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Pelvic Relaxation

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141. Axonics sacral neuromodulation system for treating refractory overactive bladder

incontinence and pelvic organ prolapse and lower urinary tract symptoms. Axonics SNM system is small and does not need to be removed for most types of MRI scans, so it may be useful for people with a low body mass index (BMI) or when an MRI is likely. 1.3 Cost modelling estimates that, over 15 years, Axonics SNM system is cost saving compared with the non-rechargeable system by about £6,025 per person. Cost savings are estimated to begin 6 years after implant. This is because the device needs (...) to be replaced less frequently than the non-rechargeable system, assuming Axonics has a life span of at least 15 years. For more details, see the NICE resource impact statement. Why the committee made these recommendations Why the committee made these recommendations Axonics SNM system uses electrical impulses to stimulate the sacral nerves in the pelvic floor or groin area, to help bladder control. The system is implanted surgically and has a small stimulator that uses a rechargeable battery. Axonics SNM

2020 National Institute for Health and Clinical Excellence - Medical technologies

142. Microhematuria: AUA/SUFU Guideline

Pelvic Medicine & Urogenital Reconstruction (SUFU). The Practice Guidelines Committee (PGC) of the AUA selected the Panel Chairs who in turn appointed the additional panel members with specific expertise in this area in conjunction with SUFU. Additionally, the Panel included representation from the American College of Obstetricians and Gynecologists (ACOG) as well as a patient advocate. Funding of the Panel was provided by the AUA; panel members received no remuneration for their work. Searches (...) symptoms Male sex Prior pelvic radiation therapy Smoking use Prior cyclophosphamide/ifosfamide chemotherapy Degree of microhematuria Family history of urothelial cancer or Lynch Syndrome Persistence of microhematuria Occupational exposures to benzene chemicals or aromatic amines (e.g., rubber, petrochemicals, dyes) History of gross hematuria Chronic indwelling foreign body in the urinary tract *The Panel recognizes that this list is not exhaustive. Clinicians should also understand

2020 American Urological Association

143. Constipation: Scenario: Constipation in adults

disorders, such as pelvic floor dyssynergia, which can teach people to relax their pelvic floor muscles during simulated defecation. Surgery, such as subtotal colectomy with ileorectal anastomosis, may be considered rarely in people with slow transit constipation if all other treatment options have been ineffective. [ ; ; ; ; ; ] Basis for recommendation The recommendations on primary care follow-up are based on expert opinion in the World Gastroenterology Organisation (WGO) Global Guidelines (...) : Specialist investigations may include: Flexible sigmoidoscopy, colonoscopy or computed tomographic colonography; abdominal X-ray may identify faecal load, impaction, or obstruction. Anorectal manometry, defecation proctogram, and colon transit time studies with radio-opaque markers or a wireless capsule to determine which of constipation is involved, such as slow colonic transit or pelvic floor dyssynergia. Specialist management may include: Biofeedback training by a physiotherapist for some defecation

2020 NICE Clinical Knowledge Summaries

144. Clinical Guideline: Gestational diabetes mellitus

, 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 therapy, initiate BGL self-monitoring and review results

2020 Queensland Health

145. Noninvasive Nonpharmacological Treatment for Chronic Pain

control over the short term; and function versus attention control in the long term (1 trial) (SOE: low). • Psychological Therapies: No difference was found in function or pain in the short term or intermediate term from one study comparing relaxation training and no intervention (SOE: low for all). ES-8 • Physical Modalities: Low-level laser therapy was associated with a moderate improvement in short-term function (2 trials) and pain (3 trials) compared with sham (SOE: moderate). • Manual Therapies (...) between groups for the following interventions compared with exercise: o Physical therapist (PT)-led relaxation training. Function or pain at short or intermediate term (1 trial, SOE: low for all). o Massage. Pain at intermediate term (1 trial, SOE: low). o Basic body awareness therapy. Function at short term (1 trial, SOE: low). Key Question 3: Osteoarthritis Pain Interventions Compared With Usual Care, Waitlist, No Treatment, Attention Control, or Sham Knee Osteoarthritis Pain • Exercise: Exercise

2020 Effective Health Care Program (AHRQ)

147. Surgical mesh repair of primary inguinal hernia in men

without surgical mesh (non- mesh/suture repair). In particular, we were asked to consider safety and patient aspects relating to surgical mesh repair of inguinal hernias. Why is this important? Surgical mesh has become an important topic in the last few years following women’s experiences of severe, chronic pain after surgical mesh was used to treat pelvic organ prolapse. In Scotland, inguinal hernia repair using surgical mesh is a common procedure accounting for around 5,000 surgeries per year (...) ). The cumulative cost of mesh is lower with a mean saving of £134 per patient, 95% CI £81 to £192. This reduction in costs is because the costs of treating additional recurrent hernias after open non-mesh repair more than outweigh the higher initial material cost of open mesh repair. The cost saving remains robust when the assumption that all recurrences result in a repeat procedure is relaxed to as low as 5% of those having a recurrence. Over the same 5-year time horizon, laparoscopic mesh repair compared

2020 SHTG Advice Statements

150. Recommendations for good practice in Ultrasound: Oocyte retrieval

instead of general anaesthesia; • decreased risk of intestinal trauma; • it can be easily learned, especially by operators trained in US; • decreased costs for patients; • and quick post-interventional recovery. However, in some patients, transabdominal ultrasound facilitated access when the ovaries were transposed or enlarged above the pelvic brim. Transabdominal-guided oocyte retrieval continues to be used at some centres for rare patients who have ovaries inaccessible by vaginal ultrasound (...) fertilisation IVM In vitro maturation LH Luteinizing hormone OHSS Ovarian hyperstimulation syndrome OPU Oocyte pick-up PACS Picture archiving and communication system PCOS Polycystic ovary syndrome PCSA Patient controlled sedation/analgesia PID Pelvic inflammatory disease RCOG Royal College of Obstetricians and Gynaecologists TVOR Transvaginal oocyte retrieval TV-US Transvaginal ultrasound US Ultrasound VA Verbal anaesthesia WG Working group WHO World Health Organisation Submitted for publication in HROpen

2019 European Society of Human Reproduction and Embryology

151. Guideline: Perineal care

Non-steroidal anti-inflammatory drugs PFMT Pelvic floor muscle training OASIS Obstetric anal sphincter injury or injuries OR Odds ratio OT Operating theatre PR Per rectum RCT Randomised controlled trial RR Relative risk USS Ultrasound scan Definition of terms Accoucheur Clinician directly assisting with birth of baby. Anal manometry A test which measures the pressures of the anal sphincter muscles. Crowning When the widest part of the fetal head (biparietal diameter) has passed through the pelvic (...) of a covering seal by cutting and appositioning the labia minora and/or the labia majora. May occur with or without excision of clitoris. 1 Obstetrician Local facilities may as required, differentiate the roles and responsibilities assigned in this document to an “obstetrician” according to their specific practitioner group requirements; for example to general practitioner obstetricians, specialist obstetricians, consultants, senior registrars and obstetric fellows. Pelvic floor muscle exercises Exercises

2020 Queensland Health

152. Guideline: Primary postpartum haemorrhage

, pulse, respirations, perfusion, colour, cerebral perfusion) o Hypovolemic shock disproportionate to the revealed blood loss o Feelings of pelvic or rectal pressure o Urinary retention · Act promptly to: o Resuscitate as required [refer to 3.3 Resuscitation] o Perform vaginal/rectal examination to determine site and extent o Consider transfer to operating theatre (OT) for clot evacuation, primary repair and/or tamponade of blood vessels · Refer to Queensland Clinical Guideline: Perineal care 38 Refer

2020 Queensland Health

153. Preterm labour and birth

blocker that relaxes smooth muscle 56 • Nifedipine is the tocolytic of choice 57,58 Contraindications* • If there are contraindications to Nifedipine, liaise with an Obstetrician to determine alternate tocolysis • Contraindications include 56 : o Maternal hypotension or cardiac disease o Previous adverse reaction to calcium channel blockers Dose* • Nifedipine 20 mg oral stat 56 • If contractions persist after 30 minutes repeat Nifedipine 20 mg oral 56 • If contractions persist after a further 30 (...) period • Low dull backache • The feeling that your baby is pushing down, called pelvic pressure • Belly cramps with or without diarrhoea • Change in the colour of your vaginal discharge • General feeling that something is not right • Bleeding from your vagina Call your health care provider immediately if: • Your baby stops moving • Your waters break • You have regular contractions • You have any bleeding from your vagina • You have a low dull backache. The pain may be felt in your lower back or move

2020 Queensland Health

154. Chronic pain syndromes

, and chronic headache syndromes. One in 3 patients over the age of 65 years is affected by chronic pain, often due to arthritis, osteoporosis with fractures and/or lumbar spinal stenosis. These conditions are treatable and should not be considered part of the normal ageing process. Untreated chronic pain in geriatric patients can result in depression, poor quality of life, and loss of independence. Some treatments, such as stretching exercises, relaxation techniques, antidepressants, and antiepileptic (...) . Chronic pain occurs due to persistent activation of neural pain pathways and muscle spasm. Chronic pain is discussed here as a syndrome and includes non-malignant conditions without localised or regional causes (such as abdominal pain or pelvic pain). [Figure caption and citation for the preceding image starts]: Acute pain occurs with trauma or illness, decreasing during healing and resolving within 3 months. Chronic pain persists after healing is completed, due to continued activation of neural pain

2018 BMJ Best Practice

155. Hysterectomy

. Leiomyomas: For symptomatic fibroids, hysterectomy providesa permanent solution to menorrhagia and the pressure symptoms related to an enlarged uterus (I-A). 2. Abnormal uterine bleeding: Endometrial lesions must be excluded and medical alternatives should be considered as a first line of therapy (III-B). 3. Endometriosis: Hysterectomy is often indicated in the presence of severe symptoms with failure of other treatments and when fertility is no longer desired (I-B). 4. Pelvic relaxation: A surgical (...) solution usually includes vaginal hysterectomy, but must include pelvic supporting procedures (II-B). 5. Pelvic pain: A multidisciplinary approach is recommended, as there is little evidence that hysterectomy will cure chronic pelvic pain. When the pain is confined to dysmenorrhea or associated with significant pelvic disease, hysterectomy may offer relief (II-C). Preinvasive Disease 1. Hysterectomy is usually indicated for endometrial hyperplasia with atypia (I-A). 2. Cervical intraepithelial

2018 Society of Obstetricians and Gynaecologists of Canada

157. Diazepam

Diazepam is a long-acting benzodiazepine used as a hypnotic, anxiolytic, anticonvulsant and muscle relaxant. Its actions are mediated (...) by enhancement of the activity of gamma-aminobutyric acid (GABA), a major inhibitory neurotransmitter in the brain. Data on the risk of congenital malformation following use of diazepam in pregnancy are highly confounded by the research techniques employed in the majority of the available studies. Evidence is therefore conflicting; with some older studies (...) of orally administered diazepam . The evaluation of the overall sedative effects of the diazepam and nitrous oxide together were better than the sedative effects of diazepam alone. Best Evidence (you may view more info by clicking 2013 20. Intra-vaginal diazepam for high-tone pelvic floor dysfunction: a randomized placebo-controlled trial. 23681047 2013 10 21 2014 06 23 2013 10 21 1433-3023 24 11 2013 Nov International urogynecology journal Int Urogynecol J Intra-vaginal diazepam for high-tone pelvic

2018 Trip Latest and Greatest

158. Tizanidine

Study to Assess the Pharmacokinetics, Safety and Tolerability, and Pharmacodynamics of Tizanidine at 4 Different Oral Dose Levels in Pediatric Subjects 2 2011 6. A double-blind comparative trial of new muscle relaxant, tizanidine (DS 103-282), and baclofen in the treatment of chronic spasticity in multiple sclerosis. 7016449 1981 08 20 1981 08 20 2014 11 20 0300-7995 7 6 1981 Current medical research and opinion Curr Med Res Opin A double-blind comparative trial of new muscle relaxant, tizanidine (...) (DS 103-282), and baclofen in the treatment of chronic spasticity in multiple sclerosis. 374-83 A double-blind trial with two parallel groups was carried out (...) to compare the antispastic effect and tolerability of a new muscle relaxant, tizanidine (DS 103-282), with those of baclofen in the treatment of spasticity due to multiple sclerosis. Twenty-one hospitalized patients with stable spasticity participated in the 6-week trial. Eleven received tizanidine and 10 baclofen in gradually

2018 Trip Latest and Greatest

159. Antenatal and Postnatal Analgesia Full Text available with Trip Pro

Antenatal analgesia Many women experience pain during pregnancy including headache, lower back pain and pelvic pain. Prior to giving advice regarding analgesic options pain should be investigated as appropriate to exclude serious causes. Non‐pharmacological interventions should be considered first line; for example, adequate rest, hot and cold compresses, massage, acupuncture, physiotherapy, relaxation and exercise. Some women find aromatherapy soothing and very useful as an aid to relaxation, so it can

2018 Royal College of Obstetricians and Gynaecologists

160. Peramivir (Alpivab) - Influenza, Human

study: renal tubular and pelvic mineralization, tubular dilatation, epithelial renal hyperplasia) and juvenile rats (drug-related minor renal cortical tubular changes), species that do not generate acyl glucuronide. The applicant has discussed this topic further, with a requirement for Assessment report EMA/CHMP/148367/2018 Page 23/108 updating sections 4.8 and 5.3 focus on the potential for renal toxicity and the possible clinical relevance. As renal necrosis has been seen in rabbits, reports

2018 European Medicines Agency - EPARs

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