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E/M Medical Decision Making

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8841. Interventions for Postpartum Depression

of evidence-based nursing practice. The document needs to be reviewed and applied, based on the specific needs of the organization or practice setting/environment, as well as the needs and wishes of the client. Guidelines should not be applied in a “cookbook” fashion but used as a tool to assist in decision making for individualized client care, as well as ensuring that appropriate structures and supports are in place to provide the best possible care. Nurses, educators, administrators, and other health (...) strategies for ongoing evaluation of guideline implementation. It is acknowledged that the individual competencies of nurses vary, across categories of nursing professionals, and depends upon their scope of practice. Knowledge, skills, attitudes, critical analysis and decision making are enhanced over time through education and experience. It is expected that individual nurses will perform only those assessments and interventions for which they have the appropriate knowledge and skill set. Furthermore

2005 Registered Nurses' Association of Ontario

8842. Care and Maintenance to Reduce Vascular Access Complications

sheet (CNO, 2004c), which was developed to provide direction to nurses when they disagree with other care providers regarding the plan of care or when they believe the client has not been given informed consent to the plan. It provides the nurse with a tool for advocacy. Practice guideline: Guide to decide (CNO, 2004d), which was designed to assist nurses to understand their accountability in performing procedures and provides a framework for decision making. Practice guideline: Medical directives (...) for the support of evidence-based nursing practice. The document needs to be reviewed and applied, based on the specific needs of the organization or practice setting/environment, as well as the needs and wishes of the client. Guidelines should not be applied in a “cookbook” fashion but used as a tool to assist in decision making for individualized client care, as well as ensuring that appropriate structures and supports are in place to provide the best possible care. Nurses, other healthcare professionals

2005 Registered Nurses' Association of Ontario

8843. Stroke Assessment Across the Continuum of Care

nursing practice. The document needs to be reviewed and applied, based on the specific needs of the organization or practice setting/environment, as well as the needs and wishes of the client. Guidelines should not be applied in a “cookbook” fashion but used as a tool to assist in decision making for individualized client care, as well as ensuring that appropriate structures and supports are in place to provide the best possible care. Nurses, other healthcare professionals and administrators who (...) , focused stroke assessment. It is acknowledged that the individual competencies of nurses vary between nurses and across categories of nursing professionals and are based on knowledge, skills, attitudes, critical analysis and decision making which are enhanced over time by experience and education. It is expected that individual nurses will perform only those aspects of stroke assessment/screening for which they have appropriate education and experience and that they will seek consultation in instances

2005 Registered Nurses' Association of Ontario

8844. Primary Prevention of Childhood Obesity

with us. Let’s make them the real winners of this important effort! RNAO will continue to work hard at developing and evaluating future guidelines. We wish you the best for a successful implementation! Doris Grinspun, RN, MSN, PhD (cand), OOnt Executive Director Registered Nurses’ Association of Ontario1 Foreward Congratulations to the RNAO from Dr. Sheela Basrur, Chief Medical Officer of Health and Assistant Deputy Minister Ministry of Health and Long-Term Care It is with great pleasure that I offer (...) resources necessary for the support of evidence-based nursing practice. The document needs to be reviewed and applied, based on the specific needs of the organization or practice setting/environment, as well as the needs and wishes of the client. Guidelines should not be applied in a “cookbook” fashion but used as a tool to assist in decision making for individualized client care, as well as ensuring that appropriate structures and supports are in place to provide the best possible care. Nurses, other

2005 Registered Nurses' Association of Ontario

8845. Caregiving Strategies for Older Adults with Delirium, Dementia and Depression

Recognition • Anticipate • Coordinate team awareness • Immediate interventions Pharmacological Interventions e.g.: • Review individual medications • Reduce/eliminate as possible • Lowest dose • Treat to therapeutic effect Other Non-Pharmacological Strategies • Therapies • Family/client support groups • Decision-making Behavioral Strategies e.g.: • No/least restraint • Create partnerships with caregivers • Behavioural rating scale Physiological Stability e.g.: • Pain assessment & treatment • Monitor (...) document providing resources necessary for the support of evidence-based nursing practice. The document needs to be reviewed and applied, based on the specific needs of the organization or practice setting/environment, as well as the needs and wishes of the client. Guidelines should not be applied in a “cookbook” fashion but used as a tool to assist in decision-making for individualized client care, as well as ensuring that appropriate structures and supports are in place to provide the best possible

2004 Registered Nurses' Association of Ontario

8846. Screening for Delirium, Dementia and Depression in the Older Adult

of evidence-based nursing practice. The document needs to be reviewed and applied based on the specific needs of the organization or practice setting/environment, as well as the needs and wishes of the client. Guidelines should not be applied in a “cookbook” fashion but used as a tool to assist in decision making for individualized client care, as well as ensuring that appropriate structures and supports are in place to provide the best possible care. Nurses, other healthcare professionals (...) assessments of geriatric mental health conditions must honour the older person’s preferences, values and beliefs and involve the individual in decision making. 4. Healthcare professionals must at all times be sensitive, respectful and culturally aware to minimize the potential indignity of the assessment experience for the older person. 5. Screening assessments of geriatric mental health conditions are complex and multi-faceted. They require specialized knowledge, skills and attitudes towards geriatric

2003 Registered Nurses' Association of Ontario

8847. Promoting Asthma Control in Children

to be reviewed and applied, based on the specific needs of the organization or practice setting/environment, as well as the needs and wishes of the client. Guidelines should not be applied in a “ cookbook” fashion but used as a tool to assist in decision making for individualized client care, as well as ensuring that appropriate structures and supports are in place to provide the best possible care. Nurses, other health care professionals and administrators who are leading and facilitating practice changes (...) and across categories of nursing professionals and are based on knowledge, skills, attitudes, critical analysis and decision making which are enhanced over time by experience and education. It is expected that individual nurses will perform only those aspects of asthma assessment and management for which they have appropriate education and experience and that they will seek appropriate consultation in instances where the client’s care needs surpass their ability to act independently. It is acknowledged

2004 Registered Nurses' Association of Ontario

8848. Integrating Smoking Cessation into Daily Nursing Practice

of evidence-based nursing practice. The document should be reviewed and applied, based on the specific needs of the organization or practice setting/environment, as well as the needs and wishes of the client. Guidelines should not be applied in a “cookbook” fashion but used as a tool to assist in decision making for individualized client care, as well as ensuring that appropriate structures and supports are in place to provide the best possible care. Nurses, other healthcare professionals (...) for the Client . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Appendix L – Quit Smoking First-Line Medications Compared . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Appendix M – Strategies to Avoid Relapse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Appendix N – List of Resources Available for Smoking Cessation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80

2003 Registered Nurses' Association of Ontario

8849. Embracing Cultural Diversity in Health Care: Developing Cultural Competence

and Long-Term Care, (MOHLTC) working in partnership with Health Canada, Office of Nursing Policy, commenced the development of evidence-based best practice guidelines in order to create healthy work environments G for nurses. G Just as in clinical decision-making, it is important that those focusing on creating healthy work environments make decisions based on the best evidence possible. The Healthy Work Environments Best Practice Guidelines G Project is a response to priority needs identified (...) and indicators 4. Guidelines and standards Figure A Figure BHealthy Work Environments Best Practice Guidelines 22 Sources and Types of Evidence on Embracing Cultural Diversity in Health Care: Developing Cultural Competence Evidence-based decision-making has become the generally accepted standard for health care practices and policies. However, it must be acknowledged that the term itself is open to multiple interpretations and perspectives. The World Health Organization defines evidence as “findings from

2007 Registered Nurses' Association of Ontario

8850. Woman Abuse: Screening, Identification and Initial Response

. The document needs to be reviewed and applied, based on the specific needs of the organization or practice setting/environment, as well as the needs and wishes of the client. Guidelines should not be applied in a “cookbook” fashion but used as a tool to assist in decision making for individualized client care, as well as ensuring that appropriate structures and supports are in place to provide the best possible care. Nurses, other health care professionals and administrators who are leading (...) a description of relevant terms and concepts and a discussion of the rationale for the development of the best practice guideline. Nursing Best Practice GuidelineIt is acknowledged that individual competence in screening varies between nurses and across categories of nursing professionals (RPNs and RNs) and is based on knowledge, skills, attitudes, critical analysis and decision-making skills, which are enhanced over time by experience and education. Individual nurses will perform screening for woman abuse

2005 Registered Nurses' Association of Ontario

8851. Nursing Management of Hypertension

on the specific needs of the organization or practice setting/environment, as well as the needs and wishes of the client. Guidelines should not be applied in a “cookbook” fashion but used as a tool to assist in decision making for individualized client care, as well as ensuring that appropriate structures and supports are in place to provide the best possible care. Nurses, other healthcare professionals and administrators who are leading and facilitating practice changes will find this document valuable (...) Appendix L – Assessing Alcohol Consumption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .118 Appendix M – Smoking Cessation – Brief Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .121 Appendix N – How Vulnerable are You to Stress? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .123 Appendix O – Summary of Medication Classes Prescribed for Hypertension

2005 Registered Nurses' Association of Ontario

8852. UK guidelines for the management of sexual and reproductive health of people living with HIV

(<1000copies/ml) and where the man was on ARV treatment CD4 count had no impact on IUI outcome. There are insufficient data at present to recommend starting ARV purely to improve IUI success rates and the decision to start medication should be primarily based on the health of the individual. Joint BHIVA-BASHH-FFP UK SRH guidelines for PLHA Created on 01/06/2007 06:58:00 Page 18 of 62 Management of HIV-positive women HIV-positive women planning to have children should receive pre-conception counselling (...) should have: • A sexual health assessment including a sexual history documented at first presentation and at 6 monthly intervals thereafter– II. • Access to staff trained in taking a sexual history and who can make an appropriate sexual health assessment – III. • Access to ongoing high quality counselling and support to ensure good sexual health and to maintain protective behaviours – IV • An annual offer of a full sexual health screen (regardless of reported history) and the outcome documented

2007 British Association for Sexual Health and HIV

8853. Management of bacterial vaginosis

study . Acta Obstet Gynecol Scand 2000;79(5):390-6. 36. Crowley T, Low N, Turner A, Harvey I, Bidgood K, Horner P. Antibiotic prophylaxis to prevent post-abortal upper genital tract infection in women with bacterial vaginosis: randomised controlled trial. BJOG 2001;108:396- 402. 37. Colli E, Landoni M, Parazzini F. Treatment of male partners and recurrence of bacterial vaginosis: a randomised trial. Genitourin Med 1997;73(4):267- 70. 38. Berger BJ, Kolton S, Zenilman JM, Cummings MC, Feldman J (...) ). Stakeholder Involvement This guideline has been produced by medical specialists from relevant disciplines. Successive drafts have been reviewed by the clinical effectiveness group of BASHH. Rigour of Development An extensive literature reviewed was carried out using Medline for the years 1970 to 2005 using the keyword "bacterial vaginosis". The Cochrane library was searched using "bacterial vaginosis". Previous guidelines were sought, and the 1998 and 2002 USA guidelines reviewed. Where available

2006 British Association for Sexual Health and HIV

8854. UK National Guideline for the use of post-exposure prophylaxis for HIV following sexual exposure

help to alleviate such anxiety. However, decision-making in this setting needs to consider the potential adverse effects of antiretroviral therapy where the risk of transmission is low. Recommendations forprescribingPEPSE The writing committee feel it is crucial to consider PEPSE as only one strategy in preventing HIV infection and, as such, it should be considered as a last measure where conventional, and proven, methods of HIV prevention have failed. A risk vs bene?t analysis should be undertaken (...) transmission of human immunode?ciency virus: variability of infectivity throughout the course of infection. European Study Group on Heterosexual Transmission of HIV . Am J Epidemiol 1998;148:88– 96 12 Overbaugh J, Sagar M, Benki S, et al. Viral and host factors in HIV-1 transmission and pathogenesis. Program and abstracts of the 9th Conference on Retroviruses and Opportunistic Infections, February 24– 28, 2002. Seattle, Washington, DC (abstr. S23) 13 Vittinghoff E, Douglas J, Judson F, et al. Per-contact

2006 British Association for Sexual Health and HIV

8855. Management of PID

in this guideline may not be appropriate for use in all clinical situations. Decisions to follow these recommendations must be based on the professional judgement of the clinician and consideration of individual patient circumstances and available resources. pid_v4_0205 page 10 All possible care has been undertaken to ensure the publication of the correct dosage of medication and route of administration. However, it remains the responsibility of the prescribing physician to ensure the accuracy (...) -control study in Abidjan, Ivory Coast. Am.J.Obstet.Gynecol. 1995;172:919-25. 7. Cohen CR, Sinei S, Reilly M, Bukusi E, Eschenbach D, Holmes KK et al. Effect of human immunodeficiency virus type 1 infection upon acute salpingitis: a laparoscopic study. Journal of Infectious Diseases 1998;178:1352-8. 8. Bukusi EA, Cohen CR, Stevens CE, Sinei S, Reilly M, Grieco V et al. Effects of human immunodeficiency virus 1 infection on microbial origins of pelvic inflammatory disease and on efficacy of ambulatory

2005 British Association for Sexual Health and HIV

8856. UK National STI Screening and Testing Guideline

Grading of recommendation A evidence at level Ia or Ib B evidence at level IIa, IIb or III C evidence at level IV The structure of the guideline is as follows: • Summary tables – which make recommendations for the testing of individual sexually transmitted infections with regard to the site that should be tested and the most appropriate test that should be used, both in asymptomatic and symptomatic men and women presenting to a UK GU medicine clinic. • Testing guidelines for individual sexually (...) -specific (poor positive predictive value – 17%). Because of the serious long term sequelae of PID and the low risk associated with antibiotic use, a low threshold for making a clinical diagnosis of PID is appropriate i.e. any sexually active woman with lower abdominal pain plus either adnexal tenderness or cervical motion tenderness. Window Period The minimum time gap between exposure to a sexually transmitted infection and its successful detection will vary depending on a number of factors, including

2006 British Association for Sexual Health and HIV

8857. UK National Guideline on the sexual health of people with HIV: sexually transmitted infections

-concordant partnerships is that HIV super-infection with a more virulent strain of the virus may occur, however there are no significant studies. The final informed decision therefore remains to be made by PWHIV in light of emerging information. Service providers and HIV community organisations (notably the Terrence Higgins Trust in the UK) have an important role in supporting PWHIV to make informed choices. Legal and ethical issues In February 2001, a man was convicted in Scotland of recklessly causing (...) if required. It is advisable that this decision be discussed with others in the team and fully documented. The PWHIV should be fully supported and given information on how to contact external agencies such as THT or NAM, ideally in writing. Expert opinion [105] states that the risk of civil or criminal liability for clinicians regarding failure to prevent onward transmission is remote. The best safeguard currently is to follow General Medical Council (GMC) guidance on disclosure and confidentiality [106

2006 British Association for Sexual Health and HIV

8858. A controlled comparison study to evaluate different management strategies for workplace trauma

diagnosis of the work environment; making appropriate recommendations and long-term evaluation of the effects of work design and work role changes on employee well- being, attitudes and behaviour. One of our core aims is to increase understanding of the well-being of people at work and to disseminate this knowledge in the scientific community, in the workplace and in the wider public domain. Atos Origin Atos Origin Medical Services is a leading UK provider of occupational health, counselling, primary (...) care, capability assessment and diagnostic services. We make a positive difference to the health and wellbeing of some of the UK's largest organisations, delivering services that benefit more than two million people each year. vi Through the provision of occupational health, employee assistance programmes, screening services and counselling, including trauma support, Atos Origin Medical Services enables employers to pro-actively promote employee wellbeing, helping to reduce sickness absence

2006 British Occupational Health Research Foundation

8859. Do Statins have a Role in Primary Prevention?

but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ. 2009;338:b2376. doi:10.1136/bmj.b2376 Ray KK, Sreenivasha RKS, Sebhat E, et al. Statins and all-cause mortality in high-risk primary prevention. A meta-analysis of 11 randomized controlled trials involving 65,229 participants. Arch Intern Med. 2010;170(12):1024-1031. Bassler D, Briel M, Montori VM, et al. Stopping randomized trials early for benefit and estimation of treatment effects: systematic review and meta-regression (...) analysis. JAMA. 2010;303(12):1180-87. Shepherd J. Cobbe SM. Ford I. Isles CG. Lorimer AR. MacFarlane PW. McKillop JH. Packard CJ. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group. New England Journal of Medicine. 333(20):1301-7, 1995 Nov 16. Downs JR. Clearfield M. Weis S. Whitney E. Shapiro DR. Beere PA. Langendorfer A. Stein EA. Kruyer W. Gotto AM Jr. Primary prevention of acute coronary events with lovastatin

2003 Therapeutics Letter

8860. Trauma - neck and back trauma

, Nicholl J, Webber L, Cox H, Dixon S, Yates D. A randomised controlled trial of pre-hospital intravenous ?uid replacement therapy in serious trauma: The NHS Health Technology Assessment Programme 4(31), 2000. 44 Revell M, Porter K, Greaves I. Fluid Resuscitation in Prehospital trauma care: a consensus view. Emergency Medical Journal 2002;19(494-98). 45 Browne GJ, Lam LT, Barker RA. The usefulness of a modified adult protocol for the clearance of paediatric cervical spine injury in the emergency (...) Trauma Emergencies October 2006 Page 7 of 8 Trauma EmergenciesAPPENDIX 1 – Immobilisation Algorithm Neck and Back Trauma Page 8 of 8 October 2006 Trauma Emergencies Trauma Emergencies In an adult patient with potential spinal injury can you con?rm the following: Patient is conscious, alert and able to fully co-operate with examination? I M M O B I L I S E Patient is not under the in?uence of alcohol or drugs – illicit or prescribed (including analgesia)? Patient has no complaint of spinal pain? (note

2007 Joint Royal Colleges Ambulance Liaison Committee

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