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61. The management of urinary incontinence in women

or, if appropriate, her carer. Indications for the use of long-term indwelling urethral catheters for women with UI include: – chronic urinary retention in women who are unable to manage intermittent self- catheterisation – skin wounds, pressure ulcers or irritations that are being contaminated by urine – distress or disruption caused by bed and clothing changes – where a woman expresses a preference for this form of management. 7 THE MANAGEMENT OF URINARY INCONTINENCE IN WOMEN (...) who are unable to manage intermittent self- catheterisation • skin wounds, pressure ulcers or irritations that are being contaminated by urine • distress or disruption caused by bed and clothing changes • where a woman expresses a preference for this form of management. Indwelling suprapubic catheters 1.6.5 Indwelling suprapubic catheters should be considered as an alternative to long-term urethral catheters. Be aware, and explain to women, that they may be associated with lower rates

2019 Best Practice Advocacy Centre New Zealand

62. Management of Poisoning

Physicians Academy of Medicine, Singapore Ministry of Manpower Health Sciences Authority College of Physicians, Singapore December 2011Level Type of Evidence 1 + + High quality meta-analyses, systematic reviews of randomised controlled trials (RCTs), or RCTs with a very low risk of bias 1 + Well-conducted meta-analyses, systematic reviews of RCTs, or RCTs with a low risk of bias 1 - Meta-analyses, systematic reviews of RCTs, or RCTs with a high risk of bias 2 + + High quality systematic reviews of case (...) control or cohort studies. High quality case control or cohort studies with a very low risk of confounding or bias and a high probability that the relationship is causal 2 + Well conducted case control or cohort studies with a low risk of confounding or bias and a moderate probability that the relationship is causal 2 - Case control or cohort studies with a high risk of confounding or bias and a signifi cant risk that the relationship is not causal 3 Non-analytic studies, e.g. case reports, case

2020 Ministry of Health, Singapore

63. Clinical Practice Guideline on the Diagnosis and Prevention of Periprosthetic Joint Infections

eAppendix 2 To View All AAOS and AAOS-Endorsed Evidence-Based Clinical Practice Guidelines and Appropriate Use Criteria in a User-Friendly Format, Please Visit the OrthoGuidelines Web-Based App at or by downloading to your smartphone or tablet via the Apple and Google Play stores! 4 View the background material via the PJI CPG eAppendix 1 View data summaries via the PJI CPG eAppendix 2 Table of Contents Summary of Recommendations 6 Risk Factors for PJI 6 Injections Prior (...) Searches 18 Defining the Strength of the Recommendations 18 Voting on the Recommendations 18 Interpreting the Strength of Evidence 19 Peer Review 20 Public Commentary 20 The AAOS Clinical practice guideline Approval Process 20 Revision Plans 20 Clinical practice guideline Dissemination Plans 20 5 View the background material via the PJI CPG eAppendix 1 View data summaries via the PJI CPG eAppendix 2 Study Attrition Flowchart 21 Recommendations 22 Risk Factors for PJI 22 Injections Prior to Arthroplasty

2020 American Academy of Orthopaedic Surgeons

64. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS) Society and the European Society of Thoracic Surgeons (ESTS) Full Text available with Trip Pro

, no recommendation can currently be made because either equipoise exists or there is a lack of available evidence. Recommendations are based not only on the quality of the evidence but also on the balance between desirable and undesirable effects. Key recommendations include preoperative counselling, nutritional screening, smoking cessation, prehabilitation for high-risk patients, avoidance of fasting, carbohydrate loading, avoidance of preoperative sedatives, venous thromboembolism prophylaxis, prevention (...) recovery after lung surgery: recommendations of the ERAS Society and the ESTS Recommendations Evidence level Recommendation grade Preoperative phase Preadmission information, education and counselling Patients should routinely receive dedicated preoperative counselling Low Strong Perioperative nutrition Patients should be screened preoperatively for nutritional status and weight loss High Strong Oral nutritional supplements should be given to malnourished patients Moderate Strong Immune-enhancing

2020 ERAS Society

65. Perioperative

systematically evaluating the quality of evidence (high, moderate, low, very low) and developing a strength of recommendation (strong, weak). For more detailed information on GRADE, please visit In addition, when GRADE methodology could not be applied, the work group developed consensus recommendations. Return to Table of Institute for Clinical Systems Improvement 4 Perioperative Sixth Edition /January 2020 Recommendations Table The following table (...) appliance or continuous positive airway pressure equipment to bring their appliance or equipment with them on the operative day for use during the recovery from anesthesia or sedation. 3. Patients with suspected sleep apnea in the perioperative period should have a follow-up evaluation, typically in concert with the patient’s primary provider (if one is available), and/or referral to sleep center. 4. Patients with known sleep apnea or suspected sleep apnea at a preoperative evaluation should have

2020 Institute for Clinical Systems Improvement

66. Infection prevention and control

on the same patient. Gloves should be disposed of as clinical waste and hands should be washed following their removal. Latex-free gloves should be available for staff or patients who have an allergy or sensitivity to latex. Facemasks The use of facemasks to decrease the incidence of postoperative wound infection has been questioned [11–13]; however, the selection and use of respiratory and facial protection equipment should be underpinned by appropriate staff education and training. In the majority (...) at the end of the operating list. Injection ports should be maintained using a sterile technique, kept free of blood and covered with a cap when not in use. Connections, injection ports and three-way taps within intravenous lines should be kept to a minimum. Needle-free Luer injection devices should be used to cover exposed female Luer injection ports. Antimicrobial stewardship and effective prescribing by anaesthetists Anaesthetists should engage in antimicrobial stewardship [23]. They should ensure

2020 Association of Anaesthetists of GB and Ireland

67. Management of Pilonidal Disease

include a large area of tissue mobilization, increased risk of hematoma/ seroma formation, and wound dehiscence. 92 Although data from several randomized trials found low (0%–6%) overall rates of surgical site infections, 77,78,80 a recent ran- domized controlled trial shows a very high rate of wound dehiscence associated with this type of flap. 92 Although many of these dehiscences were minor, and the major- ity went on to heal without recurrence, they do require ongoing wound care. There are several (...) of Colon & Rectal Surgeons, Inc. Unauthorized reproduction of this article is prohibited. JOHNSON ET AL: MANAGEMENT OF PILONIDAL DISEASE 156 76. Biter LU, Beck GM, Mannaerts GH, Stok MM, van der Ham AC, Grotenhuis BA. The use of negative-pressure wound therapy in pilonidal sinus disease: a randomized controlled trial comparing negative-pressure wound therapy versus standard open wound care after surgical excision. Dis Colon Rectum. 2014;57:1406–1411. 77. Abu Galala KH, Salam IM, Abu Samaan KR, et al

2020 American Society of Colon and Rectal Surgeons

68. Infection Control for Haemodialysis Units

with multi-resistant organisms (MROs) in dialysis units has been often high as a consequence of the high burden of comorbidities, high rates of hospitalisation and high rates of antibiotic exposure amongst its clients [11] ? MROs that are commonly found in dialysis populations are transmitted by direct and indirect contact [18] ? Cannulation, connection and disconnection of high flow and high-pressure dialysis circuits are a risk for accidental body fluid exposure [11] ? Colonisation or infection (...) in the mid-40s, in what was likely a single acquisition event of an ancestral type one SCCmec element, according to recent research based on genome-wide analyses of historic isolates [1]. MRSA emergence was likely driven by the widespread use of penicillin but remained unrecognised, until 1960, one year after the adoption of methicillin for penicillin-resistant Staph aureus. Its prevalence then rapidly increased, presumably as a result of the selection pressures created by the widespread use

2019 KHA-CARI Guidelines

69. Management of Type 2 Diabetes Mellitus

, and Treatment of High Blood Pressure (JNC 8) while =140/80 is recommended by the American Diabetes Association, although there is no level A evidence for the systolic BP goal. 15 UMHS Management of Type 2 Diabetes Mellitus June, 2017 Table 13. How to Use a Monofilament • Show the monofilament to the patient. Place the end of the monofilament on his/her hand or arm to show that the testing procedure will not hurt. • Ask the patient to turn his/her head and close his/her eyes or look at the ceiling. • Hold (...) ) should be screened for diabetes (USPSTF level B recommendation). In adults who have hypertension and diabetes, lowering blood pressure below conventional target values reduces the incidence of cardiovascular events and cardiovascular mortality and justifies screening. Screening may be reasonable for other at-risk subjects (e.g., those with obesity, history of gestational diabetes mellitus, family history, and high-risk ethnic minorities). Based on expert opinion the ADA recommends considering earlier

2020 University of Michigan Health System

70. Guidelines For Professional Ultrasound Practice

SCREENING EXAMINATIONS USING ULTRASOUND 19 1.9 ERGONOMIC PRACTICE INCLUDING MANAGING THE HIGH BMI PATIENT 21 1.10 INTIMATE EXAMINATIONS AND CHAPERONES 23 1.11 EXAMINATION TIMES 24 1.12 THE 6 C’s, PATIENT IDENTIFICATION, COMMUNICATION AND CONSENT 25 1.13 CLINICAL GOVERNANCE 27 1.14 E-LEARNING FOR HEALTHCARE 29 1.15 IMAGING SERVICES ACCREDITATION SCHEME (ISAS) 29 1.16 ULTRASOUND EQUIPMENT AND QUALITY ASSURANCE TESTING 30 1.17 RAISING CONCERNS; SAFEGUARDING; STATUTORY REQUIREMENTS FOR REPORTING FEMALE (...) by an evidence base and are effectively measurable’. Guideline: ‘A general rule, principle or piece of advice. Guidelines provide recommendations on how ultrasound examinations should be performed and are based on best available evidence. They help ultrasound practitioners in their work but they do not replace their knowledge and skills’. Protocol: An agreement, preferably based on research, between practitioners to ensure the delivery of high quality standardised ultrasound examinations. The title

2019 British Medical Ultrasound Society

71. Ménière’s Disease (Meniere) Full Text available with Trip Pro

. Prevalence estimates as low as 3.5 per 100,000 and as high as 513 per 100,000 have been reported from studies worldwide. These estimates may reflect geographic and demographic variation, but they are also likely influenced by differences in case definitions over time (eg, 1972 American Academy of Ophthalmology and Otolaryngology criteria vs 1995 AAO-HNS criteria ), settings (hospital vs outpatient), duration, and methods of case capture (survey, records, or insurance claims). One of the most rigorous (...) not require institutionalization. As such, anxiety and/or depression is common in MD patients, with 33% of men and 41% of women affected with MD carrying diagnoses of depression. Health Care Costs The diagnosis and management of MD produces significant direct health care costs. The symptom of dizziness is one of the most common reasons for ambulatory care visits in the United States and often leads to high utilization of diagnostic services (ie, imaging, audiovestibular, and cardiac testing) as well

2020 American Academy of Otolaryngology - Head and Neck Surgery

72. Opioid Treatments for Chronic Pain

are at high risk for opioid-related adverse events. No trial compared different rates of opioid tapering, though one observational study found an association between longer time to opioid discontinuation in patients on long-term, high-dose opioid therapy and decreased risk of opioid-related emergency department visit or hospitalization. 45 The Food and Drug Administration recently issued a warning on not discontinuing long-term opioid therapy abruptly. 46 No study evaluated the effectiveness of risk (...) and Burden of Chronic Pain Chronic pain, often defined as pain lasting longer than 3 to 6 months, or past the time of normal tissue healing, is common. 1 The Centers for Disease Control and Prevention (CDC) estimates that 20.4 percent of U.S. adults in 2016 had chronic pain and 8.0 percent had high impact (resulting in limitations in major life domains) chronic pain. 2 Chronic pain is associated with an annual cost conservatively estimated at $560 to $635 billion, can result in impaired physical

2020 Effective Health Care Program (AHRQ)

73. Practice Guidelines for Central Venous Access 2020: An Updated Report by the American Society of Anesthesiologists Task Force on Central Venous Access

associated with central venous access include, but are not limited to, (1) intravenous antibiotic prophylaxis; (2) aseptic preparation of practitioner, staff, and patients; (3) selection of antiseptic solution; (4) selection of catheters containing antimicrobial agents; (5) selection of catheter insertion site; (6) catheter fixation method; (7) insertion site dressings; (8) catheter maintenance procedures; and (9) aseptic techniques using an existing central venous catheter for injection or aspiration (...) or potentially contaminated ( e.g. , burned or infected skin, inguinal area, adjacent to tracheostomy, or open surgical wound); and (3) select an upper body insertion site when possible to minimize the risk of infection in adults. Catheter Fixation Literature Findings . The literature is insufficient to evaluate whether catheter fixation with sutures, staples, or tape is associated with a higher risk for catheter-related infections. Survey Findings . The consultants strongly agree and ASA members agree

2020 American Society of Anesthesiologists

74. Guidance for Return to Practice for Otolaryngology-Head and Neck Surgery: Part Two

, these procedures should be deferred or replaced with alternate options: Inhaled corticosteroids can be delivered by metered-dose inhaler rather than nebulizer, chest auscultation can be performed rather than peak flow testing, PFTs may be deferred until COVID restrictions are eased. Allergy Clinic Logistics Allergy clinics have the potential for transmission due to high volume of patients receiving injections if social distancing cannot be adequately maintained. While many clinics typically have open hours (...) /moderate dysplasia • Non obstructive, benign lesion of vocal fold • Gender affirmation surgery • Glottic incompetence causing mild to moderate dysphonia • Globus and cough without alarm signs • Procedures listed as emergent, urgent, and semi-urgent • Open airway procedures – not cancer • Tracheostomy care or change • Transtracheal injection OTOLOGY/NEUROTOLOGY Diagnoses Necessitating “Emergent” Operative Management (Tier 1) These diagnoses have high associated morbidity or even mortality

2020 American Academy of Otolaryngology - Head and Neck Surgery

75. Clinical Management of Stable Coronary Artery Disease in Patients With Type 2 Diabetes Mellitus: A Scientific Statement From the American Heart Association

of stroke, with a decrease in stroke risk with lowering of systolic blood pressure to levels <120 mm Hg. , As a result of these studies, most society guideline statements changed their recommendations to a blood pressure target <140/90 mm Hg for patients with T2DM, with the consideration of a goal of <130/80 mm Hg in select high-risk patients when it can be achieved without harm. , Intensive blood pressure control has again emerged as potentially beneficial in reducing cardiovascular risk due to SPRINT (...) (Systolic Blood Pressure Intervention Trial), in which there was a notable 25% relative/0.5% absolute reduced risk per year of cardiovascular morbidity and mortality with intensive (<120 mm Hg) as compared with standard (<140 mm Hg) systolic blood pressure control in patients with hypertension and high cardiovascular risk. Importantly, at least in part due to the ACCORD trial (Action to Control Cardiovascular Risk in Diabetes), patients with T2DM were explicitly excluded from SPRINT, so it is difficult

2020 American Heart Association

76. 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

2020 European Association of Urology

77. Labor Dystocia

strategies for treating labor dystocia in women with otherwise uncomplicated pregnancies. Strategies assessed include amniotomy, supportive care measures, epidural analgesia, frequency of cervical examination, intrauterine pressure catheters, high- versus low-dose oxytocin protocols, electronic fetal monitoring or intermittent auscultation during augmentation with oxytocin, and delayed or Valsalva pushing. Key Messages • Use of partograms did not impact important maternal or neonatal outcomes (...) relevant to supportive care measures, 25 relevant to epidural analgesia, 1 relevant to cervical examination, 1 relevant to intrauterine pressure catheters, 17 relevant to high-dose versus low-dose oxytocin protocols, 1 relevant to fetal monitoring strategies, and 7 relevant to timing of pushing in the second stage. Evidence suggests that the duration and pattern of “normal” labor progress based on modern management are quite different from historical data, and that labor progress differs between

2020 Effective Health Care Program (AHRQ)

78. Overview of sport-related injuries

-up prior to exercise. Hoelmich P. Adductor-related groin pain in athletes. Sports Med Arthrosc. 1997;5:285-291. Garrett WE, Safran MR, Seaber AV, et al. Biomechanical comparison of stimulated and nonstimulated skeletal muscle pulled to failure. Am J Sports Med. 1987;15:448-454. Related conditions Condition Description Traumatic brain injury can be sustained during contact sports or high-risk recreational activities. Faul M, Xu L (...) : the spectrum of consequences. Neurosurg Focus. 2006;21:E10. Typically presents with headache, nausea and vomiting, and confusion, which may be due to increased intracranial pressure, and diminished eye, verbal, and motor responses. An acquired focal abnormal dilation of the wall of an artery in the brain. Usually haemodynamically induced, although trauma may contribute to formation. Stress and exertion can trigger rupture through

2018 BMJ Best Practice

79. VAAFT for treating anal fistulae

that they should only be used with special arrangements for clinical governance, consent and audit or research. Fibrin glue can be injected into the fistula tract in an attempt to seal it. Evidence for this procedure reports initial success rates of 50%, but long-term findings indicate that it may be associated with a high rate of recurrence (Cirocchi et al. 2009). NICE is unaware of any CE-marked technologies which fulfil a similar function to VAAFT. VAAFT for treating anal fistulae (MIB102) © NICE 2018. All (...) patients (34.15%) had discharge from the wound. 13 patients (15.85%) had a recurrence during 6 month follow- up. Anal manometry showed that there were no statistically significant changes in the mean resting anal pressures and mean anal squeeze pressures before and after the procedure. None of the patients reported any problems with faecal continence. People with Crohn's disease and existing faecal incontinence were excluded from the study. MRI scans were done for all participants. Faecal continence

2017 National Institute for Health and Clinical Excellence - Advice

80. Canadian Urological Association guideline for the diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction

, and the behaviour of the urinary sphincters during voiding. The availability of videoUDS is not universal, and a voiding cystogram is an acceptable alternative in some cases. Urodynamic diagnoses, such as neurogenic detrusor overactivity (NDO), impaired compli- ance, reduced bladder capacity, or a high detrusor leak point pressure (DLPP, defined as the lowest vesical pressure at which urine leaks from the bladder in the absence of a detrusor contraction or increased abdominal straining) can identify a patient (...) , so too does the risk of renal dysfunction due to an increased resting pressure in the bladder being transmitted to the kid- neys. If a high DLPP only occurs at a volume greater than the usual capacity during the normal daily voiding pattern, then this DLPP may not be physiologically relevant. A low DLPP maintains low pressure drainage from the kidneys, however, this often results in urinary incontinence. Imaging Renal and bladder imaging is necessary to identify hydrone- phrosis (a late

2019 Canadian Urological Association

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