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61. Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU Full Text available with Trip Pro

, Delirium , Immobility ( mobilization /rehabilitation), and Sleep (disruption). Each section created Population, Intervention, Comparison, and Outcome, and nonactionable, descriptive questions based on perceived clinical relevance. The guideline group then voted their ranking, and patients prioritized their importance. For each Population, Intervention, Comparison, and Outcome question, sections searched the best available evidence, determined its quality, and formulated recommendations as “strong (...) ,” “conditional,” or “good” practice statements based on Grading of Recommendations Assessment, Development and Evaluation principles. In addition, evidence gaps and clinical caveats were explicitly identified. Results: The Pain , Agitation/ Sedation , Delirium , Immobility ( mobilization /rehabilitation), and Sleep (disruption) panel issued 37 recommendations (three strong and 34 conditional), two good practice statements, and 32 ungraded, nonactionable statements. Three questions from the patient-centered

2018 Society of Critical Care Medicine

62. Is the use of chlorhexidine contributing to increased resistance to chlorhexidine and/or antibiotics?

health care settings including acute care, residential aged care, paediatric, neonatal and primary care and rehabilitation as well as the laboratory setting. All forms of use of chlorhexidine in humans and all different exposures (dosage form, duration, stratification of exposure) across different settings. 1. ‘Chlorhexidine Resistance’ (with definition / measures used) to chlorhexidine established. 2. A specific intervention identified as contributing to resistance to Chlorhexidine in a specific (...) Population and setting Intervention Outcome Types of studies Qu. 2 All patients (isolates) / participants (isolates) including children and adults in different health care settings including acute care, residential aged care, paediatric, neonatal and primary care and rehabilitation as well as the laboratory setting All forms of use of chlorhexidine in humans and all different exposures (dosage form, duration, stratification of exposure) across different settings. 1. ‘Resistance against antibiotics

2018 National Health and Medical Research Council

63. Optimization of Heart Failure Treatment

doses or maximally tolerated doses, patients with chronic HFrEF should be evaluated on a regularly scheduled basis. For most patients, a reasonableintervalisevery3to6months,althoughmany may require more frequent follow-up to monitor clinical stability and revisit opportunities for further GDMT titration. Cardiac rehabilitation is bene?cial and remains underutilized. High-risk features (conveniently summarized in the acronym “INEEDHELP” in Figure 4 and Table 6)should trigger consideration (...) have delayed the progression of disease but rarely lead to a cure, such that the palliative care needs of patients, caregivers, and healthcare systems are as great as ever. Most palliative care is provided by non- palliative care specialists. Accordingly, such clinicians shoulder the primary responsibility for coordinating an end-of-life plan consistent with values and goals expressed by patient and family. The following are TABLE 16 Common Cardiac and Noncardiac Comorbidities Encountered

2017 American College of Cardiology

64. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting Full Text available with Trip Pro

in Turner syndrome R 4.1. We recommend that an infant or child is examined with transthoracic echocardiography (TTE) at the time of diagnosis, even if the fetal echocardiogram or postnatal cardiac examination was normal (⨁⨁◯◯). R 4.2. We recommend that girls or women with aortic dilatation and/or bicuspid aortic valve be counseled to seek prompt evaluation if they are experiencing acute symptoms consistent with AoD, such as chest, neck, shoulder, back or flank discomfort, particularly if it is sudden (...) recommend a formal audiometric evaluation every 5 years regardless of the initial age at diagnosis, initial hearing threshold levels, karyotype and/or presence of a mid-frequency sensorineural hearing loss, to assure early and adequate technical and other rehabilitative measures (⨁⨁◯◯). R 6.2. We recommend aggressive treatment of middle-ear disease and otitis media (OM) with antibiotics and placement of myringotomy tubes as indicated (⨁⨁◯◯). R 6.3. We recommend screening for hypothyroidism at diagnosis

2016 European Society of Human Reproduction and Embryology

65. Level of Care for Musculoskeletal Surgery

outside the inpatient hospital setting or is expected to be noncompliant with perioperative care (example: severe anxiety about receiving surgery in a nonhospital setting) • Functional status o Patient unable to care for individual needs o Functional impairment likely to necessitate inpatient rehabilitation after surgery (example: moderate to severe myelopathy) o Patient is at high risk for falls Note: The presence of medical and/or psychiatric comorbidities alone may not always justify an inpatient (...) Health. All Rights Reserved. Level of Care for Musculoskeletal Surgery and Procedures 12 Joint Outpatient Level of Care: Joint Surgery Historically, orthopedic hip, knee, and shoulder arthroscopic and sports medicine procedures (Figure 2) have been done on an outpatient basis. The performance of orthopedic arthroscopic and sports medicine procedures in the inpatient setting is generally considered not medically necessary. Requests to perform these procedures inpatient should be considered rare

2018 AIM Specialty Health

66. Management of stable angina

to prevent new vascular events 17 4.4 Medication concordance 18 5 Interventional cardiology and cardiac surgery 19 5.1 Coronary artery anatomy and definitions 19 5.2 Percutaneous coronary intervention 19 5.3 Coronary artery bypass grafting 21 5.4 Choice of revascularisation technique 23 5.5 Postintervention drug therapy 26 5.6 Postintervention rehabilitation 28 5.7 Managing restenosis 28 5.8 Managing refractory angina 28 6 Stable angina and non-cardiac surgery 30 6.1 Assessment prior to surgery 30 6.2 (...) recommended the following list of features to help characterise patient symptoms into typical, atypical and non-anginal pain. 16 Chest pain is: y a constricting discomfort in the front of the chest, or in the neck, shoulders, jaw, or arms y precipitated by physical exertion y relieved by rest or GTN within about five minutes. Typical angina – presence of all three features Atypical angina – presence of two of the three features Non-anginal pain – presence of one or none of the three features. 4 Management

2018 SIGN

67. Practice Parameter for Electrodiagnostic Studies in Carpal Tunnel Syndrome: Summary Statement

.] 4. American Academy of Physical Medicine and Rehabilitation, American Association of Electrodiagnostic Medicine, and American Academy of Neurology. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome summary statement). Arch Phys Med Rehab 1994; 75: 124!125. 5. American Association of Electrodiagnostic Medicine, American Academy of Neurology, American Academy of Physical Medicine and Rehabilitation. Practice parameter for electrodiagnostic studies in carpal tunnel syndrome (...) STATEMENT* AMERICAN ASSOCIATION OF ELECTRODIAGNOSTIC MEDICINE, AMERICAN ACADEMY OF NEUROLOGY, and AMERICAN ACADEMY OF PHYSICAL MEDICINE AND REHABILITATION Carpal tunnel syndrome (CTS) is a common clinical problem and frequently requires surgical therapy. The results of electrodiagnostic (EDX) studies have been found to be highly sensitive and specific for the * Ap p roved b y th e American Association of Electrodiagnostic Medicine: J anuary 2002, original document ap p roved Ap ril 1993 . Ap p roved b y

2002 American Association of Neuromuscular & Electrodiagnostic Medicine

68. Appropriate Use Criteria: Imaging of the Spine

, the request will often require a peer-to-peer conversation to understand the individual circumstances that support the medically necessity of performing all imaging studies simultaneously. Examples of multiple imaging studies that may require a peer-to-peer conversation include: ¾ CT brain and CT sinus for headache ¾ MRI brain and MRA brain for headache ¾ MRI cervical spine and MRI shoulder for pain indications ¾ MRI lumbar spine and MRI hip for pain indications ¾ MRI or CT of multiple spine levels (...) Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2005;64(2):199-207.MRI Thoracic Spine | Copyright © 2018. AIM Specialty Health. All Rights Reserved. 17 CPT Codes 72146 MRI of thoracic spine, without contrast 72147 MRI of thoracic spine, with contrast 72157 MRI of thoracic spine, without contrast, followed by re-imaging with contrast Standard Anatomic Coverage ? Entire thoracic spine (T1-T12), from the cervicothoracic region through

2018 AIM Specialty Health

69. Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions

progression of weight bearing to reach full weight bearing by 6 to 8 weeks after matrix- supported autologous chondrocyte implantation (MACI) for articular cartilage lesions. INTERVENTIONS – PROGRESSIVE RETURN TO ACTIVITY 2018 Recommendation C Clinicians may utilize early progressive return to activity following knee meniscal repair surgery. E Clinicians may need to delay return to activity depending on the type of articular cartilage surgery. INTERVENTIONS – SUPERVISED REHABILITATION 2018 Recommendation (...) B Clinicians should use exercises as part of the in-clinic super- vised rehabilitation program after arthroscopic meniscectomy and should provide and supervise the progression of a home-based exercise program, providing education to ensure independent performance. INTERVENTIONS – THERAPEUTIC EXERCISES 2018 Recommendation B Clinicians should provide supervised, progressive range-of- motion exercises, progressive strength training of the knee and hip muscles, and neuromuscular training to patients

2018 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

70. Botulinum neurotoxin for the treatment of movement disorders

context. The evidence supporting BoNT use in hemifacial spasm is suboptimal. The large magnitude of effects in the initial open label studies likely has discouraged efforts to study BoNT in properly controlled clinical trials. No studies have compared BoNT with the other major treatment alternatives, including oral pharmacologic and surgical therapy. Cervical dystonia. Cervical dystonia (CD) is a focal dystonia causing involuntary activation of the muscles of the neck and shoulders resulting (...) in abnormal, sustained, and painful posturing of the head, neck, and shoulders. There are limited data assessing oral medications for cervical dystonia. Recent surgical studies, including deep brain stimulation, show promise. Out of approximately 80 studies of BoNT in the treatment of CD, 14 controlled studies were identified, including seven Class I studies (four with BoNT-A, three with BoNT-B) (table e-3). Botox® and Myobloc® are FDA approved for use in CD. Three Class I studies enrolled BoNT-naïve CD

2008 American Academy of Neurology

71. Clinical Guideline on the Treatment of Carpal Tunnel Syndrome

postoperatively after routine carpal tunnel surgery (Grade B, Level II). We make no recommendation for or against the use of postoperative rehabilitation. (Inconclusive, Level II). Recommendation 9 We suggest physicians use one or more of the following instruments when assessing patients’ responses to CTS treatment for research: • Boston Carpal Tunnel Questionnaire (disease-specific) • DASH – Disabilities of the arm, shoulder, and hand (region-specific; upper limb) • MHQ – Michigan Hand Outcomes Questionnaire (...) Center Drive 2130 Taubman Health Care Center Ann Arbor, MI 48109-0340 Plastic and Reconstructive Surgery Peter C Amadio, MD Mayo Clinic 200 1st St S W Rochester, MN 55902-3008 Orthopaedic Hand Surgeon Michael Andary, MD Michigan State University B401 W Fee Hall (PMR) East Lansing, MI 48824-1316 Physical Medicine and Rehabilitation Neurology Richard W. Barth, MD 2021 K St Ste 400 Washington, DC 20006-1003 AAOS Board of Councilors Orthopaedic Hand Surgeon Kent Maupin, MD 1111 Leffingwell NE Ste 200

2008 Congress of Neurological Surgeons

72. Driving and pain

% experiencing either quite a bit of difficulty or a great deal of difficulty driving. 6 The self reported prevalence of difficulty performing basic safety manoeuvres such as checking for traffic by looking over the shoulder was 57%. 1.2. A number of common co-morbid conditions may also adversely effect driving ability in pain patients: Depression Fatigue Anxiety Sleep apnoea or sleep apnoea syndrome Impaired concentration Excessive sleepiness Suicidal thoughts There is some evidence that patients whose pain (...) Safety: A Critical Analysis of Recent Evidence. Road Safety Web Publication No. 21. Department for Transport, 2011. 4. Jones JG, McCann J, Lassere MN. Driving and arthritis. Br J Rheumatol 1991; 30(5): 361-4. 5. Veldhuijzen DS, van Wijck AJM, Wille F, et al. Effect of chronic non malignant pain on highway driving performance. Pain 2006; 122: 28-35 6. Fan A, Wilson KG, Acharya M, et al. Self-Reported Issues With Driving in Patients With Chronic Pain. Physical Medicine and Rehabilitation 2012; 4: 87-95

2017 Faculty of Pain Medicine

73. Physical activity for people with cardiovascular disease: recommendations of the National Heart Foundation of Australia Full Text available with Trip Pro

activity unless otherwise contraindicated. The associated benefits of regular physical activity for those with CVD include the following. Augmented physiological function Exercise rehabilitation consistently improves objective measures of functional capacity in those with heart disease. , Endurance training improves walking mobility among stroke survivors, and increases walking distance in people with PVD and exercise-induced claudication (NHMRC level of evidence [LOE] I, grade of recommendation [GOR (...) ] A ). (see for NHMRC classifications.) Reduction in symptoms Exercise training reduces recurrent anginal symptoms, lessens breathlessness associated with heart failure and stroke, and reduces severity of claudication pain with walking in patients with PVD (LOE I, GOR A). Enhanced quality of life Exercise rehabilitation is associated with small but consistently favourable changes in self-reported quality-of-life domains among survivors of myocardial infarction, people with heart failure and PVD (LOE II

2006 MJA Clinical Guidelines

74. Stroke and Transient Ischemic Attack ? Acute and Long-Term Management

reduces the chance of stroke. • Thrombolytic eligible patients should receive tissue plasminogen activator (tPA) as quickly as possible (within 4.5 hours of clearly defined symptom onset). • Early mobilization and appropriate positioning within 24 hours are associated with improved outcomes. • Management on a stroke rehabilitation unit improves functional outcomes. Definitions A transient ischemic attack (TIA) is a brief episode of neurologic dysfunction caused by focal brain or retinal ischemia (...) develop rapidly in poorly mobilized patients; focus on positioning and nutritional support as well as mattress optimization. Shoulder pain with hemiplegia: Consider referral to physiotherapist and physiatrist. Venous thromboembolism: Pulmonary embolism accounts for 13 – 25% of early deaths post-stroke. 16 Assess patients for prophylaxis with anticoagulant and/or leg compression with pneumatic compression devices. Graduated compression stockings are contraindicated. Malignant middle cerebral artery

2015 Clinical Practice Guidelines and Protocols in British Columbia

75. Exercise Standards for Testing and Training Full Text available with Trip Pro

Access article Exercise Standards for Testing and Training A Scientific Statement From the American Heart Association , MD, FAHA, Chair , MD, Co-Chair , MD, FAHA, Co-Chair , PhD, PT, FAHA , MD, FAHA , MD, MSPH, FAHA , PhD, ACNS, FAHA , MD , MD, FAHA , MD, PhD, FAHA , MD, MS, FAHA , PhD, PT , MD , and MD PhDon behalf of the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology, Council on Nutrition, Physical Activity and Metabolism (...) , Council on Cardiovascular and Stroke Nursing, and Council on Epidemiology and Prevention Gerald F. Fletcher , Philip A. Ades , Paul Kligfield , Ross Arena , Gary J. Balady , Vera A. Bittner , Lola A. Coke , Jerome L. Fleg , Daniel E. Forman , Thomas C. Gerber , Martha Gulati , Kushal Madan , Jonathan Rhodes , Paul D. Thompson , and Mark A. Williams and on behalf of the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee of the Council on Clinical Cardiology, Council

2013 American Heart Association

76. Treatment and recommendations for homeless people with Chronic Non-Malignant Pain

problems, including psychological sequelae of trauma and cognitive impairment. These factors also make adherence to a treatment plan for chronic pain more difficult. Barriers to effective pain management for homeless people include poor understanding of pain management in the general medical community, mutual mistrust between homeless persons and medical providers, lack of access to appropriate pain specialty clinics and other opportunities for rehabilitation, and lack of clear treatment (...) if they have ever been treated for alcohol or drug use (e.g., “Ever been to detox, a rehab program, or an outpatient clinic for drug treatment?”) To explain your reasons for asking, you might add: “As a doctor, this history really helps me understand where you are coming from.” or “Information about your drug and alcohol use can really help me figure out what is the safest and most effective treatment for you.” If a substance use problem is suspected: Evasive responses to uncomfortable questions

2011 National Health Care for the Homeless Council

77. Diagnosis and treatment of limb-girdle and distal dystrophies

of Neurology (P.N., E.R.), Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA; the Department of Neurology (M.W.), University of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (...) of Washington Medical Center, Seattle; the Department of Neurology (D.S.), Mayo Clinic, Rochester, MN; the Department of Neurology (W.D.), Massachusetts General Hospital/Harvard Medical School, Boston; St Luke's Rehabilitation Institute (G.C.), Spokane, WA; the Department of Neurology (M.W.), Penn State Hershey Medical Center, PA; the Department of Neurology (R.J.B., G.G.), University of Kansas Medical Center, Kansas City; the Neuromuscular Center (E.E.), Boston VA Medical Center, MA; the Department

2014 American Academy of Neurology

78. Palliative and End-of-Life Care in Stroke

of Hospice and Palliative Medicine, American Geriatrics Society, Neurocritical Care Society, American Academy of Physical Medicine and Rehabilitation, and American Association of Neuroscience Nurses Robert G. Holloway, MD, MPH, Chair; Robert M. Arnold, MD; Claire J. Creutzfeldt, MD; Eldrin F. Lewis, MD, MPH; Barbara J. Lutz, PhD, RN, CRRN, FAHA, FAAN; Robert M. McCann, MD; Alejandro A. Rabinstein, MD, FAHA; Gustavo Saposnik, MD, MSc, FAHA, FRCPC; Kevin N. Sheth, MD, FAHA; Darin B. Zahuranec, MD, MS, FAHA (...) hemorrhage (SAH). 2,2a Approximately 50% of deaths occur in hospitals (including emergency departments and acute rehabilitation facilities), 35% occur in nursing homes, and 15% occur in the home or other places. 3 In addition, stroke is considered a leading cause of adult disability, because >20% of patients hospitalized for stroke are discharged to a skilled nursing facility and up to 30% of all patients remain permanently disabled. 4 The pallia- tive care and end-of-life needs of patients and families

2014 Congress of Neurological Surgeons

79. Acute Low Back Pain

Acute Low Back Pain 1 Quality Department Guidelines for Clinical Care Ambulatory Low Back Pain Guideline Team Team leader Anthony E. Chiodo, MD Physical Medicine & Rehabilitation Team members David J. Alvarez, DO Family Medicine Gregory P. Graziano, MD Orthopedic Surgery Andrew J. Haig, MD Physical Medicine & Rehabilitation R. Van Harrison, PhD Medical Education Paul Park, MD Neurosurgery Connie J. Standiford, MD General Internal Medicine Consultant Ronald A. Wasserman, MD Anesthesiology, Back (...) activity. • If pain worse: Consider changing/adding medications, increasing restrictions. • Physical therapy. If no improvement, at 1-2 weeks [IIA*] consider manual physical therapy (spinal manipulation). If at Risk: Chronic Disability Prevention (Table 2) • Patient education [IA*] • Minimize restrictions • Recommend aerobic activities such as walking, biking, swimming and core strengthening exercises (Appendix C) to rehabilitate and prevent recurrent low back pain. • At 2 weeks: If work disability

2011 University of Michigan Health System

80. Evidence-Based Guideline: Diagnosis and Treatment of Limb-Girdle and Distal Dystrophies

of Neurology, Mayo Clinic, Rochester, MN (4) Department of Neurology, Massachusetts General Hospital, Boston, MA/Harvard Medical School, Boston, MA (5) St Luke's Rehabilitation Institute, Spokane, WA (6) Department of Neurology, Penn State Hershey Medical Center, Hershey, PA (7) Department of Neurology, University of Kansas Medical Center, Kansas City, KS (8) Neuromuscular Center, Boston VA Medical Center, Boston, MA (9) Department of Neurology, University of Rochester Medical Center, Rochester, NY 2 (10 (...) for Disease Control and Prevention. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. The remaining funding was provided by the American Academy of Neurology. This guideline was endorsed by the American Academy of Physical Medicine and Rehabilitation on April 17, 2014; by the Child Neurology Society on July 11, 2014; by the Jain Foundation on March 14, 2013; and by the Muscular

2013 American Association of Neuromuscular & Electrodiagnostic Medicine

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