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1862. Complications of colonoscopy

outpatient management with oral antibiotics has also been reported. 48 MORTALITY Death has been rarely reported in relation to colonos- copy, with or without polypectomy. In a 2010 review of colonoscopy complications based on prospective studies and retrospective analyses of large clinical or administra- tive databases, there were 128 deaths reported among 371,099 colonoscopies, for an unweighted pooled death rate of 0.03%. 2 All studies reported mortality within 30 days of the colonoscopy, although some (...) of infection are rare. 57 Although individual cases of infec- tion after colonoscopy have been reported, there is no de?nite causal link with the endoscopic procedure and no proven bene?t for antibiotic prophylaxis. 58 Therefore, cur- rent guidelines from the American Heart Association and ASGE recommend against antibiotic prophylaxis for pa- tients undergoing colonoscopy. 58-59 A 2008 review 60 re- ported that subsequent to the 2003 Multisociety Guideline for Reprocessing of Flexible GI Endoscopes, 61 all

2011 American Society for Gastrointestinal Endoscopy

1863. The role of endoscopy in the management of choledocholithiasis

shouldgenerallyleadtoanexpeditiousERC,thedegreeof procedure urgency depends on the clinical severity; con- sensus criteria for de?ning the severity of acutecholangitis havebeenproposed. 29 TrulyurgentERCisindicatedwhen obstructing biliary stones are associated with severe acute cholangitis that is not responding to intravenous antibiot- ics and ?uid resuscitation. 29-31 In these instances, biliary drainage is the primary focus of management rather than stone extraction. Early ERC (variably de?ned, but generally 72 hours (...) In preparation for ERC, antibiotic prophylaxis is unnec- essary in the majority of patients with suspected choledo- cholithiasis, unless cholangitis or immunosuppression is present or biliary drainage is predicted to be incomplete; a relevant ASGE guideline covers this topic in detail. 54 Proper technique for cholangiographic imaging is essen- tial for successful identi?cation of stones at ERC. 55 Despite careful attention to technique, the sensitivity of cholan- giography for choledocholithiasis

2011 American Society for Gastrointestinal Endoscopy

1864. The role of endoscopy in enteral feeding

shown that anti- microbial prophylaxis leads to a statistically signi?cant reduction in the frequency of peristomal wound infec- tion. 29,30 Antimicrobial prophylaxis is also cost-effective. 31 Parenteralcefazolin(oranotherantibioticwithsimilarcov- erage) should be administered 30 minutes before PEG placement. 32 Such prophylaxis is only necessary in those patients not already receiving appropriate antibiotic treat- ment at the time of PEG insertion. In situations in which methicillin-resistant (...) gastrostomy tube or button. Nonendoscopic replacement of a dislodged tube or button is contraindi- cated in the absence of a mature tract because of the potential for intraperitoneal spillage. In the absence of peritonitis, nonoperative management of early dislodg- ment of PEG usually requires nasogastric decompression, intravenous antibiotics, and PEG replacement several days later. DPEJ is associated with the same type of complications as seen with PEG. In a large retrospective study from

2011 American Society for Gastrointestinal Endoscopy

1865. The role of endoscopy in gastroduodenal obstruction and gastroparesis

not exceed 3 months. The macrolide antibiotics, including erythromy- cin, azithromycin, and clarithromycin, act as motilin- receptor agonists to stimulate gastric motility. Although erythromycin is a potent stimulant of gastric emptying, side effects are common with oral use (eg, nausea, vom- iting, abdominal cramping, diarrhea). Furthermore, tachy- phylaxis often will limit long-term ef?cacy. Endoscopictherapies. When gastroduodenal dysmo- tility is associated with weight loss, recurrent episodes

2011 American Society for Gastrointestinal Endoscopy

1868. Polysomnography for Sleep-Disordered Breathing Prior to Tonsillectomy in Children

), adverse effects (number needed to harm), cost of drugs or tests, frequency and duration of treatment, and desire to take or avoid antibiotics. Comorbidity can also affect patient pref- erences by several mechanisms, including the potential for drug-drug interactions when planning therapy. Statement 1. Ind Icat Ion S for PSG: Before per - forming tonsillectomy, the clinician should refer children with SdB for PSG if they exhibit any of the following: obesity, d own syndrome, craniofacial abnormalities

2011 American Academy of Otolaryngology - Head and Neck Surgery

1872. Hemothorax and Occult Pneumothorax, Management of

pleural effusion, and the use of multiple chest tubes within the same hemithorax. Hospitalization after empyema was on average 2.5 wk longer than patients without. Causative organism identified in 60%, three-quarters of these were Staphylococcus aureus. The average time to diagnosis 12 d. Antibiotics were not found to be helpful in prevention. Empyema is a significant clinical entity and should be aggressively prevented. Navsaria et al. [29] 2004 Thoracoscopic evacuation of retained posttraumatic

2011 Eastern Association for the Surgery of Trauma

1873. Asthma

, increased use of antibiotics). Therefore the CDC Advisory Committee of Immunization Practices recommends all patients older than 6 months receive influenza vaccine and that all adults receive pneumococcal polysaccharide vaccine. Influenza vaccination is performed annually for all patients with asthma over 6 months of age. Vaccination is typically performed in the fall to maximize resistance during the winter “flu season.” Children under 9 years of age receiving influenza vaccine for the first time

2011 University of Michigan Health System

1876. 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

1877. 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

1878. 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

1879. 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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