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Dysuria in Children

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81. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutritio

disease. Ifexcessiveirritabilityandpainisthesinglemanifestation,itisunlikely to be related to GERD. y Typical symptoms of GERD in older children. TABLE 2. ‘‘Red ?ag’’ symptoms and signs that suggest disorders other than gastroesophageal re?ux disease Symptoms and signs Remarks General Weight loss Lethargy Fever Excessive irritability/pain Suggesting a variety of conditions, including systemic infections Dysuria May suggest urinary tract infection, especially in infants and young children Onset (...) (QUIPS) tools. During a 3-day consensus meeting, all recommendations were discussed and ?nalized. In cases where no randomized controlled trials (RCT; therapeutic questions) or diagnostic accuracy studies were available to support the recom- mendations, expert opinion was used. The group members voted on each recommendation, using the nominal voting technique. With this approach, recommendations regarding evaluation and management of infants and children with GERD to standardize and improve quality

2018 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

82. Surveillance of healthcare-associated infections and prevention indicators in European intensive care units: HAI-Net ICU protocol, version 2.2

Surveillance of HAI and prevention indicators in European intensive care units 7 3.3 Pneumonia (PN 1 –PN 5) X-ray Two or more serial chest X-rays or CT-scans with a suggestive image of pneumonia for patients with underlying cardiac or pulmonary disease* (in patients without underlying cardiac or pulmonary disease, one definitive chest X- ray or CT-scan is sufficient). Symptoms and at least one of the following: ? fever > 38 °C with no other cause ? leukopenia ( 38 °C), urgency, frequency, dysuria (...) , or suprapubic tenderness and ? Patient has a positive urine culture, i.e. = 10 5 microorganisms per ml of urine with no more than two species of microorganisms. 3.4.2 UTI-B: not microbiologically confirmed symptomatic UTI ? Patient has at least two of the following, with no other recognised cause: fever (> 38 °C), urgency, frequency, dysuria, or suprapubic tenderness; And at least one of the following: ? positive dipstick for leukocyte esterase and/or nitrate ? pyuria urine specimen with = 10 WBC/ml or = 3

2017 European Centre for Disease Prevention and Control - Technical Guidance

83. Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update

community-dwelling adult women with symptoms of UI Subpopulations: • women engaging in athletic activity, • older women • women in the military or veterans • racial and ethnic minorities If >10% of study participants are from ineligible groups (children or adolescents, men, pregnant women, institutionalized or hospitalized participants, or have surgically-treated UI) Interventions Nonpharmacological interventions: Behavioral interventions, neuromodulation, intravesical pressure release devices

2018 Effective Health Care Program (AHRQ)

84. Suspected cancer: recognition and referral

Introduction 6 Safeguarding children 7 Patient-centred care 8 T erms used in this guideline 9 1 Recommendations organised by site of cancer 11 1.1 Lung and pleural cancers 11 1.2 Upper gastrointestinal tract cancers 13 1.3 Lower gastrointestinal tract cancers 16 1.4 Breast cancer 17 1.5 Gynaecological cancers 18 1.6 Urological cancers 20 1.7 Skin cancers 22 1.8 Head and neck cancers 24 1.9 Brain and central nervous system cancers 25 1.10 Haematological cancers 25 1.11 Sarcomas 28 1.12 Childhood cancers 29 (...) ). Page 3 of 79Gynaecological symptoms 44 Lumps or masses 45 Neurological symptoms in adults 48 Pain 48 Respiratory symptoms 49 Skeletal symptoms 52 Skin or surface symptoms 53 Urological symptoms 55 Non-specific features of cancer 57 Primary care investigations 64 Symptoms in children and young people 68 More information 74 2 Research recommendations 75 2.1 Age thresholds in cancer 75 2.2 Primary care testing 75 2.3 Cancers insufficiently researched in primary care 75 2.4 Patient experience 76 Update

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

85. Complicated urinary tract infections: ceftolozane/tazobactam

such as people with complicated lower urinary tract infection, older people or people with moderate renal impairment. Ceftolozane/tazobactam has not been studied in people with severe neutropenia, or those who are immunocompromised or who have severe renal impairment. It is not indicated for use in children (summary of product characteristics). Ceftolozane/tazobactam is administered by IV infusion. Resource implications Resource implications A vial of ceftolozane/tazobactam costs £67.03 excluding VAT (MIMS (...) to be complicated in people with increased susceptibility, Complicated urinary tract infections: ceftolozane/tazobactam (ESNM74) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 27for example children or older people; people with functional or structural abnormalities of the genitourinary tract or people who are immunocompromised, so that the infection will likely be severe (Frassetto 2015). Complicated urinary tract

2016 National Institute for Health and Clinical Excellence - Advice

86. Orthostatic hypotension due to autonomic dysfunction: midodrine

mg 3 times daily increased standing blood pressure statistically significantly more than placebo, 1 hour after the dose was taken. Improvements in patient- and investigator-rated symptoms were seen with midodrine compared with placebo in both RCTs. However, the symptom measurement scales were not reported to have been validated. Safety Safety According to the summary of product characteristics, the most common adverse effects of midodrine are piloerection, pruritus of the scalp and dysuria (...) of the scalp and dysuria, which lead to discontinuation of treatment in some people. Patients should be monitored for supine hypertension, which occurs in between 1 in 10 and 1 in 100 people. Reducing the dose of midodrine may resolve supine hypertension but, if it does not, treatment must be stopped. See the summary of product characteristics for more information. The main limitation of the 2 RCTs is the focus on disease-oriented outcomes (changes in standing blood pressure), as opposed to patient

2015 National Institute for Health and Clinical Excellence - Advice

87. Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline

, to the following patient populations after appropriate evaluation and counseling have been performed: (Expert Opinion) ? Patients planning to bear children ? Diabetes ? Obesity ? Geriatric OUTCOMES ASSESSMENT 23. Physicians or their designees should communicate with patients within the early postoperative period to assess if patients are having any significant voiding problems, pain, or other unanticipated events. If patients are experiencing any of these outcomes, they should be seen and examined. (Expert (...) , and severity of incontinence episodes ? Patient’s expectations of treatment (patient- centered goals) ? Pad or protection use ? Concomitant urinary tract symptoms (e.g., urgency, frequency, nocturia, dysuria, hematuria, slow flow, hesitancy, incomplete emptying) ? Concomitant pelvic symptoms (e.g., pelvic pain, pressure, bulging, dyspareunia) ? Concomitant gastrointestinal symptoms (e.g., constipation, diarrhea, splinting to defecate) ? Obstetric history (e.g., gravity, parity, method of delivery

2017 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction

88. Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline

incontinence and concomitant neurologic disease affecting lower urinary tract function (neurogenic bladder) surgical treatment of stress urinary incontinence after appropriate evaluation and counseling have been performed. (Expert Opinion) Physicians may offer synthetic midurethral slings, in addition to other sling types, to the following patient populations after appropriate evaluation and counseling have been performed: (Expert Opinion) Patients planning to bear children Diabetes Obesity Geriatric (...) from the history, bladder diary, questionnaires, and/or pad testing. Characterization of incontinence (stress, urgency, mixed, continuous, without sensory awareness) Chronicity of symptoms Frequency, bother, and severity of incontinence episodes Patient’s expectations of treatment (patient-centered goals) Pad or protection use Concomitant urinary tract symptoms (e.g., urgency, frequency, nocturia, dysuria, hematuria, slow flow, hesitancy, incomplete emptying) Concomitant pelvic symptoms (e.g

2017 American Urological Association

89. CRACKCast E099 – Urological Disorders

Hematuria UTIs in Adults – Rosens in Perspective Most frequent bacterial infection in adults, one of the most common causes of sepsis Diagnosis is made by: Urinary specific symptoms (dysuria, frequency, urgency, hematuria, suprapubic/CVA discomfort) Bacteriuria (note this alone does not equal UTI! – unless patient Is pregnant or immunocompromised) No other source of infection Classified as: Lower (bladder only) vs. upper (ureters and kidney) Uncomplicated or complicated How is UTI diagnosed? What (...) , unless you have a low pretest probability Urine microscopy helps identify pyuria = > 10 WBC WBC/mm3 or bacteria in the urine IDSA says a positive urine culture is: > 10 5 CFUs/ml = 95% likelihood of infection assuming the patient is symptomatic [1] Differentiate between the three major causes of dysuria? (ddx of dysuria) Cause Urethritis / UTI Vaginitis STIs Gonorrhea, chalmydia, trichomonas, HSV, NGU Mechanical trauma Irritation Clinical features Presence of pyuria Presence of hematuria (50

2017 CandiEM

90. CRACKCast E093 – Appendicitis

of urinary frequency and dysuria or rectal symptoms, such as tenesmus and diarrhea. Children “ Appendicitis is uncommon in neonates, infants and preschool children . Mortality from neonatal appendicitis approaches 28 percent and reflects the difficulty in establishing the diagnosis prior to advanced disease with bowel perforation and sepsis. Case reports indicate that abdominal distension, vomiting, and decreased feeding are the most commonly reported findings in neonates with appendicitis ….. Fever (...) , the average ionizing radiation dose associated with an abdominal x-ray is 0.7 mSv, and the average dose associated with coronary angioplasty is 15 mSv. An abdominal CT carries an excess risk of fatal cancer of 1 in 2000, a value that is even greater in children. However, this value must be tempered by the fact that the general population has a lifetime risk of being diagnosed with cancer of 1 in 3. The risk of radiation increases conversely with age, with children and fetuses having the greatest risk

2017 CandiEM

91. CRACKCast E095 – Large Intestine

: Bloating Crampy pain Excessive gas Change in bowel habits 10-30% of people progress to diverticulitis (West = left side, Japan = right side) ITIS presentation: LLQ pain (referred to groin or suprapubic) RLQ pain in some! Peritonitis (if perforation) Dysuria / pneumaturia (colovesical fistula) Vomiting / distension (if obstructed) Feces / gas from vagina (colovaginal fistula) A tentative diagnosis can be made clinically, but a CT scan is routinely performed to exclude alternative dx, or complicated (...) types: Organo-axial volvulus is more common in adults, responsible for 60% of presentations Mesentero-axial volvulus is more common in children Organo-axial volvulus more common of the two types in adults (60% of cases) RF: trauma or para-oesophageal hernia Pathophys: stomach rotates around long axis w/ antrum rotates anterosuperiorly fundus rotates posteroinferiorly Mesentero-axial volvulus More common is peds Pathophys: rotation around short axis from the lesser to greater curvature displacement

2017 CandiEM

92. Pharmacological and non-pharmacological treatment of adults with ADHD: a meta-review (Full text)

Crescenzo , Samuele Cortese , , Nicoletta Adamo , Luigi Janiri Statistics from Altmetric.com Introduction Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neuropsychiatric conditions, with a pooled worldwide prevalence estimated at about 5% in school-aged children and persistence of impairing symptoms in adulthood in up to 65% of cases. The pooled estimated prevalence of ADHD (as categorical diagnosis) in adults is around 2.5%. ADHD is characterised by a persistent and impairing (...) for the diagnosis in adults (at least five symptoms of inattention and/or hyperactivity/impulsivity, rather than six as in children) and the inclusion of specific age-appropriate examples of ADHD symptoms in adults. The International Classification of Diseases (ICD-10) describes a syndrome, namely, hyperkinetic disorder (HKD), which overlaps with the predominantly combined ADHD subtype in the DSM-IV. Specifically, the diagnosis of HKD requires symptoms of inattention and hyperactivity/impulsivity ( ). View

2017 Evidence-Based Mental Health

93. Fever in under 5s: assessment and initial management

-and- conditions#notice-of-rights). Page 17 of 401.2.3.8 Consider urinary tract infection in a child aged 3 months or older with fever and 1 or more of the following [7] : vomiting poor feeding lethargy irritability abdominal pain or tenderness urinary frequency or dysuria. [new 2013] [new 2013] 1.2.3.9 Consider septic arthritis/osteomyelitis in children with fever and any of the following signs: swelling of a limb or joint not using an extremity non-weight bearing. [2007] [2007] 1.2.3.10 Consider Kawasaki (...) Contents Overview 5 Who is it for? 5 Introduction 6 Patient-centred care 8 Key priorities for implementation 9 Thermometers and the detection of fever 9 Clinical assessment of the child with fever 9 Management by remote assessment 9 Management by the non-paediatric practitioner 10 Management by the paediatric specialist 10 Antipyretic interventions 10 1 Recommendations 12 1.1 Thermometers and the detection of fever 12 1.2 Clinical assessment of children with fever 13 1.3 Management by remote assessment

2013 National Institute for Health and Clinical Excellence - Clinical Guidelines

94. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals ? protocol version 5.3

-producing C. difficile organisms in stool. ? SYS-CSEP: no change in the definition, but change of the name from ‘clinical sepsis’ to ‘treated unidentified severe infection’ in adults and children, to differentiate this last-resort HAI case definition from the modern concept of sepsis based on organ dysfunction. TECHNICAL DOCUMENT PPS of HAIs and antimicrobial use in European acute care hospitals – protocol version 5.3 3 Objectives The objectives of the ECDC point prevalence survey of healthcare

2016 European Centre for Disease Prevention and Control - Technical Guidance

95. Point-of-care testing for urinary tract infections

by Anacleto et al., 26 the authors compared the accuracy of the Uricult Trio device against conventional urine microscopy and culture. They tested 198 mid-stream clean-catch, randomly voided (i.e. urine collected at any point in the stream) or catheterized urine samples from children aged 0-7 if the sample had been screened positive for nitrites or leukocyte esterase with a urine dipstick test. A urine sample was obtained from children 2 years of age if they presented with dysuria, urgency, flank pain (...) results in pyelonephritis. UTIs are categorised as either uncomplicated or complicated. Uncomplicated UTIs can be further sub- classified into cystitis (lower urinary tract) and pyelonephritis (upper urinary tract). Patients with cystitis typically present with dysuria, frequency, urgency, haematuria and/or suprapubic pain; pyelonephritis classically manifests with flank pain, costovertebral angle tenderness, fever, nausea and vomiting in addition Point-of-care testing for urinary tract infections

2016 NIHR DEC Oxford

96. Zavicefta (ceftazidime / avibactam) - infections

and efficacy in children and adolescents below 18 years of age have not yet been established. No data are available. Method of administration Zavicefta is administered by intravenous infusion over 120 minutes in an infusion volume of 100 mL (see section 6.6). For instructions on reconstitution and dilution of the medicinal product before administration (see section 6.6). Class D OXA ß-lactamases are also increasingly reported in Enterobacteriaceae. Amongst these, OXA- 48 is of particular concern due to its

2016 European Medicines Agency - EPARs

97. Scrotal pain and swelling

of a testicular or epididymal appendage. Testicular cancer. Squamous cell carcinoma of the scrotum. Indirect inguinal hernia. Epididymo-orchitis (including epididymitis and orchitis). Haematocele. Epididymal cyst/spermatocele. Varicocele. Hydrocele. Some boys or men may present having discovered the normal epididymis for the first time. Other causes of scrotal swelling include: Sebaceous cyst. Generalized oedema. Idiopathic scrotal oedema (mainly in children). Syphilitic gumma of the testis (round, hard (...) of lymphatic vessels (Milroy's disease). [ ; ; ] Testicular torsion Testicular torsion Testicular torsion is torsion of the spermatic cord. Torsion occurs in boys of any age, can occur in the first year of life, but most commonly in those aged 12–18 years, with peak incidence between 13–16 years. In older children and adults, testicular torsion is usually intravaginal (twisting of the cord within the tunica vaginalis). Annual incidence in the US is 1 per 4,000 males younger than 25 years of age. In 2013/14

2019 NICE Clinical Knowledge Summaries

98. Opioid dependence

, in particular, seems to promote thrombosis. Venous and arterial thrombosis can result from poor injecting technique, especially in people injecting into the groin. Poor nutrition and dental disease — people who have a history of substance use problems are more likely to have poorer oral and dental health, and may suffer from poor nutrition. Social problems, including: Crime — it is estimated that half of all recorded crime is drug related. Imprisonment. Effect on partner and children including child (...) : Supply of needles and syringes; sharing habits; knowledge of how to inject safely; correct disposal of used equipment; knowledge of HIV and hepatitis A, B, and C; issues of transmission and safer sex. For drug-misusing parents or other adults with dependent children, obtain information on the children and any drug-related risks to which they may be exposed. Medical history — current or previous physical complications of drug use such as infection with blood-borne viruses or continuing related risky

2019 NICE Clinical Knowledge Summaries

99. Pelvic inflammatory disease

, acute bowel infection, or diverticular disease. See the CKS topics on and for more information. Complications of an ovarian cyst, such as rupture, torsion, or haemorrhage — symptoms are often of sudden onset. Urinary tract infection — often associated with dysuria and/or urinary frequency. See the CKS topic on for more information. Mittelschmerz pain. Functional pain (that is of unknown physical origin) — there may be other longstanding symptoms. Basis for recommendation Basis for recommendation

2019 NICE Clinical Knowledge Summaries

100. Chlamydia - uncomplicated genital

, purulent vaginal discharge, mucopurulent cervical discharge, deep dyspareunia, dysuria, pelvic pain and tenderness, inflamed or friable cervix. In men: dysuria, urethral discharge, urethral discomfort. Samples are taken by the following methods: In women: endocervical or vulvovaginal swab, or first-void urine sample. In men: first-void urine sample or urethral swab. Treatment should be initiated promptly in all people who test positive for chlamydia, or have symptoms or signs strongly suggestive (...) or intermenstrual bleeding. Purulent vaginal discharge. Mucopurulent cervical discharge. Deep dyspareunia. Dysuria. Pelvic pain and tenderness. Cervical motion tenderness. Inflamed or friable cervix (which may bleed on contact). Suspect chlamydia in sexually active men with: Dysuria. Mucoid or mucopurulent urethral discharge. Urethral discomfort/urethritis. Epididymo-orchitis. Reactive arthritis. Symptoms of rectal chlamydia include anal discharge and anorectal discomfort, although rectal infection is usually

2019 NICE Clinical Knowledge Summaries

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