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High Pressure Injection Wound

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141. Proposals for a further expansion of day surgery in Belgium

of selected procedures and related day-care and inpatient stays (2011-2013) 91 Table 22 – Top-10 day-surgery procedures (2011-2013) 94 Table 23 – Lens extraction with insertion of an intraocular lens prosthesis, 2011-2013 96 6 Proposals for a further expansion of day surgery in Belgium KCE Report 282 Table 24 – Elective surgical procedures with high national day-care rates and outliers, 2011-2013 97 Table 25 – Excision of an epididymal cyst, 2011-2013 97 Table 26 – Elective surgical procedures (...) , though at varying rates. 2 As a matter of fact, day surgery represents an innovative tool for the health sector reform in Europe by contributing to several common objectives: improving quality of care, controlling cost, and enhancing efficiency and possibly equity. 3 In order to promote the worldwide development of high quality day surgery the International Association for Ambulatory Surgery (IAAS) was founded (in 1995); the Belgian Association of Ambulatory Surgery (BAAS) was one of its founding

2017 Belgian Health Care Knowledge Centre

142. Guidelines for the management of acute joint bleeds and chronic synovitis in haemophilia

carefully as radioactive burns may occur along the needle track. Injecting an anti-in?ammatory agent such as hydrocortisone acetate into the joint before removal also effectively ?ushes isotope out, reducing both the risk of leakage as well as a subsequent in?am- matory reaction and radiation skin burn. High dose radiation has been shown to damage articular cartilage in experimental studies, but at the therapeutic doses used in radioactive synovectomy this is unlikely [64]. A recent longitudinal study (...) , ‘recommended’) are made when there is con?dence that the bene?ts either do or do not out- weigh the harm and costs of treatment. Where the magnitude of bene?t or not is less certain, a weaker grade 2 recommendation (‘suggested’) is made. Grade 1 recommendations can be applied uniformly to most patients, whereas grade 2 recommendations require a more individualized application. The qual- ity of evidence is graded as high (A), based on high quality randomized clinical trials, moderate (B), low (C) or very

2017 United Kingdom Haemophilia Centre Doctors' Organisation

143. British Association of Dermatologists guidelines for the management of pemphigus vulgaris

is presented as a detailed review with high- lighted recommendations for practical use in the clinic (see Tables 1 and 4), in addition to an updated patient information lea?et (available on the BAD website, http://www.bad.org. uk/for-the-public/patient-information-leaflets). 1.1 Exclusions This guideline does not cover other forms of pemphigus. 2.0 Stakeholder involvement and peer review The Guideline Development Group (GDG) consisted of consul- tant dermatologists and a clinical nurse specialist (...) Guidelines for the management of pemphigus vulgaris 2017, K.E. Harman et al. 1171there are no skin lesions and a sample for DIF is to be taken from the oral mucosa, the buccal mucosa can be exposed by everting the cheek, placing the thumb at the commissure and re?ecting the corner of the mouth, applying external pressure on the cheek with the index ?nger to present the buccal mucosa. The transport medium into which samples for DIF are placed varies, including saline, Michel’s medium and snap freezing

2017 British Association of Dermatologists

144. CRACKCast E120 – Dermatologic presentations

, systemic symptoms, or vesicle formation raise concern for Stevens-Johnson syndrome. The treatment of Stevens – Johnson syndrome and toxic epider – mal necrolysis includes discontinuation of the offending agent and supportive care , including hydration , prevention of secondary infection , and expert wound management ( at a burn centre ). Morbidity and mortality are often related to infection and dehydration. High-dose IVIG may be administered to patients with severe toxic epidermal necrolysis (...) soft tissue infections, drug eruptions, or immune disorders. Patients with Stevens-Johnson syndrome (<10% TBSA) and toxic epidermal necrolysis require inpatient treatment, preferably in a burn unit. Cutaneous signs of systemic disease may include pruritus, urticaria, erythema multiforme, erythema nodosum, pyoderma gangrenosum, and others. Physicians should be familiar with one or two topical steroid preparations of low, medium, and high potency and their appropriate therapeutic use. Hydrocortisone

2017 CandiEM

145. WHO recommendations on maternal health

includes the synthesis and assessment of the quality of evidence, and is based on the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. GRADE categorizes the quality (or certainty) of the evidence underpinning a recommendation as high, moderate, low or very low. ¦ High: further research is very unlikely to change our confidence in the estimate of effect; ¦ Moderate: further research is likely to have an impact on our confidence in the effect; ¦ Low: further research (...) ¦ ¦ In undernourished populations, balanced energy and protein dietary supplementation is recommended for pregnant women to reduce the risk of stillbirths and small-for-gestational- age neonates. (Context-specific recommendation). Source ¦ ¦ In undernourished populations, high-protein supplementation is not recommended for pregnant women to improve maternal and perinatal outcomes. (Not recommended). Source Iron and folic acid supplements ¦ ¦ Daily oral iron and folic acid supplementation with 30 mg to 60 mg

2017 World Health Organisation Guidelines

146. CrackCAST E136 – Bone and Joint Infections

assessment of all diabetic patients with infected pedal ulcers. A positive result consists of detection of a hard, gritty surface; also indicated in nondiabetic ulcers due to peripheral neuropathy, vasculopathy, or pressure sores.” (uptodate). Below taken from “ Probing the wound to see if it reaches the bone can help identify osteomyelitis. Other tests such as ESR or x-ray can help make the diagnosis. Aragon-Sanchez, J et al. Diagnosing diabetic foot osteomyelitis: is the combination of probe-to-bone (...) test and plain radiography sufficient for high-risk inpatients? Diabet Me. 2011 Feb;2892):191-4. If you can probe to bone and have a positive x-ray, the likelihood ratio of osteomyelitis is 12. If you can’t probe to bone with a negative x-ray, the negative likelihood ratio is 0.02. How do you probe the wound? Get a sterile probe and gently explore the wound. If you feel something hard or gritty, it is positive. This is a Grade 2C recommendation. A high ESR and CRP obtained in the emergency

2017 CandiEM

147. CRACKCast E137 – Skin Infections

-Clav Erythema migrans Borrelia burgdorferi Doxycycline Puncture wound through foot Pseudomomas aeruginosa Ciprofloxacin [1] List 6 risk factors for cellulitis From Uptodate: Predisposing factors for development of cellulitis and/or skin abscess include: Skin barrier disruption due to trauma (such as abrasion, penetrating wound, pressure ulcer, venous leg ulcer, insect bite, injection drug use) Skin inflammation (such as eczema, radiation therapy) Edema due to impaired lymphatic drainage Edema due (...) common; this aggressively virulent agent is known as flesh-eating bacteria. Risk factors: Type I: Diabetes IV drug use Obesity Immunosuppression recent surgery traumatic wounds peripheral vascular disease Type II: any age group, especially without any medical history history of skin injury (eg laceration or burn) blunt trauma recent surgery Childbirth injection drug use varicella infection (chickenpox) [16] Describe the management of necrotizing fasciitis. Remember: Initial symptoms may be vague (eg

2017 CandiEM

148. CrackCAST E129 – Bacteria

diphtheria-tetanus or DTaP. Patients 7 years old or older should receive Tdap. HTIG prophylaxis (250 units IM) is recommended for unimmunized and underimmunized patients with high risk wounds (>6 hours old, >1 cm deep, contaminated, stellate, denervated, ischemic, infected). When tetanus toxoid and HTIG are given concurrently, separate injection sites should be used. The only contraindication to tetanus and diphtheria toxoids is a history oyf a neurologic or severe hypersensitivity reaction to a previous (...) with Td**[see notes below] ***ensure injection is in a SEPARATE SITE FROM THE htig*** Prevention of further toxin production. Metronidazole Doxycycline, macrolides an alternative Toxin production is eliminated by treatment of the C. tetani infection. Wound débridement and antibiotic administration can cause a transient release of tetanospasmin, so these measures should be delayed until after the HTIG is administered. Metronidazole (500 mg orally or IV every 6 hours) is the antibiotic of choice for C

2017 CandiEM

149. Netarsudil plus latanoprost (Roclatan) for glaucoma or ocular hypertension

as these outputs are produced as required for our stakeholders. > > > Netarsudil plus latanoprost (Roclatan) for glaucoma or ocular hypertension Netarsudil plus latanoprost (Roclatan) for glaucoma or ocular hypertension September 2017 Glaucoma describes a group of disorders characterised by sight loss. Glaucoma is generally associated with high pressure in the liquids inside the eye but it can happen when the pressure level is normal. Individuals with consistently high eye pressure are at risk of developing (...) glaucoma. Glaucoma does not normally cause any symptoms but once eye sight is lost it cannot be recovered. Approximately one in every ten blindness registrations is due to glaucoma. There are approximately half a million people living with glaucoma in England. Current treatment options include a number of different eye drop formulations to stop internal eye pressure raising. If the eye drops do not work and glaucoma is diagnosed, laser therapy or eye surgery can also be used to stop sight loss

2017 NIHR Innovation Observatory

150. Islet Cell Replacement Therapy for Insulin-Dependent Diabetes

and cancer, as well as the potential for the immunosuppressive drugs to negatively affect islet function. 4,7 Because of these risks, ViaCyte plans to use the PEC-Direct product only in people with high-risk type 1 diabetes, defined as those who experience: impaired awareness of low blood sugar levels (hypoglycemia unawareness) extreme fluctuations of blood sugar (glycemic lability) and/or frequent and severe incidences of low blood sugar (hypoglycemic episodes). 3 The PEC-Encap (VC-01) Product ViaCyte’s (...) at the University of Alberta Hospital in Edmonton. 9,16 Neither the PEC-Direct nor the PEC-Encap products are expected to be available outside of clinical trials for several years. 3,17,18 Cost The cost of the PEC-Direct and PEC-Encap products is not yet known. Who Might Benefit? ViaCyte’s PEC-Direct product is intended only for patients living with high-risk type 1 diabetes (also called “brittle” or “labile” diabetes). 3,19 Between 10% and 15% of the approximately 350,000 Canadians living with type 1 diabetes

2017 CADTH - Issues in Emerging Health Technologies

151. Islet Cell Replacement Therapy for Insulin-Dependent Diabetes

and cancer, as well as the potential for the immunosuppressive drugs to negatively affect islet function. 4,7 Because of these risks, ViaCyte plans to use the PEC-Direct product only in people with high-risk type 1 diabetes, defined as those who experience: impaired awareness of low blood sugar levels (hypoglycemia unawareness) extreme fluctuations of blood sugar (glycemic lability) and/or frequent and severe incidences of low blood sugar (hypoglycemic episodes). 3 The PEC-Encap (VC-01) Product ViaCyte’s (...) at the University of Alberta Hospital in Edmonton. 9,16 Neither the PEC-Direct nor the PEC-Encap products are expected to be available outside of clinical trials for several years. 3,17,18 Cost The cost of the PEC-Direct and PEC-Encap products is not yet known. Who Might Benefit? ViaCyte’s PEC-Direct product is intended only for patients living with high-risk type 1 diabetes (also called “brittle” or “labile” diabetes). 3,19 Between 10% and 15% of the approximately 350,000 Canadians living with type 1 diabetes

2017 CADTH - Issues in Emerging Health Technologies

152. Health Technology Update — Issue 18

) in women can lead to pelvic inflammatory disease, infertility, or complications during pregnancy. Infection by the human papillomavirus (HPV), a viral STI, usually resolves spontaneously; but some high-risk strains of the virus can lead to cervical cancer later in life. 2,3 Early diagnosis and treatment or monitoring can reduce the spread of these infections, the risk of complications, and the costs of treatment. 4 In 2016, 1,500 new cases of cervical cancer were expected to occur in Canada, and 400 (...) for analysis. 7 The cell samples are analyzed in a lab to detect high-risk strains of HPV and other STIs. 7,15 One new self-sampling device is the HerSwab. The HerSwab is available as a medical device, and is also part of the Eve Kit — a direct-to-consumer mail kit that allows women to self-collect cells for STI testing. How It Works The HerSwab is a brush-type self-sampling device with a plastic applicator handle. After inserting the tip of the device into her vagina, a woman rotates the handle to ensure

2017 CADTH - Health Technology Update

153. CRACKCast E096 – Anorectal Disorders

! Managed Medically using the WASH approach. ● Warm water sitz ● Analgesia ● Stool softeners ● High fiber diet See below Usually can be managed supportively as well. (they will ulcerate and ooze dark blood in a few days). But, if within 72 hrs of onset of symptoms, they can have the clot EXCISED. Be sure to warn patients that excision will lead to evacuation of the clot, but also rebleeding, swelling and the formation of a skin tag. People that are bad candidates for this: kids, pregnant women (...) , immunocompromised patients. Rosen’s does mention that an alternative non-surgical therapy: ● Topical nifedipine 0.3% ● Topical lidocaine gel 1.5% + Excision procedure: ● Anesthetic field block ● Elliptic incision (single crescent shaped) made on the hemorrhoid and over top of the clot) ● Clot is removed. Hemorrhoid management: WASH approach Warm water sitz baths (ideally with epsom salts) Water > 40 degrees C helps decrease anal canal pressures (a shower stream can also work). 5-10 mins BID-QID prn Analgesics

2017 CandiEM

154. Consolidated guideline on sexual and reproductive health and rights of women living with HIV

), Aditi Sharma (ICW, India), Martha Tholanah (ICW, Zimbabwe), Ruth Morgan Thomas (Global Network of Sex Work Projects [NSWP], United Kingdom), Rita Wahab (Women Living with HIV in the Middle East [MENA Rosa], Lebanon). Representatives of United Nations agencies and other external partners The Global Fund to Fight AIDS, Tuberculosis and Malaria: Kate Thomson Joint United Nations Programme on HIV/AIDS (UNAIDS) Office of the United Nations High Commissioner for Human Rights (OHCHR): Ruben Brouwer (...) involvement of women living with HIV and AIDS MNS mental, neurological and substance use MSD WHO Department for Mental Health and Substance Abuse MSM men who have sex with men OHCHR Office of the United Nations High Commissioner for Human Rights PAR participatory action research PICO population, intervention, comparator, outcome(s)Consolidated guideline on sexual and reproductive health and rights of women living with HIV viii PMNCH Partnership for Maternal, Newborn & Child Health PMTCT prevention

2017 World Health Organisation Guidelines

155. Treatment of Osteoarthritis of the Knee: An Update Review

as the direction of the reported effect across studies (or within studies if a single RCT used multiple tools to measure the same outcome), precision was assessed in terms of the similarity in effect sizes, the average variance, and the numbers of studies. Directness was assessed as it would be for pooled outcomes. Lack of pooling automatically decreased the SoE grade by one unit. Based on these domains, we rated the SoE for each comparison of interest as high, moderate, low, or insufficient (if no or too few

2017 Effective Health Care Program (AHRQ)

156. Cataracts in adults: management.

injection into the Internet Archive (or other archive sites). To use ArchiveBot, drop by #archivebot on EFNet. To interact with ArchiveBot, you issue commands by typing it into the channel. Note you will need channel operator permissions in order to issue archiving jobs. The dashboard shows the sites being downloaded currently. There is a dashboard running for the archivebot process at . ArchiveBot's source code can be found at . TIMESTAMPS Search Sign In Username or Email * Password * Remember Me Don't (...) of different intraocular lenses (see "Before Cataract Surgery," below) Types of anaesthesia The person's individual risk of complications during or after surgery (for example, the risk of postoperative retinal detachment in people with high myopia; also see "Risk Stratification," below) What to do and what to expect on the day of cataract surgery What to do and what to expect after cataract surgery What support might be needed after surgery Medicines after surgery (for example, eye drops) and medicines

2017 National Guideline Clearinghouse (partial archive)

157. Complex regional pain syndrome/reflex sympathetic dystrophy medical treatment guideline.

at, and it grabs all content under that URL, records it in a WARC, and then uploads that WARC to ArchiveTeam servers for eventual injection into the Internet Archive (or other archive sites). To use ArchiveBot, drop by #archivebot on EFNet. To interact with ArchiveBot, you issue commands by typing it into the channel. Note you will need channel operator permissions in order to issue archiving jobs. The dashboard shows the sites being downloaded currently. There is a dashboard running for the archivebot process (...) or be caused or exacerbated by opioid and hypnotic use. Refer to the Division's for more information on behavioral modifications to address sleep disturbances. Education/Informed/Shared Decision Making Evidence Statements Regarding Education/Informed Decision Making Some Evidence Information provided only by video is not sufficient education (Design: Prospective randomized controlled trial ). See the original guideline document for time to produce effect and frequency. Injections—Therapeutic For post

2017 National Guideline Clearinghouse (partial archive)

158. BTS guideline for oxygen use in adults in healthcare and emergency settings.

failure , aim at an oxygen saturation of 94% to 98% (or 88% to 92% if the patient is at risk of hypercapnic respiratory failure) ( grade D ). Continuous positive airway pressure (CPAP) with entrained oxygen or high-flow humidified nasal oxygen to maintain saturation 94% to 98% (or 88% to 92% if at risk of hypercapnia) should be considered as an adjunctive treatment to improve gas exchange in patients with cardiogenic pulmonary oedema who are not responding to standard treatment (or non-invasive (...) pressure ventilation) who do not have an alert card, it is recommended that low-concentration oxygen treatment should be started using a 24% Venturi mask at 2-3 L/min (or a 28% Venturi mask at 4 L/min or nasal cannulae at 1-2 L/min if a 24% mask is not available) with an initial target saturation of 88% to 92% pending urgent blood gas results. These patients should be treated as a high priority by emergency services and the oxygen concentration should be reduced if the saturation exceeds 92

2017 National Guideline Clearinghouse (partial archive)

159. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals ? protocol version 5.3

of a patient’s care. In general, they feed, dress, bathe and groom patients, but they can also perform more medically oriented but basic duties such as measuring and recording temperature, blood pressure, and other vital signs. Other licensed health professionals such as dieticians, physiotherapists or speech or occupational therapists, logistic personnel, students of any kind or volunteers who provide basic patient care without pay should not be included. Provide current situation if possible (...) such as measuring and recording temperature, blood pressure, and other vital signs. Other licensed health professionals such as dieticians, physiotherapists or speech or occupational therapists, logistic personnel, students of any kind or volunteers who provide basic patient care without pay should not be included. Provide current situation if possible, or the situation for the earliest available year (specify year) and specify if the number of FTEs is given for the entire hospital or for the included wards

2016 European Centre for Disease Prevention and Control - Technical Guidance

160. Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

in both feeding arteries and draining veins and higher-than-normal pressure on the venous side. Other factors that contribute to complex vascular physiology include high flow rates and shear stress, venous outflow obstruction that can result from long-standing arterial flow rates, arterial steal, and compartmentalization. Anatomic features associated with hemorrhagic presentation include the presence of intranidal aneurysms ( ) or deep venous drainage (drainage into the galenic system), venous outflow (...) , magnified views, and multiple injections, which, together with CT studies and potential additional exposure from endovascular procedures, may lead to high doses to the head and lens of the eye. For these reasons and the highly specific angioarchitectural information (discussed below) obtained in these studies, DSA may be best performed by the members of the cerebrovascular team contemplating treatment. Angiographic features that have been associated with hemorrhage in retrospective studies comparing

2017 American Heart Association

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