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62. Complex Regional Pain Syndrome (CRPS-2011)

. In this situation, it is important to consider the possibility of a missed diagnosis or an unrecognized comorbidity such as a behavioral or substance abuse disorder. 2. Phase Two –Recovery is Not Normal The sooner treatment for suspected CRPS is initiated, the more likely it is that the long term outcome will be good. When recovery is delayed, and if no specific cause for the delay is identified, CRPS may be the diagnosis. Referral to a pain management or rehabilitation medicine specialist is strongly (...) Complex Regional Pain Syndrome (CRPS-2011) Effective October 1, 2011 Hyperlink and Formatting update September 2016 Work-Related Complex Regional Pain Syndrome (CRPS): Diagnosis and Treatment 2011 TABLE OF CONTENTS I. Introduction II. Establishing Work-Relatedness III. Prevention A. Know the Risk Factors B. Identify Cases Early and Take Action C. Encourage Active Participation in Rehabilitation IV. Making the Diagnosis A. Symptoms and Signs B. Three-Phase Bone Scintigraphy C. Diagnostic

2011 Washington State Department of Labor and Industries

63. Level of Care for Musculoskeletal Surgery

) - Uncontrolled preoperative pain - Prior complication of anesthesia - Prior postoperative complication • Ileus • Urinary retention • Psychiatric/cognitive o Ongoing substance abuse o Cognitive impairment • Social o Patient resides outside of a reasonable distance (30-minute drive) of an emergency medical facility o No responsible/reliable adult (caregiver) living with, or staying with the patient who is available to care for them for at least 23 hours after surgery. o Patient does not agree to surgery (...) postoperative complication • Ileus • Urinary retention • Psychiatric/cognitive o Ongoing substance abuse o Cognitive impairment • Social o Patient resides outside of a reasonable distance (30-minute drive) of an emergency medical facility o No responsible/reliable adult (caregiver) living with, or staying with the patient who is available to care for them for at least 23 hours after surgery. o Patient does not agree to surgery outside the inpatient hospital setting or is expected to be noncompliant

2018 AIM Specialty Health

64. Clinical Guideline on the Treatment of Carpal Tunnel Syndrome

in the wrist and hand due to shape and size, infectious diseases, and substance abuse. These are all common exclusion criteria in CTS treatment studies and hence these potential risks have not been clearly assessed. 9 Persons involved in manual labor in some occupations have a greater incidence and severity of the symptoms. 7 The relationship between work, co-morbidities and personal factors require good physician judgment, experience with medical evidence and knowledge of the vast occupational literature (...) 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

2008 Congress of Neurological Surgeons

65. Providing patient and caregiver training

,age-specific,pain,ormedication adverse effects 3,8,9,15,16 ) 7.1.3 Inability to comprehend or lack of aware- ness due to factors such as anxiety, depression, hypoxemia, substance abuse. This may include denial. 9,17,18 7.1.4 Negative response to past educational ex- periences or encounters 8,15 7.1.5 Lack of health literacy, despite level of ed- ucation completed. 19-23 This may include func- tionalilliteracyindealingwiththehealthcarepro- cess. 22 7.1.6Amindsetthatleadstomisapplication,mis (...) for the prevention and treatment of a cardiopulmonary medical condition. PCGT 3.0 SETTINGS Patient,family,andcaregivertrainingsettingsinclude,but are not limited to: 3.1 Acute care hospital RESPIRATORY CARE •JUNE 2010 VOL 55 NO 6 7653.1.1 Patient’s room 3.1.2 Designated teaching area or learning center 3.1.3 Pulmonary rehabilitation department 3.2 Out-patient rehabilitation center 3.3 Patient’s home 3.4 Physician’s office or clinic 3.5 Extended care or skilled nursing facility 3.6 Patient support group meetings

2010 American Association for Respiratory Care

66. Thoracic Aortic Disease: Guidelines For the Diagnosis and Management of Patients With

substance and connective tissue. Media: bounded by an internal elastic lamina, a fenestrated sheet of elastic ?bers; layers of elastic ?bers arranged concentrically with interposed smooth muscle cells; bounded by an external elastic lamina, another fenestrated sheet of elastic ?bers. Adventitia: resilient layer of collagen containing the vasa vasorum and nerves. Some of the vasa vasorum can penetrate into the outer third of the media. 2.2. Normal Thoracic Aortic Diameter In 1991, the Society

2010 American College of Cardiology

67. Heart Disease and Stroke Statistics

participation in cardiac rehabilitation after an acute MI. Between 2011 and 2015, compared with patients who did not participate in cardiac rehabilitation, those who declared such participation were less likely to be female (OR, 0.76; 95% CI, 0.65–0.90; P =0.002) or black (OR, 0.70; 95% CI, 0.53–0.93; P =0.014), were less well educated (high school versus college graduate: OR, 0.69; 95% CI, 0.59–0.81; P <0.001 and less than high school versus college graduate: OR, 0.47; 95% CI, 0.37–0.61; P <0.001

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2019 American Heart Association

68. Best Practices for Pain Management in Infants, Children, Adolescents, and Individuals with Special Health Care Needs

of ongoing substance abuse. 98 Risk mitigation begins with understanding how to recog- nize drug seeking behavior. 2 To address the potential risk of opioid use/abuse, screening patients prior to prescribing opioids should be standard practice. 30 Screening commonly is performed with adult patients using a variety of screening tools. 99 Although screening adolescents for opioid abuse or misuse has been suggested, a standard assessment has not been identified. 77,99 Therefore, the practitioner should (...) . 101 Therefore, behavioral health support may be required for emotional disturbances such as drug abuse, depression, or post-traumatic stress disorder. 101 For professionals who suspect patients have use/abuse issues, the FDA, National Institutes of Health, National Insti- tute on Drug Abuse, the American Dental Association, and state prescription drug monitoring programs have resources available to review the history of prescriptions for controlled substances which may decrease their diver sion

2018 American Academy of Pediatric Dentistry

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

evaluation, overview of care for complex regional pain syndrome (CRPS) or sympathetically mediated pain, and diagnostic criteria and procedures for patients with CRPS/reflex sympathetic dystrophy and for further descriptions of the therapies discussed below. The grades of recommendations ( Some, Good, Strong ) are defined at the end of the Major Recommendations field. Therapeutic Procedures—Non-operative Non-operative therapeutic rehabilitation is applied to patients with CRPS or sympathetically mediated (...) : Patients undergoing therapeutic procedure(s) should be released or returned to modified or restricted duty during their rehabilitation at the earliest appropriate time. Refer to the section "Return-to-Work" below for detailed information. Reassessment of the patient's status in terms of functional improvement should be documented after each treatment. If patients are not responding within the recommended time periods, alternative treatment interventions, further diagnostic studies, or consultations

2017 National Guideline Clearinghouse (partial archive)

70. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain

, with higher dosages and more frequent infusions associated with greater risks. Larger studies, evaluating a wider variety of conditions, are needed to better quantify efficacy, improve patient selection, refine the therapeutic dose range, determine the effectiveness of nonintravenous ketamine alternatives, and develop a greater understanding of the long-term risks of repeated treatments. From the * Departments of Anesthesiology & Critical Care Medicine, Neurology, and Physical Medicine & Rehabilitation (...) presented to nor approved by either the American Society of Anesthesiologists Board of Directors or House of Delegates, it is not an official or approved statement or policy of the Society. Variances from the recommendations contained in the document may be acceptable based on the judgment of the responsible anesthesiologist. S.P.C. is funded in part by a Congressional Grant from the Center for Rehabilitation Sciences Research, Uniformed Services University of the Health Sciences, Bethesda, MD (SAP

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2018 American Society of Regional Anesthesia and Pain Medicine

71. Chronic Opioid Therapy for Chronic Non-Cancer Pain

disclosed that their participation on the Chronic Opioid Therapy Safety Guideline team includes no promotion of any commercial products or services, and that they have no relationships with commercial entities to report. 19 Appendix A. Opioid Risk Tool (ORT) Date Patient Name OPIOID RISK TOOL Mark each box that applies Item score if female Item score if male 1. Family History of Substance Abuse Alcohol ? 1 3 Illegal Drugs ? 2 3 Prescription Drugs ? 4 4 2. Personal History of Substance Abuse Alcohol ? 3 (...) of opioid analgesics and are not the same as addiction. The commission is obligated under the laws of the state of Washington to protect the public health and safety. The commission recognizes that the use of opioid analgesics for other than legitimate medical purposes poses a threat to the individual and society and that the inappropriate prescribing of controlled substances, including opioid analgesics, may lead to drug diversion and abuse by individuals who seek them for other than legitimate medical

2016 Kaiser Permanente Clinical Guidelines

72. Back Pain

a patient who has severe pain but is confident that it will go away might be at medium complexity—and they should not be the sole factor in determining appropriate interventions. Instead, complexity levels are most useful for: • Establishing a common language for communication between clinicians and patients • Identifying conditions that might otherwise be missed (e.g., depression, anxiety, substance abuse) • Incorporating the patient’s psychosocial needs into the care plan 6 Back Pain Risk (...) and NSAIDs, they have more risks and side effects, including the risk of dependence and substance abuse disorder. One study (AMDG 2015) showed that of patients who took opioids for 90 days or longer, 60 percent were still taking opioids 5 years later. The Centers for Disease Control and Prevention (2016) recommends against prescribing opioids for chronic back pain. See the Chronic Opioid Therapy Safety Guideline. Low-quality evidence shows that opioids may reduce pain in patients with chronic low back

2017 Kaiser Permanente Clinical Guidelines

73. Professional Practice Guidelines for Integrating the Role of Work and Career Into Psychological Practice

), substance abuse (Bellair & Roscigno, 2000), and other mental health concerns (Keyes & Waterman, 2003; Swanson, 2012). This is particularly critical for youth, a group for which unemployment is associated with several risk factors (Baron, 2001). Involuntary unemployment, among both youth and adults, is associated with numerous negative health outcomes, including increased depression and anxiety (Paul & Moser, 2009). Furthermore, these negative consequences are exacerbated with time such that those who (...) by mental and physical health concerns related to their service experiences (Cohen, Suri, Amick, & Yan, 2013; Davis, Pilkinton, Poddar, Blansett, Toscano & Parker, 2014), which may serve to delay their transition into civilian work. It is also important to recognize the work-relevant skills and strengths veterans bring to society. The general public often views returning veterans as being mentally unstable, violent, and as abusing substances (MacLean & Kleykamp, 2014), and veterans’ attributes

2015 American Psychological Association

74. Behavior Guidance for the Pediatric Dental Patient

Parents who have had negative dental experiences 8,20,21 as a patient may transmit their own dental anxiety or fear to the child thereby adversely affecting her attitude and response to care. 8,20-22 Long term economic hardship and inequality can lead to parental adjustment problems such as depression, anxiety, irritability, substance abuse, and violence. 13 Parental depression may result in decreased protection, caregiving, and discipline for the child, thereby placing the child at risk for a wide (...) , or physical conditions; — patients with a history of physical or psychological trauma due to immobilization (unless no other alterna- tives are available); — patients with non-emergent treatment needs in order to accomplish full mouth or multiple quadrant dental rehabilitation; and — practitioner’s convenience. • Precautions: The following precautions should be taken: — the patient’s medical history must be reviewed careful- ly to ascertain if there are any medical conditions (e.g., asthma) which may

2015 American Academy of Pediatric Dentistry

75. Oral Health Care for the Pregnant Adolescent

considerations (e.g., maintaining a healthy diet, avoiding frequent exposures to cariogenic foods and beverages, overall nutrient and energy needs) 61,62 and vitamin supplements 19-21 . • anticipatory guidance for the infant’s oral health in- cluding the benefits of early establishment of a dental home. 84,85 • anticipatory guidance for the adolescent’s oral health to include injury prevention, oral piercings, tobacco and substance abuse, sealants, and third molar assess- ment. 95 • oral changes that may (...) , it is the dentist’s responsibility to follow the as low as reasonably achievable (ALARA principle) to minimize the patient’s exposure. 70 Suppression of the mother’s reservoirs of Mutans strep- tococci (MS) by dental rehabilitation and antimicrobial treatments may prevent or at least delay infant acquisition of these cariogenic microorganisms. 73 MS, present in children with early childhood caries, is predominantly acquired from mother’s saliva. 74 The transmission of cariogenic bacteria from mother to infant

2016 American Academy of Pediatric Dentistry

76. ESC/ESH Management of Arterial Hypertension

hypertension3069 8.1.4 Treatment of resistant hypertension3070 8.2 Secondary hypertension3071 8.2.1 Drugs and other substances that may cause secondary hypertension3071 8.2.2 Genetic causes of secondary hypertension3071 8.3 Hypertension urgencies and emergencies3074 8.3.1 Acute management of hypertensive emergencies3075 8.3.2 Prognosis and follow-up3075 8.4 White-coat hypertension3076 8.5 Masked hypertension3077 8.6 Masked uncontrolled hypertension3077 8.7 Hypertension in younger adults (age <50 years)3077

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2018 European Society of Cardiology

77. Flu vaccination: increasing uptake

, if the carer had flu. 1.6.2 Providers of flu vaccination, including primary care staff and nurses working in the community (such as district nurses, specialist nurses and those working in rehabilitation) could consider: Identifying and offering eligible carers a flu vaccination as the opportunity arises. For example, this could be offered during a home visit when the person they look after is being vaccinated. Informing the carer about other local vaccination services if a patient group direction (...) an undiagnosed clinical condition) access health services attend healthcare appointments. The groups classified as underserved in this guideline are: Flu vaccination: increasing uptake (NG103) © NICE 2019. All rights reserved. Subject to Notice of rights ( conditions#notice-of-rights). Page 19 of 73people who are homeless or sleep rough people who misuse substances asylum seekers Gypsy, Traveller and Roma people people with learning disabilities young people leaving long

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

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

test, hepatitis serologies, or tumor markers could be helpful. Consider a urine drug screen to identify substance abuse that could affect a patient’s care. Imaging and other diagnostic testing depends on the specific illness. Before ordering any test, explain to the patient why each test is necessary and obtain permission, as patients may not want certain tests performed. Some patients may decline, defer, or want to space out diagnostic testing. If a patient’s vital signs or clinical condition (...) Management 35 Substance Use and Mental Health Social Supports Benefits and Entitlements Spiritual Components 47 50 53 55 Models of Care Street and Shelter-Based Care 59 Medical Respite 60 Inpatient Models 62 Transitions in Care Environments 63 Health Care for the Homeless Clinicians’ Network ADAPTING YOUR PRACTICE: Recommendations for End-of-Life Care for People Experiencing Homelessness viii Community Resources 64 Case Studies Case #1 66 Case #2 61 Case #3 Case #4 68 69 Sources and Resources Sources

2018 National Health Care for the Homeless Council

79. Recommendations for the Delivery of Psychosocial Oncology Services in Ontario

with getting on with living; adjusting to new normal • Loss of dignity or meaning in one’s life • Addiction (e.g., alcohol, nicotine, other substances of abuse) Social • Coping and adjustment to altered social roles due to illness • Communication with healthcare providers • Family conflicts and sense of isolation from family members • Relationship disruptions • Discussion of illness with partner and family • Impact of cancer on children • Difficulty in decision-making • Dealing with stigma • Domestic abuse (...) , practical, nutritional and rehabilitative challenges associated with cancer, patients and families continue to face significant barriers in finding and accessing these services in Ontario. Across the province there are marked variations in the delivery and availability of PSO services. Patients often do not know how or where to find help, while healthcare providers struggle to connect them with appropriate supports. Confusion about what PSO is and a lack of a cohesive identity and understanding about

2018 Cancer Care Ontario

80. Recommendations for the Use of Mechanical Circulatory Support: Ambulatory and Community Patient Care: A Scientific Statement From the American Heart Association

PVD Active substance abuse Impaired cognitive function Unmanaged psychiatric disorder Lack of social support CRT indicates cardiac resynchronization therapy; DT, destination therapy; NYHA, New York Heart Association; Vo 2 , oxygen consumption; and PVD, peripheral vascular disease. As of July 2014, 158 centers in the United States offer long-term MCS. Patients often live a substantial distance from the implanting center, necessitating active involvement of local first responders (emergency medical (...) Increasing diuretic requirement Symptomatic despite CRT Inotrope dependence Low peak V o 2 (<14–16) End-organ dysfunction attributable to low cardiac output Contraindications Absolute Irreversible hepatic disease Irreversible renal disease Irreversible neurological disease Medical nonadherence Severe psychosocial limitations Relative Age >80 y for DT Obesity or malnutrition Musculoskeletal disease that impairs rehabilitation Active systemic infection or prolonged intubation Untreated malignancy Severe

2017 American Heart Association


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