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Emergency Medicine Pitfalls

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141. Prostate Cancer

. Eur Urol, 2018. S0302: 30752. 3. Guyatt, G.H., et al. What is “quality of evidence” and why is it important to clinicians? BMJ, 2008. 336: 995. 4. Guyatt, G.H., et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008. 336: 924. 5. Phillips, B., et al. Oxford Centre for Evidence-based Medicine Levels of Evidence. Updated by Jeremy Howick March 2009. 6. Guyatt, G.H., et al. Going from evidence to recommendations. BMJ, 2008. 336: 1049. 7. Van den (...) food and prostate cancer risk: systematic review and meta-analysis. Int J Food Sci Nutr, 2015. 66: 587. 42. Chen, P., et al. Lycopene and Risk of Prostate Cancer: A Systematic Review and Meta-Analysis. Medicine (Baltimore), 2015. 94: e1260. 43. Rowles, J.L., 3rd, et al. Processed and raw tomato consumption and risk of prostate cancer: a systematic review and dose-response meta-analysis. Prostate Cancer Prostatic Dis, 2018. 21: 319. 44. Ilic, D., et al. Lycopene for the prevention and treatment

2018 European Association of Urology

142. Chronic Pelvic Pain

cystitis: an ESSIC proposal. Eur Urol, 2008. 53: 60. 12. Longstreth, G.F., et al. Functional bowel disorders. Gastroenterology, 2006. 130: 1480. 13. Guyatt, G.H., et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. Bmj, 2008. 336: 924. 14. Guyatt, G.H., et al. What is "quality of evidence" and why is it important to clinicians? Bmj, 2008. 336: 995. 15. Phillips B, et al. Oxford Centre for Evidence-based Medicine Levels of Evidence. Updated by Jeremy Howick (...) . Eur Urol, 2008. 53: 33. 69. Hanno, P., et al. Bladder Pain Syndrome Committee of the International Consultation on Incontinence. Neurourol Urodyn, 2010. 29: 191. 70. Yoon, B.I., et al. Clinical courses following acute bacterial prostatitis. Prostate Int, 2013. 1: 89. 71. Giamberardino, M.A., et al. Viscero-visceral hyperalgesia: characterization in different clinical models. Pain, 2010. 151: 307. 72. Wesselmann, U., et al. Emerging Therapies and Novel Approaches to Visceral Pain. Drug Discov Today

2018 European Association of Urology

143. Thyroid Cancer

Thyroid Cancer Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up † S. Filetti 1 , C. Durante 1 , D. Hartl 2 , S. Leboulleux 3 , L.D. Locati 4 , K. Newbold 5 , M.G. Papotti 6 , A. Berruti 7 , on behalf of the ESMO Guidelines Committee* 1 Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy; 2 Department of Head and Neck Oncology, Gustave Roussy and Université Paris Saclay, Villejuif; 3 Department of Nuclear (...) Medicine and Endocrine Oncology, Gustave Roussy and Université Paris Saclay, Villejuif, France; 4 Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; 5 Head and Neck Unit, The Royal Marsden NHS Foundation Trust, London, UK; 6 Department of Pathology, University of Turin, Turin; 7 Oncology Unit, University of Brescia, Brescia, Italy. *Correspondence to: ESMO Guidelines Committee, ESMO Head Office, Via Ginevra 4, 6900 Lugano, Switzerland. E-mail

2019 European Society for Medical Oncology

144. Male Infertility

guidelines on Male Infertility: the 2012 update. Eur Urol, 2012. 62: 324. 3. Guyatt, G.H., et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ, 2008. 336: 924. 4. Guyatt, G.H., et al. What is “quality of evidence” and why is it important to clinicians? BMJ, 2008. 336: 995. 5. Phillips B, et al. Oxford Centre for Evidence-based Medicine Levels of Evidence. Updated by Jeremy Howick March 2009. 1998. 6. Guyatt, G.H., et al. Going from evidence (...) -ejaculated sperm. Hum Reprod, 2011. 26: 1752. 34. Carrell, D.T. The clinical implementation of sperm chromosome aneuploidy testing: pitfalls and promises. J Androl, 2008. 29: 124. 35. Johnson, M.D. Genetic risks of intracytoplasmic sperm injection in the treatment of male infertility: recommendations for genetic counseling and screening. Fertil Steril, 1998. 70: 397. 36. Clementini, E., et al. Prevalence of chromosomal abnormalities in 2078 infertile couples referred for assisted reproductive techniques

2018 European Association of Urology

145. Trauma (blunt)

where present ​​​​​​​May require hospital admission Evidence base *GRADE: Grading of Recommendations Assessment, Development and Evaluation ( ) Sources of evidence Alteveer J, Lahmann B. An evidence-based approach to traumatic ocular emergencies. Emergency Medicine Practice 2010;12(5):1-21 Betts T, Ahmed S, Maguire S, Watts P. Characteristics of non-vitreoretinal ocular injury in child maltreatment: a systematic review. Eye (Lond). 2017;31(8):1146-54 Kuhn F, Morris R, Witherspoon CD, Mester V (...) =low, Strength of recommendation=strong) In cases of corneal abrasion consider topical antibiotic (GRADE*: Level of evidence=low, Strength of recommendation=weak) Management category Management depends on severity of injury Mild cases: B2: alleviation or palliation; referral unnecessary Severe cases: A2: first aid measures and emergency (same day) referral to A&E Possible management by ophthalmologist Assessment and investigation including imaging (e.g. X-ray, CT, MRI) Treatment of globe rupture

2018 College of Optometrists

146. Low back pain and radicular pain: development of a clinical pathway

Belgische Vereniging voor Orthopedie en Traumatologie BVGA – ABMA Belgische Vereniging van Geneesheren-Acupuncturisten – Association Belge des Médecins Acupuncteurs CEBAM Belgisch Centrum voor Evidence-Based Medicine CHC Centre Hospitalier Chrétien CHU – UVC Centre Hospitalier Universitaire – Universitair Verplegingscentrum (University Hospital Centre) 8 Low back pain and radicular pain: development of a clinical pathway KCE Report 295 COI Conflict of Interest COMI Core outcome measure index DPBW – SPMT (...) of public health) KCE Report 295 Low back pain and radicular pain: development of a clinical pathway 9 KBVFGR – SRBMPR Koninklijke Belgische Vereniging voor fysische geneeskunde & revalidatie – RBSPRM – Société Royale Belge de médecine physique et de réadaptation – Royal Belgian Society of Physical and Rehabilitation Medicine KU Catholic University (Katholieke Universiteit) LBP Low back pain LMN Lokaal Multidisciplinair Netwerk LUSS Ligue des Usagers des Services de Santé MEDLINE Medical Literature

2017 Belgian Health Care Knowledge Centre

147. Required hospital capacity in 2025 and criteria for rationalisation of complex cancer surgery, radiotherapy and maternity services

cStage Clinical stage CT Computed Tomography DBC Diagnosis Treatment Combination DC Day care 26 Required hospital capacity and criteria for rationalisation KCE Report 289 DGOS General Directorate of Care Provision (‘Direction Générale de l’Offre de Soins’) (France) DHMA Danish Health and Medicines Authority DPCA Dutch Pancreatic Cancer Audit DREES ‘Direction de la Recherche, des Etudes, de l’Evaluation et des Statistiques’ (France) DRG Diagnosis Related Group DUCA Dutch Upper GI Cancer Audit EBRT (...) External Beam Radiotherapy EC Endoscopic ED Emergency Department ENT Ear, Nose, and Throat ERCP Endoscopic Retrograde Cholangiopancreatography ERNs European Reference Networks ESRG Extended Service Related Groups ET Endocrine Tumour EU European Union EUS Endoscopic ultrasound FANC – ACFN Federaal Agentschap voor Nucleaire Contrôle/Agence Fédérale de Contrôle Nucléaire/ FDP-PET Fluorodeoxyglucose - Positron Emission Tomography FOD – SPF Federal Public Service Health, Food Chain Safety and Environment

2017 Belgian Health Care Knowledge Centre

148. Acute coronary syndrome

cardiologists, ambulance services, acute and emergency medicine specialists and laboratory services. Recommendations for postdischarge treatment, in particular, will also be of interest to general practitioners and other healthcare professionals in primary care as well as patients, carers, voluntary organisations and policy makers. 1.2.5 SUMMARY OF UPDATES TO THE GUIDELINE, BY SECTION 1.1 The need for a guideline Updated 1.2.1 Overall objectives Minor update 1.2.2 Definition of ACS Updated 1.2.3 Prognosis (...) 10.1 Early psychosocial interventions 35 10.2 Information needs of patients 35 10.3 Sources of further information 37 11 Implementing the guideline 39 11.1 Implementation strategy 39 11.2 Resource implications of key recommendations 39 11.3 Auditing current practice 39 11.4 Additional advice to NHSScotland from the Scottish Medicines Consortium 40 12 The evidence base 41 12.1 Systematic literature review 41 12.2 Recommendations for research 41 12.3 Review and updating 42 13 Development

2016 SIGN

149. BSR guideline Management of Adults with Primary Sjögren's Syndrome

2Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham3Birmingham and Midland Eye Centre, City Hospital NHS Trust, Birmingham Search for other works by this author on: Anwar R. Tappuni 4Institute of Dentistry, Queen Mary University of London Search for other works by this author on: Nurhan Sutcliffe 5Department of Rheumatology, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Barts Health NHS Trust, London Search for other works by this author (...) on: Katie L. Hackett 6Musculoskeletal Research Group, Institute of Cellular Medicine, Newcastle University & Newcastle NIHR Biomedical Research Centre, Newcastle upon Tyne7Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne Search for other works by this author on: Francesca Barone 8Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham9Rheumatology Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK Search for other

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2017 British Society for Rheumatology

150. Staff and Associate Specialist Grade Handbook (Third Edition)

and appraisal 9 9. Working less than full-time 11 10. Addiction, sickness and returning to work 13 11. Clinical governance and professional development 17 12. Medico-legal pitfalls in anaesthesia and how to avoid them 18 13. Handling patient complaints and staying out of trouble 20 14. Dignity and respect in the workplace 22 15. Good practice guidance for SAS anaesthetists 23 16. Certificate of eligibility for specialist registration 27 17. The RCoA Fellowship Examination 29 18. Personal development (...) . Alternatively the OOH PAs could remain as 4 hour units of time, but will be paid at time and a third. Where work is carried out as part of the basic 10 PA working week, this will be pensionable. PAs for any work over and above the basic 10 PA working week, such as APAs or OOH work, which are undertaken in excess of the basic 10 PA commitment, are not pensionable. All emergency work that takes place at regular and predictable times should be programmed into the working week, and counted towards the PAs

2017 Association of Anaesthetists of GB and Ireland

151. Glasgow Coma Scale for Field Triage of Trauma: A Systematic Review

conflicts of interest identified. The list of Technical Experts who provided input to this report follows: Eileen Metzger Bulger, M.D., FACS* Professor Department of Surgery University of Washington Chief of Trauma, Harborview Medical Care Seattle, WA Steven M. Green, M.D., FACEP* Professor Emergency Medicine and Pediatrics Loma Linda University Medical Center and Children’s Hospital Loma Linda, CA Julie C. Leonard, M.D., M.P.H.* Associate Professor Department of Pediatrics Division of Emergency (...) Medicine The Ohio State University College of Medicine Columbus, OH E. Brooke Lerner, Ph.D.* Professor With Tenure Departments of Emergency Medicine and Pediatrics Medical College of Wisconsin Milwaukee, WI N. Clay Mann, Ph.D., M.S.* Professor Department of Pediatrics University of Utah School of Medicine Salt Lake City, UT P. Daniel Patterson, Ph.D., M.P.H., M.S., N.R.P.* Adjunct Assistant Professor Department of Emergency Medicine University of Pittsburgh Pittsburgh, PA iv Scott M. Sasser, M.D

2017 Effective Health Care Program (AHRQ)

152. Finding Quality Addiction Care in Canada: Drug and Alcohol Treatment Guide

relationships, work, school, social activities)? Source: Diagnostic and Statistical Manual (DSM 5) If you are concerned about your own or someone else’s alcohol or other drug use, you can get a full assessment by an addiction or healthcare provider. It is best to be assessed by someone with specialized training in alcohol and other drug treatment. Who can help? Professionals with the following credentials can help if they are also trained in addiction treatment. • Medical doctors (M.D.) • Addiction Medicine (...) might be present to respond to someone having an overdose. Naloxone can temporarily reverse the effects of an opioid overdose providing time to see emergency medical attention by calling 911. In addition to the above, community-based harm reduction programs also support people who use drugs to reduce harms that come from drug use and help to stabilize and improve their health by linking them to food, safe shelter, physical health, dental care and other needed supports. Withdrawal from alcohol

2017 Canadian Centre on Substance Abuse

153. Clinical Governance Frameworks - Report

group The working group included the following fellows: • Dr Lawrie Malisano • Mr Richard Lander • Professor Michael Grigg • Professor Guy Maddern • Dr John Quinn • Associate Professor Stephen Tobin 9 Clinical governance, emergence and definitions A focus on patient safety – redressing system failures Most individuals who interact with health systems receive high quality and safe care; however, as recognised in the seminal To Err is Human report (Institute of Medicine 2000),as in all complex systems (...) summary 4 Clinical governance 4 Methods 4 Findings 4 Measuring clinical governance 4 Features of organisations with good clinical governance 5 Lessons from the case studies 5 Checklist items for the surgical team 6 Reflection on the role of a surgical director 6 Methods of review 7 Phase one – Literature review 7 Phase two – Presentation of selected case studies 7 Phase three – Developing a team-assessment tool for surgeons 7 The working group 8 Clinical governance, emergence and definitions 9 A focus

2017 ASERNIP-S

154. CRACKCast E085 – Aortic Dissection

on the topic. As with anything in medicine, its all about the anatomy and what goes wrong with it: Made up of three layers: intima, media, and adventitia Dissecting aorta is the correct term, as the common dissecting aortic aneurysm is a misnomer: most dissections do not have aneurysm. The Aorta is tres importante: Rupture through it or occlusion of it will kill you pretty quick. Pathophysiology: As the heart pendulum’s (swings) side to side it applies force (flexion forces) to ascending and descending (...) a surprisingly high +LR = 5. Feel. Feel for a pulse deficit which has a +LR = 2.7.” Watch out for pseudo hypotension: if the dissection knocks off a subclavian it will artificially drop the BP in that arm BP Pitfall: Do not assume that the patient with a normal or low BP does not have an aortic dissection. We know from the IRAD data that only about half of patients are hypertensive at initial presentation. Dissection that progress into the pericardium and end up with tamponade are often hypotensive. BP Pearl

2017 CandiEM

155. CAEP FEI | Beyond the PowerPoint Lecture

CAEP FEI | Beyond the PowerPoint Lecture CAEP FEI | Beyond the PowerPoint Lecture - CanadiEM CAEP FEI | Beyond the PowerPoint Lecture In , by Isabelle Ouellet May 26, 2017 Han is a third year Emergency Medicine resident who can’t stand PowerPoint. Every Tuesday, he attends his full academic day from 0900-1700. Almost every lecture is a didactic PowerPoint presentation, and after a few minutes of each presentation his mind starts to wander and he finds the learning style tends to be passive (...) , which tends to be low-yield. Surely all these smart residents can engage their audiences better! Despite (some) appearances to the contrary, there are many ways to deliver lecture material in Emergency Medicine. This Feature Educational Innovation (FEI), titled “ Presentation to peers: above and beyond the Power Point lecture. Experiential approach to different teaching methods by residents in emergency medicine ” was originally posted by the on December 15, 2015 and answers the question: “ How can

2017 CandiEM

156. Clinical Ultrasonography 101: Where Right Upper Quadrant Scans Go Wrong

of Toronto. (Visited 1,304 times, 1 visits today) Craig Brick Craig Brick is an Emergency Medicine resident at the University of Toronto and an Ultrasound fellow at Sunnybrook Health Sciences Centre. Latest posts by Craig Brick ( ) - May 16, 2017 Follow CRACKCast Schedule Mondays: CRACKCast Tuesdays: Medical Concepts Wednesdays: Opinion Thursdays: Throwbacks Fridays: National Interest Submit Content Join our community of educators by submitting a blog post, opinion piece, chalk talk, or lecture. Share (...) Clinical Ultrasonography 101: Where Right Upper Quadrant Scans Go Wrong Clinical Ultrasonography 101: Where Right Upper Quadrant Scans Go Wrong - CanadiEM Clinical Ultrasonography 101: Where Right Upper Quadrant Scans Go Wrong In by Craig Brick May 16, 2017 The FAST exam helped pave the way for Emergency point of care ultrasound. Compared to many emergency US applications still in their infancy, the FAST exam has been thoroughly studied, widely implemented, and has proven utility. … sorry

2017 CandiEM

157. Tiny Tips: HEART Score – A Tool for Acute Coronary Syndrome

on the HEART score, please visit www.heartscore.nl Dr Barbara Backus, MD, PhD Emergency Medicine Specialist, The Hague Medical Center, Netherlands (Visited 4,358 times, 1 visits today) Richard Tang Yuchen (Richard) Tang is a medical student at McMaster University (Class of 2018) with a strong interest in Emergency Medicine, Resuscitation, and Evidence-Based Medicine. When not stressing out about clerkship, CaRMS and other major life decisions, he spends his limited free time on nature hikes, long distance (...) Tiny Tips: HEART Score – A Tool for Acute Coronary Syndrome Tiny Tips: HEART Score - A Tool for Acute Coronary Syndrome - CanadiEM Tiny Tips: HEART Score – A Tool for Acute Coronary Syndrome In , by Richard Tang May 9, 2017 Chest Pain? Better check out the HEART (Score)! Chest pain suspected to be of cardiac origin is a common presentation in the first-world Emergency Department, but trying to decide the appropriate level of care of these patients can often be challenging. What if the chest

2017 CandiEM

158. Can Noncontrast Head Computed Tomography Within 6 Hours of Symptom Onset Exclude Aneurysmal Subarachnoid Hemorrhage?

Department of Emergency Medicine University of Arkansas for Medical Sciences Little Rock, AR Results Of 882 titles, 5 trials (8,907 pa- tients) were included for analysis. Four had a retrospective design and 1 was prospective. Aside from the single prospective cohort trial, overall trial quality was moderate to poor, with a high risk of bias. Commentary Acute-onsetatraumaticheadacheis a common emergency department (ED) presentation. Of greatest concern is the potential for sub- arachnoid hemorrhage (...) , and likelihood ratios with 95% con?dence intervals. Heterogeneity was reported with the I 2 statistic. NEUROLOGY/SYSTEMATIC REVIEW SNAPSHOT 352 Annals of Emergency Medicine Volume 68, no. 3 : September 2016radiologist.” 4 The strength of the literatureisdrivenby1 large,well- executed, prospective cohort trial by Perry et al. 1 No subarachnoid hemorrhages were missed in this trial, in which 121 of 953 patients were evaluated within 6 hours. Unfortunately, all other included trials (4) were retrospective

2016 Annals of Emergency Medicine Systematic Review Snapshots

160. First Trimester Vaginal Bleeding

University of Alabama at Birmingham, Birmingham, Alabama. m Valley Hospital, Ridgewood, New Jersey and NYU School of Medicine, New York, New York; American Congress of Obstetricians and Gynecologists. n Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels (...) due to unintentional imaging of the pregnancy [67]. Because of its ionizing radiation, CT is generally not performed to evaluate vaginal bleeding in the first trimester of pregnancy. CT may identify an ectopic pregnancy [68], but reported cases of ectopic pregnancy diagnosed on CT were often performed for other reasons or in patients not known to be pregnant [77,78]. When a patient is clinically unstable, emergent care should generally not be delayed by additional imaging with CT or MRI. RPOC may

2017 American College of Radiology

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