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Femoral Neck Stress Fracture

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181. Hip fracture

of the trochanter or femoral neck will typically cause external rotation and shortening of the leg when the patient is laying supine. Imaging [ ] Typically, radiographs are taken of the hip from the front (AP view), and side (lateral view). Frog leg views are to be avoided, as they may cause severe pain and further displace the fracture. In situations where a hip fracture is suspected but not obvious on x-ray, an MRI is the next test of choice. If an MRI is not available or the patient can not be placed (...) without having to wait for healing. In elderly patients who are medically well and still active, a may be indicated. Traction is contraindicated in femoral neck fractures due to it affecting blood flow to the head of the femur. Trochanteric fracture [ ] Fracture supported by A trochanteric fracture, below the neck of the femur, has a good chance of healing. may not be satisfactory and then becomes necessary. The use of open reduction has been reported as 8-13% among pertrochanteric fractures, and 52

2012 Wikipedia

183. Appropriate Use Criteria: Imaging of the Abdomen & Pelvis

? Lasting more than three weeks with exceptions for immunocompromised patients ? Following standard work-up to localize the source Hematoma / hemorrhage Computed Tomography (CT) AbdomenCT Abdomen | Copyright © 2018. AIM Specialty Health. All Rights Reserved. 7 Common Diagnostic Indications Hernia ? For diagnosis of a hernia with suspected complications or presurgical planning including, but not limited to the following types of hernia: ? Femoral ? Internal ? Inguinal ? Spigelian (through semilunar line

2018 AIM Specialty Health

184. Breastfeeding Programs and Policies, Breastfeeding Uptake, and Maternal Health Outcomes in Developed Countries

or breastfeeding for longer durations may be associated with lower rates of breast cancer, epithelial ovarian cancer, hypertension, and type 2 diabetes, but not fractures. Because of heterogeneity and inconsistent results, we found insufficient evidence on whether breastfeeding is associated with postpartum depression, cardiovascular disease, or postpartum weight change. x Conclusions. The body of evidence for breastfeeding programs and policies was diverse in terms of interventions and settings. Current (...) Type 2 Diabetes 92 Fracture 99 Postpartum Depression 107 xii Return to Prepregnancy Weight or Postpartum Weight Change 120 Chapter 4. Discussion 132 Key Findings and Strength of Evidence 132 Effectiveness and Harms of Breastfeeding Programs and Policies 132 Baby-Friendly Hospital Initiative Interventions 132 Other (Non-BFHI) Health Care System–Based Interventions 133 WIC-Based Interventions 135 Community-Based Interventions 136 Effectiveness and Harms of Breastfeeding Programs and Policies

2018 Effective Health Care Program (AHRQ)

186. CRACKCast E176 – Pediatric Musculoskeletal Disorders

or pelvis fractures, overuse injuries Infection : septic arthritis, osteomyelitis, myositis, Lyme disease Inflammation : transient synovitis, juvenile rheumatoid arthritis, rheumatic fever Neoplasm : leukaemia, osteogenic/Ewing’s sarcoma, metastatic disease Haematologic disorders : haemophilia, sickle cell disease Miscellaneous : Legg-Calvé-Parthes disease, slipped capital femoral epiphysis [11] Provide a differential diagnosis of limp in the toddler, school-aged child and adolescent. Toddler School (...) )*; blanch sign of Steele *Klein’s line is a line drawn along the superior margin of the femoral neck. With a normal hip, the line intersects with or falls within the epiphysis, whereas in a hip with a slipped epiphysis, the line does not come into contact with the epiphysis. Legg-Calvé-Perthes disease is diagnosed and staged by AP and frog leg lateral radiographs. ● Radiolucent, V-shaped, osteoporotic defect in the lateral epiphysis (Gage’s sign), ● speckled calcification lateral to the capital

2018 CandiEM

187. Imaging Guidelines

are not applicable for the pediatric patient or the older adult patient (55 years and older). z Clinical decision rule criteria are less sensitive for older adults indicating a need for more liberal imaging decisions. z MDCT is the preferred imaging for cervical spine fracture identification. z Perform an MRI in patients with possible spinal cord injury; clinical concern for cord compression due to disk protrusion, hematoma, or unstable fracture pattern; or neck pain or tenderness out of proportion to the CT (...) 1 1. Imaging for Extremity Vascular Injury 60 12. Interventional Radiology for Traumatic Injuries 64 13. Imaging in Penetrating Neck Injury 72 14. Imaging in Penetrating Transthoracic Trauma 76 15. Imaging in Penetrating Abdominal Trauma 80 16. Imaging in the Trauma Patient Who Is Morbidly Obese 84 17 . Imaging in the Trauma Patient Who Is Pregnant 88 18. Imaging in Geriatric Patients with Low Energy Mechanism Injuries 92 19. Imaging for Intentional Injury in Children 96 20. Imaging at Rural

2018 American College of Surgeons

189. Management of Non-neurogenic Male LUTS

and fracture with the initiation of a prostate-selective alpha antagonist: a population based cohort study. BMJ, 2015. 351: h5398. 145. Chang, D.F., et al. Intraoperative floppy iris syndrome associated with tamsulosin. J Cataract Refract Surg, 2005. 31: 664. 146. Chatziralli, I.P., et al. Risk factors for intraoperative floppy iris syndrome: a meta-analysis. Ophthalmology, 2011. 118: 730. 147. van Dijk, M.M., et al. Effects of alpha(1)-adrenoceptor antagonists on male sexual function. Drugs, 2006. 66: 287

2018 European Association of Urology

190. Chronic Pelvic Pain

. Pitfalls of the medical paradigm in chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynaecol, 2000. 14: 525. 82. Sharpe, M., et al. "Unexplained" somatic symptoms, functional syndromes, and somatization: do we need a paradigm shift? Ann Intern Med, 2001. 134: 926. 83. Malykhina, A.P. Neural mechanisms of pelvic organ cross-sensitization. Neuroscience, 2007. 149: 660. 84. Sanford, M.T., et al. The role of environmental stress on lower urinary tract symptoms. Curr Opin Urol, 2017. 27: 268. 85 (...) subtypes of chronic pelvic pain and how subtypes differ in health status and trauma history. Am J Obstet Gynecol, 2006. 195: 554. 90. Meltzer-Brody, S., et al. Trauma and posttraumatic stress disorder in women with chronic pelvic pain. Obstet Gynecol, 2007. 109: 902. 91. Iglesias-Rios, L., et al. Depression and Posttraumatic Stress Disorder Among Women with Vulvodynia: Evidence from the Population-Based Woman to Woman Health Study. Journal of Women's Health (15409996), 2015. 24: 557. 92. Anderson, A.B

2018 European Association of Urology

191. New Technologies for the Treatment of Peripheral Artery Disease

particles by the sanding action of the crown of the catheter as it spins in various elliptical orbits. 23,24 Diamondback 360 Peripheral Orbital Atherectomy System (Cardiovascular Systems). 26 Laser ablation (photoablative) atherectomy Plaque is vaporized. 23 Turbo-Elite a and Turbo-Tandem a excimer laser catheters, used with the CVX-300 excimer laser system* (Spectranetics). 23,25 Rotational atherectomy Plaque is cut using tiny blades on the tip, and in some systems, the neck or side, of the catheter (...) Emitters on the Lithoplasty catheter deliver pulses of sound waves around the interior of the artery wall to break up superficial and deeper calcifications before angioplasty balloon inflation. 15,29-32 The Lithoplasty system is intended to fracture calcifications and allow lower pressure balloon expansion, while minimizing damage to the artery wall. 15 The system consists of a single-use balloon catheter with multiple lithotripsy emitters, and a reusable generator and connector cable. 29,31 Pantheris

2018 CADTH - Issues in Emerging Health Technologies

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

and admission rates 69 Figure 14 – Outline of the statistical trend model 71 Figure 15 – Overview of time periods 72 Figure 16 – Observed evolution and forecasts for hospital inpatient stays 83 Figure 17 – Expected change in ALOS between 2014 and 2025 for important MDCs (left panel) and important APR-DRGs (right panel) 86 Figure 18 – Projected change in ALOS by APR-DRG-SOI for APR-DRGs 301 ‘Hip joint replacement’, 302 ‘Knee joint replacement’ and 347 ‘Other back and neck disorders, fractures and injuries

2017 Belgian Health Care Knowledge Centre

193. Proposals for a further expansion of day surgery in Belgium

high on the political agenda of many countries. 6 a “An Enhanced Recovery After Surgery (ERAS) programme represents an interdisciplinary model, designed with the intention of safely hastening postoperative recovery by easing the stress response. Inevitably, postoperative complications impede recovery. However, several factors other Barriers to day-surgery growth Yet, despite the growth in day surgery worldwide, several factors may impede the establishment of day surgery or may slow a further (...) , in cultures where day surgery is new, it is important to educate patients on the advantages. 6 than morbidity delay recuperation in postoperative patients, namely: pain; gut dysfunction, and immobility. Rehabilitation pathways apply evidence-based principles of care, focusing on the optimization of postoperative analgesia, early feeding, and ambulation to reduce stress and organ dysfunction.” 7 KCE Report 282 Proposals for a further expansion of day surgery in Belgium 13 ? Deficient local, home

2017 Belgian Health Care Knowledge Centre

194. CRACKCast E058 – Ankle and Foot

Malleolar Fracture Bi mall eolar fractures: *unstable Caused by an oblique shearing force May still be non-operative if stable. May need a CT scan to figure the subtle #’s Tri malleolar fractures: Medial, lateral AND posterior malleoli All need ORIF Open fractures: Irrigation, reduction ABx, tetanus Ancef, Gentamycin Add Clindamycin or Penicillin G for soil contamination (for Clostridium) Pilon fractures Distal tibial metaphysis (falls) Look for calcaneus, tibial plateau, femoral neck, acetabulum (...) to instability Clinical FEATURES: History: mechanism of injury; onset of pain and swelling; weight bearing ability; “pop” noise 2) List Ankle stress tests Phyiscal exam: LOOK; FEEL pulses/max tenderness areas/sensation; MOVE + weight bear Frequently missed injuries: ?syndesmosis, fibular head #, fifth MT #, achilles tendon rupture; peroneal tendon rupture Stress tests: Of questionable significance in the ER Potential utility in a distal fibular fracture with deltoid complex pain Anterior drawer test Assesses

2017 CandiEM

195. Code of practice and performance standards for forensic pathologists dealing with suspicious deaths in Scotland

any explanations in relation to their own findings in order to come to properly reasoned conclusions. It is important that pathologists record any briefing given to them in sufficient detail, including the date and time, to enable the practitioner themselves (or some other individual) to recall and understand any matter that they may have had in mind when conducting the examination. The absolute importance of proper notes is stressed throughout this code. PUB 110116 8 V7 Final 5 Scene (...) there is a possibility of sex-related crime, swabs will be taken from those areas considered most likely to be productive of semen or saliva (face, neck, nipples and hands) i) a swab or swabs from the perianal skin, taken before a swab or swabs from the anus j) a swab or swabs from vulva and high and low vagina, taking care to avoid contamination of the latter from the initial swabbing of the former. These swabs must be taken after swabbing of the perianal skin and anus (to avoid leakage during the course

2016 Royal College of Pathologists

196. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting

in Turner syndrome R 4.1. We recommend that an infant or child is examined with transthoracic echocardiography (TTE) at the time of diagnosis, even if the fetal echocardiogram or postnatal cardiac examination was normal (⨁⨁◯◯). R 4.2. We recommend that girls or women with aortic dilatation and/or bicuspid aortic valve be counseled to seek prompt evaluation if they are experiencing acute symptoms consistent with AoD, such as chest, neck, shoulder, back or flank discomfort, particularly if it is sudden (...) care delivery system, the pediatric and adult health care teams establish a workflow to support a coordinated transition process (⨁⨁◯◯). R 5.4. We suggest that pediatric endocrinologists and their care teams encourage peer-to-peer (and parent-to-parent) contact with TS support and advocacy organizations to enhance knowledge and confidence, reduce stress and distress and promote the reciprocal sharing of experiences (⨁⨁◯◯). 6. Health surveillance for comorbidities throughout the lifespan R 6.1. We

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2016 European Society of Human Reproduction and Embryology

197. Guidelines for the use of imaging in the management of patients with myeloma

represent treatment response Trauma Osteoporotic fracture (especially vertebral body, ribs, sacrum) Stress fracture, Bone infarcts (especially femoral head) Degenerative joint disease Orthopaedic devices and surgical interventions Diffuse bone marrow uptake Positive: intensity > normal liver but reactive changes can give similar appearances Correlation with MRI or bone marrow biopsy advised as appropriate Negative: intensity ≤ normal liver Positive: heterogeneous uptake > normal liver Equivocal (...) in the vertebrae (Mahnken et al , ; Hur et al , ). Therefore, bone changes can be identified earlier and potential instabilities and fracture risks estimated with greater reliability (Horger et al , ; Zamagni & Cavo, ), particularly in areas where it is difficult to survey by plain X‐ray, e.g. scapulae and sternum. Given the recently revised classification of multiple myeloma, CT scanning is a suitable option for patients with suspected smouldering myeloma, but is not necessary in straightforward MGUS patients

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2017 British Committee for Standards in Haematology

198. CRACKCast E087 – Peripheral Arteriovascular Disease

disease processes that affect arteries: Disease process Pathophysiology Notes Atherosclerosis ●Begins with the formation of an atheroma = a fibrofatty plaque. Usually extends into the intima. ●These lipid-cores with fibrous caps usually calcify – leading to brittle crystalline vessels. ● These can ulcerate and produce cholesterol emboli and/or lead to in-situ thrombosis. ● Commonly affects large and medium sized vessels, especially around branch points. ● Aortoilliac, femoral, popliteal, coronary (...) ) ●A blood clot or foreign body that is carried to a distant site from its point of origin. ● Most are arterial thromboembolisms and originate in the heart. (e.g. post MI, AFib). ●Other sources include bacterial emboli, tumour material, foreign bodies, etc. ● Sudden occlusion of an artery that doesn’t have collateral circulation = bad ●Embolic occlusion occurs commonly at femoral and popliteal branch points. ●Watch for life threatening reperfusion injury. ● Atheroembolism: cholesterol, calcium, platelets

2017 CandiEM

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