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Fetal Foot Measurement

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761. preeclampsia

with severe pre-eclampsia give birth preterm small-for-gestational-age babies (mainly because of fetal growth restriction arising from placental disease) are common, with 20-25% of preterm births and 14-19% of term births in women with pre-eclampsia being less than the tenth centile of birth weight for gestation NICE suggest that (1): blood pressure measurement and urinalysis for protein should be carried out at each antenatal visit to screen for pre-eclampsia at the booking appointment, the following (...) risk factors for pre-eclampsia should be determined: age 40 years or older nulliparity pregnancy interval of more than 10 years family history of pre-eclampsia previous history of pre-eclampsia body mass index 30 kg/m2 or above pre-existing vascular disease such as hypertension pre-existing renal disease multiple pregnancy more frequent blood pressure measurements should be considered for pregnant women who have any of the above risk factors the presence of significant hypertension

2010 GP Notebook

762. PE (preeclampsia)

disorders half of women with severe pre-eclampsia give birth preterm small-for-gestational-age babies (mainly because of fetal growth restriction arising from placental disease) are common, with 20-25% of preterm births and 14-19% of term births in women with pre-eclampsia being less than the tenth centile of birth weight for gestation NICE suggest that (1): blood pressure measurement and urinalysis for protein should be carried out at each antenatal visit to screen for pre-eclampsia at the booking (...) appointment, the following risk factors for pre-eclampsia should be determined: age 40 years or older nulliparity pregnancy interval of more than 10 years family history of pre-eclampsia previous history of pre-eclampsia body mass index 30 kg/m2 or above pre-existing vascular disease such as hypertension pre-existing renal disease multiple pregnancy more frequent blood pressure measurements should be considered for pregnant women who have any of the above risk factors the presence of significant

2010 GP Notebook

763. pregnancy induced hypertension with proteinuria

of pre-eclampsia and 8-10% of all preterm births result from hypertensive disorders half of women with severe pre-eclampsia give birth preterm small-for-gestational-age babies (mainly because of fetal growth restriction arising from placental disease) are common, with 20-25% of preterm births and 14-19% of term births in women with pre-eclampsia being less than the tenth centile of birth weight for gestation NICE suggest that (1): blood pressure measurement and urinalysis for protein should (...) be carried out at each antenatal visit to screen for pre-eclampsia at the booking appointment, the following risk factors for pre-eclampsia should be determined: age 40 years or older nulliparity pregnancy interval of more than 10 years family history of pre-eclampsia previous history of pre-eclampsia body mass index 30 kg/m2 or above pre-existing vascular disease such as hypertension pre-existing renal disease multiple pregnancy more frequent blood pressure measurements should be considered for pregnant

2010 GP Notebook

764. pre-eclampsia

with severe pre-eclampsia give birth preterm small-for-gestational-age babies (mainly because of fetal growth restriction arising from placental disease) are common, with 20-25% of preterm births and 14-19% of term births in women with pre-eclampsia being less than the tenth centile of birth weight for gestation NICE suggest that (1): blood pressure measurement and urinalysis for protein should be carried out at each antenatal visit to screen for pre-eclampsia at the booking appointment, the following (...) risk factors for pre-eclampsia should be determined: age 40 years or older nulliparity pregnancy interval of more than 10 years family history of pre-eclampsia previous history of pre-eclampsia body mass index 30 kg/m2 or above pre-existing vascular disease such as hypertension pre-existing renal disease multiple pregnancy more frequent blood pressure measurements should be considered for pregnant women who have any of the above risk factors the presence of significant hypertension

2010 GP Notebook

765. pregnancy (hypertension with proteinuria)

-eclampsia and 8-10% of all preterm births result from hypertensive disorders half of women with severe pre-eclampsia give birth preterm small-for-gestational-age babies (mainly because of fetal growth restriction arising from placental disease) are common, with 20-25% of preterm births and 14-19% of term births in women with pre-eclampsia being less than the tenth centile of birth weight for gestation NICE suggest that (1): blood pressure measurement and urinalysis for protein should be carried out (...) at each antenatal visit to screen for pre-eclampsia at the booking appointment, the following risk factors for pre-eclampsia should be determined: age 40 years or older nulliparity pregnancy interval of more than 10 years family history of pre-eclampsia previous history of pre-eclampsia body mass index 30 kg/m2 or above pre-existing vascular disease such as hypertension pre-existing renal disease multiple pregnancy more frequent blood pressure measurements should be considered for pregnant women who

2010 GP Notebook

766. pregnancy (pre-eclampsia)

disorders half of women with severe pre-eclampsia give birth preterm small-for-gestational-age babies (mainly because of fetal growth restriction arising from placental disease) are common, with 20-25% of preterm births and 14-19% of term births in women with pre-eclampsia being less than the tenth centile of birth weight for gestation NICE suggest that (1): blood pressure measurement and urinalysis for protein should be carried out at each antenatal visit to screen for pre-eclampsia at the booking (...) appointment, the following risk factors for pre-eclampsia should be determined: age 40 years or older nulliparity pregnancy interval of more than 10 years family history of pre-eclampsia previous history of pre-eclampsia body mass index 30 kg/m2 or above pre-existing vascular disease such as hypertension pre-existing renal disease multiple pregnancy more frequent blood pressure measurements should be considered for pregnant women who have any of the above risk factors the presence of significant

2010 GP Notebook

767. Canadian clinical practice guidelines on the management and prevention of obesity in adults and children

: cardiovascular disease and other mor- bidities, mortality and quality-of-life measures • Psychosocial outcomes: depression, mood disorders and eating disorders Using the guidelines: an illustrative case scenario These guidelines are intended as a practical guide that can be used by health care professionals in everyday clinical practice. When using the guidelines, the reader can refer to the list of recommendations (listed at the end of this summary) to find key points rapidly. Alternatively, the reader can (...) the guidelines may be used in the management of a typical adult patient as- sessed in clinical practice. Fig. 1 summarizes the assessment CMAJ • April 10, 2007 • 176(8) | Online-3CMAJ • April 10, 2007 • 176(8) | Online-4 Satisfactory progress or goal achieved? Yes Health team to advise lifestyle modification program Overweight or obese adult • Measure BMI • Measure waist circumference if BMI is > 25 and = 35 kg/m 2 Conduct clinical and laboratory investigations to assess comorbidities (Blood pressure, heart

2007 CPG Infobase

768. Aerius (desloratadine)

antagonists are one of several therapeutic options available and have been proven to be effective as initial therapy in many patients with mild SAR, especially controlling rhinorrhea, sneezing and nasal pruritus. Because antihistamines most effectively block receptor sites before histamine release, best results are obtained when they are administered on a regular basis and as a prophylactic measure prior to allergen exposure. The primary goal of H 1 receptor antagonist treatment in SAR is to reduce (...) and coating. The product is being manufactured in a facility that holds the necessary Manufacturing Authorisation. The control tests and specifications for the finished product are adequately drawn up. The company has, however, been asked as a follow up measure to re-evaluate and if necessary, tighten the limits for degradation products in the finished product specifications, as soon as the 36 months stability data are available. The identity of desloratadine is based upon retention time (HPLC) and upon R

2006 European Medicines Agency - EPARs

769. Caelyx (doxorubicin)

and nephrotoxic than doxorubicin HCl, but more dermotoxic (reversible dermal toxicity in the form of lesions on the feet and legs). A study performed in a non-rodent species led to the same conclusions. In terms of dermal toxicity, the no-effect level was 0.25 mg/kg in both rodent and non-rodent species. Two additional studies, one in a non-rodent species, have been undertaken to assess the cardiac, haematological and dermal toxicity of Caelyx. In an animal model for anthracycline cardiotoxicity, up to 50 (...) The evaluation of reproductive toxicity was restricted to fertility studies (segment II). Since there are data on the embryotoxic and teratogenic nature of doxorubicin HCl, as well as on its ability to induce long-term or permanent sterility (in rats and dogs testicular atrophy may be observed), it was considered acceptable not to repeat the studies with Caelyx. The administration of high doses of Caelyx to pregnant rodent species was associated with decreased foetal weights, decreased litter size

2005 European Medicines Agency - EPARs

770. Beromun (tasonermin)

. Hand and foot, if not affected, should be protected by Esmarch bandages. A tourniquet should be applied to the proximal limb. After connection of the limb to the isolated circuit, flow rate should be adjusted to 35 to 40 ml/litre limb volume/minute and leakage from limb to systemic circulation checked using a radioactive tracer technique (see section 4.4). Adjustment of flow rate and tourniquet may be required to ensure leakage from perfusion circuit to systemic circulation is stable (systemic (...) into the arterial line of the circuit. The temperature should then be increased to >39°C (but not exceeding 40°C) in two different sites of measurement in the tumour area. The duration of the perfusion including melphalan should be 60 minutes. Thus, the duration of the total perfusion should be 90 minutes. At the end of the perfusion, the perfusate should be collected into the reservoir while washout fluid is added simultaneously to the circuit and circulated at the same flow rate of 35 to 40 ml/litre limb

2005 European Medicines Agency - EPARs

771. Azilect (rasagiline)

activity in several models of dopaminergic motor dysfunction and hypoxia-induced cognitive deficits. • Safety pharmacology The effect of rasagiline on the cardiovascular system was assessed in dogs, rats and cats. In the dog study, conscious animals acutely treated with rasagiline (3 mg/kg, oral) were monitored by telemetry and blood pressure, heart rate as well as ECG parameters were measured. Rasagiline produced no overt treatment related changes in cardiovascular parameters in dogs. Similarly (...) were sometimes accompanied by increases in liver weight and changes in hepatocyte morphology in rats. The liver changes were consistent with changes observed in rats treated with hepatic microsomal enzyme inducers, there was however no evidence from studies that measured hepatic microsomal proteins to support this hypothesis. Suspected changes in thyroid and bladder morphology identified in the rat 13-week oral study were not corroborated by findings in either the 4-week or 26-week rat oral studies

2006 European Medicines Agency - EPARs

772. Ibandronic Sodium (Boniva)

) ----------------------- USE IN SPECIFIC POPULATIONS ----------------------- BONIVA is not recommended in patients with severe renal impairment (creatinine clearance 90 mL/min. Patients with CLcr -2.5. Women were stratified according 18 to time since menopause (1 to 3 years, >3 years) and baseline lumbar spine BMD (T-score: >-1, -1 to -2.5). The study compared daily BONIVA at three dose levels (0.5 mg, 1.0 mg, 2.5 mg) with placebo. All women received 500 mg of supplemental calcium per day. The primary efficacy measure (...) , aged 46 to 60 years, were on average 5.4 years postmenopause. All women received 400 IU of vitamin D and 500 mg calcium supplementation daily. The primary efficacy measure was the relative change in BMD at the lumbar spine after 1 year of treatment. BONIVA 150 mg once-monthly resulted in a mean increase in lumbar spine BMD of 4.12% (95% confidence interval 2.96 – 5.28) compared with placebo following 1 year of treatment (p -2.5), the clinical trial did not fully support an osteoporosis prevention

2008 FDA - Drug Approval Package

773. Pain Management Options During Labour

. Each facility should develop specific policies and procedures. Staff should be trained to recognize problems in order to rapidly institute corrective measures. Regional analgesia should not be administered until: • a qualified practitioner has examined the patient. • a registered nurse has communicated the maternal and fetal status and progress of labour with the primary care provider. • a baseline fetal heart assessment has been obtained. From the epidural point of view, continuous fetal (...) Pain Management Options During Labour British Columbia Perinatal Health Program Optimizing Neonatal, Maternal and Fetal Health ? British Columbia Reproductive Care Program (BCRCP) ? Provincial Specialized Perinatal Services (PSPS) ATTENTION: Perinatal Care Providers F502 – 4500 Oak Street, Vancouver, BC, V6H 3N1 Tel: 604-875-3737 ? Fax: 604-875-3747 www.bcphp.ca ALERT October 2010 An error has been noted in Obstetric Guideline 4: Pain Management Options During Labour. Page 22:7.3 Continuous

2007 British Columbia Perinatal Health Program

774. Transportation of infants and children in motor vehicles

are heavier than 36 kg (80 lb), are at least eight years of age and who properly fit the adult restraint in the vehicle (refer to specific seating instructions under the ‘placement of the child in the seat’ section). Conventional seat belts are designed for persons taller than 145 cm (4 feet 9 inches). However, not all children 145 cm (4 feet 9 inches) or taller are ready to use an adult seat belt, but rather may be ready depending on the way the child fits the adult seat belt. Therefore, parents need (...) to assess the way the adult seat belt fits first before deciding that a booster seat is no longer required. Booster seat legislation in some provinces specifies minimum weight, age, and standing and seated height requirements for seat belt use. Because children’s growth patterns, and weight and/or height proportions vary widely, age should only be used as a guideline. Physical measurements are much truer markers of appropriate seating needs. Developmental abilities must also be considered. Premature

2008 Canadian Paediatric Society

775. Estimating the Costs to the NHS of Smoking in Pregnancy for Pregnant Women and Infants

is small (6 more women quitting per 100 smoking women assigned to interventions). [5] Relapse rates for women who quit during pregnancy are high – 67-80% of quitters are smoking again within a year. [6, 7] Smoking in pregnancy is a major public health concern, posing risks to both mother and child. [8, 9] It is a well-known cause of many complications of pregnancy, [8] adverse foetal and infant outcomes, [9] and a suspected cause of some subtle and long-term outcomes in offspring, e.g. impaired lung (...) SIDS. [9, 32, 37, 38] Relative risks ranged from 1.2-1.6. . PAR of 3.4% to 10.5% were reported for the USA. [32, 37] One review reported a dose- response effect whilst one review reported no clear dose- response effect. [9, 37] Six reviews on maternal smoking during pregnancy and fetal growth restrictions were identified. The relative risks ranged from 2.3 to 2.8.[32, 37, 38, 46-48] A PAR of 18% was reported. [48] Three of the reviews reported a dose- response effect with a relative risk of 2.4

2008 Public Health Research Consortium

776. Assessing the challenges of applying standard methods of economic evaluation to public health programmes

34 Section 2: Methods 39 2.1 General approach 39 2.2 Specifying the methodological challenges 39 2.2.1 Attributing outcomes to interventions 39 2.2.2 Measuring and valuing outcomes 40 2.2.3 Incorporating equity considerations 40 2.2.4 Identifying intersectoral costs and consequences 41 2.3 Review of methods in existing empirical studies 41 2.3.1 Review methods 41 2.3.1.1 Selection of studies 41 2.3.1.2 Data extraction 43 2.4 Expert Workshop 49 Section 3: Methodology Review of Empirical Studies 50 (...) 3.1 Review background 50 3.2 Results 50 3.2.1 Overview 51 3.2.1.1 Public health areas 51 3.2.1.2 Location 54 3.2.1.3 Population sub-groups 57 3.2.2 Attribution of effects 57 3.2.2.1 Randomised controlled studies 58 3.2.2.2 Non-Randomised studies 60 3.2.2.3 Review studies 60 3.2.3 Measuring and valuing outcomes 61 3.2.3.1 Types of economic evaluation 62 3.2.3.2 Types of outcomes included in the economic evaluations 63 3.2.4 Equity considerations 63 3.2.5 Intersectoral costs and consequences 63

2006 Public Health Research Consortium

777. Scalpel safety in the operative setting: a systematic review

rate, and up to five times as many injuries as a safety scalpel with a lower activation rate. Evidence from one study indicated that materials such as non-pliable leather, rubber with leather lining and new rubber provided superior foot protection from dropped scalpel blades under experimental conditions. Classification and Recommendations On the basis of the evidence presented in this systematic review, the ASERNIP-S Review Group agreed on the following classifications and recommendations (...) variation in study methodology and measurement of outcomes. Standardisation of these features needs to be considered by trial designers in order to compile a clinically relevant and statistically valid body of evidence by which to assess new safety procedures and devices; however, the undertaking of randomised controlled trials (particularly of cut- resistant gloves and glove liners) is both feasible and desirable. Additionally, the undertaking of a suitably detailed audit of scalpel injuries would

2007 Publication 80

778. Birth imminent (normal delivery and delivery complications)

requires resuscitation, follow the appropriate neonatal resuscitation guideline. Any other body part presenting; if, upon inspection, a part of the baby is presenting other than the head, buttocks or feet (e.g. one foot or a hand/arm) transport the mother immediately to the NEAREST OBSTETRIC UNIT. Transfer to further care must be preceded by a Hospital Alert Call via Control. 8. Shoulder Dystocia This is when delivery of the baby’s shoulders is delayed. The baby’s anterior shoulder is stuck behind (...) to establish the stage in the pregnancy (measured in weeks of duration of the pregnancy). For example, 14/40 on a maternity plan means the mother is 14 weeks into the 40 week duration of pregnancy. The appropriate action for differing lengths of gestation would be: Birth Imminent (normal delivery and delivery complications) Obstetrics and Gynaecological Emergencies October 2006 Page 1 of 9 Obstetrics & Gynaecological Emergencies Obstetrics & Gynaecological EmergenciesLess than 20 weeks 1 Transport

2006 Joint Royal Colleges Ambulance Liaison Committee

779. Eating disorders toolkit, a practice based guide to the inpatient management of adolescents with eating disorders, with special reference to regional and rural areas

cycle, absence of any menstrual periods and date of last menstrual period. PHYSICAL ASSESSMENT Try to ensure that the physical examination is carried out sensitively. The patient will be exposing their body (a disliked aspect of themselves) to an unfamiliar person. ? Weight and height. Weigh without heavy clothing or shoes using calibrated scales (ideally those that will be used for future weighs). Measure height using a stadiometer. ? Calculate BMI (weight kg/height m 2 ). ? Chart weight, height (...) and BMI using age appropriate percentile charts. Include any other available measures to help assess progress. Rapid weight changes even within the normal percentile range can cause severe symptoms. ? Pulse, blood pressure (lying and standing) and temperature ? Assess for dehydration (sunken eyes, dry lips and tongue, poor skin turgor, slow capillary return). ? Skin inspection: acrocyanosis (blue discolouration), jaundice, carotenaemia (orange skin), dry skin, lanugo hair (soft downy hair on back

2008 Clinical Practice Guidelines Portal

780. Obstetrics/Gynaecology - birth imminent-normal delivery/delivery complications

requires resuscitation, follow the appropriate neonatal resuscitation guideline. Any other body part presenting; if, upon inspection, a part of the baby is presenting other than the head, buttocks or feet (e.g. one foot or a hand/arm) transport the mother immediately to the NEAREST OBSTETRIC UNIT. Transfer to further care must be preceded by a Hospital Alert Call via Control. 8. Shoulder Dystocia This is when delivery of the baby’s shoulders is delayed. The baby’s anterior shoulder is stuck behind (...) . It is important to establish the stage in the pregnancy (measured in weeks of duration of the pregnancy). For example, 14/40 on a maternity plan means the mother is 14 weeks into the 40 week duration of pregnancy. The appropriate action for differing lengths of gestation would be: Birth Imminent (normal delivery and delivery complications) Obstetrics and Gynaecological Emergencies October 2006 Page 1 of 9 Obstetrics & Gynaecological Emergencies Obstetrics & Gynaecological EmergenciesLess than 20 weeks 1

2007 Joint Royal Colleges Ambulance Liaison Committee

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