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1841. WEO/WGO Guidelines on endoscope disinfection: a resource-sensitive approach

by covering the detergent container. 2.3 Detergents Detergents with or without enzymes, and detergents containing antimicrobial substances, can be used for endoscope cleaning. Use of nonfoaming detergents is recommended. Foaming can inhibit good fluid contact with device surfaces and prevent a clear field of vision during the cleaning process, with a risk of injury to personnel. The detergent selected should effectively loosen organic and nonorganic material so that the flushing action of the detergent (...) growth. • In Europe, detergents commonly used may contain antimicrobial substances that reduce the risk of infection to reprocessing personnel, but they do not replace disinfection. • Enzymes generally function more effectively above room temperature (> 20– 22 °C) and should be used in accordance with the manufacturer’s recommendations. 3 Endoscope disinfection 3.1 General procedures Endoscopes should be disinfected in dedicated rooms by trained staff at the beginning and at the end of each patient

2011 World Endoscopy Organization

1843. 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

1846. 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

1847. 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

1848. 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

1849. 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

1850. 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

1851. 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

1852. 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

1853. 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

1854. 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

1855. Ultrasound - Performing Diagnostic Obstetric Ultrasound Examinations

and the probe cleaned in an antimicrobial solution following the manufacturer’s guidelines. VIII. TYPES OF FETAL SONOGRAPHIC EXAMINATIONS A. First Trimester Ultrasound Examination B. Second or Third Trimester Ultrasound Examination C. Limited Examination D. Specialized Examination Canadian Association of Radiologists CAR Standard for Performing Diagnostic Obstetric Ultrasound Examinations 5 IX. SONOGRAPHIC TECHNIQUE A. First Trimester Sonography First trimester scanning may be performed either abdominally

2010 Canadian Association of Radiologists

1856. Best practice in the management of epidural analgesia in the hospital setting

with poor analgesia and need for large volumes of infusion in adults. 5.3 The catheter should be secured in order to minimise movement in or out of the epidural space. The dressing should allow easy visibility of the insertion site and catheter. 5.4 Anaesthetists inserting epidural catheters should be aware of, and adhere to, local infection guidelines (including use of prophylactic antibiotics in special circumstances). 5.5 Local guidelines should be in place with respect to the insertion and removal

2010 Faculty of Pain Medicine

1857. Guidance on competencies for intrathecal drug delivery

for trial of IDD and evaluation of trial outcomes 6. Indications for different IDD systems e.g. selection of fixed rate or totally programmable system; use of patient controlled intrathecal bolusing 7. Basic skills in a. patient positioning b. asepsis and infection control (hand hygiene, MRSA screening, antibiotic prophylaxis, surgical asepsis) c. familiarity with implanted IDD components d. techniques of accessing the intrathecal space e. fluoroscopic placement of spinal catheter f. primary surgical

2010 Faculty of Pain Medicine

1859. Chronic lymphocytic leukaemia

and thrombopoietin analogs can be used [III, B] in selected cases not responding to corticosteroids and before splenectomy. In patients with resistantimmunecytopenia, treatment oftheunderlyingCLLis recommended. Because most CLL patients develop a severe immune defect during the course of the disease, infections are a common complication. The use of prophylactic intravenous immunoglobulin does not have an impact on overall survival [25] and is therefore not recommended to be used as routine [II, B]. Antibiotic

2011 European Society for Medical Oncology

1860. Biliary cancer

| vi41spectrum antibiotics are crucial in patients with cholangitis due to obstructive jaundice. Palliative chemotherapy added to both quantity and quality of life in advanced biliary cancer in a single phase III study [II, B], but the survival bene?t for chemotherapy in general is not yet clearly established. Resently, results of a multicenter, randomized phase III trial, the UK ABC-02 trial evaluating gemcitabine with or without cisplatin in patients with advanced or metastatic biliary tract cancer

2011 European Society for Medical Oncology

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