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Pelvic Relaxation

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

interventions mostly aim to strengthen the pelvic floor and change behaviors that influence bladder function, whereas pharmacological interventions mostly address bladder and sphincter function. This report addresses a Contextual Question and four Key Questions. Key Question 1: What are the benefits and harms of nonpharmacological treatments of UI in women, and how do they compare with each other? Key Question 2: What are the benefits and harms of pharmacological treatments of UI in women, and how do (...) Abbreviations: AE = adverse events, Imp = improvement, MBSR = mindfulness-based stress reduction, PFMT = pelvic floor muscle therapy, QoL = quality of life, Sat = satisfaction, TENS = transcutaneous electrical nerve stimulation (including transvaginal, surface, and related electric stimulation used to treat UI), UI = urinary incontinence. * The categorization of different interventions was based on recommendations from The National Institute for Health and Care Excellence (NICE) and American Urological

2018 Effective Health Care Program (AHRQ)

203. 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

204. 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

205. 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

206. Exam Series: Guide to the Back Exam

nerve root irritation. Sacroiliac Joint Pain : Position the patient in a supine figure-of-four position – Flex, Abduct, and Externally Rotate one hip – placing the foot on the opposite knee. Push down on the outstretched knee while stabilizing the opposite pelvis. Pain and decreased movement of the test leg suggests sacroiliac joint pain. Gaenslen’s: Allow the patient to hang one leg off of the bed while lying supine, then instruct them to bring the other knee to their chest. Pain in the buttock (...) and pelvis. Typically in young male patients <40. Pain should be >3 months in duration, improving with movement and worsening with rest. Limited chest expansion. Systemic manifestations include uveitis, pulmonary fibrosis, and renal amyloidosis. X-rays show a bamboo spine: squaring of the vertebral bodies. HLA-B27 positive and RF negative on serology. Degenerative disc disease Age related loss of disc height. Rare in children and older adults with fibrotic discs. Axial back pain with no lower limb

2018 CandiEM

207. Spine Surgery

Surgery 6 Definitions Conservative management should include a combination of strategies to reduce inflammation, alleviate pain, and improve function, including but not limited to the following: ? Prescription strength anti-inflammatory medications and analgesics ? Adjunctive medications such as nerve membrane stabilizers or muscle relaxants ? Physician-supervised therapeutic exercise program or physical therapy ? Manual therapy or spinal manipulation ? Alternative therapies such as acupuncture (...) segments (List separately in addition to code for primary procedure) 22846 Anterior instrumentation; 4 to 7 vertebral segments (List separately in addition to code for primary procedure) 22847 Anterior instrumentation; 8 or more vertebral segments (List separately in addition to code for primary procedure) 22848 Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List separately in addition to code for primary procedure) 22849 Reinsertion of spinal

2018 AIM Specialty Health

208. CRACKCast E180 – Labor & Delivery

fetal neck extension is associated with cord injuries and worsening dystocia, this maneuver is useful to ensure a successful vaginal delivery. This maneuver should only be attempted once the fetal elbows and chin have entered the pelvic inlet to avoid inducing the Moro reflex, in which fetal head flexion results in the arms being suddenly extended. During this maneuver, the fetal pelvis should be supported to avoid abdominal injuries. A generous episiotomy may be necessary to facilitate the maneuver (...) don’t have the luxury of whisking off the patient to the OR Let’s kick it back to our obs/gyne block and think through the causative factors; or the three P’s The passage – narrow pelvic architecture The passenger – big head, or malpresentation The power problem – uterus isn’t pushing like it should Tired mom Mother is sedated too much Chorioamnionitis Electrolyte abnormality (Ks, Cas, Mg, Phos, Na) Usually the cause is multifactorial! 6) Describe the steps in a “normal” delivery (in the ER) Let’s

2018 CandiEM

209. 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

210. FDG-PET/CT(A) Imaging in Large Vessel Vasculitis and Polymyalgia Rheumatica: Joint Procedural Recommendation of the EANM, SNMMI, PET Interest Group, and endorsed by ASNC

be avoided within 24 hours 7 before FDG administration. At the moment and after administration of FDG, patients should relax in an adequately temperature-controlled room (20-22°C (68-71.6 °F)) to minimize physiologic uptake in muscles and brown fat [29]. In some cases, FDG uptake in brown fat can be reduced by beta-blocking drugs, e.g. oral administration 20 mg propranolol one hour before FDG injection [30]. Prior to positioning on the table, patients are asked to void urine. Patients with fever (...) being positive for active LVV (evidence level II, grade B). • Typical FDG joint uptake patterns including scapular and pelvic girdles, interspinous regions of the cervical and lumbar vertebrae or the knees should be 12 Diagnostic accuracy of FDG-PET/CT(A) for LVV and PMR The diagnostic performance of FDG-PET for the detection of LVV is overall good; individual studies are summarized in Table 4, and meta-analyses are summarized in Table 5. A recent meta-analysis of eight studies including 170 LVV

2018 Society of Nuclear Medicine and Molecular Imaging

211. 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

212. Early Pregnancy Loss

to prevent early pregnancy loss. Therapies that have historically been recommended, such as pelvic rest, vitamins, uterine relaxants, and administration ofb-hCG,havenotbeen proved to prevent early pregnancy loss (60–62). Like- wise, bed rest should not be recommended for the prevention of early pregnancy loss (63). A 2008 Co- chrane review found no effect of prophylactic proges- terone administration (oral, intramuscular, or vaginal) in the prevention of early pregnancy loss (64). For threatened early (...) in the vacuum aspiration group (23, 42). How- ever, rates of hemorrhage-related hospitalization with or without transfusion are similar between treatment approaches (0.5–1%) (23, 43). Pelvic infection also can occur after any type of early pregnancy loss treat- ment. One systematic review concluded that although infection rates appeared lower among those undergo- ing expectant management than among those undergo- ing surgical evacuation (RR, 0.29; 95% CI, 0.09– 0.97), the overall rates of infection were low

2018 American College of Obstetricians and Gynecologists

213. 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

214. Erectile Dysfunction

, or urinary tract infec- tion. (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 Recom- mendation; Evidence Level: Grade C) 22. For men with ED, penile venous surgery is not recommended. (Moderate Recommendation; Evidence Level: Grade C) 23. For men with ED, low-intensity extracorporeal shock wave therapy (ESWT) should (...) Association (AUA) Erectile Dysfunction Copyright © 2018 American Urological Association Education and Research, Inc.® 10 discussion of BPH/LUTS, please see the AUA Guideline 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

2018 American Urological Association

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

or (for headache) biofeedback? Exercise was chosen as a common comparator for all conditions except headache as it is recommended in most guidelines for these conditions and a frequent comparator in the chronic pain literature. Interventions considered in the review include exercise (including aspects of physical therapy), mind-body practices (yoga, tai chi, qigong), psychological therapies (cognitive- behavioral therapy, biofeedback, relaxation techniques, acceptance and commitment therapy), multidisciplinary

2018 Effective Health Care Program (AHRQ)

216. Low Back Pain, Adult Acute and Subacute

of corticosteroids • Trauma with neurological signs Note: There is not sufficient data on a history of osteoporosis as a specific risk factor. Infection An uncommon but serious cause for back pain is infection. A spinal infection such as vertebral osteomyelitis or spinal epidural abscess can present as back pain with a fever. Consideration of other non-spine origins Low back pain can be due to visceral disease. Examples include (Goldman, 2011): • Disease of pelvic organs (prostatitis, endometriosis, chronic (...) pelvic inflammatory disease) • Renal disease (nephrolithiasis, pyelonephritis, perinephric abscess) • Aortic aneurysm • Gastrointestinal disease • Pancreatitis • Cholecystitis • Penetrating ulcer • Cardiac or pericardial disease • Pulmonary or pleural disease Evaluate Function Using tools can help with proper management of low back pain. The following are some of the available tools for low back pain evaluation. Other validated tools may be used, as well. Adult Acute and Subacute Low Back Pain

2018 Institute for Clinical Systems Improvement

217. 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

218. 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

219. Modulation of the flexion-relaxation response by spinal manipulative therapy: a control group study (Abstract)

group (n = 14) was placed in a side-lying control position for 10 seconds. All study participants performed thereafter a second block of 5 trunk flexion-extensions. Trunk and pelvis angles and surface EMG of erector spinae at L2 and L5 were recorded during the flexion-extension tasks. Flexion angles corresponding to the onset and cessation of myoelectric silence, normalized EMG, and the extension-relaxation ratio were compared across experimental conditions.A significant reduction of EMG activity (...) Modulation of the flexion-relaxation response by spinal manipulative therapy: a control group study This study evaluated the effects of spinal manipulation on spatiotemporal flexion-relaxation phenomenon parameters in individuals with chronic low back pain.Twenty-seven adults with chronic low back pain participated in this study and first performed a block of 5 complete trunk flexion-extensions. The experimental group (n = 13) was then submitted to lumbar spine manipulation, whereas the control

2009 EvidenceUpdates

220. Sacral nerve stimulation for idiopathic chronic non-obstructive urinary retention

and current treatments Indications and current treatments 2.1 Non-obstructive urinary retention is the inability to empty the bladder with no physical obstruction to the urine flow. It can occur as a result of neurological disorders, such as multiple sclerosis or spinal cord disease, or it can be idiopathic. In younger women, it may be caused by Fowler's syndrome, which is a rare disorder in which the urethral sphincter fails to relax to allow urine to be passed normally. This guidance covers idiopathic (...) ) of patients in the case series of 60 patients, 15 of whom were in the group of 30 patients who had a 1-stage procedure for implanting the neurostimulator. 5.4 Pain at the implant site, pain at the lead site and new pain (unspecified) were reported in 10% (128/1239), 2% and 4% of patients respectively, in the systematic review of 14 articles, including a total of 1239 patients. Pain at the implant site was reported in 32% (19/60) of patients in the case series of 60 patients. Leg pain, pelvic pain

2016 National Institute for Health and Clinical Excellence - Interventional Procedures

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