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Murphy Sign

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61. Summary of the clinical recommendations regarding the use of intrapartum ultrasound

: sonographic signs and comparison of diagnostic performance between transvaginal and digital examination. J Matern Fetal Neonatal Med. maj 2012;25(5):508–12. 15. Tutschek B, Torkildsen EA, Eggebø TM. Comparison between ultrasound parameters and clinical examination to assess fetal head station in labor. Ultrasound Obstet Gynecol. 2013;41(4):425–9. 16. Benediktsdottir S, Salvesen KÅ, Hjartardottir H, Eggebø TM. Reproducibility and acceptability of ultrasound measurements of head–perineum distance. Acta (...) Obstet Gynecol Reprod Biol. 1. december 2005;123(2):193–7. 43. Palatnik A, Grobman WA, Hellendag MG, Janetos TM, Gossett DR, Miller ES. Predictors of Failed Operative Vaginal Delivery in a Contemporary Obstetric Cohort. Obstet Gynecol. marts 2016;127(3):501–6. 44. Murphy DJ, Macleod M, Bahl R, Strachan B. A cohort study of maternal and neonatal morbidity in relation to use of sequential instruments at operative vaginal delivery. Eur J Obstet Gynecol Reprod Biol. maj 2011;156(1):41–5. 45. Wong GY, Mok

2020 Nordic Federation of Societies of Obstetrics and Gynecology

62. Twin delivery

has been treated successfully by laser separation, may if no further pregnancy complications (sign of TTTS or TAPS), be recommended to give birth vaginally as anastomoses have been occluded. D In MCDA pregnancies complicated by sFGR, TAPS, TTTS (without laser), PPROM or rupture of septum delivery by C/S is recommended D It is recommended that MA twins are delivered electively at GA 32-34 with prior Dexamethasone treatment for fetal lung maturation B Is is recommended that uncomplicated dichorionic (...) Guideline, No. 137.) Guidance. National Institute for Health and Care Excellence (UK); 2019. Available from: https://www-ncbi-nlm-nih- gov.auh.aub.aau.dk/books/NBK546078/ 14) Practice Bulletin No. 169. Obstet Gynecol. 2016 Oct;128(4):e131–46. Available from: http://insights.ovid.com/crossref?an=00006250-201610000-00059 15) Kingdom JC, Nevo O, Murphy KE. Discordant growth in twins. Prenat Diagn. 2005 Sep;25(9):759–65. 16) FIGO Working Group on Good Clinical Practice in Maternal-Fetal Medicine. Good

2020 Nordic Federation of Societies of Obstetrics and Gynecology

64. Opioid Treatments for Chronic Pain

: National Academies Press (US); 2011. 2. U.S. Centers for Disease Control and Prevention. Annual Surveillance Report of Drug-Related Risks and Outcomes--United States, 2017. Special Surveillance Special Report 1. Atlanta, GA: 2018. https://www.cdc.gov/drugoverdose/pdf/pubs /2017-cdc-drug-surveillance-report.pdf. 3. Vital signs: overdoses of prescription opioid pain relievers--United States, 1999-2008. MMWR Morb Mortal Wkly Rep. 2011;60(43):1487-92. PMID: 22048730. 4. Drug Abuse Warning Network. The DAWN

2020 Effective Health Care Program (AHRQ)

65. Nonopioid Pharmacologic Treatments for Chronic Pain

Director Center for Evidence and Practice Improvement Agency for Healthcare Research and Quality Suchitra Iyer, Ph.D. Task Order Officer Center for Evidence and Practice Improvement Agency for Healthcare Research and Quality v Acknowledgments The authors gratefully acknowledge the following individuals for their contributions to this project: Research Assistants Katrina Murphy, B.S., and Shelby Kuyl, B.S., both from Oregon Health & Science University; Associate Editor M. Hassan Murad, M.D., Mayo Clinic

2020 Effective Health Care Program (AHRQ)

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

–iodine alone indicates that catheter tip colonization is reduced with alcohol containing solutions (Category A3-B evidence ); equivocal findings are reported for catheter-related bloodstream infection and clinical signs of infection (Category A3-E evidence ). Survey Findings . The consultants and ASA members strongly agree with the recommendation to use a chlorhexidine-containing solution for skin preparation in adults, infants, and children. For neonates, the consultants and ASA members agree (...) chlorhexidine based on clinical judgment and institutional protocol. If a chlorhexidine-containing dressing is used, the consultants and ASA members both strongly agree with the recommendation to observe the site daily for signs of irritation, allergy or, necrosis. Catheter Maintenance Catheter maintenance consists of (1) determining the optimal duration of catheterization, (2) conducting catheter site inspections, (3) periodically changing catheters, and (4) changing catheters using a guidewire instead

2020 American Society of Anesthesiologists

68. Cardiovascular Considerations in Caring for Pregnant Patients: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

. The recent AHA scientific statement on MI with nonobstructive coronary arteries offers a comprehensive diagnostic algorithm. Treatment should be tailored to the underlying pathophysiology. Pregnancy in women with preexisting coronary artery disease is considered to be very high risk. The probability of developing ischemic complications is ≈10%, and only 21% of women have a completely uncomplicated pregnancy. In those patients with prior spontaneous coronary artery dissection, LV dysfunction, and signs

2020 American Heart Association

71. Treatment of Left-sided Colonic Diverticulitis

. Before the 2 randomized trials questioning the benefit of antibiotics in uncomplicated diverticulitis, antibiotic ther- apy was and still is a standard component of the arma- mentarium used to treat all stages of this disease. 1 The use of antibiotics continues to be appropriate for higher-risk patients with significant comorbidities, signs of systemic infection, or immunosuppression. Both of the random- ized trials supporting avoidance of antibiotics included only patients with early-stage disease (...) - terology. 2015;149:1731–1741.e3. 9. Peery AF, Crockett SD, Murphy CC, et al. Burden and cost of gastrointestinal, liver, and pancreatic diseases in the United States: Update 2018. Gastroenterology. 2019;156:254–272.e11. 10. Bollom A, Austrie J, Hirsch W, et al. Emergency department burden of diverticulitis in the USA, 2006–2013. Dig Dis Sci. 2017;62:2694–2703. 11. Masoomi H, Buchberg B, Nguyen B, Tung V, Stamos MJ, Mills S. Outcomes of laparoscopic versus open colectomy in elective surgery

2020 American Society of Colon and Rectal Surgeons

72. BTS Guideline for Long Term Macrolide Use

of the guideline. SECTION 2: METHODOLOGY OF GUIDELINE PRODUCTION Establishment of guideline development group The GDG was convened in June 2016, with the first meeting taking place in October 2016. The full GDG met three times during the development of the guideline and kept in close contact by teleconference/WebEx and email throughout the process. Methodology This is the first BTS guideline to use the GRADE approach as part of the process of guideline development. Previous guidelines have used the SIGN (...) with asthma was found therefore no recommendations in regard to these outcomes can be made in this guideline. In all cases, macrolides should be considered after current therapy has been optimised and adherence established. Other recent guidance Recommendations on macrolide therapy are not included in current NICE/BTS/SIGN asthma guidelines. 4 25 NICE guidance suggests referral to an asthma specialist and consideration of the addition of a trial of ‘an additional drug’ (which could include a macrolide

2020 British Thoracic Society

73. Antenatal Hydronephrosis-Infant

of the current evaluation, degree of hydronephrosis is based on the SFU grading. The SFU system has been in use for a longer period of time and has good inter-rater reliability [3,15,16]. There are studies that have shown increased accuracy of hydronephrosis grading system if APRPD is measured [17,18]. We therefore have included an APRPD of >15 mm on postnatal imaging as a sign of severe hydronephrosis. Over time, the UTD classification system may predominate, but at present, familiarity with the SFU system

2020 American College of Radiology

74. Management of Stillbirth

of a stillbirth, and strategies for prevention. Background Definition The U.S. National Center for Health Statistics defines fetal death as the delivery of a fetus showing no signs of life as indicated by the absence of breathing, heartbeats, pulsation of the umbilical cord, or definite movements of voluntary muscles . There is not complete uniformity among states with regard to birth weight and gestational age criteria for reporting fetal deaths. However, the suggested requirement is to report fetal deaths (...) providers need to be attuned to signs and symptoms of uterine rupture throughout the labor course. What support services and clinical counseling should be offered to the patient with a stillbirth? Patient support should include emotional support and clear communication of test results. Bereavement care should be individualized to recognize bereaved parents’ personal, cultural, or religious needs. Other components of bereavement care after a stillbirth include good communication; shared decision making

2020 American College of Obstetricians and Gynecologists

75. Postpartum Hemorrhage

PPH. Although classically, PPH has referred to pregnancies delivered beyond 20 weeks of gestation, the definition may be expanded to include hemorrhage post terminations or early pregnancy loss [3]. PPH is defined as any hemorrhage associated with signs or symptoms of hypovolemia within 24 hours of delivery, regardless of the type of delivery [4]. Many of the causes of primary PPH are diagnosed clinically, such as uterine atony, lower genital tract laceration with palpable perineal or vaginal (...) hypertrophic uterine arteries mimicking extravasation and be falsely negative in atony because of slow intermittent hemorrhage [12,18]. CTA also enables comprehensive evaluation of abdominopelvic vasculature, including vessels not often evaluated on routine angiography such as the ovarian and inferior epigastric arteries [18]. Serpiginous myometrial vessels and prominent parametrial vessels can be a sign of VUA [19], whereas the presence of a pseudoaneurysmal sac is a more specific finding [14,20,21]. CTA

2020 American College of Radiology

76. Respiratory distress and CPAP

of age o O 2 > 50% o PaCO 2 > 60 mmHg / pH 24 hours of age o O 2 > 50% o PaCO 2 > 60 mmHg / pH 60 breaths/minute · Audible expiratory grunt · Sternal, intercostal, lower costal recession · Nasal flaring · Cyanosis/Oxygen need · Increased respiratory effort Respiratory distress Capability · Level 4 neonatal service or above · Appropriate equipment and human resources available Indications · Signs of respiratory distress or · O 2 requirement = 30% to maintain SpO 2 within target range Commence · CPAP (...) at 8 cm H 2 0 · O 2 to maintain SpO 2 within target range Neonatal care · Monitor continuously: o SpO 2 (preferably right hand) o Respiratory rate o Heart rate o PiO 2 · Monitor hourly: o Vital signs + work of breathing o CPAP pressure o Gas flow o Humidifier and circuit temperature o Water level in humidifier · Vigilant surveillance and record hourly o CPAP interface positioned correctly o Septal columellar integrity o Eyes are clearly visible o Securing devices not causing indentation, pitting

2020 Queensland Health

77. Indeterminate Renal Mass

, Wolf JS, Jr., Wood DP, Jr. Renal mass core biopsy: accuracy and impact on clinical management. AJR Am J Roentgenol. 2007;188(2):563-570. 24. Murphy AM, Buck AM, Benson MC, McKiernan JM. Increasing detection rate of benign renal tumors: evaluation of factors predicting for benign tumor histologic features during past two decades. Urology. 2009;73(6):1293-1297. 25. Kim JK, Park SY, Shon JH, Cho KS. Angiomyolipoma with minimal fat: differentiation from renal cell carcinoma at biphasic helical CT (...) on enhanced biphasic MDCT a reliable sign for the noninvasive diagnosis of renal oncocytomas? AJR Am J Roentgenol. 2011;197(4):W674- 679. 29. Patel NS, Poder L, Wang ZJ, et al. The characterization of small hypoattenuating renal masses on contrast- enhanced CT. Clin Imaging. 2009;33(4):295-300. ACR Appropriateness Criteria ® 9 Indeterminate Renal Mass 30. Jinzaki M, McTavish JD, Zou KH, Judy PF, Silverman SG. Evaluation of small (

2020 American College of Radiology

78. Blunt Chest Trauma-Suspected Cardiac Injury

(most often pulmonary contusion and pneumothoraces) in 39% of patients with no thoracic symptoms or signs, a negative chest radiograph, and recent high-energy mechanism blunt trauma (MECH group). This was in contrast to patients with clinical chest symptoms or abnormal chest radiographs (CTL group) in which 66% had injuries noted with chest CT but not radiography [13]. Furthermore, additional data from chest CT scans led to alterations in management in 5% of the MECH group and 20% of the CTL group (...) —Suspected Aortic Injury” [9], supports the use of chest CT angiography (CTA) in combination with chest radiography without reservation. The authors reported evidence that CTA is highly sensitive (with a high negative predictive value) in evaluating suspected traumatic aortic injury when there are no signs of direct aortic injury. CTA is also highly specific for aortic injury, such that most centers have now abandoned invasive aortography in the initial assessment of patients with suspected aortic injury

2020 American College of Radiology

80. The use of prophylactic factor replacement for children and adults with Haemophilia A and B Full Text available with Trip Pro

to those with SHA and a similar approach to initiation and monitoring of prophylaxis is recommended. Who should receive secondary prophylaxis? In the ESPRIT trial of prophylaxis in SHA, secondary analysis showed that there were radiological signs of joint damage in none of the eight patients randomised to prophylaxis under the age of 36 months compared to three of 10 patients of the same age randomised to episodic therapy ( P < 0·05). Six of 13 boys (46%) who started prophylaxis after the age of 36 (...) months showed radiological signs of joint involvement compared to 10 of 12 (83%) of those on episodic therapy. This study demonstrates the benefit of both primary and secondary prophylaxis and the latter should be offered if a PWSH is not already established on primary prophylaxis. Who should receive tertiary prophylaxis? The SPINART study was an RCT comparing tertiary prophylaxis with on‐demand therapy in PWSHA aged 12–50 years. Those taking prophylaxis had a 94% reduction in bleeding events

2020 British Committee for Standards in Haematology

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