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High Pressure Injection Wound

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181. Adult Type 1 diabetes mellitus

, high-risk activities). • Advise adults with type 1 diabetes to aim for: - a fasting plasma glucose level of 5–7 mmol/litre on waking and - a plasma glucose level of 4–7 mmol/litre before meals at other times of the day. _________________________ 1 Refer to section 2.9 for a description on the strength of recommendations made10 | Adult type 1 diabetes mellitus | A National Clinical Guideline Insulin therapy • Offer multiple daily injection basal–bolus insulin regimens, rather than twice-daily mixed (...) in ensuring that patients get the best outcomes from their care. The Department of Health is of the view that supporting evidence-based practice, through the clinical effectiveness framework, is a critical element of the health service to deliver safe and high quality care. The National Clinical Effectiveness Committee (NCEC) is a Ministerial committee set up in 2010 as a key recommendation of the report of the Commission on Patient Safety and Quality Assurance (2008). The establishment of the Commission

2018 National Clinical Guidelines (Ireland)

182. Regorafenib (Stivarga) indicated as monotherapy for the treatment of adult patients with hepatocellular carcinoma (HCC) who have been previously treated with sorafenib treatment

- ment, incorrect statistical analysis). For each domain, assessors were expected to judge the risk of bias (‘low risk’, ‘high risk’, or ‘un- clear’) on the basis of the information retrieved from the paper and from the CSR. The results of the risk of bias assessment at both study and outcome level are presented in Table A8 and Table A9 in Appendix 1. The external validity of the included trial was assessed using the EUnetHTA guideline on applica- bility of evidence in the context of a relative (...) by the addition of one fluorine atom. Although regorafenib is a targeted therapy, there is no relevant predictive biomarker identified. Pharmacodynamics/Kinetics Absorption: a high-fat meal increased the mean area under the curve (AUC) of the drug by 48% compared with the fasted state and decreased the mean AUC of the active metabolites M-2 (N- oxide) by 20% and M-5 (N-oxide and N-desmethyl) by 51%. A low-fat meal increased the mean AUC of regorafenib by 36%, M-2 by 40%, and M-5 by 23%, compared

2018 EUnetHTA

183. 2018 IDSA Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapy

for effective monitoring for vascular access complications and antimicrobial adverse events (weak recommendation, low-quality evidence) . III. Can persons who inject drugs (PWID) be treated with OPAT at home? No recommendation can be made about whether PWID may be treated with OPAT at home (no recommendation, low-quality evidence) . Decisions should be made on a case-by-case basis. IV. Should elderly patients be allowed to be treated with OPAT at home? Elderly patients should be allowed to be treated (...) OPAT have laboratory test monitoring while on therapy? If so, which tests should be done and how often? Serial laboratory testing should be monitored in patients receiving OPAT (strong recommendation, high-quality evidence) . Data are insufficient to make evidence-based recommendations about specific tests and specific frequencies of monitoring for individual antimicrobials used in OPAT. XV. For patients receiving vancomycin as part of OPAT, should vancomycin serum levels be measured regularly

2018 Infectious Diseases Society of America

184. National Clinical Guideline on Adult type 1 diabetes mellitus

- evident that safe, effective care and treatment are important in ensuring that patients get the best outcomes from their care. The Department of Health is of the view that supporting evidence-based practice, through the clinical effectiveness framework, is a critical element of the health service to deliver safe and high quality care. The National Clinical Effectiveness Committee (NCEC) is a Ministerial committee set up in 2010 as a key recommendation of the report of the Commission on Patient Safety (...) and Quality Assurance (2008). The establishment of the Commission was prompted by an increasing awareness of patient safety issues in general and high profile health service system failures at home and abroad. The NCEC on behalf of the Department of Health has embarked on a quality assured National Clinical Guideline development process linked to service delivery priorities. Furthermore, implementing National Clinical Guidelines sets a standard nationally, to enable healthcare professionals to deliver

2018 HIQA Guidelines

185. Imaging Guidelines

, but exceptions can be made for patients with difficult access, as is often the case in seriously injured patients. 17 When a large bore peripheral IV catheter cannot be obtained, a pressure rated central venous catheter designed to accommodate high-pressure injection (consult the package insert for each brand for further clarification) is a safe alternative. 17 A central 9 Fr venous catheter is commonly placed in such patients and can be used, although many currently available products are not yet pressure (...) of approximately 0.26 to 0.7 percent. 14-16 Significant morbidity is infrequent, with most adverse events occurring in patients with severe cachexia or impaired venous or lymphatic drainage. 16 Most cases do not require significant intervention, with 97.4 percent having minimal to no adverse effects. 15 IV contrast is most frequently administered through a pressure injector for optimal diagnostic clarity. Antecubital or large forearm venous injection sites are preferred to reduce risk of contrast extravasation

2018 American College of Surgeons

186. Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU Full Text available with Trip Pro

were similar, they were significantly higher among nurses (vs patients) for position change, subcutaneous injection, blood sugar testing, and blood pressure (BP) measurement ( ). No statistical measure of agreement between nurse and ICU patient scores was reported. Finally, compared with seriously ill patients’ self-reports, surrogates correctly identified pain presence 74% of the time and pain severity 53% of the time, with a tendency to overestimate pain intensity ( ). There are families who may (...) engagement and empowerment bundle adoption). Dr. Bosma received funding from the Canadian Institutes of Health Research (CIHR) where she is the primary investigator of an industry partnered research grant with Covidien as the industry partner of the CIHR for a study investigating proportional assist ventilation versus pressure support ventilation for weaning from mechanical ventilation. Dr. Brummel participates in the ATS (Aging and Geriatrics Working Group Co-Chair) and ArjoHuntleigh (advisory board

2018 Society of Critical Care Medicine

187. End-of-Life Care for People Experiencing Homelessness

Worksheet Appendix G. Palliative Care in Recovery Appendix H. Values Worksheet Appendix I. Sample Will Appendix J. Cultural Aspects of Death and Dying Health Care for the Homeless Clinicians’ Network ADAPTING YOUR PRACTICE Recommendations for End-of-life Care for People Experiencing Homelessness 1 INTRODUCTION Homeless populations have diverse and complex end-of-life needs (McNeil, Guirguis-Younger, & Dilley, 2014). Chronic diseases and mortality rates are high in the United States, especially (...) adults in Boston, investigators found that death most often occurred in a hospital or residential dwelling; exposure to cold caused only 4 of 606 deaths (Rousseau, 1998). There are high mortality rates among people experiencing homelessness, who often die of conditions that are more easily treated in people with stable housing, such as pneumonia, influenza, HIV/AIDS, liver disease, renal disease, cold-related injuries, and cardiac arrhythmias (Hwang et al., 2001). Because they lack access to health

2018 National Health Care for the Homeless Council

188. Urinary Incontinence

factors. Int Urogynecol J Pelvic Floor Dysfunct, 2007. 18: 397. 45. Milleman, M., et al. Post-void residual urine volume in women with overactive bladder symptoms. J Urol, 2004. 172: 1911. 46. Brostrom, S., et al. Short-term reproducibility of cystometry and pressure-flow micturition studies in healthy women. Neurourol Urodyn, 2002. 21: 457. 47. Broekhuis, S.R., et al. Reproducibility of same session repeated cystometry and pressure-flow studies in women with symptoms of urinary incontinence (...) . Neurourol Urodyn, 2010. 29: 428. 48. Schick, E., et al. Predictive value of maximum urethral closure pressure, urethral hypermobility and urethral incompetence in the diagnosis of clinically significant female genuine stress incontinence. J Urol, 2004. 171: 1871. 49. Dorflinger, A., et al. Urethral pressure profile: is it affected by position? Neurourol Urodyn, 2002. 21: 553. 50. Wang, A.C., et al. A comparison of urethral pressure profilometry using microtip and double-lumen perfusion catheters

2018 European Association of Urology

189. Muscle-invasive and Metastatic Bladder Cancer

. Chrouser, K., et al. Bladder cancer risk following primary and adjuvant external beam radiation for prostate cancer. J Urol, 2005. 174: 107. 26. Nieder, A.M., et al. Radiation therapy for prostate cancer increases subsequent risk of bladder and rectal cancer: a population based cohort study. J Urol, 2008. 180: 2005. 27. Zelefsky, M.J., et al. Incidence of secondary cancer development after high-dose intensity-modulated radiotherapy and image-guided brachytherapy for the treatment of localized prostate (...) latero-montanal biopsies and urethral frozen sections during prostatocystectomy. Eur Urol, 1998. 33: 170. 81. Miladi, M., et al. The value of a second transurethral resection in evaluating patients with bladder tumours. Eur Urol, 2003. 43: 241. 82. Jakse, G., et al. A second-look TUR in T1 transitional cell carcinoma: why? Eur Urol, 2004. 45: 539. 83. Brauers, A., et al. Second resection and prognosis of primary high risk superficial bladder cancer: is cystectomy often too early? J Urol, 2001. 165

2018 European Association of Urology

190. Prostate Cancer

Broeck T., et al. A systematic review of oncological effectiveness and harms of primary local interventions for high-risk localized and locally advanced prostate cancer. PROSPERO International prospective register of systematic reviews, 2017. CRD42017078862 8. Willemse, P.M., et al. Systematic review of deferred treatment with curative intent for localised prostate cancer to explore heterogeneity of definitions, thresholds and criteria and clinical effectiveness. PROSPERO International prospective (...) . 29. Esposito, K., et al. Effect of metabolic syndrome and its components on prostate cancer risk: meta-analysis. J Endocrinol Invest, 2013. 36: 132. 30. Blanc-Lapierre, A., et al. Metabolic syndrome and prostate cancer risk in a population-based case-control study in Montreal, Canada. BMC Public Health, 2015. 15: 913. 31. Preston, M.A., et al. Metformin use and prostate cancer risk. Eur Urol, 2014. 66: 1012. 32. Freedland, S.J., et al. Statin use and risk of prostate cancer and high-grade

2018 European Association of Urology

191. Renal Transplantation

uncontrolled donors after cardiac death. Transplant Proc, 2008. 40: 1023. 45. Jochmans, I., et al. Hypothermic machine perfusion of kidneys retrieved from standard and high-risk donors. Transpl Int, 2015. 28: 665. 46. Treckmann, J., et al. Machine perfusion versus cold storage for preservation of kidneys from expanded criteria donors after brain death. Transpl Int, 2011. 24: 548. 47. Gill, J., et al. Pulsatile perfusion reduces the risk of delayed graft function in deceased donor kidney transplants (...) , irrespective of donor type and cold ischemic time. Transplantation, 2014. 97: 668. 48. Matsuno, N., et al. Machine perfusion preservation for kidney grafts with a high creatinine from uncontrolled donation after cardiac death. Transplant Proc, 2010. 42: 155. 49. Jochmans, I., et al. Graft quality assessment in kidney transplantation: not an exact science yet! Curr Opin Organ Transplant, 2011. 16: 174. 50. Thuillier, R., et al. Benefits of active oxygenation during hypothermic machine perfusion of kidneys

2018 European Association of Urology

192. Urological Trauma

Physician, 2001. 63: 1567. 261. Selikowitz, S.M. Penetrating high-velocity genitourinary injuries. Part I. Statistics mechanisms, and renal wounds. Urology, 1977. 9: 371. 262. Hudak, S.J., et al. Operative management of wartime genitourinary injuries at Balad Air Force Theater Hospital, 2005 to 2008. J Urol, 2009. 182: 180. 263. Cass, A.S., et al. Bilateral testicular injury from external trauma. J Urol, 1988. 140: 1435. 264. Michielsen, D., et al. Burns to the genitalia and the perineum. J Urol, 1998 (...) expectant (conservative) management of renal trauma--a systematic review. J Trauma, 2005. 59: 493. 29. Sujenthiran, A., et al. Is Nonoperative Management the Best First-line Option for High-grade Renal trauma? A Systematic Review. Eur Urol Focus, 2017. 30. Mingoli, A., et al. Operative and nonoperative management for renal trauma: comparison of outcomes. A systematic review and meta-analysis. Ther Clin Risk Manag, 2017. 13: 1127. 31. Bjurlin, M.A., et al. Comparison of nonoperative management

2018 European Association of Urology

193. Paediatric Urology

., et al. Correction of congenital penile curvature using modified tunical plication with absorbable sutures: the long-term outcome and patient satisfaction. Eur Urol, 2007. 52: 261. 271. Sasso, F., et al. Penile curvature: an update for management from 20 years experience in a high volume centre. Urologia, 2016. 83: 130. 272. Gittes, R.F., et al. Injection technique to induce penile erection. Urology, 1974. 4: 473. 273. Schultheiss, D., et al. Congenital and acquired penile deviation treated (...) therapy with LHRH and HCG in cryptorchid infants. Eur J Pediatr, 1993. 152 Suppl 2: S31. 66. Forest, M.G., et al. Effects of human chorionic gonadotropin, androgens, adrenocorticotropin hormone, dexamethasone and hyperprolactinemia on plasma sex steroid-binding protein. Ann N Y Acad Sci, 1988. 538: 214. 67. Aycan, Z., et al. Evaluation of low-dose hCG treatment for cryptorchidism. Turk J Pediatr, 2006. 48: 228. 68. Hesse, V., et al. Three injections of human chorionic gonadotropin are as effective

2018 European Association of Urology

194. Urological Infections

) in patients with chronic prostatitis syndrome. Andrologia, 2005. 37: 61. 256. Ohkawa, M., et al. Antimicrobial treatment for chronic prostatitis as a means of defining the role of Ureaplasma urealyticum. Urol Int, 1993. 51: 129. 257. Jimenez-Cruz, J.F., et al. Treatment of chronic prostatitis: intraprostatic antibiotic injections under echography control. J Urol, 1988. 139: 967. 258. Mayersak, J.S. Transrectal ultrasonography directed intraprostatic injection of gentamycin-xylocaine in the management (...) , and Vaginal Surgery: A Systematic Review. J Minim Invasive Gynecol, 2015. 22: 737. 294. Guenaga, K.F., et al. Mechanical bowel preparation for elective colorectal surgery. Cochrane Database Syst Rev, 2011: CD001544. 295. Dumville, J.C., et al. Preoperative skin antiseptics for preventing surgical wound infections after clean surgery. Cochrane Database Syst Rev, 2015: CD003949. 296. Webster, J., et al. Use of plastic adhesive drapes during surgery for preventing surgical site infection. Cochrane Database

2018 European Association of Urology

195. Male Sexual Dysfunction

(penile rehabilitation) in the patient after brachytherapy for prostate cancer. Brachytherapy, 2012. 11: 87. 82. Cordeiro, E.R., et al. High-intensity focused ultrasound (HIFU) for definitive treatment of prostate cancer. BJU Int, 2012. 110: 1228. 83. Williams, S.B., et al. Comparative effectiveness of cryotherapy vs brachytherapy for localised prostate cancer. BJU Int, 2012. 110: E92. 84. Hatzichristou, D., et al. Diagnosing Sexual Dysfunction in Men and Women: Sexual History Taking and the Role (...) : reproducibility, evaluation criteria and the effect of sexual intercourse. J Urol, 1998. 159: 1921. 110. Hatzichristou, D.G., et al. Hemodynamic characterization of a functional erection. Arterial and corporeal veno-occlusive function in patients with a positive intracavernosal injection test. Eur Urol, 1999. 36: 60. 111. Sikka, S.C., et al. Standardization of vascular assessment of erectile dysfunction: standard operating procedures for duplex ultrasound. J Sex Med, 2013. 10: 120. 112. Pathak, R.A., et al

2018 European Association of Urology

196. Penile Cancer

in Five Continents Vol. VIII. IARC Scientific Publication No. 155. Vol. Vol III. 2002, The International Agency for Research on Cancer, 150 cours Albert Thomas, 69372 Lyon CEDEX 08, France. 16. Parkin, D.M., et al. Chapter 2: The burden of HPV-related cancers. Vaccine, 2006. 24 Suppl 3: S3/11. 17. Baldur-Felskov, B., et al. Increased incidence of penile cancer and high-grade penile intraepithelial neoplasia in Denmark 1978-2008: a nationwide population-based study. Cancer Causes Control, 2012. 23: 273 (...) carcinoma of the penis. Scand J Urol Nephrol Suppl, 2000: 189. 22. Maden, C., et al. History of circumcision, medical conditions, and sexual activity and risk of penile cancer. J Natl Cancer Inst, 1993. 85: 19. 23. Tsen, H.F., et al. Risk factors for penile cancer: results of a population-based case-control study in Los Angeles County (United States). Cancer Causes Control, 2001. 12: 267. 24. Afonso, L.A., et al. High Risk Human Papillomavirus Infection of the Foreskin in Asymptomatic Men and Patients

2018 European Association of Urology

197. CRACKCast E146 – Radiation Injuries

in plastic bags – soap and water to wash down skin will help further. High pressure, repeat cleaning methods may be required Universal precautions, including rubber gloves, shoe covers, and respirators if airborne contamination is suspected, are effective in protecting personnel and the work area from contamination. The only variation is to wear two sets of gloves and to change the outer pair when appropriate to avoid cross-contamination. Assess for Local and Acute Radiation syndrome Local radiation (...) CRACKCast E146 – Radiation Injuries CRACKCast E146 – Radiation Injuries - CanadiEM CRACKCast E146 – Radiation Injuries In , by Adam Thomas January 22, 2018 This Episode of CRACKCast covers Rosen’s Chapter 138, Radiation Injuries. While this is not a commonly seen presentation, we need to know how to diagnose and manage radiation injuries when they occur! Shownotes: Rosens in Perspective: Don’t let this chapter give you PTSD – as you rack your brain to remember high school physics! Let’s get

2018 CandiEM

198. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm Full Text available with Trip Pro

mortality 33 Perioperative morbidity 33 Endoleak 34 Access site complications 34 Acute limb thrombosis 34 Postimplantation syndrome 34 Ischemic colitis 34 Role of elective EVAR in the high-risk and unfit patient 34 OSR 35 Indications 35 Surgical approach 35 Aortic clamping 35 Graft type and configuration 36 Maintenance of pelvic circulation 37 Management of associated intra-abdominal vascular disease 37 Management of associated intra-abdominal nonvascular disease 38 Perioperative outcomes of open AAA (...) APPENDIX: SEARCH STRATEGY Summary of guidelines for the care of patients with an abdominal aortic aneurysm Physical examination In patients with a suspected or known abdominal aortic aneurysm (AAA), we recommend performing physical examination that includes an assessment of femoral and popliteal arteries. In patients with a popliteal or femoral artery aneurysm, we recommend evaluation for an AAA. Level of recommendation 1 (Strong) Quality of evidence A (High) Assessment of medical comorbidities

2018 Society for Vascular Surgery

199. Practice Guidelines for Moderate Procedural Sedation and Analgesia Full Text available with Trip Pro

forms of bidirectional communication during procedures performed with moderate sedation/analgesia ; (2) monitoring patient ventilation and oxygenation, including ventilatory function, by observation of qualitative clinical signs, capnography, and pulse oximetry; (3) hemodynamic monitoring, including blood pressure, heart rate, and electrocardiography; (4) contemporaneous recording of monitored parameters; and (5) availability/presence of an individual responsible for patient monitoring. Literature (...) of the patient, procedure, or equipment; (3) monitor all patients by pulse oximetry with appropriate alarms; (4) determine blood pressure before sedation/analgesia is initiated unless precluded by lack of patient cooperation; (5) once moderate sedation/analgesia is established, continually monitor blood pressure and heart rate during the procedure unless such monitoring interferes with the procedure; (6) use electrocardiographic monitoring during moderate sedation in patients with clinically significant

2018 American Society of Anesthesiologists

200. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented (...) modulators β-hCG injections, corticosteroid injections, clomiphene hCG indicates human chorionic gonadotropin; NR, not reported; and SCAD, spontaneous coronary artery dissection. The average age of women with SCAD ranges from 45 to 53 years, but examples of patients presenting with SCAD in their second through eighth decades of life have been reported. , , , , , , , One study reported that men presented with SCAD at a slightly younger age than women (mean age, 48.6 [SD, 9.8] years versus 52.3 [SD, 9.2

2018 American Heart Association

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