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181. Intraoperative tests (RD-100i OSNA system and Metasin test) for detecting sentinel lymph node metastases in breast cancer

of inflammation, infection and scarring. 3.7 Axillary lymph node dissections result in major and minor complications for 80% of women. Major complications include a 22% incidence of seromas (pockets of fluid under the skin), a 21% incidence of arm lymphoedema (general swelling) and a 14% infection rate. Other complications include pain, limited mobility, numbness and sensory loss. Sentinel lymph node biopsy is associated with a 7% incidence of lymphoedema, a 7% incidence of seroma and a 2% infection rate (...) into the management pathway and the subgroups are separated based on whether or not patients receive an axillary lymph node dissection. This section of the model calculates the long-term outcomes for each subgroup and at this point, a discrete event simulation model, previously developed at the University of Sheffield (ScHARR-TAG), was used to model the natural disease history of the patients once their outcome from the diagnostic decision tree had been determined. In the model, after surgery, patients receive

2013 National Institute for Health and Clinical Excellence - Diagnostics Guidance

182. Management Considerations for Pediatric Oral Surgery and Oral Pathology

mimic an odontogenic infection. Occasionally in upper face infections, it may be difficult to find the true cause. Infec- tions of the lower face usually involve pain, swelling, and trismus. 13 They frequently are associated with teeth, skin, local lymph nodes, and salivary glands. 13 Swelling of the lower face more commonly has been associated with dental infection. 15 Most odontogenic infections can be managed with pulp therapy, extraction, or incision and drainage. 3 Infections of odontogenic (...) will render the sample nondiagnositic. 5. proper identification of the specimen is essential. The formalin container should be labelled with the name of the patient and the location. Multiple tissue samples from different locations should not be placed in the same container, unless they are uniquely identified, such as tagged with a suture. 6. complete the surgical pathology form including patient demographics, the submitting dentist’s name and ad- dress, and a brief but accurate history. It is important

2015 American Academy of Pediatric Dentistry

183. Neck pain - acute torticollis

. Photophobia or phonophobia. Gait disturbance, clumsy or weak hands, or loss of sexual, bladder, or bowel function. Ataxia. Altered muscle tone. Hoffman's sign. Hyper-reflexia. Lhermitte's sign: flexion of the neck causes an electric shock-type sensation that radiates down the spine and into the limbs. Age related factors for people aged under 20 years include: Congenital abnormalities. Birthmarks. Altered hair distribution. Skin tags. Family history. Infections related to substance misuse. Age related (...) of cancer — in these people, aetiology of pain should be assumed to be cancer, until it is excluded. Presence of fever — in these people, neck pain should be assumed to be secondary to an infection until proven otherwise. Assess the appearance of the neck and the range of motion. Palpate the neck for tenderness. Evaluate for evidence of neurological involvement (for example, decrease in sensation, or strength, or abnormal reflexes). Inspect the skin — for example, for papulovesicular rash in a prodromal

2018 NICE Clinical Knowledge Summaries

184. Neck pain - cervical radiculopathy

abnormalities. Family history. Infections related to substance misuse. Skin tags. Age related factors for people aged over 50 years: History of cancer. Vascular disease. Other red flag features include: A history of inflammatory arthritis, cancer, tuberculosis, immunosuppression, drug abuse, AIDS, or other infections. A history of violent trauma (for example, a road traffic accident) or a fall from a height or minor trauma in a person at risk of osteoporosis (especially in post–menopausal women). Minor (...) . Inspect the skin — for example, for papulovesicular rash, petechiae or purpura. Consider examining for Kernig's sign (painful/resisted extension of leg bent at hip and knee) and Brudzinski's sign (reflective flexion of the knees when patient is on his/her back and the neck is bent forwards) to demonstrate nuchal rigidity if meningitis is suspected. Exclude of neck pain. A combination of tests can be used to help identify cervical radiculopathy, including: The Spurling test — flex the neck laterally

2018 NICE Clinical Knowledge Summaries

185. Neck pain - non-specific

distribution. Birthmarks. Congenital abnormalities. Family history. Infections related to substance misuse. Skin tags. Age related factors for people aged over 50 years: History of cancer. Vascular disease. Other red flag features include: A history of inflammatory arthritis, cancer, tuberculosis, immunosuppression, drug abuse, AIDS, or other infections. A history of violent trauma (for example, a road traffic accident) or a fall from a height or minor trauma in a person at risk of osteoporosis (especially (...) . Assess the appearance of the neck and the range of motion. Palpate the neck for tenderness. Inspect the skin — for example, for papulovesicular rash, petechiae or purpura. Evaluate for evidence of neurological involvement (for example, decrease in sensation, or strength, or abnormal reflexes). A combination of tests can be used to help identify cervical radiculopathy, including the Spurling test. For more information, see the CKS topic on . Consider examining for Kernig's sign (painful/resisted

2018 NICE Clinical Knowledge Summaries

186. Hadron therapy in children ? an update of the scientific evidence for 15 paediatric cancers

are promising and the clinical experience appears to be positive. The stakes are high in every respect, not only because this is about children with cancer. The price tag for a new proton centre can easily exceed 30 million Euros and the running costs are similarly high. Understandably, those who have set out on this path defend their case through thick and thin; and they are determined to conquer a place for this innovative technique in the health care landscape. From experience we know that this type (...) than 105 000 with proton therapy 4 . Proton beam therapy in children has only been introduced a couple of decades ago; in the US, paediatric patients comprised 13% of all patients treated with PBT in 2012 5 . Photon radiation (i.e. conventional radiotherapy) deposits most of its energy below the skin surface and in normal tissue going in (‘proximal dose’), hits the target site (the tumour) and still deposits energy and thus affects normal tissues when coming out past the target (‘distal dose

2015 Belgian Health Care Knowledge Centre

187. Topical administration

Topical administration Topical administration | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Topical administration Topical administration ). Atopic Eczema is an episodic disease with periods of exacerbation and remission ( ).The term atopic describes a group of conditions such as asthma, eczema and hayfever which are linked by the increased activity of allergy component of the immune system the cause of which can be both environmental and genetic (...) ( ). Eczema causes the skin to become itchy and inflamed which causes the skin to become red and dry and in severe cases may result in weeping, blistered, crusted, scaly and thickened skin ( ). The state of skin can have detrimental effects on the child’s sleep which causes tiredness and irritability ( ). NICE guidelines ( ) suggest eczema should be treated in a stepped approach which is individualised for each patient. Emollients form the basis of eczema treatment and should be applied regularly even

2015 Publication 1593

188. Stoma care

Stoma care Stoma care | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Stoma care Stoma care ). There are basically two designs of pouch: A one-piece pouch has an adhesive flange with a pouch bonded onto it. A two-piece pouch has an adhesive flange and a separate pouch, which attaches to the flange. Both the one piece and the two-piece pouch can have a closed end or an open or drainable end ( ). Urinary pouches have non-refluxing valves and an adaptor (...) to attach to an overnight drainage bag ( ). Children with colostomies, which produce formed stool, have the opportunity to use a colostomy plug: A faceplate is attached to the skin and a plug is inserted into the stoma. A cap on the end of the plug is then clipped onto the faceplate. The plug has to be removed at least twelve hourly and a bag attached to the faceplate ( ). In the early post-operative period a one piece, drainable transparent pouch should be applied ( ). Stoma siting The majority

2015 Publication 1593

189. Sharps injuries: exposure to blood borne viruses

Sharps injuries: exposure to blood borne viruses Sharps injuries: exposure to blood borne viruses | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Sharps injuries: exposure to blood borne viruses Sharps injuries: exposure to blood borne viruses (227.95 KB) b) Report to line manager The manager should ensure risk assessment occurs by: During normal working hours: send staff member to the Occupational Health Department (OHD). Outside normal working hours (...) spinal fluid human breast milk peritoneal fluid pleural fluid pericardial fluid saliva in association with dentistry (likely to be contaminated with blood) synovial fluid any other body fluid containing visible blood unfixed tissues and organs exudates or other tissue fluid from burns or skin lesions vaginal secretions semen 3.2 At risk research material Lentiviral vectors in use at Institute of Child Health (ICH). 3.3 Significant occupational exposure ( ) 3.3.1 Percutaneous exposure When the skin

2015 Publication 1593

190. Recovery: care of the child/young person

Recovery: care of the child/young person Recovery: care of the child/young person | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Recovery: care of the child/young person Recovery: care of the child/young person ) ( ). Preoperative assessment for general anaesthesia The anaesthetist will assess the child in order to ascertain if s/he is fit enough to undergo anaesthesia and surgery. This is likely to include an examination of the respiratory (...) to recovery staff should include: ( ) care and placement of drains precautions about dressings special nursing requirements, such as positioning of the child details of pre-operative skin integrity and any visible changes post -surgery ensuring the correct charts accompany the patient noting that personal belongings such as hearing aids and comforters, toys etc are present ( any isolation precautions and reason required Surgical handover should be included if there are specific surgical instructions

2015 Publication 1593

191. Nasojejunal (NJ) and orojejunal (OJ) management

Nasojejunal (NJ) and orojejunal (OJ) management Nasojejunal (NJ) and orojejunal (OJ) management | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Nasojejunal (NJ) and orojejunal (OJ) management Nasojejunal (NJ) and orojejunal (OJ) management If the child is commenced on enteral feeding whilst he/she is an inpatient at GOSH, and it is envisaged that this method of feeding will continue following discharge, discharge planning should commence at the earliest (...) ( ). Universal testing paper ( ). 20ml syringe to withdraw aspirate from the stomach. Sterile water to flush the tube clear of aspirate, once correct placement has been confirmed. Non-sterile gloves. Tape to secure the tube to the child’s skin. A drink with a straw or a dummy for the child to suck on ( ). Phone fluoroscopy (or main x-ray if out of hours, or child on NICU/PICU/CICU) to request a check of an NJ tube placement and arrange this for at least one hour post insertion. Placement of the tube

2015 Publication 1593

192. Ketogenic diet

Ketogenic diet Clinical guidelines | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Clinical guidelines Clinical guidelines Clinical guidelines are used by the health professionals at Great Ormond Street Hospital for a wide range of conditions, treatments and tests. Search below for clinical guidelines, or filter by speciality. Clinical guidelines Search for clinical guidelines Search This guideline provides guidance on peripheral venous cannulation (...) of providing nutrition to children who have intestinal failure. Five per cent glucose solution is no longer commercially available. This guideline explains how a solution can be made up on the ward by adding dextrose monohydrate (eg Nutrivit glucose powder) to a 90ml bottle of sterile water. The purpose of this guideline is to provide guidance about intravenous and subcutaneous immunoglobulin infusions at Great Ormond Street Hospital (GOSH). Epidermolysis bullosa (EB) is a genetically determined skin

2015 Publication 1593

193. Intraosseous insertion

Intraosseous insertion Clinical guidelines | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Clinical guidelines Clinical guidelines Clinical guidelines are used by the health professionals at Great Ormond Street Hospital for a wide range of conditions, treatments and tests. Search below for clinical guidelines, or filter by speciality. Clinical guidelines Search for clinical guidelines Search This guideline provides guidance on peripheral venous (...) of providing nutrition to children who have intestinal failure. Five per cent glucose solution is no longer commercially available. This guideline explains how a solution can be made up on the ward by adding dextrose monohydrate (eg Nutrivit glucose powder) to a 90ml bottle of sterile water. The purpose of this guideline is to provide guidance about intravenous and subcutaneous immunoglobulin infusions at Great Ormond Street Hospital (GOSH). Epidermolysis bullosa (EB) is a genetically determined skin

2015 Publication 1593

194. Intrathecal cytotoxic chemotherapy: administration via a lumbar puncture or Ommaya reservoir

Intrathecal cytotoxic chemotherapy: administration via a lumbar puncture or Ommaya reservoir Intrathecal cytotoxic chemotherapy: administration via a lumbar puncture or Ommaya reservoir | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Intrathecal cytotoxic chemotherapy: administration via a lumbar puncture or Ommaya reservoir Intrathecal cytotoxic chemotherapy: administration via a lumbar puncture or Ommaya reservoir ), and the updated national guidance (...) ChloraPrep®, 2% chlorhexidine in 70% isopropyl alcohol* lumbar puncture needle (specifically designed needle that will not connect with intravenous syringes) ( ) ( ) sterile gauze squares Op-site® spray or similar sterile gloves apron sterile field *2% chlorhexidine gluconate in 70% isopropyl alcohol should not be used on the skin of pre-term infants under 35 weeks gestational age. It can be used with caution in children under two months of age. However, if there is any evidence of skin reaction

2015 Publication 1593

195. Immunoglobulin infusions: intravenous and subcutaneous

Immunoglobulin infusions: intravenous and subcutaneous Immunoglobulin infusions: intravenous and subcutaneous | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Immunoglobulin infusions: intravenous and subcutaneous Immunoglobulin infusions: intravenous and subcutaneous ) ( ). In addition, it can be used as supportive therapy for secondary immunodeficiency where extrinisic factors such as chemotherapy cause damage to the immune system, eg following stem cell (...) in children under two. The thighs become more muscular as the child gets older ( ). The abdomen is preferred in older children/young people as the skin is more pliable and allows larger volumes to be infused ( ). Trial and error may be required until best site and infusion time is identified for a particular patient. Choice of site may change with weight gain/loss and dose adjustment. Remove the local anaesthetic cream (if used) five minutes before the needles are inserted ( ). Draw up the immunoglobulin

2015 Publication 1593

196. External ventricular drainage

External ventricular drainage External ventricular drainage | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here External ventricular drainage External ventricular drainage ). Patients with an EVD must only be cared for by nursing staff competent to do so. The following wards are able to take patients with an EVD: Koala Ward Bumblebee Ward Paediatric Intensive Care Neonatal Intensive Care ( ) It is the responsibility of all nursing staff caring for a patient (...) is sutured and covered with a sterile dressing. The new catheter is tunnelled under the skin, exiting on the abdominal wall and connects to an external drainage system. This system does not have a pressure valve so drainage depends upon gravity. The exit site must be planned carefully to prevent an unsightly scar, reduce the risk of infection and reduce risk of accidental removal ( ). The ventricular catheter is connected to an external drainage system in the operating theatre ( ). The system has several

2015 Publication 1593

197. Cytotoxic and cytostatic medication - safe handling and administration

Cytotoxic and cytostatic medication - safe handling and administration Clinical guidelines | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Clinical guidelines Clinical guidelines Clinical guidelines are used by the health professionals at Great Ormond Street Hospital for a wide range of conditions, treatments and tests. Search below for clinical guidelines, or filter by speciality. Clinical guidelines Search for clinical guidelines Search This guideline (...) ). Epidermolysis bullosa (EB) is a genetically determined skin fragility disorder. Pages 1 Filter by: Specialty Policies and legal statements Follow Us Great Ormond Street Hospital Tel: 020 7405 9200 Great Ormond Street Hospital for Children NHS Foundation Trust Great Ormond Street London WC1N 3JH © 2019, Great Ormond Street Hospital for Children NHS Foundation Trust

2015 Publication 1593

198. Central venous access (temporary) for extracorporeal therapies

Central venous access (temporary) for extracorporeal therapies Clinical guidelines | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Clinical guidelines Clinical guidelines Clinical guidelines are used by the health professionals at Great Ormond Street Hospital for a wide range of conditions, treatments and tests. Search below for clinical guidelines, or filter by speciality. Clinical guidelines Search for clinical guidelines Search This guideline provides (...) ). Epidermolysis bullosa (EB) is a genetically determined skin fragility disorder. Pages 1 Filter by: Specialty Policies and legal statements Follow Us Great Ormond Street Hospital Tel: 020 7405 9200 Great Ormond Street Hospital for Children NHS Foundation Trust Great Ormond Street London WC1N 3JH © 2019, Great Ormond Street Hospital for Children NHS Foundation Trust

2015 Publication 1593

199. Analgesia: patient controlled and nurse controlled

Analgesia: patient controlled and nurse controlled Clinical guidelines | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Clinical guidelines Clinical guidelines Clinical guidelines are used by the health professionals at Great Ormond Street Hospital for a wide range of conditions, treatments and tests. Search below for clinical guidelines, or filter by speciality. Clinical guidelines Search for clinical guidelines Search This guideline provides guidance (...) ) is a genetically determined skin fragility disorder. Pages 1 Filter by: Specialty Policies and legal statements Follow Us Great Ormond Street Hospital Tel: 020 7405 9200 Great Ormond Street Hospital for Children NHS Foundation Trust Great Ormond Street London WC1N 3JH © 2019, Great Ormond Street Hospital for Children NHS Foundation Trust

2015 Publication 1593

200. Tuberculosis (TB): care of the child and protection of staff and patients

Tuberculosis (TB): care of the child and protection of staff and patients Tuberculosis (TB): care of the child and protection of staff and patients | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Tuberculosis (TB): care of the child and protection of staff and patients Tuberculosis (TB): care of the child and protection of staff and patients Please note: that the NICE Guidance is in the process of being updated and this is expected to be published (...) not with child. The parent/carer should be referred to a local TB service (or UCLH if resident at GOSH and live outside London) for a skin test ( ). Chest X-ray abnormal Ideally any parent/carer requiring treatment for TB should not be at GOSH but at home managed by their local service. If they are is the only available carer, the parent/carer must be kept in isolation until he/she has received two weeks of anti-TB medication (if sensitive to the medication) ( ). If the parent/carer remains at GOSH, movement

2015 Publication 1593

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