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High Pressure Injection Wound

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141. 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

142. Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (Full text)

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 PubMed abstract

143. 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

144. Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update

, sneezing, or other activities that increase intraabdominal pressure. Urgency UI is defined as the involuntary loss of urine associated with the sensation of a sudden, compelling urge to void that is difficult to defer. Mixed UI occurs when both stress and urgency UI are present. 4 Both nonpharmacological and pharmacological interventions are available for management of UI. Some causes of UI are amenable to surgical interventions, but we focus only on nonsurgical interventions. Nonpharmacological (...) community-dwelling adult women with symptoms of UI Subpopulations: • women engaging in athletic activity, • older women • women in the military or veterans • racial and ethnic minorities If >10% of study participants are from ineligible groups (children or adolescents, men, pregnant women, institutionalized or hospitalized participants, or have surgically-treated UI) Interventions Nonpharmacological interventions: Behavioral interventions, neuromodulation, intravesical pressure release devices

2018 Effective Health Care Program (AHRQ)

145. Cenegermin (Oxervate) - neurotrophic keratitis

acid TFF Tangential flow filtration TMA Trimethylamine TMP Transmembrane pressure TPP Target product profile TSE transmissible spongiform encephalopathies TrkA Tropomyosin receptor kinase A Assessment report EMA/351805/2017 Page 7/104 TYMC Total yeasts and moulds count UF/DF ultrafiltration diafiltration USP United States Pharmacopoeia UV Ultraviolet 4-VP 4-Vinylpyridine VAS Visual Analogue Scale WCB Working cell bank WFI Water for injection Assessment report EMA/351805/2017 Page 8/104 1 (...) substance EC50 50% (median) Effective Concentration ELISA Enzyme-Linked Immunosorbent Assay EPC End of production cells EOR Edge of range ETDRS Early Treatment Diabetic Retinopathy Study EQ-5D EuroQol 5D EU European Union FP Finished product FMEA Failure modes and effects analysis GMP Good manufacturing practice Assessment report EMA/351805/2017 Page 5/104 HCIC Hydrophobic charge interaction chromatography HDPE High density polyethylene HCP Host cell protein HEK293 Human Embryonic Kidney 293 Cells HETP

2017 European Medicines Agency - EPARs

146. 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

147. WHO recommendations: intrapartum care for a positive childbirth experience

heart rate FIGO International Federation of Gynecology and Obstetrics GBS group B streptococcus GDG Guideline Development Group GRADE Grading of Recommendations Assessment, Development and Evaluation GRC Guidelines Review Committee GREAT Guideline-driven, Research priorities, Evidence synthesis, Application of evidence, and Transfer of knowledge HIC high-income country HIE hypoxic-ischaemic encephalopathy HIV human immunodeficiency virus HRP UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme (...) . In addition, the increasing use of labour interventions in the absence of clear indications continues to widen the health equity gap between high- and low-resource settings. This guideline addresses these issues by identifying the most common practices used throughout labour to establish norms of good practice for the conduct of uncomplicated labour and childbirth. It elevates the concept of experience of care as a critical aspect of ensuring high-quality labour and childbirth care and improved woman

2018 World Health Organisation Guidelines

148. Dupilumab (Dupixent) - Atopic Dermatitis

injection sites. These are considered a reaction to injection of high concentration of human protein. Of note, no immunological effects of REGN646 were observed in the repeat-dose toxicity studies. There were no test-article-related changes in peripheral blood lymphocyte subpopulations. In addition, there were no treatment-related changes in serum IgM, IgG and IgE, with the exception of the 13-week study. In this study, lower IgE serum levels were observed in individual monkeys who had received (...) Clinical Practice GISS Global Individual Signs Score HADS Hospital Anxiety and Depression Scale HADS-A Hospital Anxiety and Depression Scale – subscale for anxiety HADS-D Hospital Anxiety and Depression Scale – subscale for depression HbA1c Haemoglobin A1c HbcAb Hepatitis B core antibody HbsAg Hepatitis B surface antigen HIV Human immunodeficiency virus HLT High level term hs-CRP High-sensitivity C-reactive protein ICF Informed consent form ICH International Conference on Harmonisation IDMC Independent

2017 European Medicines Agency - EPARs

149. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain (Full text)

, and other mechanisms. Parameters such as heart rate, blood pressure, cardiac output, and myocardial oxygen consumption increase even with subanesthetic doses. In the pulmonary system, ketamine causes bronchodilation that appears to be due to circulating catecholamines. Pharyngeal and laryngeal reflexes are mostly preserved, as is respiratory function, and there are increased secretions. The speed of injection may play a role in maintenance of respiratory function, implying that subanesthetic infusions (...) , and Cochrane Database of Systematic Reviews, as well as by examination of the reference sections of all manuscripts. Articles considered for inclusion were animal and experimental studies, systematic and other types of reviews, meta-analyses, clinical trials, and, for certain sections in which high-grade evidence was lacking (eg, treatment, complications), case reports and series. Key words used for the review section included “ketamine,” “ N -methyl-D-aspartate receptor,” “central sensitization,” whereas

2018 American Society of Regional Anesthesia and Pain Medicine PubMed abstract

150. Postpartum Pain Management

analgesia is preferred because of greater analgesic efficacy and higher patient satisfaction (24, 28). Women who undergo cesarean birth may benefit from local anesthetics delivered by wound infiltration or transversus abdominis plane block (24, 29, 30). A trans- versus abdominis plane block involves using a blunt-tip needle to inject 20–30 mL of anesthetic in the plane between the internal oblique and transversus abdominis muscles to target the peripheral nerves innervating the lower abdomen; the block (...) ),butthereisnosignificantdifferenceat6hours after birth (18). Because NSAIDs have an analgesic and antiinflammatory ceiling effect, increasing the dose does not improve analgesia and increases the risk of adverse effects (19–21). Nonsteroidal antiinflammatory drugs are associatedwithgastrointestinalcomplicationssuchasdys- pepsia, ulcer, and gastrointestinal bleeding, and may be associated with increased blood pressure, although recent data have questioned the association between NSAIDs and hypertension (22, 23). When a standard dose

2018 American College of Obstetricians and Gynecologists

151. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm (Full text)

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 PubMed abstract

152. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy (Full text)

immunosorbent assay serum testing). If negative, under the guidance of dermatology, sending the patient serum for indirect immunofluorescent testing to rule out other autoimmune blistering diseases could be considered. Recommendation 1.2b – Management. If blisters are < 10% body surface area (BSA), asymptomatic, and noninflammatory (eg, the case with friction blisters or pressure blisters), cessation of ICPi is not necessary, and only observation and/or local wound care is warranted. Once a blister (...) grade 3 toxicities as follows: Should hold ICPi therapy and consult with dermatology. Should treat skin with topical emollients and other petrolatum emollients, oral antihistamines, and high-strength topical corticosteroids. Dimethicone may also be offered as an alternative to petrolatum. Administer IV (methyl)prednisolone (or equivalent) at doses of 1 to 2 mg/kg and taper over at least 4 weeks. Admit to burn and/or consult wound services with attention to supportive care, including fluid

2018 American Society of Clinical Oncology Guidelines PubMed abstract

153. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association (Full text)

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 PubMed abstract

154. Practice Guidelines for Moderate Procedural Sedation and Analgesia (Full text)

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 PubMed abstract

155. Outcome Measures Framework: Information Model Report

classified. The existence of one of the desired components produced a definition of low availability. If an outcome contained two components but additional information has to be sought elsewhere, the outcome was deemed to have medium data availability. The existence of all three components was identified as a measure with high data availability. Depression Eighteen depression registries were evaluated, with 84 outcomes. Of the 84 outcomes, 31 (37%) were ascribed to primary outcomes, and 53 (63%) were (...) medium availability, while only 4% met the criteria for high availability of outcome detail. Asthma Seventeen registries were evaluated in the asthma-specific analyses. Within these 17 registries, 57 outcomes were noted within the ClinicalTrials.gov entries. Of the 57 outcomes, 21 were noted as primary outcomes and 36 were secondary outcomes. The level of data availability within ClinicalTrials.gov was evaluated by the existence of three components: an outcome definition (e.g., asthma severity

2018 Effective Health Care Program (AHRQ)

156. 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

157. ILCOR Scientific Knowledge Gaps and Clinical Research Priorities for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: A Consensus Statement (Full text)

pressure associated with high-quality pediatric CPR, as well as with improved outcomes. Vasopressors During Cardiac Arrest The efficacy of vasopressor administration during adult OHCA has been questioned because of the results of several prospective randomized trials and associated meta-analyses. , However, no human studies have compared epinephrine or combinations of vasopressors with controls for pediatric OHCA, although a small case series suggested that the use of epinephrine could be harmful (...) of treatment recommendations supported by high-quality science. , To promote transparency, each systematic review was accompanied by a list of knowledge gaps identified by the task forces as they wrote treatment recommendations that were frequently qualified as weak on the basis of low-quality evidence. When insufficient or conflicting evidence prohibited formulation of a treatment recommendation, the following language was used: “The confidence in effect estimates is so low that the panel feels

2018 American Heart Association PubMed abstract

158. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review

care or an attention control on both function and pain at short- term, intermediate-term, and long-term followup (SOE: moderate). At short and intermediate term, multidisciplinary rehabilitation slightly improved pain compared with exercise (SOE: x moderate). High-intensity multidisciplinary rehabilitation (=20 hours/week or >80 hours total) was not clearly better than non–high-intensity programs. Chronic neck pain: At short and intermediate terms, acupuncture and Alexander Technique were (...) benefits may be warranted (e.g., when harms and costs are small). Additional information is found in the full report and Appendix H. Grading the Strength of Evidence for Major Comparisons and Outcomes The overall strength of evidence (SOE) for each KQ and primary outcome (pain, function) was graded high, moderate, low, or insufficient based on study limitations; consistency of results across studies; the directness of the evidence linking the interventions with health outcomes; effect estimate

2018 Effective Health Care Program (AHRQ)

159. Perineal care

and intrapartum risk reduction measures History of FGM? · Refer to clinician *experienced in FGM · Assess degree of FGM · Consider deinfibulation History of OASIS? · Refer/consult with obstetrician · Counsel about mode of birth at: o First visit o Around 36 weeks · Inform of risk factors for recurrence: o High grade of previous tear o Birth weight > 4 kg o Instrumental birth · Indications for elective CS: o Current symptoms of anal incontinence o Psychological and/or sexual dysfunction o Sonographic evidence (...) of anal sphincter defect (e.g. defect > 30 degrees) o Low anorectal manometric pressures (e.g. incremental squeeze pressure 4 kg · OP position · Instrumental birth · Shoulder dystocia · Prolonged second stage · Midline episiotomy · Previous OASIS Woman elects vaginal birth? Elective CS Yes Yes No No Yes *Experienced clinician: The clinician best able to provide the required clinical care in the context of the clinical circumstances and local and HHS resources and structure. May include clinicians

2018 Queensland Health

160. A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology (Full text)

of genomics and proteomics in microbiology, interpretation of results still depends on the quality of the specimens received for analysis whether one is suspecting a prokaryote or a eukaryote as the etiologic agent, both of which are featured in this document. Microbes tend to be uniquely suited to adapt to environments where antibiotics and host responses apply pressures that encourage their survival. A laboratory instrument may or may not detect those mutations, which can present a challenge to clinical (...) that the laboratory report “everything that grows.” This can provide irrelevant information that could result in inaccurate diagnosis and inappropriate therapy. “Background noise” of commensal microbiota must be avoided where possible. Many body sites have normal, commensal microbiota that can easily contaminate the inappropriately collected specimen and complicate interpretation. Therefore, specimens from sites such as lower respiratory tract (sputum), nasal sinuses, superficial wounds, fistulae, and others

2018 Infectious Diseases Society of America PubMed abstract

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