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1781. 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

1782. 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

1783. 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

1784. 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

1785. 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

1786. 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

1787. 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

1788. 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

1789. 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

1790. 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

1791. 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

1792. 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

1793. 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

1794. 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

1795. 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

1796. 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

1797. 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

1798. 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

1799. 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

1800. 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

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