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Emergency Medicine Pitfalls

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61. Assessment of abdominal pain in pregnancy

Consultant in Family Medicine Parker D Sanders and Isabella Sanders Professor of Primary Care Rochester MN Disclosures JB declares that he has no competing interests. Lead Obstetrician Lothian Simpson Centre for Reproductive Health The Royal Infirmary Edinburgh Scotland Disclosures RH declares that she has no competing interests. Professor UCLA School of Public Health and David Geffen School of Medicine Los Angeles Medical Director Health Disaster Management/Emergency Medical Services Orange County (...) Obstet Gynecol Rep Biol. 2007;131:4-12. http://www.ncbi.nlm.nih.gov/pubmed/16982130?tool=bestpractice.com Diagnostic challenges and pitfalls The physiological and anatomical changes of various organs during the course of pregnancy result in major diagnostic challenges for the clinician. Reproductive organs share the same visceral innervations as the lower ileum, sigmoid colon, and rectum. It is therefore often difficult to differentiate between pain of gynaecological and GI origin. Pain may be due

2018 BMJ Best Practice

62. Diagnosis and management of epilepsy in adults

practice 69 11.4 Additional advice to NHSScotland from Healthcare Improvement Scotland and the Scottish Medicines Consortium 69 12 The evidence base 72 12.1 Systematic literature review 72 12.2 Recommendations for research 72 12.3 Review and updating 73 13 Development of the guideline 74 13.1 Introduction 74 13.2 The guideline development group 74 13.3 Consultation and peer review 76 Abbreviations 78 Annexes 80 References 84| 1 1 Introduction 1.1 THE NEED FOR A GUIDELINE Since the publication of SIGN (...) , this guideline was updated to take account of new drug safety advice from the Medicines and Healthcare products Regulatory Agency (MHRA), published in April 2018, relating to use of valproate medicines in women and girls of childbearing potential. 454 Warnings have been inserted where relevant in sections 4 and 5 to reflect this advice. 2 Key recommendations New 3 Diagnosis Updated 4 Treatment Updated September 2018 5 Epilepsy and women’s health Updated September 2018 6 Psychiatric comorbidity New 7 Sleep

2018 SIGN

63. Quality indicators for pulmonary rehabilitation programs in Canada: A CTS expert working group report

University, Halifax, Nova Scotia, Canada; b Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada; c Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada; d Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; e Division of Respirology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; f Division of Pulmonary Medicine, Department of Medicine (...) , University of Alberta, Edmonton, Alberta, Canada; g G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, Alberta, Canada; h Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; i Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; j Department of Medicine, University of Toronto, Toronto, Ontario, Canada; k Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; l Division of Respirology, Critical Care and Sleep

2019 Canadian Thoracic Society

64. Transition from children's to adults' services for young people using health or social care services

services (NG43) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 4 of 32Recommendations Recommendations People using services have the right to be involved in discussions and make informed decisions about their care, as described in your care. Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (...) that they share with adults' services. This should be in the young person's preferred format. It should be produced early enough to form part of discussions with the young person about planning their transition (for example 3 months before transfer). It could contain: a 1-page profile information about their health condition, education and social care needs their preferences about parent and carer involvement emergency care plans history of unplanned admissions their strengths, achievements, hopes

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

65. Menopause

used on a regular, twice-weekly basis for relief of vaginal dryness. Long-term use is agreed by NICE with no monitoring of the endometrium or progestrogen needed. Women with breast cancer may be able to use local oestrogens – seek specialist advice. Prescribed alternatives to HRT These are not first line treatments but may be used with selective women who can not take hormones. Selective serotonin reuptake inhibitors (SSRIs) and seratonin and norepinephrine reuptake inhibitors (SNRIs) Emerging (...) the General Medical Council’s Prescribing guidance: prescribing unlicensed medicines for further information. The therapeutic approach The way in which menopause is perceived and experienced is influenced by its timing, personal meaning and severity of bodily symptoms which

2018 Royal College of Nursing

66. Guidelines on Diagnosis and Management of Syncope

contribution of the European Heart Rhythm Association (EHRA) Endorsed by: European Academy of Neurology (EAN), European Federation of Autonomic Societies (EFAS), European Federation of Internal Medicine (EFIM), European Union Geriatric Medicine Society (EUGMS), European Society of Emergency Medicine (EuSEM) The disclosure forms of all experts involved in the development of these Guidelines are available on the ESC website . For the Supplementary Data which include background information and detailed (...) EEG Electroencephalogram EFAS European Federation of Autonomic Societies EFIM European Federation of Internal Medicine EHRA European Heart Rhythm Association ENS European Neurological Society EPS Electrophysiological study ESC European Society of Cardiology EUGMS European Union Geriatric Medicine Society EuSEM European Society of Emergency Medicine HBPM Home blood pressure monitoring HCM Hypertrophic cardiomyopathy HR Heart rate ICD Implantable cardioverter defibrillator ILR Implantable loop

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2018 European Society of Cardiology

68. Accountable care organisations

for review questions 1 and 2 41 Appendix 4 — US Centers for Medicare & Medicaid Services ACO quality outcome measures 69 Appendix 5 — Case studies 71 6 ACCOUNTABLE CARE ORGANISATIONS| SAX INSTITUTE List of acronyms ACC Accountable Care Collaborative ACCHS Aboriginal Community Controlled Health Service ACO Accountable Care Organisation AHC Accountable Health Community AQC Alternative Quality Contract A & E Accident & Emergency BCBSMA Blue Cross Blue Shield of Massachusetts CCG Clinical Commissions Group (...) CCO Coordinated Care Organisation CMMI Centers for Medicare & Medicaid Services Innovation CMS Centers for Medicare & Medicaid Services DOH Department of Health EHR Electronic Health Record EM Electronic Medical Record ER Emergency Room ESRD End Stage Renal Disease FFS Fee for Service FLO Florence Simple Telehealth FY Financial Year HCP Health Care Partners HCH Health Care Homes HIT Health Information Technology HMO Health Maintenance Organisation iCMP integrated Care Management Program LHD Local

2018 Sax Institute Evidence Check

69. Management of Stroke in Neonates and Children

of telestroke or telemedicine as a specific way of bringing expertise to emergency providers who may have less experience with acute focal deficits and stroke in children. Telestroke has been effective in adult stroke medicine and has been used in other settings in pediatric cardiovascular care. Pediatric stroke specific guidelines should be developed at the local, regional, and national levels. To leverage regional stroke expertise, partnerships between emergency medical services, comprehensive stroke (...) and plays a role in angiogenesis. Maternal factors that may be associated with perinatal AIS include primiparity or a history of infertility, chorioamnionitis, oligohydramnios, premature rupture of membranes, vacuum extraction, emergency cesarean section, coagulation disorders, and preeclampsia. Individuals with presumed perinatal ischemic stroke have similar risk factors. , The likelihood of neonatal AIS increases dramatically with an increasing number of risk factors, but in many individuals

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2019 American Heart Association

70. What Is the Accuracy of Physical Examination, Imaging, and the LRINEC Score for the Diagnosis of Necrotizing Soft Tissue Infection? (SRS diagnosis)

characteristics. No single element of the physical examination, radiography, or the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score has suf?cient sensitivity to exclude necrotizing soft tissue infection. EBEM Commentators Michael D. April, MD, DPhil Brit Long, MD Department of Emergency Medicine San Antonio Uniformed Services Health Education Consortium Fort Sam, Houston, TX Jestin N. Carlson, MD, MS, and Alan Jones, MD, serve as editors of the SRS series. Editor’s Note: This is a clinical (...) characteristics of one or more of INFECTIOUS DISEASE/SYSTEMATIC REVIEW SNAPSHOT 22 Annals of Emergency Medicine Volume 73, no. 1 : January 2019Of 2,290 initial citations, the au- thors included 23 studies including 16 retrospective cohort studies, 2 prospective cohort studies, and 5 retrospective case- control studies. Pooled sensitivity values for physical examination ?ndings ranged from 21.0% for hypotension to 46.0% for fever (Table). The sensitivity of CT presence of fascial edema, fascial enhancement

2018 Annals of Emergency Medicine Systematic Review Snapshots

71. ESC/ESH Management of Arterial Hypertension

million), and ischaemic stroke (1.5 million). Both office BP and out-of-office BP have an independent and continuous relationship with the incidence of several CV events [haemorrhagic stroke, ischaemic stroke, myocardial infarction, sudden death, heart failure, and peripheral artery disease (PAD)], as well as end-stage renal disease. Accumulating evidence is closely linking hypertension with an increased risk of developing atrial fibrillation (AF), and evidence is emerging that links early elevations (...) ventricular. There is also emerging evidence that an increase in serum uric acid to levels lower than those typically associated with gout is independently associated with increased CV risk in both the general population and in hypertensive patients. Measurement of serum uric acid is recommended as part of the screening of hypertensive patients. The SCORE system only estimates the risk of fatal CV events. The risk of total CV events (fatal and non-fatal) is approximately three times higher than the rate

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2018 European Society of Cardiology

72. Headache

in an ambulatory family practice setting disclosed that most scans were ordered because the clinician suspected that a tumor (49%) or a subarachnoid hemorrhage (SAH) (9%) might be present. Fifty-nine (17%) were ordered because of patient expectation or medicolegal concerns [22]. When considering such a common disorder as headache, indications for imaging use become relevant. This is particularly true in the face of emerging and rapidly evolving technologies in use today [23-26]. In frequent conditions (...) University Hospital, Indianapolis, Indiana. 2 Panel Chair, Mallinckrodt Institute of Radiology, Saint Louis, Missouri. 3 Panel Vice- chair, Mayo Clinic Jacksonville, Jacksonville, Florida. 4 Emory Healthcare, Atlanta, Georgia. 5 University of Illinois College of Medicine, Chicago, Illinois, American Association of Neurological Surgeons/Congress of Neurological Surgeons. 6 Hampton Roads Radiology Associates, Norfolk, Virginia. 7 Emory Universtiy, Atlanta, Georgia. 8 Mount Sinai School of Medicine, New

2019 American College of Radiology

73. Clinically Suspected Vascular Malformation of the Extremities

, University of Michigan Health System, Ann Arbor, Michigan. e Mayo Clinic, Rochester, Minnesota. f Tufts University School of Medicine, Boston, Massachusetts; Society for Vascular Surgery. g Massachusetts General Hospital, Boston, Massachusetts. h University of Alabama at Birmingham, Birmingham, Alabama. i Mayo Clinic, Rochester, Minnesota. j University of Michigan Health System, Ann Arbor, Michigan. k UT Southwestern Medical Center, Dallas, Texas. l UT Southwestern Medical Center, Dallas, Texas. m (...) [3,6,20]. Although MRI is generally considered high yield for evaluating lesion extent and often can distinguish between the various types of vascular malformations and soft-tissues masses, its evaluation of flow dynamics and intralesional vascular anatomy is limited when compared with MRA [3]. MRA Extremity MRA has emerged as the preferred modality for assessing vascular malformations, particularly in patients with a vascular murmur and suspected high-flow malformation, due to its exceptional ability

2019 American College of Radiology

74. ACR–ASNR–SPR Practice Parameter for the Performance of Computed Tomography (CT) Perfusion in Neuroradiologic Imaging Revised

, limitations of available resources, or advances in knowledge or technology subsequent to publication of this document. However, a practitioner who employs an approach substantially different from the guidance in this document is advised to document in the patient record information sufficient to explain the approach taken. The practice of medicine involves not only the science, but also the art of dealing with the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity (...) , and diseases of the central nervous system, spine, and head and neck and the subtle findings for which urgent therapy may be warranted, such as in acute stroke. Additionally, supervising physicians should have appropriate knowledge of alternative imaging methods, including the use of and indications for such specialized studies as angiography, ultrasonography, MRI, and nuclear medicine studies. 3. The physician should be familiar with the appropriate requirements for patient preparation for the examination

2019 American Society of Neuroradiology

75. Developing a Value Framework for Genetic Diagnosis: Part I A Systematic Review of Outcomes Hierarchies and Measurement Approaches

Coronary artery disease CBA Cost-benefit analysis CEA Cost-effectiveness analysis CGS Clinical genetic services CUA Cost-utility analysis EMR Electronic medical records EU European Union EGAPP Evaluation of Genomic Applications in Practice and Prevention HbA 1 c Hemoglobin A 1 c HRQL Health-related quality of life IOM Institute of Medicine NICE United Kingdom (UK) National Institute for Health and Clinical Excellence NIH National Institutes of Health (DHHS) NQMC National Quality Measures Clearinghouse (...) guidelines ”on the effectiveness and appropriate use of health services. 1 In 1990, the Institute of Medicine (IOM) defined quality in health care as: “..the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” 2,3 This definition was reaffirmed in 2001 in a report from the IOM Committee on Quality of Health Care entitled Crossing the Quality Chasm: A new health system for the 21 st

2019 American College of Medical Genetics and Genomics

76. Global Vascular Guidelines for patients with chronic limb-threatening ischemia

(Steering Committee) d , x Florian Dick Affiliations Department of Vascular Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland , MD (Steering Committee) e , x Robert Fitridge Affiliations Department of Vascular and Endovascular Surgery, The University of Adelaide Medical School, Adelaide, South Australia , MBBS (Steering Committee) f , x Joseph L. Mills Affiliations Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine, Houston, Tex , MD (Steering Committee) g , x (...) on smoking cessation, diet, exercise, and preventive foot care. Following EBR, long-term limb surveillance is advised. The effectiveness of nonrevascularization therapies (eg, spinal stimulation, pneumatic compression, prostanoids, and hyperbaric oxygen) has not been established. Regenerative medicine approaches (eg, cell, gene therapies) for CLTI should be restricted to rigorously conducted randomizsed clinical trials. The GVG promotes standardization of study designs and end points for clinical trials

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2019 Society for Vascular Surgery

77. ACR–ASNR Practice Parameter for the Performance of Computed Tomography (CT) of the Brain

to publication of this document. However, a practitioner who employs an approach substantially different from the guidance in this document is advised to document in the patient record information sufficient to explain the approach taken. The practice of medicine involves not only the science, but also the art of dealing with the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis (...) ) Perfusion in Neuroradiologic Imaging [133]. B. Patient monitoring equipment and facilities for cardiopulmonary resuscitation, including vital signs monitoring equipment, support equipment, should be immediately available. Appropriate emergency equipment and medications must be immediately available to treat adverse reactions associated with administered medications. The equipment and medications should be monitored for inventory and drug expiration dates on a regular basis. The equipment, medications

2019 American Society of Neuroradiology

78. ACR–ASNR–SPR Practice Parameter for the Performance and Interpretation of Cervicocerebral Computed Tomography Angiography (CTA)

by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of this document. However, a practitioner who employs an approach substantially different from the guidance in this document is advised to document in the patient record information sufficient to explain the approach taken. The practice of medicine involves not only the science, but also the art of dealing with the prevention, diagnosis, alleviation, and treatment of disease (...) an assessment of the vasculature of interest, the end-organ, and adjacent tissues. Appropriate emergency equipment and medications must be immediately available to treat adverse reactions associated with administered medications. The equipment and medications should be monitored for inventory and drug expiration dates on a regular basis. The equipment, medications, and other emergency support must also be appropriate for the range of ages and sizes in the patient population. VIII. RADIATION SAFETY

2019 American Society of Neuroradiology

79. ACR–ASNR–SPR Practice Parameter for the Performance of Magnetic Resonance Imaging (MRI) of the Head and Neck

, or advances in knowledge or technology subsequent to publication of this document. However, a practitioner who employs an approach substantially different from the guidance in this document is advised to document in the patient record information sufficient to explain the approach taken. The practice of medicine involves not only the science, but also the art of dealing with the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible (...) , contraindications to magnetic field exposure (see section V below), artifacts from metallic objects in the head and neck, and long scan times relative to CT for emergent indications. CT may be a better option than MRI if there are patient limitations such as significant claustrophobia, altered mentation, or an underlying medical condition such as congestive heart failure or a breathing disorder that makes lying flat difficult. CT may also be the procedure of choice for evaluating neck lesions associated

2019 American Society of Neuroradiology

80. WHO Guideline: recommendations on digital interventions for health system strengthening

devices, orthotics and prosthetics. Telemedicine, remote care and mobile health are helping us transform health by delivering care in people’s homes and strengthening care in health facilities. Artificial intelligence is being used to give paraplegic patients improved mobility, to manage road traffic and to develop new medicines. Machine learning is helping us to predict outbreaks and optimize health services. Propelled by the global ubiquity of mobile phones, digital technologies have also changed (...) is that they are evolving rapidly; so will this guideline. As new technologies emerge, new evidence will be used to refine and expand on these recommendations. WHO is significantly enhancing its work in digital health to ensure we provide our Member States with the most up-to-date evidence and advice to enable countries to make the smartest investments and achieve the biggest gains in health. Ultimately, digital technologies are not ends in themselves; they are vital tools to promote health, keep the world safe

2019 World Health Organisation Guidelines

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