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181. Blood pressure monitoring

( ). The exception to this would be children who need long cuffs for large arm circumference. If the cuff covers the brachial area the radial pulse should be used. The tubing may lie inferior (going down), superior (going up) or posterior (at the back) ( ). The arm should be well supported at the level of mid-sternum ( ). Auscultation only The first BP reading should be estimated by palpation. Palpate over artery, place the stethoscope/Doppler/fingers over the pulse. Do not press too firmly or touch the cuff (...) also be taken with patients who are obese as a thick layer of fat surrounding the arm dampens the oscillations coming from the artery, and accuracy is reduced. Rationale 43: If the monitor inflation settings are too high this may cause considerable discomfort to the child and cause the BP to increase due to a pain response. Frequent repeated measurement can cause purpura, ischemia and neuropathy, for this reason the BP cuff should be reapplied hourly and the skin observed for colour, warmth

2013 Publication 1593

182. Aseptic technique in theatre

Aseptic technique in theatre Aseptic technique in theatre | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Aseptic technique in theatre Aseptic technique in theatre ). Surgical aseptic technique is a method employed to maintain asepsis and minimise the risk of introducing pathogens into a surgical wound . It protects the patient from the impact of healthcare associated infections such as delayed recovery, longer hospitalisation, increased pain (...) the sterile field . Staff scrubbed should stay within the sterile field during the intraoperative procedure and not walk around or go outside the operating theatre in their sterile gown and gloves . When changing positions scrub staff should pass back-to-back or face-to-face ). Scrubbed staff should avoid changing levels, such as sitting and standing . A wide space should be observed between scrubbed staff and non-scrubbed staff. When moving about the theatre circulating practitioner should maintain

2014 Publication 1593

183. Ureteric stent

perform a hand wash and dry hands thoroughly record the procedure and volume of urine in the child’s health records ( ) The child and family must be reminded that pain may be experienced as the kidney pelvis fills up and during the first micturition. The child’s first micturition must be documented on the fluid balance chart and in the child’s health care record ( ). The child's doctor must be informed if the child: is unable to pass urine ( ) has dysuria or loin pain if the entry site leaks (...) on their first micturition ( pressure should be applied) ( ) The dressing should be removed after 24 hours ( ). O nce the site is healed a dressing will no longer be required. Discharge The child’s parents should be advised to contact the ward if, once discharged, they have concerns about the wound site ( ). The family must be told to contact the ward if the child experiences any of the following problems: if the child is unable to pass urine ( ) the child has dysuria or loin pain ( ) Rationale Rationale 1

2014 Publication 1593

184. Pregnancy and Renal Disease

be arranged for women taking these medications. Options for maternity care, determined by the MDT, include: ? Advice regarding pregnancy care and delivery, with referral back to the local maternity unit ? Shared maternity care between the Maternal Medicine Centre and the local unit ? Maternal Medicine Centre to lead and deliver maternity care References 1. Nair M, Kurinczuk JJ, Brocklehurst P et al. Factors associated with maternal death from direct pregnancy complications: a UK national case-control

2019 Renal Association

185. Guidelines for Living Donor Kidney Transplantation

to be used should it not be possible to transplant it into the intended recipient. The donor is asked to explicitly consent to one of the following options: implantation into another recipient, re-implantation back into the donor, research, or disposal of the organ. Typically, this consent is taken during discussion with the surgeon and the donor’s wishes are recorded in the referral letter prior to the independent assessment for the HTA. 2.7 Prohibition of Commercial Dealings in Human Material Section

2018 Renal Association

187. Shared follow-up and survivorship care for low-risk endometrial cancer: A guide for women

with your primary care team and/or specialist team. Symptoms of endometrial cancer returning include: vaginal bleeding or discharge new, constant and worsening pain in the pelvic area, stomach area or back of the legs changes in bowel habits difficulty or pain when urinating nausea, vomiting or bloating persistent cough or shortness of breath unexplained weight loss. If you notice any new or unusual symptoms between follow-up visits, do not wait until your next scheduled appointment. See your GP as soon (...) Shared follow-up and survivorship care for low-risk endometrial cancer: A guide for women canceraustralia.gov.au SHARED FOLLOW-UP AND SURVIVORSHIP CARE FOR LOW-RISK ENDOMETRIAL CANCER A guide for women on shared follow-up and survivorship care Why is follow-up and survivorship care important? After treatment for low-risk endometrial cancer, it is important to have follow-up visits to: check whether the cancer has come back monitor and address any side effects of treatment receive practical

2020 Cancer Australia

188. Management of Hyperlactation

experience multiple breastfeeding complications, including breast pain, plugged ducts, and mastitis. Dyads are at risk for early weaning and/or exclusive pumping due to latch dif?culties and/or forceful letdown. Maternal and infant signs and symptoms of hy- perlactation are summarized in Table 1. If medical compli- cations and/or psychological distress occur, women with hyperlactation may be advised to decrease their milk pro- duction. Behavioral interventions, herbal therapies, and pre- scription (...) adverse drug reactions and the potential for complete cessation of milk production. Until the rate of milk production is normalized, mothers can try using the laid-back/biological nursing position to decrease ?ow rate and maintain a positive direct breast- feeding relationship. To maximize the fat content of the milk—particularly if there is clinical concern for signi?cant foremilk-hindmilk imbalance—mothers can perform gentle breast massage (Level 3) 12 before feeds and prioritize hand expression

2020 Academy of Breastfeeding Medicine

190. Appropriate prescribing of psychotropic medication for non-cognitive symptoms in people with dementia

– compulsive disorder, chronic pain, agitation, generalised anxiety disorder, bipolar disorder, childhood enuresis (bedwetting), migraine and sleep disorders.Antipsychotic medication One of a group of medications used in the treatment of psychosis. Some of the antipsychotic medications are also approved for use in other conditions such as mood disorders or Tourette’s syndrome. Usually referred to as “typical” or “atypical”. The first-generation antipsychotic (FGA) medications, referred to as “typical (...) health history (including depression) and medication history; physical examination, including consideration of possible delirium, or undetected pain or discomfort (with an appropriate assessment of same); assessment of the severity, type, frequency, pattern, and timing of symptoms, and other potentially contributory or comorbid factors. This assessment should be performed in an appropriate environment that optimises the person’s comfort and ability and includes any support that the person may require

2019 National Clinical Guidelines (Ireland)

191. American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee

, and passive range of motion and are always used in conjunction with exer cise (http://guide toptp racti ce.apta.org/conte nt/1/SEC38. extract). A limited number of studies have addressed manual ther- apy added to exercise versus exercise alone in hip and knee OA. Although manual therapy can be of benefit for certain conditions, such as chronic low back pain, limited data in OA show little addi- tional benefit over exercise alone for managing OA symptoms. Iontophoresis is conditionally recommended against (...) people worldwide (1–5), and is a leading cause of disability among older adults. The knees, hips, and hands are the most commonly affected appendicular joints. OA is characterized by pathology involving the whole joint, includ- ing cartilage degradation, bone remodeling, osteophyte forma- tion, and synovial inflammation, leading to pain, stiffness, swelling, and loss of normal joint function. As OA spans decades of a patient’s life, patients with OA are likely to be treated with a number of different

2020 American College of Rheumatology

192. Clinical Exercise Stress Testing in Adults

is complaining of and in particular if an individual is complaining of chest pain, make an assessment as to the nature of the chest pain. Features of the history that suggest an unstable situation, where stress testing may be inappropriate, should be determined. The medical practitioner should examine the individual to determine whether or not there is unrecognised valvular disease or a heart failure. Prior to performing the exercise test the electrocardiogram should be examined to exclude features (...) for an individual patient, based on the clinical history, physical examination, and resting electrocardiogram. The number of tests to be observed and to be performed under supervision will vary according to the skills and training of the medical practitioner, and the back-up and support facilities available. d) Healthcare Professional for Clinical Exercise Stress Test The second person or healthcare professional for clinical exercise stress tests should be a person with appropriate training. There are three

2014 Cardiac Society of Australia and New Zealand

193. Squamous cell carcinoma

group supports performing a superficial parotidectomy concominatly with the nodal dissection, as studies have shown an inferior disease-specific survival with radiation therapy alone 74 .The typical nodal ba- sins in which the majority of therapeutical lymphadenectomies (TLNDs) are performed are the neck, axilla and groin basins. Few patients experience the possibility of unusual metastatic de- posits in the popliteal fossa or in the epitroclear region or in the dorsal posterior triangle on the back (...) is not feasible. RT is particular helpful as a palliative treatment, in order to relieve pain and to stop hemorrhage as well to limit the extension of the tumor to adjacent critical areas such as the orbita or oral cavity. Electrochemotherapy is a treatment modality that can find indication in locally advanced lesions. It helps to control the progression of inoperable loco-regional SCC recurrences with the benefit of controlling bleeding lesions and of reducing painful symptoms when present. The two most

2014 European Dermatology Forum

194. Venous Legs Ulcers

mellitus because compression of the arteries may not be possible due to medial sclerosis. 5 Conclusion Level 3 An estimated 25% of the patients with a leg ulcer have arterial insufficiency 38 . The palpation of the ankle artery at the back of the foot is an unreliable test. A systolic ankle pressure index does provide a reliable indication. C Stoffers 1996 37 Forssgren A 2012 36 Recommendation 10 It is recommended that patients with a leg ulcer should be subjected to an additional investigation (...) a positive bacterial culture result and a slow wound healing 44,45,46,47,48. Various authors then also concluded that there was no reason for routine cultures in a venous leg ulcer. However, a culture is done before surgery and in the interest of the policy for detecting MRSA. A sample for culture is always obtained if there 25 are signs of cellulitis or erysipelas, increased pain, an increase in the size of the ulcer, erythema around the wound and a purulent exudate. There is one Cochrane review

2014 European Dermatology Forum

196. A guide to understanding the implications of the Ionising Radiation (Medical Exposure) Regulations in diagnostic and interventional radiology

they can request imaging within their scope of practice. The employer’s procedures must reflect this referral group, their scope of practice and training and competency records should be kept updated. A patient is attending a physiotherapist for assessment and treatment of neck pain and stiffness. The physiotherapist refers the patient to the local hospital for an X-ray where there is a documented agreement in the employer’s procedures allowing them to make X-ray referrals. However, the patient attends (...) to check performance before the equipment is put back into clinical practice. Professional responsibility Each individual duty holder must comply with the employer’s procedures. If any duty holder considers that the employer’s procedures or practices are unsafe or do not reflect local practice, they have a professional responsibility to bring this to the attention of a senior colleague as defined locally. All duty holders should also be constantly alert to the possibility of an error from any source

2015 Royal College of Radiologists

197. Standards for Conscious Sedation in the Provision of Dental Care

must be maintained. The effective management of anxiety and pain is an essential part of the delivery of dental care. Behavioural management, the use of local analgesia and methods of conscious sedation are all central components of care for patients who are frequently anxious about receiving dental treatment. Conscious sedation, provided when appropriate, in a skilled manner and in the correct environment, is widely used, valuable and effective. INTRODUCTION Introduction8 This is based (...) on establishing the best patient management and involves provision of information, counselling and reassurance as primary measures of anxiety control. When pain control is required for a dental procedure to be carried out under conscious sedation, appropriate use of local analgesia is also required. Conscious sedation is not a substitute for effective behaviour management and local analgesia. Behaviour management, local analgesia or general anaesthesia may each have a role in facilitating patient care

2015 Royal College of Anaesthetists

198. Post-Hysterectomy Vaginal Vault Prolapse

procedure or due to weakening of these supports over time. Case series dating back to 1960 have identified the incidence of PHVP as ranging from 0.2% to 43%. 3–5 More recently, PHVP has been reported to follow 11.6% of hysterectomies performed for prolapse and 1.8% for other benign diseases. 6 A large study from Austria estimated the frequency of PHVP requiring surgical repair to be between 6% and 8%. 7 3. Identification and assessment of evidence A search of MEDLINE, EMBASE and The Cochrane Library (...) follow-up of 2 years. 29 In this series, twenty women complained of right buttock pain; all resolved spontaneously by 6 weeks’ follow-up, while five women subsequently developed de novo anterior vaginal wall prolapse. No information was provided about sexual dysfunction in this study. 5.2 Does subtotal hysterectomy have a place in the prevention of PHVP? Subtotal hysterectomy is not recommended for the prevention of PHVP. There is no evidence to support the role of subtotal hysterectomy in preventing

2015 Royal College of Obstetricians and Gynaecologists

199. Management of carpal tunnel syndrome evidence-based clinical practice guideline

? Hand dominance ? Symptomatic limb ? Age ? BMI Strength of Recommendation: Moderate Evidence Description: Evidence from two or more “Moderate” strength studies with consistent findings, or evidence from a single “High” quality study for recommending for or against the intervention. PATIENT REPORTED NUMBNESS OR PAIN Limited evidence supports that patients who do not report frequent numbness or pain might not have carpal tunnel syndrome. Strength of Recommendation: Limited Evidence Description (...) as compared to placebo. Strength of Recommendation: Moderate Evidence Description: Evidence from two or more “Moderate” strength studies with consistent findings, or evidence from a single “High” quality study for recommending for or against the intervention. KETOPROFEN PHONOPHORESIS Moderate evidence supports that ketoprofen phonophoresis could provide reduction in pain compared to placebo. Strength of Recommendation: Moderate Evidence Description: Evidence from two or more “Moderate” strength studies

2016 American Academy of Orthopaedic Surgeons

200. Clinical Practice Guideline on Prevention of Orthopaedic Implant in Patients Undergoing Dental Procedures

make provisions for making recommendations based on expert opinion. This recognizes the reality of medicine, wherein certain necessary and routine services (e.g., a history and physical) should be provided even though they are backed by little or no experimental evidence, and wherein certain diseases, disorders, or conditions are so grave that issuing a recommendation in the absence of evidence is more beneficial to patients than not issuing one. To prevent the bias that can result when

2012 American Academy of Orthopaedic Surgeons

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