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22. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease

and Evidence Review? ? ? ? ? ? ? ? ? e728 1?2? Organization of the Writing Committee ? ? ? ? ? ? e730 1?3? Document Review and Approval ? ? ? ? ? ? ? ? ? ? ? e730 1?4? Scope of Guideline ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? e731 2? Clinical Assessment for PAD ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? e733 2?1? History and Physical Examination: Recommendations ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? e733 3? Diagnostic Testing for the Patient With Suspected Lower Extremity PAD (Claudication or CLI (...) of vertebral artery steal), no further imaging or intervention is warranted. Recommendations for History and Physical Examination (Continued) COR LOE Recommendations Table 4. Patients at Increased Risk of PAD Age =65 y Age 50–64 y, with risk factors for atherosclerosis (eg, diabetes mellitus, history of smoking, hyperlipidemia, hypertension) or family history of PAD 63 Age 1.40). 27,67–69,72 See Online Data Supplement 4. Standardized reporting improves communication among healthcare providers. Calculated

2017 American Heart Association

23. Management of Diabetes Mellitus in Primary Care

information. New technology and more research will improve patient care in the future. The CPG can assist in identifying priority areas for research and to inform optimal allocation of resources. Future studies examining the results of CPG implementation may lead to the development of new evidence particularly relevant to clinical practice. VA/DoD Clinical Practice Guideline for the Management of Type 2 Diabetes Mellitus in Primary Care April 2017 Page 17 of 160 IV. Guideline Work Group Guideline Work (...) allows the provider to follow a simplified linear approach in assessing the critical information needed at the major decision points in the clinical process, and includes: • An ordered sequence of steps of care • Relevant observations and examinations • Decisions for consideration • Actions to be taken A clinical algorithm diagrams a guideline into a step-by-step decision tree. Standardized symbols are used to display each step in the algorithm and arrows connect the numbered boxes indicating

2017 VA/DoD Clinical Practice Guidelines

24. Cerumen Impaction Full Text available with Trip Pro

and coordination of care. Introduction Cerumen, or “earwax,” is a naturally occurring substance that cleans, protects, and lubricates the external auditory canal. It is also the primary reason why the ear canal can become obstructed. While often harmless, blockage of the ear canal by cerumen can lead to a host of symptoms: hearing loss, tinnitus, fullness, itching, otalgia, discharge, odor, and cough. In addition, cerumen impaction can prevent diagnostic assessment by preventing complete examination (...) , or both. (3) Clinicians should assess the patient with cerumen impaction by history and/or physical examination for factors that modify management, such as ≥1 of the following: anticoagulant therapy, immunocompromised state, diabetes mellitus, prior radiation therapy to the head and neck, ear canal stenosis, exostoses, and nonintact tympanic membrane. (4) Clinicians should not routinely treat cerumen in patients who are asymptomatic and whose ears can be adequately examined. (5) Clinicians should

2017 American Academy of Otolaryngology - Head and Neck Surgery

25. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children Full Text available with Trip Pro

: Isolation Measures for Patients with CDI XIII. Should private rooms and/or dedicated toilet facilities be used for isolated patients with CDI? Accommodate patients with CDI in a private room with a dedicated toilet to decrease transmission to other patients. If there is a limited number of private single rooms, prioritize patients with stool incontinence for placement in private rooms (strong recommendation, moderate quality of evidence) . If cohorting is required, it is recommended to cohort patients (...) of evidence) on entry to a room of a patient with CDI and while caring for patients with CDI. XV. When should isolation be implemented? Patients with suspected CDI should be placed on preemptive contact precautions pending the C. difficile test results if test results cannot be obtained on the same day (strong recommendation, moderate quality of evidence) . XVI. How long should isolation be continued? Continue contact precautions for at least 48 hours after diarrhea has resolved (weak recommendation, low

2017 Infectious Diseases Society of America

28. Newborn Nursing Care Pathway

and as defined by the woman) is encouraged to support and participate in all aspects of newborn care • While in hospital (whenever possible), assessments and procedures should be performed in the mother’s room (to ensure mother-infant togetherness and to provide anticipatory guidance and information) Introduction3 Newborn Guideline 13: Newborn Nursing Care Pathway • Prior to, during, and following procedures that may cause newborn discomfort/pain, mothers should be encouraged to comfort their newborns (...) physiologic stability following term vaginal delivery: • Respiratory rate between 40-60/ min • Axillary temperature of 36.5- to 37.4 C 10 and stable heart rate (100-160 bpm) 11 • Suckling/rooting efforts and evidence of readiness to feed • Physical examination reveals no significant congenital anomalies • No evidence of sepsis • No jaundice developing 12 – 24 hours >24 – 72 hours >72 hours – 7 days and beyond HeAd Assess: • Shape • Size • Fontanelles • Circumference prn Assess mother’s/family/ supports

2015 British Columbia Perinatal Health Program

29. Asthma

to identify when their asthma might not be well controlled. • Take medication correctly. Patient instructions for using inhalers and devices are available on ghc.org, at https://provider.ghc.org/open/caringForOurMembers/patientHealthEducation/index.jhtml (Under "Conditions, Diseases, & Symptoms," see "Asthma.") • Limit or control environmental factors that trigger or worsen symptoms, including: tobacco smoke, strong odors or sprays, dust mites, cockroaches, animal dander, pollen, outdoor mold, and indoor (...) asthma. Long-term controller medications are the mainstay in therapy for persistent asthma. Use of these medications reduces risk of emergency room visits and decreases overuse of rescue medications (albuterol). The Asthma Medication Ratio HEDIS ® measure is in place to encourage the use of controller medications for persistent asthma. Asthma Medication Ratio (AMR) HEDIS measure The percentage of members 5–85 years of age who were identified as having persistent asthma and had a ratio of controller

2015 Kaiser Permanente Clinical Guidelines

30. Telehealth Services for the Treatment of Psychiatric Issues

standard telephones with or without some type of voice-recording technology, and written information via the internet. 5 Telepsychiatry has been performed at several sites including hospitals, emergency rooms, community mental health centers, clinics, physician offices, nursing homes, assisted living facilities, prisons, schools, and patients’ homes. 1,2,5,6 Care provided through telepsychiatry includes pre-hospitalization assessment, in-hospital care, assessment post-hospital follow-up care, scheduled (...) specific psychiatric diagnoses, treatments, or populations. 4,5,7 Disadvantages of telepsychiatry include the fact that some areas do not have the necessary telecommunication connectivity, and diagnostic assessment may be liable to variations according to technical issues including devices characteristics, bandwidth and resolution, and even room setup where the patient receives the care. 1,3,4 Although many studies and reviews have been published on telepsychiatry and telemental health care, the area

2015 Canadian Agency for Drugs and Technologies in Health - Rapid Review

31. Aromatherapy and Essential Oils (PDQ®): Health Professional Version

and healthy humans have been published in the context of odor and neurobiology (and in the absence of the specific term aromatherapy). In addition to uses,[ ] aromatherapy has also been proposed for use in care [ , ] and to treat a variety of and illnesses such as , , and .[ - ] Aromatherapy has also been studied via for airway reactivity.[ ] Studies on aromatherapy have examined a variety of other conditions: sedation and ;[ , ] startle reflex and reaction time;[ , ] states such as mood, , and general (...) to result from the binding of chemical components in the essential oil to in the , impacting the brain’s emotional center, the . Topical application of aromatic oils may exert , , and effects. Studies in show and effects of specific essential oils as well as positive effects on behavior and the immune system. studies in humans support the influence of odors on the limbic system and its emotional pathways. Human clinical trials have investigated aromatherapy primarily in the treatment of and in patients

2018 PDQ - NCI's Comprehensive Cancer Database

32. Treatment-Related Nausea and Vomiting (PDQ®): Health Professional Version

, cyclophosphamide, and other drugs (e.g., doxorubicin and ifosfamide) given at high doses or on 2 or more consecutive days. Anticipatory N&V (ANV): ANV is nausea and/or vomiting that occurs before a new cycle of chemotherapy is begun, in response to conditioned stimuli such as the smells, sights, and sounds of the treatment room. ANV is a classically conditioned response that typically occurs after three or four chemotherapy treatments after which the patient experienced acute or delayed N&V. Breakthrough N&V (...) nurse, chemotherapy room). These previously neutral stimuli then become conditioned stimuli and elicit ANV in future chemotherapy cycles. ANV is not an indication of psychopathology but is rather a learned response that, in other life situations (e.g., food poisoning), results in adaptive avoidance. A variety of correlational studies provide empirical support for classical conditioning. For example, the prevalence of ANV before treatment with any chemotherapy is very rare, and few patients ever

2018 PDQ - NCI's Comprehensive Cancer Database

33. Urinary tract infection (lower) - men

tenderness, odorous or cloudy urine, haematuria. UTI can present with atypical symptoms in men who are frail and elderly, in institutional care, or who have an indwelling urinary catheter. Diagnosis of a UTI should be confirmed by obtaining a urine sample for culture and sensitivity before starting antibiotic treatment. Urine dipstick tests or microscopy should not be relied on to confirm the diagnosis. For men with an indwelling urinary catheter, clinical judgement rather than urine dipstick tests (...) urinary tract infection (UTI) if a man has: Symptoms of a UTI — this may include: Dysuria (pain or discomfort on passing urine). Frequency. Urgency (the desire to pass urine immediately). Nocturia (having to urinate during the night more frequently than usual). Suprapubic pain. Signs of a UTI — this may include: Suprapubic tenderness. Odorous urine. Cloudy urine. Haematuria. In men who are frail and elderly, and/or catheterized, and/or in institutional care, do not rely on classical symptoms or signs

2018 NICE Clinical Knowledge Summaries

34. Lower Extremity Peripheral Artery Disease: Guideline on the Management of Patients With

of Guideline e76 2.CLINICAL ASSESSMENT FOR PAD ... e79 2.1. History and Physical Examination: Recommendations e79 3.DIAGNOSTIC TESTING FOR THE PATIENT WITH SUSPECTED LOWER EXTREMITY PAD (CLAUDICATION OR CLI) ... e80 3.1. Resting ABI for Diagnosing PAD: Recommendations e80 3.2. Physiological Testing: Recommendations . e81 3.3. Imaging for Anatomic Assessment: Recommendations e86 4.SCREENING FOR ATHEROSCLEROTIC DISEASE INOTHERVASCULARBEDSFORTHE PATIENT WITH PAD .. ... e87 4.1. Abdominal Aortic Aneurysm (...) ), no further imaging or intervention is warranted. JACC VOL. 69, NO. 11, 2017 Gerhard-Herman et al. MARCH 21, 2017:e71–126 2016 AHA/ACC Lower Extremity PAD Guideline e793. DIAGNOSTIC TESTING FOR THE PATIENT WITH SUSPECTED LOWER EXTREMITY PAD (CLAUDICATION OR CLI) 3.1. Resting ABI for Diagnosing PAD: Recommendations TABLE 5 History and/or Physical Examination Findings Suggestive of PAD History n Claudication n Other non–joint-related exertional lower extremity symptoms (not typical of claudication) n

2016 American College of Cardiology

35. Nutrition in Cancer Care (PDQ®): Health Professional Version

.[ , ] Standardized definitions and cutoff points that designate malnutrition or cachexia are being developed; however, the true prevalence of malnutrition in the oncology population is unknown. A growing body of literature examines the prevalence of malnutrition in obese cancer patients. In a study of clinical data obtained from 1,469 patients with metastatic primary cancers, 41.9% were identified as overweight or obese.[ ] Upon assessment, 50% were at risk of being malnourished, and 12% were already (...) by the patient. There are four sections comprising 17 data points evaluating weight/weight history, food intake, symptoms, and activities/function. The remainder of the PG-SGA is completed by a health care practitioner, accounting for information about disease and metabolic demand and the completion of a physical exam. The abPG-SGA and PG-SGAsf use only the section completed by the patient. Responses are then scored and, on the basis of the score, patients are stratified into four nutrition triage categories

2017 PDQ - NCI's Comprehensive Cancer Database

36. Are Cognition and Sleep Affected by Exposure to Carbon Dioxide and Bio Effluents During Sleep?

: University of Aarhus Information provided by (Responsible Party): University of Aarhus Study Details Study Description Go to Brief Summary: The aim of the project is to examine whether children's sleep and cognition are affected by exposure to CO2 and other bio effluents during sleep. The participants of the study are 36 children recruited from local schools in Aarhus, Denmark. The study takes place in the climate chambers at the Department of Public Health, Aarhus University. These chambers allow (...) for experimental testing on humans with advanced exposure generation while avoiding contamination from other sources and controlling temperature, humidity, noise, odor, and light. The children will be sleeping in the chambers under three different conditions: One night of good ventilation with a CO2 level of maximum 800 ppm One night of good ventilation with high levels of CO2 (3,000 ppm) One night of poor ventilation with high concentrations of CO2 (3000 ppm) and other bio effluents. The study is a within

2018 Clinical Trials

37. Efficacy & Safety of OPN-375 Adults With Bilateral Nasal Polyps Using Nasoendoscopic Video

: OPN-375 Phase 3 Detailed Description: The primary objective of this study is to evaluate the efficacy and safety of OPN-375 186 μg twice a day in adults with Bilateral Nasal Polyps using Nasoendoscopic video. The secondary objectives of this study are to evaluate the safety of OPN-375 via adverse event reports, vital signs, and nasal examination. In addition, to measure any change in subject symptoms and functioning from Baseline to 12 and 24 weeks during the study, using the Sinonasal Outcome (...) ] Secondary Outcome Measures : Assessment for safety by recording adverse events and adverse events of special interests [ Time Frame: 24 Weeks, up to 30 days after last dose ] Includes scoring severity of the adverse event as 1=mild, 2=moderate, 3=severe Assessment for safety through nasal examination [ Time Frame: 24 Weeks, up to 30 days after last dose ] Assessed in nasal examination worksheet which includes recording the presence of any epistaxis, septal erosion/perforation, ulceration/erosion of area

2018 Clinical Trials

38. Trichomonas Vaginalis Genotyping in Upper Egypt

discharge . Traditionally physicians make the diagnosis based on clinical grounds, but in women, the characteristics of the vaginal discharge, including color and odor, are poor predictors of T. vaginalis. Since no symptom alone or in combination is sufficient to diagnose T. vaginalis infection reliably, laboratory diagnosis is necessary ,Diagnosis of T. vaginalis infection is established by the traditional method wet mount test, in which "corkscrew" motility observed . Anyhow, culture has long been (...) to Intervention Details: Diagnostic Test: culture and pcr The swab immersed in Diamond's Modified medium culture tube and squeezed for cultivation and examined daily with a light microscope to identify T. vaginalis Samples from culture will be placed in 1 ml of a commercial PCR transport medium (AMPLICOR; Roche Diagnostic Systems, Branchburg, N.J.) and kept at 4°C until arrival at the laboratory within 4 days of collection. An equal volume of specimen diluent (AMPLICOR) was added to the sample

2018 Clinical Trials

39. Electronic Cigarettes Full Text available with Trip Pro

, there would be a public health benefit if e-cigarettes proved to be much less hazardous than combustible cigarettes and if smokers could switch entirely from conventional cigarettes to e-cigarettes. However, in general, the health effects of e-cigarettes have not been well studied, and the potential harm incurred by long-term use of these devices remains completely unknown. Nevertheless, some studies have examined the health effects of e-cigarettes by considering the constituents of their aerosol (...) . There are some studies of prolonged NRT in smokers who have quit smoking. , In these studies, no adverse effects have been found when nicotine medication was administered for months to several years. Other studies indicate that patients with known cardiovascular disease tolerate NRT well for periods up to 12 weeks. Because most of the toxicity from cigarette smoking derives from combustion products, the health effects of smokeless tobacco could be examined to assess potential long-term adverse effects

2014 American Heart Association

40. The Non-Surgical Management of Hip & Knee Osteoarthritis (OA)

– 2014 Page 3 of 126 Clinical Practice Guideline for the Non-Surgical Management of Osteoarthritis Table of Contents Executive Summary 5 Background 7 Methods 8 Scope and Structure 9 Guideline Working Group 14 Recommendations 15 Algorithm 17 Module A: Diagnosis & Evaluation 18 A1. History & Physical Examination 18 A2. Plain Radiography 19 A3. Magnetic Resonance Imaging (MRI) 20 A4. Routine Use of Laboratories and Synovial Fluid Analysis 21 Module B: Core Non-Surgical Treatment Principles 22 B1 (...) Module E: Complementary & Alternative Medicine 43 E1. Nutritional Supplements/Nutraceuticals/Dietary Supplements 43 E2. Acupuncture and Chiropractic Care 45 Module F. Referrals for Surgical Consultation 47 Appendix A: Guideline Development Process 50 Introduction 50 Methodology 50 Appendix B: Evidence Table 83 Page 4 of 126 Clinical Practice Guideline for the Non-Surgical Management of Osteoarthritis Appendix C: Patient History and Physical Examination 88 Knee History 88 Knee Physical Examination 88

2014 VA/DoD Clinical Practice Guidelines

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