colleges Ambulance Liaison Committee

1752. Suspected abuse of vulnerable adults and 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

2006 Joint Royal Colleges Ambulance Liaison Committee

1753. 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

2006 Joint Royal Colleges Ambulance Liaison Committee

1754. 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

2006 Joint Royal Colleges Ambulance Liaison Committee

1755. UK National Guideline on the sexual health of people with HIV: sexually transmitted infections

issues or perception by the HIV physician that sexual activity is less likely [29]. It is recognised that social exclusion also adds to stigma experienced by people living with HIV [30]. Ensuring cultural sensitivity requires appropriate use of language with the trained interpreters (who are not known to the person). Taking a sexual history requires appropriate knowledge, skills and attitudes. Different HIV populations may also require specifically targeted health promotion materials. All HIV service (...) for disclosure to the party at risk after notification of the original patient. It is then up to that individual to decide whether to take the matter further in a legal sense. Where the other party has no capacity to consent (e.g. through learning disabilities or because they are under the age of consent), then the clinician can report the matter on their behalf. The British HIV Association are in the process of producing a briefing paper to cover these complex and rapidly evolving issues [108]. At time

2006 British Association for Sexual Health and HIV

1756. Therapeutic brief 14 - simplifying inhaler devices for chronic obstructive pulmonary disease

medication regimens (especially minimising use of multiple devices) and patient education may help achieve these aims. Therapeutic Brief 14 – Simplifying inhaler devices for Chronic Obstructive Pulmonary Disease. March 2008. Veterans’ Medicines Advice and Therapeutics Education Services Simplifying inhaler devices for Chronic Obstructive Pulmonary Disease Key points For inhaler devices; Select the most appropriate inhaler device and minimise the number of devices used. Show patients how to use (...) their inhaler device(s), and ask them to demonstrate their technique to you. Re-check inhaler technique each time a prescription is written or dispensed until you are sure the patient has mastered the technique. Consider re-checking every 2 to 3 months thereafter. Consider a Metered Dose Inhaler (MDI) and spacer in place of a nebuliser. Inside Therapeutic brief 14 Educate patients on inhaler use p2 Minimise the number and types of inhaler devices p3 Consider replacing nebuliser with MDI and spacer p3 Select

2008 Clinical Practice Guidelines Portal

1757. Eating disorders toolkit, a practice based guide to the inpatient management of adolescents with eating disorders, with special reference to regional and rural areas

and internationally. A full list of acknowledgements can be found in Appendix 1. Eating Disorder Toolkit - A Practice-Based Guide to the Inpatient Management of Adolescents with Eating Disorders, with Special Reference to Regional and Rural Areas This work is copyright. This document may be reproduced in whole for clinical use, study and training purposes subject to the inclusion of an acknowledgement of the source. It may not be reproduced for commercial usage or sale. Reproduction for purposes other than those (...) Observation and Physical Monitoring 50 Hypothermia 52 Amenorrhoea 54 Osteoporosis and Osteopaenia 57 Constipation ___________________________________________ 59 Eating, Nutrition and Physical Activity 61 Refeeding Guideline 65 Managing Meals and Snacks 68 Example Meal Plan 69 Meal Plan Template 70 Providing Nutrition Education 72 Bingeing 73 Purging 74 Physical Activity Eating Disorders Toolkit - Introduction to the Toolkit ii ________________________________________________ 79 Working with the Young

2008 Clinical Practice Guidelines Portal

1758. Comorbidity of mental disorders and substance use

. PARC must be acknowledged for their contribution of resources to the original document. Dr Chris Wurm (National Centre for Education and Training on Addiction), Associate Professor Chris Alderman (Drug and Therapeutics Information Service, Repatriation General Hospital) and Ms Jody Braddon (Pharmacist, Drug and Therapeutics Information Service) must also be acknowledged for their contributions to the original document. Thanks must go to Damian McCabe who was the Project Officer for the original (...) with comorbid mental disorders and substance use issues. At the time, the information contained in the resource was based on clinician knowledge in the area and what management approaches were effective based on prior experience. The updated guidelines provide a greater breadth of information on the same previously discussed topics and have a greater academic foundation. The current guidelines also include information not previously included relating to brain injury, gambling, tobacco, inhalants

2008 Clinical Practice Guidelines Portal

1759. Opioid prescription in chronic pain conditions guidelines for South Australian general practitioners

Key pain and addiction-related terms 12 Educational material on prescribing Schedule 8 (S8) opioid analgesics 12 Educational activities 12 section iii Pain and its Treatment 15 Why is pain management important? 16 What are the goals of pain management? 16 How can a GP assess a patient’s pain? 16 When should a GP refer to a pain management specialist for advice on patient management? 17 How can GPs assess for risks of abuse, addiction, and diversion, and manage their patients accordingly? 19 (...) was released, the group (see: Appendix A) met to discuss the need for education of both the health care community and the law enforcement and regulatory community. The group reviewed existing educational material and ultimately decided to produce Prescription Pain Medications – Frequently Asked Questions and Answers for Health Care Professionals and Law Enforcement Personnel, that would cover the clinical and regulatory issues surrounding the prescribing of controlled drugs. Background The goal

2008 Clinical Practice Guidelines Portal

1760. 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

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