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Fetal Foot Measurement

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101. Biologic therapy for psoriasis

SPCs) quantified · that maternal IgG, and therefore biologic drugs currently licensed for psoriasis, are actively transferred to the developing fetus during the second and third trimester and that the impact of this on fetal and neonatal development and risk of infection has not been adequately studied · that live vaccines must be avoided in infants born to mothers taking biologic therapy beyond 16 weeks gestation · relevant patient information resources X R29 Advise women of child-bearing (...) 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

2017 British Association of Dermatologists

102. Interventions Targeting Sensory Challenges in Children with Autism Spectrum Disorder - An Update

high risk of bias [ROB]). Populations, intervention approaches, and outcomes assessed varied across studies. Relative to usual care or other interventions, sensory integration–based approaches improved measures related to sensory and motor skills in the short term (3 RCTs with high, moderate, and low ROB and 1 high ROB retrospective cohort study). Environmental enrichment improved nonverbal cognitive skills in treated children compared with standard care in two small RCTs (low and moderate ROB (...) in measures of motor abilities, memory and visualization, and combined sensory motor and cognitive skills conducted by an unblinded investigator (p values 50% across both) that may affect the generalizability of the results. After 6 months, the 15 treatment group showed more improvement than did the control group in receptive language skills, but both groups improved comparably for expressive language. The treatment group had significantly more improvement on mean nonverbal IQ scores as well as parent

2017 Effective Health Care Program (AHRQ)

103. Management of Uterine Fibroids

embolism (UAE) reduce fibroid size, and improve symptoms and quality of life. High intensity focused ultrasound reduces fibroid size, but impact on quality of life was not measured. Myomectomy and hysterectomy also improve quality of life. Direct comparisons of interventions provide little evidence. • For women in their 30s, the chance of needing retreatment for fibroids within the next 2 years was 6–7 percent after medical treatment or myomectomy and 44 percent after UAE. For older women, the chance (...) Fibroids 1 Medications 1 Procedures 2 Surgery 3 Additional Management Concerns 3 Scope and Key Questions 4 Scope 4 Key Questions 5 Analytic Framework 5 Organization of This Report 6 Methods 8 Topic Refinement and Review Protocol 8 Finding and Selecting Studies 8 Published Literature 8 Gray Literature 9 Inclusion and Exclusion Criteria 10 Data Extraction and Management 11 Outcomes 11 Outcome Measures 12 Quality (Risk of Bias) Assessment of Individual Studies 13 Data Synthesis 14 Grading the Strength

2017 Effective Health Care Program (AHRQ)

104. 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

105. 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 (...) , brief opening of eyes at intervals, some sucking movements Deep—regular breathing, eyes closed, no spontaneous activity Hyperactive Moro reflex* Baby exhibits pronounced jitteriness of the hands during or at the end of the test for Moro reflex Markedly hyperactive Moro reflex* Baby exhibits jitteriness and repetitive jerks of the hands and arms during or at the end of the test for the Moro reflex Mild tremors when disturbed** Baby exhibits observable tremors of the hands or feet when being handled

2017 Queensland Health

106. 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

107. 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 Full Text available with Trip Pro

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

108. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

Cardiovascular Nurses Association Representative. ‖American Academy of Physician Assistants Representative. ¶Task Force Liaison. #Association of Black Cardiologists Representative. **American Pharmacists Association Representative. ††ACC/AHA Prevention Subcommittee Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association (...) Liaison. ‡‡American College of Preventive Medicine Representative. §§American Society of Hypertension Representative. ‖‖Task Force on Performance Measures Liaison. ¶¶American Geriatrics Society Representative. ##National Medical Association Representative. ***Former Task Force member; current member during the writing effort. , Karen J. Collins *American Society for Preventive Cardiology Representative. †ACC/AHA Representative. ‡Lay Volunteer/Patient Representative. §Preventive Cardiovascular Nurses

2017 American Heart Association

109. High Blood Pressure in Adults: Guideline For the Prevention, Detection, Evaluation and Management

of the available BP-related risk information and antihypertensive treatment trial expe- rience have been generated by using “traditional” of?ce methods of BP measurement, there is a growing evidence base supporting the use of automated of?ce BP mea- surements (S4.1-1). TABLE 8 Checklist for Accurate Measurement of BP (S4.1-3,S4.1-4) Key Steps for Proper BP Measurements Speci?c Instructions Step 1: Properly prepare the patient 1. Have the patient relax, sitting in a chair (feet on ?oor, back supported) for>5min (...) that left/right inter-arm differences are insigni?cant. If differences are signi?cant, instruct patient to measure BPs in the arm with higher readings. Instructions on HBPM procedures: n Remain still: n Avoid smoking, caffeinated beverages, or exercise within 30 min before BP measurements. n Ensure$5 min of quiet rest before BP measurements. n Sit correctly: n Sit with back straight and supported (on a straight-backed dining chair, for example, rather than a sofa). n Sit with feet ?at on the ?oor

2017 American College of Cardiology

110. Heart Disease and Stroke Statistics 2017 Update: A Report From the American Heart Association Full Text available with Trip Pro

. 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

2017 American Heart Association

111. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association Full Text available with Trip Pro

to be the first day of fever) together with at least 4 of the 5 following principal clinical features. In the presence of ≥4 principal clinical features, particularly when redness and swelling of the hands and feet are present, the diagnosis of KD can be made with 4 d of fever, although experienced clinicians who have treated many patients with KD may establish the diagnosis with 3 d of fever in rare cases ( ): 1. Erythema and cracking of lips, strawberry tongue, and/or erythema of oral and pharyngeal mucosa (...) 2. Bilateral bulbar conjunctival injection without exudate 3. Rash: maculopapular, diffuse erythroderma, or erythema multiforme-like 4. Erythema and edema of the hands and feet in acute phase and/or periungual desquamation in subacute phase 5. Cervical lymphadenopathy (≥1.5 cm diameter), usually unilateral A careful history may reveal that ≥1 principal clinical features were present during the illness but resolved by the time of presentation. Patients who lack full clinical features of classic

2017 American Heart Association

112. 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

114. ASCIA Position Paper - Hereditary Angioedema (HAE)

ASCIA Position Paper - Hereditary Angioedema 10 © ASCIA 2017 3.5 Special circumstances In a number of circumstances individuals with HAE require special measures to protect them from the risk of swelling. 3.5.1 Pregnancy The published experience regarding the effect of pregnancy on HAE has yielded conflicting results. The most substantial study on clinical manifestations of HAE to date has been a case series of 30 patients by Frank et al looking at the clinical characteristics of HAE. In this series (...) and C1-INH functional assay. In an untreated patient a normal C4 level makes the diagnosis of HAE unlikely. Serum C4 levels are invariably low during attacks however in approximately 2% of cases, the serum C4 level is normal in between attacks 21 . In patients with isolated angioedema where clinical suspicion of HAE is low, screening with C4 levels may be adequate. If HAE is strongly suspected, serum C4 and serum C1-INH level and function should be measured. In general, C1-INH level and functional

2017 Australasian Society of Clinical Immunology and Allergy

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

of a dilated aorta with rapid increase in diameter (⨁◯◯◯). R 3.16. We suggest that in case of an acute ascending AoD before the fetus is viable, to perform emergency aortic surgery understanding that fetal viability may be at risk. If the fetus is viable, it is reasonable to perform cesarean section first, followed by aortic surgery, which should be performed under near-normothermia, pulsatile perfusion, high pump flow and avoidance of vasoconstrictors (⨁◯◯◯). R 3.17. We suggest that exercise testing (...) suspected or has been confirmed prenatally, a fetal echocardiogram should be performed (⨁⨁◯◯). R 4.11. We recommend that diagnosis of a bicuspid aortic valve or a left-sided obstructive lesion in a female fetus or child should prompt a genetic evaluation for TS (⨁⨁◯◯). R 4.12. We recommend referral to a pediatric cardiologist when congenital heart disease is detected prenatally in a fetus with TS to provide counseling regarding the anatomy and physiology of the specific defect, recommended site and mode

2017 European Society of Endocrinology

116. Diagnosis and management of Silver-Russell syndrome: 1st international consensus statement Full Text available with Trip Pro

, 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

117. Standards for obstetrical ultrasound assessments

? ? ? ? ? ? ? ? 17 APPENDIX 4 – CONTACT INFORMATION AND FDS REFERRAL CRITERIA ? ? ? ? 19 APPENDIX 5 – PGSP MINIMUM REPORTING STANDARDS FOR NUCHAL TRANSLUCENCY ULTRASOUND MEASUREMENTS ? ? ? ? ? ? ? ? ? ? ? ? 20 APPENDIX 6 – CROWN RUMP LENGTH (CRL) CHART ? ? ? ? ? ? ? ? ? ? ? ? ? ? 22 APPENDIX 7 – INTERGROWTH 21ST FETAL GROWTH STANDARDS REVIEW ? ? 23 APPENDIX 8 – AMNIOTIC FLUID VOLUME ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 24 APPENDIX 9 – SOGC – 1ST TRIMESTER DATING ULTRASOUND ? ? ? ? ? ? ? ? ? 27 APPENDIX 10 (...) are identified, the ultrasound examination must be expanded appropriately and all abnormal findings documented, measured (if appropriate) and reported? ? ? When significant fetal growth and/or fluid volume abnormalities and/or structural malformations are identified, recommendations given in the final report should include a referral to, or consultation with, the Fetal Diagnostic Service (FDS), the Provincial Medical Genetics Program, or other specialists? Appendix 4 ? ? When a fetal soft marker(s

2016 CPG Infobase

118. Oncaspar - pegaspargase

, the recommended posology is 2000 U/m 2 every 14 days (see SmPC section 4.2). Treatment may be monitored based on the trough serum asparaginase activity measured before the next administration of Oncaspar. If asparaginase activity values fail to reach target levels, a switch to a different asparaginase preparation could be considered (see section 4.4). Oncaspar can be given by intramuscular injection or intravenous infusion. For smaller volumes of Oncaspar, the preferred route of administration (...) structure of asparaginase, physicochemical properties and purity of asparaginase. This includes overall amino acid sequence, N-terminal sequence, disulphide bond configuration, molecular mass and isoelectric point as well as product and process related impurities. Furthermore biologic activity was determined by enzyme kinetics. Specification The proposed release tests are acceptable, including measures of enzymatic activity, and methods to control for product-related substances, product-related

2016 European Medicines Agency - EPARs

119. Lonsurf (trifluridine / tipiracil) - adult patients with metastatic colorectal cancer (CRC)

shown to cause embryo-foetal lethality and embryo-foetal toxicity in pregnant rats when given at dose levels lower than the clinical exposure. No peri/post-natal developmental toxicity studies have been performed. Trifluridine may cause foetal harm when administered to pregnant women. Women should avoid becoming pregnant while taking Lonsurf and for up to 6 months after ending treatment. Therefore, women of child-bearing potential must use highly effective contraceptive measures while taking Lonsurf (...) , decreased sperm, increased cellular debris in epididymis tubules, swelling of liver sinusoidal lining cells. These effects are expected due to the mechanism of action of FTD. Effects are observed EMA/CHMP/287846/2016 Page 32/106 at systemic concentrations below the human recommended dose. TAS-102 induced teratogenicity and embryo foetal mortality at 150 mg/kg/day and impaired embryo-foetal growth in absence of maternal toxicity at 50 mg/kg/day. Developmental toxicity is expected due to the mechanism

2016 European Medicines Agency - EPARs

120. Taltz (ixekizumab) - Psoriasis

, complete quality data, non- clinical and clinical data based on applicants’ own tests and studies and/or bibliographic literature substituting/supporting certain test(s) or study(ies). Information on Paediatric requirements Pursuant to Article 7 of Regulation (EC) No 1901/2006, the application included an EMA Decision P/0090/2012 on the agreement of a paediatric investigation plan (PIP). At the time of submission of the application, the PIP P/0090/2012 was not yet completed as some measures were (...) on the severity and location of outbreaks, individuals may experience significant physical discomfort and some disability. Itching and pain can interfere with basic functions, such as self-care and sleep. Participation in sporting activities and certain occupations can be difficult for those with plaques located on their hands and feet. Plaques on the scalp can be particularly embarrassing for cosmetic reasons because plaques flake. There are 3 primary forms of treatment for psoriasis: topical therapy

2016 European Medicines Agency - EPARs

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