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141. Imaging Program Guidelines: Pediatric Imaging

or recurrent headache, when at least one of the following is present: ? Change in quality (pattern or intensity) of a previously stable headache ? Headache persisting for a period of up to 6 months duration and not responsive to medical treatment, and no prior imaging has been done to evaluate the headache ? Headache associated with at least one of the following: ? Abnormal reflexes ? Altered mental status ? Cranial nerve deficit ? Gait/motor dysfunction ? Nystagmus ? Seizure ? Sensory deficit ? Sign (...) , and no prior imaging has been done to evaluate the headache ? Headache associated with at least one of the following: ? Abnormal reflexes ? Altered mental status ? Cranial nerve deficit ? Gait/motor dysfunction ? Nystagmus ? Seizure ? Sensory deficit ? Sign of increased intracranial pressure (increased head circumference, vomiting, papilledema, symptoms that worsen with valsalva) Note: Imaging is not generally indicated for typical presentations of migraine. MRI of the Head/Brain – Pediatrics | Copyright ©

2017 AIM Specialty Health

145. Vision in Children Ages 6 Months to 5 Years: Screening

in primary care settings ( ). Visual acuity tests screen for visual deficits associated with amblyopia and refractive error. Ocular alignment tests screen for strabismus. Steroacuity tests assess depth perception. , For children younger than 3 years, screening may include the fixation and follow test (for visual acuity), the red reflex test (for media opacity), and the corneal light reflex test (for strabismus). , Instrument-based vision screening (ie, with autorefractors and photoscreeners) may be used (...) in very young children, including infants. Autorefractors are computerized instruments that detect refractive errors; photoscreeners detect amblyopia risk factors (ocular alignment and media opacity) and refractive errors. , Vision screening in children older than 3 years may include the red reflex test, the cover-uncover test (for strabismus), the corneal light reflex test, visual acuity tests (eg, Snellen, Lea Symbols [Lea-Test], and HOTV [Precision Vision] charts), autorefractors and photoscreeners

2017 U.S. Preventive Services Task Force

146. Diagnosis and Treatment of Low Back Pain

. Recommendations # Recommendation Strength* Category† A. Diagnostic Approach 1. For patients with low back pain, we recommend that clinicians conduct a history and physical examination, that should include identifying and evaluating neurologic deficits (e.g., radiculopathy, neurogenic claudication), red flag symptoms associated with serious underlying pathology (e.g., malignancy, fracture, infection), and psychosocial factors. Strong for Reviewed, Amended 2. For patients with low back pain, we suggest (...) are serious or progressive or when red flag symptoms are present. Strong for Reviewed, Amended 5. For patients with low back pain greater than one month who have not improved or responded to initial treatments, there is inconclusive evidence to recommend for or against any diagnostic imaging. Not applicable Reviewed, New-added B. Education and Self-care 6. For patients with chronic low back pain, we recommend providing evidence- based information with regard to their expected course, advising patients

2017 VA/DoD Clinical Practice Guidelines

148. Eye Care in the Intensive Care Unit

of the vulnerable patient 4 3 Identifying disease of the eye 6 Exposure keratopathy and corneal abrasion 6 Chemosis 8 Microbial infections 8 4 Rare eye conditions in ICU 10 Red eye in a septic patient: possible endogenous endophthalmitis 10 Other problems 11 5 Delivering treatment to the eye when it is prescribed 11 Red eye in ICU patient 12 6. Systemic fungal infection and the eye for intensivists 14 7. Tips for ophthalmologists seeing patients in ICU 14 8. Authors 16 9. References 17 2017/PROF/350 3 1 Summary (...) ) or treatments (e.g. the drying effects of gas flows from CPAP or oxygen masks). In particular muscle relaxants reduce the tonic contraction of the orbicularis muscle around the eye which normally keeps the lids closed, and sedation reduces blink rate and impairs (and can eliminate) the blink reflex. Whatever the cause, those unable to close the eye for themselves, or in whom blinking rates are substantially reduced, are at increased risk of damage to the front of the eye, and this risk is higher in those

2017 Intensive Care Society

149. Suspected cancer: recognition and referral

on the lip or in the oral cavity or or a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia. [new 2015] [new 2015] 1.8.4 Consider a suspected cancer pathway referral by the dentist (for an appointment within 2 weeks) for oral cancer in people when assessed by a dentist as having either: a lump on the lip or in the oral cavity consistent with oral cancer or or Suspected cancer: recognition and referral (NG12) © NICE 2019. All rights reserved. Subject (...) to Notice of rights ( conditions#notice-of-rights). Page 24 of 79a red or red and white patch in the oral cavity consistent with erythroplakia or erythroleukoplakia. [new 2015] [new 2015] Th Thyroid cancer yroid cancer 1.8.5 Consider a suspected cancer pathway referral (for an appointment within 2 weeks) for thyroid cancer in people with an unexplained thyroid lump. [new [new 2015] 2015] 1.9 Brain and central nervous system cancers Adults Adults 1.9.1 Consider an urgent

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

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

referral. Implementation Tools for application A documentation proforma is included along with some practical examples of outcome measures. Plans for review Review is planned in 5 years.2 Spasticity – what is it and why does it matter? 2.1 Definition and pathophysiology The term ‘spasticity’ was originally defined by Lance in 1980 (Lance 1980) as a velocity-dependent increase in muscle tone resulting from hyper-excitability of the tonic stretch reflex in people with upper motor neurone (UMN) syndrome

2018 British Society of Rehabilitation Medicine

151. Complex regional pain syndrome in adults. UK guidelines for diagnosis, referral and management in primary and secondary care 2018 (2nd edition)

for use throughout the UK. Systematic review methodology for the 2018 guidelines See Appendix 2 for the detailed methodology used in the 2012 guideline and 2018 revision. A previous systematic review considered the treatment of complex regional pain syndrome in adults, and included papers published from July 2000 to February 2012. 3 This 2013 Cossins et al review built on a previous review (Forouzanfar et al 2002, 4 which considered the treatment and prevention of reflex sympathetic dystrophy and CRPS (...) trauma, atherosclerosis in older people or thrombangiitis obliterans (Burger’s disease)) ? Raynaud’s disease ? lymphatic or venous obstruction ? Gardner–Diamond syndrome (see the list of differential diagnoses in the Rheumatology, neurology, neurosurgery and SEM section) ? brachial neuritis or plexitis (Parsonage–Turner syndrome or neuralgic amyotrophy) ? erythromelalgia (may include all limbs) ? self-harm Table 2 Earlier names for CRPS Algodystrophy Causalgia Algoneurodystrophy Reflex sympathetic

2018 British Society of Rehabilitation Medicine

152. CCS and CPCA Position Statement on the Approach to Syncope in the Pediatric Patient

, 2016 Accepted: September 28, 2016 ; Received: September 13, 2016 ; | ---- Figure 1 Clinical pathway for pediatric syncope patients. ECG, electrocardiogram; VVS, vasovagal syncope. ---- | ---- Figure 2 History and physical examination. ECG, electrocardiogram; LOC, loss of consciousness; LQTS, long QT syndrome. ---- | ---- Figure 3 ECG findings in syncope. “Red light” might suggest malignant arrhythmia in certain contexts; “yellow light” might require a nonurgent evaluation in cardiology; “green (...) of the history. Syncope occurring midexertion suggests a cardiac etiology. A family history, which includes sudden death in the young or from unknown causes or causes that might be suspected to be other than natural can be a red flag. The electrocardiogram is the most frequently ordered test, but the yield is low and the test is not cost-effective when applied broadly to a population of patients with syncope. We recommend an electrocardiogram when the history is not suggestive of vasovagal syncope

2016 Canadian Cardiovascular Society

153. Don?t Tie Me Down! Do Neckties Spread Infection?

provide no objective clinical utility in patient care or in protection of the physician. Unlike the stethoscope, penlight, or reflex hammer, they are useless for eliciting clinical findings in a patient. They are solely an accessory, with no practical use. In fact, a tie provides a convenient garrote around the neck of physician for the particularly disturbed patient. There is a paucity of data in the United States regarding patient preferences as to whether or not physicians should wear a tie (...) Knuckleballers, Active Bowtie Wearers, Major League Baseball NYU-Bellevue House Staff Dickey, Toronto Blue Jays Rabi Upadhyay, PGY-2 Stephen Wright, Boston Red Sox Matt McNeill, PGY-3 Whenever one retires (Tim Wakefield) or graduates from the program (David Levine), another one comes along to take his place. And so the fragile tradition lives on. The bowtie-wearer’s attitude has always been: “I know I’m dressed like Winston Churchill. Deal with it.” That can now be amended to: “I know I’m dressed like Pee

2016 Clinical Correlations

154. Preterm labour and birth

to hypermagnesaemia • Common (> 1%): nausea and vomiting, flushing • Infrequent (0.1–1%): headache, dizziness Baseline observations • Vital signs: BP, pulse, respiratory rate • Oxygen saturation (SpO 2 ) • Patellar reflex • Abdominal palpation • Monitor contractions for 10 minutes • FHR/CTG Monitoring during loading dose • BP, pulse, and RR every 5 minutes (for minimum 20 minutes) until stable • SpO 2 continuously • Contractions for 10 mins every 30 mins • Continuous CTG if greater than or equal to 24 weeks (...) gestation o Interpret CTG relevant to gestational age if less than 28 weeks o Document reason if CTG not able to be performed • Auscultate FHR every15–30 minutes if less than 24 weeks gestation • Observe for side effects • Check deep tendon reflexes (patellar or, if epidural insitu, biceps) after completion of loading dose o Notify obstetrician if absent and do not commence maintenance dose Monitoring during maintenance dose • BP, pulse, respiratory rate, SpO 2 every 30 minutes • Temperature every 2

2016 Queensland Health

155. Perinatal substance use: maternal

cry, excessive sucking and agitation 26,29 , poor clarity of infant cues during feeding, delayed information processing, general cognitive delay 14 , lower arousal, poor quality of movement, poor self- regulation, non-optimal reflexes 15 • Intraventricular haemorrhage 14 Lactation • Cocaine and metabolites have been detected in baby’s urine for up to 60 hours following breastfeed • Discourage use when breastfeeding: o After individual dose, discontinue breastfeeding for twenty four hours o (...) and withdrawal • Outpatient support including follow up and ongoing support 2 • High levels may result in: o Miscarriage o Stillbirth o Preterm birth 5,53 Lactation • Alcohol enters breast milk and persists for several hours • Adversely affects lactation, infant behaviour (feeding and arousal) and psychomotor development of the breastfed baby 48,56 • More than two standard drinks per day linked to: o Decreased lactation-reduced milk ejection reflex, milk production and milk consumption by baby o Earlier

2016 Queensland Health

156. Hypertensive disorders of pregnancy

stable then every 30 minutes • Respiratory rate and patellar reflexes hourly • Temperature 2nd hourly • Continuous CTG monitoring if > 24 weeks (interpret with caution if : greater than, 10 years • Nulliparity • Pre-existing medical conditions o APLS o Pre-existing diabetes o Renal disease o Chronic hypertension o Chronic autoimmune disease • Age > 40 years • BMI > 35 kg/m 2 • Multiple pregnancy • Elevated BP at booking • Gestational trophoblastic disease • Fetal triploidy Maternal investigations (...) creatinine greater than or equal to 90 micromol/L or • Oliguria Haematological • Thrombocytopenia (platelets less than 100 x 10 9 /L) • Haemolysis: schistocytes or red cell fragments on blood film, raised bilirubin, raised lactate dehydrogenase (LDH), decreased haptoglobin • Disseminated intravascular coagulation (DIC) Liver • Raised transaminases • Severe epigastric or right upper quadrant pain Neurological • Severe headache • Persistent visual disturbances (photopsia, scotomata, cortical blindness

2016 Queensland Health

157. Otitis Media with Effusion (OME)

AOM, most often between the ages of 6 months and 4 years. In the first year of life, >50% of children will experience OME, increasing to >60% by age 2 years. When children aged 5 to 6 years in primary school are screened for OME, about 1 in 8 are found to have fluid in one or both ears. The prevalence of OME in children with Down syndrome or cleft palate, however, is much higher, ranging from 60% to 85%. , Figure 3. Position of the eustachian tube (red) as it connects the middle ear space

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2016 American Academy of Otolaryngology - Head and Neck Surgery

158. Management of Concussion-mild Traumatic Brain Injury (mTBI)

and generally accepted as current best practice. The Work Group recognized primary care providers should consider, as appropriate during each encounter, the following physical findings, signs and symptoms (“red flags”) that may indicate a neurologic condition that requires urgent specialty consultation (e.g., consultation with neurology, neuro-surgical): • Progressively declining level of consciousness • Progressively declining neurological exam • Pupillary asymmetry • Seizures • Repeated vomiting

2016 VA/DoD Clinical Practice Guidelines

159. Diagnosis of Acute Gout: A Clinical Practice Guideline from the American College of Physicians

, redness observed over joints, painful or swollen first metatarsophalangeal joint, proven or suspected tophi, and the comorbid risk factor of hyperuricemia. Details on each algorithm are provided in the accompanying evidence review ( ). DECT Low-quality evidence from 3 observational studies ( ) showed that DECT had a sensitivity of 85% to 100% and specificity of 83% to 92% for predicting gout compared with assessment of synovial fluid MSU crystals or clinical algorithms. Ultrasonography Low-quality (...) gout is more frequent than generally admitted. As a consequence, this facinating paper is really usefull, especially fot the GP. A 60 year-long clinical experience allows me to state that in healthy individual, the nail pressure upon the helix brings about the Gastric Aspecific Reflex (in the stomach both fundus and body dilate, while antral-pyloric region contracts) after a Latency Time of 10 seconds precisely. On the contrary, in individual involved by gout constitution, this Latency Time lowers

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2016 American College of Physicians

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