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181. BTS Clinical Statement on Pulmonary Arteriovenous Malformations

disease or symptoms, there is no evidence that patients with PAVMs require supplemental oxygen during air travel. 82 Supplementary oxygen may be helpful for rare patients describing cardiorespiratory symptoms (usually in the setting of concurrent cardiac, respiratory or bone marrow disease) or neurological symptoms such as ‘dizzy spells,’ impaired cognition or other indicators of reduced cerebral oxygen delivery. 80 iii) There is no indication for ‘prophylactic’ venesection for the asymptomatic PAVM (...) at median age of 41 years. 88 Symptoms suggesting an individual with PAVMs may be at higher risk of ischaemic stroke include previous typical symptoms of transient ischaemic attacks and frequent migraines. 26 Both low serum iron and high fibrinogen are associated with ischaemic stroke and myocardial infarction, with risks potentially mediated by enhanced platelet aggrega- tion. 18 90 As in the general population, 91 the majority of isch- aemic strokes in patients with PAVM are treated with antiplatelet

2017 British Thoracic Society

182. BHIVA guidelines for the management of tuberculosis in adults living with HIV

be prescribed with caution due to potential DDIs. When considering treatment for LTBI, the potential benefit needs to be carefully balanced against the risk of drug-related adverse events. Individuals treated for LTBI should be informed of symptoms of hepatotoxicity, such as anorexia, nausea, vomiting, abdominal discomfort, persistent fatigue or weakness, dark-coloured urine, pale stools or jaundice. Patients experiencing these symptoms, particularly those aged >65 years, should be advised to contact (...) transaminase elevations and other hepatic abnormalities in patients receiving isoniazid. Ann Intern Med 1969; 71: 1113–1120. 25. Grant AD, Mngadi KT, van Halsema CL et al. Adverse events with isoniazid preventive therapy: experience from a large trial. AIDS 2010; 24 Suppl 5: S29–36. 26. Gray EL, Goldberg HF. Baseline abnormal liver function tests are more important than age in the development of isoniazid-induced hepatoxicity for patients receiving preventive therapy for latent tuberculosis infection

2018 British HIV Association

183. HIVA/BASHH guidelines on the use of HIV pre-exposure prophylaxis (PrEP)

(PEPSE) 65 6.4.2 HIV testing 65 6.4.3 Acute HIV infection 65 6.4.4 Assessment of renal function 65 6.4.5 STI screen 66 6.4.6. Assessment of viral hepatitis status 66 6.4.7 References 68 6.5 Other considerations 70 6.5.1 Women who are pregnant or trying to conceive 70 6.5.2 Bone health 70 6.5.3 References 70 6.6 Prescribing PrEP 71 6.6.1 What to use 71 6.6.2 Lead-in period 71 6.6.3 Frequency of dosing to attain benefit 71 6.6.4 On-demand dosing 71 6.6.5 Indications for post-exposure prophylaxis (...) following suboptimal adherence to PrEP 72 6.6.5 References 73 BHIVA/BASHH guidelines on the use of PrEP 4 7 Clinical follow-up and monitoring on treatment 75 7.1 Overview 75 7.2 Continued prescribing 75 7.3 Assessing adherence and adverse events 75 7.4 Management of short-term side effects 75 7.5 Monitoring on PrEP 77 7.5.1 HIV testing 77 7.5.2 Management of HIV seroconversion 77 7.5.3 STI screening 78 7.5.4 Viral hepatitis 78 7.5.5 Renal monitoring 78 7.5.6 Pregnancy testing 79 7.5.7 Bone monitoring 79

2018 British HIV Association

184. Interventions Targeting Sensory Challenges in Children with Autism Spectrum Disorder - An Update

the effectiveness and safety of interventions targeting sensory challenges in children with autism spectrum disorder (ASD). Data sources. We searched MEDLINE ® , Embase ® , the Cumulative Index of Nursing and Allied Health Literature ® , and PsycINFO ® from January 2010 to September 2016. Review methods. We included studies comparing interventions incorporating sensory-focused modalities with alternative treatments or no treatment. Studies had to include at least 10 children with ASD ages 2–12 years. Two (...) disorder: case reports of a family with review of the literature. Autism Res Treat. 2011;2011:129795. doi: 10.1155/2011/129795. PMID: 22937241.X- 1, X-3, X-4 728. Lopez Moratalla N, Palacios Ortega S. [Delay the age of procreation, decline in fertility and increased use of assisted reproduction: risk of birth defects]. Cuad Bioet. 2011 May-Aug;22(75):259-72. PMID: 22040138.X-1 729. Macdonald M, Esposito P, Ulrich D. The physical activity patterns of children with autism. BMC Res Notes. 2011;4:422. doi

2017 Effective Health Care Program (AHRQ)

185. BSR guideline Management of Adults with Primary Sjögren's Syndrome Full Text available with Trip Pro

2Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham3Birmingham and Midland Eye Centre, City Hospital NHS Trust, Birmingham Search for other works by this author on: Anwar R. Tappuni 4Institute of Dentistry, Queen Mary University of London Search for other works by this author on: Nurhan Sutcliffe 5Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Barts Health NHS Trust, London Search for other works by this author (...) on: Katie L. Hackett 6Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University & Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne7Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne Search for other works by this author on: Francesca Barone 8Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham9Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK Search for other

2017 British Society for Rheumatology

186. CRACKCast E123 – Selected Oncologic Emergencies

CRACKCast E123 – Selected Oncologic Emergencies CRACKCast E123 - Selected Oncologic Emergencies - CanadiEM CRACKCast E123 – Selected Oncologic Emergencies In , , by Adam Thomas November 2, 2017 This 123rd episode of CRACKCast covers Rosen’s 9th edition, Chapter 115, Selected Oncologic Emergencies. With an ever aging population, cancer incidence continues to rise. Therapies continue to prolong life often with high risks of side effects, and emergency physicians need to be equipped to treat (...) when evaluating spinal cord compression. CT of the spine with myelography may be performed if MRI is contraindicated or unavailable. Plain films are not sufficiently sensitive to rule out spinal cord compression. Intravenous corticosteroids (dexamethasone 10 mg bolus) should be given to any patient with neurological deficits from known or suspected metastatic spinal cord compression. Consideration should be given to emergent surgical and radiation treatment if compatible with goals of care. Cardiac

2017 CandiEM

187. Ankle and Foot Surgical Guideline

or Ankle Fusion Arthrosis due to post-traumatic arthritis from a previous work- related injury A discrete documented work-related ankle injury AND Pain Visual or radiographic deformity AND/OR Decreased range of motion (ROM) Note: The nature/form of the deformity should be documented Weight bearing plain films of the ankle reveal bone-on-bone arthrosis (e.g. severe loss of joint space) on at least one view At least 6 weeks of any of the following: Activity modification, Non- opioid analgesics, Bracing 4 (...) A discrete documented work-related ankle injury AND Pain Diagnostic lidocaine injection* demonstrates > 50 % pain relief and at least 3 point improvement on visual analog scale *Use contrast and fluoroscopy to confirm placement in the joint Positive results indicate pain originates within the joint Negative result is an indicator NOT to perform surgery MRI demonstrates bone marrow edema associated with a focal lesion OR CT scan demonstrates an osteochondral defect At least 6 weeks of any of the following

2017 Washington State Department of Labor and Industries

188. Management of Opioid Therapy (OT) for Chronic Pain

Reviewed, New- added V A / D o D Cli ni cal P r a cti ce G ui d el i n e f o r O p ioid T h e r a p y for Ch r on ic Pa in February 2017 Page 8 of 198 # Recommendation Strength* Category† 6. a) We recommend against long-term opioid therapy for patients less than 30 years of age secondary to higher risk of opioid use disorder and overdose. b) For patients less than 30 years of age currently on long-term opioid therapy, we recommend close monitoring and consideration for tapering when risks exceed (...) days, approximately 65% remained on opioids through the 4.8 year follow-up period.[56,57] Rates of continuation in Veterans, based on this study, appeared to be related to age, marital status, race, geography, mental health comorbidity, and dosage. Compared to others, those who were age 50-65 years, were married, were a race other than African American, and who lived in a rural setting were more likely to continue using opioids. Veterans on higher doses of opioids were more likely to continue

2017 VA/DoD Clinical Practice Guidelines

189. Diagnosis and Treatment of Low Back Pain

or physical examination Cancer ? History of cancer with new onset of LBP ? Unexplained weight loss ? Failure of LBP to improve after one month ? Age greater than 50 years Infection ? Fever ? Intravenous drug use ? Recent infection ? Immunosuppression Fracture ? History of osteoporosis ? Chronic use of corticosteroids ? Older age (75 years or older) ? Recent trauma ? Younger patients with overuse at risk for stress fracture Ankylosing spondylitis ? Morning stiffness ? Improvement with exercise (...) ? Alternating buttock pain ? Awakening due to low back pain during the second part of the night (early morning awakening) ? Younger age Herniated disc ? Radicular back pain (e.g., sciatica) ? Lower extremity dysesthesia and/or paraesthesia ? Positive straight-leg-raise test or crossed straight-leg-raise test ? Severe/progressive lower extremity neurologic deficits ? Symptoms present for more than one month Spinal stenosis ? Radicular back pain (e.g., sciatica) ? Lower extremity dysesthesia

2017 VA/DoD Clinical Practice Guidelines

190. Urotrauma

and/or percutaneous nephrostomy tube, when possible. (Recommendation; Evidence Strength: Grade C) 13b. Surgeons may manage endoscopic ureteral injuries with open repair when endoscopic or percutaneous procedures are not possible or fail to adequately divert the urine. (Expert Opinion) Bladder Trauma 14a. Clinicians must perform retrograde cystography (plain film or CT) in stable patients with gross hematuria and pelvic fracture. (Standard; Evidence Strength: Grade B) 14b. Clinicians should perform retrograde (...) or violent conflict. Traumatic injuries are the leading cause of death in the United States for people ages 1-44 years, and a significant cause of morbidity and loss of productive life across all ages. 6 Worldwide, traumatic injuries are the sixth leading cause of death and the fifth leading cause of moderate and severe disability. 7 Young males ages 15-24 have the greatest burden of injury. 8 Isolated urologic injuries are uncommon in major trauma as the kidneys, ureters, and bladder are well protected

2017 American Urological Association

192. Sinonasal Disease

episodes of acute bacterial rhinosinusitis (ABRS) occur annually, the term recurrent acute rhinosinusitis (RARS) is used. The most common imaging finding is mucosal thickening. Involvement is usually bilateral. Acutely infected sinuses may demonstrate air-fluid levels, as well as associated bone rarefaction. In chronic phases, there may be a reactive sclerosis indicating osteitis, which may require antibiotics. In other cases, reactive osteosclerotic changes may have sinus margin contraction that does (...) not reverse over time [9]. The absence of bone erosion or destruction favors an inflammatory process rather than neoplasm. Because rhinosinusitis is a clinical diagnosis, imaging should be interpreted in conjunction with the clinical and endoscopic findings [10-17]. Up to 3% to 40% of asymptomatic adults may have abnormalities on sinus computed tomography (CT) scans, as do more than 80% with minor upper respiratory tract infections [18-20]. Special Imaging Considerations Sinus CT imaging may be performed

2017 American College of Radiology

193. Chronic Ankle Pain

Chronic Ankle Pain Revised 2017 ACR Appropriateness Criteria ® 1 Chronic AnklePain American College of Radiology ACR Appropriateness Criteria ® Chronic Ankle Pain Variant 1: Chronic ankle pain. Initial imaging. Procedure Appropriateness Category Relative Radiation Level X-ray ankle Usually Appropriate ? Tc-99m bone scan ankle Usually Not Appropriate ??? US ankle Usually Not Appropriate O CT ankle without IV contrast Usually Not Appropriate ? CT ankle with IV contrast Usually Not Appropriate (...) May Be Appropriate O CT ankle and hindfoot without IV contrast May Be Appropriate ? CT ankle and hindfoot with IV contrast Usually Not Appropriate ? CT ankle and hindfoot without and with IV contrast Usually Not Appropriate ? MRI ankle and hindfoot without and with IV contrast Usually Not Appropriate O Tc-99m bone scan ankle and hindfoot Usually Not Appropriate ??? US ankle and hindfoote Usually Not Appropriate O CT arthrography ankle and hindfoot Usually Not Appropriate ? MR arthrography ankle

2017 American College of Radiology

194. Chronic Wrist Pain

Not Appropriate O US wrist Usually Not Appropriate O CT wrist without IV contrast Usually Not Appropriate ? CT wrist with IV contrast Usually Not Appropriate ? CT wrist without and with IV contrast Usually Not Appropriate ? CT arthrography wrist Usually Not Appropriate ? X-ray arthrography wrist Usually Not Appropriate ? Tc-99m bone scan wrist Usually Not Appropriate ??? Variant 2: Chronic wrist pain. Routine radiographs normal or nonspecific. Persistent symptoms. Next study. Procedure Appropriateness (...) bone scan wrist Usually Not Appropriate ??? ACR Appropriateness Criteria ® 2 Chronic Wrist Pain Variant 3: Chronic wrist pain. Routine radiographs normal or nonspecific. Suspect inflammatory arthritis. Next study. Procedure Appropriateness Category Relative Radiation Level MRI wrist without and with IV contrast Usually Appropriate O MRI wrist without IV contrast Usually Appropriate O US wrist May Be Appropriate O MR arthrography wrist Usually Not Appropriate O CT wrist without IV contrast Usually

2017 American College of Radiology

195. Imaging After Total Knee Arthroplasty

on the basis of radiographs [18]. Duff et al [15] found radiographs not to be of help because loosening, periostitis, focal osteolysis, and radiolucent lines were seen in both infected and uninfected knees. If standard radiographs are inconclusive, then oblique or fluoroscopically positioned films may be useful. Fluoroscopically positioned radiographs provide optimal visualization of the prosthesis-bone interface and are ACR Appropriateness Criteria ® 14 Imaging After Total Knee Arthroplasty especially (...) contrast 1 ? MRI knee without IV contrast 1 O MRI knee without and with IV contrast 1 O US knee 1 O Tc-99m 3-phase bone scan knee 1 ??? In-111 WBC and Tc-99m sulfur colloid scan knee 1 ???? FDG-PET/CT whole body 1 ???? Aspiration knee 1 Varies Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate *Relative Radiation Level ACR Appropriateness Criteria ® 2 Imaging After Total Knee Arthroplasty Variant 2: Status post total knee arthroplasty. Measuring component

2017 American College of Radiology

196. ASCIA Clinical Update - Primary Immunodeficiencies (PID)

work? The immune system is a collection of tissues (e.g. bone marrow, thymus, lymph nodes and spleen), cells (e.g. lymphocytes, neutrophils and macrophages) and molecules that can be broadly divided into two parts, the innate and adaptive immunity. There can be significant overlap between these 2 systems. Innate immune responses: • Are present before there is contact with pathogens • Are limited in specificity • Have no memory or long lived protection • Are mediated by cells (e.g. neutrophils (...) , natural killer [NK] cells) and circulating molecules (e.g. complement proteins) Adaptive immune responses: • Are slower to initiate • Respond specifically to antigens • Result in immunological memory • Are mediated by cells (T cells, B cells, dendritic cells) and circulating molecules (antibodies) ASCIA INFORMATION FOR HEALTH PROFESSIONALS 2 Effects of age on the immune system Whilst newborns have maternal antibodies that crossed the placenta during pregnancy, their adaptive immune systems are still

2017 Australasian Society of Clinical Immunology and Allergy

197. CRACKCast E058 – Ankle and Foot

is to approach ankle and foot as a single unit 1) Describe the bones of the foot and important joints/ligaments Ankle complex Ankle mortise formed by (1) medial tibia + talus; (2) tibial plafond (articular horizontal surface) + talus; (3) lateral malleolus (fibula) + talus Form a contiguous joint capsule lined with cartilage called “talocrural joints” Tibiofibular joint also articulates Ankle support held by 3 ligaments Syndesmotic, lateral collateral, medial collateral Four geographic tendon groups Flexor (...) the tibiofibular syndesmosis Externally rotate the foot (knee at 90, ankle neutral) +’ve with: Pain at the syndesmosis Sensation of lateral talar motion Syndesmosis stress tests: Cross-leg test Mid-calf squeeze test 3) Describe an approach to ankle x rays (including the Ottawa ankle rules) Radiology: 3 views is standard Plain radiographs miss: Subtle fractures, osteochondral lesions, stress fractures, ligament injuries Bone scan is useful for stress fractures, syndesmosis injury or osteochondral lesions CT

2017 CandiEM

198. Oral health: local authorities and partners

representative to lead on, and act as an advocate for, oral health representatives from relevant community groups. Recommendation 2 Carry out an oral health needs assessment The group responsible for the oral health needs assessment and strategy (see recommendation 1) should: Define the scope of an oral health needs assessment for the local population. This should include: What the assessment will and will not cover, for example, access to services for groups at high risk of poor oral health, certain age (...) disease and how fluoride can help prevent it promoting the use of fluoride toothpaste as soon as teeth come through (see Delivering better oral health for appropriate concentrations) encouraging people to regularly visit the dentist from when a child gets their first tooth giving a practical demonstration of how to achieve and maintain good oral hygiene and encouraging tooth brushing from an early age advising on alternatives to sugary foods, drinks and snacks as pacifiers and treats using sugar-free

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

199. Acute lymphoblastic leukemia

Princess Margaret Hospital Modified DFCI 91-01/AL.4 protocol for Philadelphia Chromosome/BCR- ABL1 positive adult patients aged 60 years old 67 CLINICAL PRACTICE GUIDELINE LYHE-005 Version 1 Page 5 of 70 SUMMARY OF RECOMMENDATIONS 1. Diagnosis and Work-up 1.1. All patients suspected of leukemia should undergo bone marrow studies incorporating morphological assessment, immunophenotyping, cytogenetic +/- FISH and molecular evaluation. 1.1.1. For B-cell ALL, results of BCR-ABL by PCR or t(9;22 (...) from the proliferation and expansion of lymphoid blasts in the blood, bone marrow and other organs (Bassan and Hoelzer 2011). ALL occurs with a bimodal distribution with an early peak in children 4 – 5 years old followed by a second peak at ~ 50 years of age (Fullmer, et al 2010) with the worldwide incidence being ~ 1 – 4.75/100,000 individuals with a male:female prevalence of roughly 1·3:1 (Bassan and Hoelzer 2011). It is the most common childhood acute leukemia accounting for ~ 80

2016 CPG Infobase

200. Prostate cancer: triptorelin (Decapeptyl SR)

of triptorelin as adjuvant treatment to radical prostatectomy. Safety Safety An initial increase in testosterone levels can cause transient worsening of signs and symptoms of prostate cancer in the first weeks. LHRH agonists may reduce bone mineral density, increase the risk of depression and cause metabolic changes (glucose intolerance and increased risk of cardiovascular disease). P Patient factors atient factors Intramuscular injection every 4 weeks, 3 months or 6 months. An almost complete suppression (...) therapy before radiotherapy. Population: 28 patients (average age 68 years) with localised histologically confirmed prostate adenocarcinoma referred for conformal 3-dimensional radical radiotherapy. Nineteen patients were at high risk, defined as having a T3 or Gleason score greater than 7 or a prostate-specific antigen (PSA) level greater than 20 ng/ml. Intervention: intramuscular triptorelin 11.25 mg every 3 months in combination with flutamide 250 mg 3 times a day as neoadjuvant treatment for 2

2014 National Institute for Health and Clinical Excellence - Advice

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