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81. British guideline on the management of asthma

and asymptomatic • symptoms of wheeze, cough, breathlessness and chest tightness that vary over time • recorded observation of wheeze heard by a healthcare professional • personal/family history of other atopic conditions (in particular, atopic eczema/dermatitis, allergic rhinitis) • no symptoms/signs to suggest alternative diagnoses. ? In patients with a high probability of asthma: • record the patient as likely to have asthma and commence a carefully monitored initiation of treatment (typically six weeks (...) to consider in an initial structured clinical assessment Episodic symptoms (see sections 3.2.1 and 3.2.2) 13, 18, 19, 21, 22 62, 73, 74 More than one of the symptoms of wheeze, breathlessness, chest tightness and cough occurring in episodes with periods of no (or minimal) symptoms between episodes. Note that this excludes cough as an isolated symptom in children. 75 For example: • a documented history of acute attacks of wheeze, triggered by viral infection or allergen exposure with symptomatic

2019 SIGN

82. Optimisation of RIZIV – INAMI lump sums for incontinence

in the frail elderly and cognitive impaired. Subtypes of incontinence: stress, urgency, mixed and other The SUI clinical subtype or the loss of urine on effort, exertion, sneezing or coughing (increasing intra-abdominal pressure) typically includes the younger and middle-aged female patient presenting during pregnancy or after childbirth. Urgency and mixed UI often presents in middle-aged women affected by bladder and or pelvic floor problems and middle-aged and older men. Urgency is defined (...) as the leakage of urine with or immediately preceded by urgency (a sudden compelling desire to urinate that is difficult to delay) whereas MUI is the leakage of urine associated with both urgency and exertion, effort, sneezing or coughing often accompanied by an overactive bladder (OAB), frequency and nocturia. The urgency and mixed types tend to suffer from higher volume leakage episodes. In men UUI is mostly represented (40-80%), followed by mixed forms of UI (10-30%), and SUI in less than 10

2020 Belgian Health Care Knowledge Centre

83. Cerebral palsy in under 25s: assessment and management

by a speech and language therapist with training in assessing and treating dysphagia. 1.8.2 Refer the child or young person to a local specialist multidisciplinary team with training in assessing and treating dysphagia if there are clinical concerns about eating, drinking and swallowing, such as: coughing, choking, gagging, altered breathing pattern or change in colour while eating Cerebral palsy in under 25s: assessment and management (NG62) © NICE 2019. All rights reserved. Subject to Notice of rights (...) , drinking and swallowing difficulties or concerns about nutritional status low weight for age (below the 2nd centile) Cerebral palsy in under 25s: assessment and management (NG62) © NICE 2019. All rights reserved. Subject to Notice of rights ( conditions#notice-of-rights). Page 22 of 46history of low-impact fracture use of anticonvulsant medication. 1.12.2 Recognise that there is an increased risk of low-impact fractures in children and young people with cerebral palsy

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

84. Cystic fibrosis: diagnosis and management

, such as: recurrent lower respiratory tract infections clinical or radiological evidence of lung disease (in particular bronchiectasis) persistent chest X-ray changes chronic wet or productive cough chronic sinus disease obstructive azoospermia (in young people and adults) acute or chronic pancreatitis malabsorption rectal prolapse (in children) pseudo-Bartter syndrome. 1.1.3 Refer people with suspected cystic fibrosis to a specialist cystic fibrosis centre if: they have a positive or equivocal sweat test result (...) of clinical history and medicines adherence, and a physical examination with measurement of weight and length or height Cystic fibrosis: diagnosis and management (NG78) © NICE 2019. All rights reserved. Subject to Notice of rights ( conditions#notice-of-rights). Page 15 of 43measurement of oxygen saturation taking respiratory secretion samples for microbiological investigations, using sputum samples if possible, or a cough swab or nasal pharyngeal aspirate (NPA) lung

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

85. Romosozumab (Evenity) - treatment of severe osteoporosis

for restricted use within NHSScotland. Indication under review: treatment of severe osteoporosis in postmenopausal women at high risk of fracture. SMC restriction: to use in patients who have experienced a fragility fracture and are at imminent risk of another fragility fracture (within 24 months). In a phase III study in post-menopausal women with osteoporosis who were at high risk of fracture, romosozumab for 12 months followed by an oral bisphosphanate reduced the risk of fractures compared with an oral (...) bisphosphonate alone. This advice applies only in the context of approved NHSScotland Patient Access Scheme (PAS) arrangements delivering the cost-effectiveness results upon which the decision was based, or PAS/ list prices that are equivalent or lower. Vice Chairman Scottish Medicines Consortium 2 Indication Romosozumab is indicated in the treatment of severe osteoporosis in postmenopausal women at high risk of fracture. 1 Dosing Information The recommended dose is 210mg

2020 Scottish Medicines Consortium

86. Primary Care Guidance for Persons With Human Immunodeficiency Virus: 2020 Update by the HIV Medicine Association of the Infectious Diseases Society of America

, seizures, sleep disorders • Abdomen: hepatomegaly, splenomegaly, masses, tenderness • Genitourinary: dysuria, urethral or vaginal discharge or lesions, hematuria • Genitourinary: ulcers, warts, chancres, rashes; gynecologic exam including bimanual exam, discharge; if born male: testicular exam; evaluation for hernia • Orthopedic: hip pain, joint pain, fractures, diagnosis of or risk factors for osteopenia/osteoporosis • Anorectal: ulcers, warts, fissures, internal or external hemorrhoids, masses (...) , anxiety, mania, mood swings, lower extremity paresthesias, pain, or numbness, paralysis or weakness, cognitive difficulties, dizziness, seizures, sleep disorders • Abdomen: hepatomegaly, splenomegaly, masses, tenderness • Genitourinary: dysuria, urethral or vaginal discharge or lesions, hematuria • Genitourinary: ulcers, warts, chancres, rashes; gynecologic exam including bimanual exam, discharge; if born male: testicular exam; evaluation for hernia • Orthopedic: hip pain, joint pain, fractures

2020 Infectious Diseases Society of America

88. Vagus Nerve Stimulation for chronic major depressive episodes

% had cough. The FDA database (MAUDE) recorded 120 adverse events relating to VNS, including lead fracture, high impedance and corrosion. In the pre-MSAC response, it was acknowledged that 19 issues were detected with VNS devices between 2007 and 2018, for which corrections or removals of the product were voluntarily initiated. Four of these issues were related to the generator and leads under consideration in this application, none required device explant. MSAC considered that the comparative cost (...) benefit of VNS+TAU over TAU. Results for VNS+TAU showed a manageable safety profile. In the Berry meta-analysis (2013), the most common adverse events were voice alteration, dyspnoea, pain, cough, and incision pain. In addition, there was a trend towards diminishing adverse events (AE) over the 2 years of VNS treatment. This decrease of side effects over time was also seen in the extended assessment of harm which was based on 5-year follow-up data from study D-23, and long-term (up to 3 years) safety

2019 Medical Services Advisory Committee

90. Hypercalcaemia: How should I assess unexplained hypercalcaemia?

: in cases of malignancy-associated hypercalcaemia, it may be difficult to determine if symptoms are due to hypercalcaemia itself or the underlying malignancy. Any symptoms suggesting underlying malignancy, such as fever, weight loss, night sweats, decreased appetite, cough, general malaise. Any known medical conditions or co-morbidities, such as osteoporosis, fragility fractures, renal stones, or malignancy. Any past history of radiotherapy to the head and neck. Any family history of hypercalaemia

2020 NICE Clinical Knowledge Summaries

92. Evidence summary for surgical outcomes in patients with COVID-19

the infection in the post-operative period. (12) In a Chinese study, Mi et al. included 10 patients with fractures, seven of whom had nosocomial infections. (13) Three patients, two of whom had COVID-19 positive RT- PCR results, underwent orthopaedic surgeries. Two of these patients also had other viral co-infections. One of the surgical patients with underlying cirrhosis and Alzheimer’s disease died and the other two patients developed severe pneumonia. In total, four of the 10 patients died. The clinical (...) outcomes for the surviving patients were not known at the time of writing. (13) The authors suggested that the clinical characteristics and early prognosis of COVID-19 in patients with fracture tended to be more severe than those reported for adult patients with COVID-19 without fracture, and that surgical treatment should be carried out cautiously. Dai et al. included 105 patients with cancer, of whom eight underwent surgery within 40 days before the onset of COVID-19 symptoms. (8) The authors

2020 Health Information and Quality Authority

94. Nutrition screening and use of oral nutrition support for adults in the acute care setting

) Table 3. Indicators of dysphagia Obvious indicators of dysphagia Less obvious indicators of dysphagia - Difficult, painful chewing or swallowing - Regurgitation of undigested food - Difficulty controlling food or liquid in the mouth - Drooling - Hoarse voice - Coughing or choking before, during or after swallowing - Globus sensation - Nasal regurgitation - Feeling of obstruction - Unintentional weight loss - for example, in people with dementia - Change in respiration pattern - Unexplained (...) effects of undernutrition is presented in Table 5 below. Malnutrition effects Physical and psychosocial impact Impaired immune response Impaired ability to fight infection. Reduced muscle strength and fatigue Inactivity and reduced ability to work, shop, cook and self-care. Poor muscle function may result in falls, and poor respiratory muscle function may result in poor cough pressure - delaying expectoration and recovery from chest infection. Inactivity In bed-bound patients this may result

2020 National Clinical Guidelines (Ireland)

95. Consensus Practice Guidelines on Interventions for Lumbar Facet Joint Pain from a Multispecialty, International Working Group Full Text available with Trip Pro

of the historical features or clinical tests discriminated between patients diagnosed with facet joint pain and those who had negative blocks. Following up on a prospective study that examined the association between 90 physical examination signs and symptoms and IA LA injections, Revel et al performed a placebo-controlled crossover study in 80 patients based on the presence of five of seven criteria they found in their first study: age >65 years, absence of exacerbation with coughing, relief with recumbency (...) by coughing or sneezing reaching predictive significance. The authors concluded that these tests were a poor screening tool to select patients for facet interventions, which require high sensitivity. In a subsequent attempt to better refine clinical prediction rules in 120 patients with LBP, the same authors performed double blocks, stratifying responses into 5% intervals from 75% pain relief to >95% relief. At cut-off values <90%, no clinical findings predicted positive response to facet injections

2020 American Society of Regional Anesthesia and Pain Medicine

96. Guideline on the management of patients with giant cell arteritis Full Text available with Trip Pro

symptoms and signs of GCA include headache; scalp tenderness/hyperaesthesia; jaw or tongue claudication; temporal artery tenderness, nodularity or reduced pulsation; visual manifestations including diplopia or changes to colour vision; limb claudication; PMR (pain and stiffness of the shoulder and hip girdles) and fever, sweats or weight loss. Less commonly, patients may have carotidynia, audiovestibular symptoms, dry cough or indications of tongue or scalp ischaemia that may precede necrosis. However (...) branches, and for comorbidities relevant to treatment, such as diabetes mellitus, hypertension and bone fracture risk. Consensus score: 9.53. Assessments to be performed in all patients with GCA are detailed in . As well as confirmatory tests for GCA (see Key Recommendation 1), alternative explanations for patients’ symptoms should be considered, particularly if these confirmatory tests are negative. Factors relating to prognosis [risk factors (prognostic) PICO questions 1–6] were reviewed. Overall

2020 British Society for Rheumatology

97. Obstetric Management of Patients with Spinal Cord Injuries

respiratory volumes from upward displacement of the diaphragm by the enlarging gravid uterus is particularly problematic for patients with tetraplegia, in whom the diaphragm is the primary muscle of respiration . Reduced diaphragmatic function can impair effective coughing, and atelectasis and the accumulation of bronchial secretions can lead to bronchopneumonia . For patients with borderline function, ventilatory support and meticulous attention to pulmonary care is necessary during pregnancy (...) and delivery. Supine positioning in labor may exacerbate respiratory complications . Isolated or serial pulmonary function testing as well as specialty involvement or co-management from respiratory therapists or pulmonary medicine specialists may be warranted. Falls Weight gain and changes in the center of gravity as pregnancy advances can contribute to falls in pregnancy, which can cause fractures and other injuries . Falls can occur with transfers in and out of wheelchairs, from the tipping over

2020 American College of Obstetricians and Gynecologists

98. Guidance for Return to Practice for Otolaryngology-Head and Neck Surgery: Part Two

/moderate dysplasia • Non obstructive, benign lesion of vocal fold • Gender affirmation surgery • Glottic incompetence causing mild to moderate dysphonia • Globus and cough without alarm signs • Procedures listed as emergent, urgent, and semi-urgent • Open airway procedures – not cancer • Tracheostomy care or change • Transtracheal injection OTOLOGY/NEUROTOLOGY Diagnoses Necessitating “Emergent” Operative Management (Tier 1) These diagnoses have high associated morbidity or even mortality (...) intratympanic (IT) steroid therapy, which has non-inferior outcomes. Intratympanic injections should be done by the clinician without an assistant in the room if possible and with the patient wearing a mask to minimize risk of coughing. Clinicians should weigh the immunosuppressive risk of systemic steroids against the repeat visits and instrumentation necessary for IT steroid injections. o Treatment of Bell’s Palsy or other otologic conditions with oral steroids should be decided in the context of patient

2020 American Academy of Otolaryngology - Head and Neck Surgery

99. Covid-19: Reference guide for emergency medicine

for emergency medicine Front door parallel streams 4 | Reference guide for emergency medicine Reason to admit (to an acute hospitals) checklist Same-day emergency care should always be considered – admission may be required but is seldom the default option. 5 | Reference guide for emergency medicine ED/AMU coronavirus assessment tool Clinical Assessment History and vital signs. Particular note of Persistent new cough Fever > 37.8 0 c, Dyspnea Flu like illness Chest examination often normal. ‘Silent hypoxia (...) Syncope without ECG conduction defect, rhythm disturbance or hypotension MSK Patients requiring physio/analgesia alone Upper limb fracture Fracture of the lower limb except femur, tibia, calcaneum Dislocation once reduced Minor stable vertebral fractures General surgery Renal/biliary colic in whom pain is controlled Abdominal pain with normal CT and pain controlled Abscess not showing signs of sepsis Haematuria without clot retention, hypotension or anaemia Bacterial infection NEWS < 3 with clinical

2020 NHS England

100. Consensus Practice Guidelines on Interventions for Lumbar Facet Joint Pain

more frequent in patients with pain relief from facet blocks: older age; absence of pain exacerbation by coughing, absence of pain exacerbation by lumbar hyperextension, absence of pain exacerbation by forward flexion and rising from forward flexion, absence of pain exacerbation by extension- rotation and pain relieved by recumbency. Revel et al 45 Prospective, controlled n=80–42 who received lidocaine =75% LBP reduction IA local anesthetic or placebo (IA saline) The presence of at least five (...) of the seven Revel’s criteria (above) including pain reduction by recumbency resulted in 92% sensitivity and 80% specificity. Manchikanti et al 50 Prospective n=120 =75% pain reduction MBB (double comparative diagnostic blocks) The prevalence of clinical findings (pain better by sitting/lying, pain worsened by sitting/standing/walking/coughing/lumbar spine range of motion, positive straight leg raising test and pain referral pattern) were similar between positive and negative block groups. Back pain

2020 American Academy of Pain Medicine

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