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Fetal Foot Measurement

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21. Perinatal Mortality Guideline

before, during or after birth, starting at greater than or equal to 20 weeks of gestation and ending 7 completed days after birth. Gestational Age – Fetal age or duration of pregnancy measured from the first day of the last normal menstrual period, and expressed in completed days or weeks. Gestation may be determined from LMP , data from early ultrasound, or from combining the two. The current BC recommendation is to use the first ultrasound after 7 weeks gestation to date the pregnancy unless timed (...) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 APPENDIX A: PERINATAL MORTALITY FORM . . . . . . . . . . . . . . . 26 APPENDIX B: DIAGNOSIS OF FETAL ASPHYXIA (HYPOXIC ACIDAEMIA) . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 While every attempt has been made to ensure that the information contained herein is clinically accurate and current, Perinatal Services BC acknowledges that many issues remain controversial, and therefore may be subject to practice interpretation. © Perinatal Services BC, 2017 Perinatal Services BC West Tower

2017 British Columbia Perinatal Health Program

22. Diabetes Type 1

the abnormal test on a different day. An abnormal result on the repeated test is diagnostic for diabetes. Diagnosis for a patient with classic symptoms of hyperglycemia (i.e., polyuria, polydipsia, weight loss) can be made with a single random plasma glucose result of 200 mg/dL or higher. A repeat measurement is not needed. Table 1. Diagnosing diabetes Test Results Interpretation HbA1c 6.5% or higher Diabetes 5.7–6.4% Impaired glucose tolerance 1 Lower than 5.7% Normal Random plasma glucose 200 mg/dL (...) Choices, Better Health®. Foot care For patients at very high risk or increased risk of developing foot ulcers, recommend daily foot care. The pamphlet “Living Well with Diabetes: Foot care for people with diabetes” is available online and can be ordered from the Resource Line (#63). Foot-ulcer risk definitions: ? Patients at very high risk are those with a previous foot ulcer, amputation, or major foot deformity (claw/hammer toes, bony prominence, or Charcot deformity). ? Patients at increased risk

2017 Kaiser Permanente Clinical Guidelines

23. CRACKCast Episode 183 – The Immunocompromised Patient

tachypnea or tachycardia, mental status changes, metabolic acidosis, increased volume requirements, rapid changes in serum glucose or sodium concentration, or acute abdominal pain. In neutropenic cancer patients, most severe infections and almost all instances of bacteremia occur when the neutrophil count is less than 100 cells/mL. In neutropenic patients, the temperature should be measured orally or tympanically, not rectally. In neutropenic cancer patients, pneumonia and anorectal infection are more (...) the respiratory or gastrointestinal tract. Immunoglobulin E (IgE), surface of mast cells and basophils responsible for immediate-type hypersensitivity reactions important in defense against helminthic pathogens. IgG widely distributed in tissues accounts for 75% of the total immunoglobulin mass. It crosses the placenta and provides fetal immunity during the first 6 months of life Congenital or acquired deficiencies of IgG lead to infection with encapsulated organisms Complement complex interaction of 30

2018 CandiEM

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

. AIM Specialty Health. All Rights Reserved. 2 Table of Contents Description and Application of the Guidelines 3 Administrative Guidelines 4 Ordering of Multiple Studies 4 Pre-test Requirements 5 Abdominal & Pelvic Imaging 6 CT of the Abdomen 6 MRI of the Abdomen 15 MRCP of the Abdomen 20 CTA/MRA of the Abdomen 22 CTA Abdominal Aorta and Bilateral Illiofemoral Lower Extremity Run-off 26 CT of the Pelvis 28 MRI of the Pelvis 35 Fetal MRI 41 CTA/MRA of the Pelvis 43 CT of the Abdomen & Pelvis (...) for headache ¾ MRI brain and MRA brain for headache ¾ MRI cervical spine and MRI shoulder for pain indications ¾ MRI lumbar spine and MRI hip for pain indications ¾ MRI or CT of multiple spine levels for pain or radicular indications ¾ MRI foot and MRI ankle for pain indications ¾ Bilateral exams, particularly comparison studies There are certain clinical scenarios where simultaneous ordering of multiple imaging studies is consistent with current literature and/or standards of medical practice

2018 AIM Specialty Health

26. Resuscitation - neonatal

sharing · Include known risk factors affecting resuscitation and management in discussions between maternal and neonatal/paediatric caregivers including: o Maternal conditions o Antenatal diagnoses o Fetal well-being assessments 1 · Include parents in discussions and decision making o Prepare parent(s) for the possibility of resuscitation · Refer to Table 5 Communication and information sharing Documentation 1 · Appoint one person to be responsible for documentation where this is feasible · Use (...) , congenital cyanotic heart disease) · Maternal pyrexia · Maternal infection · Chorioamnionitis · Heavy sedation · Previous fetal or neonatal death · No/minimal antenatal care Fetal 1 · Multiple gestation (e.g. twins, triplets) · Preterm gestation (especially less than 35 completed weeks) · Gestation greater than 41 completed weeks · Large for dates based on ultrasound estimation of fetal weight · Fetal growth restriction · Alloimmune haemolytic disease (e.g. anti-D, anti-Kell, especially if fetal or other

2018 Queensland Health

27. Neonatal stabilisation for retrieval

service capability · Seek advice: o Contact RSQ o Phone 1300 799 127 Maternal risk · Severe hypertensive disorder · Antepartum haemorrhage · Other care requirements beyond service’s CSCF Fetal risk · Threatened preterm birth · Fetal anomalies · FGR · Multiple pregnancy · Other care requirements beyond service’s CSCF Yes Yes No No CSCF: Clinical services capability framework; FGR: Fetal growth restriction; QCG: Queensland Clinical Guidelines; RSQ: Retrieval Services Queensland Queensland Clinical (...) Preterm 90–95% o Term 92–98% · Measure preductally– right hand Signs of respiratory distress? Baby breathing spontaneously? Yes No No Yes Commence CPAP · MAP: 8 cm H 2 O · Check capillary blood gas · Observe for CPAP failure · O 2 to maintain oxygen saturations · O 2 /air: o Flow 8–10 L/minute o Humidified/warm (37 ºC) · Refer to QCG: o Neonatal respiratory distress including CPAP o Neonatal resuscitation Signs of CPAP failure · O 2 requirement > 50% · Increased work of breathing · Respiratory

2018 Clinical Practice Guidelines Portal

28. Imaging Guidelines

. National Council on Radiation Protection and Measurements report shows substantial medical exposure increase. Radiology. 2009; 253(2): 293-296. 9. Wellis VM. Pediatric Anesthesia and Pain Management Practice Guidelines for the MRI and MRT. Palo Alto: Lucile Packard Children’s Hospital, Stanford University Medical Center, Department of Anesthesia and Pain Management. Available at: http://med.stanford.edu/content/dam/sm/ pedsanesthesia/documents/mri.pdf. Published 1998, Accessed April 12, 2018. 10

2018 American College of Surgeons

29. BHIVA guidelines on the management of HIV in pregnancy and postpartum

group included two patient representatives who were involved in all aspects of the guideline development. BHIVA guidelines on the management of HIV in pregnancy and postpartum 8 1.3 Dissemination and implementation The following measures have been/will be undertaken to disseminate and aid implementation of the guidelines: • E-publication on the BHIVA website and in the journal HIV Medicine; • Publication in HIV Medicine; • Shortened version including concise summary of recommendations; • E-learning (...) should not be delayed because of pregnancy, to protect both maternal and fetal health. All women should have commenced cART by week 24 of pregnancy. In women with a history of preterm delivery (PTD) it may be prudent to start cART as soon as possible after the first trimester to maximise time on cART prior to delivery although there are no supporting data and avoidance of PIs associated with PTD may be considered (see section 6.6). 6.3 Woman is not already on cART: what to start 6.3.1 Women

2019 British HIV Association

30. Management Of Haemophilia

Synovitis 30 7.2 Joint Arthropathy 31 7.3 Pseudotumour 31 8. INHIBITORS 33 8.1 Treatment of Acute Bleeding 34 8.2 Prophylaxis Therapy 34 8.3 Eradication of Inhibitors 35 9. HOME THERAPY 37 10. ADHERENCE IN HAEMOPHILIA TREATMENT 39 11. SPECIAL SITUATIONS 41 11.1 Surgeries and Invasive Procedures 41 11.2 Management of Pregnant Carrier 42 11.3 Vaccination 43 11.4 Circumcision 43 12. DENTAL CARE 44 12.1 Preventive Dental Measures 44 12.2 Dental Procedures 44 12.3 Management of Oral Bleeding 46 13 (...) . MONITORING 48 13.1 Inhibitors 48 13.2 Bleeding Frequency 48 13.3 Joint Health 49 13.4 Radiological Measures 49 14. IMPLEMENTING THE GUIDELINES 50 14.1 Facilitating and Limiting Factors 51 14.2 Potential Resource Implications 51 REFERENCES 53 Appendix 1 Example of Search Strategy 59 Appendix 2 Clinical Questions 60 Appendix 3 Guidelines on Sample Collection and 62 TransportationManagement of Haemophilia Appendix 4 Recommended Sports/Physical Activities in 63 Haemophilia Appendix 5 Development of Abnormal

2018 Ministry of Health, Malaysia

31. Low Back Pain, Adult Acute and Subacute

of fear-avoidance beliefs occur early in low back patients (Coudeyre, 2007). George et al. (2015) found that psychological risk status, depressive symptoms and pain intensity were predictive of six-month recovery status. Further- more, elevated fear-avoidance, kinesiophobia and depressive symptoms co-occurred with nonrecovery at six months (George, 2015). Objective measurement of a range of yellow flags can be captured by a validated, comprehensive and reli - able tool such as the STarT Back Tool (...) , and include test and measures that assess neurologic, musculoskeletal and biomechanical dysfunction. The following are components of the low back pain exam: • Neurologic evaluation, including reflex sensation, and neural tension and strength - straight leg raising - ability to walk on heels and toes - symmetrical great toe extensor strength • Palpation of related structures • Assessment of posture • Evaluation of lumbar spine range of motion (quantity and quality, asymmetry/inconsistency) • Evaluation

2018 Institute for Clinical Systems Improvement

32. British Association of Dermatologists guidelines for the management of pemphigus vulgaris

formation is highly suggestive of PV, but the diag- nosis should be con?rmed by the characteristic deposition of IgG and/or complement on the cell surfaces of epithelial ker- atinocytes. Indirect immuno?uorescence (IIF) is less sensitive than DIF 19–21 but may be helpful if a biopsy is dif?cult, for example in children and uncooperative adults. Commercial enzyme-linked immunosorbent assays (ELISAs) are available for direct measurement of desmoglein 1 and des- moglein 3 antibodies in serum (...) a bone density scan early in the course of treatment may be needed. In anticipation of using an adjuvant immunosuppressant, appropriate recommended additional investigations and vacci- nations should be undertaken. A baseline measure of disease activity (see section 91) and quality of life, supplemented by IIF and ELISA titres if facilities exist, will be useful for disease monitoring and judging treatment responses (see sections 90–92). 9.0 Disease monitoring Decisions concerning ongoing disease

2017 British Association of Dermatologists

33. ABCD position statement on standards of care for management of adults with type 1 diabetes

albumin:creatinine ratio ? Foot examination ? Smoking ? Check that retinal screening/ophthalmology review is up to date ? Measure TSH and consider a coeliac screen 12 The following should be discussed at least annually ? Need for medication for BP, lipids, albuminuria etc ? Erectile difficulties/plans for pregnancy ? Review of care plan and referral for specialist review if required eg nephrology, podiatry, cardiology, ophthalmology ? Immunisation requirements 3.3 Psychological support The importance (...) are now focusing on more complex circumstances (eg acute foot disease, pregnancy, children and young people, insulin pumps, advanced kidney disease, inpatients and other complex conditions.) There appears to be an assumption that ‘uncomplicated’ type 1 diabetes does not require specialist care, but failure to provide the support people with type 1 diabetes need to manage their condition increases the chance that they will join one of the groups requiring specialist care for ‘complicated’ diabetes

2017 Association of British Clinical Diabetologists

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

monitoring growth-promoting treatment by measurement of height at least every 4–6 months during the first year of treatment and at least every 6 months thereafter (⨁⨁⨁◯). R 2.4. We recommend monitoring the safety of growth-promoting therapy by measurement of IGF-I at least annually (⨁⨁◯◯). R 2.5. We suggest that for TS patients treated with GH the measured IGF-I should ideally be no greater than 2 SDS above the mean for age. If an IGF-I value is measured above +3 SDS, a GH dose decrease is warranted (...) against routine oocyte retrieval for fertility preservation of young TS girls before the age of 12 years (⨁◯◯◯). R 3.4. We recommend considering oocyte donation for fertility, only after thorough screening and appropriate counseling (⨁⨁⨁⨁). R 3.5. We recommend that management of pregnant women with TS should be undertaken by a multidisciplinary team including maternal–fetal medicine specialists and cardiologists with expertise in managing women with TS (⨁⨁⨁◯). R 3.6. We suggest that other options

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2016 European Society of Human Reproduction and Embryology

35. Biologic therapy for psoriasis

reviewed and updated with reference to the specific SPC and high quality, up-to-date guidelines and the Department of Health (DoH) Green Book (see section 11). 28 3.1 Developing the review questions and outcomes The GDG agreed clinical questions relevant to the scope of the guideline and a set of outcome measures of importance to patients, ranked according to the GRADE methodology. Review questions were developed using a PICO framework (patient, intervention, comparison and outcome) for intervention (...) relate to other factors (for example, other co-therapies or the underlying disease) that the risk of fetal abnormalities in women with psoriasis who conceive on biologic therapy has not been adequately studied and therefore cannot be áá British Association of Dermatologists guidelines for biologic therapy for psoriasis 2017 20 X For example http://www.medicinesinpregnancy.org/Medicine--pregnancy XI There are no known interactions between biologic therapies and contraceptive methods (see drug-specific

2017 British Association of Dermatologists

36. VA/DoD clinical practice guideline for the management of type 2 diabetes mellitus in primary care.

a regimen including basal insulin and short-acting meal time or basal insulin and correction insulin for non-critically ill hospitalized patients with type 2 diabetes. ( Weak for; Reviewed, New-added ) The Work Group suggests providing medication education and diabetes survival skills to patients before hospital discharge. ( Weak for; Reviewed, Amended ) Selected Complications and Conditions The Work Group recommends performing a comprehensive foot risk assessment annually. ( Strong for; Not Reviewed (...) the pregnancy and referred to a maternal fetal medicine provider (when available) before, or as early as possible, once pregnancy is confirmed. ( Strong for; Not Reviewed, Amended ) Refer to the original guideline document for considerations for pharmacological therapy. Definitions The relative strength of the recommendation is based on a binary scale, "Strong" or "Weak." A strong recommendation indicates that the Work Group is highly confident that desirable outcomes outweigh undesirable outcomes

2017 National Guideline Clearinghouse (partial archive)

37. BTS guideline for oxygen use in adults in healthcare and emergency settings.

of Hypoxaemia and Hypercapnia Fully trained clinicians should assess all acutely ill patients by measuring respiratory rate, pulse rate, blood pressure and temperature and assessing circulating blood volume and anaemia (see section 7 in the original guideline document). Expert assistance from specialists in intensive care or from other disciplines should be sought at an early stage if patients are thought to have major life-threatening illnesses and clinicians should be prepared to call for assistance when (...) is below or above the target range ( grade D ). Good Practice Points for Clinical Assessment of Patients with Suspected Hypoxaemia The medical history should be taken when possible in an acutely breathless patient and may point to the diagnosis of a particular acute illness such as pneumonia or pulmonary embolism or an exacerbation of a chronic condition such as COPD, asthma or heart failure. Never discontinue oxygen therapy to obtain an oximetry measurement on room air in patients who clearly require

2017 National Guideline Clearinghouse (partial archive)

38. Perinatal substance use: neonatal

caregiver intervention Baby is unable to decrease crying within a 15 second period using self-consoling measures Continuous high pitched cry Baby cries intermittently or continuously for greater than 5 minutes despite caregiver intervention NB: Since a baby’s cry may vary in pitch, this should not be scored if high pitched crying is not accompanied by other signs described above Sleep Longest period baby sleeps within the entire scoring interval including light and deep sleep Light—irregular breathing (...) supportive measure Central nervous system disturbances Excessive or high pitched crying • Soothe baby with swaddling • Talk quietly/sing/hum • Hold baby firmly to body and rock gently • Use a baby sling • Reduce environmental stimuli o Slow movements o Dimmed lighting o Remove from noise exposure Sleeplessness • Reduce environmental stimuli • Minimise handling, swaddle baby, rock gently • Encourage skin to skin cuddles with parent(s) Excoriation (chin, knees, elbow, toes, nose) • Apply protective skin

2017 Queensland Health

39. Heart Disease and Stroke Statistics 2017 Update: A Report From the American Heart Association

. 2017;135:e146–e603. DOI: 10.1161/CIR.0000000000000485 Benjamin et al and all-cause mortality (relative risk, 0.55; 95% CI, 0.37–0.80). • The health benefits of pursuing cardiovascular health are observed across races/ethnicities and the nation. New data on measures of cardiovascu- lar health in Hispanics find similar results as previ- ous reports in non-Hispanic groups. Studies from non-US populations also support the importance of Life’s Simple 7 on future disease prevention. • Trends in improvements (...) coronary syndromes, HF, and stroke contin- ues to show gains, with compliance rates above 95% for some measures. • Although performance on inpatient quality-of-care measures or quality-of-care measures at discharge in patients after MI or stroke remains high (>90% for most measures), performance on outpatient quality-of-care measures, especially those that Downloaded from http://ahajournals.org by on March 27, 2019e153 CLINICAL STATEMENTS AND GUIDELINES Circulation. 2017;135:e146–e603. DOI: 10.1161/CIR

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2017 American Heart Association

40. 2017 AHA/ACC Key Data Elements and Definitions for Ambulatory Electronic Health Records in Pediatric and Congenital Cardiology: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards

of quality performance measurement initiatives, particularly those for which the comparison of providers is an implicit or explicit aim, has further raised awareness about the importance of data standards. Indeed, a wide audience, including nonmedical professionals such as payers, regulators, and consumers, may draw conclusions about care and outcomes. To understand and compare care patterns and outcomes, the data elements that characterize them must be clearly defined, consistently used, and properly (...) to occur. The other domains include: congenital heart defect nomenclature, adult congenital heart disease, critical care, cardiomyopathy, cardiac transplantation, pulmonary hypertension, congenital cardiac surgery, echocardiography, diagnostic and interventional catheterization, exercise stress testing and physiology, electrophysiology, cardiac magnetic resonance imaging, fetal physiology, perfusion, and cardiac anesthesia. The reason that this domain was chosen first was that there are other nascent

2017 American Heart Association

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