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3901. Leg cramps

findings on physical examination; good response to passive and active stretching; residual tenderness in the affected muscle; and causing sleep disruption. A history and examination may help exclude secondary causes (for example lower motor neuron problems, metabolic problems, medications, and pregnancy) or other conditions which mimic leg cramps (including claudication, restless legs syndrome, myalgia and myositis, Baker’s cyst, deep vein thrombosis, dystonia, myoclonus). Investigations are usually

2018 NICE Clinical Knowledge Summaries

3902. Learning disabilities: When should I suspect a learning disability?

information, and time taken to learn new skills. Family and social history. Developmental history (birth, pregnancy, developmental milestones). Health problems as a child. Input from other professionals, both as a child and as an adult. Educational history (types of schools, level of help and support required, statements of special educational needs). Occupational history (both paid and voluntary). Medical history (physical and psychological difficulties, head injury, epilepsy). Mental health issues (...) . History of emotional care and support (including known attachment difficulties, significant bereavements). Family/carer interpretations of the person’s difficulties. Previous cognitive assessments. Current medication. Vision and hearing. Motor difficulties. In addition to evidence of impairment of intellectual and social functioning which arose before adulthood, factors that may raise the index of suspicion for a learning disability include: Some chromosomal and genetic anomalies — such as Down's

2018 NICE Clinical Knowledge Summaries

3903. Learning disabilities: Scenario: Confirmed learning disability

with: Assessment and care co-ordination. Behavioural assessment and treatment. Care management. Community nursing. Epilepsy care. Independent supported living. Mental health. Psychiatry. Psychology. Specialist occupational therapy. Speech and language therapy. Support for children and adults with complex health needs. Support for parents and families. Transition into adult care. Creative therapies. Note: a direct referral to some of these services may be required if they are not available locally under (...) information, please see the CKS topics on and . Asking the person if they are registered with a dentist, how often they see the dentist and checking that they understand the importance of looking after their teeth and mouth. Recording any diagnosed chronic illnesses. A physical health review, including assessment for signs and symptoms of which are common in people with learning disabilities. Depending on the person's age, it may also be appropriate to enquire about signs and symptoms of age-related

2018 NICE Clinical Knowledge Summaries

3904. Learning disabilities: Scenario: Behaviour that challenges and mental health problems

it starts, and regularly throughout. If prescribing medication: Be aware that only primary care practitioners with training/expertise in the care of people with a learning disability should initiate treatment with psychotropic drugs. Additionally, specialists with expertise in treating mental health problems in people with learning disabilities should start medication in adults with more severe learning disabilities (unless there are locally agreed protocols for shared care) and children and young (...) medication, including side-effects, to the person and their family members, carers, or care workers, when the medication will be reviewed, plans for reducing or discontinuing the medication, and if appropriate, full details of all medication the person is taking, including the doses, frequency, and purpose. When switching medication, pay particular attention to discontinuation or interaction effects that may occur during titration. Only change one drug at a time, to make it easier to identify

2018 NICE Clinical Knowledge Summaries

3905. Knee pain - assessment: Non-traumatic causes

: recent joint surgery/corticosteroid injection, prosthetic joint, other joint disease, rheumatoid arthritis, intravenous drug use, immunosuppression (for example diabetes, use of long-term corticosteroids, alcoholism), or adjacent skin infection or ulceration. Red flags for a tumour — see the CKS topics on , and . Persistent, non-mechanical bone pain. Pain at night or at rest. Unexplained weight loss. Previous cancer. Hard, localised mass adjacent to the knee. Swelling may not be present until late (...) . There is no limp and no limitation of physical activities, and the child has normal motor development. Systematically well. Signs: Physical examination is normal apart from possible joint hypermobility. Other causes: Bipartite patella is usually asymptomatic (and discovered as an incidental finding on X-ray), but may present with anterior knee pain during adolescence. Pain is associated with knee extension and squatting. On examination, there is tenderness over the location of the bipartite patella, most

2018 NICE Clinical Knowledge Summaries

3906. Jaundice in adults: Scenario: Management of jaundice in adults

a suspected cancer pathway referral is based on the NICE guideline Suspected cancer: recognition and referral [ ] and expert opinion in the review articles Jaundice in primary care: a cohort study of adults aged >45 years using electronic medical records [ ] and Pancreatic cancer [ ]. It is noted in the NICE guideline that the evidence on which the recommendation is based does not distinguish between obstructive and non-obstructive jaundice. A cohort study [ ] using data from the UK General Practice (...) [ ] . The recommendation to refer people with suspected alcohol-related liver disease to a specialist in this field is taken from the NICE guideline Alcohol-use disorders: Diagnosis and clinical management of alcohol-related physical complications [ ]. The recommendation to refer people with a hepatitic picture on LFTs to gastroenterology is based on expert opinion in the regional clinical guideline Ambulatory emergency care pathways [ ] and the review article ABC of diseases of liver, pancreas, and biliary system

2018 NICE Clinical Knowledge Summaries

3907. Clinical guide for the management of critical care for adults with COVID-19 during the Coronavirus pandemic

antibiotics 8 Treatment of other conditions in the context of COVID-19 8 Impact of non-steroidal anti-inflammatory drugs (NSAIDs), ACE-inhibitors and ARBs on COVID-19 9 4 Clinical decision-making 9 General comments 9 Referral and admission to intensive care or palliative care 9 Treatment decisions 10 5 Management of respiratory failure 10 Oxygen therapy 10 High flow nasal oxygen 11 CPAP and NIV 11 Intubation 12 Mechanical ventilation 12 Management of early (pneumonitis) phase 14 Management of later (...) is the mainstay of COVID-19 management. Anti-viral therapy ? Remdesivir may be considered for patient admitted to critical care ? For dosing, Remdesivir should be given as a 200mg loading dose IV then 100mg IV once daily for the next 9 days if ventilated or 5 days of not ventilated. ? Remdesivir is currently available under the early access to medicines scheme (EAMS) and approved indications will be updated regularly. Steroid therapy ? The RECOVERY trial has provided initial results on dexamethasone in COVID

2020 ICM Anaesthesia COVID-19

3908. Management of Hypertension (HTN) in Primary Care

of sexual dysfunction, depression, cough, and angioedema 4. Family history of hypertension, premature CHD, cerebrovascular accident (CVA), DM, dyslipidemia, or renal disease 5. Other symptoms suggesting other causes of elevated BP 6. Results and adverse effects of any previous antihypertensive therapy 7. History of recent change in weight, physical activity, tobacco use 8. Dietary habits, including intake of sodium and total caloric intake 9. History of all prescribed and over-the-counter medications (...) , herbal remedies, and dietary supplements, some of which may raise blood pressure or interfere with the effectiveness of antihypertensive medications 10. History of alcohol and illicit drug use (especially cocaine and other stimulants) 11. Psychosocial and environmental factors (e.g., family situation, employment status and working conditions, level of comprehension) that may influence hypertension controlOctober 2014 Page 24 of 135 A physical exam should include an evaluation for signs of secondary

2020 VA/DoD Clinical Practice Guidelines

3909. Management of Hypertension (5th Edition)

diuretics / K + sparing diuretics Acceptable (no outcome trial evidence yet) ARB / CCB ß-Blocker / thiazide-like diuretics DRI/diuretic ARB = angiotensin receptor blocker ACEI = angiotensin-converting enzyme inhibitor CCB = calcium channel blocker DRI = direct renin inhibitor 6.1c Target Blood Pressure Efforts must be made to reach target BP. For patients 140/90 mmHg with three drugs, including a diuretic at optimal doses, there is a need to exclude medication non-compliance and isolated office (...) artery stenosis.20 6.2 FOLLOW–UP VISITS Follow up intervals should be individualised based on global CV risk, pre-treatment BP levels and drugs used. For high and very high risk patients, it is advisable to bring the BP to target within 3 to 6 months. 89 Once target BP is achieved, follow-up at three to six-month intervals is appropriate. As a rule, once the BP is controlled, most patients will require life-long treatment. 6.3 STEP-DOWN THERAPY Step-down therapy is discouraged in the vast majority

2018 Ministry of Health, Malaysia

3910. Diagnosis and Management of Focal Liver Lesions

disease processes and to eval- uate for the presence of concomitant renal cysts. Management of PCLD Treatment of PCLD is guided by the presence of symptoms that are oft en directly related to the volume of the liver rather than to specifi c cysts. Th erefore, treatment should be focused on decom- pressing the liver or reducing the cyst volume as much and as safely as possible. Some recent interest in medical therapy has been stirred by reports of the use of somatostatin analogs and mammalian target (...) with hepatic failure and / or poor quality of life ( 162,199 – 202 ). Outcomes have been reported to be compara- ble or superior to other indications for liver transplantation, with 1-year survival of 90 % and 5-year survival of 70 – 80 % ( 203,204 ). Nevertheless, strong recommendations cannot be made because of the overall limitations of the currently available data. Recom me nd a ti o n s 31. Routine medical therapy with mammalian target of rapamy- cin inhibitors or somatostatin analogs

2014 American College of Gastroenterology

3911. Acute Pain Management: Scientific Evidence

and on the multidisciplinary committee, including medical, nursing, allied health and complementary medicine professionals and consumers. Acute Pain Management: Scientific Evidence covers a wide range of clinical topics. The aim of the document is, as with the first three editions, to combine a review of the best available evidence for acute pain management with current clinical and expert practice, rather than to formulate specific clinical practice guidelines. Accordingly, the document aims to summarise the substantial (...) Cognitive-behavioural interventions 262xvii CONTENTS 7.2 Transcutaneous electrical nerve stimulation 265 7.3 Acupuncture and acupressure 265 7.3.1 Postoperative pain 265 7.3.2 Other acute pain states 267 7.4 Physical therapies 269 7.4.1 Manual and massage therapies 269 7.4.2 Warming and cooling intervention 270 7.4.3 Other therapies 271 References 271 8. SPECIFIC CLINICAL SITUATIONS 279 8.1 Postoperative pain 279 8.1.1 Multimodal postoperative pain management 279 8.1.2 Procedure-specific postoperative

2015 Clinical Practice Guidelines Portal

3912. Managing Chronic Cough Due to Asthma and NAEB in Adults and Adolescents: CHEST Guideline and Expert Panel Report

?rlukastwerenotrelatedtoairway in?ammation when assessed with non-invasive measures. Question 2: How iscough duetoasthmabest treated?: The previous CHEST Cough guideline for cough due to asthma included a good response to corticosteroids as con?rmation of the diagnosis. To avoid this tautology, we investigated the objective response to drug therapies including corticosteroids for cough due to asthma. The studies included in this systematic review were placebo- controlled RCTs, RCTs without placebo, and observational studies (...) due to asthma or NAEB. Eligible studies were identi?ed in MEDLINE, CENTRAL, and SCOPUS and assessed for relevance and quality. Guidelines were developed and voted upon using CHEST guideline methodology. RESULTS: Of the citations reviewed, 3/1,175, 53/656, and 6/134 were identi?ed as being eligible for inclusion in the three systematic reviews, respectively. In contrast to established guidelines for asthma therapies in general and the inclusion in some guidelines for a role of biomarkers of airway

2020 American College of Chest Physicians

3913. COVID-19 Pandemic Breast Cancer Consortium’s Considerations for Re-Entry

of neoadjuvant endocrine therapy in postmenopausal women 11 , but limited data in premenopausal women. 12 Careful monitoring of patients and their tumors during neoadjuvant endocrine therapy is important as some tumors will progress on treatment. Patients are generally evaluated for side effects and compliance with medication after 4-6 weeks of treatment. Careful assessment of response with repeat physical examination by the surgeon after approximately 3 months of endocrine therapy, with imaging (...) rooms and patient-medical staff interactions in exam and procedure rooms. Many visits can still be conducted by telehealth with necessary tests ordered remotely. However, as physical exam findings can impact the recommendations for type of surgery and reconstruction, in-person visits will still be necessary. Local infection control policies should be followed and may include screening patients for COVID-19 symptoms by phone prior to their appointment and upon arrival to clinic, along with other risk

2020 American College of Surgeons

3914. Use of N95, Surgical, and Cloth Masks to Prevent COVID-19 in Health Care and Community Settings: Living Practice Points From the American College of Physicians Full Text available with Trip Pro

Successfully Your password has been changed Verify Phone Enter the verification code Congrats! Your Phone has been verified Search American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.) , American College of Physicians, Philadelphia, Pennsylvania (A.Q., I.E.) , American College of Physicians, Philadelphia, and Villanova University, Villanova, Pennsylvania (J.Y.) , Penn Medicine, Philadelphia, Pennsylvania (M.C.M., M.A.F.) , University of Massachusetts Medical School and Saint Vincent (...) Hospital, Worcester, Massachusetts (G.M.A.) , Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.) , Penn Medicine, Philadelphia, Pennsylvania (M.C.M., M.A.F.) , University of Illinois College of Medicine at Urbana-Champaign, Champaign, Illinois (J.A.J.) , Portland Veterans Affairs Medical Center and Oregon Health & Science University, Portland, Oregon (A.J.O., L.L.H.) , Key Question 1 What is the effectiveness of N95 respirators versus

2020 American College of Physicians

3915. EANM procedural guidelines for myocardial perfusion scintigraphy using cardiac-centered gamma cameras Full Text available with Trip Pro

Accesses 1 Citations 7 Altmetric Abstract An increasing number of Nuclear Medicine sites in Europe are using cardiac-centered gamma cameras for myocardial perfusion scintigraphy (MPS). Three cardiac-centered gamma cameras are currently the most frequently used in Europe: the D-SPECT (Spectrum Dynamics), the Alcyone (Discovery NM 530c and Discovery NM/CT 570c; General Electric Medical Systems), and the IQ-SPECT (Siemens Healthcare). The increased myocardial count sensitivity of these three cardiac (...) nonprofit medical association that facilitates communication worldwide among individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. These guidelines are intended to assist practitioners in providing appropriate nuclear medicine care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. The ultimate judgment regarding the propriety of any specific

2019 European Association of Nuclear Medicine

3916. Irritable bowel syndrome: Scenario: Management of irritable bowel syndrome

physical activity, and encourage weight loss if the person is overweight or obese. See the CKS topic on for more information. Adults should aim to do 30 minutes of moderate intensity physical activity on at least 5 days of the week. Arrange to review the person, depending on clinical judgement, and if there are ongoing or refractory symptoms, consider further management options such as . Basis for recommendation The recommendations on the initial management of irritable bowel syndrome is largely based (...) fibre on abdominal pain, global assessment, or symptom score compared with placebo [ ]. A subsequent meta-analysis of 14 RCTs (n = 906) found a significant benefit of soluble fibre on global IBS symptoms, compared with insoluble fibre (bran) which was ineffective. No significant heterogeneity between studies was noted, however there were differences in the study definitions of IBS used, different settings and durations of therapy. It concludes that fibre supplementation is inexpensive and generally

2019 NICE Clinical Knowledge Summaries

3917. Irritable bowel syndrome

, if there are predominant symptoms of diarrhoea and/or bloating. Trying soluble fibre supplements or foods high in soluble fibre if there are predominant symptoms of constipation. Drinking an adequate fluid intake. Encouraging regular physical activity. If symptoms persist despite initial dietary and lifestyle advice, further management options include a trial of: A bulk-forming laxative for constipation symptoms, with additional laxatives if needed. Linaclotide for refractory constipation symptoms. Loperamide (...) for diarrhoea symptoms. An antispasmodic drug for abdominal pain or spasm. A low-dose tricyclic antidepressant (TCA) for refractory abdominal pain. A selective serotonin reuptake inhibitor (SSRI) for refractory abdominal pain, if a TCA is ineffective, contraindicated, or not tolerated. If there is no alternative explanation for ongoing symptoms, specialist referral may be appropriate to: A gastroenterologist for further investigation. A dietitian for specialist advice on single food avoidance and exclusion

2018 NICE Clinical Knowledge Summaries

3918. Insomnia: How should I assess a person with suspected insomnia?

. For more information see the CKS topics on and . Past medical history including: Previous sleep problems and treatment. Comorbidities such as chronic pain, medical disorders (such as chronic obstructive pulmonary disease, heart failure or gastro-oesophageal reflux disease) and psychological disorders (such as stress, anxiety, or depression). Impact of insomnia on quality of life, ability to drive, employment, relationships, and mood. Medications and substance use including caffeine, alcohol, nicotine (...) and illicit drugs. Carry out an examination where appropriate: Depending on the specific clinical situation examination may help identify comorbid conditions. Consider the need for investigations: A sleep diary can help assess sleep difficulties and daytime impairment over time; it should be kept for 2 weeks and record: The time of going to bed and getting up. The time taken to get to sleep and the number and duration of episodes of waking through the night. Episodes of daytime tiredness and naps. Times

2019 NICE Clinical Knowledge Summaries

3919. Multimorbidity: Scenario: Assessment

of regular medicines a person is prescribed. People taking 15 or more regular medicines are likely to be at higher risk of adverse events and drug interactions. Consider that people may need a multimorbidity approach, if they : Find it difficult to manage their treatments or day-to-day activities. Receive care and support from multiple services and need additional services. Have both long-term physical and mental health conditions. Have frailty or are at risk of falls. Frequently seek unplanned (...) for recommendation These recommendations are based on the National Institute for Health and Care Excellence (NICE) guidelines Multimorbidity: clinical assessment and management [ ], and Multimorbidity and polypharmacy [ ]. Polypharmacy and multimorbidity In a study of 180,815 adults in primary care approximately 20.8% of people with two medical conditions were prescribed 4–9 drugs and 1.1% were prescribed 10 or more [ ]. For people with six or more conditions, these were 47.7% and 41.7%, respectively

2019 NICE Clinical Knowledge Summaries

3920. Multimorbidity

their treatments or day-to-day activities. Receive care and support from multiple services and need additional services. Have both long-term physical and mental health conditions. Have frailty or are at risk of falls. Frequently seek unplanned or emergency care. Are prescribed more than 10 regular medicines, or are prescribed fewer than 10 regular medicines, but are at particular risk of adverse events. Assessment of people with multimorbidity should include: Establishing the extent of disease burden (...) Multimorbidity Multimorbidity | Topics A to Z | CKS | NICE Search CKS… Menu Multimorbidity Multimorbidity Last revised in May 2018 Multimorbidity is two or more long-term health conditions Management Background information Multimorbidity: Summary Multimorbidity is the presence of two or more long-term health conditions, which can include: Defined physical or mental health conditions, such as diabetes or schizophrenia. Ongoing conditions, such as learning disability. Symptom complexes

2019 NICE Clinical Knowledge Summaries

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