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Contraction Stress Test

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161. The management of urinary incontinence in women

or OAB. Weight 1.2.3 Advise women with UI or OAB who have a BMI greater than 30 to lose weight. 1.3 Physical therapies Pelvic floor muscle training 1.3.1 Offer a trial of supervised pelvic floor muscle training of at least 3 months’ duration as first-line treatment to women with stress or mixed UI. 1.3.2 Pelvic floor muscle training programmes should comprise at least 8 contractions performed 3 times per day. 1.3.3 Do not use perineometry or pelvic floor electromyography as biofeedback as a routine (...) Assessment of pelvic floor muscles 6 Bladder diaries 6 Absorbent products, urinals and toileting aids 6 Indwelling urethral catheters 6 General principles when using overactive bladder (OAB) medicines 7 Choosing OAB medicines 7 Surgical approaches for stress urinary incontinence (SUI) 7 The multidisciplinary team (MDT) 7 Maintaining and measuring surgical expertise and standards for practice 7 1. Recommendations 8 1.1 Assessment and investigation 8 1.2 Lifestyle interventions 11 1.3 Physical therapies 11

2019 Best Practice Advocacy Centre New Zealand

162. Re-imagining Community Healthcare Services

to be involved meaningfully and consistently. ? Putting in place financial models to facilitate change. ? Commissioning and contracting differently. ? Exploiting innovations in technology. ? Developing quality and improvement skills – Improving performance in healthcare services and transforming care on a sustainable basis depends in part on building capabilities for quality improvement among the staff delivering care. ? Getting the basics right – capacity to engage with stakeholders and measure and monitor (...) for the first time, the provider already knows their details. Their journey and scheduling are integrated. ? People at risk of particular conditions have easier access to follow-up tests and services and benefit from more individually tailored treatment and management plans. ? The quality of healthcare is high as health workers spend quality time with people, make fewer errors and make better decisions. Potential benefits to the hospital setting when re-imagining community healthcare services Emerging

2019 Monash Health Evidence Reviews

163. Guidelines on Supraventricular Tachycardia (for the management of patients with) Full Text available with Trip Pro

literature review, weigh the strength of evidence for or against a particular treatment or procedure, and include estimates of expected health outcomes where data exist. Patient-specific modifiers, comorbidities, and issues of patient preference that might influence the choice of particular tests or therapies were considered, as were frequency of follow-up and cost-effectiveness. In controversial areas, or with regard to issues without evidence other than usual clinical practice, consensus was achieved (...) or AVRT, although an AT may also present in this way. Characteristics in terms of the regularity or irregularity are helpful. The duration of individual episodes may help in terms of differentiation. Re-entrant tachycardias tend to last longer than AT episodes, which may occur in a series of repetitive runs. Clear descriptions of pounding in the neck (the so-called ‘frog sign’) or ‘shirt flapping ’ would point to the possible competing influences of atrial and ventricular contraction on the tricuspid

2019 European Society of Cardiology

164. Diagnosis and Management of Acute Pulmonary Embolism Full Text available with Trip Pro

of clinical (pre-test) probability 12 4.3 Avoiding overuse of diagnostic tests for pulmonary embolism 13 4.4 D-dimer testing 13 4.4.1 Age-adjusted D-dimer cut-offs 13 4.4.2 D-dimer cut-offs adapted to clinical probability 13 4.4.3 Point-of-care D-dimer assays 13 4.5 Computed tomographic pulmonary angiography 13 4.6 Lung scintigraphy 14 4.7 Pulmonary angiography 15 4.8 Magnetic resonance angiography 15 4.9 Echocardiography 15 4.10 Compression ultrasonography 16 4.12 Computed tomography venography 18 5 (...) 8.2 Anticoagulant-related bleeding risk 34 8.3 Regimens and treatment durations with non-vitamin K antagonist oral anticoagulants, and with other non-vitamin K antagonist antithrombotic drugs 34 8.5 Management of pulmonary embolism in patients with cancer 36 9 Pulmonary embolism and pregnancy 37 9.1 Epidemiology and risk factors for pulmonary embolism in pregnancy 37 9.2 Diagnosis of pulmonary embolism in pregnancy 37 9.2.1 Clinical prediction rules and D-dimers 37 9.2.2 Imaging tests 37 9.3

2019 European Society of Cardiology

165. Evidence Brief - Barriers and Facilitators to Use of Medications for Opioid Use Disorder

by the Substance Abuse and Mental Health Services Administration (SAMHSA). 9 OTPs can exist in multiple settings including intensive outpatient programs, residential programs, and hospital settings. OTPs are highly regulated, with requirements that patients receive psychosocial supports, complete frequent urine drug tests, and receive a limited number of take-home medications (thereby requiring frequent visits). 4 As of 2018, VHA operated 32 OTPs nationwide, but also contracts with an unknown number of OTPs

2019 Veterans Affairs Evidence-based Synthesis Program Reports

166. Evidence for smoking quitlines

37 NHMRC level IV: Case series with post-test or pre-test/post-test outcomes 41 6 Quality assessment of evidence 48 Review Question 1 – key components 48 Evidence Base [A rating] 48 Consistency [B rating] 48 Clinical impact [C rating] 48 Generalisability [B rating] 49 Applicability [B rating] 49 Review question 2 – barriers and facilitators 50 Evidence Base [B rating] 50 Consistency [C rating] 50 Clinical impact [C rating] 50 Generalisability [B rating] 50 Applicability [B rating] 50 7 Analysis (...) be classified according to the NHMRC level of evidence, including: systematic reviews of randomised controlled trials, randomised controlled trials, pseudo-randomised controlled trials, comparative studies with concurrent controls, comparative studies without concurrent controls, case series with either post-test or pre-test/post-test outcomes. Participants and interventions: Studies were included if they were conducted with any participants recruited from within a quitline service, used data from quitline

2019 Sax Institute Evidence Check

167. Learning from the Experience of Accountable Care Organizations in the U.S.

public ACOs have been largely stewarded by the Centre for Medicare and Medicaid. Beneficiaries are attributed to public ACOs based on being a Medicare beneficiary that also meets an agreed-upon definition, typically reliant on seeking a certain amount of care from providers included in the ACO.(3) However, providers attached to the ACO may also be delivering care to non-ACO beneficiaries. ACOs are reimbursed using shared-savings arrangements which are outlined in a shared-savings contract between (...) the payer (in the public system this is Medicare or Medicaid, and in the commercial, a private insurer) and the ACO. The shared savings contract defines the terms of the arrangement including a common understanding of the baseline cost of care from which improvements are benchmarked, as well as the extent of risk taken on by the ACO.(3) Providers attached to the ACO have been traditionally reimbursed for their services using traditional fee-for-service payments, although this is increasingly shifting

2019 McMaster Health Forum

168. Management of Poisoning

of an anaphylactoid reaction does not preclude the use of N-acetylcysteine on another occasion, if indicated (pg 112). Grade D, Level 316 B Methionine can be considered as an alternative antidote for paracetamol poisoning, especially in the setting of known allergy to N-acetylcysteine (pg 112). Grade B, Level 1+ Management of non-accidental toxic ingestions D Admission is recommended, irrespective of levels for non-accidental ingestion. Serum levels must be tested. Multi-drug poisoning should be considered (pg (...) and radiological investigations (pg 124). Grade D, Level 2+ Psychotropics Benzodiazepines D Qualitative screening of urine or blood is not recommended. Screening rarely in? uences treatment decisions because of long turnaround time, lack of available or reliable tests, poor correlation clinically and may not alter emergency treatment options. However urine and blood screening may support evidence of exposure (pg 129). Grade D, Level 3 GPP Monitor arterial blood gas if there is respiratory depression. Obtain

2020 Ministry of Health, Singapore

169. A palliative approach to care in the last 12 months of life

persons and their families prepare for death, ensuring their comfort and supporting decision making that is consistent with the person’s prognosis and goals of care G (3). Family: “Those closest to the [person] in knowledge, care and affection. The person defines his or her ‘family’ and who will be involved in his/her care and/or present at the bedside. May include: ? the biological family; ? the family of acquisition (related by marriage/contract); and ? the family of choice and friends (including (...) in the last 12 months of life and their families? Outcomes: Compassion fatigue G ; stress/distress; resilience G Note: These priority recommendation questions are condensed versions of the more comprehensive PICO research questions G (population, intervention, comparison, outcomes) developed by the RNAO expert panel to guide the systematic reviews G and development of this BPG. For the PICO research questions and the detailed process of how the expert panel determined these priority recommendation

2020 Registered Nurses' Association of Ontario

170. Management of glucocorticoids during the peri-operative period for patients with adrenal insufficiency

might be misattributed to the pregnancy itself. Serum total and free cortisol is normally increased 20–40% in pregnancy, so it may be advisable to prescribe a higher maintenance dose for women with adrenal insuf?ciency in the latter stages of pregnancy [4, 33– 37]. The recommendations for peri- and postoperative surgical stress doses are the same in pregnancy as for other adults. During delivery, 100 mg hydrocortisone should be injected at the onset of active labour (contractions every 5 min (...) –adrenalaxissuppressionifadministered for 1 month or moreby oral,inhaled, intranasal, intra-articular or topicalroutes; this chronicadministration of glucocorticoidsisthemostcommoncauseofsecondaryadrenalsuppression,sometimesreferredtoastertiary adrenal insuf?ciency. A pragmatic approach to adrenal replacement during major stress is required; consideringtheevidenceavailable,blanketrecommendationswouldnotbeappropriate,anditisessentialfor the clinician torememberthat adrenal replacementdosing following surgical stressor illness isin

2020 Association of Anaesthetists of GB and Ireland

171. The promotion of well?being among children exposed to intimate partner violence: A systematic review of interventions Full Text available with Trip Pro

been associated with reduced cognitive ability and educational achievement (Kitzmann, Gaylord, Holt, & Kenny, ), under‐immunization (Bair‐Merritt, Blackstone, & Feudtner, ), and both psychological (e.g., posttraumatic stress, depression, aggression; Evans, Davies, & DiLillo, ) and physical health problems (e.g., ischemic heart disease, obesity; Felitti et al., ). These negative developmental sequalae appear to be evident across nations and cultures; for example, the link between IPV exposure (...) , and specifically, by telling their stories and histories of IPV victimization, connecting events to emotional reactions, and enhancing self‐esteem, it is theorized that levels of traumatic stress will decrease, with subsequent improvements in parenting and child well‐being (Graham‐Bermann et al., ). Interventions taking a cognitive‐behavioral orientation share the basic premise that psychological distress is maintained by maladaptive cognitions, or general beliefs about oneself and the world, contributing

2019 Campbell Collaboration

172. Citizen engagement in public services in low? and middle?income countries: A mixed?methods systematic review of participation, inclusion, transparency and accountability (PITA) initiatives Full Text available with Trip Pro

the political system; within the management and administration of public sector offices and institutions; and in the ways in which public officials and service providers engage with service users (external engagement) (Waddington, Stevenson, Sonnenfeld, & Gaarder, ). In this framing, good governance interventions attempt to influence the social contract that mediates the relationships between government and citizens, regarding who has access to what power and in return for what accountability for service (...) effective and equitable (USAID, ). PITA characteristics influence the functioning of the social contract and its systems throughout each of the three accountability domains, and thus, good governance interventions may target one or more of these (Figure ). For example, within the political system domain, the PITA characteristics have a direct impact on who has access to the electoral systems and who can contest the policy arena. Elected officials must exercise some basic level of downwards

2019 Campbell Collaboration

173. Hot spots policing of small geographic areas effects on crime Full Text available with Trip Pro

of criteria including: (a) Reference information (title, authors, publication etc.) (b) Nature of description of selection of site, problems and so forth. (c) Nature and description of selection of comparison group or period (d) The unit of analysis (e) The sample size (f) Methodological type (randomized experiment or quasiexperiment) (g) A description of the hot spots policing intervention (h) Dosage intensity and type (i) Implementation difficulties (j) The statistical test(s) used (k) Reports (...) interventions at residential and commercial addresses (Sherman et al., ). More recently, Blattman et al. ( ) evaluated the impacts of increased police patrol and, separately, increased police patrol plus municipal services on high‐crime street segments in Bogotá, Colombia. In total, the 65 studies included in this review yielded 78 experimental and quasiexperimental tests of hot spots policing on crime. Across the 78 tests of hot spots policing, the specific types of hot spots policing interventions fit

2019 Campbell Collaboration

174. Encorafenib (Braftovi) - unresectable or metastatic melanoma with a BRAF V600 mutation

require dose reduction, temporary discontinuation or permanent discontinuation. See summary of product characteristics (SPC) for information on dose modifications for adverse events. 1-3 It is recommended that patients continue treatment with encorafenib and binimetinib until patients no longer derive benefit or the development of unacceptable toxicity. Before taking encorafenib and binimetinib, patients must have confirmation of BRAF V600 mutation using a validated test. The efficacy and safety (...) % CI: 0.41 to 0.71) A Progression-free survival (data cut-off November 2018) Median follow-up (months) NR NR Events (n) NR NR Median PFS 14.9 months 7.3 months KM estimate of PFS at 2 years 37% 20% Hazard ratio (95% CI) 0.51 (95% CI: 0.39 to 0.67) B A = p<0.001; B = p-value not reported; CI = confidence interval; KM = Kaplan-Meier; NR = not reported; PFS = progression-free survival A hierarchical statistical testing strategy was applied for the key secondary outcomes of this study. When assessed

2020 Scottish Medicines Consortium

175. Teduglutide (Revestive) - short bowel syndrome (SBS)

outcome was the percentage of patients who achieved a response (defined as a 20% to 100% reduction from baseline in the weekly parenteral support volume) at week 20 which was maintained at week 24 and was analysed in the intention to treat population which included all randomised patients. Response was achieved by 63% (27/43) of patients in the teduglutide group and 30% (13/43) of patients in the placebo group (p=0.002). The study used a step-down testing procedure for six secondary outcomes (...) with no formal statistical testing after the first non- significant difference. Secondary outcomes included the percentage change from baseline to week 24 in parenteral support (32% versus 21% of patients in the teduglutide and placebo groups respectively, p=0.030) and the mean absolute change from baseline to week 24 in parenteral support (-4.4 litres/week [from a baseline of 12.9 litres/week] in the teduglutide group compared with -2.3 litres/week [from a baseline of 13.2 litres/week] in the placebo group

2020 Scottish Medicines Consortium

176. Surgical mesh repair of primary inguinal hernia in men

hernia repair available on the market 5 . Six suppliers have been awarded a contract by National Procurement to provide mesh products for hernia repair in NHSScotland: B Braun, Bard Ltd, Covidien (UK) Ltd, Elemental Healthcare Ltd, Johnson & Johnson Medical Ltd and PFM Medical UK Ltd (Mr P Hornby, Head of Strategic Sourcing & Commercial, National Procurement. Personal communication, SHTG Advice | 8 08 May 2019). Organic mesh products are no longer within the scope of this national contract, but may (...) be contracted separately if required. Epidemiology Risk factors for developing an inguinal hernia include having a personal or family history of hernia, older age, being male, chronic cough, prolonged constipation, abdominal wall injury and smoking 6 . The estimated lifetime risk of a groin hernia (inguinal or femoral hernia) is 27% in men compared with 3% in women 6 . In 2014–2015, audit data from NHS England indicated that 92% of patients undergoing an inguinal hernia repair were men 3 . Incidence

2020 SHTG Advice Statements

177. Diagnosis and Treatment of Low Back Pain

are written utilizing a standard language that indicates the strength of the recommendation. “A” recommendations indicate a test or intervention is “recommended”; “B” recom- mendations “suggest” a test or intervention and “C” recommendations indicate a test or intervention “may be considered” or “is an option.” “I” or “Insufficient Evidence” statements clearly indicate that “there is insufficient evidence to make a recommendation for or against” a test or intervention. Work group con- sensus statements (...) clearly state that “in the absence of reliable evidence, it is the work group’s opinion that” a test or intervention may be appropriate. Recommendations were developed based on a specific definition, inclusion/exclusion criteria, and the resulting literature which excluded conditions such as presence of a neurological deficit or leg pain experienced below the knee, among others. Given the exclusion criteria, these guideline rec- ommendations address a subset of low back pain care as opposed to low

2020 North American Spine Society

178. Recognition and Initial Management of Fulminant Myocarditis: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

peptide) or NT-proBNP (N-terminal pro-BNP) should be sent to confirm the presence of increased myocardial wall stress and evidence of myonecrosis. Table 2. Initial Ancillary Testing in the Emergency Department for the Hemodynamically Stable Patient With Suspected Early FM ECG: ST-T–wave changes, concave ST-segment elevation, focal ST-segment elevation mimicking an AMI in a particular coronary distribution. Diffuse ST-segment elevation with PR depression may be present, suggesting inflammation (...) nervous system drugs such as clozapine and carbamazepine. Avoid NSAIDs because they may increase Na retention, cause myocardial harm, and exacerbate renal hypoperfusion. ACS indicates acute coronary syndrome; AHF, acute heart failure; EMB, endomyocardial biopsy; FM, fulminant myocarditis; LFT, liver function test; NSAID, nonsteroidal anti-inflammatory drug; RHF, right-sided heart failure; RUQ, right upper quadrant; URI, upper respiratory infection; and VAD, ventricular assist device. Unique Diagnostic

2020 American Heart Association

179. 2020-2023 Value Assessment Framework

, devices, tests, and delivery system innovations, as well as earlier iterations of the framework. During that time ICER has actively sought the input of all stakeholders and made iterative changes to its methods and overall procedures to enhance their transparency and to improve the ability of all parties to participate meaningfully in the process. ICER has also benefitted from public comment opportunities during each framework revision cycle, including two comment periods for the 2020-2023 framework (...) patients. 1.3. The Population Perspective and Intended Uses of the ICER Value Assessment Framework The ICER Value Assessment Framework describes the conceptual framework and set of associated methods that guide the development of ICER evidence reports. ICER reports are intended to support deliberation on medical policies related to health services (e.g., tests or treatments) and delivery system interventions (e.g., preventive programs, changes to the organization of medical personnel). To inform

2020 California Technology Assessment Forum

180. Staff and associate specialist (SAS) grade handbook

, Association of Anaesthetists3 Association of Anaesthetists | The SAS Handbook 2020 Back to contents Click arrows below to view sections Contents 1. Why Join the Association of Anaesthetists? 2. Other support mechanisms and organisations Employment issues 3. Model Charter for SAS grades 4. SAS contract and job planning 5. Revalidation and appraisal 6. Working less than full-time 7. Addiction, sickness and returning to work 8. Clinical governance and professional development 9. Medico-legal pitfalls (...) departments have dedicated SAS mentors (consultants or senior SAS doctors) whose role is to support and guide SAS doctors in their professional practice, personal wellbeing, and personal and professional development. The Department of Health, the BMA, several deaneries and many independent organisations offer mentoring schemes and training. It has been proven in several studies that mentoring helps to improve confidence and reduce stress. Deanery support Most deaneries have dedicated Associate Deans

2020 Association of Anaesthetists of GB and Ireland

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