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1821. Lactational mastitis and breast abscess. Diagnosis and management in general practice

practice. Discussion Lactational mastitis is usually bacterial in aetiology and can generally be effectively managed with oral antibiotics. Infections that do not improve rapidly require further investigation for breast abscess and nonlactational causes of inflammation, including the rare cause of inflammatory breast cancer. In addition to antibiotics, management of lactational breast infections include symptomatic treatment, assessment of the infant’s attachment to the breast, and reassurance (...) or anatomical conditions such as cleft palate or tongue-tie which may interfere with attachment. 6,9 Observation of breastfeeding can determine if there are difficulties with attachment to the breast. A lactation consultant may be helpful. Investigation Mastitis is a clinical diagnosis and investigations are not indicated in the initial assessment. 1 breast infection that does not improve with a course of appropriate antibiotics should be investigated with breast ultrasound. 5 This may distinguish

2011 Clinical Practice Guidelines Portal

1822. 2011 update to NHFA and CSANZ guidelines for the prevention, detection and management of chronic heart failure in Australia

Institute ? exible diuretic regimen Acute infection Antibiotic Rx as appropriate Institute ? exible diuretic regimen New arrhythmia e.g. atrial ? brillation Refer Acute ischaemia/infarction Refer Other e.g. anaemia, pulmonary embolism Refer Institute ? exible diuretic regimen (20 mg frusemide for each kilogram of weight gain) No improvement within 24 hours (no weight loss or weight gain) Improved (next day weight loss) Refer Resume previous dose Review maintenance medicine Is ACEI, beta-blocker dose

2011 Clinical Practice Guidelines Portal

1823. Guidelines for the prevention, detection and management of chronic heart failure (updated October 2011)

Institute ? exible diuretic regimen Acute infection Antibiotic Rx as appropriate Institute ? exible diuretic regimen New arrhythmia e.g. atrial ? brillation Refer Acute ischaemia/infarction Refer Other e.g. anaemia, pulmonary embolism Refer Institute ? exible diuretic regimen (20 mg frusemide for each kilogram of weight gain) No improvement within 24 hours (no weight loss or weight gain) Improved (next day weight loss) Refer Resume previous dose Review maintenance medicine Is ACEI, beta-blocker dose

2011 Clinical Practice Guidelines Portal

1824. Prevention, identification and management of foot complications in diabetes

management and early institution of antibacterial therapy • MRI for diagnosing osteomyelitis in patients with diabetic foot ulcers (but at higher cost) • Novel therapies such as bio-engineered live skin equivalents and hyperbaric oxygen therapy (HBOT) None of these evaluations considered the Australian context and some had methodological issues such that some of the results may be overstated and need to be interpreted with caution. The authors of the studies conclude that more quality economic studies (...) , should foot assessments be carried out in people with or without foot ulcer? EO 3-5 5 When should a patient be referred to a high risk foot clinic? (What are the risk factors for a poor foot related outcome for people in a primary care setting?) EO 11 Intervention 6 Which interventions improve foot related clinical outcomes – a) For people without foot ulceration? b) For people with foot ulcer? EBR 6-14, EO 6, EO 8-10 7 Under what circumstances are antibiotics effective in the treatment of foot

2011 Clinical Practice Guidelines Portal

1825. Australian consensus guidelines for the management of neutropenic fever in adult cancer patients

in a clinic or home setting. Greater guidance is provided so that clinicians can con?dently implement ambulatory strategies for neutropenic fever, where appropriate. A recommended approach to ambulatory care is provided in the adjunct paper by Worth etal. 15 Antibacterial prophylaxis While the 2002 IDSA guidelines discouraged use of antibiotic prophylaxis with ?uoroquinolones (FQ) for neutropenicpatientsowingtoconcernsofemerginganti- biotic resistance, 3 recent evidence suggests this approach may reduce (...) -aminoglycoside combination therapy in cancer patients with neutropaenia. Cochrane Database Syst Rev. 2003; CD003038. 20 Tam C, O’Reilly M, Andresen D, Lingaratnam S, Kelly A, Burbury K etal. Use of empiric antimicrobial therapy in neutropenic fever. Intern Med J. 2010; 41b: 90–101. 21 Kern WV. Risk assessment and risk-based therapeutic strategies in febrile neutropenia. Curr Opin Infect Dis. 2001; 14: 415–22. 22 Gafter-Gvili A, Fraser A, Paul M, Leibovici L. Meta-analysis: antibiotic prophylaxis reduces

2011 Clinical Practice Guidelines Portal

1826. UK National Guideline for the Management of Pelvic Inflammatory Disease

, and empirical antibiotic treatment, should be considered and usually offered in any young (under 25) sexually active woman who has recent onset, bilateral lower abdominal pain associated with local tenderness on bimanual vaginal examination, in whom pregnancy has been excluded. Complications • Women with HIV may have more severe symptoms associated with PID but respond well to standard antibiotic therapy 6 . No change in treatment recommendations compared to HIV uninfected patients is required 7-9 . (Grade (...) of this, and the lack of definitive diagnostic criteria, a low threshold for empiric treatment of PID is recommended. Broad spectrum antibiotic therapy is required PID guideline V4 page 6 to cover N. gonorrhoeae, C. trachomatis and a variety of aerobic and anaerobic bacteria commonly isolated from the upper genital tract in women with PID 1, 2 . Some of the best evidence for the effectiveness of antibiotic treatment in preventing the long term complications of PID comes from the PEACH study where women were treated

2011 British Association for Sexual Health and HIV

1827. Transrectal Ultrasound Guided Biopsy of the Prostate

in the searches was January 2000 – September 2010. 1.3 Limitations of the search In Medline and Embase the search results were limited to randomised controlled trials (RCTs), in Central to Controlled Clinical Trials. In all databases, output was limited to human studies and English language publications. 1.4 Search keywords The reference search included the following key words (in alphabetical order): • Antibiotic • Biopsy • Cancer • Ciprofloxacin • Doppler • Infectious • Competency • Complication • Consent (...) and background, preferred way of communicating and needs. 11. Ensure that informed consent has been obtained or obtain it. 12. Ensure that pre-procedure criteria have been met such as stopping relevant medications and administration of prophylactic antibiotics. Items 10-12 To ensure safety of the patient and staff, to promote patient’s comfort and reduce anxiety. 13. Apply local procedure-specific infection control guidelines. 14. Position the patient correctly for the procedure (left lateral with legs

2011 European Association of Urology Nurses

1829. Maternity Care Pathway

if available A If ECV unsuccessful, consider if woman is an appropriate candidate for Breech Vaginal Delivery based on resources, woman’s preference and other risk factors 6115 Obstetric Guideline 19: Maternity Care Pathway F) Routine Care at 37 – 41 weeks Time Sensitive Review and discuss Group B Strep screening results and options for antibiotic prophylaxis in labour Routine care as outlined in section B • Follow-up of all tests/interventions • Discuss woman’s adjustment to pregnancy (mood, work, stress

2010 British Columbia Perinatal Health Program

1832. Repair of Third- and Fourth-degree Perineal Tears Following Childbirth

, the vagina, perineal muscles and skin are closed with an absorbable synthetic suture material and an indwelling catheter is inserted. Antibiotics and laxatives are commonly prescribed for 7–10 days. Leaving a third- or fourth-degree tear unsutured is not recommended, as this is likely to be associated with increased risk of complications. 7. Statement of patient: procedures which should not be carried out without further discussion Other procedures which may be appropriate but not essential at the time (...) /womens-health/clinical-guidance/management-third-and-fourth-degree-perineal-tears-green- top-29]. 3. Royal College of Obstetricians and Gynaecologists. Presenting Information on Risk. Clinical Governance Advice No. 7. London: RCOG; 2008 [www.rcog.org.uk/womens-health/clinical-guidance/presenting-information-risk]. 4. Duggal N, Mercado C, Daniels K, Bujor A, Caughey AB, El-Sayed YY . Antibiotic prophylaxis for prevention of postpartum perineal wound complications: a randomized controlled trial. Obstet

2010 Royal College of Obstetricians and Gynaecologists

1833. Management of Women with Obesity in Pregnancy

haemorrhage, post partum anaemia and the need for blood transfusion. 58 Active management in all women is associated with a reduced incidence of prolonged third stage of labour and with a reduction in the use of therapeutic oxytocic drugs. † Evidence level 1++ Women with a BMI =30 having a caesarean section have an increased risk of wound infection, and should receive prophylactic antibiotics at the time of surgery, as recommended by the NICE Clinical Guideline No. 13 (Caesarean Section, April 2004). 59 (...) A retrospective observational study of 287,213 singleton pregnancies reported an aOR of 2.24 (99% CI 1.91–2.64) for wound infection in obese women compared with healthy- weight women. 10 Evidence level 2++ In the general maternity population, a systematic review of randomised trials in women undergoing elective or non-elective caesarean sections showed that the incidence of wound infections was significantly reduced with antibiotic prophylaxis compared with no prophylaxis. 60 The RR of infection for elective

2010 Royal College of Obstetricians and Gynaecologists

1834. Care Bundles: Safer Practice in Intrapartum Care Project

recorded. A care bundle can be viewed as a way of prompt- ing people to act in accordance with best-accepted practice. Care bundles in obstetrics In the UK, care bundles have previously been developed in the areas of critical care nursing, infection control and preventative antibiotics for surgery. 12 They have formed a large part of the work of the Health Foundation’s Safer Patients Initiative. Obstetric care bundles within the UK have not yet been widely implemented. This joint NPSA/RCOG/RCM project

2010 Royal College of Obstetricians and Gynaecologists

1835. Late Intrauterine Fetal Death and Stillbirth

. This can include a double bed for her partner or other companion to share, away from the sounds of other women and babies. Care in labour should given by an experienced midwife. The physical priorities of women with an IUFD vary greatly according to their individual clinical findings. 6.5 What are the recommendations for intrapartum antimicrobial therapy? Women with sepsis should be treated with intravenous broad-spectrum antibiotic therapy (including antichlamydial agents). Routine antibiotic (...) maternal antibiotic therapy Maternal serology: Occult maternal–fetal 2+ 30, 32–35, Stored serum from booking tests can ? viral screen infection 48 provide baseline serology ? syphilis Parvovirus B19, rubella (if nonimmune at ? tropical infections booking), CMV, herpes simplex and Toxoplasma gondii (routinely) Hydrops not necessarily a feature of parvovirus-related late IUFD Treponemal serology – usually known already Others if presentation suggestive, e.g. travel to endemic areas Maternal random blood

2010 Royal College of Obstetricians and Gynaecologists

1836. Grown-Up Congenital Heart Disease

and during any invasive pro- cedure in order to reduce the rate of healthcare-associated IE. GUCH patients should also be discouraged from getting piercings and tattoos. The approach to antibiotic endocarditis prophylaxis has changed for several reasons. In short, transient bacteraemia occurs not only after dental procedures but frequently in the context of daily routine activities such as tooth brushing, ?ossing, or chewing. Due to the lack of scienti?c evidence for the ef?cacy of antibiotic prophylaxis (...) , the estimated huge number of patients that may need to be treated to prevent one single case of IE, the small but existing risk of anaphylaxis, and the general problem of emergence of resistant microorganisms resulting from widespread, often inap- propriate use of antibiotics, it is currently recommended by expert consensus to limit antibiotic prophylaxis to patients with the highest risk of IE undergoing the highest risk procedures (IIaC). This recommendation includes the following patient groups

2010 European Society of Cardiology

1837. RCPCH and Neonatal and Paediatric Pharmacists Group (NPPG) joint statement on unlicensed medicines

the implementation of research into NHS practice. We support its function in relation to research opportunities and implications for practice - Provides input into the governance and management of this online resource, which aims to improve medications safety in paediatric research and practice Current work Use of delayed prescriptions of antibiotics for infants and children Delayed prescribing (also known as 'back up' prescribing) involves the supply of a prescription to a patient with clear instructions about (...) when to obtain the treatment in relation to their symptoms. Our statement, endorsed by the Royal College of General Practitioners (RCGP), summarises current knowledge and highlights special issues when considering delayed prescriptions of antibiotics in infants and children. Using standardised strengths of unlicensed liquid medicines in children - joint position statement The Neonatal and Paediatric Pharmacists Group (NPPG) and RCPCH have developed a list of strengths for the prescription of 17

2010 Royal College of Paediatrics and Child Health

1838. Chronic suppurative lung disease and bronchiectasis in children and adults in Australia and New Zealand. A position statement from the Thoracic Society of Australia and New Zealand and the Australian Lung Foundation

for children who have either two or more episodes of chronic (> 4 weeks) wet cough per year that respond to antibiotics, or chest radiographic abnormalities persisting for at least 6 weeks after appropriate therapy. Intensive treatment seeks to improve symptom control, reduce frequency of acute pulmonary exacerbations, preserve lung function, and maintain a good quality of life. Antibiotic selection for acute infective episodes is based on results of lower airway culture, local antibiotic susceptibility (...) patterns, clinical severity and patient tolerance. Patients whose condition does not respond promptly or adequately to oral antibiotics are hospitalised for more intensive treatments, including intravenous antibiotics. Ongoing treatment requires regular and coordinated primary health care and specialist review, including monitoring for complications and comorbidities. Chest physiotherapy and regular exercise should be encouraged, nutrition optimised, environmental pollutants (including tobacco smoke

2010 MJA Clinical Guidelines

1839. Evidence-based guidelines for the management of hip fractures in older persons: an update Full Text available with Trip Pro

independently by two assessors, who recorded individual study results, and an assessment of study quality and treatment conclusions was made according to Cochrane Collaboration protocols. If necessary, a third review was performed to reach consensus. Results: 128 new studies were identified and 81 met our inclusion criteria. Recommendations for time to surgery, thromboprophylaxis, anaesthesia, analgesia, prophylactic antibiotics, surgical fixation of fractures, nutritional status, mobilisation (...) with the classic midline approach (B). 8. Type of analgesia Adequate analgesia should be administered before and immediately after surgery. Three-in-one femoral nerve block is an effective method of providing analgesia to patients with hip fracture in the emergency department (A), and is useful for reducing postoperative pain (A). Intrathecal morphine is a useful and safe technique for providing postoperative pain relief after hip fracture surgery (B). 9. Prophylactic antibiotics (A) Prophylactic intravenous

2010 MJA Clinical Guidelines

1840. CICADA: Cough in Children and Adults: Diagnosis and Assessment. Australian Cough Guidelines summary statement Full Text available with Trip Pro

pointers. Chest x-ray and spirometry are usually normal. Medium-term antibiotic treatment (2–6 weeks) should lead to complete cough resolution (GRADE: strong). The diagnosis can only be definitive when patients become asymptomatic with treatment. Asthma Asthma is considered as a cause of chronic cough if the cough is episodic and associated with other features such as expiratory wheeze and/or exertional dyspnoea, or exhibits an obstructive ventilatory pattern on lung function testing (particularly (...) therapy and to guide antibiotic selection. Allergy assessment can be helpful if there is associated allergic rhinitis. Management is according to current evidence-based guidelines and involves nasal saline irrigation, intranasal corticosteroid therapy for a minimum trial of 1 month, and oral antibiotic therapy for 3 weeks to 3 months for purulent chronic rhinosinusitis. Short-course prednisone treatment can be added for associated nasal polyposis (GRADE: strong). Obstructive sleep apnoea Obstructive

2010 MJA Clinical Guidelines

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