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Appearance, Behavior and Attitude Exam

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81. Breastfeeding Promotion in the Prenatal Setting

level when appropriate. Instructional photos and pictures can also be used where literacy is a concern. Understand the speci?c ?nancial, work, time, and sociocultural obstacles to breastfeeding and work with families to overcome them. Healthcare providers should be aware of their own personal cultural attitudes when interacting with patients. 2 (III) 3. Consider behavioral and psycho-educational approaches to breastfeeding support. Self-ef?cacy and breastfeeding con?dence play a large role (...) , exclusivity, and duration. 8–16 Yet, healthcare providers consistently overestimate the amount and adequacy of coun- seling and support that pregnant women receive. 17–24 Al- though the focus of this protocol is on the prenatal setting, programs or interventions that include preconception, prenatal, and postnatal components should be strongly considered as they appear to yield larger positive results on breastfeeding duration and exclusivity. 8,10,25–27 The quality of evidence (levels of evidence I, II-1

2015 Academy of Breastfeeding Medicine

82. Take that, antivaxers! This is nearly the end…of 2017, that is—with puppies!

appeared to suffer any long term emotional scars. Denice Walter My friend’s ( now ex) husband owned a series of large dogs ( Danes etc) but the one I knew best was an Akita. He liked to “dance with ladies”- which meant that this great big slobbering – but beautiful- mess would put his huge front paws on your shoulders and look soulfully into your face for as long as you could tolerate it, slow dancing. I’m 5’6″ so he would be at least my height when posed in this fashion. I believe that he weighed (...) laces and lick everyone they encounter to death. I hope Orac’s bunch find good homes- also, don’t worry Orac: puppies that get plenty of love and play and warmth do just fine. kfunk937 Some of them like to jump, too. You have not experienced the joys of mammals who think they’re parrots until the cat sequestered in your bathroom for anti-social attitudes toward your constant companion of 15 years goes from ounces to kilos, with claws, when you’re trying to exit the necessary room. From her POV, it’s

2017 Respectful Insolence

83. Substance Abuse in Canada: The Effects of Cannabis Use during Adolescence (Report)

the insights gained from personal knowledge can be compelling, all good scientists know that solid research evidence is not established with the casual study of a single person. Current debates about cannabis use are rife with mere opinion and misinformation. And, to complicate the matter further, the evidence related to the possible health risks of cannabis use appears to be contradictory. How do we weigh the evidence? Is it a drug with a variety of adverse or hazardous effects or does it pose low risk (...) to people’s health? What is one to believe? There are many websites and authorities that claim to offer accurate information about cannabis. Indeed, a simple Google search of the word cannabis yields over 60 million results. How can the average person make sense of this confusing picture? Several researchers have engaged young people to better understand their attitudes and beliefs about cannabis — why they use it or don’t use it and, more specifically, what they want to know about it (Bottorff, Johnson

2015 Canadian Centre on Substance Abuse

84. safeTALK for youth suicide prevention: new review finds no evidence of safety or efficacy

existing systematic reviews and meta-analyses, searched Google, the websites of various relevant governments and organisations, and also the ‘grey’ (unpublished) literature. The aim of the systematic review was to: investigate the quality of available evidence of the effectiveness of SafeTALK. Results Surprisingly, if also of concern, there appears to have been only one peer-reviewed study of SafeTALK conducted (Mellanby et al., 2010); the other five pieces of research yielded by the search were one (...) dissertation, and four evaluation reports. Of this sparse literature, the authors say “together, these [studies] constitute the available world literature on SafeTALK.” Only one of these studies (Eynan, 2011; the doctoral dissertation) performed any type of statistical analysis, finding that those who had received safeTALK training reported significantly higher knowledge and positive attitudes towards suicidal individuals. None of the studies assessed whether safeTALK training affected self-reported

2016 The Mental Elf

85. AUA White Paper on Implementation of Shared Decision Making into Urological Practice

Barriers to the Implementation of Shared Decision Aids Despite the benefits of SDM, its uptake and use in practice has been surprisingly limited. 71,72 Barriers to implementation of SDM are many and varied. 32 Such barriers are categorized below as stemming from the attitudes and behaviors of both providers and patients, as well as from system-level influences. Some barriers involve multiple categories. Provider Barriers Providers sometimes do not see the need for SDM or do not believe the evidence (...) Paratesticular Tumors Penis Retroperitoneum Cytology Online Learning For Medical Students Exams/LLL/Certifications Exam Prep Research Research Funding AUA Funding Research Education & Events Online Research Education Courses Research Resources Biorepositories and Other Resources Research Publications Research Career Opportunities Advocacy Scholar & Fellowship Programs Comment Letters & Resources International International Opportunities Annual Meeting Membership Collaborations Academic Exchanges Giving Back

2015 American Urological Association

86. Vasectomy

Vasectomy Vasectomy Guideline - American Urological Association advertisement Toggle navigation About Us About the AUA Membership AUA Governance Industry Relations Education AUAUniversity Education Products & Resources Normal Histology and Important Histo-anatomic Structures Urinary Bladder Prostate Kidney Renovascular Diseases Andrenal Gland Testis Paratesticular Tumors Penis Retroperitoneum Cytology Online Learning For Medical Students Exams/LLL/Certifications Exam Prep Research Research (...) and patient because the balance between benefits and risks/burdens appears relatively equal or appears unclear; Options may be supported by Grade A, B or C evidence. For some clinical issues, there was little or no evidence from which to construct evidence-based statements. Where gaps in the evidence existed, the Panel provides guidance in the form of Clinical Principles or Expert Opinion with consensus achieved using a modified Delphi technique if differences of opinion existed among Panel members. 3

2015 American Urological Association

87. Lateral Patellar Dislocations and Instability ? Post-Operative Management

concerns as appropriate. Evidence-Based Care Guideline for Post-Operative Management of Lateral Patellar Dislocations and Instability in children and adults aged 8-25 years Guideline 46 Copyright © 2015 Cincinnati Children's Hospital Medical Center; all rights reserved. Page 5 of 38 Table 1: Initial Exam Initial Exam Palpation/ Visual Inspection Palpate and visually inspect the following: ? Global lower extremity for areas of lost/abnormal sensation, signs of Deep Vein Thrombosis (DVT) ? Surgical (...) (LocalConcensus 2014 [5]). Range of Motion and Flexibility Evaluate lower extremity passive ROM (PROM), active ROM (AROM) and flexibility for all lower extremity joints (hip, knee, and ankle) using a fluid filled goniometer or linear goniometer as appropriate (Rao 2001 [4b], Watkins 1991 [4b]). ? Hip flexion, extension, abduction, adduction, internal rotation and external rotation ? Knee flexion and extension ? Ankle plantarflexion and dorsiflexion ? Any other motions that appear to be functionally limited

2015 Cincinnati Children's Hospital Medical Center

88. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer

). FTC ex- hibits other differences in sonographic features compared to PTC. These tumors are more likely to be iso- to hyperechoic, noncalci?ed, round (width greater than anterioposterior di- mension) nodules with regular smooth margins (82). Similarly, the follicular variant of papillary cancer (FVPTC) is also more likely than conventional PTC to have this same appearance as FTC (79). Distant metastases are rarely observed arising from follicular cancers 70–90 a Recommend FNA at ‡1cm Intermediate (...) active surveillance for an average of 60 months (95). Only 43 patients (3.5%) had clinical progression of disease by their stated criteria (tumor growing to >12 mm or appearance of new lymph node metastases). Interestingly, the younger pa- tients ( 60 years old had the lowest rate of clinical progression (1.6%). Despite the evidence that cautious observation is a safe and effective alternative to immediate surgical resection, very few PTMC patients outside of those two centers in Japan are given

2015 Pediatric Endocrine Society

89. Tinnitus

of recent onset from those with persistent symptoms (= 6 months) to prioritize intervention and facilitate discus- sions about natural history and follow-up care; (d) educate patients with persistent, bothersome tinnitus about manage- ment strategies; (e) recommend a hearing aid evaluation for patients who have persistent, bothersome tinnitus associated with documented hearing loss; and (f) recommend cognitive behavioral therapy to patients with persistent, bothersome tinnitus. The panel recommended (...) that include hearing aids and specific forms of sound therapy, cognitive behavioral 1 Otolaryngology–Head and Neck Surgery, Johns Hopkins Outpatient Center, Baltimore, Maryland, USA; 2 Division of Otolaryngology–Head and Neck Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA; 3 Partnership for Health Analytic Research, LLC, Los Angeles, California, USA; 4 Department of Otolaryngology, State University of New Y ork at Downstate Medical Center, Brooklyn, New Y ork, USA; 5

2014 American Academy of Otolaryngology - Head and Neck Surgery

90. Detection and Nonoperative Management of Pediatric Developmental Dysplasia of the Hip in Infants up to Six Months of Age

independent medical judgment, given the individual patient’s clinical circumstances. Disclosure Requirement In accordance with AAOS policy, all individuals whose names appear as authors or contributors to Clinical Practice Guideline filed a disclosure statement as part of the submission process. All panel members provided full disclosure of potential conflicts of interest prior to voting on the recommendations contained within this Clinical Practice Guidelines. Funding Source This Clinical Practice (...) studies show little clear advantage to one approach over another. SURVEILLANCE AFTER NORMAL INFANT HIP EXAM Limited evidence supports that a practitioner re-examine infants previously screened as having a normal hip examination on subsequent visits prior to 6 months of age. Strength of Recommendation: Limited Description: Evidence from one or more “Low” strength studies with consistent findings, or evidence from a single Moderate quality study recommending for or against the intervention or diagnostic

2014 American Academy of Orthopaedic Surgeons

91. Management of Hypertension (HTN) in Primary Care

, herbal remedies, and dietary supplements, some of which may raise blood pressure or interfere with the effectiveness of antihypertensive medications 10. History of alcohol and illicit drug use (especially cocaine and other stimulants) 11. Psychosocial and environmental factors (e.g., family situation, employment status and working conditions, level of comprehension) that may influence hypertension controlOctober 2014 Page 24 of 135 A physical exam should include an evaluation for signs of secondary (...) for Phase 1 and Phase 5 Korotkoff sounds. The first appearance of sound (Phase 1) is used to record the SBP. Phase 5, at the disappearance of sound, is the diastolic blood pressure (DBP). Listen for 10 to 20 mmHg below Phase 5 for any further sound then deflate the cuff completely. • The BP should be recorded in even numbers to the nearest 2 mmHg with the patient's position, arm used, and cuff size documented. • BP readings should be repeated in the same arm and averaged, if different. One-two minutes

2014 VA/DoD Clinical Practice Guidelines

92. Diagnosis and Treatment of Adult Isthmic Spondylolisthesis

? Spondylolisthesis occurs in 40% to 66% of patients with bilateral spondylolysis. Spondylolisthesis is unlikely to occur in patients with unilateral spondylolysis. Grade of Recommendation: B Diagnosis and Imaging What are the most appropriate physical examination findings consistent with the diagnosis of isthmic spondylolisthesis in adult patients? There is insufficient evidence to make a recommendation for or against the use of palpation in the physical exam diagnosis of adult patients with isthmic

2014 North American Spine Society

93. Screening Pelvic Examination in Adult Women

Talenti Unaffiliated July 1, 2014 Really? I'm not sure what the impetus for this study was, but it appears to follow from the societal conditioning that women's bodies are inherently more private than men's. We do back flips trying to find a female chaperone for pelvic exams, but don't seem to care who is in the room for male GU exams, rectal exams, or Foley insertions. Even for symptomatic patients, we treat women differently. For the woman with UTI symptoms, do you do a pelvic? Most do (...) longitudinal cohort study assessed women's attitudes about, and experiences with, pelvic examination (13 000 participants from 6 countries). Most studies included only women in their reproductive years. The overall quality of the studies was low. Women who reported pain or discomfort during the pelvic examination ranged from 11% to 60% (median, 35%; 8 studies including 4576 participants), and 10% to 80% reported fear, embarrassment, or anxiety (median, 34%; 7 studies including 10 702 participants). Women

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2014 American College of Physicians

94. Treatment and recommendations for homeless people with Opioid Use Disorders

? Judith Martin MD, Deputy Medical Director of Community Behavioral Health Services, Medical Director of Substance Use Services, Department of Public Health, City and County of San Francisco, San Francisco, California ? Sharon Stancliff MD, Medical Director, Harm Reduction Coalition, New York, New York ? Alexander Y Walley, MD, MSc, Assistant Professor of Medicine, Clinical Addiction Research and Education Unit, Boston Medical Center /Boston University School of Medicine, Boston, Massachusetts ? Ansell (...) for comorbidities that are strongly associated with opioid use disorders, including polysubstance use and sexually transmitted/ bloodborne infections. ? Evaluate findings from the clinical history, physical exam, and diagnostic testing to determine diagnosis and severity of opioid use disorder; identify any contraindications to medication-assisted treatment or acute conditions requiring a higher level of care. PLAN OF CARE ? Work collaboratively with patients to develop realistic, attainable, short-term goals

2014 National Health Care for the Homeless Council

95. General practice management of type 2 diabetes 2014-15

stringent Patient attitude and expected treatment efforts Highly motivated, adherent, excellent self-care capacities Less motivated, non-adherent, poor self-care capacities Risks potentially associated with hypoglycaemia, other adverse events Low High Disease duration Newly diagnosed Longstanding Life expectancy Long Short Important comorbidities Absent Few/mild Severe Established vascular complications Absent Few/mild Severe Resources, support system Readily available Limited Figure 3. A guide

2014 Clinical Practice Guidelines Portal

96. Effectiveness of Family and Caregiver Interventions on Patient Outcomes among Adults with Cancer or Memory-Related Disorders

Adaptations of Couples Cognitive Behavioral Therapy to Usual Care 48 Table 7. KQ1 – Cancer: Outcomes at Post-Treatment – Trials Comparing Family Assisted Approaches to Patient Care to Usual Care or Wait List Control 50 Table 8. KQ1 – Cancer: Outcomes at Post-Treatment – Trials Comparing Family Focused CBT Interventions that Include Family Coping and Problem Solving to Usual Care 52 Table 9. KQ1 – Cancer: Outcomes at Post-Treatment – Trials Comparing Unique Interventions to Usual Care 54 Table 10. KQ2 (...) symptoms associated with treatment or disease progression (e.g., for cancer: pain, sexual functioning; for memory-related disorders: agitation, wandering or other problem behaviors). Utilization included all types of health care utilization, including hospitalization, institutionalization, or emergency room visits, and relationship adjustment including family functioning and relationship quality. 3 Effectiveness of Family and Caregiver Interventions on Patient Outcomes among Adults with Cancer

2013 Veterans Affairs Evidence-based Synthesis Program Reports

97. Migrant Farm Workers and Sexual Health

risk among Hispanic farm workers in South Florida: Women are at higher risk than men. AIDS and Behavior 2004;8(2):165-74. 3. Magis-Rodriguez C, Lemp G, Her- nandez MT, Sanchez MA, Estrada F, Bravo-Garcia E. Going North: Mexican migrants and their vulner- ability to HIV. Journal of Acquired Immune Deficiency Syndromes 2009;51 Suppl 1:S21-S25. 4. Augustave, W., Devore, R., Morel, W., and Troia, T. Migrant and sea- sonal farmworkers: Health care access and HIV/AIDS in this popu- lation. New York State (...) behaviors among California farmworkers: Results from a popu- lation-based survey. The Journal of Rural Health 2008;24(3):279-84. 17. Apostolopoulos Y, Sonmez S, Kronenfeld J, Castillo E, McLendon L, Smith D. STI/HIV risks for Mexi- can migrant laborers: Exploratory ethnographies. Journal of Immi- grant & Minority Health 2006;8 (3):291-302. 18. Persichino J, Ibarra L. HIV and Latino migrant workers in the USA. Ethnic and Racial Studies 2012;35 (1):120-34. 19. Varela-Ramirez A, Mejia A, Garcia D, Bader J

2013 Ontario HIV Treatment Network

98. HIV, viral hepatitis and STIs - a guide for primary care

genital secretions and discharges readily seed uninfected mucous membrane and cause infection in columnar cells. During birth, transmission occurs from a mother with cervical chlamydial infection to the child very efficiently (overall risk is 50–75%).HIV, VIRAL HEPATITIS AND STIs – A GUIDE FOR PRIMARY HEALTH CARE 15 Indirect transmission of chlamydial infection by fomites appears to be extremely uncommon. Lymphogranuloma venereum (LGV) serovars are transmitted similarly by direct surface-to-surface (...) contact or contamination of susceptible genital surfaces by contaminated secretions. An LGV outbreak in 2010 in men who have sex with men (MSM) appeared to occur predominantly via anal intercourse with multiple partners, fisting and use of contaminated sex toys. For all practical purposes, transmission of the genital serovars of C. trachomatis is sexual and vertical only, and conjunctival infection in the adult results from auto-inoculation with infected secretions from genitals to eye

2014 Clinical Practice Guidelines Portal

99. Safety and quality issues associated with the care of patients with cognitive impairment in acute care settings

to provide education and support for other staff, volunteers to assist patients with CI with everyday activities and to reduce the incidence of delirium, patient identifiers to alert staff that the patient has CI, and re-designing the hospital environments to better suit patients with CI. Most projects reported some favourable outcomes. In summary, the following interventions appear to represent good practice and are effective in improving at least some outcomes for patients with CI or improving the care (...) to a dedicated geriatric ward and care from a specialist multidisciplinary team appears to improve patient outcomes. • The use of volunteers to assist patients with CI appears to be very useful and is well accepted by patients and staff. • The use of specialist dementia nurses to provide education and support to other hospital staff has been well received and appears to promote good dementia care. • Staff dementia education and training can improve knowledge and confidence in interacting with patients

2013 Sax Institute Evidence Check

100. Patient Modesty: Volume 85

appears on the CBC News website, under Health (http://www.cbc.ca/news/health/prostate-digital-rectal-exam-1.4570631) but he also published his findings in the Annals of Family Medicine (our version of JAMA, I suppose). We'll see if this sticks or not (some doctors aren't exactly pleases with Dr. Profetto's findings) but I'm definitely keeping this handy for my next doctor appointment. Dany At , JF said... I think a video camera that staff is unable to access would be the way to go. That would make (...) Patient Modesty: Volume 85 Bioethics Discussion Blog: Patient Modesty: Volume 85 What have you been reading, hearing or TV viewing that has provoked some feelings of comfort or concern about what is happening in the world of medicine, medical care, treatment or science? Ethics is all about doing the right thing. Are you aware of any issues in medicine or biologic science which are being done right, could be improved or in fact represent totally unethical behavior? Write about them here.. and I

2018 Bioethics Discussion Blog

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