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Fetal Foot Measurement

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41. Management of Type 2 Diabetes Mellitus

of risk factors and complications is summarized in Table 12. Diet, exercise, and pharmacologic interventions should be initiated for: Hypertension [IA] Cardiovascular risk reduction [IA] Hyperlipidemia [IA] Diabetes complications as indicated Each regular diabetes visit Annually • Blood pressure measured and controlled [IA]. • Check HbA1c every 3 months if on insulin; every 6 months if on oral agents or diet only and well- controlled. [II]. Optimize glycemic control [IA]. • Review and reinforce diet (...) 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

2017 University of Michigan Health System

42. Management of Diabetes Mellitus in Primary Care

test values, as well as evidence suggesting that there may be racial/ethnic differences, suggests that reliance upon HbA1c test results alone are not congruent with fasting blood glucose levels.[4,5] Racial differences were reported among participants in the Diabetes Prevention Program. Despite having comparable measures of glycemia, African Americans had significantly higher HbA1c levels (6.2%) than Whites (5.8%).[6] The VA/DoD DM CPG recommends that HbA1c values between 6.5%-7.0% be confirmed (...) recommendation indicates that the Work Group is highly confident that desirable outcomes outweigh undesirable outcomes. If the Work Group is less confident of the balance between desirable and undesirable outcomes, they give a weak recommendation. They also determined the direction of each recommendation (For or Against). Similarly, a recommendation for a therapy or preventive measure indicates that the desirable consequences outweigh the undesirable consequences. A recommendation against a therapy

2017 VA/DoD Clinical Practice Guidelines

43. Diagnosis and management of Silver-Russell syndrome: 1st international consensus statement

, length and head circumference) and reference data from a relevant population . Intrauterine growth retardation Also known as intrauterine growth restriction, this diagnosis is based on at least two ultrasonography measurements at least 2 weeks apart, with fetal weight below the 10th percentile for gestational age. Intrauterine growth retardation might or might not result in a baby born SGA . Silver–Russell syndrome (SRS) A distinct syndromic growth disorder in which prenatal and postnatal growth (...) of Clinical Genetics, University of Amsterdam, Netherlands. Her interests include basic and clinically applied research on the genetic aetiology of Beckwith–Wiedemann syndrome and associated childhood tumours; genomic imprinting; innovation of DNA-diagnostics for imprinting disorders; mechanisms of genomic imprinting; and epigenetic gene regulation in clinical conditions including trauma, child abuse and neglect and fetal alcohol syndrome. She has 44 publications including development and validation

2017 Pediatric Endocrine Society

44. European Society of Endocrinology Clinical practice guidelines for the care of girls and women with Turner syndrome

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. For an IGF-I value between +2 (...) 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

2017 European Society of Endocrinology

45. Prosthetic and Amputee Rehabilitation - Standards and Guidelines (3rd Edition)

Recommendations and scope of provision of prosthetics for ex-servicemen with service attributable injury 57 10. Miscellaneous topics 61 Counselling 61 Outcome Measures 62 Cosmesis 66 Limbs for Leisure 68 Water Activity Limbs 69 Section II Standards for Amputee and Prosthetic Rehabilitation (3 rd Edition) 71 APPENDICES 79 Appendix 1 – Membership of the Working Party 79 Appendix 2 – Glossary of terms 81 Appendix 3 - Useful addresses 83 Introduction BSRM Working Party Report – Amputee and Prosthetic (...) . Clinical Reference Groups (CRG) were set up to advise NHS England. The CRG for Complex Disability Equipment, which included Prosthetic/Amputee Rehabilitation Services for National Commissioning led on the development of the service specifications for commissioning. 4,5 Other services under this umbrella were assistive electronic technology and assistive communication aids. This CRG was also tasked to formulate clinical service delivery models, care pathways, and outcome measures from April 2013 onwards

2018 British Society of Rehabilitation Medicine

46. CCS/CPCA Position Statement on Pulse Oximetry Screening in Newborns to Enhance Detection of Critical Congenital Heart Disease

that test 1 foot alone or sequentially the right hand and either foot. Differences in saturations of > 3% between the right hand and either foot is also abnormal (> 2 SD of measurement variability). x 17 De Wahl Granelli, A., Mellander, M., Sunnegardh, J., Sandberg, K., and Ostman-Smith, I. Screening for duct-dependant congenital heart disease with pulse oximetry: a critical evaluation of strategies to maximize sensitivity. Acta Paediatr . 2005 ; 94 : 1590–1596 | | Many types of CCHD require a patent (...) available with a high specificity (99.9%) and moderately high sensitivity (76.5%). When an abnormal saturation is obtained, the likelihood of having CCHD is 5.5 times greater than when a normal result is obtained. The use of pulse oximetry combined with current strategies has shown sensitivities of up to 92% for detecting CCHD. False positive results can be minimized by screening after 24 hours, and testing the right hand and either foot might further increase sensitivity. Newborns with abnormal

2016 Canadian Cardiovascular Society

47. ABCD position statement on standards of care for management of adults with type 1 diabetes - this has been superseded by the 2017 version - see above

? Creatinine/(e.gFR) ? Urinary albumin/creatinine ratio ? Foot examination ? Smoking ? Check that retinal screening/ophthalmology review is up to date ? Measure TSH and consider a coeliac screen The following should be discussed at least annually ? Need for medication for BP, lipids, albuminuria etc ? Erectile difficulties/plans for pre.gnancy ? Review of care plan and referral for specialist review if required e.g nephrology, podiatry, cardiology, ophthalmology ? Immunisation requirements 3.3 (...) of care Inpatient care The National Diabetes Inpatient Audit (NaDIA), a snapshot audit of diabetes inpatient care in England and Wales on single day in September in 2013, showed that 15.8% of hospital inpatients had diabetes, of whom 6.6% had type 1 diabetes. The audit monitors staffing levels in the hospital diabetes team and measures of patient harm including medication errors, inappropriate use of intravenous insulin infusions, episodes of hypoglycaemia and DKA arising in hospital and new foot

2016 Association of British Clinical Diabetologists

48. CRACKCast E049 – General Principles to Orthopedic Injuries

, meniscus, disks, Ultrasound Can very accurately dx disruptions of bony cortices: Long bones Orbital floor Ankle/foot Rib fractures 1) List 10 complications of fractures Complication Info Key points Hemorrhage Blood loss, shock, and death! Pelvic, femur, tib-fib Vascular injury See chapter 48! Knee – popliteal artery Femoral neck – AVN of femoral head 10-20% of injuries may have normal palpable pulses These injuries can lead to late complications Nerve injury Neuropraxia – contusion to a nerve leading (...) pressure Venous obstruction (DVT) Venous ligation 2) Decreased compartment volume Closure of fascial defects Excessive traction of #’d limbs 3) External pressure Casts, air splints, dressings Lying on a limb 4) Misc: Muscle hypertrophy Popliteal cysts Leaky cannulae Interstitial infusions / pressure infusions Sites: Tibia Forearm Thigh Hand/foot Interesting causes (based on etiology): 1. Content increase anticoagulant/coagulopathic bleed Post-op arterial bypass graft Exercise induced Seizures Eclampsia

2016 CandiEM

49. Neonatal resuscitation

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

2016 Clinical Practice Guidelines Portal

50. Neonatal resuscitation

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

2016 Clinical Practice Guidelines Portal

51. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

Summary 4-30 Evidence Base 30 Post-hoc Question: By inductive evaluation of all evidence-based recommendations, what are the core recommendations for medical care of patients with obesity? 30 Q1. Do the 3 phases of chronic disease prevention and treatment (i.e., primary, secondary, and tertiary) apply to the disease of obesity? 31 Q2. How should the degree of adiposity be measured in the clinical setting? 33 Q2.1. What is the best way to optimally screen or aggressively case-find for overweight (...) incontinence 52 Q3.14. Gastroesophageal reflux disease (GERD) 52 Q3.15. Depression 56 Q4. Does BMI or other measures of adiposity convey full information regarding the impact of excess body weight on the patient’s health? 56 Q5. Do patients with excess adiposity and related complications benefit more from weight loss than patients without complications, and, if so, how much weight loss would be required? 58 Q5.1. Is weight loss effective to treat diabetes risk (i.e., prediabetes, metabolic syndrome

2016 American Association of Clinical Endocrinologists

52. Guidelines for the use of local anesthesia in office-based dermatologic surgery

. Are the same topical anesthetics used in adults also recommended/safe in children? Local infiltration anesthesia A. Is local infiltration anesthesia safer/more effective than other types of anesthesia to reduce pain? B. Does the method to calculate the maximum anesthetic doses change when infiltrated anesthetics are delivered over an extended time period compared to a short time period? C. Do the local anesthetic serum levels change based on the method of delivery? D. Is there a measure of care better (...) than other anesthetics for the same procedure? B. Does the volume and dose of lidocaine and epinephrine correlate with patient safety in tumescent anesthesia? C. Does a slow infusion rate result in less pain or a better anesthetic effect than fast infusion rates? D. Is there a measure of care better/safer than others to decrease symptoms of local anesthetic systemic toxicity for patients anesthetized using the tumescent technique? Evidence was obtained for the clinical questions determined

2016 American Academy of Dermatology

53. Cerebral palsy

policies or guidelines since 1 May 2019. New safety alerts New safety alerts No new safety alerts since 1 May 2019. Changes in product availability Changes in product availability No changes in product availability since 1 May 2019. Goals and outcome measures Goals and outcome measures Goals Goals To support primary health care professionals to: Recognise the specific features of cerebral palsy. Refer for specialist confirmation of a diagnosis where cerebral palsy is suspected. Support and advise (...) people with confirmed cerebral palsy, and their family/carers. Recognise the health issues associated with cerebral palsy and manage, or refer if appropriate. Outcome measures Outcome measures No outcome measures were found during the review of this topic. Audit criteria Audit criteria No audit criteria were found during the review of this topic. QOF indicators QOF indicators No QOF indicators were found during the review of this topic. QIPP - Options for local implementation QIPP - Options for local

2019 NICE Clinical Knowledge Summaries

54. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

Psychiatry 2014, 14(Suppl 1):S1 http://www.biomedcentral.com/1471-244X/14/S1/S1 Page 8 of 83no functional impairment in fully recovered patients as measured by a scale such as the Sheehan Disability Scale or SF-36 [32,119,120]. Objective scales can be used to help assess a patient’s progress. The Clinical Global Impression (CGI) scale is brief, comprehensive, and can easily be used at each appointment to assess improvement. The clinician-rated Hamilton Anxiety Rating Scale (HARS) can assess anxi- ety (...) was significantly favored over medications for the treatment of panic disorder in a meta-analysis [71]. In a meta-analysis of 42 studies, expo- sure and combinations of exposure, cognitive restructur- ing and other CBT techniques had the most consistent evidence of efficacy for the treatment of panic disorder [56]. Strategies that included exposure were the most effective for panic measures. For measures of agorapho- bia, combined strategies were more effective than single techniques, which did not result

2014 CPG Infobase

55. Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

ventricular fibrillation (VF) and for the prevention of sudden death are detailed in Table . 3.1 Epidemiology of sudden cardiac death In the past 20 years, cardiovascular mortality has decreased in high-income countries 19 in response to the adoption of preventive measures to reduce the burden of CAD and HF. Despite these encouraging results, cardiovascular diseases are responsible for approximately 17 million deaths every year in the world, approximately 25% of which are SCD. 20 The risk of SCD is higher (...) that affect either the integrity of the heart's muscle (see section 7) or its electrical function (see section 8). Every time a heritable disease is identified in a deceased individual, the relatives of the victim may be at risk of being affected and dying suddenly unless a timely diagnosis is made and preventive measures taken. Unfortunately, even when an autopsy is performed, a proportion of sudden deaths, ranging from 2 to 54%, 48 remain unexplained ( Web Table 2 ): this broad range of values is likely

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2015 European Society of Cardiology

56. Newborn Nursing Care Pathway

Norm and Normal Variations • Refer to POS Parent education/ Anticipatory Guidance • Refer to >12 – 24 hr Norm and Normal Variations • Refer to POS • Moulding resolves ~ 3 days • Average head circumference 33 – 35 cm once moulding disappears (ensure consistent way of measuring) 14 Parent education / Anticipatory Guidance • Refer to >12 – 24 hr • Prevent plagiocephaly (flat spots on head) and strengthen neck muscles by placing baby on abdomen when awake (tummy time) for several short periods each day (...) and capacity to identify variances that may require further assessments Norm and Normal Variations • Symmetrical in size, shape, movement & flexion • Intact, straight spine • Full range of motion • Clavicles intact • Bow-legged, flat-footed • Equal gluteal folds • Equal leg length Parent education/ Anticipatory Guidance • Refer to >12 – 24 hr Variance • Asymmetrical extremities • Curvature of spine • Non-intact spine • Tufts of hair along an intact spine – may require ultrasound to rule out spina bifida

2015 British Columbia Perinatal Health Program

57. Breastfeeding Healthy Term Infants

the infant and administer Vitamin K on the mother; delay eye prophylaxis up to one hour 54,55 and postpone infant weight and measur ements until completion of the first feeding • Continue skin-to-skin contact in a position that facilitates the infant to touch the breast if labor has been long or stressful. Place infant skin-to-skin on father or another designate if maternal skin-to-skin is not feasible 56 • Assist mother with breastfeeding as soon as possible or within 1 to 2 hours • Maintain a quiet (...) and foot rest for comfort and to elevate the infant to the level of the mother’s breast Mother’s arm or hand holds and supports the infant’s upper back and shoulders, cradling the neck/ base of the skull 13 • Lying position On the bed, mother and infant side-lie, facing each other; use pillows under mother’s head, behind her back, and as necessary between her legs Hold infant close; infant head and neck positions as described above Following the breastfeeding session the baby is placed on his

2015 British Columbia Perinatal Health Program

58. Late Effects of Treatment for Childhood Cancer (PDQ®): Health Professional Version

and undiagnosed conditions detected by screening and surveillance measures.[ ] Figure 2. Cumulative incidence of chronic health conditions for (A) grades 3 to 5 chronic health conditions, (B) multiple grade 3 to 5 conditions in survivors, (C) multiple grade 3 to 5 conditions in siblings, (D) conditioned based on no previous grade 3 to 5 conditions among survivors by ages 25, 35, or 45, and (E) conditioned based on no previous grade 3 to 5 conditions among siblings by ages 25, 35, or 45. Gregory T. Armstrong (...) privately insured to report a cancer-related visit (adjusted relative risk [RR], 0.83; 95% CI, 0.75–0.91) or a cancer center visit (adjusted RR, 0.83; 95% CI, 0.71–0.98). Uninsured survivors had lower levels of utilization in all measures of care than privately insured survivors. In contrast, publicly insured survivors were more likely to report a cancer-related visit (adjusted RR, 1.22; 95% CI, 1.11–1.35) or a cancer center visit (adjusted RR, 1.41; 95% CI, 1.18–1.70) than were privately insured

2018 PDQ - NCI's Comprehensive Cancer Database

59. Pruning Emtree: Does Focusing Embase Subject Headings Impact Search Strategy Precision and Sensitivity?

(such as mental health and public health), focusing the intervention Emtree terms led to reductions in both sensitivity and precision. In the latter case we are likely to see a large impact on the performance measures from reducing the effectiveness of one strategy in one review. Overall these findings suggest that focusing Emtree headings is likely to reduce already suboptimal sensitivity for only small gains in precision. If it can be ascertained that a strategy is highly sensitive then focusing

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

60. Reducing the Risk - Thrombosis and Embolism during Pregnancy and the Puerperium

and consideration given to antenatal anti-Xa monitoring and the potential for antithrombin replacement at initiation of labour or prior to caesarean section. [New 2015] If anti-Xa levels are measured, a test that does not use exogenous antithrombin should be used and 4-hour peak levels of 0.5–1.0 iu/ml aimed for. [New 2015] Other heritable thrombophilic defects are lower risk and can be managed with standard doses of thromboprophylaxis. [New 2015] Acquired thrombophilia – see also section 4.4 Women with VTE (...) factors including major antepartum haemorrhage, coagulopathy, progressive wound haematoma, suspected intra-abdominal bleeding and postpartum haemorrhage may be managed with anti-embolism stockings (AES), foot impulse devices or intermittent pneumatic compression devices. Unfractionated heparin (UFT) may also be considered. If a woman develops a haemorrhagic problem while on LMWH the treatment should be stopped and expert haematological advice sought. Thromboprophylaxis should be started

2015 Royal College of Obstetricians and Gynaecologists

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