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Fetal Foot Measurement

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21. Recommendations for good practice in Ultrasound: Oocyte retrieval Full Text available with Trip Pro

or serum beta-hCG test should be performed. Serum beta-hCG levels below 23 mUI/ml suggest inadequate hCG administration ( ). The WG does not suggest routine hCG testing for all patients before OPU. In agonist trigger cycles, the baseline serum level of LH should be measured on the day of the trigger. If no oocytes are found during OPU, LH levels can be checked and compared with baseline LH levels. If LH levels are below 0.5 mIU/ml, the trigger should be repeated with recombinant hCG instead of GnRH (...) -cervical locations (without further sedation or analgesia) with good results ( ; ). Satisfaction with the procedure was higher when the blocks were used during a general anaesthesia and post-operative pain was also lower ( ). Other forms of anxiolysis – VA by the sedationist is a very important part of any OPU that is performed with conscious sedation and/or local anaesthetics ( ). VA is a conversational distraction associated with measures to ensure a calming environment, thereby reducing pain

2020 European Society of Human Reproduction and Embryology

22. Guidance on self-monitoring of blood pressure in pregnancy

be used to replace BP measurements on the day of a scheduled clinic (i.e. intermittently) or can be done routinely and more frequently (e.g. daily or weekly) in addition to usual care. Service evaluations have been carried out examining use, and the results of trialling this intervention in over 2,400 normotensive women and 600 hypertensive women are expected later in 2020. No concerns have been raised to date over safety. BP self-monitoring is already done informally by many pregnant women (...) history of pre-eclampsia - multi-fetal pregnancy4 3 – Normotensive women All other normotensive pregnant women as part of standard antenatal care (including those who may need to self-isolate for a period). 2.2 Exclusion criteria BP self monitoring should not be offered or continued for women who require admission under local trust guidelines (e.g. severe hypertension, pre-eclampsia with adverse features). 3. Guidelines for implementation of home blood pressure monitoring There are four components

2020 Royal College of Obstetricians and Gynaecologists

23. Consensus Statement on organization of routine and specialist obstetric ultrasound services in the context of COVID-19

(Figure?2). Ultrasound examinations should be carried out in accordance with the ISUOG guidelines for performing first- and second-trimester fetal ultrasound 5,9 or national and local guidelines 6,7 , with the recommendation to consider saving sweeps of the anatomic regions instead of still images, to shorten the duration of the direct-contact scan time. Offline capturing of specific planes and obtaining biometric measurements should be considered. The sonologist/sonographer can adopt any technique (...) not requiring regular treatment or those with epilepsy not on treatment; 4. Those with high body mass index. In units in which uterine artery (UtA) Doppler is measured at 20–24 weeks, growth scans for pregnancies at risk of fetal growth restriction can be triaged based on values of mean UtA pulsatility index (PI); those with normal Doppler findings should have one fetal growth scan at 32–36?weeks and those with UtA-PI?>?95 th percentile should have regular scans from 28?weeks onwards. 9 Women should

2020 British Medical Ultrasound Society

24. Tigecycline

Therapeutic indications Tigecycline Accord is indicated in adults and in children from the age of eight years for the treatment of the following infections (see sections 4.4 and 5.1): • Complicated skin and soft tissue infections (cSSTI), excluding diabetic foot infections (see section 4.4); • Complicated intra-abdominal infections (cIAI). Tigecycline Accord should be used only in situations where other alternative antibiotics are not suitable (see sections 4.4, 4.8 and 5.1). Consideration should be given (...) seen with tigecycline at exposures of 8 and 10 times the human daily dose based on AUC in rats and dogs, respectively. These alterations were shown to be reversible after two weeks of dosing. Bone discolouring was observed in rats which was not reversible after two weeks of dosing. Results of animal studies indicate that tigecycline crosses the placenta and is found in foetal tissues. In reproduction toxicity studies, decreased foetal weights in rats and rabbits (with associated delays

2020 European Medicines Agency - EPARs

25. Covid-19 Thromboprophylaxis

of thrombosis or bleeding? Should tests like D-dimer be ordered? • As we are still gathering information about the nature of the coagulopathy associated with COVID-19, it is reasonable to measure D-dimer, PT, aPTT, and fibrinogen levels in hospitalized patients; importantly INR is not sufficiently sensitive for coagulopathy. • Severe COVID-19 is associated with high D-dimer levels which appear to predict mortality. A relationship between elevated D-dimer levels and mortality, however, has been shown (...) RECOMMENDATIONS FOR THE PREGNANT PATIENT FOR THROMBOSIS PREVENTION 1. Adequate hydration. 2. Encourage walking around the home. 3. Do flexo-extension exercises and circular movements with the feet several times a day. 4. Avoid prolonged standing or sitting and avoid crossing your legs. 5. Perform gentle exercise, such as pilates for pregnant women or yoga. 6. In case of doubts, appearance of symptoms or worsening, contact the health center, the area obstetrician or obstetrics on-call team. RECOMMENDATIONS

2020 Belgian Health Care Knowledge Centre

26. Cerebral palsy in under 25s: assessment and management

, particularly outside the home. 1.8.10 Advise parents or carers that intra-oral devices have not been shown to improve eating, drinking and swallowing in children and young people with cerebral palsy. 1.8.11 Use outcome measures important to the child or young person and their parents or carers to review: Cerebral palsy in under 25s: assessment and management (NG62) © NICE 2019. All rights reserved. Subject to Notice of rights ( conditions#notice-of-rights). Page 18 (...) and management (NG62) © NICE 2019. All rights reserved. Subject to Notice of rights ( conditions#notice-of-rights). Page 20 of 461.10 Optimising nutritional status 1.10.1 Regularly review the nutritional status of children and young people with cerebral palsy, including measuring their height and weight (or consider alternative anthropometric measurements, particularly if height and weight cannot be measured). 1.10.2 Provide timely access to assessment and nutritional

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

27. Recommendations for good practice in Ultrasound: Oocyte retrieval

not suggest routine hCG testing for all patients before OPU. - In agonist trigger cycles, baseline serum level of luteinizing hormone (LH) should be measured on the day of the trigger. If no oocytes are found during OPU, LH levels can be checked and compared with baseline LH levels. If LH levels are below 0,5 mIU/mL, the trigger should be repeated with recombinant hCG instead of GnRH agonists (Meyer et al., 2015). - In patients undergoing OPU under general anaesthesia and/or undergoing a natural cycle (...) during a general anaesthesia and postoperative pain was also lower (Rolland et al., 2017). Other forms of Anxiolysis - Verbal anaesthesia (VA) by the sedationist is a very important part of any OPU that is performed with conscious sedation and/or local anaesthetics (Gange and Baum, 2017). Verbal anaesthesia is a conversational distraction associated with measures to ensure a calming environment, thereby reducing pain, anxiety, and stress. Good VA begins with clear preoperative communication

2019 European Society of Human Reproduction and Embryology

28. Treatment of Patients with Schizophrenia

Schizophrenia 18 Implementation 18 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement 31 Review of Available Guidelines from Other Organizations 32 Quality Measurement Considerations 32 Statement 2: Use of Quantitative Measures 33 Implementation 33 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement 36 Review of Available Guidelines from Other Organizations 38 Quality Measurement Considerations 38 Statement 3: Evidence-based (...) Treatment Planning 39 Implementation 39 4 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement 50 Review of Available Guidelines from Other Organizations 51 Quality Measurement Considerations 51 Pharmacotherapy 52 Statement 4: Antipsychotic Medications 52 Implementation 52 Balancing of Potential Benefits and Harms in Rating the Strength of the Guideline Statement 110 Review of Available Guidelines from Other Organizations 111 Quality Measurement Considerations 112

2020 American Psychiatric Association

29. Clinical practice guideline for limb salvage or early amputation

” quality studies with consistent findings, or evidence from a single “High” quality study for recommending for or against the intervention. Also requires no or only minor concerns addressed in the EtD framework. B. In the absence of reliable evidence, the workgroup suggests the physician team should prioritize patient survival in the limb reconstruction vs. amputation decision. Limb specific damage control (i.e. temporizing) measures or immediate amputation should be considered when further attempts (...) addressed in the EtD framework. AMPUTATION/LIMB SALVAGE Injury patterns requiring ankle arthrodesis or foot free tissue transfer may be an indication for amputation in the non-acute phase and should be addressed in shared decision making with the patient. Strength of Recommendation: Limited Evidence from two or more “Low” quality studies with consistent findings or evidence from a single “Moderate” quality study recommending for or against the intervention. Also, higher strength evidence can

2020 American Academy of Orthopaedic Surgeons

30. Prenatal Care

• Less fetal demise, but absolute risk is small (NNT = 410) Gestational Age Determination The gestational age-based estimated date of delivery (EDD) should be established prior to 20 weeks’ gestational age and reviewed prior to planning any intervention. • In vitro fertilization is expected to be accurate to ± 1 day. • Ovulation induction, artificial insemination, a single intercourse record, ovulation predictor assay, or basal body temperature measurement are typically accurate to ± 3 days. • Last (...) Oversight Team Karl T. Rew, MD R. Van Harrison, PhD Literature search service Taubman Health Sciences Library For more information: 734-936-9771 der/clinical-care-guidelines © Regents of the University of Michigan Prenatal Care Patient population: Women of childbearing age, pregnant women, and their fetuses. Objectives: (1) Promote maternal and infant health. (2) Reduce maternal mortality and morbidity and fetal loss. (3) Reduce preterm birth, intrauterine growth restriction

2020 University of Michigan Health System

31. Trastuzumab (Ogivri) - breast cancer or stomach cancer

been conducted in Cynomolgus monkeys at doses up to 25 times that of the weekly human maintenance dose of 2 mg/kg trastuzumab intravenous formulation and have revealed no evidence of impaired fertility or harm to the foetus. Placental transfer of trastuzumab during the early (days 20–50 of gestation) and late (days 120–150 of gestation) foetal development period was observed. It is not known whether trastuzumab can affect reproductive capacity. As animal reproduction studies are not always (...) predictive of human response, trastuzumab should be avoided during pregnancy unless the potential benefit for the mother outweighs the potential risk to the foetus. In the post-marketing setting, cases of foetal renal growth and/or function impairment in association with oligohydramnios, some associated with fatal pulmonary hypoplasia of the foetus, have been reported in pregnant women receiving trastuzumab. Women who become pregnant should be advised of the possibility of harm to the foetus

2019 European Medicines Agency - EPARs

32. Management of Type 2 Diabetes Mellitus

and physical activity [IID]. • Check weight, calculate BMI [IID]. • Feet should be inspected at each visit if neuropathy present. Otherwise visual foot exam and neuropathy evaluation annually [IA]. • Smoking cessation counseling provided for patients with tobacco dependence [IB]. • Review and reinforce key self- management goals (See Table 3) [IA]. • Dilated retinal examination by eye care specialist: if good blood sugar and blood pressure control and previous eye exam was normal, every 2 years (...) ; if diabetic changes, annually or more frequently per eye care provider [IB]. Treat retinopathy [IA]. • Screen for microalbuminuria if not already on an ACE inhibitor or ARB [IB]. Prescribe an ACE inhibitor (or ARB, if ACE contraindicated) for microalbuminuria or proteinuria [IA]. • Serum creatinine and estimated glomerular filtration rate (eGFR) [ID]. • Monofilament testing of feet (see Table 13) [IA]. • Prescribe moderate dose statin; measure lipids for adherence. • Smoking status assessed [IB]. • All

2020 University of Michigan Health System

33. Guidelines For Professional Ultrasound Practice

Practice. Revision 3, December 2018 Minor amendments, March 2019. 3 2.12.1 Shoulder 97 2.12.2 Elbow 101 2.12.3 Wrist and hand 104 2.12.4 Hip 106 2.12.5 Knee 107 2.12.6 Foot and Ankle 109 2.12.7 Rheumatology Ultrasound Examinations 112 2. 13 ELASTOGRAPHY 122 2.14 CONTRAST ENHANCED ULTRASOUND (CEUS) 124 2.15 INTERVENTIONAL AND ‘EXTENDED SCOPE’ EXAMINATIONS (SONOGRAPHERS) 127 2.16 PATIENT GROUP DIRECTIONS 127 2.17 ACQUISITION, ARCHIVING AND USE OF ULTRASOUND DATA 130 2.18 AUDIT AND LEARNING FROM (...) by an evidence base and are effectively measurable’. Guideline: ‘A general rule, principle or piece of advice. Guidelines provide recommendations on how ultrasound examinations should be performed and are based on best available evidence. They help ultrasound practitioners in their work but they do not replace their knowledge and skills’. Protocol: An agreement, preferably based on research, between practitioners to ensure the delivery of high quality standardised ultrasound examinations. The title

2019 British Medical Ultrasound Society

34. COVID-19 Ultrasound Practice Suggestions

. Consider saving movie clips for fetal anatomy rather than images to expedite the examination. Adjust the ultrasound examination based upon indications and need. Focus on the following mandated planes unless otherwise indicated: • Fetal head: o BPD/HC o LV/Cavum o Posterior fossa o Upper lip/philtrum • Fetal chest: o 4CV o LVOT o RVOT o 3VT • Fetal abdomen: o AC o Cord insertion o Kidneys o Bladder • Spine: o Axial planes o Sagittal planes • Extremities: o FL o Confirm 4 extremities/hands and feet (...) COVID-19 Ultrasound Practice Suggestions The Society for Maternal-Fetal Medicine COVID-19 Ultrasound Practice Suggestions Developed with guidance from Alfred Abuhamad, MD and Joanne Stone, MD 3.24.20 (this is an update from draft posted on 3-23-2020) The following ultrasound practice suggestions are based on expert opinion and intended to supplement existing guidance from the Centers for Disease Control and Prevention (CDC) with information on optimizing prenatal ultrasound care in the context

2020 Society for Maternal-Fetal Medicine

35. Covid-19: Recommendations for GDM screening and oral glucose tolerance test (OGTT) during pregnancy and postpartum

2.7.1 Standardisation of HbA1c measurement 15 3 Antenatal care 16 3.1 Maternal surveillance 17 3.2 Fetal surveillance 18 3.3 Psychosocial support 18 3.4 Self-monitoring 19 3.5 Medical nutrition therapy 20 3.6 Physical activity 21 3.6.1 Cautions and contraindications for physical activity 22 4 Pharmacological therapy 23 4.1 Metformin 23 4.2 Insulin therapy 24 4.2.1 Insulin type by glycaemic abnormality 24 4.3 Hypoglycaemia 25 4.4 Education for safe self-administration of Insulin therapy 26 5 Birthing (...) • There is limited evidence or consensus regarding specific antepartum tests or their frequency 54 • Monitoring type and frequency is influenced by the presence of other pregnancy complications (e.g. antepartum haemorrhage, preeclampsia, fetal growth restriction) as well as severity of maternal hyperglycaemia 24 • Fetal abdominal circumference (AC) greater than or equal to 75% for gestational age, measured at 29 to 33 weeks gestation, correlates with an increased risk for birth of an LGA infant 55 Fetal growth

2020 Queensland Health

36. Physical Activity and Exercise During Pregnancy and the Postpartum Period

inactivity is the fourth-leading risk factor for early mortality worldwide . In pregnancy, physical inactivity and excessive weight gain have been recognized as independent risk factors for maternal obesity and related pregnancy complications, including gestational diabetes mellitus (GDM) . Concerns that regular physical activity during pregnancy may cause miscarriage, poor fetal growth, musculoskeletal injury, or premature delivery have not been substantiated for women with uncomplicated pregnancies (...) exercise. There are few maternal medical conditions in which aerobic exercise is absolutely contraindicated. When questions exist regarding safety of aerobic exercise in pregnancy, consultation with relevant specialists and subspecialists (eg, obstetrics and gynecology, maternal–fetal medicine, cardiology, pulmonology), when indicated, is advised. In women who have obstetric or medical comorbidities, exercise regimens should be individualized. Obstetrician–gynecologists and other obstetric care

2020 American College of Obstetricians and Gynecologists

37. Management of Stillbirth

accident should include vascular ectasia and thrombosis in the umbilical cord, chorionic plate, and stem villi. In addition to the previous findings, for a probable diagnosis, a regional distribution of avascular villi or villi showing stromal karyorrhexis is suggested . Examination of the Stillborn Fetus The general examination of the stillborn fetus should be done promptly, noting any dysmorphic features and obtaining measurements of weight, length, and head circumference . Foot length may (...) of a stillbirth, and strategies for prevention. Background Definition The U.S. National Center for Health Statistics defines fetal death as the delivery of a fetus showing no signs of life as indicated by the absence of breathing, heartbeats, pulsation of the umbilical cord, or definite movements of voluntary muscles . There is not complete uniformity among states with regard to birth weight and gestational age criteria for reporting fetal deaths. However, the suggested requirement is to report fetal deaths

2020 American College of Obstetricians and Gynecologists

38. Labor Dystocia

strategies for treating labor dystocia in women with otherwise uncomplicated pregnancies. Strategies assessed include amniotomy, supportive care measures, epidural analgesia, frequency of cervical examination, intrauterine pressure catheters, high- versus low-dose oxytocin protocols, electronic fetal monitoring or intermittent auscultation during augmentation with oxytocin, and delayed or Valsalva pushing. Key Messages • Use of partograms did not impact important maternal or neonatal outcomes (...) relevant to supportive care measures, 25 relevant to epidural analgesia, 1 relevant to cervical examination, 1 relevant to intrauterine pressure catheters, 17 relevant to high-dose versus low-dose oxytocin protocols, 1 relevant to fetal monitoring strategies, and 7 relevant to timing of pushing in the second stage. Evidence suggests that the duration and pattern of “normal” labor progress based on modern management are quite different from historical data, and that labor progress differs between

2020 Effective Health Care Program (AHRQ)

39. Abdominal and pelvic imaging

evaluation of fetal and placental conditions - Fetal MRI for indications involving the fetus or placenta, following nondiagnostic ultrasound - MRI pelvis for pelvimetry or other obstetrical complications Uterine artery embolization procedures Advanced imaging is considered medically necessary for management prior to a uterine artery embolization procedure. IMAGING STUDY - MRI pelvis Gastrointestinal Indications Appendicitis Advanced imaging is considered medically necessary in EITHER of the following (...) as for deeply infiltrating endometriosis involving the uterosacral ligaments, rectovaginal septum, vaginal wall, pouch of Douglas, and rectosigmoid. 18 Obstetric indications Advanced imaging is considered medically necessary for diagnosis and management of ANY of the following: ? Fetal anomalies ? Assessment prior to fetal intervention ? Placental complications ? Complications related to monochorionic twins ? Pelvimetry ? Other obstetrical complications IMAGING STUDY - Ultrasound is required for initial

2020 AIM Specialty Health

40. What helps to support people affected by Adverse Childhood Experiences? A Review of Evidence

Cognitive Behavioural Therapy (CBT) 39 Psychoeducation 42 Treatments aimed predominately at parents 44 Parent / foster carer training 45 Cross-sector support 47 Educational 49 Housing and life skills 50 Foster care / out-of-home care 52 5 Stakeholder workshop 53 5.1 Findings 53 Inflexibility of school system and teachers’ attitudes 53 ACEs impact people in different ways and at different times 53 Ethnic background 54 Recreation and practical skills 54 Counselling and talking therapies 54 Ways to measure (...) as Usual GLOSSARY Externalising behaviours Maladaptive behaviours towards the environment, such as physical, aggressive, disruptive or oppositional behaviour Internalising behaviours Symptoms associated with anxiety and depression such as fearfulness and sleeplessness Limited evidence Findings based on less than three studies (as used in overview of interventions) Mixed results Results which are partly effective and partly not, either within primary studies (e.g. on different outcome measures within

2019 EPPI Centre

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