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Fetal Foot Measurement

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681. Enabling medication management through health information technology

of Studies Reporting Statistically Significant Process Changes Table 9. Summary of the Number of Statistically Significant Process Changes in Studies of Table 11. Study Designs Used in Studies Measuring Intermediate Outcomes Across the Phases Table 12. Clinician Study Participants in Studies Assessing Intermediate Outcomes Across the Table 13. Patient Study Participants in Studies Assessing Intermediate Outcomes Across the Table 14. Research Design for Studies Across the Phases of Medication Management (...) for Implementers and Users would become evident from our review of the evidence in KQ1: Effectiveness. We supplemented these articles with other studies addressing values propositions by stakeholders. KQ4: System ES-3 Characteristics addresses the impact of MMIT application features on the likelihood that the systems will be purchased, implemented, and used. The evidence for this question comes from studies of all designs that measure implementation, use, and purchasing decisions. KQ5: Sustainability addresses

2011 EvidenceUpdates

682. Safety of Probiotics to Reduce Risk and Prevent or Treat Disease

be assessed and reported in primary studies, and reviews should consider all studies measuring the outcome regardless of whether the study was conducted to evaluate the efficacy of the intervention or the occurrence of adverse events. Long-term effects of probiotic interventions are largely unknown, and there is a need to evaluate long-term interventions. In addition, large cohort studies following self-selected use of probiotic organisms are needed to fully understand the efficacy and safety

2011 EvidenceUpdates

683. Sexual and Reproductive Health for Individuals with Inflammatory Bowel Disease

The SPC for ciclosporin 58 indicates that measuring blood levels of ciclosporin is questionable in non-transplant patients because the relationship between blood levels and clinical effect is less well established. Therefore, if drugs are being used concomitantly that are known to increase ciclosporin concentration, frequent assessment of renal function and careful monitoring of ciclosporin side effects may be more appropriate. 58 Short courses of broad-spectrum antibiotic may reduce the efficacy (...) and after ileal pouch-anal anastomosis for inflammatory bowel disease: immediate and long-term consequences and outcomes. Dis Colon Rectum 2004; 47: 1127–1135. 39 Rahimi R, Ikfar S, Rezaie R, Abdollahi M. Pregnancy outcome in women with inflammatory bowel disease following exposure to 5-aminosalicylic acid drugs: a meta-analysis. Reprod Toxicol 2008; 25: 271–275. 40 Moskovitz DN, Bodian C, Chapman ML, Marion JF, Rubin PH, Scherl E, et al. The effect on the fetus of medications used to treat pregnant

2009 Association of Coloproctology of Great Britain and Ireland

684. Patient Modesty: Volume 67

. They are open to listening and recognizing what is being said on all these blogs and bulletin boards about patient modesty. Artiger is no different. What I have noticed is that the one measurable item is time. Artiger , you, and all the "good" providers take time to build the trust and relationship with the patient. The "bad" providers take the "get over it approach." This response is very indicative of a "you are wasting my time" scenario. --Banterings At , said... And Banterings, it shouldn't take much (...) between the lines?" Isn't that a bit like arguing against male / female washroom segregation? (for those who are ok with, or prefer peeing a few feet away from someone of the opposite gender) Pretty sure she meant mandate to make the patients preference the one that's followed, not what the medical side feels like. Jason K At , Anonymous said... Good Morning My last post was either stated incorrectly or misunderstood. What I meant was, what responsibility does the medical community have because

2014 Bioethics Discussion Blog

685. Duchenne Muscular Dystrophy and Becker Muscular Dystrophy

, CK determinations, fetal sex determination) combined with recombinant DNA analysis and dystrophin immunostaining of muscle tissue. Treatment Supportive measures Sometimes prednisone or deflazacort Sometimes, for cardiomyopathy, an ACE inhibitor and/or beta-blocker Sometimes corrective surgery No specific treatment exists. Gentle (ie, submaximal) active exercise is encouraged for as long as possible to avoid disuse atrophy or complications of inactivity. Passive exercises may extend the period (...) of ambulation. Orthopedic interventions should be aimed at maintaining function and preventing contractures. Ankle-foot orthoses worn during sleep may help prevent flexion contractures. Leg braces may temporarily help preserve ambulation or standing. Corrective surgery is sometimes needed, particularly for scoliosis. Obesity should be avoided; caloric requirements are likely to be less than normal because of decreased physical activity. Respiratory insufficiency may be treated with noninvasive ventilatory

2013 Merck Manual (19th Edition)

686. Approach to the Patient With a Suspected Inherited Disorder of Metabolism

-Opitz syndrome) during fetal development. Autonomic symptoms can result from hypoglycemia caused by increased glucose consumption or decreased glucose production (eg, vomiting, diaphoresis, pallor, and tachycardia in GSD or ) or from metabolic acidosis (eg, vomiting and Kussmaul respirations in organic acidemias). Some conditions cause both (ie, in propionic acidemia, accumulation of acyl-CoAs causes metabolic acidosis and inhibits gluconeogenesis, thus causing hypoglycemia). Nonphysiologic jaundice (...) after the neonatal period usually reflects intrinsic hepatic disease, especially when accompanied by elevation of liver enzymes, but may be due to inherited disorders of metabolism (eg, untreated galactosemia, hereditary fructose intolerance, ). Unusual odors in body fluids reflect accumulation of specific compounds (eg, sweaty feet odor in , smoky-sweet odor in , mousy or musty odor in phenylketonuria, boiled cabbage odor in tyrosinemia). Change in urine color on exposure to air occurs in some

2013 Merck Manual (19th Edition)

687. Neonatal Resuscitation

Bradycardia Seizures None Common (70%) Uncommon EEG Normal Low voltage, periodic or paroxysmal, epileptiform activity Periodic or isoelectric Risk of death 1% 5% > 60% Risk of severe handicap 1% 20% > 70% Adapted from Sarnat HB, Sarnat MS: Neonatal encephalopathy following fetal distress. Archives of Neurology 33:696–705, 1975. Clinical Calculator: Resuscitation Initial measures for all neonates include providing warmth, drying, and stimulating breathing (eg, flicking the soles of the feet, rubbing (...) % of neonates require some respiratory assistance at birth. Less than 1% need extensive resuscitation. Causes are numerous (see Table: ), but the common pathway involves asphyxia or respiratory depression. The incidence rises significantly if birth weight is < 1500 g. Table Problems in the Neonate That May Require Resuscitation Problem Possible Causes Failure to breathe Antepartum mechanism Maternal toxemia Recent intrapartum asphyxia Cord compression Fetal exsanguination Maternal hypotension Uterine tetany

2013 Merck Manual (19th Edition)

688. Neonatal Hyperbilirubinemia

serum bilirubin concentration). The serum bilirubin level required to cause jaundice varies with skin tone and body region, but jaundice usually becomes visible on the sclera at a level of 2 to 3 mg/dL (34 to 51 mcmol/L) and on the face at about 4 to 5 mg/dL (68 to 86 mcmol/L). With increasing bilirubin levels, jaundice seems to advance in a head-to-foot direction, appearing at the umbilicus at about 15 mg/dL (258 mcmol/L) and at the feet at about 20 mg/dL (340 mcmol/L). Slightly more than half (...) of all neonates become visibly jaundiced in the first week of life. Almost all hyperbilirubinemia in the immediate neonatal period is unconjugated, which is termed indirect bilirubin, based on older laboratory measurement methods; conjugated bilirubin is termed direct bilirubin. For further discussions of cholestasis and disorders of bilirubin excretion in the neonatal period see . Podcast Consequences of hyperbilirubinemia Hyperbilirubinemia may be harmless or harmful depending on its cause

2013 Merck Manual (19th Edition)

689. Hypothyroidism

of hypothyroidism on the pregnancy and fetal development. Patients should have annual measurement of serum TSH and free T 4 to assess progress of the condition if untreated or to adjust the l -thyroxine dosage. Symptoms and Signs Symptoms and signs of primary hypothyroidism are often subtle and insidious. Various organ systems may be affected. Metabolic manifestations: Cold intolerance, modest weight gain (due to fluid retention and decreased metabolism), hypothermia Neurologic manifestations: Forgetfulness (...) . Hypothyroidism can result from radiation therapy for cancer of the larynx or Hodgkin lymphoma (Hodgkin disease). The incidence of permanent hypothyroidism after radiation therapy is high, and thyroid function (through measurement of serum TSH) should be evaluated at 6- to 12-mo intervals. Secondary hypothyroidism Secondary hypothyroidism occurs when the hypothalamus produces insufficient thyrotropin -releasing hormone (TRH) or the pituitary produces insufficient TSH. Sometimes, deficient TSH secretion due

2013 Merck Manual (19th Edition)

690. Genetic Evaluation

Showing Enlarged Nuchal Translucency in a Fetus at 10 Weeks Photo from Jeffrey S. Dungan, MD. Traditionally, 1st-trimester combined screening includes measurement of Maternal serum beta-hCG (total or free) Pregnancy-associated plasma protein A (PAPP-A) Fetal nuchal translucency (by ultrasonography) Fetal Down syndrome is typically associated with high levels of beta-hCG, low levels of PAPP-A, and enlarged fetal nuchal translucency (NT). Although enlarged NT is associated with increased risk of fetal (...) trimester) noted during ultrasonography Risk of fetal chromosomal abnormality depends on specific anatomic findings. *Measured during the 1st or 2nd trimester. ACOG = American College of Obstetricians and Gynecologists. Procedures All procedures used to diagnose genetic disorders, except ultrasonography, are invasive and involve slight fetal risk. If testing detects a serious abnormality, the pregnancy can be terminated, or in some cases, a disorder can be treated (eg, fetal surgery to repair ). Even

2013 Merck Manual (19th Edition)

691. Abruptio Placentae

coagulation. Diagnosis is clinical and sometimes by ultrasonography. Treatment is modified activity (eg, a woman's staying off her feet for most of the day) for mild symptoms and prompt delivery for maternal or fetal instability or a near-term pregnancy. Abruptio placentae and other obstetric abnormalities increase the risk of morbidity or mortality for the woman, fetus, or neonate (see ). Abruptio placentae occurs in 0.4 to 1.5% of all pregnancies; incidence peaks at 24 to 26 wk gestation. Abruptio (...) that mother and fetus can be closely monitored and, if needed, rapidly treated. (Modified activity involves refraining from any activity that increases intra-abdominal pressure for a long period of time—eg, women should stay off their feet most of the day.) Corticosteroids should be considered (to accelerate fetal lung maturity) if gestational age is < 34 wk. Corticosteroids may be given if all of the following are present The pregnancy is late preterm (34 to 36 wk). The mother has not previously received

2013 Merck Manual (19th Edition)

692. Overview of Hypertension

or 3 measurements taken at 2 or 3 different times with the patient: Seated in a chair (not exam table) for > 5 min, feet on floor, back supported With their limb supported at heart level with no clothing covering the area of cuff placement Having had no exercise, caffeine, or smoking for at least 30 min At the first visit, measure BP in both arms and subsequent measurements should use the arm that gave the higher reading. A properly sized BP cuff (see Table 9 BP Cuff Size in Adults (...) or a diastolic BP approaching 60 mm Hg increases risk of these adverse events. Even the elderly and frail elderly can tolerate a diastolic BP as low as 60 to 65 mm Hg well and without an increase in cardiovascular events. Ideally, patients or family members measure BP at home, provided they have been trained to do so, they are closely monitored, and the sphygmomanometer is regularly calibrated. Treatment of requires special considerations because some antihypertensive drugs can harm the fetus. Lifestyle

2013 Merck Manual (19th Edition)

693. Sickle Cell Disease

crises are treated with analgesics and other supportive measures. Transfusions are occasionally required. Vaccines against bacterial infections, prophylactic antibiotics, and aggressive treatment of infections prolong survival. Hydroxyurea may decrease the frequency of crises and the acute chest syndrome. Homozygotes (about 0.3% of blacks in the US) have sickle cell anemia; heterozygotes (8 to 13% of blacks) are typically not anemic but have an increased risk of other complications (...) . Hemoglobinopathies Hemoglobin molecules consist of polypeptide chains whose chemical structure is genetically controlled. The normal adult Hb molecule (Hb A) consists of 2 pairs of chains designated alpha and beta. Normal blood also contains a ≤ 2.5% concentration of Hb A 2 (composed of alpha and delta chains). Fetal Hb (Hb F, which has gamma chains in the place of beta chains) gradually decreases, particularly in the first months of life, until it makes up < 2% of total Hb in adults (see ). Hb F concentration

2013 Merck Manual (19th Edition)

694. Male Hypogonadism in Children

in , reproductive insufficiency, or both. Diagnosis is by measurement of serum testosterone , luteinizing hormone, and follicle-stimulating hormone and by stimulation tests with human chorionic gonadotropin or gonadotropin-releasing hormone. Treatment depends on the cause. (See also in adults.) Classification There are 3 types of hypogonadism: primary, secondary, and a type caused by defective androgen action, primarily due to defective androgen receptor activity. Primary hypogonadism In primary (...) in childhood may cause delayed growth, hypothyroidism, diabetes insipidus, hypoadrenalism, and lack of sexual development when puberty is expected. Hormone deficiencies, whether originating in the anterior or posterior pituitary, may be varied and multiple. Kallmann syndrome is characterized by anosmia due to aplasia or hypoplasia of the olfactory lobes and by hypogonadism due to deficiency of hypothalamic gonadotropin-releasing hormone (GnRH). It occurs when fetal GnRH neurosecretory neurons do

2013 Merck Manual (19th Edition)

695. Overview of Congenital Cardiovascular Anomalies

and is considered positive if ≥ 1 of the following is present: Any oxygen saturation measurement is < 90%. The oxygen saturation measurements in both the right hand and foot are < 95% on 3 separate measurements taken 1 h apart. There is > 3% absolute difference between the oxygen saturation in the right hand (preductal) and foot (postductal) on 3 separate measurements taken 1 h apart. All neonates with a positive screening result should undergo a comprehensive evaluation for congenital heart disease and other (...) in a Polish population. Paediatr Perinat Epidemiol 23(1):29-40, 2009. doi: 10.1111/j.1365-3016. 2008.00979.x. 2. : Advances in the understanding of the genetic determinants of congenital heart disease and their impact on clinical outcomes. J Am Heart Assoc 7(6):e006906, 2018. doi:10.1161/JAHA.117.006906. Normal Fetal Circulation Fetal circulation is marked by Right-to-left shunting of blood around the unventilated lungs through a patent ductus arteriosus (connecting the pulmonary artery to the aorta

2013 Merck Manual (19th Edition)

696. Syphilis

or bone abnormalities *Can also exist in a permanently latent (asymptomatic) state. Infection is usually transmitted by sexual contact (including genital, orogenital, and anogenital) but may be transmitted nonsexually by skin contact or transplacentally, causing . Risk of transmission is about 30% from a single sexual encounter with a person who has primary syphilis and 60 to 80% from an infected mother to a fetus. Infection does not lead to immunity against reinfection. Symptoms and Signs Syphilis (...) . Otosyphilis may affect the cochlea (causing hearing loss and tinnitus) or vestibular system (causing vertigo and nystagmus). Trophic lesions , secondary to hypoesthesia of the skin or periarticular tissues, may develop in the later stages. Trophic ulcers may develop on the soles of the feet and penetrate as deeply as the underlying bone. (Charcot joints), a painless joint degeneration with bony swelling and abnormal range of movement, is a classic manifestation of neuropathy. Diagnosis Serologic reaginic

2013 Merck Manual (19th Edition)

697. Systemic Lupus Erythematosus (SLE)

patients. These test results may be associated with the lupus anticoagulant and a prolonged PTT. Abnormal values in one or more of these assays suggest the presence of antiphospholipid antibodies (eg, anticardiolipin antibodies), which should then be measured directly by enzyme-linked immunosorbent assay (ELISA). Antiphospholipid antibodies are associated with arterial or venous thrombosis, thrombocytopenia, and, during pregnancy, spontaneous abortion or late fetal death but may be present (...) IN THIS CHAPTER Test your knowledge Sciatica Which of the following deficits is the most objective finding in sciatica? CNS Motor Reflex Sensory NEWS & VIDEOS February 2019 Briefing - Rheumatology Here are what the editors at HealthDay consider to be the most important developments in Rheumatology for February 2019. This roundup includes the latest research news from journal articles... 3D Model The Foot Video How to Examine the Wrist SOCIAL MEDIA Add to Any Platform Loading , MD, The University of Vermont

2013 Merck Manual (19th Edition)

698. Identification of Muscle-specific Biomarkers of Fatty Acid Beta-oxidation

Dietary Guidelines with caloric deficits individualized for each subject. Aerobic exercise was monitored over approximately 14 weeks, several times per week, to elicit significantly increased VO2max. Outcome Measures Go to Primary Outcome Measures : Change in VO2max [ Time Frame: Week 1 vs. Week 16 ] Overnight fasted subjects will start the test at a low cycle ergometer resistance level and encouraged to maintain a steady rate of pedaling, and resistance will increase at 2-min intervals until (...) mass will be measured by DXA using a whole body scan. The scan will be performed at the beginning of the study and after the diet and exercise intervention. Our technical staff at WHNRC is trained and certified in the DXA method. The volunteer will wear light-weight surgical scrubs. The scan time takes no longer than 30 minutes to complete, with a radiation exposure less than 0.1 mrem. As subjects will be menstruating during the test week, there is no risk to a developing fetus. A pregnancy test

2011 Clinical Trials

699. Analgesia in Labor, a Prospective Parallel Study to Compare Regional Analgesia and Intravenous (IV) Pethidine Analgesia

Outcome Measures : The degree of motor block [ Time Frame: 24 hours ] The degree of motor block was assessed according to a modified Bromage scale (Grade I: free movement of legs and feet; Grade II: just able to flex knees with free movement of feet; Grade III: unable to flex knees, but with free movements of feet; Grade IV: unable to move legs or feet) before administration of E analgesia, 10 and 30 minutes after the first dose. The start of the analgesia was regarded as time 0. The duration (...) Posted : February 7, 2011 Last Update Posted : February 7, 2011 Sponsor: Cairo University Information provided by: Cairo University Study Details Study Description Go to Brief Summary: To compare combined spinal epidural, epidural and IV pethidine analgesia and their effects on the mother, fetus, newborn and the course of labor. Condition or disease Intervention/treatment Phase Labor Active Dilated Cm Other: Epidura, CSE & IV Not Applicable Study Design Go to Layout table for study information Study

2011 Clinical Trials

700. Pre-eclampsia Full Text available with Trip Pro

as are increased in the maternal circulation in women who develop pre-eclampsia. These findings have given rise to the hypothesis that pre-eclampsia is a disease process by which a placental lesion such as hypoxia allows increased fetal material into the maternal circulation, that in turn leads to an and endothelial damage, and that ultimately results in pre-eclampsia and eclampsia. One hypothesis for vulnerability to pre-eclampsia is the maternal-fetal conflict between the maternal organism and fetus. After (...) due to increased blood flow to the impaired placenta. This results in a conflict between maternal and fetal fitness and survival because the fetus is invested in only its survival and fitness while the mother is invested in this and subsequent pregnancies. Another evolutionary hypothesis for vulnerability to pre-eclampsia is the idea of ensuring pair-bonding between the mother and father and paternal investment in the fetus. Researchers posit that pre-eclampsia is an adaptation for the mother

2012 Wikipedia

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