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361. Donor site management for burn patients

te to h e a l . G e n e ra ll y , o n l y s m a ll a r e a s of f u ll t hi c k n e ss s k i n ar e u se d . D e fi nit ion s Epidermal Burn depth Skin layer Epidermis Split thickness Dermis Subcutaneous tissue Muscle Mid dermal Deep dermal Full thickness Super?cial dermal Full thickness Donor site depths Figure 1: Cross section of skin showing donor depths Donor site management for burn patients October 2020 Agency for Clinical Innovation 2 www.aci.health.nsw.gov.auCommon donor sites C o m m o n

2020 Agency for Clinical Innovation

362. Skin graft management for burn patients

n o g ra f t s . A ll o g ra f t s a r e g ra f t s f ro m t h e s a m e s p e c i e s a n d c a n i n c l u d e c a d a ve r i c o r ‘ li v i n g d o n o r ’ f ro m a r e l a t i ve o r ot h e r p e r s o n . A x e n o g ra f t is a t issu e g ra f t f ro m a n ot h e r s p e c i e s , su c h a s p o r c i n e , b ov i n e o r s h a r k . T his is u su a ll y m a te r i a l f ro m t h e s e s p e c i e s im p r e gn a te d into a dr e s sin g m a te r ia l . D e fi nit ion s Epidermal Burn

2020 Agency for Clinical Innovation

363. Rickettsial diseases

) or an eschar (the bite site of the ectoparasite). Epidemic typhus ( Rickettsia prowazekii ) is now rare but may occur in situations of mass crowding, poverty, famine, and war where there is an increased risk of human body louse infestation. Doxycycline is the drug of choice for treatment in all patients. Definition Rickettsial infections (rickettsioses) occur worldwide and are associated with the patient having been bitten by an ectoparasite such as a louse, mite, flea, or tick. Rickettsioses of humans (...) species occur in geographically different parts of the world: for example, Mediterranean spotted fever caused by Rickettsia conorii and Queensland tick typhus caused by Rickettsia australis . The SFG are mainly tick transmitted. See our separate Rocky Mountain spotted fever topic for detailed information on this condition. The TG consists of two species: Rickettsia prowazekii (epidemic louse-borne typhus) which is human body louse transmitted, and Rickettsia typhi (murine typhus) which is rodent flea

2018 BMJ Best Practice

364. Bartonella infection

in distribution ( B henselae ), whereas others are geographically localised ( B bacilliformis ). Bartonella species are transmitted from an infected natural host to the susceptible human host either by direct contact (cat bite or scratch for B henselae ) or via an insect vector (body lice for B quintana , sand fly for B bacilliformis ). Bartonella species infect erythrocytes and cause vascular proliferation, giving rise to prolonged fever, lymphadenopathy, and hepatosplenomegaly. Laboratory diagnosis

2018 BMJ Best Practice

365. Bed bugs

Center Jackson MS Disclosures RD declares that he has no competing interests. Faculty Physician Dermatology and Pediatric Dermatology Phoenix Children's Hospital Phoenix AZ Disclosures XN declares that she has no competing interests. Professor Director Medical Entomology Centre University of Cambridge Cambridge UK Disclosures IFB has been a consultant to various manufacturers of pharmaceutical products, alternative therapies, and combs for treating louse infections. IFB is an author of several

2018 BMJ Best Practice

366. Febrile seizure

The American Academy of Pediatrics announced a standard definition of febrile seizures as a seizure occurring in febrile children between the ages of 6 and 60 months who do not have an intracranial infection, metabolic disturbance, or history of afebrile seizures. Capovilla G, Mastrangelo M, Romeo A, et al. Recommendations for the management of "febrile seizures": Ad Hoc Task Force of LICE Guidelines Commission. Epilepsia. 2009 Jan;50(suppl 1):S2-6. http://onlinelibrary.wiley.com/doi/10.1111/j.1528

2018 BMJ Best Practice

367. Overview of dermatitis

(3):185-90. https://www.aafp.org/afp/2015/0201/p185.html http://www.ncbi.nlm.nih.gov/pubmed/25822272?tool=bestpractice.com It is a chronic condition that includes dandruff (pityriasis capitis) in adults and cradle cap in infants. An explosive, often generalised onset of seborrhoeic dermatitis may be a marker for HIV infection, regardless of age. Variable course that seldom completely subsides. An infant form (cradle cap) usually resolves within the first few months of life. Symptom control (...) dermatitis, superficial fungal (tinea and candidiasis) and dermatophyte infections, lichen sclerosis, viral warts, scabies, lice, arthropod bite, or cutaneous neoplasia. Lotti T, Buggaiani G, Prignano F. Prurigo nodularis and lichen simplex chronicus. Dermatol Ther. 2008 Jan-Feb;21(1):42-6. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1529-8019.2008.00168.x http://www.ncbi.nlm.nih.gov/pubmed/18318884?tool=bestpractice.com Lynch PJ. Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital

2018 BMJ Best Practice

368. Rickettsial diseases

) or an eschar (the bite site of the ectoparasite). Epidemic typhus ( Rickettsia prowazekii ) is now rare but may occur in situations of mass crowding, poverty, famine, and war where there is an increased risk of human body louse infestation. Doxycycline is the drug of choice for treatment in all patients. Definition Rickettsial infections (rickettsioses) occur worldwide and are associated with the patient having been bitten by an ectoparasite such as a louse, mite, flea, or tick. Rickettsioses of humans (...) species occur in geographically different parts of the world: for example, Mediterranean spotted fever caused by Rickettsia conorii and Queensland tick typhus caused by Rickettsia australis . The SFG are mainly tick transmitted. See our separate Rocky Mountain spotted fever topic for detailed information on this condition. The TG consists of two species: Rickettsia prowazekii (epidemic louse-borne typhus) which is human body louse transmitted, and Rickettsia typhi (murine typhus) which is rodent flea

2018 BMJ Best Practice

369. Overview of dermatitis

(3):185-90. https://www.aafp.org/afp/2015/0201/p185.html http://www.ncbi.nlm.nih.gov/pubmed/25822272?tool=bestpractice.com It is a chronic condition that includes dandruff (pityriasis capitis) in adults and cradle cap in infants. An explosive, often generalised onset of seborrhoeic dermatitis may be a marker for HIV infection, regardless of age. Variable course that seldom completely subsides. An infant form (cradle cap) usually resolves within the first few months of life. Symptom control (...) dermatitis, superficial fungal (tinea and candidiasis) and dermatophyte infections, lichen sclerosis, viral warts, scabies, lice, arthropod bite, or cutaneous neoplasia. Lotti T, Buggaiani G, Prignano F. Prurigo nodularis and lichen simplex chronicus. Dermatol Ther. 2008 Jan-Feb;21(1):42-6. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1529-8019.2008.00168.x http://www.ncbi.nlm.nih.gov/pubmed/18318884?tool=bestpractice.com Lynch PJ. Lichen simplex chronicus (atopic/neurodermatitis) of the anogenital

2018 BMJ Best Practice

370. Appropriate prescribing of psychotropic medication for non-cognitive symptoms in people with dementia

(Co-chair) Head of School of Pharmacy, University College Cork. Dr. Ashling Murphy Postdoctoral Researcher, Centre for Gerontology and Rehabilitation, University College Cork. Dr. Paul Gallagher Consultant Geriatrician, Cork University Hospital; Senior Lecturer Dept. of Medicine UCC; Irish Society of Physicians in Geriatric Medicine representative. Dr. Kieran Walsh Pharmacist; School of Pharmacy, University College Cork. Dr. Aisling Jennings General Practitioner, Kinsale; PhD candidate, Department

2019 National Clinical Guidelines (Ireland)

371. Blepharitis: What else might it be?

. Parasitic infections such as pediculosis palpebrarum (Phthirus pubis), or dermodex folliculorum. Dermatological conditions such as: Psoriasis. Atopic and contact dermatitis. Erythema multiforme. Pemphigus and pemphigoid. Stevens-Johnson syndrome and toxic epidermal necrolysis. Eyelid tumours . Benign — actinic keratosis, squamous cell papilloma, sebaceous gland hyperplasia, haemangioma, and pyogenic granuloma. Malignant — basal cell carcinoma, squamous cell carcinoma, sebaceous carcinoma, melanoma

2019 NICE Clinical Knowledge Summaries

372. Blepharitis

diagnosis of chronic blepharitis includes malignant tumours of the eyelid (such as squamous cell, basal cell, or sebaceous cell carcinoma), eczema, infection, infestation (such as pubic lice) and autoimmune disease (such as pemphigoid). Management of blepharitis includes: Advising the person on the chronic nature of the condition and the need for maintenance treatment. Eyelid hygiene measures and warm compresses. Consideration of topical antibiotics (such as chloramphenicol) if hygiene measures have

2019 NICE Clinical Knowledge Summaries

373. Conjunctivitis - allergic: How do I assess a person with suspected allergic conjunctivitis?

, loss of lashes (may indicate sebaceous gland carcinoma), vesicles (herpes), lice infestation or blepharitis. Periorbital area — look for swelling and erythema which may indicate orbital or periorbital cellulitis. Periorbital cellulitis can develop from conjunctivitis in young children. A dull blue discolouration below the eye sometimes called the ‘allergic shiner’ resulting from venous congestion may be present in some people with allergies. Lymph nodes — look for regional lymphadenopathy

2019 NICE Clinical Knowledge Summaries

374. Conduct disorders in children and young people: When to suspect a conduct disorder

inappropriate expectations, exposure to frightening or traumatic experiences, or persistent emotional unavailability. The child or young person appears neglected for example they could have severe or persistent infestations such as scabies or head lice, they could be persistently smelly and dirty, or be failing to thrive. For further information on recognition of child maltreatment and how to proceed if this is suspected, see the CKS topic on . Differential diagnosis The differential diagnoses of conduct

2019 NICE Clinical Knowledge Summaries

375. Insect bites and stings: Scenario: Management in primary care

to infestation with: Bedbugs — advise the person to contact pest control services. Pest control is necessary as bedbugs can be difficult to eradicate and insecticide resistance is common. Fleas — advise the person that flea bites are often associated with contact with domestic pets (especially cats and dogs) and that animals should be examined and treated if necessary. If the person has recently moved house, flea infestations may remain from previous pet owners. Lice — see the CKS topics (...) are not affected by insect repellents. If tick-infested areas cannot be avoided: Cover exposed skin with long-sleeved shirts and trousers tucked into socks (light coloured fabrics are useful as it is easier to see ticks against a light background). Consider using an insect repellent containing DEET (diethyl-toluamide) — available over-the-counter. Inspect skin at regular intervals throughout the day and at the end of the day and remove any attached ticks— thoroughly check children’s head, scalp and neck areas

2019 NICE Clinical Knowledge Summaries

376. Insect bites and stings: How should I assess a person with a suspected insect bite or sting?

, papule or nodule. Bites from infected ticks may result in Lyme disease which can present with erythema migrans (sometimes called a bullseye rash). For more information, see the CKS topic on . Horse flies and stable flies — painful bites which may bleed and often become secondarily infected. Midge bites — typically multiple small papular lesions on exposed skin. Spider bites — may leave 2 clearly visible puncture wounds. Head, body and pubic lice — can lead to excoriation due to itching caused (...) by louse salivary antigens. For more information see the CKS topics on and . Investigations Investigations are not usually required as generally the diagnosis of an insect bite or sting can be made from the history and examination. Investigations for severe reactions to insect bites or stings should be carried out in secondary care. Basis for recommendation The recommendations on assessment of a person with a suspected insect bite or sting are based on the clinical guidelines Stinging insect

2019 NICE Clinical Knowledge Summaries

377. Child abuse and neglect

into account that children often become dirty and smelly during the course of the day. Use judgement to determine if persistent lack of provision or care is a possibility. Examples include: child seen at times of the day when it is unlikely that they would have had an opportunity to become dirty or smelly (for example, an early morning visit) if the dirtiness is ingrained. 1.3.26 Consider neglect if a child has severe and persistent infestations, such as scabies or head lice. 1.3.27 Consider neglect

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

378. Healthy Ageing in Scotland: the pilot survey

drinks in young and older adults. Stuart has authored over 50 original peer-reviewed research articles, review articles, and book chapters. He is Chair of the Sport and Exercise Nutrition register and is an Advisory board member for Nutrition and Biochemistry with the Journal of Sports Sciences. He is currently also Head of Sport within the Faculty of Health Sciences and Sport, and provides consultancy advice to nutritionists, dietitians and coaches working in track and field athletics, cycling

2018 Health Economics Research Unit

379. Scabies: What else might it be?

different (lesions mainly occur in areas that have been in contact with the animal), there are no burrows. The infestation tends to be self-limiting and often requires no treatment. Pubic lice — suggested by itchy, red papules in any course body hair. For more information, see the CKS topic on . Body lice — itching is the principal complaint. The body is often covered in excoriations and there may be secondary bacterial infection. Insect bites — suggested by itchy papules or papulovesicles and absence (...) . Urticaria pigmentosa — suggested by numerous reddish-brown or pale, monomorphic maculopapules, plaques, or nodules appearing symmetrically anywhere on the body, except the face, head, palms, or soles. The differential diagnoses of crusted scabies include: Psoriasis — characterized by red, scaly, sharply-demarcated, indurated plaques, present, particularly over the extensor surfaces and scalp. Dariers's disease (Keratosis follicularis) — characterized by greasy, skin-coloured, brown or yellow-brown

2018 NICE Clinical Knowledge Summaries

380. Neck lump: History

respiratory tract infection causing lymphadenopathy — fever, cough, and sore throat. Other local potential causes of lymphadenopathy — for example earache, toothache, headlice. Recent travel, insect bites, or exposure to pets or other animals — suggestive of an inflammatory or infectious cause of neck lump. Smoking, heavy alcohol use, or previous radiation to the neck — increase the risk of malignancy. Trauma — may indicate haematoma, or if time has elapsed since the traumatic incident, fibrosis

2018 NICE Clinical Knowledge Summaries

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