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221. 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

: A patient’s self-report of pain is the reference standard for pain assessment in patients who can communicate reliably. Among critically ill adults who are able to self-report pain , the 0–10 Numeric Rating Scale (NRS) administered either verbally or visually is a valid and feasible pain scale. Rationale: Four studies served to answer the above question ( ). One study evaluated 111 medical/surgical ICU patients for pain in a randomized order using five different self-report scales: 1) 0–10 cm Visual (...) Analog Scale Horizontal (VAS-H); 2) 0–10 cm Visual Analog Scale (VAS) Vertical; 3) Verbal Descriptor Scale (VDS): no pain , mild pain , moderate pain , severe pain , and extreme pain ); 4) 0–10 NRS Oral (NRS-O); and 5) 0–10 NRS Visual (NRS-V) in a horizontal format ( ). The NRS-V had the highest rate of success (i.e., response obtained) (91%); the VAS-H the lowest (66%). The NRS-V success rate was significantly greater than the VDS and VAS (both p < 0.001) and NRS-O ( p < 0.05). It also had the best

2018 Society of Critical Care Medicine

222. End-of-Life Care for People Experiencing Homelessness

to the patient’s verbal and nonverbal cues. Goals of Care 1. Providing the best in care at the end of life requires that providers assist their patients in clarifying their priorities for making treatment decisions and establishing goals of care. Terminally ill patients should be allowed to maintain a sense of control by taking an active part in their own treatment. 2. Goals of care are individual choices that may be different from those of the health care team but should be respected and honored. Health Care (...) to have experienced some form of previous trauma. 4. Many screening tools are available for evaluating a patient’s functional status, mental health, and pain. As completing multiple assessments can be overwhelming, evaluate which assessments are necessary at each visit and limit the number performed according to the patient’s verbal and non-verbal cues. Rationale: Complex medical and psychosocial issues associated with homelessness often warrant a limited physical exam or deferral of the physical exam

2018 National Health Care for the Homeless Council

223. Evaluation and Management of Right-Sided Heart Failure

of right-sided heart failure (RHF) include, among others, primary cardiomyopathies with right ventricular (RV) involvement, RV ischemia and infarction, volume loading caused by cardiac lesions associated with congenital heart disease and valvular pathologies, and pressure loading resulting from pulmonic stenosis or pulmonary hypertension from a variety of causes, including left-sided heart disease. Progressive RV dysfunction in these disease states is associated with increased morbidity and mortality (...) and biochemical markers are associated with worsening RHF and can serve to guide clinical assessment and therapeutic decision making. Pharmacological and mechanical interventions targeting isolated acute and chronic RHF have not been well investigated. Specific therapies promoting stabilization and recovery of RV function are lacking. Conclusions: RHF is a complex syndrome including diverse causes, pathways, and pathological processes. In this scientific statement, we review the causes and epidemiology of RV

2018 International Society for Heart and Lung Transplantation

224. Pharmacological treatment for memory disorder in multiple sclerosis

) for auditory‐verbal memory and the 10/36 spatial recall test (10/36 SRT) for visual‐spatial memory, the paced auditory serial addition test (PASAT) and the symbol digit modality test (SDMT) for processing speed/working memory, and the controlled oral word association test (COWAT) for language. The MACFIMS includes the PASAT and the SDMT, the California Verbal Learning Test‐II (CVLT‐II) for auditory‐verbal memory, and the Brief Visuospatial Memory Test‐Revised (BVMTR) for visual‐spatial memory, the D‐KEFS (...) . Scolaris Search Portlet Scolaris Search Portlet Basic Search Scolaris Language Selector Scolaris Language Selector English Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet Content Language Selection Your language preference is set to English . Where translations are available, article sections will display in this language. Return to . Scolaris Content Display Scolaris Content Display Read comments on this Review(0) Cochrane Clinical Answers Editorials Podcasts Special

2018 European Academy of Neurology

225. Standards and guidelines for clinical genetics laboratories - cytogenetics

. E4.1.6 With the exception of PUBS, at least 90% of final results must be completed and reported (verbal or written) within 14 calendar days from receipt of specimen, unless additional studies are necessary. E4.1.7 Laboratories consistently failing to meet these standards should consider splitting or sending samples to another laboratory until the problems are resolved. E4.1.8 Laboratories should have specific requirements for the acceptance and rejection of specimens that include the volume (...) is documented in a CVS sample, cytogenetic studies of amniotic fluid are recommended. E4.4 Fetal Blood: Percutaneous Blood Sampling (PUBS) E4.4.1 Fetal Blood: Processing Standards E4.4.1.1 Final results of PUBS should not be released until the sample has been confirmed to be fetal in origin. E4.4.1.2 A minimum of 2 cultures should be established, if adequate specimen is submitted. E4.4.1.3 Processing after 48 and 72 hours in culture is recommended. E4.4.1.4 Final reports (verbal or written) should

2018 American College of Medical Genetics and Genomics

226. Best Practices on Periodicity of Examination, Preventive Dental Services, Anticipatory Guidance/Counseling, and Oral Treatment for Infants, Children, and Adolescents

, emotional, and psychological milestones. 2,9,19,20,95,96 Individualized discussion and counseling should be an integral part of each visit. Topics to be included are oral/dental development and growth, speech/language development, nonnutritive habits, diet and nutrition, injury prevention, tobacco product use, substance use/abuse, intraoral/perioral piercing, and oral jewelry/accessories. 2,9,15,19,27,95-102,213,214 Anticipatory guidance regarding the characteristics of a normal healthy oral cavity (...) during the posteruption maturation process. 95 Assessment of developmental milestones (e.g., fine/gross motor skills, language, social interactions) is crucial for early recognition of potential delays and appropriate referral to therapeutic services. 29 Speech and language are integral components of a child’s early development. 101 Abnormal delays in speech and language production can be recognized early with referral made to address these concerns. Communication and coordination of appliance

2018 American Academy of Pediatric Dentistry

227. HIV (Human Immunodeficiency Virus) Screening and Pre-Exposure Prophylaxis (PrEP)

screening for those at the same time. Patients must be screened at all exposed sites, so consider using rectal and/or oral swabs if appropriate. Patients must be informed—verbally or in writing—that a test for HIV will be done. In Epic, the order includes an alert that asks, “HIV test discussed with pt, pt agrees, has plan to get results?” A yes response is required for the order to be placed. Written consent is NOT a requirement for an HIV test. Patient consent can be part of the consent for multiple (...) , Health Profile, Clinical Improvement & Prevention Kathryn Ramos, Patient Health Education Resources, Clinical Improvement & Prevention Annette Sabath, MD, Pathology

2013 Kaiser Permanente Clinical Guidelines

228. Management of the Developing Dentition and Occlusion in Pediatric Dentistry

. Intraoral and panoramic radiographs to: a. establish dental age; b. assess eruption problems; c. estimate the size and presence of unerupted teeth; and d. identify dental anomalies/pathology. 4. Lateral and AP cephalograms to: a. produce a comprehensive cephalometric analysis of the relative dental and skeletal components in the anteroposterior, vertical, and transverse di- mensions; b. establish a baseline growth record for longitudinal assessment of growth and displacement of the jaws; and c (...) -limiting and does not persist in adults. 26 The spectrum of bruxism management ranges from patient/parent education, occlusal splints, and psychological techniques to medications. 19,21,27,28 Tongue thrusting, an abnormal tongue position and devia- tion from the normal swallowing pattern, may be associated with anterior open bite, abnormal speech, and anterior pro- trusion of the maxillary incisors. 16 There is no evidence that intermittent short-duration pressures, created when the tongue and lips

2014 American Academy of Pediatric Dentistry

229. Complex regional pain syndrome/reflex sympathetic dystrophy medical treatment guideline.

). Opioids produce significantly more adverse effects than placebo such as constipation, drowsiness, dizziness, nausea, and vomiting (Design: Systematic review and meta-analysis of randomized clinical trials ). Naloxegol can alleviate opioid induced constipation and 12.5 mg starting dose has an acceptable side effect profile (Design: Two identical and simultaneous multicenter randomized double-blind studies ). Some Evidence In the setting of chronic low back pain with disc pathology, a high degree (...) identification of the pathologic condition. Operative treatment is indicated when the natural history of surgically treated lesions is better than the natural history for non-operatively treated lesions. Surgical procedures are seldom meant to be curative and would be employed in conjunction with other treatment modalities for maximum functional benefit. Functional benefit should be objectively measured and includes the following: Return-to-work or maintaining work status Fewer restrictions at work

2017 National Guideline Clearinghouse (partial archive)

230. Management of Toxicities from Immunotherapy: ESMO Clinical Practice Guidelines

of Gastroenterology, Kremlin Bic^ etre Hospital, Assistance Publique-Ho ˆpitaux de Paris (AP-HP), Paris, France; 3 Department of Medicine, Dermatology Unit, Gustave Roussy Cancer Campus, Villejuif, France; 4 Department of Pathology, Aberdeen University Medical School & Aberdeen Royal In?rmary, Aberdeen, UK; 5 Oncology Department, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland; 6 Royal Marsden Hospital NHS Foundation Trust, London, UK; 7 Department of Medicine V, Hematology, Oncology (...) neutrophils and increased crypt/gland apoptosis. Intra-epithelial lymphocytes were rarely prominent. A recent pathology study based upon eight cases has described two patterns: active colitis with neutrophilic crypt micro- abscesses and atrophy as well as crypt epithelial cell apoptosis (n¼ 5) or lymphocytic colitis characterised by increased intraepi- thelial lymphocytes (n¼ 3) [52]. A preliminary report con?rmed and extended this description. It depicted four different patterns of GI irAEs induced

2017 European Society for Medical Oncology

231. 4th ESO?ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 4)

of Munich (LMU), Munich, Germany; 8 Direction Of?ce, ULACCAM (Union Latinoamericana Contra el Ca ´ncer de la Mujer), Mexico DF, Mexico; 9 Department of Oncology, PURCS School of Medicine, Porto Alegre, Brazil; 10 Department ofOncology-Pathology,Karolinska Institute & University Hospital, Stockholm, Sweden; 11 European Society of Breast Cancer Specialists (EUSOMA) and Department of Medical Oncology, Nuovo Ospedale di Prato - Istituto ToscanoTumori, Prato, Italy; 12 CB Boers Organization, Wormer (...) , Aarhus, Denmark; 30 Cancer Institute Hospital, Breast Oncology Centre, Tokyo, Japan; 31 Institute of Oncology of Southern Switzerland, Geneva University Hospitals, Swiss Group for Clinical Cancer Research (SAKK), International Breast Cancer Study Group (IBCSG), Bellinzona, Switzerland; 32 Oncology Institute, Shaare Zedek Medical Centre, Jerusalem, Israel; 33 Department of Pathology, Centre Jean Perrin, Clermont-Ferrand Cedex, France; 34 IDIBAPS (Institut d’Investigacions Biome `diques August Pi

2018 European Society for Medical Oncology

232. WHO recommendations: intrapartum care for a positive childbirth experience

document. The list of GDG members can be found in Annex 2. 2.3 External Review Group This group included six technical experts and stakeholders with an interest in the provision of evidence-based intrapartum care. The group was geographically representative and gender balanced, and the members had no important conflicts of interest (see section 2.13). The External Review Group (ERG) peer-reviewed the final guideline document to identify any factual errors and comment on clarity of the language

2018 World Health Organisation Guidelines

233. BSR guideline Management of Adults with Primary Sjögren's Syndrome Full Text available with Trip Pro

2015). Additional references were added through regular updates to the draft recommendations up to January 2016. Non-English language papers were excluded unless a translation was published. We also excluded treatments not currently available in the UK unless there was a significant likelihood they would become available in the near future. Identified papers were reviewed, categorized and the level of evidence graded according to international criteria from Ia through to IV and A through to B (...) pathology other than SS including sarcoidosis, IgG4 disease [ ] and graft vs host disease [ ] may be implicated. Salivary gland aplasia and ductal atresia [ ] are both rare causes of oral sicca and viral infections including hepatitis C and HIV can cause salivary gland disease with hypertrophy and sicca symptoms. Xerostomia can be a feature of oral dysaesthesias with no objective reduction in salivary flow rate. Oral dysaesthesia or burning mouth syndrome is a chronic pain condition currently classified

2017 British Society for Rheumatology

234. PET Evidence from Primary Studies and Systematic Reviews and Recommendations from Clinical Practice Guidelines

-language reports of studies that met the following criteria: 1. Studied the use of 18-fluorodeoxyglucose (FDG) PET in cancer, sarcoidosis, or epilepsy in humans. 2. Evaluated the use of the following radiopharmaceutical tracers: ? 68 Ga-DOTA-NOC, 68 Ga-DOTATOC, 68 Ga DOTATATE ? 18 F-choline, 11 C-choline (prostate cancer) ? 18 F-FET ([ 18 F]fluoroethyl-L-tyrosine) (brain) ? 18 F-FLT ([ 18 F]3-deoxy- 3 F-fluorothymidine) (various) ? 18 F-MISO ([ 18 F]fluoromisonidazole) (hypoxia tracer) ? 18 F-FAZA (...) diagnostic modality. 5. Used a suitable reference standard (pathological and clinical follow-up) when appropriate. 6. Included =12 patients for a prospective study/randomized controlled trial (RCT) or =50 patients (=25 patients for sarcoma) for a retrospective study with the disease of interest. Inclusion Criteria for Systematic Reviews 1. Reviewed the use of FDG PET/computed tomography (CT) in cancer, sarcoidosis, or epilepsy. 2. Contained evidence related to diagnostic accuracy; change in patient

2018 Cancer Care Ontario

235. Mental health care in the perinatal period: Australian clinical practice guideline

or arrange immediate further assessment and, if there is any disclosure of suicidal ideation, take urgent action in accordance with local protocol/policy. vii CBR When screening Aboriginal and Torres Strait Islander women, consider language and cultural appropriateness of the tool. viii CBR Use appropriately translated versions of the EPDS with culturally relevant cut-off scores. Consider language and cultural appropriateness of the tool. 1 EBR Use the Edinburgh Postnatal Depression Scale (EPDS (...) in the broader clinical assessment. xi CBR Undertake psychosocial assessment in conjunction with a tool that screens for current symptoms of depression/ anxiety (i.e. the EPDS). xii CBR Consider language and cultural appropriateness of any tool used to assess psychosocial risk. x CBR As part of the clinical assessment, use anxiety items from screening tools (e.g. EPDS items 3, 4 and 5, Depression, Anxiety and Stress Scale (DASS) anxiety items and Kessler Psychological Distress Scale (K-10) items 2, 3, 5

2018 Clinical Practice Guidelines Portal

237. Occupational Therapy for people Undergoing total hip replacement

tasks such as self-care, work or leisure. (COT 2016) Clinical reasoning must take account of individual preferences and needs, including the complexities of treating service users with multiple pathologies, or those with cognitive or emotional dysfunctions, dementia and learning disabilities. Shorter length of hospital stay has necessitated, in many services, prioritisation of inpatient therapy to elements such as mobility and self-care that are essential for safe discharge, rather than adopting

2018 Publication 1554

239. Genital examination in women

Knowledge and skills 7 The examination environment 7 Prior to examination 7 The examination 9 Abdominal inspection and examination 9 External genital examination 9 V aginal examination 9 Speculum examination 10 Bimanual genital examination 10 Following the examination 11 Specific considerations 12 History of trauma 12 V aginismus 12 Female genital mutilation 12 Police use of restraints 13 Requests for female only practitioners 13 Protecting the practitioner 13 Antenatal contraindications 13 Language (...) , with clarity around their roles. The purpose of this document is to provide standards and sample assessment tools for training in genital examination in women for registered nurses working in sexual and reproductive health settings, and related health and social care settings. It assumes an extensive knowledge of relevant anatomy, physiology and pathology. It is envisaged that this document could be used by registered health care professionals who would require training in genital examination in order

2016 Royal College of Nursing

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

were identified that addressed chlorhexidine use resulting in chlorhexidine/antibiotic-resistance strains of bacteria. The search was limited to English language publications. Electronic searches The following information sources were searched: • CENTRAL (Cochrane Central Register of Controlled Trials, The Cochrane Library) • CINAHL (Cumulative Index to Nursing & Allied Health Literature) • Cochrane Database of Systematic Reviews • DARE (Database of Abstracts of Reviews of Effects) • Joanna Briggs (...) are reconsidered and reasons for any limits be provided. Limiting inclusion to studies published in the English language and human studies is acceptable, although the language restriction may introduce publication bias. These comments have been addressed and now made clear that ‘No use of chlorhexidine will be excluded from the literature review’. It now stated for Publication Date and limits: As directed, the reviewer will consider all relevant studies regardless of publication status (published, unpublished

2018 National Health and Medical Research Council


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