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3941. Angina

to hospital. Management of stable angina includes lifestyle advice: People who smoke should be offered advice and assisted to stop. A cardioprotective diet should be encouraged. Advice and support should be offered to help achieve and maintain a healthy weight if people are overweight or obese. An increase in physical activity levels should be encouraged within the limits set by their symptoms. Limitation of alcohol consumption to within recommended levels should be encouraged. Drugs used to treat angina (...) by valve disease (for example aortic stenosis), hypertrophic obstructive cardiomyopathy, or hypertensive heart disease. Stable angina usually occurs predictably with physical exertion or emotional stress, and is relieved within minutes of rest, or with a dose of sublingual glyceryl trinitrate. Unstable angina is new (usually within 24 hours) onset angina, or abrupt deterioration in previously stable angina, often occurring at rest. Unstable angina usually requires immediate admission, or referral

2015 NICE Clinical Knowledge Summaries

3942. Analgesia - mild-to-moderate pain: Scenario: Weak opioids

— it is associated with a two-fold to three-fold increased risk of hospitilization due to hyponatraemia compared to codeine. Basis for recommendation Adverse effects The information on adverse effects is based on the manufacturers' Summaries of Product Characteristics [ ; ; ], a reference textbook Martindale: the complete drug reference [ ], the British National Formulary [ ] and a pharmaceutical database, [ ]. Dependence and tolerance The information on dependence is based on a Medicines and Healthcare products (...) products Regulatory Agency in the guidance Advice from the CSM Expert Working Group on analgesic options in treatment of mild-to-moderate pain [ ]. The recommendations for both ultra rapid and poor codeine metabolizers are based on expert opinion in Guidelines for Cytochrome P450 2D6 Genotype and Codeine Therapy: 2014 Update issued by the Clinical Pharmacogenetics Implementation Consortium [ ]. Use of tramadol in adults In 2013, the Advisory Council on the Misuse of Drugs called for tramadol

2015 NICE Clinical Knowledge Summaries

3943. Analgesia - mild-to-moderate pain: Scenario: Aspirin

[ ] and the expert opinion in the text book Medical Pharmacology at a glance [ ]. The dose required for analgesia causes intolerable gastrointestinal adverse effects in many people [ ]. Many healthcare professionals prefer treatment with other anti-inflammatory drugs which are likely to be better tolerated [ ]. Dose of aspirin The dosage information is taken from the BNF [ ]. What are the cautions and contraindications for aspirin? Do not prescribe aspirin to : People with: A history of true hypersensitivity (...) . For more information on breastfeeding and aspirin, contact the Drugs in Lactation Advisory Service on 0121 311 1974. Basis for recommendation Pre-conception CKS found no studies of the effect of aspirin on conception rates. The recommendation to avoid analgesic doses of aspirin if the woman is having difficulty conceiving has been extrapolated from advice issued by the Committee on Safety of Medicines regarding nonsteroidal anti-inflammatory drugs (NSAIDs). Pregnancy These recommendations are based

2017 NICE Clinical Knowledge Summaries

3944. Anaemia - B12 and folate deficiency: What are the signs and symptoms of vitamin B12 or folate deficiency anaemia?

of cutaneous sensation. Loss of mental and physical drive. Muscle weakness. Optic neuropathy. Psychiatric disturbances – these range from mild neurosis to severe dementia. Symmetrical neuropathy affecting the legs more than the arms — this usually presents with ataxia or paraesthesia. Urinary or faecal incontinence. Basis for recommendation This information is based on expert opinion in medical textbooks, Hoffbrand's essential haematology [ ] , a chapter on Megaloblastic anaemia and miscellaneous (...) deficiency anaemias in Oxford textbook of medicine [ ] and a narrative review Vitamin B12 deficiency [ ]. © .

2018 NICE Clinical Knowledge Summaries

3945. Amenorrhoea: How should I assess for an underlying cause of primary amenorrhoea?

of a vagina and uterus cannot be confirmed by physical examination, or in place of a pelvic examination in young girls who are not sexually active). Serum prolactin. Do not examine the breasts before taking blood for prolactin levels, as this may then be falsely elevated. If the breasts have been examined, delay the blood test for at least 48 hours. Thyroid-stimulating hormone. Follicle-stimulating hormone and luteinizing hormone. Total testosterone (if there are features of androgen excess). Other (...) ] of the pituitary fossa is required). Causes include pituitary adenoma, empty sella syndrome, hypothyroidism, and drugs (including antipsychotics [particularly risperidone], antidepressants [particularly selective serotonin reuptake inhibitors], and antiemetics [such as metoclopramide or domperidone]). If prolactin levels are mildly elevated (for example 500–1000 mIU/L, normal range less than 500 mIU/L), it should be repeated before referral. The most likely causes of mild hyperprolactinaemia in primary care

2018 NICE Clinical Knowledge Summaries

3946. Antenatal care - uncomplicated pregnancy: Scenario: Antenatal care - uncomplicated pregnancy

appointments are sufficient for a parous woman (who has borne at least one viable offspring — usually after 24 weeks). Management at each appointment varies depending on the stage of the pregnancy. How should I manage a woman at first contact? Identify women who: May need . Refer to a specialist as appropriate. Are taking any medication (including over-the-counter drugs). If necessary, arrange for an immediate medication review. If you are unsure about the safety of a medication during pregnancy, contact (...) moderate exercise during pregnancy. There is no evidence that a moderate course of exercise during pregnancy is associated with adverse outcomes. To avoid sports that may cause abdominal trauma (for example vigorous racquet sports), falls, or excessive joint stress. Scuba diving should be avoided as it has been associated with an increased risk of birth defects and fetal decompression disease. What advice can I give regarding use of medicines and complementary therapies during pregnancy? Advise

2019 NICE Clinical Knowledge Summaries

3947. Anaemia - iron deficiency: When should I consider a diagnostic trial of iron treatment?

a response to treatment, see . Basis for recommendation These recommendations are based on the British Society of Gastroenterology Guidelines for the management of iron deficiency anaemia [ ], the British Journal of Haematology UK guidelines on the management of iron deficiency in pregnancy [ ], expert opinion including a chapter on Iron metabolism and its disorders in a medical textbook Oxford textbook of medicine [ ], review articles Iron deficiency in pregnancy, obstetrics, and gynecology [ ], Iron (...) deficiency anemia: evaluation and management [ ] and Investigating microcytic anaemia [ ]. A therapeutic trial of oral iron for 3 weeks is less invasive than other tests and may aid diagnosis, but depends on compliance [ ]. A trial of iron therapy is both diagnostic and therapeutic. In pregnant women with no haemoglobinopathy it should be considered as the first-line diagnostic test for normocytic or microcytic anaemia, which can be assumed to be caused by iron deficiency until proven otherwise

2018 NICE Clinical Knowledge Summaries

3948. Anaemia - iron deficiency: What investigations should I arrange to confirm iron deficiency anaemia?

deficiency anaemia: assessment, prevention, and control [ ], the British Society of Gastroenterology Guidelines for the management of iron deficiency anaemia [ ], the British Journal of Haematology UK guidelines on the management of iron deficiency in pregnancy [ ], the British Columbia Medical Association (BCMA) guideline Iron deficiency: investigation and management [ ], expert opinion in medical textbooks including chapters on Blood disorders specific to pregnancy [ ] , and Iron metabolism and its (...) disorders [ ] in the Oxford textbook of medicine , a chapter on Haematology in the Oxford handbook of clinical medicine [ ] a chapter on Iron deficiency anaemia in the ABC of clinical haematology [ ], and review articles Iron deficiency in pregnancy, obstetrics, and gynecology [ ], Interpreting iron studies [ ], Best practice in primary care pathology: review 3 [ ] Iron Deficiency anemia: evaluation and management [ ] and Iron deficiency anaemia [ ]. Measuring ferritin levels Iron deficiency should

2018 NICE Clinical Knowledge Summaries

3949. Blackouts: How do I diagnose the underlying cause of a blackout?

. Note: potential underlying causes for orthostatic hypotension include treatment with alpha-blockers, diuretics, tricyclic antidepressants, antihypertensives (particularly diuretics), levodopa or dopaminergic agonists, volume depletion, physical deconditioning due to prolonged bed rest, diseases causing peripheral neuropathy (such as diabetes mellitus), Parkinson's disease, or Lewy body dementia. Polypharmacy with antihypertensive and antidepressant medicines is often the cause of orthostatic (...) clinically that this is CAD, then the patient should be admitted for specialist review. Cardiac arrhythmia — suggested by history of CAD, use of medicines that promote atrioventricular block or Torsades de Pointes, and/or history of Wolff-Parkinson-White syndrome, long QT syndrome, or Brugada syndrome. Abnormalities including ventricular arrhythmia (including ventricular ectopic beats) or sustained atrial arrhythmia may be seen on ECG. Pulmonary embolism — suggested by dizziness, shortness of breath

2019 NICE Clinical Knowledge Summaries

3950. Microhematuria: AUA/SUFU Guideline

Recommendation; Evidence Level: Grade C) Initial Evaluation 3. In patients with microhematuria, clinicians should perform a history and physical examination to assess risk factors for genitourinary malignancy, medical renal disease, gynecologic and non-malignant genitourinary causes of microhematuria. (Clinical Principle) 4. Clinicians should perform the same evaluation of patients with microhematuria who are taking antiplatelet agents or anticoagulants (regardless of the type or level of therapy (...) dipstick test (trace blood or greater) should prompt UA with microscopic evaluation, but should not be used alone to diagnose MH. Close Initial Evaluation Guideline Statement 3 3. In patients with microhematuria, clinicians should perform a history and physical examination to assess risk factors for genitourinary malignancy, medical renal disease, gynecologic and non-malignant genitourinary causes of microhematuria. (Clinical Principle) × Discussion A detailed history and physical examination should

2020 American Urological Association

3951. Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Joint Guideline

For Medical Students Exams/LLL/Certifications Exam Prep Global Academic Exchanges Membership 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 Practice Resources Coding and Reimbursement Practice Managers' Network (PMN) Patient Safety and Quality of Care Accreditations and Reporting (...) Patient Education Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Joint Guideline (2020) AUA/SUO Joint Guideline: Published 2016; Amended 2020 Diagnosis and Treatment of Non-Muscle Invasive Bladder Cancer: AUA/SUO Guideline provides a risk-stratified clinical framework for the management of non-muscle invasive bladder cancer. Diagnosis and use of urine markers is discussed in addition to variant histologies, resection, intravesical therapy, BCG therapy, cystectomy, enhanced

2020 American Urological Association

3952. Disorders of Ejaculation: An AUA/SMSNA Guideline

prior sexual experience during penetrative sex. (Expert Opinion) Clinicians should assess medical, relationship, and sexual history and perform a focused physical exam to evaluate a patient with premature ejaculation. (Clinical Principle) Clinicians may use validated instruments to assist in the diagnosis of premature ejaculation. (Conditional Recommendation; Evidence Level: Grade C) Clinicians should not use additional testing for the evaluation of a patient with lifelong premature ejaculation (...) Medicine developed new terminology for lifelong and acquired DE. Lifelong, alternatively classified as primary, delayed ejaculation was defined as a lifelong experience or inability to ejaculate in all of almost all (75%-100%) occasions of coital activity, associated with distress. Voluntary cessation of coital activity may subsequently occur after a variable time to avoid frustration, physical exhaustion, or genital irritation of self or partner. Men with lifelong DE might or might not be able

2020 American Urological Association

3953. Intracytoplasmic sperm injection (ICSI) for non–male factor indications: a committee opinion

Intracytoplasmic sperm injection (ICSI) for non–male factor indications: a committee opinion Intracytoplasmic sperm injection (ICSI) for non–male factor indications: a committee opinion Practice Committees of the American Society for Reproductive Medicine and the Society for Assisted Reproductive Technology American Society for Reproductive Medicine and Society for Assisted Reproductive Technology, Birmingham, Alabama Intracytoplasmicsperminjection (...) Steril 2020;114:239–45.2020 by American Society for Reproductive Medicine.) El resumen está disponible en Español al ?nal del artículo. Discuss: You can discuss this article with its authors and other readers at https://www.fertstertdialog.com/users/16110-fertility- and-sterility/posts/30600 I ntracytoplasmic sperm injection (ICSI) was introduced in 1992 to improve fertilization in couples with male factor infertility undergoing in vitro fertilization (IVF) or in couples with fertilization failure

2020 Society for Assisted Reproductive Technology

3954. Cryostorage of reproductive tissues in the in vitro fertilization laboratory: a committee opinion

Cryostorage of reproductive tissues in the in vitro fertilization laboratory: a committee opinion Cryostorage of reproductive tissues in the in vitro fertilization laboratory: a committee opinion PracticeCommitteesoftheAmericanSocietyforReproductiveMedicine,SocietyforReproductiveBiologists and Technologists, and Society for Assisted Reproductive Technology American Society for Reproductive Medicine, Birmingham, Alabama (...) Society for Repro- ductive Medicine.) Discuss: You can discuss this article with its authors and other readers at https://www.fertstertdialog.com/users/16110-fertility- and-sterility/posts/30748 C ryostorage tanks are cylindrical stainless-steel or aluminum containers with multilayered insulated sides. The vacuum between the insulated layers prevents boiling and minimizes loss of liquid nitrogen (LN 2 ), allowing the tank to sustain LN 2 at a nearly steady rate. When sub- merged in LN 2

2020 Society for Assisted Reproductive Technology

3955. Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline

. Multidisciplinary nature of treatment in today’s advanced prostate cancer care paradigm As the therapeutic landscape evolves to include increasingly complex combinations of systemic therapies with or without local therapies, advances in imaging, and germline and somatic genetic testing, treating men with advanced prostate cancer is increasingly one that must embrace multidisciplinary management approaches. Team members should include urologists, medical oncologists, and radiation oncologists at a minimum when (...) Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline Advanced Prostate Cancer: AUA/ASTRO/SUO Guideline - American Urological Association advertisement Toggle navigation About Us 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

2020 American Urological Association

3956. Clinical management of mosaic results from preimplantation genetic testing for aneuploidy (PGT-A) of blastocysts: a committee opinion

Clinical management of mosaic results from preimplantation genetic testing for aneuploidy (PGT-A) of blastocysts: a committee opinion Clinical management of mosaic results from preimplantation genetic testing for aneuploidy (PGT-A) of blastocysts: a committee opinion Practice Committee and Genetic Counseling Professional Group (GCPG) of the American Society for Reproductive Medicine American Society for Reproductive Medicine, Birmingham, Alabama (...) with intermediate copy number results. This document does not endorse, nor does it suggest that PGT-A is appropriate for all cases of in vitro fertilization. (Fertil Steril 2020;114:246–54.2020 by American Society for Reproductive Medicine.) Key Words: Preimplantation genetic testing for aneuploidy, assisted reproductive technology, mosaicism, infertility, aneuploidy Discuss: You can discuss this article with its authors and other readers at https://www.fertstertdialog.com/users/16110-fertility- and-sterility

2020 Society for Assisted Reproductive Technology

3957. Chronic obstructive pulmonary disease: Scenario: Stable chronic obstructive pulmonary disease

to use it. Warn people using nebulized bronchodilators that it is dangerous to exceed the prescribed dose, and that they must seek medical advice if there is no response to their usual dose — doses of bronchodilators given by nebulization are usually much higher than from inhalers. Use a nebuliser system that is known to be efficient and offer a choice between a facemask and a mouthpiece to administer therapy, unless the drug specifically requires a mouthpiece (for example, anticholinergic drugs (...) a trial of short-acting and long-acting bronchodilators, or for people who cannot use inhaled therapy — consider discussing with a respiratory specialist. Plasma levels and interactions must be monitored and doses adjusted appropriately. Particular caution is required if prescribing theophylline to older people due to differences in pharmacokinetics, increased incidence of comorbidities and interactions with multiple other medications. If prescribed, assess effectiveness of theophylline

2019 NICE Clinical Knowledge Summaries

3958. Chronic obstructive pulmonary disease: Diagnosis of chronic obstructive pulmonary disease

-term oxygen therapy/home noninvasive ventilation; multimorbidity; and frailty should be taken into account. Use of multidimensional indices (such as BODE) should not be used to assess prognosis as they are unreliable and time-consuming [ ]. Examination Clinical signs of COPD may not develop until lung function becomes severely impaired – absence of physical signs does not exclude a diagnosis of COPD [ ; ]. Pulse oximetry should not be used as a diagnostic tool but can be helpful in determining (...) of COPD on wellbeing and daily life can be assessed using the COPD Assessment test (CAT) — available in the . Previous exacerbations or hospitalization. Past medical history and comorbidities including: Anxiety and depression. Cardiovascular disease and metabolic syndrome. Lung or liver disease. Osteoporosis. Asthma. Family history including: Lung or liver disease – consider such as alpha-1 antitrypsin deficiency. Examine the person: Carry out a general examination including vital signs (such as heart

2020 NICE Clinical Knowledge Summaries

3959. Child maltreatment - recognition and management: Scenario: Managing a child or young person where maltreatment is suspected or considered

to keep abreast of changes. Record in the child or young person's clinical record exactly what is observed and/or heard, from whom, and when. Document all your concerns including any considered minor, and decisions you have made/actions you have taken relating to those concerns, such as information you have shared or reasons for not sharing information. If a girl or young woman tells you they have experienced female genital mutilation (FGM), or you observe physical signs of FGM, you must report (...) at some SARCS (check local availability), or can be arranged through a genito-urinary medicine (GUM) clinic. A general examination may be appropriate to assess the person's general health and to look for other injuries. If there are features that have led you to consider child maltreatment: Look for other alerting features in the child or young person's history, presentation, or interactions with their parents or carers, now or in the past. Discuss your concerns with a more experienced colleague

2018 NICE Clinical Knowledge Summaries

3960. Child maltreatment - recognition and management

of presentation to healthcare services most commonly due to injuries, either inflicted or due to inadequate supervision. Less commonly, this may occur due to fabricated or induced illness. Unusual or marked change in the child's behaviour or emotional state, different from what is expected for their age and developmental stage, and not explained by a medical condition, neurodevelopment disorder or stressful situation (outwith the maltreatment). Injury or injuries with features suggestive of physical or sexual (...) : Summary Child maltreatment includes any type of abuse or neglect of a child/young person caused by inflicting harm or by failing to act to prevent harm. It can be classified as physical, sexual, or emotional abuse, neglect, and fabricated or induced illness. Physical abuse involves causing physical harm to a child such as shaking, hitting, throwing, burning, or suffocating. Sexual abuse involves forcing or tempting a child to take part in sexual activities. Emotional abuse includes conveying

2018 NICE Clinical Knowledge Summaries

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