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Self Skin Exam

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81. Wrinkles

, botulinum toxin injections, chemical peels), and surgical procedures (laser ablation, dermabrasion, rhytidectomy). Treatments are generally more effective for fine wrinkles. Deep creases require more aggressive techniques, such as plastic surgery procedures. May have a negative psychological impact on the patient as a result of a poor self-image. Definition Wrinkles are lines or creases of the skin that appear as a natural part of ageing. The ageing process produces loss of skin thickness and elasticity (...) , resulting in progressive skin atrophy, laxity, and wrinkling. These cutaneous alterations are exacerbated by the actinic damage of chronic sun exposure. Wrinkles most frequently appear on sun-exposed areas (i.e., face, neck, dorsum of hands). Hyperdynamic muscular activity may also result in folding and creasing of the overlying skin. History and exam presence of risk factors age >40 years chronic sun exposure smoking lines on face horizontal neck folds lines on dorsum of hands and wrists dynamic lines

2018 BMJ Best Practice

82. Urticaria and angio-oedema

Urticaria and angio-oedema Urticaria and angio-oedema - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Urticaria and angio-oedema Last reviewed: February 2019 Last updated: March 2018 Summary Urticaria is a skin condition characterised by erythematous, blanching, oedematous, non-painful, pruritic lesions that typically resolve within 24 hours and leave no residual markings. Angio-oedema is swelling involving (...) the deeper layers of the sub-dermis and occurs in association with urticaria in about 40% of cases. It can also occur in the absence of urticaria. Acute urticaria lasts less than 6 weeks and is often due to a hypersensitivity reaction to a specific trigger. Underlying viral infections are also a common cause of acute urticaria, particularly in children. Acute urticaria is generally self-limiting. Chronic urticaria is characterised by daily or near-daily episodes of hives occurring for 6 weeks or more

2018 BMJ Best Practice

83. Bulimia nervosa

, enemas, or other medication. Binge-eating episodes typically occur, on average, at least weekly for 3 months. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., (DSM-5). Washington, DC: American Psychiatric Publishing; 2013. History and exam presence of risk factors recurrent episodes of binge eating recurrent inappropriate compensatory behaviour eating disturbance not exclusively during periods of anorexia nervosa depression and low self-esteem concern (...) about weight and body shape dental erosion parotid hypertrophy Russell's sign arrhythmia age 20 to 35 years menstrual irregularity drug-seeking behaviour deliberate misuse of insulin self-injurious behaviour GI symptoms history of dieting marked fluctuations in weight shoplifting behaviour use of ipecac needle marks on skin vomiting in pregnancy female sex personality disorder body-image dissatisfaction history of sexual abuse impulsivity family history of alcoholism family history of depression

2018 BMJ Best Practice

84. Langerhans cell histiocytosis

(i.e., syndrome characterised by the abnormal proliferation of histiocytes). Weitzman S, Egeler RM. Histiocytic disorders of children and adults: introduction to the problem, overview, historical perspective and epidemiology (adapted from Favara BE, et al. Med Pediatr Oncol 1997). In: Weitzman S, Egeler RM, eds. Histiocytic disorders of children and adults. Cambridge, UK: Cambridge University Press; 2005:3. History and exam age <15 years bone pain and/or swelling skin rash polyuria and polydipsia (...) to immune dysregulation. Clinical presentation is heterogeneous and ranges from self-healing bone lesions to multi-system, life-threatening disease. Tissue biopsy of lesional cells showing the presence of CD1a and langerin (CD207) is definitive for diagnosis in the correct clinical setting. Multi-system disease is treated with systemic, multi-agent chemotherapy. Treatment of relapsed disease and central nervous system neurodegenerative disease remains a challenge. Prognostic factors include rapid

2018 BMJ Best Practice

85. Miliaria

with prompt self-resolution. Miliaria rubra consists of non-folliculocentric, erythematous papulovesicles with associated pruritus. Miliaria profunda consists of non-folliculocentric, pruritic flesh-coloured papules as a result of multiple bouts of miliaria rubra. This form of miliaria is often associated with anhidrosis of the affected skin and can result in heat exhaustion. The main treatment of choice for all forms of miliaria is placement of the patient in a cool environment. Definition Miliaria (...) Miliaria Miliaria - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Miliaria Last reviewed: February 2019 Last updated: March 2018 Summary All forms of miliaria are due to occlusion or disruption of the eccrine sweat ducts at various levels of the skin due to excessive sweating in hot or humid environments. Miliaria crystallina consists of non-folliculocentric, asymptomatic, fragile, clear vesicles that rupture easily

2018 BMJ Best Practice

86. Sunburn

typically runs a self-limited course and is treated symptomatically. Education about future sunburn prevention via sun avoidance during peak daylight hours and the use of protective clothing/sunscreen are key interventions. Definition Sunburn is an acute inflammatory reaction of the skin induced by over-exposure to UV radiation. Skin findings include erythema and oedema, with or without vesiculation, followed by desquamation. Symptoms include pain and/or pruritus. Acute sunburn is a self-limited (...) condition and typically requires only supportive care. However, primary prevention is critical, as cellular damage caused by UV radiation is irreversible and may with time increase the risk of skin cancer. History and exam presence of risk factors sun exposure lack of sun protection skin discomfort pruritus skin tenderness sensation of warmth erythema chronic actinic damage malaise, fever, chills, nausea, headache oedema vesicles/bullae Fitzpatrick skin type I-III photo-sensitising medications

2018 BMJ Best Practice

87. Erythema multiforme

of underlying infection remain the mainstay of therapy. Definition Erythema multiforme (EM) is typically an acute, self-limiting but often relapsing, mucocutaneous inflammatory condition. It is a hypersensitivity reaction associated with certain infections, vaccinations, and, less commonly, medications. The disease is characterised clinically by target lesions, which can be described as annular erythematous rings with an outer erythematous zone and central blistering sandwiching a zone of normal skin tone (...) ://onlinelibrary.wiley.com/doi/10.1111/j.1365-4632.2011.05348.x/full http://www.ncbi.nlm.nih.gov/pubmed/22788803?tool=bestpractice.com History and exam presence of risk factors target lesions of the extremities recurrent disease mucosal erosions targetoid lesions rapid onset of lesions self-limiting course clustered vesicles on an erythematous base rhonchi, rales, and/or wheezes red tympanic membranes hepatomegaly prior occurrence herpes simplex virus (HSV) infection cytomegalovirus (CMV) infection Epstein-Barr virus

2018 BMJ Best Practice

88. Optimisation of RIZIV – INAMI lump sums for incontinence

and age at admission for faecal and urinary incontinence (2014) 107 Figure 26 – Distribution of sex and age at admission for faecal and urinary incontinence (2014): patients aged 0 – 20 years 107 Figure 27 – Evolution of number of patients benefiting from a small or large incontinence lump sum, or from reimbursements for self-catheterisation material or incontinence material covered by article 27 (extrapolated from EPS 2008 – 2015) 113 Figure 28 – Age distribution of patients receiving an incontinence (...) lump sum, per lump sum and sex (extrapolated from EPS 2015)* 116 Figure 29 – Reimbursements for incontinence lump sums, for material of article 27 and self- catheterisation, and number of patients receiving an incontinence lump sums (2008-2016) 121 Figure 30 – Amounts reimbursed and number of sessions of complex monodisciplinary rehabilitation of the pelvic floor (2009-2016) 123 Figure 31 – Complex monodisciplinary rehabilitation of the pelvic floor: number of patients (left chart) and average

2019 Belgian Health Care Knowledge Centre

89. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU

Tumors 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 (...) outcomes of acute cystitis and rUTI. For the purposes of this guideline, the Panel considers only recurrent episodes of uncomplicated cystitis in women. This guideline does not apply to pregnant women, patients who are immunocompromised, those with anatomic or functional abnormalities of the urinary tract, women with rUTIs due to self-catheterization or indwelling catheters or those exhibiting signs or symptoms of systemic bacteremia, such as fever and flank pain. This guideline also excludes those

2019 Canadian Urological Association

90. Canadian Urological Association guideline for the diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction

be warranted. History and physical exam In the setting of a diagnosed or probable neurological dis- ease, a careful evaluation must be carried out to identify symptoms and signs associated with neurogenic bladder dysfunction, with an emphasis on identifying common and potentially serious complications. In most cases, investiga- tions followed by appropriate management can minimize this morbidity. The general approach to the clinical history specifically relevant to a patient with NLUTD is shown in Table 1 (...) care provider should involve more than a referral; a summary of childhood procedures, up-to-date baseline investigations, and a period of overlapping care may be beneficial. 31 Voiding diaries should be considered for all patients. 32 They allow the patient to self-reflect on their urinary habits and the physician to measure changes over time in a non- invasive manner and interpret urodynamic findings in the context of the patient’s day-to-day urinary patterns. Validated questionnaires

2019 Canadian Urological Association

91. Transoral robotic surgery (TORS) for head and neck cancer of unknown primary, oropharyngeal cancer and supraglottic laryngeal cancer

: thin, flat cells that are found in tissues that form the surface of the skin, the lining of hollow organs of the body, and the lining of the respiratory and digestive tracts 3 .74 3 Literature search A systematic search of the secondary literature was carried out between 13 and 20 June 2017 to identify systematic reviews, health technology assessments and other evidence-based reports. Medline, Medline in process, Embase, Web of Science and Cochrane databases were searched for systematic reviews (...) trial. Participants self-selected their treatment which may have introduced selection bias to this study. Some participants in both TORS study groups received adjuvant chemoradiotherapy, which makes it difficult to separate the effect of TORS from the effect of adjuvant chemoradiotherapy. The study by Genden et al (2011) reported no statistically significant difference in 18-month Kaplan- Meier estimated overall or disease-free survival between the TORS and chemoradiotherapy groups (Table 2

2018 Evidence Notes from Healthcare Improvement Scotland

92. Treating Opioid Use Disorder During Pregnancy: Guideline Supplement

.) 8. Breastfeeding should be encouraged in mothers who are stable on OAT. (See Rooming-in and Breastfeeding.)11 Introduction Obtaining accurate prevalence data on substance use during pregnancy is particularly difficult primarily due to the stigma and prejudice against pregnant women who use substances. While non-medical opioid use during pregnancy is less frequently self-reported than alcohol and tobacco use, it is recognized by the Public Health Agency of Canada as a significant concern across (...) and 4 of the Guideline for detailed guidelines on utilizing UDT as an assessment and monitoring tool. Clinicians should be sensitive to specific vulnerabilities of this population and clearly describe the propose of each test. The patient’s informed consent should be sought prior to performing point-of-care UDT or ordering laboratory tests. Patients who self-report ongoing substance use, test positive for substance use, or those who decline or are unable to provide a urine sample, should receive

2018 British Columbia Perinatal Health Program

93. Chest imaging

for pain or radicular indications ? MRI foot and MRI ankle for pain indications ? Bilateral exams, particularly comparison studies There are certain clinical scenarios where simultaneous ordering of multiple imaging studies is consistent with current literature and/or standards of medical practice. These include: ? Oncologic imaging – Considerations include the type of malignancy and the point along the care continuum at which imaging is requested ? Conditions which span multiple anatomic regions (...) Specialty Health. All Rights Reserved. 6 ? Repeated imaging of the same anatomical area by different providers for the same member over a short period of time Pre-Test Requirements Critical to any finding of clinical appropriateness under the guidelines for specific imaging exams is a determination that the following are true with respect to the imaging request: ? A clinical evaluation has been performed prior to the imaging request (which should include a complete history and physical exam and review

2019 AIM Specialty Health

94. Prenatal Care

drinking, offer a referral to a behavioral health professional. • Has HIV/STI risk, perform risk-reduction counseling. Connect patients to resources for family assistance and information. Offer information about nonprofit statewide programs in Washington state: • Within Reach: http://withinreachwa.org/ • ParentHelp123: www.parenthelp123.org Physical examination Lactation assessment should be included in the physical exam. Ultrasound is preferred at the initial visit to determine gestational age (...) an elevated risk of aneuploidy • Previously identified chromosome 21, 18, or 13 translocation in self or partner Alpha-fetoprotein (AFP) Neural tube defects 15–22 weeks All women who elect cell-free DNA testing 1 Some women might elect not to do this screening. Figure 1. Screening for aneuploidy and neural tube defects: shared decision making for women at high risk Pregnant woman at high risk for aneuploidy?* Patient accepts? Offer screening per Table 6 (trisomy 21 and 18, neural tube defects). Cell-free

2018 Kaiser Permanente Clinical Guidelines

95. Syphilis in pregnancy

: clinician with specialist knowledge and experience in the testing, result interpretation, management and treatment of syphilis in the pregnant woman and/or her baby Additional investigations Consider · FBC, ELFT · Chest x-ray · Long bone radiographs · CSF · Neuroimaging · Ophthalmologic exam · Auditory brain stem response Treatment for congenital syphilis 0–7 days of age · Benzyl penicillin 50 mg/kg IV 12 hourly for 10 days 8–30 days of age · Benzyl penicillin 50 mg/kg IV 8 hourly for 10 days > 30 days (...) , QSSS, midwife, nurse, nurse practitioner, obstetrician, personnel managing follow-up and/or contact tracing. Pinta/yaws/bejel Infections caused by bacteria that are closely related to Treponema pallidum. Pinta affects only the skin while yaws and bejel can also affect the joints and bones. Not endemic in Australia. QSSS Queensland Syphilis Surveillance Service (QSSS) is an important source of information, support and advice for health care providers engaged in the detection and management of women

2019 Queensland Health

96. Professional Practice Guidelines for the Psychological Practice with Boys and Men

or others (for reviews, see Pleck, 1981, 1995). The negative effects of gender role strain are mental and physical health problems for the individ- ual and within relationships (O’Neil, 2008, 2013; Pleck, 1995). Boys and men experience gender role strain when they (a) deviate from or violate gender role norms of masculinity, (b) try to meet or fail to meet norms of masculinity, (c) experience discrepancies between real and ideal self-concepts based on gender role stereotypes, (d) personally devalue (...) with increasing frequency (Wong & Wester, 2016). GENDER ROLE CONFLICT Gender role conflict (GRC) is defined as problems resulting from adherence to “rigid, sexist, or restrictive gender roles, learned during socialization, that result in personal restriction, devalua- tion, or violation of others or self” (O’Neil, 1990, p. 25). GRC is the most widely studied aspect of masculine gender role strain, and researchers have demonstrated that men experience conflict relat- ed to four domains of the male gender role

2019 American Psychological Association

97. Management of Acute Compartment Syndrome

The quality-of-life after lower leg compartment syndrome was studied by Giannoudis et al. (2002). Thirty patients who were a minimum of one-year post-injury completed the EQ-5D (EuroQol) and were compared to age/ sex-matched patients who had sustained closed tibia fracture without compartment syndrome. Patients with a skin-graft reported more pain and discomfort than patients without a skin-graft. Patients whose wounds were closed faster had significantly better self-rated health status than patients (...) Pressure Methods 7 Pressure Monitoring in Late/Missed ACS 8 Physical Exam (Awake) 8 Physical Exam (Obtunded) 8 Alternative methods of Diagnosis 9 Fasciotomy Methods 9 Fasciotomy for Late/Missed ACS 9 Associated Fracture 9 Wound Management 10 Pain Management Effects on Diagnosis 10 Development Group Roster 11 Voting Members 11 Non-Voting Oversight Chairs/Staff 11 Introduction 12 Overview/Military Application 12 Goals and Rationale 12 Intended Users 13 Patient Population 14 Burden of Disease 14 Etiology

2019 American Academy of Orthopaedic Surgeons

98. Identifying Policies, Financial Support and Professional Regulations for Medically Necessary Hair Removal

for dermatological laser procedures. o The non-systematic review indicated that complications can arise from using hair-bearing skin in genital gender-affirming surgery, there is limited data regarding hair-removal practices in preparation for genital gender-affirming surgeries, and that hair-removal techniques vary among dermatologists and other practitioners. o While not directly relevant to the synthesis, the systematic review identified variability in procedures for hair removal, including the types (...) of and settings used for lasers, application time and pain outcomes. o The systematic review also noted that non-invasive anesthetic methods may be favourable compared to placebo or no anesthesia, and that better pain reduction was achieved through topical anesthetic drugs and pneumatic skin flattening as compared to skin cooling, but it also indicated that this evidence is insufficient to draw conclusions. • Eight out of the 10 provinces were found to have provincial regulations for hair-removal equipment

2018 McMaster Health Forum

99. Robot-assisted surgery in thoracic and visceral indications

and visceral surgery. Thoracic surgery is concerned with conditions of the lungs, chest wall and diaphragm and is generally dominated by treatment of malignant disease. Thoracic procedures that were exam- ined in the review included, in accordance with the project plan, pulmonary lobectomy, lung seg- mentectomy and mediastinal surgery. Visceral surgery deals with all aspects of the surgical treat- ment of benign and malignant diseases of abdominal organs, the entire gastrointestinal tract, en- docrine

2019 EUnetHTA

100. The Collaborative Assessment, OTCA12, on “C-reactive protein point-of-care testing (CRP POCT) to guide antibiotic prescribing in primary care settings for acute respiratory tract infections (RTIs)

are caused by bacteria and may respond to antibiotics. Depending on the site of infec- tion, RTIs may be classified as upper (pharyngitis, tonsillitis, laryngitis, rhinosinusitis, otitis media and the common cold) or lower (pneumonia, bronchitis, tracheitis and acute infective exacerba- tions of chronic obstructive pulmonary disease [COPD]). Influenza may affect both the upper and lower respiratory tract. (A0002) Most RTIs are self-limiting. The natural course of upper respiratory tract infections (URTIs (...) positivity, diagnostic criteria (including use of CRP levels in isolation or as part of a clinical algorithm), patient popula- tions and the absence of a universal reference standard for the diagnosis of RTIs requiring antibi- otics. For the purposes of analysis, studies were grouped according to the types of RTI identified in the systematic review. Two studies reported on the usefulness of CRP testing in diagnosing sinusitis. Both studies exam- ined a range of thresholds and selected a threshold of 10

2019 EUnetHTA

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