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21. Vestibular Assessment ? Eye movement Recordings

, to the best knowledge of the BSA, the evidence-base and consensus on good practice given the stated methodology and scope of the document and at the time of publication. Although care has been taken in preparing this information, the BSA does not and cannot guarantee the interpretation and application of it. The BSA cannot be held responsible for any errors or omissions, and the BSA accepts no liability whatsoever for any loss or damage howsoever arising. This document supersedes any previous recommended

2016 British Society of Audiology

22. Height: measuring a child/young person

scapula, wherever possible, against the backboard arms loosely at their side The child/young person’s head must be positioned with the lower margins of the orbit in the same horizontal plane as the external auditory meatus, i.e. the corner of the eyes horizontal to the middle of the ear . The headboard of the apparatus should be weighted with a 500gram wipeable beanbag and placed carefully on the child/young person’s head . Ensure the child/young person is in the correct position and hold (...) the child/young person’s head with the lower margins of the orbit in the same horizontal plane as the external auditory meatus, i.e. the corner of the eyes horizontal to the middle of the ear . The other person should position the child/young person with their: feet together heels touching the back plate of the measuring instrument legs straight and in alignment with the body buttocks against the backboard scapula, wherever possible, against the backboard The patient’s ankles should be supported

2014 Publication 1593

23. External ventricular drainage

. This is to prevent the filters within the drip chamber becoming wet which could affect the efficiency of the drainage ( ). It is the responsibility of the neurosurgeon to give instructions on the level at which the drain is to be set or the amount of drainage required each hour and document in the patient’s medical records. The level of the ventricles must be estimated to create a zero reference point: Draw an imaginary line between the outer aspect of the child’s eye and the external auditory meatus (...) records. If the EVD continues to not drain, the child may need to return to theatre for a new drain to be inserted. The frequency of observations increased (every fifteen minutes may be required dependant on the child's neurological status). Any changes in neurological status must be highlighted to the neurosurgical team promptly. Drain management: fluid and electrolyte balance CSF contains approximately 120mmol/l of sodium. The child should have their electrolytes measured regularly, daily if losses

2015 Publication 1593

24. Management of Infants at Risk for Group B Streptococcal Disease

involvement such as bulging fontanelle or seizures. Focal syndromes such as pneumonia, bone or joint infection, cellulitis, or adenitis often have findings that point to the site of infection. Osteomyelitis frequently is insidious and may not be associated with fever. Complications are common for meningitis and can include neurodevelopment impairment, hearing loss, persistent seizure disorders, or cerebrovascular disease. Evaluation for GBS disease is the same as that for all forms of sepsis

2019 American Academy of Pediatrics

25. Canadian guideline for Parkinson disease

and accommodations that people living with the condition and their caregivers must make. Difficulty with writing and speaking, and loss of independence, may lead to social withdrawal and isolation as well as depression, frustration and anger. Access to services such as primary care, therapies for speech, exercise programs and emo- Parkinson-final-E.indd 13 2019-09-05 2:39 PMAppendix to: Grimes D, Fitzpatrick M, Gordon J, et al. Canadian guideline for Parkinson disease. CMAJ 2019. doi: 10.1503/cmaj.181504 (...) before 40 years Refer to specialist to identify the type of parkinsonism and treatment approach Presence of red ?ags may suggest atypical disease or secondary parkinsonism Young-onset PD: typically slow progression of motor changes and fewer nonmotor features Find slowness with rest tremor or stiffness. Change in gait may be present Typical PD with age of onset after 40 years Consider obtaining brain CT or MRI Poor treatment response, early falls, rapid progression, marked autonomic or cognitive loss

2019 CPG Infobase

27. Hereditary Hemochromatosis

that stores and releases intracellular iron. Body iron stores are regulated at the level of intestinal iron absorption, as there are no physiologic processes for the excretion of excess iron other than blood loss via menses or sloughing of senescent intestinal mucosal or epidermal cells ( ). Hepcidin, a 25-amino acid peptide produced mainly in the liver, is considered the key regulator of iron stores by inhibiting of iron absorption ( ). Primary iron overload disorders are defined as inherited conditions (...) in the broad way it can present clinically ( ). Fatigue and arthralgias are the most common symptoms encountered early in the disease ( ). However, up to 18% of men and 5% of women may have hepatic iron overload in the absence of clinical symptoms ( ). Disease manifestations usually occur earlier in men than in women, most commonly in the fourth to fifth decades of life ( ). In women, clinical symptoms usually appear after postmenopause, due to iron loss during menstruation, pregnancy, and lactation

2019 American College of Gastroenterology

28. Muscle-invasive bladder cancer

) status of 2 or higher, grade 2 hearing loss or neuropathy, untreated infection, heart failure (NYHA Class III and IV) and an eGFR = 50 ml/min/1.73m 2 . Relative contraindications for NAC include an eGFR between 50 and 60 ml/min/1.73m 2 , a history of recurrent infection and concomitant immunosuppression (LE 2, strong recommendation). – Patients with contraindications to cisplatin-based neoadjuvant chemotherapy should proceed directly to radical local therapy (LE 2, strong recommendation

2019 Canadian Urological Association

29. Home-Based Cardiac Rehabilitation: Scientific Statement

in overestimation of treatment effects (40,42,50–52). Reporting of loss to follow-up or dropouts was very diverse across studies according to intervention arm. Similarly, the dose (intensity, duration, and frequency) of the interventions Thomas et al. JACC VOL. -,NO. -,2019 Home-Based Cardiac Rehabilitation -,2019:-–- 8for HBCR and for CBCR varied signi?cantly in the studies reviewed, making precise interpretation of the results challenging. This is particularly dif?cult when in- terventions were individualized (...) ; identifying the patient’sstage of readinesstochange; encouraging patients to hear themselves express why they want to change; and helping patients to identify, understand, and work through the barriers, challenges, and opportunities that in?uence their health-related be- haviors (e.g., job-related stressors, ?nancial challenges) (81). Additional steps involve helping patients overcome inertia and gain momentum with small serial successes overtime,whichshouldbeviewedasanallytosuccessful lifestyle modi

2019 American College of Cardiology

30. Meningococcal meningitis and septicaemia guidance notes: Diagnosis and treatment in general practice - Ireland

The disease is uncommon, but remains a leading infectious cause of childhood death in Ireland 1 despite the success of meningococcal vaccines. Around 1 in 10 survivors will have a major disability including amputations, brain damage and hearing loss, and over 1 in 3 survivors have one or more problems with physical, cognitive, and psychological functioning 2 . It is more prevalent in winter and may follow outbreaks of influenza 3 . The risk is highest in children under five and adolescents (...) for survivors Although most people recover well, there is a wide range of possible long term sequelae: n Hearing loss and other sensory disabilities n Neurological damage including learning, motor and neuro-developmental deficits and epilepsy n Orthopaedic damage including amputation, growth plate damage and arthritis n Post necrotic tissue/skin loss requiring reconstructive surgery n Renal impairment or chronic damage to other organ systems n Psychiatric and behavioural problems including post-traumatic

2019 Meningitis Research Foundation

31. Meningococcal meningitis and septicaemia guidance notes: Diagnosis and treatment in general practice - UK

illness by the hospital that treated the child because although most people recover well, there is a wide range of possible long term sequelae to be aware of: n hearing loss and other sensory disabilities n neurological damage including learning, motor and neuro-developmental deficits and epilepsy n orthopaedic damage including amputation, growth plate damage and arthritis n post necrotic tissue/skin loss requiring reconstructive surgery n renal impairment or chronic damage to other organ systems n (...) edition UK2 Meningococcal disease can kill a healthy person of any age within hours of the first symptoms The disease is uncommon, but remains the leading infectious cause of death in UK children 1 despite the success of meningococcal vaccines. Over one third of survivors will have one or more clinically significant deficits in physical, cognitive, and psychological functioning and around one in ten will be left with major sequelae such as deafness, amputations and brain damage 2 . It is more

2019 Meningitis Research Foundation

32. Integrated care for older people (?ICOPE)?: guidance for person-centred assessment and pathways in primary care

pathways to manage COGNITIVE DECLINE 19 5. Care pathways to improve MOBILITY 25 6. Care pathways to manage MALNUTRITION 33 7. Care pathways to manage VISUAL IMPAIRMENT 41 8. Care pathways to manage HEARING LOSS 51 9. Care pathways to manage DEPRESSIVE SYMPTOMS 59 10. Care pathways for SOCIAL CARE AND SUPPORT 67 11. Care pathways to SUPPORT THE CAREGIVER 75 12. Develop a personalized care plan 78 13. How health and long-term care systems can support implementation of the WHO ICOPE approach 81 References (...) in public health approaches to ageing is needed. Conventional approaches to health care for older people have focused on medical conditions, putting the diagnosis and management of these at the centre. Addressing these diseases remains important, but focusing too much on them tends to overlook di?culties with hearing, seeing, remembering, moving and the other common losses in intrinsic capacity that come with ageing The well-being of every person will bene?t at some time in their life from the identi

2019 World Health Organisation Guidelines

33. Integrated care for older people (?ICOPE)? implementation framework: guidance for systems and services

to 2050, the proportion of the global population aged 60 years and over will nearly double. 1 Many of these people are likely to experience losses in their health, including developing multimorbidities, and to live in low- and middle-income settings. At the same time, the world has united around the United Nations 2030 agenda for sustainable development. This pledges that no one will be left behind and that every human being will have the opportunity to fulfil their potential with dignity and equality (...) and the services within them are designed – to ensure care is of high quality, integrated, affordable, accessible and centred on the needs and rights of older people. 3 Integrated care, particularly for older people and people with chronic health con- ditions, is widely accepted as a mechanism to improve health outcomes and system efficiency. 3 Building sustainable long-term care systems WHO defines long-term care as “the activities undertaken by others to ensure that people with significant loss of intrinsic

2019 World Health Organisation Guidelines

34. Diagnosis and antenatal management of congenital cytomegalovirus infection Full Text available with Trip Pro

include jaundice, petechial rash, hep- atosplenomegaly, and death. In a classic article, 14 in- fantswerefollowedupovertimetoestimaterisksof long-term sequelae. Of those not symptomatic at birth, up to 25% experience sequelae during the ?rst 2 years of life. These sequelae include sensorineural hearing loss, cognitive de?cit with an intelligence quotient 90%chanceofagoodoutcomefreeofsequelae. The sensitivity of prenatal diagnosis techniques varies TABLE Ultrasoundabnormalitiesfromcasesof con (...) , a herpesvirus, is the most common viral infectionofthefetusandistheleadingnongeneticcauseof congenital deafness, 2 affecting nearly 40,000 infants each yearintheUnitedStates.Fetalinfectioncanresultinawide range of outcomes for children, from asymptomatic infec- tiontoseveredisabilityanddeath.Birthprevalencere?ects all neonatal infections detected at birth as a result of both primary and recurrent infections. Birth prevalence also var- ies geographically and is estimated to be 0.48-1.3% in the UnitedStates

2016 Society for Maternal-Fetal Medicine

35. Shingles

Ear involvement can lead to hearing and balance problems Neurologic changes, including altered mental status, headache, muscle weakness, loss of coordination, or tremor may present rarely Confirmation of shingles diagnosis is based on the presence of the characteristic symptoms described above and the patient's history. Rule out the following conditions that may present with similar symptoms: Herpes simplex virus (HSV) Most common alternate cause Dermatomal presentation is rare with HSV; suspect (...) Potential need for systemic antibiotic therapy Neurologic changes (confusion, delirium) May indicate severe disease; needs further assessment Severe pain Can indicate severe disease or need for systemic corticosteroids or stronger analgesics eg, opioids Ophthalmic (vesicles on tip of nose, blurred vision, eye pain) or auricular involvement (vesicles in or around ear, reduced hearing, vertigo) Higher likelihood of severe complications, such as visual or auditory impairment, and requires medical

2018 medSask

36. Headache

hours prior to headache Aura (25%) - onset one hour before headache begins; visual, auditory and motor issues Headache phase Postdrome - feeling of exhaustion, and sudden head movement can cause transient pain Cluster headache Rarest form of headache Onset age 25-50 years old Will have several attacks over a period of time, and then goes into remission for months or years Severe unilateral, orbital or temporal pain Each attack lasts 15 minutes to three hours May also cause tearing, nasal congestion (...) change Any headache that becomes progressively severe, changes in headache pattern, or is accompanied by symptoms such as blackout or memory loss Presents with unilateral eye pain with red eye, fixed and dilated pupil or diminished vision; suspect glaucoma If the headache came on suddenly (rapid time to peak headache intensity, such as from a few seconds to 5 minutes) If the headache is the patient’s worst headache Concurrent fever, neck stiffness or impaired consciousness Non-emergent referral

2018 medSask

37. Clinical Handover in Acute and Children’s Hospital Services

associated with clinical handover whether as part of shift or inter-departmental clinical handover or communication of information in relation to the deterioration in a patient’s condition, are similar and include: • Inappropriate or delayed treatment being provided for patients including the delay in critical referrals which threaten the life, health or well being of patients in the acute hospital setting • Loss of trust and confidence amongst staff and patients in the performance of the healthcare

2015 National Clinical Guidelines (Ireland)

39. Guidance on the clinical management of depressive and bipolar disorders, specifically focusing on diagnosis and treatment strategies

a framework for understanding the complex pathology that underpins clinical mood disorders. Mood disorders diagnostic criteria Criteria for depressive disorders. Depressive disorders usually feature low mood and/or a loss of pleasure (anhedonia). These are often accompanied by somatic symptoms such as changes to weight, psychomotor disturbance, fatigue and sleep disturbances such as insomnia or hypersomnia, cognitive symptoms, such as diminished concentration and negative cognitions characterised (...) of Prior Episodes Multiple prior depressive episodes Fewer prior episodes Mood symptoms Lability of mood/manic symptoms Depressed mood and low energy Psychomotor symptoms Psychomotor retardation Psychomotor retardation less likely Sleep disturbances Hypersomnia and/or increased day time napping Initial insomnia/reduced sleep Appetite Changes Hyperphagia and/or increased weight Appetite and/or weight loss Other symptoms Other ‘atypical’ depressive symptoms such as hypersomnia, hyperphagia, ‘leaden

2015 Royal Australian and New Zealand College of Psychiatrists

40. Clinical Practice Guidelines on Prevention, Diagnosis and Management of Tuberculosis

reported in these patients. This is probably due to the reduction in inflammatory response as a result of the immunocompromised state. 4528 Clinical presentation of patients with extrapulmonary tuberculosis varies widely in both immunocompetent and immunocompromised hosts. In general, the presentation in HIV patients is similar to that seen in non-HIV patients, although the signs and symptoms (such as fevers, weight loss, and malaise) may be attributed to HIV itself and the possibility of tuberculosis (...) include abdominal pain, pronounced weight loss followed by loss of appetite, nausea, vomiting or diarrhea. 52 Most common sites of involvement are the terminal ileum, caecum and less commonly the peritoneum. Appropriate tissue specimens, e.g. ascitic fluid and surgical biopsy specimens taken from the affected organ, should be sent for histological evaluation, microscopic examination and mycobacterial culture, for confirmation of the disease. Skeletal tuberculosis Pain and swelling of the affected

2016 Ministry of Health, Singapore

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