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Pelvic Relaxation

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181. Spine imaging

medications such as nerve membrane stabilizers or muscle relaxants o Physician-supervised therapeutic exercise program or physical therapy o Manual therapy or spinal manipulation o Alternative therapies such as acupuncture o Appropriate management of underlying or associated cognitive, behavioral or addiction disorders Clinical Indications The following section includes indications for which advanced imaging of the spine is considered medically necessary, along with prerequisite information and supporting (...) developed and validated criteria (ASAS cohort) for spondyloarthritis, as well as for their subsets, axial SpA and peripheral SpA. 17 While sacroiliitis is the most common MRI manifestation of axial spondyloarthropathy, bone marrow edema can be seen in the vertebra as well and characteristic patterns have been described. 18 Consensus among guidelines that radiography of the pelvis and/or spine is the preferred imaging modality for initial evaluation of SpA: ? The first-line imaging modality

2019 AIM Specialty Health

183. BSPGHAN Motility Working Group consensus statement- Anorectal manometry in children with defecation disorders Full Text available with Trip Pro

is secondary to constipation, but in approximately 20% it is associated with conditions such as non‐retentive fecal incontinence (NFI). Pelvic floor dyssynergia, which describes poor coordination between pelvic floor muscles and abdominal wall muscles during defecation, can also lead to FI and will require different management strategies. In children with FI secondary to CC, the majority will have functional constipation but up to 5% are affected by other medical conditions that lead to delayed transit (...) parameters can be obtained (Table ). It is, however, recognized that is certain circumstances (eg, significant child distress or anxiety, learning difficulties, or in infants with suspected Hirschsprung's disease) ARM can be done under sedation. If sedation is needed, muscle relaxants should be avoided and clarity given to the parents and recipient healthcare professionals with regard to the limited information obtained (essentially limited to resting pressure of the anal sphincter and RAIR

2020 British Society of Paediatric Gastroenterology Hepatology and Nutrition

185. Guidance For: Prone Positioning in Adult Critical Care

before start of procedure Minimum of 5 people plus 1 for chest drains Yes No All team members aware of role Yes No Appropriate ventilator settings Yes No Cardiovascular stability Yes No Adequate sedation (ie. RASS -5) Yes No Adequate muscle relaxation – consider need for bolus Yes No Pillows positioned correctly – chest, pelvis, knees Yes No Team members familiar with procedure Yes No Appendix 1. LocSSIP PROCEDURE SAFETY CHECKLIST: Prone Ventilation in Critical Care PaO2/FiO2 Ratio Grade Laryngoscopy (...) or BiVAD support Relative: • Multiple Trauma e.g. Pelvic or Chest fractures, Pelvic fixation device • Severe facial fractures • Head injury/Raised intracranial pressure • Frequent seizures • Raised intraocular pressure • Recent tracheostomy <24hrs • CVS instability despite resuscitation with fluids and inotropes • Previously poor tolerance of prone position • Morbid obesity • Pregnancy 2 nd /3 rd trimester c. Equipment • Low air loss mattress/kinetic therapy bed or local equivalent • Airway trolley

2019 Faculty of Intensive Care Medicine

186. Diagnosis and Treatment of Non-Neurogenic Overactive Bladder (OAB) in Adults: an AUA/SUFU Guideline

about OAB, the benefits versus risks/burdens of the available treatment alternatives and the fact that acceptable symptom control may require trials of multiple therapeutic options before it is achieved. Clinical Principle Treatment: First-Line Treatments: Behavioral Therapies 6. Clinicians should offer behavioral therapies (e.g., bladder training, bladder control strategies, pelvic floor muscle training, fluid management) as first line Approved by the AUA Board of Directors April 2019 Authors (...) ’ disclosure of potential conflicts of interest and author/staff contributions appear at the end of the article. © 2019 by the American Urological Association American Urological Association (AUA)/ Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Guideline DIAGNOSIS AND TREATMENT OF OVERACTIVE BLADDER (Non-Neurogenic) IN ADULTS: AUA/SUFU GUIDELINE E. Ann Gormley, Deborah J. Lightner, Kathryn L. Burgio, Toby C. Chai, J. Quentin Clemens, Daniel J. Culkin, Anurag Kumar Das

2019 American Urological Association

187. Pentosan polysulfate sodium (Elmiron) - bladder pain syndrome characterised by either glomerulations or Hunner’s lesions

be a patient disutility associated with use of bladder instillations relative to PPS although the level of this disutility is uncertain. ? The ICER versus BSC for patients who are considered inappropriate for bladder instillation is sensitive to the response rate assumed for placebo in the meta-analyses, the utility for BSC and an assumption that the efficacy of BSC wanes after one year (increases the ICER if this assumption is relaxed). However, BSC alone is not considered a major comparator to pentosan (...) , and after application of the appropriate SMC modifiers, the Committee accepted pentosan polysulfate sodium for use in NHSScotland. Other data were also assessed but remain confidential.* Additional information: guidelines and protocols The European Association of Urology (EAU) published guidelines on “Chronic Pelvic Pain” in March 2018. This recommends multimodal behavioural, physical and psychological techniques alongside oral or invasive treatments for bladder pain syndrome. It recommends: ? dietary

2019 Scottish Medicines Consortium

188. WHO consolidated guideline on self-care interventions for health: sexual and reproductive health and rights

of caesarean sections, among others). Low- to moderate-certainty evidence REC 1b: Nurse-led applied relaxation training programme (content includes group discussion of anxiety and stress-related issues in pregnancy and purpose of applied relaxation, deep breathing techniques, among other relaxation techniques). REC 1c: Psychosocial couple-based prevention programme (content includes emotional self-management, conflict management, problem solving, communication and mutual support strategies that foster (...) Executive summary TABLE 1 (continued) RECOMMENDATION (REC) a STRENGTH OF RECOMMENDATION, CERTAINTY OF EVIDENCE Interventions for leg cramps REC 5: Magnesium, calcium or non-pharmacological treatment options can be used for the relief of leg cramps in pregnancy, based on a woman’s preferences and available options. Not specified Interventions for low back and pelvic pain REC 6: Regular exercise throughout pregnancy is recommended to prevent low back and pelvic pain. There are a number of different

2019 World Health Organisation Guidelines

189. Gynaecological Cancers: a Handbook for Aboriginal and Torres Strait Islander Health Workers and Health Practitioners

in the cervix • Stage II: cancer has spread to the vagina or other tissue next to the cervix • Stage III: cancer has spread to tissue on the side of the pelvis (pelvic sidewall) • Stage IV: cancer has spread to the bladder or rectum, or beyond the pelvis to the lung, liver or bones. i31 CERVICAL CANCER Treatments for cervical cancer The aims of treatment for cervical cancer are to: • remove the cancer • destroy the cancer cells and slow growth of the cancer and/or • manage the symptoms of cervical cancer (...) the effects of treatment on fertility and menopause, go to Chapter 7. Types of surgery for cervical cancer include: • trachelectomy: removal of the cervix only • hysterectomy: removal of the womb and cervix (Figure 4.1). Depending on the size and type of the cancer, the surgeon may also remove: - a small part of the upper vagina - ligaments supporting the cervix - lymph nodes in the pelvis (pelvic lymphadenectomy). • lymph node dissection (pelvic lymphadenectomy): removal of some lymph nodes in the pelvis

2018 Cancer Australia

191. Mindfulness?based stress reduction (MBSR) for improving health, quality of life and social functioning in adults: a systematic review and meta?analysis Full Text available with Trip Pro

, with a total of 8,135 participants who were randomized to MBSR or a control group ( ). Table 1. Study characteristics Study name Target Group Outcome Measures F‐up (ms) N MBSR hours Practice Min/day Atten‐dance % Women % ITT / Non‐ITT Alterman 2004 Substance abusers ASI, SF‑36‑Vit, SF‑36 PH, SF‑36 MH, SAS, LOT, LAP‑R, PANAS‑Pos 5 31 23 58 Non‐ITT Amutio 2015 Physicians Basic relaxation, Positive energy, Transcendence, Core‐mindfulness, FFMQ 72 28 57 ITT Anderson 2007 Healthy adults BAI, BDI, Anger Rum (...) sensory, MAAS 28 20 75 Non‐ITT Bränström 2010 Cancer patients HADS Anx, HADS Depr, IES‐aviodance, IES‐hyperarousal, IES‐intrusion, PSS, PSOM, FFMQ AA, FFMQ D, FFMQ NJ, FFMQ NR, FFMQ O, Coping self‐efficacy 4 71 16 73 98,6 ITT Carmody 2011 Hot flushes HADS anx, PSS, Overall QOL, Sleep quality 110 27 100 Non‐ITT Carson 2004 Normal couples BSI men, BSI women, Ind relax IRI men, Ind relax IRI wom, INSPIRIT men, INSPIRIT wom, LOT optimism men, LOT optimism wom 3 57 27 32 80 50 Non‐ITT Cohen‐Katz 2005

2017 Campbell Collaboration

192. Erectile dysfunction: Scenario: Management of erectile dysfunction

— for young men who have always had difficulty in obtaining or maintaining an erection; for men with a history of trauma (for example to the genital area, pelvis, or spine); if an abnormality of the penis or testicles is found on . To endocrinology — for men who have hypogonadism (characterized by abnormal testosterone, follicle-stimulating hormone, luteinizing hormone, or prolactin levels). To cardiology — for men who have severe/unstable cardiovascular disease (CVD) that would make sexual activity (...) for erectile dysfunction. They work by inhibiting the breakdown of cyclic guanosine monophosphate (cGMP) by cGMP-specific PDE5 in the cavernosal tissue of the penis. Inhibition of PDE5 (and the subsequent increase in cGMP levels) results in smooth muscle relaxation with increased arterial blood flow, leading to compression of the subtunical venous plexus then penile erection [ ]. Efficacy and safety of PDE-5 inhibitors For the 2017 update of the Male Sexual Dysfunction Guidelines, the EAU identified

2018 NICE Clinical Knowledge Summaries

194. Padeliporfin (Tookad) - prostate cancer / Prostatic Neoplasms

of positive cores, prostate volume and disease status (unilateral or bilateral) in addition to treatment to provide an adjusted comparison of the 2 treatment groups with respect to probability of success/failure for co-primary endpoint A and the HR of progression for co-primary endpoint B. In the Cox model analysis, the proportional hazard assumption was checked graphically plotting the log(-log[survival]) and was to be relaxed if necessary. For co-primary endpoint B, subjects who withdrew from the study (...) radiotherapy (location -pelvis, bone, other), TURP, other non- radical therapy). Updates on the status of recruitment are expected to be given by the applicant post-authorisation. Assessment report EMA/644309/2017 Page 93/146 Criteria for retreatment of the same lobe were not presented but were presumed to be the same as for initial treatment. It is not known how many patients were considered eligible for or were offered retreatment. Very few patients actually underwent retreatment. The percentage necrosis

2017 European Medicines Agency - EPARs

195. Erectile Dysfunction

should be counseled regarding post-operative expectations. (Clinical Principle) 20. Penile prosthetic surgery should not be performed in the presence of systemic, cutaneous, or urinary tract infection. (Clinical Principle) 21. For young men with ED and focal pelvic/penile arterial occlusion and without documented generalized vascular disease or veno-occlusive dysfunction, penile arterial reconstruction may be considered. (Conditional Recommendation; Evidence Level: Grade C) 22. For men with ED (...) on this topic. DRE may also permit assessment of the bulbocavernous reflex, which provides information on neural integrity of the pelvis. Absence of the bulbocavernous reflex is not in itself diagnostic, however, as this reflex is absent in up to 30% of normal patients. 51 DRE should be considered for men with TD who may proceed with testosterone therapy. Selected laboratory tests . With the possible exception of serum testosterone, glucose/hemoglobin A1c, and in some cases serum lipids, no routine serum

2018 American Urological Association

196. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm Full Text available with Trip Pro

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

2018 Society for Vascular Surgery

197. A letter to my younger self

to see a trauma patient with a reasonable mechanism – but because he is stable and pain-free, you’ll decide not to do the pelvic XRay. That’s a mistake. You’re going to miss his unstable pelvic fracture. Thankfully one of your colleagues will find it and the patient ends up being ok. But, know that this will eat at you for weeks. You’ll talk to friends and colleagues who will make you feel better, but honestly – nothing makes a mistake easy to swallow. You just have to learn from it, it’ll make you (...) and reputations tarnished by poor interactions with allied health professionals. When someone is being rude to a nurse, stand up for them. It isn’t until you’re more senior that you have the confidence to this, and you’ll regret not doing it in some situations, but remember that your allied health colleagues are advocating for patients, and don’t deserve any abuse, from anyone, ever. Take vacations Real ones. Where you completely step away from working / studying, and relax. You’ll come to realize when you’ve

2018 CandiEM

198. British Association of Dermatologists? guidelines for the investigation and management of generalized pruritus in adults without an underlying dermatosis

a computed tomography scan of the neck, chest, abdomen and pelvis. A number of cancer treatments, including radiotherapy, can lead to pruritus by a variety of mechanisms. 63–65 Treatment of the malignancy can often help to resolve pruritus. 63,65,74 Can- cer-drug-induced pruritus requires modi?cation or discontinua- tion of medications. 63,64 Biological therapies are now commonly used in oncology. A recent meta-analysis of 33 RCTs concluded that pruritus was a signi?cant side-effect of cancer treatment (...) as ‘psy- chogenic’. The French psychodermatology group proposed that psychogenic pruritus should be renamed ‘functional itch disorder’. Relevant diagnostic criteria are outlined in Table 4. 182 A nursing programme ‘Coping with Itch’ included educa- tion on how to avoid trigger factors, how to apply treatments, lifestyle interventions, patient support groups, relaxation tech- niques and changes to cognition and behaviour. 186 A con- trolled study found no signi?cant difference in the intensity of itch

2018 British Association of Dermatologists

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

preferences. Recommended Opioid analgesia for pain relief 20. Parenteral opioids, such as fentanyl, diamorphine and pethidine, are recommended options for healthy pregnant women requesting pain relief during labour, depending on a woman’s preferences. Recommended Relaxation techniques for pain management 21. Relaxation techniques, including progressive muscle relaxation, breathing, music, mindfulness and other techniques, are recommended for healthy pregnant women requesting pain relief during labour

2018 World Health Organisation Guidelines

200. Utian Translational Science Symposium report: New Ttherapies for Leiomyomas: When Surgery May Not Be the Best Option

symptoms may produce pelvic pressure; uri- nary frequency, urgency, and incontinence; abdominal distension; constipation; back pain; or dyspareunia. 4 Repro- ductivedysfunction,althoughusuallyadiagnosisofexclusion from other factors, may include difficulty conceiving and recurrentpregnancyloss.Pregnanciesmaybecomplicatedby abnormalplacentation,small-for-gestational-ageinfants,pre- mature delivery, malpresentation, increases in caesarean delivery rates, or postpartum haemorrhage. 4,5 Risks for uterine (...) because of necrosis or torsion of a pedunculated leio- myoma, deep vein thrombosis because of physical obstruc- tion, or even polycythemia because of erythropoietin produced by the leiomyoma. 11 A mass may be observed or palpatedinthelowerabdomen,andirregularuterineenlarge- ment may be found during pelvic examination. A pelvic ultrasound will confirm the diagnosis. Magnetic resonance imaging(MRI)or3-Dultrasoundcanbeusedforpreoperative mappingandmayberequiredtodifferentiateanovarianfrom a uterine mass

2018 The North American Menopause Society

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