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Postpartum Inpatient Management

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101. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

, and no angiographic or clinical predictors of acute worsening have been identified. Because of these findings, inpatient monitoring for an extended period is typically recommended as part of a conservative strategy for SCAD management. , , Conservative therapy may not be appropriate in high-risk patients with ongoing ischemia, left main artery dissection, or hemodynamic instability. In such cases, it is the consensus of the working group that urgent intervention with PCI or coronary artery bypass grafting (CABG (...) syndrome, myocardial infarction, and sudden death, particularly among young women and individuals with few conventional atherosclerotic risk factors. Patient-initiated research has spurred increased awareness of SCAD, and improved diagnostic capabilities and findings from large case series have led to changes in approaches to initial and long-term management and increasing evidence that SCAD not only is more common than previously believed but also must be evaluated and treated differently from

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2018 American Heart Association

102. A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology

, the pediatric needs of specimen management are also emphasized. There is intentional redundancy among the tables and sections, as many agents and assay choices overlap. The document is intended to serve as a guidance for physicians in choosing tests that will aid them to quickly and accurately diagnose infectious diseases in their patients. , , , , Contents Introduction and Executive Summary I. Bloodstream Infections and Infections of the Cardiovascular System II. Central Nervous System Infections III (...) interpretation. Clearly, microbes grow, multiply, and die very quickly. If any of those events occur during the preanalytical specimen management processes, the results of analysis will be compromised and interpretation could be misleading. Physicians and other advanced practice providers need confidence that the results provided by the microbiology laboratory are accurate, significant, and clinically relevant. Anything less is below the community standard of care for laboratories. To provide that level

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2018 Infectious Diseases Society of America

103. WHO recommendations on home-based records for maternal, newborn and child health

__________________________________________________________________________________ 27 Annex 1. Priority guideline questions and outcomes_______________________________________________________ 30 Annex 2. WHO staff and external experts involved in preparing this guideline _____________________________ 31 Annex 3. Summary of declarations of interest and their management ______________________________________ 33 Annex 4. Knowledge outcomes _________________________________________________________________________ 35 Annex 5. Effects of using home-based records on maternal, newborn (...) in their design and the information they document. They can be: maternal home-based records that include identifying information, antenatal notes, and care during childbirth and after birth; vaccination-only cards which record vaccination history; expanded vaccination-plus cards which provide a record of vaccinations and health care, growth and development and illness management for newborns and children. Another type of home- based record is child health books, which record vaccinations, health care, growth

2018 World Health Organisation Guidelines

104. CRACKCast E180 – Labor & Delivery

cord and deliver the infant rapidly. The high frequency of nuchal loops (one in five births) means that the emergency clinician should expect to encounter this problem. 16) List 4 DDx of PPH. Describe the management of each. The differential diagnosis of primary postpartum hemorrhage includes uterine atony, genital tract trauma, retained placental tissue, and coagulopathies, or the “four Ts”—tone, trauma, tissue, and thrombin. A few common measures for all these causes! (especially for the shocky (...) 17) What is the management of Uterine inversion and Uterine rupture? Uterine inversion: Usually occurs during stage 4 of labour And usually culminates in a passive early postpartum hemorrhage The patient will complain of sudden, severe abdominal pain. The abdominal examination reveals tenderness and an absence of the uterine corpus, which is potentially visualized at the cervical os or bulging from the introitus. Profuse bleeding with hemodynamic instability can also occur. Ultrasound may assist

2018 CandiEM

105. Induction of labour

all elements of standard practice and accepts that individual clinicians are responsible for: · Providing care within the context of locally available resources, expertise, and scope of practice · Supporting consumer rights and informed decision making in partnership with healthcare practitioners, including the right to decline intervention or ongoing management · Advising consumers of their choices in an environment that is culturally appropriate and which enables comfortable and confidential (...) · Individual circumstances · Proposed IOL methods · Options for pain management · Options if: o IOL unsuccessful o IOL declined o Expectant management preferred · Time for decision-making · Obtain informed consent · Document above Membrane sweep · Discuss antenatally · Offer prior to IOL Balloon catheter Dinoprostone Oxytocin Pre IOL assessment · Review history · Confirm gestation · Baseline observations · Abdominal palpation (presentation, attitude, position, lie, engagement) · CTG: consult obstetrician

2018 Queensland Health

106. Continuous glucose monitoring (CGM real-time) and flash glucose monitoring (FGM) as personal, standalone systems in patients with diabetes mellitus treated with insulin

), Norway Dedicated Reviewer(s) Agency for Health Quality and Assessment of Catalonia (AQUAS), Spain Healthcare Improvement Scotland (HIS), Scotland Regione Emilia-Romagna (RER), Italy Observer(s) Administracao Central do Sistema de Saude (ACSS), Portugal Agency for Health Technology Assessment and Tariff System (AOTMiT), Poland Project Manager Ludwig Boltzmann Institute for Health Technology Assessment (LBI-HTA), Austria Further contributors International Diabetes Federation European Region, Brussels (...) 1.4, 27 July 2018 EUnetHTA Joint Action 3 WP4 5 APPENDIX 1: METHODS AND DESCRIPTION OF THE EVIDENCE USED 152 DOCUMENTATION OF THE SEARCH STRATEGIES 152 DESCRIPTION OF THE EVIDENCE USED 162 Guidelines for diagnosis and management 162 Evidence tables of individual studies included for clinical effectiveness and safety 174 rtCGM MDII patients EVIDENCE TABLES 174 rtCGM MDII or CSII mixed patients EVIDENCE TABLES 278 rtCGM CSII patients EVIDENCE TABLES 323 rtCGM vs FGM EVIDENCE TABLES 340 FGM vs SMBG

2018 EUnetHTA

107. Guidelines for the Evaluation and Treatment of Perimenopausal Depression

recommendations on how to identify, characterize and treat clinical depression are lacking. To address this gap, an expert panel was convened to systematically review the published literature and develop guidelines on the evaluation and management of perimenopausal depression. The areas addressed included: 1) epidemiology; 2) clinical presentation; 3) therapeutic effects of antidepressants; 4) effects of hormone therapy; and 5) efficacy of other therapies (eg, psychotherapy, exercise, and natural health (...) -related mood symptoms or ‘windows of vulnerability’ for reproductive-related depression across the female lifecycle has gained attention in recent decades. 1,2 Epidemiologic findings, animal data and clinical observations have shed some light into plausible mechanistic hypotheses on why some but not all women may be particularly sensitive to changes in the hormonal milieu experienced premenstrually, during the postpartum period or during the menopause transition. 3-9 The notion of a menopause

2018 The North American Menopause Society

108. Chronic Pelvic Pain

guidelines on chronic pelvic pain. Eur Urol, 2010. 57: 35. 5. Engeler, D.S., et al. The 2013 EAU guidelines on chronic pelvic pain: is management of chronic pelvic pain a habit, a philosophy, or a science? 10 years of development. Eur Urol, 2013. 64: 431. 6. McMahon, S.B., et al. Visceral pain. Br J Anaesth, 1995. 75: 132. 7. Shoskes, D.A., et al. Clinical phenotyping of patients with chronic prostatitis/chronic pelvic pain syndrome and correlation with symptom severity. Urology, 2009. 73: 538. 8. Magri (...) prostatitis/chronic pelvic pain syndrome: A MAPP: Research Network Neuroimaging Study. Neuroimage Clin, 2015. 8: 493. 66. Abrams, P., et al. A new classification is needed for pelvic pain syndromes--are existing terminologies of spurious diagnostic authority bad for patients? J Urol, 2006. 175: 1989. 67. Baranowski, A., et al., Urogenital Pain in Clinical Practice. 2008, New York. 68. Baranowski, A.P., et al. Urogenital pain--time to accept a new approach to phenotyping and, as a consequence, management

2018 European Association of Urology

109. Required hospital capacity in 2025 and criteria for rationalisation of complex cancer surgery, radiotherapy and maternity services

DEVELOPED FOR THE CURRENT STUDY 59 1.5.1 Defining scope and concepts 61 1.5.2 Rationale for statistical trend analysis 68 1.5.3 Statistical trend model 70 1.5.4 Projection outcomes 78 1.6 INTRODUCTION RESULTS 80 1.7 BASELINE FORECAST RESULTS OF THE PROJECTION MODEL 81 1.7.1 Future need for hospital inpatient care 81 2 Required hospital capacity and criteria for rationalisation KCE Report 289 1.7.2 Future need for hospital day care 104 1.7.3 Capacity requirements for isolated categorical hospitals (...) of hospital inpatient stays 50 Figure 5 – Projected and observed number of nursing days 51 Figure 6 – Absolute difference in ALOS (projections – observations) in days, calculated by APR-DRG 54 Figure 7 – Absolute difference in ALOS (projections – observations) in days, calculated by APR-DRG, for APR-DRGs with trend analysis 55 Figure 8 – Absolute difference in ALOS (projections – observations) in days, calculated by APR-DRG, for APR-DRGs without trend analysis 56 Figure 9 – Relative difference in ALOS

2017 Belgian Health Care Knowledge Centre

110. Psychosocial, pharmacological, and legal interventions for improving the psychosocial outcomes of children with substance-misusing parents

of interventions on child psychosocial outcomes. Examples of eligible interventions are briefly described below (not exhaustive). Based on existing literature in the area, we anticipate that the majority of the included studies will utilise a treatment-as-usual comparison condition (e.g., methadone maintenance, case-management without the intervention under consideration). Interventions will be included irrespective of whether it is initiated during the prenatal or postnatal period (...) and there will be no restrictions on the intervention setting or treatment format (e.g., inpatient, outpatient, community settings, family home, one-on-one or group settings). In addition, studies will be included if the intervention focuses on the misuse of alcohol, illicit drugs, and/or prescription drugs. Home-Visiting Home-visiting interventions are characterised by regular home visits by health practitioners or paraprofessionals and aim to improve the psychosocial and health outcomes for mothers and infants (Segal et al

2016 Campbell Collaboration

111. National minimum retesting intervals in pathology: A final report detailing consensus recommendations for minimum retesting intervals for use in pathology

, Mestman J, Negro R et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011;21:1081–1125. CEff 161215 31 V7 Final Ref Clinical situation Recommendation Source B-P13 Pregnant women – monitoring thyroxine replacement therapy Both TSH and fT4 (and fT3 if TSH below detection limit) should be measured to assess thyroid status and monitor thyroxine therapy in pregnancy The thyroid status of hypothyroid patients (...) pregnancy – with serum fT4 and TSH every 4 weeks until 16–20 weeks gestation and at least once between 26–32 weeks) Stagnaro-Greenet A, Abalovich M, Alexander E, Azizi F, Mestman J, Negro R,et al. Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and postpartum. Thyroid 2011; 21:1081–1125. B-P15 Women with diabetes who are planning to become pregnant Monthly measurement of HbA 1C NICE CG. Diabetes in pregnancy: Management of diabetes

2016 Royal College of Pathologists

112. Epilepsy in Pregnancy

to WWE to prevent postpartum haemorrhage. What is the optimal timing and mode of delivery for WWE based on seizure control? WWE should be reassured that most will have an uncomplicated labour and delivery. The diagnosis of epilepsy per se is not an indication for planned caesarean section or induction of labour. How should women with non-epileptic attack disorder be counselled in pregnancy and how should their non-epileptic seizures be managed? Inappropriate medical intervention, including AED (...) for a significant period may be offered a water birth after discussion with their epilepsy specialist. Postpartum management What is the risk of seizure deterioration postpartum and how can this be minimised? WWE and their caregivers need to be aware that although the overall chance of seizures during and immediately after delivery is low, it is relatively higher than during pregnancy. WWE should be advised to continue their AEDs postnatally. Mothers should be well supported in the postnatal period to ensure

2016 Royal College of Obstetricians and Gynaecologists

113. Alcohol: Adult Unhealthy Drinking

disorder, regardless of AUDIT-C score. Table 4b. AUDIT-C score interpretation for pregnant women Score Interpretation Management Follow-up < 3 points Potential risk to fetus. Brief intervention (see p. 10). Rescreen every trimester and at the 6-week postpartum visit. 3–12 points High risk. The higher the score, the greater the potential for harm to the fetus. Assessment for alcohol use disorder using DSM-5 criteria (see Table 6, p. 12), comorbidities, and readiness to change. If alcohol use disorder (...) and Behavioral Health can assist in assessments/engagement. • Ambulatory treatment/management of alcohol withdrawal. • Medications for managing alcohol craving and alcohol use disorder. In Behavioral Health • Mental health care: individual and group psychotherapy, psychiatric care and psychological testing. • Chemical dependency care (through a contracted network of providers): assessment and evaluation, chemical dependency counseling, and residential treatment. • Inpatient detoxification (through

2016 Kaiser Permanente Clinical Guidelines

114. Expert opinion on neuraminidase inhibitors for the prevention and treatment of influenza - review of recent systematic reviews and meta-analyses

of inpatients 14 Post-exposure prophylaxis 15 Pre-exposure and seasonal prophylaxis 17 Limitations in evidence base 18 Remaining gaps in the current knowledge base 20 Efficacy and effectiveness against severe outcomes in previously healthy individuals 20 Efficacy and effectiveness in risk groups 20 Efficacy and effectiveness against emerging zoonotic and pandemic influenza strains 20 Cost-effectiveness in primary care and hospital use 20 Options for recommendations in EU/EEA Member States 21 Recommendations (...) not confirmed in laboratory. Intention to treat – infected Analysis of only laboratory-confirmed, influenza-infected participants of influenza trials. Isolation The separation of infected persons to prevent transmission to susceptible ones. Isolation refers to separation of ill persons; quarantine refers to separation of potentially exposed but well persons. Long-term care facility Healthcare facility for inpatients that require a long-term stay. Morbidity Disease; any departure, subjective or objective

2017 European Centre for Disease Prevention and Control - Expert Opinion

115. Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals ? protocol version 5.3

them. ? Private, for profit: Hospitals that are legal entities set up for the purpose of producing goods and services and are capable of generating a profit or other financial gain for their owners. ? Other or unknown: Hospital ownership cannot be categorised as one of one of the above, or hospital ownership is unknown. Note: If applicable, prioritise ‘for profit’ over ownership of the building, e.g. if a hospital building is state-owned but the management is private (for profit), select ‘private (...) hygiene, not only the compliant observations. Number of blood cultures per year. Number of inpatient blood culture sets received and incubated by the microbiological laboratory for the current hospital over the period of one year. Provide data for the previous year or report the most recent available data (specify year data in a separate variable). If the number of blood culture sets is not available, estimate by dividing the [total number of blood culture bottles processed] by the [total number

2016 European Centre for Disease Prevention and Control - Technical Guidance

116. Early pregnancy loss

clinicians are responsible for: • Providing care within the context of locally available resources, expertise, and scope of practice • Supporting consumer rights and informed decision making in partnership with healthcare practitioners, including the right to decline intervention or ongoing management • Advising consumers of their choices in an environment that is culturally appropriate and which enables comfortable and confidential discussion. This includes the use of interpreter services where (...) management • EPAS or equivalent • Serial ß-hCG as per methotrexate protocol • USS in one week then as clinically indicated o If fetal heart present, refer to MFM • Avoid conception for 4 months due to potential teratogenicity Medical Indications • Haemodynamically unstable • Signs of rupture • Any ß-hCG level • Persistent excessive bleeding • Heterotopic pregnancy • Contraindications to medical or expectant management Procedure • Laparoscopy method of choice • Laparotomy if: o Haemodynamically unstable o

2017 Queensland Health

117. Normal birth

of standard practice and accepts that individual clinicians are responsible for: · Providing care within the context of locally available resources, expertise, and scope of practice · Supporting consumer rights and informed decision making, including the right to decline intervention or ongoing management · Advising consumers of their choices in an environment that is culturally appropriate and which enables comfortable and confidential discussion. This includes the use of interpreter services where (...) to contractions · Review birth plan and note preferences · Discuss advantages/disadvantages of options Repeat contacts · Review entire contact history and clinical circumstances with each contact · Refer/consult/request woman to present for assessment as required Discuss, consult, refer, manage as per professional # and Queensland guidelines Risk factors? Not yet in labour Antenatal assessment Triage stage of labour Second stage Refer to flow chart: Normal Birth–Second stage First stage Refer to flow chart

2017 Queensland Health

118. Postplacental insertion of intrauterine devices

is also needed on the incidence and management of malpositioned IUDs after postplacental placement. Studies on antepartum and postpartum contra- ceptive counseling and decision making, particularly to ensure reproductive autonomy and to avoid coercion, is necessary. Finally, policy research is needed to address barriers to IUD insertion, including cost and insurance barriers as well as institutional barriers at the hospital and state level. Sources Authors used the following search terms in the Ovid (...) . Whitaker, B.A. Chen / Contraception 97 (2018) 2– Reversible-Contraception/Immediate-Postpartum-LARC-Medicaid- Reimbursement. [3] WhitemanMK,CoxS,TepperNK,CurtisKM,JamiesonDJ,Penman- Aguilar A, et al. Postpartum intrauterine device insertion and postpartum tubal sterilization in the United States. Am J Obstet Gynecol 2012;206(2):127 e1–7 [Evidence Grade: II-2]. [4] Moniz MH, Chang T, Heisler M, Admon L, Gebremariam A, Dalton VK, et al. Inpatient

2017 Society of Family Planning

119. Heart Disease and Stroke Statistics 2017 Update: A Report From the American Heart Association

of adults with congenital heart disease adds to management complexity and emphasizes the need for coordinated care by adult congenital cardiovascular specialists. Disorders of Heart Rhythm (Chapter 17) • The frequency and adverse consequences of clini- cally unrecognized and asymptomatic atrial fibrilla- tion (AF) are increasingly reported, particularly in older adults. For instance, in a community-based study in Sweden, >7000 people 75 to 76 years of age were monitored intermittently; 3% had newly (...) amputation, as well as shorter hospital length of stay. • Endovascular repair may yield better outcomes in the first few years, but after 8 years of follow-up in one study, the open repair group and the endovas- cular repair group demonstrated similar survival. Of note, individuals in the endovascular repair group had a higher rate of eventual aneurysm rupture (5.4%) than patients who underwent open repair (1.4%). Quality of Care (Chapter 25) • Overall, inpatient quality of care for patients with acute

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2017 American Heart Association

120. Hospital Disaster Preparedness for Obstetricians and Facilities Providing Maternity Care

antepartum, intrapartum, postpartum and neonatal care) warrant special consideration in the event of a disaster. Pregnancy increases the risks of untoward outcomes from various infectious diseases. Trauma during pregnancy presents anatomic and physiologic considerations that often can require increased use of resources such as higher rates of cesarean delivery. Recent evidence suggests that floods and human-influenced environmental disasters increase the risks of spontaneous miscarriages, preterm births (...) of maternal care designations and should have integrated regional referral networks based on these levels. Hospitals with maternity services should develop specific strategies for stabilizing and transporting obstetric patients, managing surge capacity and the need for consultative services, sheltering-in-place, and incorporating regional facilities that do not provide maternity services. Hospitals providing care for maternal and neonatal patients should communicate using a common terminology, such as OB

2017 American College of Obstetricians and Gynecologists

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