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1681. Management of Hyperosmolar Hyperglycaemic State (HHS)

Table 2). Table 2 – Potassium replacement in HHS Anti-infective therapy As with all acutely ill patients, sepsis may not be accompanied by pyrexia. An infective source should be sought on clinical history and examination and C-reactive protein may be helpful (Gogos 2001). Antibiotics should be given when there are clinical signs of infection or imaging and/or laboratory tests suggest its presence. Anticoagulation Patients in HHS have an increased risk of arterial and venous thromboembolism (Whelton (...) prophylactic LMWH ? Consider IV antibiotics if sepsis identified or suspected B. 60 minutes to 6 hours Aims ? To achieve a gradual decline in osmolality (3-8 mosmol/kg/hr) o Using 0.9% normal saline aim to give a further 0.5 – 1 L/hr depending on clinical assessment of dehydration / risk of precipitating heart failure and fluid balance (target is to achieve positive fluid balance of 2-3 L by 6 hours) o Measure glucose, urea and electrolytes hourly and calculate osmolality (2Na + + glucose + urea) n

2012 Association of British Clinical Diabetologists

1682. Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS) Society Recommendations

., Yamada, T., Takii, Y., Kondo, K., Ohue, M. et al. Randomized, multicenter trial of antibiotic prophylaxis in elective colorectal surgery: single dose vs 3 doses of a second-generation cephalosporin without metronidazole and oral antibiotics. Arch Surg . 2007 ; 142 : 657–661 | | | Initial administration should be as near as possible to the skin incision and ≤1 h before the incision. x 79 Bratzler, D.W. and Houck, P.M. Antimicrobial prophylaxis for surgery: an advisory statement from the National (...) Surgical Infection Prevention Project. Am J Surg . 2005 ; 189 : 395–404 | | | | | , x 82 Steinberg, J.P., Braun, B.I., Hellinger, W.C., Kusek, L., Bozikis, M.R., Bush, A.J. et al. Timing of antimicrobial prophylaxis and the risk of surgical site infections: results from the Trial to Reduce Antimicrobial Prophylaxis Errors. Ann Surg . 2009 ; 250 : 10–16 | | | The choice of antibiotic is dependent upon local guidelines, and should be different from the drug of choice for treatment of established

2012 ERAS Society

1683. Obsessive Compulsive Disorder

be helpful because exacerbations can be assayed with subsequent titers to detect any sudden increase in antibody levels, but a GABHS culture is the inves- tigation of choice. Positive antistreptococcic anti- bodytitersarenot,bythemselves,anindicationfor antibiotic treatment. At the present time, no neuro- imaging procedures have been validated for the assessment or diagnosis of OCD or related comor- bid disorders. Educational Assessment. School and educational histories provide an ecologically valid

2012 American Academy of Child and Adolescent Psychiatry

1684. Investigation and management of Acute Transfusion Reactions

by dyspnoea (see section on Subsequent management). If the identity check shows ABO incompatibility due to transfusion of a unit intended for another patient, contact the transfusion laboratory immediately to prevent a further ‘wrong’ blood incident. If bacterial contamination is suspected, take blood cultures from the patient (peripheral vein and through central line, if present) and start broad‐spectrum IV antibiotics (the local regimen for patients with neutropenic sepsis would be appropriate

2012 British Committee for Standards in Haematology

1685. Investigation and management of Chronic Lymphocytic Leukaemia

. This regimen is associated with a significant risk of infection and meticulous attention should be paid to antimicrobial prophylaxis and supportive care. Routine antimicrobial prophylaxis with oral co‐trimoxazole, aciclovir and itraconazole and monitoring for cytomegalovirus (CMV) reactivation is recommended. Table 12. Phase 2 and 3 studies of initial therapy for patients with TP53 abnormality Study Regimen Patients ( n ) CR (%) OR (%) Median PFS (months) OS (%) Hallek et al ( ) FC 29 4 45 0 (2 years) 41 (...) for high‐risk CLL should ideally be delivered as part of a clinical trial. Outside of trials, alemtuzumab in combination with pulsed high dose glucocorticoid is the treatment of choice. Meticulous attention should be paid to antimicrobial prophylaxis and supportive care. The use of alemtuzumab in combination with drugs other than steroids should be confined to clinical trials Subcutaneous alemtuzumab injection is associated with comparable efficacy and less toxicity in CLL and this has become

2012 British Committee for Standards in Haematology

1688. Recommendations for imaging in children in non-dedicated paediatric centres

. Paediatrics. 2011 [cited 2017 Oct 19]; 128(3):595-610. Available from: http://pediatrics.aappublications.org/content/pediatrics/early/2011/08/24/peds.2011- 1330.full.pdf • National Institute for Health and Clinical Excellence (NICE). Urinary Tract Infection in under 16s: Diagnosis and Management. c. 2007 [updated 2017 September; cited 2017 Oct 19]. Available from: http://guidance.nice.org.uk/CG54 • Pennesi M, Travan L, Peratoner L, Bordugo A, Cattaneo A, Ronfani L, Minisini S, Ventura A. Is antibiotic

2012 Clinical Practice Guidelines Portal

1689. The Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease

, and grades of recommendation 7 Table 2.1 Prevention in the context of ARF and RHD 19 Table 2.2 Recommended antibiotic treatment for streptococcal pharyngitis 24 Table 3.1 Evolution of the diagnostic criteria for ARF since 1992 31 Table 3.2 2012 Updated Australian guidelines for the diagnosis of ARF 32 Table 3.3 Key points in identifying major manifestations of ARF 36 Table 3.4 Upper limits of normal of P-R interval 37 Table 3.5 Key points in identifying minor manifestations of ARF 37 Table 3.6 Suggested (...) 3.13 Medications used in ARF 51 Table 4.1 Major elements of secondary prevention of ARF/RHD 55 Table 4.2 Recommended antibiotic regimens for secondary prevention 57 Table 4.3 Factors that affect the duration of secondary prophylaxis 57 Table 4.4 Duration of secondary prophylaxis 58 Table 4.5 Potential strategies to improve the delivery of secondary prophylaxis 60 Table 4.6 Measures that may reduce the pain of BPG injections 61 Table 4.7 Procedures requiring endocarditis prophylaxis in patients

2012 Clinical Practice Guidelines Portal

1691. Australian Diabetes Foot Network - management of diabetes-related foot ulceration - a clinical update Full Text available with Trip Pro

for polymicrobial infections with gram-positive cocci, gram-negative bacilli and/or anaerobes. When these risk factors are present, broad-spectrum antibiotic therapy should immediately be commenced and then modified according to culture results. Clinically non-infected wounds require neither wound culture nor antimicrobial therapy. Osteomyelitis Osteomyelitis can complicate DRFUs, increasing the risk of amputation. A positive “probe to bone” test is highly suggestive of osteomyelitis and should be performed (...) antibiotics. Clinical signs and laboratory markers typically associated with infection can be blunted or absent in people with diabetes, so should not be relied on in isolation to assess infection severity. An increase in skin pigmentation may be a sign of inflammation and/or infection in individuals with pigmented skin. Clinically infected wounds should be cultured by deep tissue swabs taken after debridement or by tissue samples, for identification of microorganisms and antibiotic sensitivities. Mild

2012 Clinical Practice Guidelines Portal

1692. Hypothyroidism investigation and management

their thyroxine on an empty stomach, at least half an hour before other drugs (this includes espresso coffee). 16 medicines that may increase thyroxine requirements include: 15 • the oral contraceptive pill • anti-epileptic medication (eg. carbamazepine, phenytoin) • some antibiotics (eg. rifampicin) • the new tyrosine kinase inhibitors (eg. imatinib). Absorption much of the variability in replacement thyroxine doses between individuals, after adjustment for body weight, is derived from differences

2012 Clinical Practice Guidelines Portal

1693. Anaphylaxis recognition and treatment

with the combination of known food allergy and asthma. 2 Causes of anaphylaxis Anaphylaxis in Australia is most commonly caused by: Medicines: medicines account for 57% of anaphylaxis deaths, most commonly antibiotics, nonsteroidal anti-inflammatory drugs (NSAIDs), opiates and anaesthetics 3 Insect venom: venom from the stings of bees, wasps and ants accounts for 18% of anaphylaxis deaths. 1 However, this is highly dependent on geographical location, for example, insects cause 30% of cases of anaphylaxis deaths (...) to participate in a randomised controlled trial of venom immunotherapy. 19 As part of this trial, she has an insect sting challenge and suffers severe anaphylaxis with a marked rise in mast cell tryptase* A man, 80 years of age, presents with urosepsis. After being given intravenous antibiotic his systolic BP falls from 180 to 100 mmHg. This is interpreted as a sign of worsening sepsis and he is given another broader spectrum antibiotic. His BP falls below 90 mmHg and an inotrope infusion (but not adrenaline

2012 Clinical Practice Guidelines Portal

1694. Maxillofacial trauma

and severe osteomyelitis are not uncommon in overlooked, untreated mandibular fractures. Prophylactic antibiotics are recommended if treatment is delayed. Penicillin, or alternatively clindamycin, are appropriate because of the disruption of the mucosa with direct communication to the underlying fracture area. 10 Definitive treatment It is beyond the scope of this article to discuss the intricacies of definitive surgical treatment. However, it is important to dispel community perception that management (...) that on presentation the patient be advised not to blow their nose or valsalva as this can produce acute facial emphysema that can be quite distressing. Similarly, air travel is not recommended for 2 weeks after this type of injury. It is reasonable considering the antral involvement of these fractures to commence a course of antibiotic therapy: 5–7 days of amoxycillin and clavulanic acid. Vision must be assessed, and if intact, referral can usually be delayed for 7–14 days. Maxillary and midface fractures Midface

2012 Clinical Practice Guidelines Portal

1695. Rheumatic fever identification, management and secondary prevention

prevention. Discussion Recurrent episodes of acute rheumatic fever may lead to rheumatic heart disease. Early detection of acute rheumatic fever and provision of secondary prophylaxis with antibiotics is paramount to the prevention of rheumatic heart disease. Primary healthcare providers can play an important role in identifying acute rheumatic fever and ensuring adherence to treatment within the context of a complex interplay of cultural and socioeconomic factors. The recent establishment of RHD (...) ventricle Moderately dilated left atrium Moderate mitral regurgitation Mild aortic regurgitation, ? bicuspid aortic valve Further reading NHFA/CSANZ Diagnosis of ARF. Outlines the diagnosis of ARF including identification of high risk groups, clinical and laboratory criteria and differential diagnoses. Available at Management of ARF. Outlines the medical and surgical management of RHD. Available at Secondary prevention of ARF. Outlines the antibiotic regimens for secondary prophylaxis, ways to deal

2012 Clinical Practice Guidelines Portal

1696. British Association of Dermatologists' guidelines for the management of bullous pemphigoid

antibiotics and nicotinamide (strength of recommendation D; level of evidence 4) Since the development of the last guideline in 2002 there have been no additional relevant publications regarding the treatment of BPwithantibiotics. However, antibiotics withanti-in?amma- tory effects are used widely in the treatment of BP. A German survey reported that about 10% of the dermatologists use a combination of antibiotics and nicotinamide as a ?rst-line treat- ment for BP; 45 a survey in the U.K. showed that 80 (...) % of respon- dents use antibiotics as part of their management of BP. 40 Mostly doxycycline is used in the U.K. (40%), followed by minocycline (31%) and lymecycline (19%). A total of 63% of respondents thought that antibiotics are sometimes effective, while 28% thought that they are never effective (all quoted per- centages for the U.K. survey are based on valid responses). 40 The most reported side-effect was gastrointestinal upset, fol- lowed by pigmentation and Candida infection; hypersensitivity

2012 British Association of Dermatologists

1698. Evaluation and treatment of recurrent pregnancy loss: a committee opinion

loss, any use of antibiotics is not supported by the evidence. Male Factors Standardsemenparameters,includingspermmorphology,do not appear to be predictive of recurrent pregnancy loss (72). Sperm aneuploidy and DNA fragmentation have been studiedincoupleswithrecurrentpregnancyloss(73).Abnor- mal DNA fragmentation may be seen in the setting of ad- vanced paternal age or may result from correctable environmental factors, such as exogenous heat, toxic expo- sures,varicoceles

2012 Society for Assisted Reproductive Technology

1699. 2012 ACCF/SCAI Expert Consensus Document on Cardiac Catheterization Laboratory Standards Update

important. Patient preparation should include a checklist of items to be reviewed when the patient ?rst arrives at the laboratory. Appropriate consent should include risks, bene?ts, alterna- tive therapies, and the potential need for ad hoc procedures. All PCI consent forms should outline the potential for emergency surgery. A “time-out” should be a required part of each procedure and should include the name, the proce- dure, the signed consent, allergies, antibiotic administration, the correct site

2012 Society for Cardiovascular Angiography and Interventions

1700. Catheterisation Indwelling catheters in adults ? Urethral and Suprapubic

“ Nitrofurantoin”. Nitrofurazone is a bactericidal compound which is used as an antibiotic. Antibiotic-impregnated catheters may decrease the frequency of asymptomatic bacteriuria within 1 week. According to Tenke (2008) there is, however, no evidence that antibiotic- impregnated catheters decrease symptomatic infection. Therefore, they cannot be recommended routinely. [12, 45] Potential toxicity and/or antibiotic resistance using antimicrobial catheters is unknown. [21] (LE: 4)23 Catheterisation: Indwelling (...) and carers for the changing of a suprapubic catheter. [45] 4. Patients with artificial heart valves may require antibiotic therapy prior to initial insertion or routine catheter change; however this will depend on local healthcare management policy. 5. Patients on anticoagulant therapy will require their coagulation levels checking prior to insertion of a suprapubic catheter. Anticoagulant therapy and coagulations levels will depend on local healthcare management policy. See 4.1 for alternatives. See

2012 European Association of Urology Nurses

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