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4081. Multiple Sclerosis and Urinary Tract Infection

SUGGESTED CITATION Toward Optimized Practice (TOP) Working Group for Multiple Sclerosis and UTI. 2013 Nov. Multiple sclerosis and management of urinary tract infection: clinical practice guideline. Edmonton, AB: For more information see GUIDELINE COMMITTEE The committee consisted of representatives from family medicine, neurology, internal medicine, infectious disease, urology, medical microbiology and pharmacy. November 2013 2017 minor revision MS and Management of UTI (...) immediately after obtaining the urine sample and stopped only if the results are fully negative, i.e., no nitrites, leukocytes, blood, WBC, RBC or bacteria ? Start antibiotic therapy immediately after urine sample is collected. (See Appendix A) and determine treatment based on patient history and presentation) ? Tell patient to phone back if not feeling better within 48-72 hours, or sooner if symptoms worsen X Do not use a urine dipstick X Do not wait for urine culture results to start antibiotics. Treat

2017 Accelerating Change Transformation Team

4082. Guidance for Members on Driving and Pain

With Chronic Pain. Physical Medicine and Rehabilitation 2012; 4: 87-95 7. Hetland A, Carr DB. Medications and Impaired Driving: A Review of the Literature. Ann Pharmacother 2014; 48(4): 494- 506. 8. Effects of medicinal drugs on actual and simulated driving. DRUID 6 th Framework Programme, 2011. http://www.dru - 9. Psychomotor relevant performance: 1. After single dose administration of opioids….to drug naïve (...) of impairment: o When commencing a new pain medicine o When increasing or reducing the dose o When another drug is added that may affect driving ability o When medication is taken in conjunction with alcohol • Patients should be warned that even if they do not feel impaired, they are more likely to suffer a road traffic accident if they are taking medication such as strong opioids. • Patients should be advised to be especially careful driving when they are more at risk of an accident, such as driving

2017 Faculty of Pain Medicine

4083. Headache

- programs/hta/aagap/headache) may be helpful to monitor the effect of prophylactic therapy. If multiple trials of prophylactic drug monotherapy have not been successful, preventive drug combinations and/or referral to a headache specialist should be considered. ? Indications for Migraine Preventive Medication Consider migraine pharmacological prophylactic therapy in the following situations: 1. Recurrent migraine attacks are causing significant disability despite optimal acute drug therapy. Prophylaxis (...) /research-programs/hta/aagap/headache. 4. When starting prophylaxis, evaluate the patient for the presence of acute medication overuse. 5. For most prophylactic drugs, initiate therapy with a low dose and increase the dosage gradually to minimize side effects. 6. Increase the dose until the drug proves effective, until dose-limiting side effects occur, or a target dose is reached. 7. Provide an adequate drug trial. Unless side effects mandate discontinuation, continue the prophylactic drug for at least

2016 Accelerating Change Transformation Team

4084. Erectile Dysfunction

A APPENDIX A Presence of sexual problems? • Detailed medical, sexual, and social history • Focused physical examination • Laboratory evaluation screening for: - Unrecognized systemic diseases (see Table 1) - Testosterone • Treat associated medical conditions • Modify medication regimen Psychogenic cause likely Persistent erectile dysfunction? Erectile Dysfunction Algorithm Yes Neurogenic or Vasculogenic cause likely Trial of therapy (education, PDE5 inhibitors Consider sex therapy/psychiatric referral (...) Recommendations Medications Linked to ED 1 Drug Class Agents Diuretic Thiazides, spironolactone Antihypertensive drugs Calcium-channel blockers, beta-blockers, methyldopa, clonidine, reserpine, guanethidine Cardiac or cholesterol drugs Digoxin, gemfibrozil, clofibrate Antidepressants Selective serotonin-reuptake inhibitors, tricyclic antidepressants, lithium, monoamine oxidase inhibitors Tranquilizers Butyrophenones, phenothiazines H2 antagonists Ranitidine, cimetidine Hormones Progesterone, estrogens

2016 Accelerating Change Transformation Team

4085. Cervical Cancer Screening

informed decisions about cervical cancer screening. ? Use electronic medical records (EMRs) to track and flag patients due/overdue for screening in order to offer screening opportunistically. ? Utilize the support and services offered by the ACCSP to improve appropriate screening and increase screening rates for those un/under-screened. INCREASED RISK SURVEILLANCE ? For women who have ever had: Surveillance Recommendations • Biopsy confirmed high-grade squamous intra epithelial lesions (HSIL (...) to represent a serious abnormality, putting these young women at risk of over-diagnosis and over-treatment. Furthermore, harms have not been measured as well as benefits until recently. Such harms include: 1. Inconvenience, discomfort and embarrassment that women feel from attending for Pap tests, and having uncomfortable bimanual examinations 2. Physical and psychological impact of being informed about an abnormal test, and according to the abnormality, being asked to undergo repeat testing, referral

2016 Accelerating Change Transformation Team

4086. Uterus Transplantation Intersociety Roundtable

Uterus Transplantation Intersociety Roundtable 1 Uterus Transplantation Intersociety Roundtable Chicago, Illinois April 21, 2016 Summary A Roundtable to discuss the development of uterus transplantation in the United States was convened under the sponsorship of the American Society for Reproductive Medicine (ASRM) in collaboration with the American Society of Reconstructive Transplantation (ASRT) on April 21, 2016, in Chicago, Illinois. Invitees included the leadership of the major professional (...) collaborative effort among many different subspecialists encompassing obstetric and gynecologic surgery, reproductive medicine, traditional transplant surgery and medicine, organ procurement organizations (OPOs), and a host of supporting subspecialists. Professional societies in these various subspecialties play a crucial role in shaping best practices, endorsing and supporting responsible innovations, insisting on professional standards, and providing a forum for education and open display of results

2016 Society for Assisted Reproductive Technology

4087. Depression in Multiple Sclerosis

fatigue). ? Consider any drug interactions with all other medications prescribed for the patient. o MS-specific medications are not generally more problematic with respect to drug interactions with certain anti-depressants. See Table 2 in Appendix B for common MS medications and considerations if prescribing an antidepressant. Identification and Management of Depression in MS | December 2015 Clinical Practice Guideline Page 3 of 20 Recommendations ? Manage depression as usual for patients taking (...) interferon ß. ? Discuss antidepressant options with patient. Decision-making should be shared between patient and provider. ? Ask about recreational drug and alcohol use as it may affect antidepressant effectiveness and adherence. NON-PHARMACOTHERAPY PRACTICE POINT Primary care providers should inquire about cognitive behavioural therapy (CBT) and other mental health services within their own PCN if applicable. Many PCNs have excellent resources for patients. ? Recommend cognitive behavioural therapy

2015 Accelerating Change Transformation Team

4088. Adult Insomnia

acute insomnia only if there is a substantial negative impact on daytime performance. ? Intervene early and suggest behavioral therapy such as cognitive behavioural therapy - insomnia (CBT-I). ? Consider using short term (e.g., two weeks) pharmacotherapy with close follow-up based on the severity and urgency of the presentation. ? Start medication at same time as CBT-I. ? Follow-up to monitor progress in two to four weeks. This timeframe is suggested and realistic for acute insomnia follow-up (...) patients with physical or mental health issues. BENZODIAZEPINES (BZDS) ? Use of BZDs during pregnancy remains controversial at this time. ? If a BZD must be prescribed, lorazepam is preferred during pregnancy and lactation. OTHER MEDICATIONS ? Limit use of non-benzodiazapine hypnotics (zopiclone, zaleplon, and zolipdem) or use with caution. ANTIDEPRESSANTS ? If an antidepressant is required, nortriptyline is considered safe for use in pregnancy. ? Consider trazodone for reducing sleep-onset latency

2015 Accelerating Change Transformation Team

4089. Urinary Tract Infection - Long Term Care Facilities

status is deteriorating rapidly and antibiotics need to be initiated prior to receiving C&S results: o Select a narrow spectrum antibiotic for empiric therapy as per Bugs & Drugs o Promptly review C&S results and alter empiric antimicrobial therapy, if indicated o STOP ANTIBIOTICS if C&S results are not consistent with diagnosis of UTI. ? Consider an alternate diagnosis if symptoms do not improve within 48 hours following initiation of appropriate antibiotic therapy. ? If the resident’s medical (...) /min because drug levels in the bladder may not reach sufficient concentrations to be effective and incidence of adverse effects is higher in those with decreased renal function. Repeat C&S after initiation or completion of antibiotic therapy is NOT necessary unless typical UTI signs and symptoms persist (after 48-72 hours of starting treatment) or recur. There is no need to check for a microbiological cure. This applies to complicated UTI as well. SPECIMEN COLLECTION Correct specimen collecting

2015 Accelerating Change Transformation Team

4090. Clinical Competence in Myocardial Perfusion Scintigraphic Stress Testing

within the trainees department. Typical theoretical content; ? IRMER ? Responsibilities of key personnel in the context of the regulations ? Duties and responsibilities of the employer, operator, practitioner and medical physics expert in the context of the regulations Basic qualifications and experience to practice Training in radiation protection 8 ? Justification, authorisation and optimisation of nuclear medicine exposures ? Ionising radiation, interactions, dose quantities ? Patient management (...) part of the procedure. This firstly provides information from which to determine whether a test is beyond the stressors’ skills and therefore whether medical assistance is necessary. Secondly, it also provides details that guide a safe and effective procedure for each individual patient (5, 10). Non-medical professionals already use physical assessment to diagnose conditions in other settings such as rapid access chest pain clinics, preoperative assessment units, and diagnostic outpatient clinics

2016 British Nuclear Medicine Society

4091. DOVE - Doctors Opposing Violence Everywhere

problem that receives far less attention than many uncommon medical disorders. The terrible physical impact of violence is often exceeded by long lasting psychological effects. The purpose of this guideline is to help physicians understand the mechanisms underlying violence and to increase confidence in the identification and management of health problems associated with violence. Further, the guideline will outline the professional and legal expectations of clinicians and highlight the connections (...) to 24 years. Based on police-reported data, over half (51%) of victims of intimate partner violence suffered physical injuries requiring medical treatment. 7 On average, every six days a woman in Canada is killed by her intimate partner. In 2011, from the 89 police reported spousal homicides, 76 of the victims (over 85%) were women. 5 RECOMMENDATIONS The clinical role can be summarized by the “three Rs” – Recognize, Relate and Refer. The key to understanding the clinical role lies in the nuances

2015 Accelerating Change Transformation Team

4092. Osteoporosis

of treatment for increased fracture risk. OST NEGATIVE >10 LOW RISK FOR OSTEOPOROSIS ? Offer prevention strategies only. OST POSITIVE ( -1.5 reassessing BMD at intervals 10% TO >20% ? Offer medication. ? Inform patient of the benefit (~30% relative reduction in fracture) and the risks of each type of medication. (See Table 1: Therapy and Adverse Effects.) ? Discuss the risks and benefits of medication options and assist the patient in making an informed decision regarding medication use. ? Do not re-assess (...) BMD within the first five years of therapy for patients who opt to initiate medication therapy. Diagnosis and Management of Osteoporosis | February 2016 Clinical Practice Guideline Page 5 of 17 Recommendations Therapy Possible Adverse Effects IV bisphosphonate: zoledronic acid (Aclasta®). Self-limiting flu like symptoms after first dose Oral bisphosphonates: alendronate (Fosamax ®), risedronate (Actonel ®), etidronate (Didrocal ®). Also available are: Actonel DR™, Fosavance® (Fosamax® with vitamin

2016 Accelerating Change Transformation Team

4093. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

, wallet) in a central, consistent location. X Avoid high intensity or multisensory situations or events. Autonomic ? Manage as per usual care. Neuroendocrine ? Manage as per usual care. Immune ? Consider anti-parasitics or antiviral therapy where pathogen(s) can be confirmed by testing. Sensitivity to chemicals and drugs ? Patients with ME/CFS often have increased sensitivity to food, chemicals and medications and should avoid these irritants. There is no special diet for ME/CFS. ? Workplace (...) of the sleep disturbing and sedating effects of alcohol, its use should be avoided or minimized. COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) Like patients with other medical conditions without an evidence based treatment, patients with ME/CFS are vulnerable to trying expensive, non-established and speculative treatments in hope of a cure. A review of the evidence of such therapies revealed generally poor methodologies and little if any evidence of benefit. Equivocal evidence was found for traditional

2016 Accelerating Change Transformation Team

4094. Radionuclide Cardiac Ventriculogram

and evaluation methods: quantitative estimation of global and regional LVEF, visual assessment of cine images (e.g. evaluation of the presence and extent of regional dysfunction) and visual assessment of amplitude & phase parametric images. The guideline is suitable for several referral criteria, including the evaluation of cardiac function in patients undergoing cardiotoxic drug therapy (e.g. chemotherapy). There will not be detailed coverage of the following aspects of gated cardiac blood pool imaging (...) dynamic 1. Introduction 3 vascular structures in some projections, quantitative analysis can only be carried out in an LAO projection. However, other projections may be acquired for qualitative assessment of motion on walls which are not observable on the LAO view. The writing group consisted of medical and scientific staff experienced in radionuclide cardiac ventriculograms. Members of the British Nuclear Cardiology Society (BNCS) committee, British Nuclear Medicine Society (BNMS) Professional

2016 British Nuclear Medicine Society

4095. Pneumonia: Nursing Home Acquired

For residents being transferred to hospital, administer a dose of antibiotics prior to transfer. CONTINUING MANAGEMENT In the LTCF setting, successful management of NHAP includes reassessing patients daily including monitoring and documentation of vital signs. The entire care team should be involved (physicians, nurses, pharmacists, dieticians, healthcare aides, occupational therapy and physiotherapy staff) to monitor medical status, food and fluid intake, response to antibiotics and physical and mental (...) . ? Select empiric antibiotic therapy for NHAP according to recommendations in Bugs & Drugs 1,2 as microbiologic diagnosis of NHAP has significant limitations X DO NOT prescribe antibiotics for viral respiratory infections or for the prevention of NHAP. Inappropriate use of antibiotics leads to adverse patient outcomes and preventable increases in antimicrobial resistance in pathogenic and commensal bacterial flora. ? Provide oxygen therapy if O2 saturation is 40 bpm o Pulse >125 bpm o Systolic blood

2015 Accelerating Change Transformation Team

4096. Occupational Asthma

-profit, grant awarding charity established in 1991 to contribute to the best possible physical and mental well-being of workers. Our mission: 'Bringing employers and researchers together to produce research that will contribute to good employee health and performance at work'. BOHRF raises and deploys funds for occupational health research of practical value and practical guidelines based on evidence to reduce the enormous cost to employers and workers of work-related illnesses in the UK. SUGGESTED (...) . Identification and evaluation of a worker presenting with respiratory symptoms 50 D. Management of the worker confirmed to have occupational asthma 62 References 72 2 G U I D E L I N E D E V E L O P M E N T G R O U P S 2009 - 2010 Dr P J Nicholson (Chairman) Faculty of Occupational Medicine / Society of Occupational Medicine Mrs C Boyle (Scientific Secretary) Health & Safety Executive Professor P S Burge Birmingham Heartlands Hospital / Birmingham University Professor P Cullinan National Heart & Lung

2010 British Occupational Health Research Foundation

4097. Management of Acute ST Segment Elevation Myocardial Infarction (STEMI) – (4th Edition)

in 2007 and 2014 respectively. Rapid developments have taken place, especially in the area of pre-hospital care. This 4th edition was developed to provide a clear and concise approach based on current evidence with the focus being on efforts to reduce the time from first medical contact, improve pre-hospital care as well support the application of guideline-directed therapies. This CPG has been prepared by a panel of committee members from the National Heart Association of Malaysia (NHAM) and Ministry (...) Physician and Head, Department of Medicine, Hospital Melaka Dr Keshab Chandran Nair General Practitioner, Klinik Anis, 17, Jalan Bunga Melur 2/18, Section 2, 40000 Shah Alam Dr Liew Houng Bang Consultant Cardiologist, Hospital Queen Elizabeth II Dr Mastura Hj Ismail Family Medicine Specialist, Klinik Kesihatan Seremban 2 Dr Ong Tiong Kiam Consultant Cardiologist, Sarawak Heart Centre Dr Pearl Leong Yuet Mae President, Private Medical Practitioners Association of Selangor and KL Pearl’s Clinic Of Care

2019 Ministry of Health, Malaysia

4098. Guidelines on Acute Pain Management

physical therapy requirements and mobilisation. Page 3 PS41 2013 4.4 Unexpected levels of pain, or pain that suddenly increases, may signal the development of a new medical, surgical or psychiatric diagnosis. 4.5 All side effects and significant complications should be recorded, as should treatment changes resulting from these issues. 5. PHARMACOLOGICAL THERAPIES 5.1 Drugs that may be used include opioids, non-steroidal anti-inflammatory drugs and local anaesthetics, as well as adjuvant agents (...) , ketamine and other drugs. 6. NON-PHARMACOLOGICAL THERAPIES 6.1 Non-pharmacological therapies must be considered as complementary to pharmacological therapies. 6.2 Psychological interventions, acupuncture, transcutaneous electrical nerve stimulation and physical therapy may be effective in some acute pain settings. Page 4 PS41 2013 7. ACUTE PAIN SERVICES 7.1 A multidisciplinary approach to the management of acute pain, such as with an acute pain service, can lead to improved pain relief, patient

2015 Australian and New Zealand College of Anaesthetists

4099. NZSHS Syphilis in Pregnancy Guideline

treated, or treatment inadequately documented • Maternal syphilis treated but with inadequate follow-up or without a satisfactory 4-fold drop in RPR titre • Treatment of syphilis in pregnancy with a non-penicillin regimen including ceftriaxone • Treatment of the mother 1:4 (VDRL > 1:2) • Abnormal fetal ultrasound findings Infants born to mothers with syphilis and HIV require the same evaluation, therapy or follow-up as is recommended for all infants exposed to syphilis in-utero. 17 These infants (...) will require additional tests and treatment for exposure to HIV in-utero, which is outside the scope of these guidelines. Physical signs of early congenital syphilis The majority of neonates with congenital syphilis will have no signs or symptoms at the time of birth. 11,14 Many signs are also non-specific and may mimic other conditions. All neonates born to women who have had syphilis during pregnancy should be assessed at birth by a neonatologist or paediatrician. Early signs: • Hepatosplenomegaly

2020 New Zealand Sexual Health Society

4100. 2020 Adult Congenital Heart Disease (previously Grown-Up Congenital Heart Disease) (Management of) Guidelines General measures 21 Anticoagulation 21 Shunt repair 22 Pulmonary arterial hypertension-directed medical therapy 22 3.4.4 Surgical treatment 22 3.4.5 Catheter intervention 23 3.4.6 Infective endocarditis 23 3.4.7 Antithrombotic treatment 23 3.4.8 Management of cyanotic patients 23 Adoptive mechanisms 24 Multisystem disorder 24 Clinical presentation and natural history 24 Late complications 24 Diagnostic aspects 24 (...) Laboratory precautions 25 Indications for intervention 25 Medical therapy 25 Follow-up recommendations 25 Additional considerations 26 3.5 Additional considerations 26 3.5.1 Sex differences 26 3.5.2 Adult congenital heart disease at more advanced age 26 3.5.3 Advance care planning and end-of-life care 26 3.5.4 Insurance and employment 26 3.5.5 Exercise and sports 27 3.5.6 Non-cardiac surgery 27 3.5.7 Pregnancy, contraception, and genetic counselling 27 Pregnancy

2020 European Society of Cardiology


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