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Pelvic Relaxation

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221. Occupational Therapy for people Undergoing total hip replacement

and Sackley 2016 [C]; Stewart and McMillan 2011 [C]; Ververeli et al 2009 [B]) [New evidence 2017] 1B 23. It is suggested that given the increase in evidence of improved service user satisfaction and earlier functional independence, without adverse effects on dislocation rates when hip precautions are relaxed or discontinued, occupational therapists engage in local discussion/review of hip precaution protocols with their surgical and multidisciplinary teams. (Barnsley et al 2015 [B]; Coole et al 2013 [C

2018 Publication 1554

222. Low back pain and radicular pain: evaluation and management

(NSAIDs) 102 3.3.2 Paracetamol 107 3.3.3 Opioids 110 3.3.4 Antidepressants 114 3.3.5 Anticonvulsants 117 3.3.6 Skeletal muscle relaxants 120 3.3.7 Antibiotics 122 3.3.8 Oral Methylprednisolone 124 3.4 INVASIVE TREATMENTS 124 3.4.1 Spinal injections 124 3.4.2 Radiofrequency denervation for facet joint pain 128 3.4.3 Epidural injections 134 3.4.4 Surgery and prognostic factors 140 3.4.5 Disc replacement 143 3.4.6 Spinal fusion 146 3.4.7 Spinal decompression 151 4 IMPLEMENTATION AND UPDATING

2017 Belgian Health Care Knowledge Centre

224. Does trunk muscle training with an oscillating rod improve urinary incontinence after radical prostatectomy? A prospective randomized controlled trial Full Text available with Trip Pro

exercises and oscillating rod therapy (IG) or standard pelvic floor muscle exercises and relaxation therapy (CG). Main outcome measures: Urinary incontinence (1- and 24-hour pad test) was assessed, and health-related quality of life (HRQL; Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire) was measured for all patients before and after three weeks of treatment. Results: One hundred and eighty-four patients (mean (SD) age: 64.1 (6.94) years) completed the study. The IG showed (...) an oscillating rod to strength the pelvic floor and deep abdominal musculature and to speed up recovery of continence after radical prostatectomy. Design: Prospective randomized controlled clinical trial. Setting: Inpatient uro-oncology rehabilitation clinic. Subjects: Ninety-three (intervention group (IG)) and ninety-one patients (control group (CG)) with urinary incontinence after prostatectomy were examined. Intervention: All patients were randomly allocated to either standard pelvic floor muscle

2020 EvidenceUpdates

225. Musculoskeletal Strains and Sprains - Guidelines for Prescribing NSAIDs

. Increased intensity or change in character of pain. Pelvic or abdominal pain (other than dysmenorrhea) - Refer to . Accompanying nausea, vomiting, fever, or other signs of systemic infection or disorder. Visible joint changes, abnormal movement, weakness or inability to bear weight in any limb, or suspected fracture. Age less than 2 years. Comorbidities such as GI disorders, cardiovascular disease, renal dysfunction, liver dysfunction if NSAID therapy is being considered. Pain due to trauma (...) sodium Indicated for self-care treatment of mild to moderate pain. Ibuprofen and naproxen do not have significant anti-inflammatory effects at OTC dosages. Should not be used for longer than 10 days in adults or 5 days in children without physician supervision. Advise patient not to exceed recommended doses on package instructions. OTC Muscle Relaxants - methocarbamol / ASA, acetaminophen or ibuprofen Indicated for short-term treatment of spasm associated with acute musculoskeletal conditions. Poor

2017 medSask

226. Spasticity in adults: management using botulinum toxin - 2nd edition

to postural management requires a planned approach encompassing all activities and interventions that impact on an individual’s posture and function (Gericke 2006). • For immobile patients this typically involves the use of profiling beds, sleep systems, wedges, T rolls, wheelchairs and seating to optimise the position of the head, pelvis, trunk and limbs. • For ambulant patients, mobility equipment (walking sticks/frames) should be selected carefully and set at the correct height. 4.4 Stretching

2018 British Society of Rehabilitation Medicine

227. Commissioning guide for rectal bleeding

procedure using x-rays and computers to produce images of the colon and rectum Commissioning guide 2017 Rectal Bleeding 3 Diltiazem Unlicensed medication to relax the anal sphincter and improve blood supply to allow fissure healing digital rectal examination (DRE) medical examination of the back passage with a finger diverticular disease pockets in the bowel from weakness of the muscle layers in the bowel wall faecal calprotectin stool test for inflammatory bowel disease faecal occult blood (FOB) stool (...) test to check whether there is blood hidden in faeces flexible sigmoidoscopy telescope examination of the lower bowel full blood count (FBC) a blood test for anaemia Glyceryl trinitrate (GTN) medication to relax the anal sphincter and improve blood supply to allow fissure healing haemorrhoidal artery ligation operation doppler guided haemorrhoidal operation designed to identify and tie off blood vessels haemorrhoids piles high value care pathway clear and consistent commissioning guideline

2018 Association of Coloproctology of Great Britain and Ireland

229. CRACKCast E099 – Urological Disorders

in 10% of people with ABP Chronic pelvic pain syndrome Complex pain syndrome with urinary symptoms and sexual dysfunction and no organic etiology Asymptomatic inflammatory prostatitis [1] Describe the diagnosis and management of prostatitis Acute bacterial prostatitis: clinical diagnosis UTI symptoms, fevers, chills, dysuria, frequency, urgency, perineal or low back pain Tender and swollen prostate on rectal exam Urine culture, blood cultures if febrile, and STI testing At risk for urinary retention (...) leads to irreversible damage after 1-2 weeks and risk for pyelonephritis, perinephric abscess, and gram -ve sepsis. [1] Name the areas of narrowing in the ureter Stone passage and need for surgical intervention depends on: [1] Calculus size Stone size Pass rate (%) by 4 wks < 5mm 90% 5-8 mm 15% > 8 mm 5% [2] Location There are five areas of narrowing along the ureter – fig 89.4 Calyx of the kidney Ureteropelvic junction (UPJ) Uretero-pelvic brim (ureter arches over iliac vessels posteriorly

2017 CandiEM

230. CRACKCast E092 – Small Intestine

, including adenomas, leiomyomas, and lipomas; metastatic disease, ovarian cancer.) Hernias Be worried about the closed loop internal hernia – in someone post bariatric surgery! Question 3) List causes of functional small bowel obstruction. Metabolic disease (especially hypokalemia) Medications (eg. narcotics) Infection (retroperitoneal, pelvic, intrathoracic) Abdominal trauma Laparotomy Question 4) List 5 lab tests useful in the diagnosis of SBO. What findings are expected on AXR? On CT? This is a trick (...) % of patients with mesenteric ischemia have a prior history of embolic events !!! *** (eg. DVT, PE, Stroke) Question 9) How is mesenteric ischemia diagnosed? List 4 lab abnormalities expected in acute mesenteric ischemia. List 5 findings on AXR. CT abdo/pelvis with IV contrast is the most utilised, but mesenteric angiography is the GOLD STANDARD! Duplex U/S is not widely used due to inability to image past proximal vessel or rule out bowel infarction. Lab: Leukocytosis, Elevated hematocrit secondary

2017 CandiEM

232. WHO Guidelines on Integrated Care for Older People (ICOPE)

of Recommendations Assessment, Development and Evaluation ICOPE integrated care for older people mhGAP Mental Health Gap Action Programme PFMT pelvic floor muscle training PICO population, intervention, comparison, outcome RCT randomized controlled trial WHO World Health Organizationvii Executive summary Over the past 50 years, socioeconomic development in most regions has been accompanied by large reductions in fertility and equally dramatic increases in life expectancy. This phenomenon has led to rapid changes (...) with a good understanding of mental health care for older adults. (Quality of the evidence: very low; Strength of the recommendation: conditional) Module II: Geriatric syndromes Urinary incontinence Recommendation 7: Prompted voiding for the management of urinary incontinence can be offered for older people with cognitive impairment. (Quality of the evidence: very low; Strength of the recommendation: conditional) Recommendation 8: Pelvic floor muscle training (PFMT), alone or combined with bladder control

2017 World Health Organisation Guidelines

234. Gastrointestinal Stromal Tumours: ESMO-EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up

is endoscopic ultrasound assessment and then follow-up, reserving excision for patients whose tumour increases in size or becomes symptomatic [IV, C]. As an option, the patient can choose to undergo a histological assessment, also depending on age, life expectancy and comorbidities. If follow-up is the choice, an evidence-based, optimal surveillance policy is lacking. A logical approach may be to have a short-term ?rst control (e.g. at 3 months) and then, in the case of no evidence of growth, a more relaxed (...) follow-up schedule may be selected. In a histologically proven small GIST, standard treatment is exci- sion, unless major morbidity is expected. Alternatively, in the case of a likely low-risk GIST on biopsy, the decision can be made with the patient to follow up the lesion. However, an exception is the standard approach to rectal nodules represented by biopsy or exci- sion after endorectal ultrasound assessment and pelvic magnetic resonance imaging (MRI), regardless of the tumour size and mitotic

2018 European Society for Medical Oncology

235. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: Executive Summary Full Text available with Trip Pro

, proper methods are recommended for accurate measurement and documentation of BP ( ). Table 8. Checklist for Accurate Measurement of BP Key Steps for Proper BP Measurements Specific Instructions Step 1: Properly prepare the patient 1. Have the patient relax, sitting in a chair (feet on floor, back supported) for >5 min.2. The patient should avoid caffeine, exercise, and smoking for at least 30 min before measurement.3. Ensure patient has emptied his/her bladder.4. Neither the patient nor the observer

2017 American Heart Association

236. Diagnosis and Treatment of Low Back Pain

-inflammatory drugs, with consideration of patient-specific risks. Strong for Reviewed, Amended 22. For patients with chronic low back pain, we suggest offering treatment with duloxetine, with consideration of patient-specific risks. Weak for Reviewed, New-added 23. For patients with acute low back pain or acute exacerbations of chronic low back pain, we suggest offering a non-benzodiazepine muscle relaxant for short-term use. Weak for Reviewed, New-added 24. For patients with chronic low back pain, we (...) suggest against offering a non- benzodiazepine muscle relaxant. Weak against Reviewed, New-added 25. For patients with low back pain, we recommend against benzodiazepines. Strong against Reviewed, New-replaced 26. For patients with acute or chronic low back pain with or without radiculopathy, we recommend against the use of systemic corticosteroids (oral or intramuscular injection). Strong against Reviewed, Amended 27. For patients with low back pain, we recommend against initiating long-term opioid

2017 VA/DoD Clinical Practice Guidelines

237. Approaches to Limit Intervention During Labor and Birth

be offered a variety of nonpharmacologic techniques. None of the nonpharmacologic techniques have been found to adversely affect the woman, the fetus, or the progress of labor, but few have been studied extensively enough to determine clear or relative effectiveness. During the first stage of labor, water immersion has been found to lower pain scores without evidence of harm (8, ). Intradermal sterile water injections, relaxation techniques, acupuncture, and massage may result in reduction in pain (...) and descend while conserving the woman’s energy for pushing efforts ( ). This practice is called delayed pushing, laboring down, or passive descent. The second stage of labor has two phases: 1) the passive descent of the fetus through the maternal pelvis and 2) the active phase of maternal pushing. Studies that suggest an increased risk of adverse maternal and neonatal outcomes with increasing second-stage duration generally do not account for the duration of these passive and active phases ( , ). Two

2017 American College of Obstetricians and Gynecologists

238. Radiologic Management of Iliac Artery Occlusive Disease

Doppler lower extremity 8 Plethysmography and pulse volume recording 6 CTA pelvis with runoff 7 MRA pelvis with runoff 7 Catheter directed angiography 5 This procedure should be performed only at the time of endovascular therapy. Risk factor analysis, lipid profile and ABIs 9 No further treatment or evaluation needed 1 Best medical management including supervised exercise program only 9 Anticoagulation adjunctive therapy 3 Antiplatelet adjunctive therapy 7 Rating Scale: 1,2,3 Usually not appropriate (...) ; 4,5,6 May be appropriate; 7,8,9 Usually appropriate Variant 2: Long history of mild claudication. Acute-onset left lower-extremity pain. Absent left femoral pulse on palpation, faint dorsalis pedis and posterior tibial pulses by Doppler. Next steps. Treatment/Procedure Rating Comments Ankle brachial index 8 US duplex Doppler lower extremity 8 Plethysmography and pulse volume recording 5 CTA pelvis with runoff 8 MRA pelvis with runoff 7 This procedure takes longer to perform. Rating Scale: 1,2,3

2017 American College of Radiology

239. The 2017 hormone therapy position statement of The North American Menopause Society

, 2017 2017 The North American Menopause SocietyCopyright @ 2017 The North American Menopause Society. Unauthorized reproduction of this article is prohibited. Urinarytractsymptoms(includingpelvicfloordisorders) Vaginal ET may improve incontinence by increasing the number of vessels around the periurethral and bladder neck region 73 and has been shown to reduce the frequencyandamplitudeofdetrusorcontractionstopromote detrusormusclerelaxation. 74,75 Estrogentherapy,alongwith pelvic floor training (...) , pessaries, or surgery, may improve synthesis of collagen and improve vaginal epithelium, but evidence for effectiveness for pelvic organ prolapse is lacking. 76 Two large trials found that users of systemic HT (CEE 0.625mgþMPA2.5mg)hadanincreasedincidenceofstress incontinence. 77,78 Increased incontinence was found in women using oral estrogen alone (RR, 1.32; 95% CI, 1.17- 1.48) and in those using combined estrogen and progestogen (RR,1.11;95%CI,1.04-1.18). 79 Vaginalestrogenuseshowed

2017 The North American Menopause Society

240. AIM Clinical Appropriateness Guidelines for Spine Surgery

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 ? Appropriate management of underlying or associated cognitive, behavioral (...) vertebral segments (List separately in addition to code for primary procedure) 22845 Anterior instrumentation; 2 to 3 vertebral 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

2017 AIM Specialty Health

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