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161. Depression

or use with caution if history of GI bleeding, patient over 80 years or taking non-steroidal anti-inflammatory drugs/ aspirin insomnia, sweating, impaired sexual function vivid dreams, agitation, hyponatraemia. Mirtazapine tablet and oro-dispersible tablet appetite stimulant and sedative, particularly at lower doses well tolerated in the elderly and patients with heart failure. Tricyclic antidepressants (under specialist advice) amitriptyline: also treats nerve pain. Side effects include: avoid

2018 Scottish Palliative Care Guidelines

162. Mouth Care

be rinsed thoroughly after meals. Dentures should be left out of the mouth overnight and soaked. Refer to ‘Edentulous patients’ advice. Mouth care if receiving chemotherapy/radiotherapy– key differences See local cancer centre/cancer network policy. Patients may be advised to avoid antipyretic analgesics (paracetamol, aspirin) if at risk of neutropenia (can mask fever due to sepsis). Patients receiving head and neck radiotherapy should avoid oil-based products. Other specialist advice regarding oral (...) drinks (such as sips of water) should be taken frequently through the day. Saliva stimulation should be considered if patient able to comply sugar-free chewing gum. Saliva substitutes or oral gel if other measures insufficient. Refer to section 12.3.5 of British National Formulary (BNF). Practice point: Avoid Glandosane ® in dentate patients (long term use of acidic product may demineralise tooth enamel) Fluoride mouthwash (0 . 05%) can be used at a different time from brushing Prescription of high

2018 Scottish Palliative Care Guidelines

163. Management of Pregnancy Subsequent to Stillbirth Full Text available with Trip Pro

: moderate). 6 Low-dose aspirin may reduce the risk of perinatal death in women at risk for placental insufficiency. Some women with a history of stillbirth may fall into this category (GRADE: high). 7 Women with a history of stillbirth may be at risk for fetal growth restriction in the subsequent pregnancy and may benefit from serial growth ultrasound (GRADE: high). While there is limited evidence supporting routine biophysical profile studies, some women and their families may benefit from increased

2018 Society of Obstetricians and Gynaecologists of Canada

164. Treatment algorithm for Cancer-associated Thrombosis (CAT)

with the concomitant use of anticoagulant regimens and acetylsalicylic acid or nonsteroidal anti-inflammatory drugs, and any potential pharmacokinetic interactions 23 . All doacs are substrates of P-glycoprotein 24–26 . Apix- aban and rivaroxaban are also substrates of cytochrome P450 (CYP3A4); edoxaban and dabigatran are not. Table iv lists common drug–drug interactions associated with P-glycoprotein and CYP450 metabolism. However, assess- ment of the potential for clinically significant interactions is complex (...) for patients with GFR per the Cockcroft-Gault formula of 30-50 mL/min) • Significant GI surgery or absorption disorders (consider LMWH for patients with impaired GI absorption) • Pre-existing conditions and co-medication (e.g., ASA, other antiplatelet medications) Type of cancer? Active GI or urothelial tumours Reassess on a regular basis (at least every 3 months or if there are changes in management or patient condition) Other types, non-active GI/urothelial tumours Yes No Consider stopping No Yes

2018 Thrombosis Interest Group of Canada

165. Antenatal and Postnatal Analgesia Full Text available with Trip Pro

in bioavailabililty. When used in intravenous form, the variations in bioavailability are overcome and the onset of analgesic effect is only 5 minutes. 2.1.2 Nonsteroidal anti‐inflammatory drugs (NSAIDs) Arachidonic acid is metabolised by the isoenzymes COX‐1 and COX‐2 to prostaglandins, which are mediators of pain and inflammation. NSAIDs relieve pain through peripheral inhibition of COX enzymes and, hence, inhibition of prostaglandin synthetase, and their clinical effects depend on their selectivity (...) recommendation is for women taking gabapentin to also take high dose folic acid preconceptually and in the first trimester. Gabapentin has not been associated with an increased risk of miscarriage. 3.2 After 30 weeks of gestation 3.2.1 Paracetamol Paracetamol is considered safe for use throughout pregnancy. , , 3.2.2 NSAIDs The FDA recommend avoiding the use of NSAIDs after 30 weeks of gestation, since they can lead to neonatal pulmonary hypertension and premature closure of the ductus arteriosus. , NSAIDs

2018 Royal College of Obstetricians and Gynaecologists

166. Care of Women with Obesity in Pregnancy

after caesarean (VBAC) section. B What nutritional supplements should be recommended to women with obesity who wish to become pregnant? Women with a BMI 30 kg/m 2 or greater wishing to become pregnant should be advised to take 5 mg folic acid supplementation daily, starting at least 1 month before conception and continuing during the ?rst trimester of pregnancy. D Obese women are at high risk of vitamin D de?ciency. However, although vitamin D supplementation may ensure that women are vitamin D (...) pregnancy) may bene?t from taking 150 mg aspirin daily from 12 weeks of gestation until birth of the baby. B Women who develop hypertensive complications should be managed according to the NICE CG107. P What special considerations are recommended for prevention, screening, diagnosis and management of venous thromboembolism in women with obesity? Clinicians should be aware that women with a BMI 30 kg/m 2 or greater, prepregnancy or at booking, have a pre-existing risk factor for developing venous

2018 Royal College of Obstetricians and Gynaecologists

167. Management of Decompensated Cirrhosis

, amoxicillin/clavulanic acid, ?rst given i. v. then orally, has similar results with respect to SBP resolution and mortality as cefotaxime 259 and at a much lower cost. How- ever, there is only one comparative study with a small sample size and results should be con?rmed in larger trials. In addition, some concern exists regarding amoxicillin/clavulanic acid as its use is associated with a high rate of drug induced liver injury (DILI). 260 Administration of i.v. cipro?oxacin for seven days results

2018 European Association for the Study of the Liver

168. Prescribing in Older People

clinical evidence for using lower doses than those recommended in clinical practice guidelines.(66) The majority of reported presentations due to adverse drug events in older people are due to anticoagulants, diuretics, analgesics and hypoglycaemics.(67) Other commonly implicated high risk medications with a large percentage of fatal and non-fatal events include methotrexate, digoxin, aspirin, beta blockers and anticonvulsants.(68) Adverse effects of other medicines, such as falls and impaired physical

2018 Australian and New Zealand Society for Geriatric Medicine

170. Detection and management of women with Fetal Growth Restriction in singleton pregnancies

as it is antenatally. 13 Care of the newborn with SGA/FGR should include monitoring and maintenance of oxygenation, temperature and blood glucose levels. 7 Paired cord blood gases or lactate should be undertaken to assess acid base status at birth. In the care of the preterm growth restricted neonate, consider specific issues relating to prematurity such as lung disease, increased risk of infection, neurological complications and necrotising enterocolitis. Subsequent pregnancy care The birth of a baby with FGR (...) modifiable risk factors for FGR e.g. smoking cessation, optimising pre-existing medical conditions and weight reduction if obese. 1 Consider low dose aspirin (100-150mg nocte) in addition to serial ultrasound assessment in a subsequent pregnancy for women who have had previous FGR. 6 Consider specialist review at booking where available. Timing of ultrasound surveillance in a subsequent pregnancy can be tailored according to gestation at birth and underlying cause of previous FGR. Education and clinical

2019 Centre of Research Excellence in Stillbirth

171. Stroke, Diagnosis and Initial Treatment of Ischemic Stroke

Association (ASA) Stroke Document 4-5 Recommendations 6-45 Quality Improvement Support 46 Supporting Evidence 47-49 References 48-49 Disclosure of Potential Conflicts of Interest 50-52 External Review and Acknowledgements 53 Document History and Development 54-55 Document History 54 ICSI Document Development and Revision Process 55 Institute for Clinical Systems Improvement 3 Diagnosis and Initial Treatment of Ischemic Stroke Twelfth Edition/June 2019 Evidence Grading The American Heart (...) Association (AHA)/American Stroke Association (ASA) uses its own system for clas- sifying recommendations and evaluating the levels of evidence. This system is explained in the AHA/ASA stroke document. Since this is an endorsement document, ICSI did not use its own system to evaluate the levels of evidence or classify recommendations. Where new literature was available to support the existing recommendations or qualification statement for an existing recommendation, the new literature was cited

2019 Institute for Clinical Systems Improvement

172. Professional Use of Digital and Social Media

are considered a subset of digital media.* Social media—forms of electronic communication, such as web sites for social networking and microblogging, through which users create online communities to share information, ideas, personal messages, and other content. y Mobile media—forms of electronic media accessed through a mobile device, such asa smartphone or tablet. This term encompasses social media sites that users access through a device’s Internet browser or web- based applications (apps), as well

2019 American College of Obstetricians and Gynecologists

174. Guidelines for the management of hereditary colorectal cancer

colonoscopy should be performed from age 40 years until age 75 years. (GRADE of evidence: moderate; Strength of recommendation: weak) Prevention & Lifestyle Modification in Familial CRC o We recommend that individuals with LS should be advised that regular use of daily aspirin reduces CRC risk. (GRADE of evidence: moderate; Strength of recommendation: strong) o We suggest that people with LS should be offered research opportunities to take aspirin daily at different dosages. If they decline research (...) participation they may be advised on their choices regarding dose of aspirin, risks and benefits of long-term Aspirin use and ensure their medical practitioner is aware of their intake. (GRADE of evidence: low ; Strength of recommendation: weak) o There is insufficient evidence of the benefit of chemoprophylaxis in polyposis syndromes. (GRADE of evidence: moderate; Strength of recommendation: strong) o We suggest that individuals at increased familial risk of CRC should be strongly encouraged not to smoke

2019 British Society of Gastroenterology

175. Recommendations for Prevention and Control of Influenza in Children, 2019–2020

because of the potential for increased wheezing after immunization. In this age range, many children have a history of wheezing with respiratory tract illnesses and are eventually diagnosed with asthma; children who have known or suspected immunodeficiency disease or who are receiving immunosuppressive or immunomodulatory therapies; close contacts and caregivers of those who are severely immunocompromised and require a protected environment; children and adolescents receiving aspirin or salicylate

2019 American Academy of Pediatrics

176. Diagnosis and management of patients at risk of gastric adenocarcinoma Full Text available with Trip Pro

of the antrum and the acid and pepsinogen-secreting oxyntic glands of the corpus. GA is defined as the loss of pre-existent glands native to the gastric compartment. The two phenotypic features of GA include the loss of glandular mass with fibrosis of the lamina propria and replacement of the native gastric glands by metaplastic or pseudopyloric glands. The Correa cascade describes the stepwise progression of precursor lesions towards intestinal-type gastric cancer. H. pylori infection initiates the cascade (...) , with the greatest risk in younger men. No difference was found, however, in a US study looking at pantoprazole. It can be concluded that although there is an association between PPI use and gastric cancer, no causal link has been proved. Furthermore, this association may be limited to specific populations and limited to patients who have had H. pylori eradication. We make reference to a BSG position statement, which recommends that if acid suppression is required after H. pylori eradication, H2 antagonists

2019 British Society of Gastroenterology

177. Canadian Association of Gastroenterology Clinical Practice Guideline for the Medical Management of Pediatric Luminal Crohn’s Disease

pertaining to the medical management of luminal CD in pediatric patients Abbreviations used in this paper: 5-ASA, 5-aminosalicylate; CAG, Canadian Association of Gastroenterology; CD, Crohn’s disease; CI, confidence interval; CPG, clinical practice guideline; EEN, exclusive enteral nutrition; GRADE, Grading of Recommendation Assessment, Development, and Evaluation; HR, hazard ratio; HSTCL, hepatosplenic T-cell lymphoma; IBD, inflammatory bowel disease; NMA, network meta-analysis; OR, odds ratio; PEN (...) for or against many treatments (14 statements); however, the available evidence and ensuing discussion relevant to these treatments is presented. e38 Journal of the Canadian Association of Gastroenterology, 2019, Vol. 2, No. 3Table 1. Summary of Consensus Recommendations for the Management of Pediatric Crohn’s Disease a Aminosalicylates Recommendation 1: In patients with moderate CD, we recommend against the use of 5-ASAs to induce clinical remission. GRADE: Strong recommendation, very-low-quality evidence

2019 Canadian Association of Gastroenterology

180. Safe Delivery of paediatric ENT surgery in the UK- a national strategy

18.9 (±8.4) OSA - Study group: urgent, - Control group: elective Not reported Major airway 20.3% vs 6.8% Minor airway 40.7% vs 29.5% 1. Mixed population (46% comorbidities) 2. More comorbidities in study group and more severe OSA 3. Risk factor for postop medical intervention: -comorbidity -SaO2 nadir years Helmus, Rapids (1979) (25) Retrospective record review and questionnaire 108 3 yrs: - primary: 0% vs 0.4% - secondary: 0% vs 0.7% Minor airway 3 yrs: 1.8% vs 0.3% No major airway 1. Only ASA-1 (...) and ASA- 2 2. Pt 2 years of age Theilhaber, Arachchi, Armstrong, Davey, Nixon (2014) (29) Retrospective chart review 72 2.8 yrs (range 1- 13) OSA Major airway 8.3% Minor airway 31.9% If uncomplicated PACU stay: 98.3% chance of uncomplicated hospital stay 1. No difference with regards to age, sex, comorbidities, severity of OSA. 2. Small group 3. Only patients admitted to ICU included 4. Mixed population (45.8% significant ant comorbidities) Bhattacharyya (2010) (30) Retrospective database review from

2019 Association of Paediatric Anaesthetists of Great Britain and Ireland


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