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Pelvic Relaxation

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1181. Oxybutynin transdermal patch (Kentera)

within NHS Scotland for the treatment of urge incontinence and/or increased urinary frequency and urgency in patients with unstable bladder, restricted to patients who derive clinical benefit from oral oxybutinin but who experience intolerable anticholinergic side effects. It should be used in conjunction with non-pharmacological measures, including pelvic floor muscle exercises and bladder retraining. Transdermal oxybutynin appears to have similar efficacy to oral antimuscarinics and a lower rate (...) (Detrunorm®) 15mg once to four times daily £159-£636 Tolterodine tablets (Detrusitol®) 1-2mg twice daily £377-£397 Tolterodine MR capsules (Detrusitol XL®) 4mg daily £377 Trospium tablets (Regurin®) 20mg twice daily £316 Solifenacin tablets (Vesicare®)** 5-10mg daily £335-£436 ** solifenacin was not recommended for use by SMC in November 2004 Summary of evidence on comparative efficacy Oxybutynin is an antimuscarinic agent which acts by relaxing smooth muscle in the bladder. It has been available

2005 Scottish Medicines Consortium

1183. Prevention of Constipation in the Older Adult Population

or twice a day; or 30-60 minutes daily or 3 to 5 times per week). Ambulating at least 50 feet twice a day is recommended for individuals with limited mobility. 10.2 For persons unable to walk or who are restricted to bed, exercises such as IV pelvic tilt, low trunk rotation and single leg lifts are recommended. 11.0 Evaluate client response and the need for ongoing interventions, through the IV use of a bowel record that shows frequency, character and amount of bowel movement pattern, episodes

2005 Registered Nurses' Association of Ontario

1184. Nursing Management of Hypertension

or the failure of other factors to compensate for these malfunctioning mechanisms (Woods, Motzer & Bridges, 2005). Systolic Pressure: Systolic pressure represents the pressure when the heart contracts and forces blood into the blood vessels. This is the higher of the two numbers and is usually expressed first (HSFO, 2005a). Diastolic Pressure: Diastolic pressure represents the pressure when the heart is relaxed. This is the lower of the two numbers and is usually expressed second (HSFO, 2005a). Clinical

2005 Registered Nurses' Association of Ontario

1185. Anterior vaginal repair for urinary incontinence in women. (Abstract)

(failure rate within first year after anterior repair 48/198, 24% vs 30/266, 11%; RR 2.15, 95% CI 1.4 to 3.28) and long-term (80/193, 41% vs 51/261, 20%; RR 2.25, 95% CI 1.66 to 3.04). There was some evidence from one of these trials that this was reflected in fewer repeat operations for incontinence. These findings held irrespective of the co-existence of prolapse (pelvic relaxation). Although later prolapse operation appeared to be equally common after vaginal or abdominal operation there were too

2000 Cochrane

1186. Laparoscopically assisted vaginal hysterectomy: a suitable substitute for abdominal hysterectomy?

uterine corpus or cervical abnormalities, one chronic pelvic pain, 13 pelvic relaxation and 5 ovarian abnormalities. The matched patients in the TAH group were similar in most respects, the exceptions being the 13 patients with pelvic relaxation and cases performed at the discretion of the individual surgeons. Effectiveness results The mean operating time was 230 (+/- 5) minutes (range: 130 - 390) in the LAVH group, and 120 (+/- 3) minutes (range: 25 - 270) in the TAH group, (p<0.001)). The mean blood (...) diagnoses. For example, 13 patients with preoperative cases of pelvic relaxation were not matched in the TAH group. Also, as the authors identified, some of the patients in the TAH group might not be suitable for LAVH. Validity of estimate of measure of benefit The authors did not calculate a summary measure of benefit. The fact that the effectiveness results showed a shorter hospital stay was one of the reasons used to argue that the patients could return to a normal life quicker with LAVH. It would

2000 NHS Economic Evaluation Database.

1187. Complementary and alternative medicine (CAM) in reproductive-age women: a review of randomized controlled trials

. One trial supported acupuncture for back or pelvic pain, while massage improved both back pain and mood in another. Positive benefits were seen for plant-derived rutosides, magnesium and immersion in water. Labour induction and outcomes. No major effects were observed for acupuncture point stimulation for inducing labour. One trial of moxibustion for turning breech babies showed promising results. Mind-body therapies and massage might reduce anxiety and pain during labour but more research (...) is needed. The benefits of perineal massage were inconsistent. Neither aromatherapy nor homeopathy reduced perineal discomfort. Listening to a relaxation or imagery tape increased the volume of milk in mothers of premature infants. The application of cabbage leaves or cabbage extract failed to help breast engorgement in four controlled trials. Authors' conclusions There was some limited evidence for selected CAM therapies. It is necessary to clarify safety issues as these therapies are popular among

2003 DARE.

1188. Vocational outcome of intervention for low-back pain

and ensures through a care plan, that suitable services are provided to meet their needs, within the limits imposed by the insurance company. Interventions including analgesics, muscle relaxants, epidural and intra-articular injections, traction, orthoses, biofeedback, acupuncture and transcutaneous nerve stimulation were excluded. Participants included in the review Individuals with acute or chronic low-back pain were included. Outcomes assessed in the review The following outcomes were assessed: rate (...) pain (4 studies): The studies compared different periods of bed rest or the avoidance of bed rest with a short period of bed rest. There was moderate evidence for the efficacy of avoiding bed rest or for short periods of bed rest, in terms of the duration of sick leave after 3 months for patients with and without radiating pain. Spinal manipulation in acute pain (6 studies): There was limited evidence for the efficacy of spinal manipulation in comparison with placebo in cases of pelvic joint

1997 DARE.

1189. Position Statements: Management of Anal Fissure & Management of Acute Severe Colitis

). Theaetiologyofthetypical?ssureisnotclear.Trauma from passing a large or hard stool is a common initiator [3], but many traumatic ?ssures heal and others do not. Resting anal pressure is higher in patients with an anal ?ssure [4]. Ambulatory manometry has shown persisting high anal resting tone interpreted as due to hypertonia of the internal anal sphincter with poor spontaneous relax- ation in patients with a chronic ?ssure [5]. In a study examining the in?uence of ischaemia, it was found that the higher the sphincter (...) bran supplements (5 g three timesaday)andwarmsitzbathsweresuperiorwithfewer recurrences than topically applied local anaesthetic or hydrocortisone cream [12]. Recurrence rates were reduced from 68–16% at 1 year following continued conservative management [13]. Medical Therapies Relaxation of internal anal sphincter tone is achieved by the reduction of intracellular calcium in the Table 1 Levels of evidence and grades of recommendation. Level of evidence Grade of evidence I Evidence obtained from

2008 Association of Coloproctology of Great Britain and Ireland

1190. SPECT/CT and PETCT Imaging

radiopharmaceutical used.b. For either a CT scan done for attenuation correction/anatomic localization (AC/AL) or a diagnostic CT scan of the abdomen or pelvis, an intravenous or intraluminal gastrointestinal contrast agent may be administered to provide adequate visualization of the gastrointestinal tract unless medically contraindicated or unnecessary for the clinical indication (see Section E.2.b). B. Information Pertinent to Performing Procedure See also the Procedure Guidelines for General Imaging (...) " sections of Practice Guideline for the Performance of Computed Tomography of the Extracranial Head and Neck in Adults and Children, the Practice Guideline for thePerformance of Paediatric and Adult Thoracic Computed Tomography (CT), and the Practice Guideline for the Performance of Computed Tomography (CT) of the Abdomen and Computed Tomography (CT) of the Pelvis. 1. Field of view, positioning, and preacquisition preparation a. See the specific Procedure Guideline for the pathophysiology being imaged

2006 British Nuclear Medicine Society

1192. Clinical practice guidelines for the psychosocial care of adults with cancer

with cancerSupport towards the end of life – Chapter 3.6 Level Evidence Pain can be significantly controlled by relaxation therapy, and educational I 15 programs, aimed at enhancing pain control, improve adherence to treatment II 578 The expression of feelings improves adjustment II 401 Psychological interventions can improve quality of life in areas such as I 15,17 mood, self-esteem, coping, sense of personal control, and physical and functional adjustment II 579,580 Exploring and responding to specific (...) concerns – Chapter 3.7 Level Evidence Referring people who have risk factors to specialised psychological services I 359 minimises the likelihood of their developing significant distress A range of interventions, such as psycho-educational interventions and I 15 anxiety reduction strategies are useful for decreasing distress in patients with cancer Cognitive and behavioural techniques, eg muscle relaxation and imagery, I 15,16,17 are effective treatments for anxiety. However, when anxiety or panic

2003 National Breast and Ovarian Cancer Centre

1193. Clinical practice guidelines for the psychosocial care of adults with cancer

with cancerSupport towards the end of life – Chapter 3.6 Level Evidence Pain can be significantly controlled by relaxation therapy, and educational I 15 programs, aimed at enhancing pain control, improve adherence to treatment II 578 The expression of feelings improves adjustment II 401 Psychological interventions can improve quality of life in areas such as I 15,17 mood, self-esteem, coping, sense of personal control, and physical and functional adjustment II 579,580 Exploring and responding to specific (...) concerns – Chapter 3.7 Level Evidence Referring people who have risk factors to specialised psychological services I 359 minimises the likelihood of their developing significant distress A range of interventions, such as psycho-educational interventions and I 15 anxiety reduction strategies are useful for decreasing distress in patients with cancer Cognitive and behavioural techniques, eg muscle relaxation and imagery, I 15,16,17 are effective treatments for anxiety. However, when anxiety or panic

2002 Cancer Australia

1194. Clinical practice guidelines for the management of advanced breast cancer

to the appropriate chapter. PSYCHOSOCIAL INTERVENTIONS 1. Psychosocial interventions can improve physical, functional and psychological adjustment and should be considered for introduction into patient care. These include the following: a) Appropriate counselling; an offer of I 76 2.2 referral for further support should be made whenever concern exists. b) Relaxation therapy to ease cancer pain. I 136 8 c) Education programs to improve pain II 352 8 control. d) Supportive group counselling to improve II 348, 349 (...) of anxiety and depression. i) Behavioural techniques, such as muscle III 344 7 relaxation and imagery, to reduce distress in cases of mild anxiety. j) Encouraging the expression of thoughts II 71 2.2 and feelings about the diagnosis and its meaning. Guidelines Level of Reference Chapter evidence6 Clinical practice guidelines for the management of advanced breast cancer 2. Thorough review of women with advanced IV 31 2.2 breast cancer involves an assessment of mood and coping, and enquiries about how

2000 Cancer Australia

1196. Outcomes of routine episiotomy: a systematic review. Full Text available with Trip Pro

are consistent in demonstrating no benefit from episiotomy for prevention of fecal and urinary incontinence or pelvic floor relaxation. Likewise, no evidence suggests that episiotomy reduces impaired sexual function--pain with intercourse was more common among women with episiotomy.Evidence does not support maternal benefits traditionally ascribed to routine episiotomy. In fact, outcomes with episiotomy can be considered worse since some proportion of women who would have had lesser injury instead had (...) suggests that immediate maternal outcomes of routine episiotomy, including severity of perineal laceration, pain, and pain medication use, are not better than those with restrictive use. Evidence is insufficient to provide guidance on choice of midline vs mediolateral episiotomy. Evidence regarding long-term sequelae is fair to poor. Incontinence and pelvic floor outcomes have not been followed up into the age range in which women are most likely to have sequelae. With this caveat, relevant studies

2005 JAMA

1197. I have a lady with vulva varicose veins. She is also pregnant. What advice do I give her?

and Parkes-Weber syndrome). In some cases, vulvar varices are seen as part of the so-called "pelvic congestion syndrome." Clinically, vulvar varices may present as small isolated protrusions, mainly in the labia majora, or as large masses, involving the vulva and even the perivulvar area. The treatment of choice of vulvar varices seen during pregnancy is conservative and symptomatic. Surgical pathologists need to be aware of the existence of vulvar varicose veins and its possible presence in biopsy (...) relief and symptom relief and induce relaxation without harmful side-effects. Reflexology may be used for specific conditions in the lower limbs and generalised oedema as it moves fluids from extravascular compartments without affecting intravascular fluids (Mollart 2003). Treatment during pregnancy, however,mainly concentrates on the reprieve of symptoms. For the majority of women , varicose veins subside on their own within three or four months of the baby’s birth. Any corrective treatment is often

2008 TRIP Answers

1198. What volume of urine is acceptable post micturition in the bladder? What are the causes and treatment options for incomplete bladder emptying?

of the bladder or cessation of urination; it may be acute or chronic. Causes include impaired bladder contractility, bladder outlet obstruction, detrusor-sphincter dyssynergia (lack of coordination between bladder contraction and sphincter relaxation), or a combination. Retention is most common among men, in whom prostate abnormalities or urethral strictures cause outlet obstruction. In either sex, retention may be due to drugs (particularly those with anticholinergic effects, including many OTC drugs (...) ), severe fecal impaction (which increases pressure on the bladder trigone), or neurogenic bladder in patients with diabetes, multiple sclerosis, Parkinson's disease, or prior pelvic surgery resulting in bladder denervation.” Treatment “ Relief of acute urinary retention requires urethral catheterization. Subsequent treatment depends on cause. In men with benign prostatic hypertrophy, drugs (usually á-adrenergic blockers or 5á-reductase inhibitors) or surgery may help decrease bladder outlet resistance

2008 TRIP Answers

1199. How do you manage women, at term, with a transverse lie pregnancy?

upwards. An oxytocin infusion is started while the longitudinal lie is maintained by gentle lateral pressure on the uterus. Once the head enters the pelvic brim the membranes are ruptured and the infusion continued. Edwards & Nicholson (1969) produced excellent results with this approach, but although it works well with patients of low parity, in the grand multipara the tendency is for the membranes to rupture spontaneously before the head enters the brim and the lie then becomes oblique or reverts (...) to transverse as the amniotic fluid drains out. "Elective caesarean section is performed if stabilising induction cannot easily be achieved. "If the transverse lie is first diagnosed in labour, placenta praevia and fetal abnormality must be excluded by ultrasound, which can also sometimes demonstrate a cord in the lower segment. Provided these complications are not present, external version to a longitudinal lie may be attempted between contractions, with the use of a beta-stimulant to relax the uterus

2006 TRIP Answers

1200. The relationship of vaginal prolapse severity to symptoms and quality of life. (Abstract)

degrees of pelvic relaxation than women who present without symptoms. Prolapse severity and quality of life scores are significantly different in those women symptomatic of prolapse. There was a stronger relationship between posterior prolapse and bowel symptoms than anterior prolapse and urinary symptoms. Sexual dysfunction was related to cervical descent. (...) examined using the Pelvic Organ Prolapse Quantification system (POP-Q). POP-Q scores in those with and without prolapse symptoms were compared. Urinary and bowel symptoms and sexual function were compared and related to prolapse severity and location.POP-Q scores, P-QOL scores, urinary and bowel symptoms and sexual function.Three hundred and fifty-five women were recruited-233 symptomatic and 122 asymptomatic of prolapse. The median P-QOL domain scores ranged between 42-100 in symptomatic women and 0

2005 BJOG

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