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1621. Diagnostic and therapeutic approach to persistent or recurrent fevers of unknown origin in adult stem cell transplantation and haematological malignancy Full Text available with Trip Pro

, dyspnoeic, hypotensive, presence of markers of septicaemia, cough, haemoptysis, pleuritic chest pain, etc). PFUO in a clinically well patient receiving voriconazole or posaconazole prophylaxis are more likely to have a non‐fungal aetiology, while the likelihood of breakthrough azole‐resistant Aspergillus infection or other azole‐resistant IFI is increased in those who are clinically unwell. , We recommend continuing voriconazole or posaconazole prophylaxis in clinically well patients and changing (...) of NCBRDT, , the combination of negative NCBRDT with a normal HRCT scan makes an IFI highly unlikely and a non‐fungal infection or a non‐infectious pathology more likely. In this clinical scenario, we recommend continuing L‐AMB or ABLC while determining the cause and following recommendations (3) and (4) in above. If no IFI is diagnosed, switch back to voriconazole or posaconazole; use the same dose if drug levels were therapeutic or adjust accordingly. 1.6. Any abnormalities on HRCT scan of thorax

2008 Clinical Practice Guidelines Portal

1622. UK guidelines for the management of sexual and reproductive health of people living with HIV

analysis, and the female partner has an endocrine profile and baseline pelvic scan in the early follicular phase of her cycle (day 2-5), a mid-luteal progesterone to measure ovulation and non-invasive test of tubal patency (e.g. hysterosalpingogram), unless there is a history of pelvic pain or infection where laparoscopy is the preferred method for assessing tubal patency 42 . Most couples electing to have sperm washing are voluntarily infertile and do not have significant fertility issues (...) 54 . This raises the theoretical possibility of the embryo becoming infected at the laboratory stage even before the embryo is transferred back to the woman. Centres electing to treat positive women need to monitor all IVF or ICSI cycles in positive women and audit short and long term outcome.. Management of positive women should involve a multidisciplinary team comprising HIV physician, fertility specialist and obstetrician with a special interest in HIV. The couple should have a sexual health

2007 British Association for Sexual Health and HIV

1623. UK National Guideline on the sexual health of people with HIV: sexually transmitted infections

-being following successful antiretroviral treatment has put sexual activity back on the agenda of PWHIV [11,12]. There is recognised synergy between HIV and STIs which may enhance transmission of both [13,14] and globally there is evidence that improved STI control reduces HIV spread [15], however there remains uncertainty regarding whether antiretroviral therapy can reduce sexual transmission of HIV [16]. Public health implications have been highlighted by several syphilis outbreaks which have (...) to foscarnet and cidofovir which do not depend upon TK but which inhibit viral DNA polymerase. Both topical 1% foscarnet cream [74] and 1% cidofovir gel [77] have been shown to produce significant benefits in lesion healing, pain reduction and virological effect in drug resistant herpes in PWHIV. (Evidence level Ib, A). There is limited evidence to support the use of topical trifluorothymidine alone or in combination with interferon-alpha [78,79]. (Evidence level IIb, B). Systemic therapy with either

2006 British Association for Sexual Health and HIV

1624. The Anaesthesia Team 3

between the anaesthetist, surgeon and nurses. A high quality acute pain management service should include identifying the patient’s individual requirements on admission and then ‘tracking’ the patient from the surgical ward, through recovery, critical care if appropriate and back to the ward. The acute pain team Potential members of an acute pain team include: • A consultant anaesthetist(s) with sessional commitments to the team, • Trainee anaesthetists, as part of the on-call team and as part (...) . Introduction 4 3. Organisation and management 5 4. Pre-operative assessment 7 5. The operating department 8 6. Recovery post-anaesthetic care unit (PACU) 14 7. Postoperative pain management 16 References 18 To be reviewed by 2015. © Copyright of the Association of Great Britain & Ireland. No part of this book may be reproduced without the written permission of the AAGBI. 3 1. Recommendations Comprehensive peri-operative care can only be provided by an anaesthesia team led by consultant anaesthetists. All

2010 Association of Anaesthetists of GB and Ireland

1625. Workload for Consultant Anaesthetists in Ireland

published revised consultant qualifications with effect from 16 March 2009. These qualifications are given in Appendix 1 of this guideline. It should be noted that the only special interests that are specified are those in paediatric anaesthesia, intensive care medicine and pain medicine. Reporting relationship The contract states that the consultant’s “reporting relationship” and “accountability for the discharge of his/her contract” is to “the Chief Executive Officer/General Manager/Master (...) to bring practice back into line but if within a further period of 3 months the appropriate ratio is not established, he/she will be required to remit private practice fees in excess of this ratio to the research and study fund under the control of the clinical director. • The clinical director may exercise some discretion in dealing with the implementation of the ratio either for an individual or a group of 12 consultants once the overall ratio in relation to the particular clinical activity

2010 Association of Anaesthetists of GB and Ireland

1626. Eating disorders toolkit, a practice based guide to the inpatient management of adolescents with eating disorders, with special reference to regional and rural areas

to their needs or particular patient needs, rather than reading the document from front to back. For example, upon entering the service all Registrars may be familiarised with the specific sections relevant to key medical management. The dietitian should be familiar with sections on nutrition and refeeding. All key clinicians should be familiar with the assessment, treatment planning and discharge planning sections, and so forth. Sections that would be required more quickly, such as the “Emergency Department (...) Child and Family team (along with local GP and dietitian) may be an option. ? For patients with EDNOS and BN, request for consultation will depend on the severity of the illness, availability of specialist services and the experience, interest, skill and time of the clinicians involved. ? Local hospital admissions may be required via the emergency department if the young person is medically or psychologically unwell. Referral to a specialist unit or back to the community may occur following

2008 Clinical Practice Guidelines Portal

1627. Comorbidity of mental disorders and substance use

, buprenorphine, pethidine, dextropropoxyphene, methadone, tramadol* Opiates are analgesic drugs derived from the opium poppy. The term ‘opioids’ includes both opiates (based on naturally occurring compounds) and synthetic compounds that act on opiate receptors. Opioids are generally taken to produce a sense of wellbeing and to reduce the effects of stress and pain. Opioids are addictive and habit forming. Regular use quickly creates tolerance leading the user to seek increasingly larger doses of the drug (...) to achieve the same effect. Physical withdrawal effects, while very unpleasant, are rarely life-threatening. Opioids are frequently injected. Harmful chemical contaminants used as cutting agents may include talc, glucose, quinine and strychnine. Effects sought from the substance: Sense of wellbeing, reduction in stress and pain relief. Associated harms: Respiratory depression, clouded mental functioning, nausea, vomiting, sweating, itchy skin, constipation, and lung complications (due to aspiration

2008 Clinical Practice Guidelines Portal

1628. Pharmacological treatment of bipolar disorder in primary care Full Text available with Trip Pro

communicate with one another, the GP often serves as the focal point around which the other services are provided, including contact with family and carers ( ). With respect to pharmacological management, the main priorities for the GP are to assess efficacy, encourage adherence to treatment and monitor for potential side effects. Ideally, treatment plans are developed and initiated following consultation with a psychiatrist, particularly in complex cases, and with referral back to the psychiatrist during (...) Therapeutic levels: 350–700 mmol/L (guide only) ‡ Carbamazepine GIT: dry mouth, vomiting, diarrhoea, anorexia, constipation, abdominal pain CNS: dizziness, headache, ataxia, drowsiness, blurred vision, diplopia Skin: rash Agranulocytosis, aplastic anaemia, severe skin reactions (including Stevens–Johnson syndrome), SIADH, arrhythmias, orofacial dyskinesias, hepatitis Acute mania: 400–1200 mg/day, titrated gradually Maintenance: 200–400 mg/day Therapeutic levels: 20–50 mmol/L (guide only) Carbamazepine

2010 Clinical Practice Guidelines Portal

1629. Flowchart: Assessment and management of preterm labour and birth

Flowchart: Assessment and management of preterm labour and birth Queensland Health State of Queensland (Queensland Health) 2016 http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en Queensland Clinical Guidelines, Guidelines@health.qld.gov.au Queensland Clinical Guidelines www.health.qld.gov.au/qcg Assessment and management of preterm labour Review History • Medical, surgical, obstetric, social Assess for signs and symptoms • Pelvic pressure • Lower abdominal cramping • Lower back pain (...) IV bolus over 20 minutes o Maintenance dose: 1 g/hour for 24 hours or until birth – whichever occurs first Prepare for birth • Recommend vaginal birth unless there are specific contraindications to vaginal birth or maternal conditions necessitating caesarean section Antenatal corticosteroids ( 50 ng/mL or • Cervical dilation or • Cervical change over 2–4 hours or • ROM or • Contractions regular & painful or • Further observation or investigation indicated or • Other maternal or fetal concerns

2016 Queensland Health

1630. Establishing breastfeeding

after use Page 3 of 28 Flow Chart: Management of the healthy term sleepy baby in the first 24–48 hours Waking strategies • Initiate skin to skin contact • Temporarily remove wraps • Change nappy • Gently massage arms, legs, back • Observe for feeding cues Implement waking strategies with mother Attempt breastfeed Baby has not fed • By 2 hours post birth or • For 8 hours since last feed in first 24 hours of life or • For 5 hours since last feed if more than 24 hours old Concerns identified (...) health record Queensland Clinical Guideline: Establishing breastfeeding Refer to online version, destroy printed copies after use Page 11 of 28 2.3 Skin to skin contact Table 6. Skin to skin contact Aspect Consideration Benefits for baby • Breast seeking behaviour 49 • Less crying 5 • Socially interactive behaviour with mother 49 • Physiological stability (temperature, blood glucose level and heart rate) 5 • Increased pain threshold and decreased cortisol levels 49 • Earlier initiation of first

2016 Clinical Practice Guidelines Portal

1632. Clinical practice guidelines for the psychosocial care of adults with cancer

interventions showed much lower rates of anxiety, depression, mood disorders, nausea, vomiting and pain, and significantly greater knowledge about disease and treatment, than the control group (Level I). 15 1.2 DEVELOPMENT OF THESE GUIDELINES Need for generic evidenced based psychosocial clinical practice guidelines The Psychosocial clinical practice guidelines: providing information support and counselling for women with breast cancer, published in 2000, is the only comprehensive psychosocial guidelines (...) with cancerSupport towards the end of life – Chapter 3.6 Level Evidence Pain can be significantly controlled by relaxation therapy, and educational I 15 programs, aimed at enhancing pain control, improve adherence to treatment II 578 The expression of feelings improves adjustment II 401 Psychological interventions can improve quality of life in areas such as I 15,17 mood, self-esteem, coping, sense of personal control, and physical and functional adjustment II 579,580 Exploring and responding to specific

2003 National Breast and Ovarian Cancer Centre

1633. Helicobacter pylori. The latest in diagnosis and treatment

Helicobacter pylori. The latest in diagnosis and treatment 608 Reprinted from AustRAliAn F Amily PhysiciAn Vol. 37, No. 8, August 2008 thEmE upper abdominal pain Helicobacter pylori is strongly linked to peptic ulcer disease and is classified as a group 1 carcinogen by the World h ealth Organization’s international Agency for Research on c ancer. s ocioeconomic level seems to be the major determinant of risk of infection. in Australia, 25–30% of the population is infected, with the prevalence (...) .tga.gov . au/docs/pdf/unapproved/sascata.pdf) • fax the completed form to the TGA for approval (it will be faxed back to you by the TGA after 1 week) • deliver the SAS form to the drug supplier to be filled Table 6. Common side effects PPIs Headache and diarrhoea Clarithromycin Gastrointestinal (GI) upset, diarrhoea, and altered taste Amoxicillin GI upset, diarrhoea, and headache Metronidazole Tends to be dose related, a metallic taste, dyspepsia, a disulfiram-like reaction with alcohol consumption

2008 The Royal Australian College of General Practitioners

1634. Vertigo part 1 - assessment in general practice

e d g a z e toward the affected side followed by a corrective saccadic eye movement back to the centre. facial nerve involvement or a cerebrovascular event. The vesicles of h e r p e s z o s t e r o n t h e e x t e r n a l e a r m i g h t a l s o b e v i s i b l e . O t o s c o p i c examination may reveal signs of inflammation associated with acute vestibulopathy, scarring of the eardrum from chronic suppurative otitis media, or an erosive cholesteatoma. The Hennebert sign is positive w h e n t (...) . 7. Labuguen R. Initial evaluation of vertigo. Am Fam Physician 2006;73:244–51. 8. Baloh RW . Superior semicircular canal dehiscence syndrome: Leaks and squeaks can make you dizzy. Neurology 2004;62:684–5. 9 . B a l o h R W . D i f f e re n t i a t i n g b e t w e e n p e r i p h e r a l a n d c e n t r a l c a u s e s o f v e r t i g o . Otolaryngol Head Neck Surg 1998;119:55–9. 10. Paine M. Dealing with dizziness. Australian Prescriber 2005;28:94–7. 11. Jorns-Häderli M, Straumann D, Palla

2008 The Royal Australian College of General Practitioners

1635. Best Practice in the Management of Epidural Analgesia in the Hospital Setting

(European Society of Regional Anaesthesia) Dr Felicity Plaat (Association of Anaesthetists of Great Britain and Ireland) Professor Ian Power (Faculty of Pain Medicine) Mrs Kate Rivett (Patient and Public Representative) Revision date: November 2015INSIDE BACK COVER – TO BE LEFT BLANKfaculty of pain M edicine Churchill House 35 Red Lion Square London W C1R 4S G 020 7 092 167 3/1729 fpm@rcoa.ac.uk www.rcoa.ac.uk/fpm © 2010 Design and layout by The Royal College of Anaesthetists Registered Charity (...) Best Practice in the Management of Epidural Analgesia in the Hospital Setting Best practice in the management of epidural analgesia in the hospital setting FACUL TY OF PAIN MEDICINE of The Royal College of Anaesthetists November 2 0 1 0 Royal College of Anaesthetists Royal College of Nursing Association of Anaesthetists of Great Britain and Ireland British Pain Society European Society of Regional Anaesthesia and Pain Therapy Association of Paediatric Anaesthetists of Great Britain and Ireland1

2011 Association of Anaesthetists of GB and Ireland

1636. Polio

in severity from a fever to aseptic meningitis or paralysis. Headache, gastrointestinal disturbance, malaise and stiffness of the neck and back, with or without paralysis, may occur. The ratio of inapparent to paralytic infections may be as high as 1000 to 1 in children and 75 to 1 in adults, depending on the polio virus type and the social conditions (Sutter et al., 2004). Transmission is through contact with the faeces or pharyngeal secretions of an infected person. The incubation period ranges from (...) as soon as the child is fit for immunisation. Adverse reactions Pain, swelling or redness at the injection site are common and may occur more frequently following subsequent doses. A small, painless nodule may form at the injection site; this usually disappears and is of no consequence. The incidence of local reactions is lower with tetanus vaccines combined with acellular pertussis vaccines than with whole-cell pertussis vaccines and is similar to that after DT vaccine (Miller, 1999; Tozzi and Olin

2009 The Green Book

1637. Guideline for the Screening and Treatment of Retinopathy of Prematurity

that are insufficient for the diagnosis of plus disease, but that cannot be considered normal.UK Retinopathy of Prematurity Guideline – May 2008 72 Screening for Retinopathy of Prematurity (ROP) For parents of all babies less than 32 weeks gestational age or birthweight under 1501 grams (3lb) Information Leaflet for Parents What is Retinopathy of Prematurity? The retina is the delicate tissue lining the back of the inside of the eye which detects light and allows us to see. Retinopathy of Prematurity (ROP (...) ) and an indentor (to rotate the eye) to enable a better view of the retina. Is the examination painful? Eye examinations can be uncomfortable even for adults and babies sometimes cry or show signs of distress when their eyes are examined. The ophthalmologist will make the examination as quick as possible although they do need enough time to see the retina properly. If a speculum, indentor or a camera are used then anaesthetic eye drops should be used to minimise the discomfort to your baby. Research has also

2008 British Association of Perinatal Medicine

1638. Intermediate care - Hospital at Home in COPD

before referral to HaH is not necessary. [Grade D] ECG The usefulness of an ECG has not been the specific subject of a study in exacerbations of COPD. In the absence of specific symptoms or signs such as chest pain or arrhythmia, it is unlikely that this test would alter management. [Level of evidence IV] Recommendation N (R11) An ECG need not be routinely performed when considering patients for home management of their exacerbation but is indicated if the resting heart rate is,60/min or.110/min (...) arose out-of-hours. 7 The authors did not report how this arrangement impacted on primary care services. All schemes have included assessment by a respiratory physician before recruitment to HaH. Patients are usually discharged from the service by the respiratory practitioner who has been supervising the home care. At that stage clinical responsibility is formally transferred back to primary care either by fax or email. [Level of evidence III] Recommendations N (R20) After recruitment to HaH

2007 British Thoracic Society

1639. Osteoporosis: Diagnosis, Treatment and Fracture Prevention

testing to further stratify risk and guide treatment; if high risk, consider treatment. BMD is NOT indicated for: Investigation of chronic back pain Investigation of exaggerated dorsal kyphosis (fractures are best excluded by radiography) Screening women aged < 65 years, unless significant clinical risk factors have been identified Part of a routine evaluation around the time of menopause Confirmation of OP when a fragility fracture occurs T-score classification (number of standard deviations above (...) Consider as an alternative when other more effective drugs cannot be used Effective in decreasing acute pain associated with vertebral osteoporotic fractures Calcitonin injection is currently not approved for the treatment of OP; it is sometimes prescribed for patients who have pain due to acute vertebral fractures (See ) The intranasal spray formulation is used for OP. However, Health Canada is currently assessing the possibility of an increased risk of cancer with long-term use of calcitonin 4.2.6

2013 Clinical Practice Guidelines and Protocols in British Columbia

1640. Management of Proximal Femoral Fractures

intracapsular fracture to be treated by internal ?xation with multiple screws or a sliding hip screw. Untreated, disruption to the capsular blood supply of the head of the femur by a displaced intracapsular fracture can lead to avascular necrosis of the bone, resulting in a painful hip of limited function. Therefore, surgical treatment involves hemiarthroplasty; even then, intracapsular fracture is associated with longer-term arthritis, and increasingly, total hip arthroplasty is preferred for younger (...) patients. Compared to uncemented arthroplasty, cemented arthroplasty improves hip function and is associated with lower residual pain postoperatively. Figure 2 Common sites of proximal femoral fractures. Arrows show the insertion of the joint capsule. Grif?ths et al. | Guidelines: proximal hip fractures Anaesthesia 2011 Anaesthesia ª 2011 The Association of Anaesthetists of Great Britain and Ireland 15Extracapsular fractures These include inter- and subtrochanteric fractures, and can be further divided

2011 Association of Anaesthetists of GB and Ireland

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