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Self Skin Exam

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181. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease

to diagnose CLI by using TBI with waveforms, transcutaneous oxygen pressure (TcPO 2 ), or skin perfusion pressure (SPP). 112–116 See Online Data Supplement 5. The toe pressure and TBI may be discordant with the ABI 0.90 to 1.40 in some patients with diabetes mellitus and a nonhealing wound (Figure 2). 115,116 A TBI =0.70 is considered diagnostic of PAD. 101,104,105 Doppler or plethysmographic waveforms taken at the toe supplement the toe pressure and TBI measurement and may be severely dampened (...) to activity level or present at rest Modified from Norgren L et al. 35 PAD indicates peripheral artery disease. Table 7. Alternative Diagnoses for Nonhealing Wounds With Normal Physiological Testing (Not PAD-Related) Condition Location Characteristics and Causes Venous ulcer Distal leg, especially above medial mellolus Develops in regions of skin changes due to chronic venous disease and local venous hypertension Typically wet (ie, wound drainage) rather than dry lesion Distal small arterial occlusion

2017 American Heart Association

182. Ankle and Foot Surgical Guideline

of employment is defined in Washington State statute as “a sudden and tangible happening, of a traumatic nature, producing an immediate or prompt result, and occurring from without, and such physical conditions as result therefrom.” d A legal test for whether the department or self-insured employer is liable for the care that a worker receives for an injury is whether the workplace injury is “a proximate cause” of the accepted condition being treated. An injury may be a proximate cause of a condition being (...) . A thorough occupational and non-occupational exposure history is essential for determining whether a condition is work-related and whether it is due to an acute or chronic exposure. For chronic exposures, it is important to document where, when, and for how long they occurred, as they could span multiple employers who would then share liability for an occupational disease. Providers should submit the Occupational Disease and Employment History form to the department or self-insurer as soon as possible

2017 Washington State Department of Labor and Industries

183. Early pregnancy loss

, Brisbane Qld 4001, email ip_officer@health.qld.gov.au, phone (07) 3234 1479. Refer to online version, destroy printed copies after use Page 2 of 39 Queensland Clinical Guideline: Early pregnancy loss Flow Chart: Assessment of suspected early pregnancy loss Haemodynamically stable? Assessment • History • Confirm pregnancy • Physical Exam • Serial ß-hCG • USS (TVS preferred) • FBC and blood group • MSU as indicated • STI screen as indicated Ectopic pregnancy Refer to flowchart: Ectopic pregnancy Confirm (...) to MFM for follow-up— direct injection of potassium chloride may be indicated Advice for women • Refer to Section 1.2 for information/advice requirements • Provide information about usual cytotoxic precautions post treatment with methotrexate • Avoid: o Sun exposure (to limit skin inflammation) o Foods and vitamins containing folate/folic acid • Advise: o Pelvic examination and sexual intercourse carry risk of rupture in acute phase of resolution o Common side effects of methotrexate include: nausea

2017 Queensland Health

184. Screening for Atrial Fibrillation: 2017 European Heart Rhythm Association (EHRA) Consensus Document

quality of life. Its natural evolution usually progresses from short self-terminating rare episodes with little or no symptoms to longer, more frequent, more prolonged and usually clinically detectable ones, even if individ- ual variations can also be observed. 8 An earlier detection of AF could thus allow an earlier adequate management to avoid later complications. 9,10 Screening for AF is not yet recommended by all scientific AF guide- lines, even in specific ‘at risk’ populations. The present (...) , with or without known AF cases in the screened population), which limits the comparability of the results. Four of these studies relied on self-reporting to ascertain AF history, rather than conducting a search of individual patient records. 82,88,90,92 In two others, it was unclear whether or not patient records were searched. 76,86 In general the highest yields were observed in the studies with the highest expected baseline prevalence of AF, as indicated by the age range and/or number of AF risk factors

2017 Heart Rhythm Society

185. 2017 AHA/ACC Key Data Elements and Definitions for Ambulatory Electronic Health Records in Pediatric and Congenital Cardiology: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards

data elements and definitions for electrophysiological studies and procedures: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (ACC/AHA/HRS Writing Committee to Develop Data Standards on Electrophysiology). Circulation . 2006 ; 114 :2534–70. Chandrasekar A . Auscultation of lungs-method of exam . Loyola University Medical Education Network . Available at: . Accessed April 2, 2016. Fang J, O’Gara P . The history and physical examination

2017 American Heart Association

186. Breast Cancer Screening

to discuss breast health. BREAST AWARENESS Encourage women to report changes in their breasts; in particular, nipple discharge, rash on nipples, inversion, dimpling or new mass in the breast or axilla. BREAST SELF-EXAMINATION (BSE) BSE is not recommended as a screening method. OTHER TECHNOLOGY Magnetic Resonance Imaging: MRI should not be used for screening the average risk population. MRI may be used in specific circumstances as determined by a radiologist. Ultrasound: Ultrasound should not be used (...) increase the likelihood of engaging women to make informed decisions about breast cancer screening. PRACTICE POINTS Initiate discussion about screening mammography with women of the appropriate age Use outreach, opportunistic screening and checklists to increase the likelihood of engaging women to make informed decisions about screening BACKGROUND RISK Breast cancer is the most common form of cancer in women in Alberta other than non-melanoma skin cancer. 5 Approximately 1 in 8 women is expected

2016 Toward Optimized Practice

187. Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer

Penis Retroperitoneum Cytology Online Learning For Medical Students Exams/LLL/Certifications Exam Prep Research Research Funding AUA Funding Research Education & Events Online Research Education Courses Research Resources Biorepositories and Other Resources Research Publications Research Career Opportunities Advocacy Scholar & Fellowship Programs Comment Letters & Resources International International Opportunities Annual Meeting Membership Collaborations Academic Exchanges Giving Back Practice (...) a strength rating of A (high), B (moderate) or C (low) for support of Strong, Moderate, or Conditional Recommendations. In the absence of sufficient evidence, additional information is provided as Clinical Principles and Expert Opinions. Guideline Statements Initial Patient Evaluation and Counseling Prior to treatment consideration, a full history and physical exam should be performed, including an exam under anesthesia, at the time of transurethral resection of bladder tumor for a suspected invasive

2017 American Urological Association

188. Urotrauma

Urotrauma Urotrauma Guideline - American Urological Association advertisement Toggle navigation About Us About the AUA Membership AUA Governance Industry Relations Education AUAUniversity Education Products & Resources Normal Histology and Important Histo-anatomic Structures Urinary Bladder Prostate Kidney Renovascular Diseases Andrenal Gland Testis Paratesticular Tumors Penis Retroperitoneum Cytology Online Learning For Medical Students Exams/LLL/Certifications Exam Prep Research Research (...) and treatment of urotrauma. Guideline Statements Renal Trauma 1. Clinicians should perform diagnostic imaging with intravenous (IV) contrast enhanced computed tomography (CT) in stable blunt trauma patients with gross hematuria or microscopic hematuria and systolic blood pressure < 90mmHG. (Standard; Evidence Strength: Grade B) 2. Clinicians should perform diagnostic imaging with IV contrast enhanced CT in stable trauma patients with mechanism of injury or physical exam findings concerning for renal injury

2017 American Urological Association

189. Management of Type 2 Diabetes Mellitus

and physical activity [IID]. • Check weight, calculate BMI [IID]. • Feet should be inspected at each visit if neuropathy present. Otherwise visual foot exam and neuropathy evaluation annually [IA]. • Smoking cessation counseling provided for patients with tobacco dependence [IB]. • Review and reinforce key self- management goals (See Table 3) [IA]. • Dilated retinal examination by eye care specialist: if good blood sugar and blood pressure control and previous eye exam was normal, every 2 years (...) % or greater, confirmed by second test, is diagnostic of diabetes. Alternatively, diabetes can be diagnosed by two separate fasting glucoses = 126 mg/dL; with symptoms, a glucose = 200 mg/dL confirmed on a separate day by a fasting glucose = 126 mg/dL; or 2 -hour postload glucose = 200 mg/dl during an oral glucose tolerance test [B]. (See Table 1. See Table 2 for differential diagnosis.) Treatment. Essential components of the treatment for diabetes include diabetes self-management education and support

2017 University of Michigan Health System

190. Management of Osteoarthritis of the Hip

this document regarding risk stratification. EMOTIONAL AND PHYSICAL IMPACT Older adults with self-reported osteoarthritis of the hip visit their physicians more frequently and experience greater functional limitations than others in the same age group. Pre-operatively patients who have moderate to severe osteoarthritis of the hip requiring surgery experience: 1. Inability to return to prior living circumstances 2. Need for increased level of care and supervision 3. Decreased quality of life 4. Decreased

2017 American Academy of Orthopaedic Surgeons

191. Management of Diabetes Mellitus in Primary Care

shared decision-making, consider all treatment options and develop a treatment plan based on the balance of risks, benefits, and patient-specific goals, values, and preferences. B. Guide patients on the self-management of their DM and glucose monitoring, including benefits and risks, and their expectations. C. Educate and involve family caregivers and co-workers in accordance with patient preferences regarding core knowledge of DM management. D. Within and between VA and DoD healthcare systems, work (...) such as physical, sensory, or learning disabilities. Family involvement should be considered if appropriate, especially in elderly patients.[24] When properly executed, SDM [25,26] may decrease patient anxiety, increase trust in clinicians,[27] and improve treatment adherence.[28] Improved patient-clinician communication can be used to convey openness to discuss any future concerns. As part of the patient-centered care approach, clinicians should review the outcomes of previous self- change efforts, past

2017 VA/DoD Clinical Practice Guidelines

192. Interventions to Address Sexual Problems in People With Cancer

of breast cancer who are experiencing dyspareunia, vaginal atrophy, or other vaginal pain. - Clinicians should offer pain relievers to women on aromatase inhibitors who are experiencing arthralgia that interferes with intimacy. Clinicians may suggest the use of skin protectants/sealants applied to the external folds of the vulva in women using pads for leakage and/or discharge. Vaginal dilators may be of benefit in the management of vaginismus and/or vaginal stenosis and can be offered to anyone having (...) to cultural and religious influences, sexual function is affected in a multifactorial way by one’s overall health (the patient’s and that of his/her partner), partner relationships, previous sexual history, medications, fatigue and stress, mood, view of sexual self, body image, incontinence, and hormonal changes. Cancer can independently affect sexual function by the nature of the disease and its treatment and/or result in changes to health, body image, or view of sexual self, and altered relationships

2017 American Society of Clinical Oncology Guidelines

193. Diagnosis and Treatment of Low Back Pain

21 Module A: Initial Evaluation of Low Back Pain 22 Module B: Management of Low Back Pain 24 VII. Discussion of Recommendations 26 A. Diagnostic Approach 26 B. Education and Self-care 31 C. Non-pharmacologic and Non-invasive Therapy 33 D. Pharmacologic Therapy 39 E. Dietary Supplements 46 F. Non-surgical Invasive Therapy 48 G. Team Approach to Treatment of Chronic Low Back Pain 50 VA/DoD Clinical Practice Guideline for Diagnosis and Treatment of Low Back Pain September 2017 Page 4 of 110 VIII (...) 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

194. Management of Opioid Therapy (OT) for Chronic Pain

to poorly localized symptoms such as diffuse pain, burning, numbness, or a feeling of skin sensitivity. A comprehensive pain assessment includes a biopsychosocial interview and focused physical exam. Elements of the biopsychosocial pain interview include a pain-related history, assessment of pertinent medical and psychiatric comorbidities including personal and family history of SUD, functional status and functional goals, coping strategies, and a variety of psychosocial factors such as the patient’s (...) , particularly overdose and OUD, often far outweigh the potential benefits. As such, in accounting for all four domains, these factors contributed to Strong recommendations in multiple instances. # Recommendation Strength* Category† Initiation and Continuation of Opioids 1. a) We recommend against initiation of long-term opioid therapy for chronic pain. b) We recommend alternatives to opioid therapy such as self- management strategies and other non-pharmacological treatments. c) When pharmacologic therapies

2017 VA/DoD Clinical Practice Guidelines

195. An update to the Greig Health Record: Preventive health care visits for children and adolescents aged 6 to 17 years ? Technical report

a victim who is perceived as unable to defend herself or himself.” It includes physical and verbal aggression. Bullying also includes more subtle, relational aggression that uses manipulations of relationships and reputations to harm another child. Technology-assisted bullying is known as cyberbullying. Victims of bullying are at higher risk for self-harm even before adolescence and may suffer long-term sequelae into adulthood. Bullies themselves are more likely to be incarcerated, unemployed or have (...) on topics from addiction and anxiety to self-harm and suicide prevention. Substances and Addictions This heading in the record has been updated from Substance Abuse to Substances and Addictions. The section has been revised to recognize that harmful habits can include smoking, alcohol, drugs, gambling and excessive screen time associated with signs of addiction. Screen time can include use of the Internet, video gaming and smart phone use. Gambling Underage gambling can start in children as young as 9

2016 Canadian Paediatric Society

196. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline

communities to refer to individuals who have permanently transitioned through medical interventions or desired to do so. Biological Determinants of Gender Identity Development One’s self-awareness as male or female changes gradually during infant life and childhood. This process of cognitive and affective learning evolves with interactions with parents, peers, and environment. A fairly accurate timetable exists outlining the steps in this process ( ). Normative psychological literature, however, does

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2017 Pediatric Endocrine Society

197. Antibacterial-coated sutures versus non-antibacterial-coated sutures for the prevention of abdominal, superficial and deep, surgical site infection (SSI)

dehiscence, failure to provide adequate wound support in closure of the sites where expansion, stretching or distension occur, failure to provide adequate wound support in elderly, malnourished or debilitated patients or in patients suffering from conditions which may delay wound healing, infection, minimal acute inflammatory tissue reaction, localized irritation when skin sutures are left in place for longer than 7 days, suture extrusion and delayed absorption in tissue with poor blood supply, calculi (...) and it was shown not to have carcinogenic potential or genotoxicity. It is rapidly absorbed, well distributed, metabolised and excreted from the human body, which reflects a minimal impact on the patient and environment [5] (B0002). Health problem Surgical wound infection or SSI is a type of healthcare-associated infection in which a wound infection occurs after an invasive (surgical) procedure. SSI is also defined as an infection that occurs within 30 days after the operation and involves the skin

2017 EUnetHTA

199. Primary Cutaneous Lymphomas: ESMO Clinical Practice Guidelines

, with a 10-year survival of 90% and almost 100%, respectively [39]. LyP is clinically characterised by recur- rent, self-healing papulonecrotic or papulonodular skin lesions. Since a curative therapy is not available and none of the available treatment modalities affects the natural course of the disease, in patients with relatively few non-scarring lesions, an expectant LyP C-ALCL Solitary/localised (90%) Multifocal (10%) Local RT Excision [IV, A] Low-dose MTX Low-dose RT [IV, A] Expectant policy (...) . This publication supersedes the previously published version—Ann Oncol 2013; 24 (Suppl. 6): vi149–vi154. Incidenceand epidemiology Primary cutaneous lymphomas (PCLs) are de?ned as non- Hodgkin lymphomas that present in the skin with no evidence of extracutaneous disease at the time of diagnosis. After gastrointes- tinal lymphomas, PCLs are the second most common group of extranodal non-Hodgkin lymphomas, with an estimated annual incidence of 1/100 000 in Western countries. PCLs must be distin- guished from

2018 European Society for Medical Oncology

200. Diarrhoea in Adult Cancer Patients: ESMO Clinical Practice Guidelines

2019Figure 1. Algorithm for diagnostic exams of ChT-related diarrhoea. a In case of neutropaenic fever, management according to ESMO guidelines on management of febrile neutropaenia [11]. CBC, complete blood count; ChT, chemotherapy; CRP, C-reactive protein; CT, computed tomography; ESMO, European Society for Medical Oncology; PPI, proton pump inhibitor; STEC, Shiga toxin-producing Escherichia coli; US, ultrasound. Annals of Oncology Clinical Practice Guidelines Volume 29 | Supplement 4 | October 2018 (...) of the patient-reported outcomes (PROs) CTCAE system will allow a clearer pattern of symptoms to be collected; there is a rapid need to complement the current way of measuring diarrhoea, both in everyday practice and in clinical trials. It should be recognised that diarrhoea, caused by the disease it- self and as a consequence of oncological treatments, impacts greatly on the QoL of cancer patients. Examinationsandinvestigations(Figure1) Physicalexamination Lying and standing blood pressure, heart rate

2018 European Society for Medical Oncology

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