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1901. Advice on the safe introduction and continued use of isotretinoin in acne in the UK

that suicidal behaviour is multifactorial and is one of the commoner causes of death in young adults who constitute the group most likely to be exposed to isotretinoin. A larger study of 7195 patients treated with isotretinoin, compared with 13 700 treated with antibiotics, drawn from Table 1 Selected psychiatric events reported to Medicines and Healthcare Products Regulatory Agency with isotretinoin (January 2010) Number of reports Depression 193 Anxiety 26 Mood swings 26 Aggression 21 Suicide completed 29 (...) and quality of life in acne vulgaris patients treated with isotretinoin compared to antibiotic and topical therapy. Australas J Dermatol 2002; 43:262–8. 34 Strahan JE, Raimer S. Isotretinoin and the controversy of psychiatric adverse effects. Int J Dermatol 2006; 45:789–99. 35 Hull PR, D’Arcy C. Isotretinoin use and subsequent depression and suicide: presenting the evidence. Am J Clin Dermatol 2003; 4:493–505. 36 Marqueling AL, Zane LT. Depression and suicidal behavior in acne patients treated

2010 British Association of Dermatologists

1902. British Association of Dermatologists' guidelines for the management of lichen sclerosus

There are reports of bene?ts from calcitriol, antimalarials, stanozolol, antipruritic and antihistamine agents, such as oxat- omide, and various antibiotics (for which the main rationale is the uncertain link with Borrelia infection). These and others are summarized in reviews listed previously, but must all be viewed as less well-proven or anecdotal. 20–24 Treatment failure If treatment with topical corticosteroids appears to fail to bring LS under control then it is important to consider the following

2010 British Association of Dermatologists

1903. Continent Urinary Diversion

of bowel preparation uses polyethyleneglycol and sodium phosphate. New studies have shown that systematic bowel preparation fails to offer significant benefit for the patient [61, 62] although there is no general consensus in the literature. Scientific literature warrants a practice based on solid evidence, which includes correct antimicrobial prophylaxis and a meticulous surgical technique, because this offer the best surgical expectations and an increased patient comfort. [61] The new mechanical

2010 European Association of Urology Nurses

1904. Laboratory Tests in the Diagnosis of Allergic Diseases

significant sensitivity, e.g. older children can retain positive RAST tests to egg and are able to eat pavlova or scrambled eggs without symptoms. Conversely, a negative result does not necessarily exclude clinically significant allergy . Anaphylaxis (e.g. following administration of an antibiotic) can cause a transient drop in allergen-specific IgE sufficient to cause "false negative" results. In addition, patients can remain allergic to substances despite their serum IgE levels declining to undetectable (...) practitioner for the performance of the test Suitable for patients with Skin disease Dermatographism Recent antihistamine Rx Infancy / cord blood sampling Severe anaphylaxis in whom there is a concern that skin testing may provoke an anaphylactic reaction (foods, latex, stinging insects, antibiotics) Expensive Less sensitive than Skin Tests RAST tests to "mixes" of allergen may give falsely negative results Delay before results are available Information is more abstract -i.e. less immediately relevant

2010 Australasian Society of Clinical Immunology and Allergy

1905. Diagnosis and Management of Primary Sclerosing Cholangitis

utilized such as sphincterotomy, catheter or balloon dilatation, and stent placement. 51–54 Of these, only endoscopic biliary sphincterotomy and balloon dila- tation with or without stent placement have been found to be of value. 51–59 Because injecting contrast agent into an obstructed duct may precipitate cholangitis, perioper- ative antibiotics should be administered. Sphincterotomy alone has been performed in small subsets of patients, usually when stent placement was unsuccessful. In these small (...) by documentingbacterialinfectionofthebilein15outof37 PSC patients (40.5%) with a dominant stricture but not in the absence of such stenosis; short-course antibiotic treatmentprovednotveryeffectiveineradicatingbacteria fromthebileductsofpatientswithdominantstrictures. 66 However, most patients respond to therapeutic drainage of the obstruction plus antibiotics. Occasional patients withrecurrentbacterialcholangitismaybene?tfrompro- phylactic long term antibiotics. Rarely, recurrent cholan- gitis can be so severe as to become the primary indication

2010 American Association for the Study of Liver Diseases

1906. Unscheduled Care Facilities

consider that HPs working within a UCF should have referral rights to agreed clinical specialties, social care facilities, community therapy services e.g. Intravenous antibiotics and translating services in order to enhance the patient experience wherever possible. HPs should also have referral rights to GP practices for primary care appointments, as appropriate 5 Royal College of Paediatrics & Child Health Service for Children in Emergency Departments: Report of the Intercollegiate Committee

2009 Royal College of Emergency Medicine

1907. Palliative Care for the Older Person

is larger than the burden in cognitively intact individuals [32]. They are often unable to comprehend the need for interventions, and may perceive it as assault [32]. Antibiotic therapy may be warranted in many situations but clinicians should be aware that its effectiveness is limited by the recurrent nature of infections in advanced dementia [32]. Sometimes time-limited trials of interventions can provide more evidence of their merits to family [22]. Artificial feeding or provision of nutrition has

2009 Australian and New Zealand Society for Geriatric Medicine

1908. Guidelines for the management of community-acquired pneumonia in adults

? 7.5 What arrangements should be made for follow-up after hospital discharge and by whom? iii32 Section 8 Antibiotic management 8.1 Introduction 8.2 Antibiotic stewardship and the individual clinician’s responsibility to prevent the overuse of antibiotics when managing CAP 8.3 Antibiotic resistance of respiratory pathogens 8.4 Newer antibiotics 8.5 Clinical studies of management and international differences in recommendations 8.6 Formulations of these recommendations 8.7 Empirical antibiotic (...) choice for CAP treated in the community 8.8 Should general practitioners administer antibiotics prior to hospital transfer in those patients who need admission? 8.9 When should the first dose of antibiotics be given to patients admitted to hospital with CAP? 8.10 Empirical antibiotic choice for adults hospitalised with low severity CAP 8.11 Empirical antibiotic choice for adults hospitalised with moderate severity CAP 8.12 Empirical antibiotic choice for adults hospitalised with high severity CAP

2009 British Infection Association

1909. Research Reporting Standards for Percutaneous Vertebral Augmentation

, and radiation therapy, whenusedinconjunctionwithvertebral augmentation, should be reported. Use of local and systemic medications, such as intravenous antibiotics, should be re- ported. Whether patients were treated according to the originally intended protocol should be reported. OUTCOMES ASSESSMENT Thegoalofvertebralaugmentationis to improve patients’ quality of life by relieving pain and returning patients to theirbaselinelevelofactivitybeforethe onsetofpainrelatedtoavertebralcom- pression fracture

2009 Society of Interventional Radiology

1910. Antithrombotic Therapies in Spine Surgery

this guideline. How a given question was asked might influence how a study was evaluated and interpreted as to its level of evidence in an- swering that particular question. For example, a randomized control trial reviewed to evaluate the differences between the outcomes of patients who received antibiotic prophylaxis with those who did not might be a well designed and implemented Level I therapeutic study. This same study, howev- er, might be classified as giving Level II prognostic evidence if the data

2009 North American Spine Society

1911. Management of Pregnancy

reports of efficacy in the obstetric literature. Antimicrobial therapy, including treatment of bacterial vaginosis, does not appear to meaningfully reduce the preterm birth rate. Tocolysis of preterm labor with various agents remains unproven in the prevention of preterm delivery but is often used to prolong latency to allow the administration of antenatal corticosteroids. In contrast to these controversial or minimally effective treatments, recent data suggest that the administration of progesterone

2009 VA/DoD Clinical Practice Guidelines

1912. Guidelines for the Safe Administration of Injectable Drugs in Anaesthesia

above, but also timely administration (e.g. prompt correction of hypotension or bradycardia) and adherence to protocols where appropriate (e.g. antibiotic administration). Improvements in safe drug delivery depend on an appreciation of the causes of errors related to drug management and use, and on active adoption of techniques accepted as likely to reduce such events, including regular audit and review of practices. Drugs used in anaesthesia may be the target for diversion or abuse. Secure storage

2009 Australian and New Zealand College of Anaesthetists

1914. Clostridium Difficile Transfer/Discharge Checklist

that information is available and guidance provided about treatment including antibiotic prescribing, for patients who have a recurrent episode of Clostridium difficile and are admitted to a different facility. The RQIA Independent Review expressed concern that systems were not in place for hospitals to easily identify patients who had a previous history of Clostridium difficile infection during a previous admission to other health and social care facilities. This guideline will aim to address this gap (...) antibiotic treatment. The normal balance of bacteria in the gut may be disrupted and the patient may acquire Clostridium difficile from another individual or the environment. The organism is then able to multiply in the gut and produce the toxins that cause illness. The symptoms range from mild diarrhoea to severe inflammation and, rarely, perforation of the bowel. Clostridium difficile occurs most commonly in the frail elderly or in a debilitated individual. Occasionally, patients may die from

2009 Regulation and Quality Improvement Authority

1915. Testicular non-seminoma

); only in this case and in the case of infection at day 22 should the next cycle be delayed until recovery. Supportive management with prophylactic use of G-CSF or antibiotics and modern anti-emetic therapy (5HT 3 receptor antagonist + steroid6 NK-1 receptor antagonist) are recommended. High-dose chemotherapy has proved not to be of bene?t in three randomized trials. management after primary chemotherapy If restaging 4 weeks after the last treatment cycle reveals elevated markers and/or residual

2010 European Society for Medical Oncology

1916. Cancer, fertility and pregnancy

of unrecognized pregnancy. Lung Cancer 2008; 60: 455–457. 28. Kal HB, Strukmans H. Radiotherapy during pregnancy: fact and ?ction. Lancet Oncol 2005; 6: 328–333. 29. International Commission on Radiological Protection. Pregnancy and Medical Radiation. Ann ICRP 2000: 30 iii–viii, 1–43. 30. Orecchia R, Lucignani G, Tosi G. Prenatal irradiation and pregnancy: the effcts of diagnostic imaging and radiation therapy. Recent Results Cancer Res 2008; 178: 3–20. 31. Nahum GG, Uhl K, Kennedy DL. Antibiotic use

2010 European Society for Medical Oncology

1917. Management of febrile neutropenia

, with a view to proceeding to imaging of the chest and upper abdomen, to exclude probable fungal or yeast infection, or abscesses. When the pyrexia lasts for >4–6 days, initiation of antifungal therapy may be needed [I, A]. duration of therapy If the neutrophil count is ‡0.5 · 10 9 /l, the patient is asymptomatic and has been afebrile for 48 h and blood cultures are negative, antibacterials can be discontinued [II, A]. If the neutrophil count is £0.5 · 10 9 /l, the patient has suffered no complications (...) and has been afebrile for 5–7 days, antibacterials can be discontinued except in certain high-risk cases with acute leukaemia and following high-dose chemotherapy when antibacterials are often continued for up to 10 days, or until the neutrophil count is ‡0.5 · 10 9 /l [II, A]. Patients with persistent fever despite neutrophil recovery should be assessed by an ID physician or clinical microbiologist and antifungal therapy considered [II, A]. note Levels of Evidence [I–V] and Grades of Recommendation

2010 European Society for Medical Oncology

1918. Hematopoietic growth factors

. Indications for primary prophylaxis of FN by hGFs Reasonable only if Parameter Probability of FN of 20% based on chemotherapy and/or special situations (see Table 4) or Affected: ANC recovery [I], fever [I], infection rate [I], use of i.v. antibiotics [II], hospital discharge [I] Dose reduction deemed detrimentaltooutcome[A] Controversial:infectious mortality[I],earlymortality Not affected: survival [I] i.v., intravenous. Table 3. Examples of regimens with a risk of FN of 20% Bladder cancer MVAC (...) prevents febrile neutropenia in patients with breast cancer: a multicenter, double-blind, placebo-controlled phase III study. J Clin Oncol 2005; 23: 1178–1184. 2. Timmer-Bonte JN, de Boo TM, Smith HJ et al. Prevention of chemotherapy- induced febrile neutropenia by prophylactic antibiotics plus or minus granulocyte colony-stimulating factor in small cell lung cancer: a Dutch randomized phase III study. J Clin Oncol 2005; 23: 7974–7984. 3. ASCO Recommendations for the use of hematopoietic colony

2010 European Society for Medical Oncology

1919. Prostate cancer

density, DRE ?ndings, prostate size, ethnicity, age, comorbidities, patient values and history of previous biopsy [II, B]. Prostate biopsy should be performed under antibiotic cover with transrectal ultrasound (TRUS) guidance, and a minimum of eight cores obtained [III, A]. The extent of involvement of each core and the commonest and the worst Gleason grades should be reported [IV]. staging and risk assessment General health and co-morbidities should be assessed. Patients who are not considered

2010 European Society for Medical Oncology

1920. Gastric marginal zone lymphoma of MALT type

on the histopathologic evaluation of the gastric biopsies [III, A]. If the presence of active Helicobacter pylori infection is not demonstrated by histochemistry, it must be ruled out by urea breath test and/or faecal antigen test. In addition to routine histology and immunohistochemistry, FISH analysis (or PCR) for detection of t(11;18) may be useful for identifying patients that are unlikely to respond to antibiotic therapy [III, B]. staging and risk assessment The initial staging procedures should include (...) of positron emission tomography (PET) scan is controversial and has little clinical utility [IV, D]. treatment plan Eradication of H. pylori with antibiotics should be employed as the sole initial treatment of localized (i.e. con?ned to the stomach) H. pylori-positive gastric MALT lymphoma [II, A]. Any of the highly effective anti-helicobacter antibiotic regimens proposed can be used. In case of unsuccessful H. pylori eradication, a second-line therapy should be attempted with alternative triple

2010 European Society for Medical Oncology

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