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1601. Canadian clinical practice guidelines on the management and prevention of obesity in adults and children

is not taking any prescription medications but occasionally takes an over-the-counter nonsteroidal anti- inflammatory drug (NSAID) for low back pain. She is a for- mer smoker who works in a sedentary occupation and does not exercise regularly (because of lack of time). Her mother (age 72 years) has type 2 diabetes, and her father (age 75 years) has coronary artery disease. On physical examination, Ms. A appears generally well. She weighs 89 kg and is 1.6 m tall. Blood pressure is 135/85 mm Hg, heart rate

2007 CPG Infobase

1602. Statement on travellers and sexually transmitted infections

to be independent of country of origin, travel “style” (e.g. business, back-packer) and country of destination . Although many travellers carry condoms, they often “forget” to use them in the heat of the moment . Even when they use condoms, there may be greater risks of failure because of the poor quality of locally purchased products , improper storage (i.e. at the bottom of the knapsack for 2 months at 40° C), and improper application or sexual practices that may lead to higher likelihood of condom failure (...) . The consequences of acquiring an STI while travelling STIs can result in both short-term problems (e.g. genital ulcers, urethritis, cervicitis) and long-term or chronic complications (e.g. infertility and ectopic pregnancy, pelvic inflammatory disease or chronic pelvic pain, liver disease secondary to HBV, cervical dysplasia secondary to human papillomavirus [HPV], immunodeficiency due to HIV). Several of these chronic infections can significantly shorten life (e.g. cancers secondary to hepatitis viruses

2006 CPG Infobase

1603. Clinical practice guidelines for communicating prognosis and end-of-life issues with adults in the advanced stages of a life-limiting illness, and their caregivers Full Text available with Trip Pro

to positively influence a patient’s hope. Reassure that support, treatments and resources are available to control pain and other symptoms, but avoid premature reassurance. Explore and facilitate realistic goals and wishes, and ways of coping on a day-to-day basis, where appropriate. Encourage questions and further discussions: Encourage questions and information clarification; be prepared to repeat explanations. Check understanding of what has been discussed and if the information provided meets (...) obtaining a sense of hope from relationships, beliefs and faith, maintaining dignity, finding inner peace, thinking about meaningful events in their lives, having symptom control and reassurance that pain will be controlled, and enjoying a sense of humour, including occasional humour from the health care professional. , In addition, studies have found that hope can be maintained by having a health care professional who is knowledgeable and offers to answer all of the patient’s questions, offers hope

2007 MJA Clinical Guidelines

1604. Syphilis in pregnancy

Primary · Lesions begin as a raised papule that ulcerates (chancre) and may 16,26,4 : o Be painless or painful (approximately half reported as painful) 33 o Be solitary or multiple (approximately one third reported as multiple) 33 o Typically occur at the site of inoculation (e.g. vagina, penis, anus, rectum, lips, in or on the mouth) o Discharge clear serum—may also be purulent, destructive o Spontaneously heals within three to six weeks without treatment Secondary · Follows untreated primary stage (...) , and cytokines, leading to an acute inflammatory response 24 · More common during treatment for infectious syphilis 24 due to high bacterial burden 31 · Case studies report JHR occurs in up to 44% of pregnant women treated for syphilis 44,45 · Concerns about JHR relevant only to the first dose of treatment Symptoms · Onset within 2–12 hours post treatment and lasts several hours 44 · Usually self-limiting 44,46 resolving by 24 hours after treatment 24 · Fever, headaches, rigors, joint pain chills, malaise

2020 Queensland Health

1605. Prevention and Management of Dermatological Toxicities Related to Anticancer Agents: ESMO Clinical Practice Guidelines Full Text available with Trip Pro

sensitive areas and association with symptoms of pruritus and pain, result in a need for preventive or reactive therapies. Indeed, the negative effect on quality of life (QoL) from dermatological AEs from targeted therapies is significant and greater than that of dermatological AEs resulting from cytotoxic agents [ Rosen A.C. Case E.C. Dusza S.W. et al. Impact of dermatologic adverse events on quality of life in 283 cancer patients: a questionnaire study in a dermatology referral clinic. Am J Clin (...) , these guidelines will focus on papulopustular exanthema, hand-foot syndrome (HFS), pruritus, nail changes (paronychia, onycholysis) and alopecia. Acneiform rash (Papulopustular exanthema) Incidence Papulopustular eruption (acneiform rash) is characterised by an eruption consisting of papules and pustules typically appearing in the face, scalp and upper chest and back [ Lacouture M.E. Mechanisms of cutaneous toxicities to EGFR inhibitors. Nat Rev Cancer. 2006; 6 : 803-812 ]. It represents the most frequent AEs

2020 European Society for Medical Oncology

1606. Management of Breathlessness in Patients with Cancer: ESMO Clinical Practice Guidelines

as a standalone intervention for breathlessness is lacking, but evidence from its use in cancer-related fatigue and/or pain is generally applicable. Distraction using music or visualisation has been tested in small studies. An uncontrolled study (n=53) found guided imagery with theta music reduced breathlessness in patients with advanced cancer, and a retrospective analysis reported positive responses to music therapy sessions in a palliative care setting. In COPD, auditory distraction with music improved (...) breathlessness in Australia. A dose range of 10–30 mg per 24 hours is licensed, with an explicit statement that additional morphine sulfate IR doses should not be given for breathlessness but may be needed for concurrent pain. Opioid-tolerant patients There are few RCTs to inform use of opioids for treatment of breathlessness in patients with cancer taking regular opioids for pain. A cross-over, placebo-controlled trial found that a single dose of subcutaneous morphine given at 50% higher than the scheduled

2020 European Society for Medical Oncology

1607. Neurological and Vascular Complications of Primary and Secondary Brain Tumours: EANO-ESMO Clinical Practice Guidelines for prophylaxis, diagnosis, treatment and follow-up Full Text available with Trip Pro

, mental changes, gait difficulties, cranial nerve palsies and focal or irradiating (radicular) neck and back pain [ Le Rhun E. Weller M. Brandsma D. et al. EANO-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with leptomeningeal metastasis from solid tumours. Ann Oncol. 2017; 28 : iv84-iv99 ]. Unspecific symptoms of raised intracranial pressure are headache, with or without nausea and vomiting, cognitive impairment, personality changes and gait disturbances (...) and Bevacizumab in Progressive Glioblastoma. N Engl J Med. 2017; 377 : 1954-1963 ]. Diagnosis The diagnosis of VTE can be challenging because symptoms and signs may be unspecific and brain tumour patients often have neurological deficits, which can be clinically more dominant and mask VTE-related symptoms and signs. Classical symptoms include leg swelling, erythema and pain of the limb for deep vein thrombosis (DVT), and tachycardia, thoracic pain, shortness of breath or haemoptysis for PE. Of note, in most

2020 European Society for Medical Oncology

1608. Best practice for the nuclear medicine technologist in CT-based attenuation correction and calcium score for nuclear cardiology Full Text available with Trip Pro

the value of Agatston score for clinical risk predication as gold standard, all using the same reference protocol for CCS acquired at 120 kV and reconstructed at 3 mm slice thickness with filtered back projection (FBP), there have been changes in methodology, aiming to an optimization of the parameters (Blaha et al. ). For the CCS protocol optimization, the noise thresholds used in clinical practice of < 20 HU and < 23 HU are recommended for CCS imaging in small-/medium- and large-sized patients (...) (3.75 mm vs 2.5 mm), there was a high agreement between the CCS measured using cardiac CT and CCS using AC images from cardiac PET MPI. A manual threshold of 50 HU (instead of 130 HU) was used to identify the calcification. This was the first study to quantify CCS using AC images obtained during PET MPI in a cohort of 91 patients. Išgum et al. ( ) moved back the threshold level to 130 HU because they stated that a 50 HU introduces more artifacts from the non-calcium structure for the set of images

2020 European Association of Nuclear Medicine

1609. EANM procedural guidelines for PET/CT quantitative myocardial perfusion imaging Full Text available with Trip Pro

requires a slightly longer acquisition time than with [ 15 O]water and 82 Rb [ ]. In blood, [ 13 N]NH 3 is mainly present as ammonium ion (NH 4 + ), which can cross the cell membrane through the sodium–potassium exchange system, whilst [ 13 N]NH 3 diffuses passively because of its lipophilicity. Within the cell, [ 13 N]NH 3 may enter various metabolic pathways, among which the glutamic acid–glutamine is the most important, or back diffuse to blood [ ]. Thus, the final myocardial uptake is influenced (...) as activity is detected on the PET detectors. [ 13 N]NH 3 In case of [ 13 N]NH 3 , at least 5 half-lives should be left between the two studies (i.e. ≈50 min). To optimise the patient throughput it is reasonable to proceed with the acquisition of the resting study of at least another patient and then come back to the former one for the stress acquisition. Shortened protocols for [ 13 N]NH 3 have been proposed, adjusting for residual activity of the resting injected dosage, but the effectiveness

2020 European Association of Nuclear Medicine

1610. Urinary Tract Infections in the Primary Care Setting – Investigation

transplant patients (< 8 weeks post-transplant) à refer to renal transplant service Spinal cord injury (including intermittent catheter use) No testing required if symptoms of UTI or systemic infection are absent. 6 UTI symptoms may be atypical, and include increased spasticity, autonomic dysreflexia, new or worsening urinary incontinence or leakage, a sense of unease with vague back and abdominal pains. 37 No antibiotics This is a diagnostically challenging group as patients with neurogenic bladders (...) . pyelonephritis and systemic infection) based on . This definition of complicated UTI may be different than that described in some literature. Table 1. Symptoms/Signs of UTI used for classification Cystitis 18,21,22 Complicated UTI (beyond bladder) 18,23–25 NOT symptoms/signs of UTI in isolation 7,20 Acute dysuria* Urinary frequency Urinary urgency Suprapubic pain New incontinence Gross hematuria (gross hematuria in the absence of other symptoms requires referral to urology) *Note: in older women, new onset

2020 Clinical Practice Guidelines and Protocols in British Columbia

1611. Acute coronary syndromes

antiplatelet therapy to people with chest pain before a diagnosis of unstable angina or NSTEMI is made. [2020] [2020] For a short explanation of why the committee made the 2020 recommendation and how it might affect practice, see the rationale and impact section on dual antiplatelet therapy for people with unstable angina or NSTEMI. Full details of the evidence and the committee's discussion are in evidence review A: antiplatelet therapy. Risk assessment Risk assessment 1.2.7 As soon as the diagnosis

2020 National Institute for Health and Clinical Excellence - Clinical Guidelines

1612. 2020 Guidelines for the Prevention, Diagnosis and Treatment of Lyme Disease

PRESENTATIONS SHOULD PATIENTS BE TESTED FOR LYME DISEASE? Recommendations: In patients presenting with 1 or more of the following acute disorders: meningitis, painful radiculoneuritis, mononeuropathy multiplex including confluent mononeuropathy multiplex, acute cranial neuropathies (particularly VII, VIII, less commonly III, V, VI and others), or in patients with evidence of spinal cord (or rarely brain) inflammation, the former particularly in association with painful radiculitis involving related spinal (...) PATIENTS WITH EARLY LYME DISEASE RECEIVE AN ELECTROCARDIOGRAM (ECG) TO SCREEN FOR LYME CARDITIS? Recommendation: We suggest performing an ECG only in patients with signs or symptoms consistent with Lyme carditis (weak recommendation, low-quality evidence). Comment: Symptoms and signs of cardiac involvement in Lyme disease include dyspnea, edema, palpitations, lightheadedness, chest pain, and syncope. XVII. WHICH PATIENTS WITH LYME CARDITIS REQUIRE HOSPITALIZATION? Recommendation: In patients

2020 Infectious Diseases Society of America

1613. Field guide for the management of drug-resistant tuberculosis

: abdominal pain, nausea, vomiting, rapid deep breathing, general weakness. Treatment: 1 Stop Lzd and replace with another drug with similar characteristics (e.g., imipenem or meropenem + clavulanic acid). 44 Chapter 6 Identification and management of adverse events – pharmacovigilance 6.2.8 Haematological disorders Bone marrow aplasia Suspected drug: Lzd. Treatment: 1 Discontinue Lzd immediately in case of severe medullar aplasia (Grade 3) of the white or red blood cells, or platelets. 2 Consider blood (...) ; • Put the sediment back into suspension in 50 ml of sterile distilled water; • Carry out a second centrifugation at 3,000g for 15 min; • Remove the supernatant and use the sediment. b) For culture on solid egg-based medium Principle This form of transportation uses antiseptic CPC, which enables live TB bacilli to be conserved at room temperature for a month. Materials required • 50 ml (Falcon ® ) tubes that are sterile, conical, plastic, graduated (do not re-use tubes). • 1% CPC solution: dissolve

2018 International Union Against TB and Lung Disease

1614. Best practice for the care of patients with tuberculosis: a guide for low-income countries

living with HIV) • loss of appetite • weight loss • fatigue, a general feeling of illness (malaise) • night sweats • fever • sputum which may contain blood (haemoptysis) • shortness of breath or • chest pain. These symptoms are even more indicative of TB if the person has had contact with someone known to have the disease. Ensuring healthcare workers have an adequate level of awareness about TB symptoms will help prevent cases being missed. Extra-pulmonary TB may or may not be accompanied by a cough (...) , and other symptoms may be present as well including pain and swelling or deformation of the site affected. Special care should be taken when assessing children as symptoms vary and they seldom produce sputum, which means TB can be more difficult to diagnose in children. 2 Assessing risk of drug resistance The development of drug resistance is often a result of mismanagement of drug-susceptible TB (often called acquired drug resistance or amplified drug resistance) by healthcare workers, due to health

2017 International Union Against TB and Lung Disease

1615. Lessons from research for doctors in training: recognition and early management of meningococcal disease in children and young people

, Bacterial Meningitis and Meningococcal Septicaemia in Children, accessible from the RCPCH website www.rcpch.ac.uk/e-learning.4 5 Case history Child of 5 years attends Emergency Department with sudden onset fever and painful right hand. ED triage assessment: 1)? Injury soft tissue 2) unwell, pyrexia. Sudden onset pain in right hand. No history of trauma, she is reluctant to have it touched. She is also generally unwell. Spots erupting on arm and back. Last had Calpol 2.5 hours ago. Observation taken (...) discussions and learning. The clinical management points are based on “Management of Meningococcal Disease in Children and Young People” (see inside back cover) incorporating the NICE Guideline Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management CG102.1 Contents SECTION 1 Introduction 2-3 SECTION 2 Clinical case histories: discussion and learning points 4-41 SECTION 3 Background to the Disease 42 n Disease burden 42 n Characteristics of meningococcal

2018 Meningitis Research Foundation

1616. Clinical practice guide for improving the management of adult COVID-19 patients in secondary care

is to maintain essential services both acute and elective during a second wave and subsequent outbreaks. The enthusiasm of these trusts to share their learning and best practice with our GIRFT team at virtual deep dive visits has resulted in this document. This is important because the first wave of the pandemic saw a large fall in the number of acute medical patients presenting as an emergency. Since the end of the lockdown, acute and emergency medical activity has retuned back to the pre-lockdown numbers

2020 British Thoracic Society

1617. Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease

of the following acute disorders: meningitis, painful radiculoneuritis, mononeuropathy multiplex including confluent mono- neuropathy multiplex, acute cranial neuropathies (particu- larly VII, VIII, less commonly III, V, VI and others), or in patients with evidence of spinal cord (or rarely brain) inflam- mation, the former particularly in association with painful radiculitis involving related spinal cord segments, and with IDSA-AAN-ACR Lyme Disease Guidelines • cid 2020:XX (XX XXXX) • 5 epidemiologically (...) RECEIVE AN ELECTROCARDIOGRAM (ECG) TO SCREEN FOR LYME CARDITIS? Recommendation: 1. We suggest performing an ECG only in patients with signs or symptoms consistent with Lyme carditis (weak recom- mendation, low-quality evidence). comment: Symptoms and signs of cardiac involvement in Lyme disease include dyspnea, edema, palpitations, lightheadedness, chest pain, and syncope. XVII. WHICH PATIENTS WITH LYME CARDITIS REQUIRE HOSPITALIZATION? Recommendation: 1. In patients with or at risk for severe cardiac

2020 American Academy of Neurology

1618. Glaucoma (primary open angle)

, increasing to 4-5% of those over 80 years. It is more likely to affect people with a family history of the same condition, and people of West African ancestry, including West Indians and African Americans. The condition is not painful and patients may be unaware that they have it until they have started to lose vision. The optometrist examining a patient for POAG, will look for the characteristic appearance of ‘cupping’ of the optic disc (the head of the optic nerve at the back of the eye). The optic

2018 College of Optometrists

1619. Scleritis

. An even more severe form of Anterior Scleritis seen in 15% of these cases is known as Necrotising Scleritis, in which the scleral tissue melts away, often without pain; vision is likely to be greatly impaired. One in 10 cases of Scleritis takes the form known as Posterior Scleritis, which affects the sclera of the back part of the eye, so that the front of the eye may appear normal and the optometrist will need to use special instruments to help to make the diagnosis. Scleritis is a serious condition (...) or severe pain (eye ‘ache’ may be referred to brow or jaw) which is exacerbated by eye movement May disturb sleep Gradual onset Tenderness of globe Photophobia Epiphora Visual loss Possible history of previous episodes Signs Scleritis may involve the anterior sclera, the posterior sclera, or both Anterior scleritis (90% of cases) (a) Non-necrotising (75% of cases) usually unilateral hyperaemia of superficial and deep episcleral vessels; does not blanch with vasoconstrictors (e.g. gutt. 2.5%) anterior

2018 College of Optometrists

1620. Corneal hydrops

seems likely to occur (GRADE*: Level of evidence=low, Strength of recommendation=weak) Referral B2: alleviation/palliation: normally no referral A3: first aid measures and urgent referral (if vascularisation present) Possible management by ophthalmologist Treat pain, prophylactic antibiotic if indicated, topical steroid if corneal vessels proliferate, penetrating keratoplasty if scarring reduces acuity following resolution Possible intracameral gas injection Evidence base *GRADE*: Grading (...) known as keratoconus. Usually for no apparent reason, the back membrane of the cornea splits, allowing fluid from within the eye to flood into the cornea which then loses its clarity. The vision may be badly affected. The condition usually improves by itself over a period of 2-4 months. If there is any complication in the recovery period, for example if new blood vessels appear in the cornea, patients are quickly referred to the ophthalmologist for specialist treatment. These patients are usually

2020 College of Optometrists

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