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Pelvic Relaxation

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282. Sonidegib (Odomzo)

for musculoskeletal adverse reactions. The incidence of musculoskeletal adverse reactions requiring medical intervention (magnesium supplementation, muscle Reference ID: 3796270Addendum to Clinical Review Denise Casey NDA 205266 Odomzo ® (sonidegib) 7 relaxants, and analgesics or narcotics) was 29%, including four patients (5%) who received intravenous hydration or were hospitalized. Obtain baseline serum CK and creatinine levels prior to initiating ODOMZO, periodically during treatment, and as clinically

2014 FDA - Drug Approval Package

283. Ureteric stent

perform a hand wash and dry hands thoroughly record the procedure and volume of urine in the child’s health records ( ) The child and family must be reminded that pain may be experienced as the kidney pelvis fills up and during the first micturition. The child’s first micturition must be documented on the fluid balance chart and in the child’s health care record ( ). The child's doctor must be informed if the child: is unable to pass urine ( ) has dysuria or loin pain if the entry site leaks (...) 32: To enabled stent to be gently pulled. Rationale 33: To relax the abdominal wall. Rationale 34: If the stent gets caught it can cause muscular/bladder spasms. Rationale 35: The internal suture may still be intact or it may be caught on oedematous tissue. Rationale 36: To prevent the leakage of urine and bleeding. Rationale 37: The bladder or urethra may be oedematous causing pain or obstruction. Rationale 38: Increased bladder pressure may cause a leak. Rationale 39: If the bladder bleeds

2014 Publication 1593

284. Early Management of Head Injury in Adults

and cross-match, arterial blood gases, radiological investigations [CT scan (where available), chest x-ray, pelvic X-rays and other investigations as appropriate] *The investigations should not delay transfer. A copy of the summary and transfer record should be kept in the referring hospital for audit purposes and potential medico-legal consideration. 19, level III Recommendation 4 • Hypotension, hypoxia, hypocarbia and hypercarbia, and inadvertent cervical injury should be avoided before and during

2015 Ministry of Health, Malaysia

285. Management of Cervical Cancer

Kebangsaan Malaysia Medical Centre, Kuala LumpurManagement of Cervical Cancer (Second Edition) viii ALGORITHM 1. ASSESSMENT OF CERVICAL CANCER Histologically -confirmed cervical cancer Staging by a gynaecologist/gynae-oncologist Visible lesion • Pelvic examination • Cervical conisation • Laboratory tests as indicated • Pelvic examination ± anaesthesia • Cystoscopy and sigmoidoscopy if indicated • Imaging assessment: o CT/MRI If above not feasible: o CXR o U/S KUB o IVU o Skeletal survey if indicated (...) (Second Edition) ALGORITHM 3. MANAGEMENT OF FIGO STAGE IA2 FIGO Stage 1A2 Fertility preservation required *If repeat conisation is not feasible, proceed with trachelectomy Yes No Treat as FIGO stage IB Repeat conisation* Follow-up Consider adjuvant if node positive Simple/ extrafascial hysterectomy + pelvic lymphadenectomy Cervical conisation + pelvic lymphadenectomy Node positive Margin positive Yes No Yes No Treat as FIGO stage IB Follow-up Margin positive Yes No xManagement of Cervical Cancer

2015 Ministry of Health, Malaysia

286. Core Competencies for Management of Labour

supine positions) ¦ Intact perineum ¦ Promoting pelvic floor integrity ¦ Optimal fetal oxygenation • Nursing interventions that promote normal labour progress ¦ Woman-centred care ¦ Continuous labour support ¦ Freedom of movement during labour ¦ Hydration ¦ Position changes ¦ Empty bladder ¦ Avoiding routine interventions and restrictions ¦ Appropriate use of technology ¦ Evaluation of uterine activity • Comfort and support measures • Ongoing maternal assessments • Ongoing fetal assessments • How (...) • Relaxation/breathing techniques • Hydrotherapy & thermal therapy • Psychoprophylaxis & complementary therapies • Environmental • Sterile water injections (intradermal or subcutaneous) • Administration of Nitronox or Entonox • Administration of opioids e.g. morphine, fentanyl • Assisting with insertion of an epidural catheter 17. IV initiation 18. Obstetrical triage 19. Preparation of the sterile delivery table 20. Preparation and use of the newborn receiving unit (radiant warmer) 21. Support

2014 British Columbia Perinatal Health Program

289. Gestational diabetes mellitus

Headache o Decreased fetal movements o Uterine contractions, vaginal bleeding, amniotic fluid leakage o Back or pelvic pain o Chest pain o Muscle weakness o Calf pain or swelling or sudden swelling of ankles, hands and/or face • Refer to Appendix B for a guide to target heart rate ranges by age and BMI Queensland Clinical Guideline: Gestational diabetes mellitus Refer to online version, destroy printed copies after use Page 23 of 38 4 Pharmacological therapy Before commencing pharmacological glycaemic

2015 Queensland Health

290. Neuro-urology

of the nervous system involved, including the peripheral nerves in the pelvis, can result in neuro-urological symptoms. Depending on the extent and location of the disturbance, a variety of different LUT changes might occur, which can be symptomatic or asymptomatic. Moreover, neuro-urological symptoms can cause a variety of long-term complications; the most dangerous being deterioration in renal function. Since symptoms and long-term complications do not correlate [6], it is important to identify patients (...) stenosis Male (5%) and female (3%) > 35 yrs have had a lumboscitic episode related to disc prolapse. Incidence: approx. 5/100,000/yr More common: > 45 yrs, females. 26% difficulty to void and acontractile detrusor at urodynamic testing. 14% frequent voiding while normal urodynamics testing [42]. Cauda equina lesions lead to detrusor hypocontractility (83%) and complete EUS denervation (60%) [37-39]. 27% significant LUTS (mainly difficulty to void) [42]. Iatrogenic pelvic nerve lesions Rectum cancer

2015 European Association of Urology

292. Male Sexual Dysfunction

DYSFUNCTION - UPDATE MARCH 2015 Table 1: Pathophysiology of ED Vasculogenic - Cardiovascular disease (hypertension, coronary artery disease, peripheral vasculopathy, etc.) - Diabetes mellitus - Hyperlipidaemia - Smoking - Major pelvic surgery (RP) or radiotherapy (pelvis or retroperitoneum) Neurogenic Central causes - Degenerative disorders (multiple sclerosis, Parkinson’s disease, multiple atrophy, etc.) - Spinal cord trauma or diseases - Stroke - Central nervous system tumours Peripheral causes - Type 1 (...) , vascular and the tissue compartments. It includes arterial dilation, trabecular smooth muscle relaxation, and activation of the corporeal veno-occlusive mechanism [11]. ED is defined as the persistent inability to attain and maintain an erection sufficient to permit satisfactory sexual performance [12]. ED may affect physical and psychosocial health and may have a significant impact on the quality of life (QoL) of sufferers and their partners [13-15]. There is increasing evidence that ED can

2015 European Association of Urology

293. Urological Trauma

4.3.4.2.4 Iatrogenic bladder trauma 26 4.3.4.2.5 Intravesical foreign body 26 4.3.5 Follow-up 26 4.3.6 Statements and recommendations for bladder injury 26 4.4 Urethral Trauma 27 4.4.1 Epidemiology, aetiology and pathophysiology 27 4.4.1.1 Iatrogenic urethral trauma 27 4.4.1.1.1 Transurethral catheterisation 27 4.4.1.1.2 Transurethral surgery 27 4.4.1.1.3 Surgical treatment for prostate cancer 27 4.4.1.1.4 Radiotherapy for prostate cancer 28 4.4.1.1.5 Major pelvic surgery and cystectomy 28 4.4.1.2 Non (...) crashes [12]. Ureteral trauma is relatively rare and mainly due to iatrogenic injuries or penetrating gunshot wounds – both in military and civilian settings [13]. Traumatic bladder injuries are usually due to blunt causes (MVA) and associated with pelvic fracture [14], although may also be a result of iatrogenic trauma. The anterior urethra is most commonly injured by blunt or “fall-astride” trauma, whereas the posterior urethra is usually injured in pelvic fracture cases - the majority of which

2015 European Association of Urology

294. Muscle-invasive and Metastatic Bladder Cancer

(extravesical mass) T4 Tumour invades any of the following: prostate stroma, seminal vesicles, uterus, vagina, pelvic wall, abdominal wall T4a Tumour invades prostate stroma, seminal vesicles, uterus, or vagina T4b Tumour invades pelvic wall or abdominal wall N - Regional Lymph Nodes Nx Regional lymph nodes cannot be assessed N0 No regional lymph-node metastasis N1 Metastasis in a single lymph node in the true pelvis (hypogastric, obturator, external iliac, or presacral) N2 Metastasis in multiple lymph (...) nodes in the true pelvis (hypogastric, obturator, external iliac, or presacral) N3 Metastasis in common iliac lymph node(s) M - Distant Metastasis M0 No distant metastasis M1 Distant metastasis 5. DIAGNOSTIC EVALUATION 5.1 Primary diagnosis 5.1.1 Symptoms Painless haematuria is the most common presenting complaint. Others include urgency, dysuria, increased frequency, and in more advanced tumours, pelvic pain and symptoms related to urinary tract obstruction. 5.1.2 Physical examination Physical

2015 European Association of Urology

296. Early Pregnancy Loss

of anticoagulants, aspirin, or both, has not been shown to reduce the risk of early pregnancy loss in women with thrombophilias except in women with antiphospholipid syndrome ( , ). Are there any effective interventions to prevent early pregnancy loss? There are no effective interventions to prevent early pregnancy loss. Therapies that have historically been recommended, such as pelvic rest, vitamins, uterine relaxants, and administration of β-hCG, have not been proved to prevent early pregnancy loss (...) evacuation. Hemorrhage and infection can occur with all of the treatment approaches. In the Management of Early Pregnancy Failure Trial, women randomized to the misoprostol group were significantly more likely to have a decrease in their hemoglobin levels greater than or equal to 3 g/dL than women in the vacuum aspiration group (23, ). However, rates of hemorrhage-related hospitalization with or without transfusion are similar between treatment approaches (0.5–1%) (23, ). Pelvic infection also can occur

2015 American College of Obstetricians and Gynecologists

297. Irritable Bowel Syndrome (IBS)

as a consequence of an intestinal infection (postinfectious IBS) or to be precipitated by major life events, or occur during a period of considerable stress. — Symptoms may develop following abdominal and/or pelvic surgery. © World Gastroenterology Organization, 2015 WGO Global Guidelines IBS 6 — Symptoms may be precipitated by antibiotic treatment. In general, there is a lack of recognition of the condition; many patients with IBS symptoms do not consult a physician and are not formally diagnosed. 2.1 IBS (...) in the left lower quadrant However, it is now evident that afflicted patients may have more chronic symptoms in between discrete episodes/attacks, and that left-sided and bilateral, but not right-sided diverticular disease, may increase the risk for IBS [15]. Endometriosis Main symptoms and/or findings: • Cyclical lower abdominal pain • Enlarged ovaries or nodules dorsal to the cervix (on digital vaginal examination) Pelvic inflammatory disease Main symptoms and/or findings: • Chronic lower abdominal pain

2015 World Gastroenterology Organisation

298. A cost-effectiveness analysis of maternal genotyping to guide treatment for postpartum pain and avert infant adverse events

and intended to continue breastfeeding their infants • willing to participate in follow-up interviews, medical chart extraction • able to complete follow-up interviews in English In addition, if any one of the following exclusion criteria were present the subject was not included in the study: • the subject was taking other medications known to be associated with sedating side effects (including benzodiazepines, muscle relaxants, psychotropic medications) • the subject was taking, or addicted to, other

2015 SickKids Reports

299. Are claims for newer drugs for overactive bladder warranted?

relaxes the bladder smooth muscle during the storage phase, increasing bladder capaci- ty. 17 Dose-dependent increases in blood pressure, heart rate and QT prolongation with higher doses led to a recommended usual dose of 25 mg/day in Canada. 18 Effectiveness vs. placebo is similar to antimuscarinic drugs. 18 References 1. Therapeutics Initiative. Drugs for overactive bladder symptoms. Therapeutics Letter Sept-Dec 2005; 57:1-2. 2. Therapeutics Initiative. Is newer better? New drugs for treatment (...) of overactive bladder. Therapeutics Letter Sept-Oct 2007; 66:1-2. 3. Abrams P, Cardozo L, Fall M et al. The standardization of termi- nology of lower urinary tract function: report of the Standardization Sub-committee of the International Continence Society. Neurourol Urodyn 2002; 21(2):167-178. 4. Haylen BT, de Ridder D, Freeman RM et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol

2015 Therapeutics Letter

300. Botulinum Toxin for an Overactive Bladder

limited, several randomised controlled trials (RCTs) have been published in the last 3 years. However, the role of BoNT-A in treatment algorithms is yet to be fully established. This paper reviews the existing data, provides suggested guidance on the advice to give patients and initial dosing, and highlights where information is still lacking. Generally, patients with OAB are initially treated with conservative measures (lifestyle changes, caffeine intake reduction, pelvic floor exercises and bladder (...) Urol 2007;177:2231–6. 11. Flynn MK, Amundsen CL, Perevich M, Liu F, Webster GD. Outcome of a randomized, double-blind, placebo controlled trial of botulinum A toxin for refractory overactive bladder. J Urol 2009;181:2608–15. 12. Tincello DG, Kenyon S, Abrams KR, Mayne C, Toozs-Hobson P, Taylor D, et al. Botulinum toxin A versus placebo for refractory detrusor overactivity in women: a randomised blinded placebo-controlled trial of 240 women (the RELAX study). Eur Urol 2012;62:507–14. 13. Rapp DE

2014 Royal College of Obstetricians and Gynaecologists

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