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Cough fracture

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83. 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

84. 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

85. 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

86. 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

87. 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

88. 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

89. 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

91. 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

92. Non-small cell lung cancer

are cough, chest pain, haemoptysis, dyspnoea, and weight loss. A suspicious lung mass can be biopsied during bronchoscopy or using CT guidance. Staging studies (i.e., CT, PET, mediastinal sampling) are required to determine extent of local or regional disease and to evaluate for metastases. Treatment depends on stage of disease, histological subtype, molecular genotype, and patient comorbidities. Surgery, radiotherapy, and chemotherapy are the most common modalities, but molecular-targeted therapy (...) :// (last accessed 14 September 2017). There are 3 main types of NSCLC (adenocarcinoma, squamous cell carcinoma, and large cell carcinoma) and these are grouped into further subtypes. History and exam presence of risk factors cough dyspnoea haemoptysis chest and/or shoulder pain weight loss male sex fatigue pulmonary examination abnormalities hoarseness confusion personality changes nausea and vomiting headache dysphagia bone pain

2018 BMJ Best Practice

93. Small cell lung cancer

Organization classification of lung tumours. Eur Respir J. 2001;18:1059-1068. History and exam presence of risk factors cough dyspnoea haemoptysis chest pain weight loss age 65 to 70 years male sex fatigue pulmonary examination abnormalities hoarseness confusion personality changes nausea and vomiting headache dysphagia bone pain and/or fractures seizures cervical or supraclavicular (...) Small cell lung cancer Small cell lung cancer - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Small cell lung cancer Last reviewed: February 2019 Last updated: February 2018 Summary Small cell lung cancer (SCLC) is an aggressive malignancy. Approximately two-thirds of patients have evidence of distant metastasis at presentation. It primarily develops in older adult smokers. Most common presenting symptoms are cough

2018 BMJ Best Practice

94. Overview of musculoskeletal pain

of prior fragility fracture or low bone-mass density, which is defined as a T-score <-2.5. Screening is based on individual risk factors, including older age, female sex, maternal history of fragility fractures/osteoporosis, post-menopausal, low BMI, and tobacco use. Patients may report sudden back pain from atraumatic activities such as standing from a seated position, bending forward, or coughing and sneezing. Pain is characteristically exacerbated by movement. Worsening pain over weeks to months (...) /jama/fullarticle/197628 Related conditions Condition Description Chronic fibrosing condition characterised by insidious, progressive, and severe restriction of both active and passive shoulder range of motion. Many patients experience shoulder pain, but shoulder pain is not an essential component of adhesive capsulitis. Although other fractures around and including the ankle can occur (such as distal tibial plafond fractures

2018 BMJ Best Practice

95. Epistaxis

of the second branch of the trigeminal nerve dry weather and low humidity oxygen dependence septal deviation nasal and other facial fracture other nasal trauma nasal foreign body rhinitis nasal polyp environmental irritants topical nasal drugs primary coagulopathy (e.g., haemophilia) acquired coagulopathy (e.g., use of aspirin, anticoagulant, NSAIDs) familial hereditary haemorrhagic telangiectasia barotrauma ulceration secondary to infection (e.g., herpes zoster, or bacterial infection) forceful coughing

2018 BMJ Best Practice

96. Pulmonary embolism

. 1989 Mar;95(3):498-502. Venous thromboembolic disease is the preferred term to describe the spectrum of disease beginning with the risk factors of Virchow's triad, progressing to deep venous thrombosis, and resulting in life-threatening PE. History and exam presence of risk factors chest pain dyspnoea tachypnoea presyncope or syncope hypotension (systolic BP <90 mmHg) feeling of apprehension cough tachycardia fever unilateral swelling (...) /tenderness of calf haemoptysis elevated jugular venous pressure sternal heave accentuated pulmonary component of S2 increasing age diagnosis of deep vein thrombosis (DVT) obesity (BMI ≥29 kg/m²) surgery within the last 2 months bed rest >5 days previous venous thromboembolic event family history of venous thromboembolism (VTE) active malignancy cigarette smoking chronic obstructive pulmonary disease (COPD) recent trauma or fracture congestive heart failure (CHF) central venous catheterisation pregnancy

2018 BMJ Best Practice

97. Sofosbuvir/velpatasvir/voxilaprevir (chronic hepatitis C) - Addendum to Commission A17-35

spasms 1 (2.0) 2 (5.0) Nervous system disorders 9 (18.4) 9 (22.5) Headache 9 (18.4) 5 (12.5) Psychiatric disorders 2 (4.1) 3 (7.5) Respiratory, thoracic and mediastinal disorders 3 (6.1) 1 (2.5) Cough 2 (4.1) 0 (0) Vascular disorders 2 (4.1) 0 (0) a: MedDRA version 19.0. AE: adverse event; MedDRA: Medical Dictionary for Regulatory Activities; n: number of patients with (at least one) event; N: number of analysed patients; PT: Preferred Term; RCT: randomized controlled trial; SOC: System Organ Class (...) ) Hepatobiliary disorders 1 (2.0) 0 (0) Cholelithiasis 1 (2.0) 0 (0) Infections and infestations 1 (2.0) 0 (0) Perineal abscess 1 (2.0) 0 (0) Injury, poisoning and procedural complications 0 (0) 1 (2.5) Multiple fractures 0 (0) 1 (2.5) Road traffic accident 0 (0) 1 (2.5) Musculoskeletal and connective tissue disorders 0 (0) 1 (2.5) Myositis 0 (0) 1 (2.5) Psychiatric disorders 0 (0) 1 (2.5) Suicide attempt 0 (0) 1 (2.5) Respiratory, thoracic and mediastinal disorders 1 (2.0) 0 (0) Asthma 1 (2.0) 0 (0

2018 Institute for Quality and Efficiency in Healthcare (IQWiG)

99. Prospective, randomized comparison of continuous thoracic epidural and thoracic paravertebral infusion in patients with unilateral multiple fractured ribs--a pilot study (Abstract)

, it has never been compared with TEA in terms of efficacy and outcome in patients with fractured ribs.Thirty adult patients of either sex, having three or more unilateral fractured ribs, were randomized to receive continuous bupivacaine infusion through either thoracic epidural or thoracic paravertebral catheter. Visual Analog Scale scores at rest and on coughing, respiratory rate, peak expiratory flow rate, and PaO2/FIO2 ratio were measured before and after administration of block at regular (...) Prospective, randomized comparison of continuous thoracic epidural and thoracic paravertebral infusion in patients with unilateral multiple fractured ribs--a pilot study Thoracic epidural analgesia (TEA), a commonly used analgesic technique in patients with multiple fractured ribs, is technically demanding and associated with certain side effects or complications. Thoracic paravertebral block (TPVB) is a simple and effective method of providing continuous pain relief in these patients. However

2009 EvidenceUpdates Controlled trial quality: uncertain

100. Corticosteroids for treatment of sore throat Full Text available with Trip Pro

. Some patients with sore throat also experience headache, fever, muscle stiffness, cough, and general malaise. Acute sore throat is common, but only a minority of patients will visit their general practitioner. A survey reported that the main reasons are to establish the cause of the symptoms, obtain pain relief, and to gain information on the course of the disease. Data from Dutch and Flemish primary care databases show that, for every 1000 consecutive patients consulting a general practitioner, 50 (...) quality evidence) The panel also considered evidence from observational studies that used higher doses of steroids. A large retrospective US cohort study of private insurance claims assessed adverse events in 327 452 adults who received an outpatient prescription of corticosteroids. There was a small absolute increase in the rate of sepsis, venous thromboembolism, and fracture in the first 30 days (GRADE low quality evidence, due to suboptimal verification of diagnosis in large databases

2017 BMJ Rapid Recommendations

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