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121. Treatment of Patients with Schizophrenia

or abnormalities of motor tone • Sight and hearing • Speech, including fluency and articulation • Mood, degree of hopelessness, and level of anxiety • Thought content, process, and perceptions, including current hallucinations, delusions, negative symptoms, and insight • Cognition • Current suicidal ideas, suicide plans, and suicide intent, including active or passive thoughts of suicide or death o If current suicidal ideas are present, assess: patient’s intended course of action if current symptoms worsen

2020 American Psychiatric Association

124. Testosterone Testing - Protocol

because the prevalence of hypogonadism among patients with erectile dysfunction is low. Table 1: Symptoms and signs of testosterone deficiency in men, in order of specificity , Specific to testosterone deficiency Supportive of testosterone deficiency Not specific to testosterone deficiency Loss of body (axillary, facial, pubic) hair Very small testes (<6 mL) Breast discomfort, gynecomastia Eunuchoidal body proportions Infertility, low sperm count Height loss, low-trauma fracture, low bone mineral (...) . Men Women , Confirmed or suspected: Hypothalamic/pituitary tumour* Hyperprolactinemia* Hemochromatosis Idiopathic hypogonadotropic hypogonadism Cryptorchidism, anorchia Genetic conditions including Klinefelter syndrome, Kallmann syndrome, myotonic dystrophy Male factor infertility Confirmed or suspected: Rapid virilisation/rapid hair loss* Symptoms consistent androgen-secreting tumour of adrenal or ovarian origin* Cushing syndrome* Acromegaly* Congenital adrenal hyperplasia (CAH) Polycystic ovary

2019 Clinical Practice Guidelines and Protocols in British Columbia

125. Children and young people exposed prenatally to alcohol

, separation anxiety disorder or generalised anxiety disorder. A diagnosis of oppositional defiant disorder or conduct disorder is manifested (in part) by a frequent loss of temper, arguing, becoming easily angered or annoyed, showing vindictive or other negativistic behaviours. Disturbances of affect regulation should only be attributed to PAE if they longstanding, and should not be attributed to PAE if they are formulated to be in response to unfavourable life events or environmental conditions

2019 SIGN

127. Cytomegalovirus Infection in Pregnancy

, petechiae, jaundice, chorioretinitis, thrombocytopenia and anemia, and long-term sequelae consist of sensorineural hearing loss, mental retardation, delay of psychomotor development, and visual impairment. These guidelines provide a framework for diagnosis and management of suspected CMV infections. Evidence Medline was searched for articles published in English from 1966 to 2009, using appropriate controlled vocabulary (congenital CMV infection) and key words (intrauterine growth restriction

2018 Society of Obstetricians and Gynaecologists of Canada

128. Joint SOGC?CCMG Opinion for Reproductive Genetic Carrier Screening: An Update for All Canadian Providers of Maternity and Reproductive Healthcare in the Era of Direct-to-Consumer Testing

births), hemophilia A (1/5000 male births), and hemophilia B (1/30,000 male births). (III-A) (GRADE low/moderate) 3. A positive history of potential genetic/syndromic and chromosomal disorders as well as congenital anomalies, intellectual disability, stillbirth, sudden death, and other major health concerns such as cardiomyopathy, epilepsy, hearing loss, autism, and psychiatric disorders obtained as part of a three-generation pedigree review requires timely consultation referral to a reproductive

2016 Society of Obstetricians and Gynaecologists of Canada

129. Peri-operative care of people with dementia

cholinergic transmission, producing loss of consciousness, analgesia, akinesia and amnesia. It is unclear whether this change is prolonged, additive to age and/or dementia related in cholinergic transmissionorcontributorytoPOD/POCD[25]. Clinically, it is dif?cult to disentangle the effects of co- morbidity,illness,surgeryandperi-operativecomplications (including delirium) from any direct neurotoxic effects of anaesthesia and surgery that independently accelerate the rateoflong-termcognitivedecline[26 (...) derangements in physiology and without complication, a person’s cognition can be expected to follow its pre- operative trajectory [38, 39]. Moreover, when surgery alleviatessymptomsorpainandenhancesqualityoflife,for example, by improving vision, hearing or mobility, cognition might be improved postoperatively, or further deteriorationavoided[40,41]. Involvingrelativesandcarers People with cognitive impairment are likely to experience furtherchallengestothosenormallyexperiencedbypeople undergoing surgery

2019 Association of Anaesthetists of GB and Ireland

131. Head and neck imaging

%) the American Academy of Otolaryngology–Head and Neck Surgery protocol is recommended, which proposes = 15 dB between ears, averaging 0.5 to 3 kHz. 122 MRI of the head and the internal auditory canal, commonly known as an IAC protocol, is most effective in screening for CPA tumors. Clinicians should not order CT of the head/brain in the initial evaluation of a patient with presumptive sudden sensorineural hearing loss. 123 Hoarseness, dysphonia, and vocal cord weakness/paralysis ADULT Advanced imaging (...) Laryngeal edema 17 Osseous lesions 17 Osteonecrosis of the jaw 17 Salivary gland ductal calculi 17 Torticollis (Pediatric only) 17 Tracheal stenosis or upper airway obstruction 18 Signs and Symptoms 18 Dizziness or vertigo 18 Hearing loss 18 Hoarseness, dysphonia, and vocal cord weakness/paralysis 19 Horner’s syndrome 20 Localized facial pain 20 Lymphadenopathy 20 Stridor 21 Tinnitus 21 Pulsatile tinnitus (Pediatric only) 21 Visual disturbance or visual field defect 22 References 22 Codes 24 History 24

2019 AIM Specialty Health

132. Information for women considering preventive mastectomy

service provided by each State and Territory Cancer Council. The national phone number is 13 11 20. You can also request services in languages other than English. Breast Cancer Support Service Each State and Territory Cancer Council also provides a Breast Cancer Support Service. This free and con? dential service can be contacted by ringing the Cancer Council Helpline number on 13 11 20 or toll free on 1800 624 973. The TTY number for deaf or hearing-impaired people is 02 9334 1865. The Breast Cancer (...) . • A longer recovery may be needed depending on the type of surgery. • The need for more operations if there are complications. • Additional scarring if tissue is taken from another part of your body. • Longer operation time. • Other potential side-effects such as discomfort or pain; infection; ? rmness of the breast; need for future implant replacement; and/or some loss of strength in the arm or stomach. • Financial costs. Whatever choice you make, it’s important to be realistic about the possible

2019 European Society of Endocrinology

133. Risk reduction and management of delirium

be frightening and can carry on when they wake up • hear voices or noises which may not be present (auditory hallucinations) • see objects or people that are not present or in different context (visual hallucinations) • get upset that other people are trying to harm them • be agitated or restless, unable to sit still, and have an increased risk of having a fall • be sleepy and slow to move and respond • be reluctant to eat or drink • have a temporary change in personality • have all or some of the above (...) with probable delirium in emergency department and acute hospital settings. ? Where delirium is detected, the diagnosis of delirium should be clearly documented and coded to aid transfers of care (eg handover notes, referral and discharge letters). 2.2 Risk reduction R The following components should be considered as part of a package of care for patients at risk of developing delirium: • orientation and ensuring patients have their glasses and hearing aids • promoting sleep hygiene • early mobilisation

2019 SIGN

134. Appropriate Use Criteria: Imaging of the Brain

(Adult only) 17 Neurocutaneous disorders 18 Pseudotumor cerebri (Pediatric only) 18 Seizure disorder 18 Seizure, refractory 19 Imaging of the Brain Copyright © 2019. AIM Specialty Health. All Rights Reserved. 3 Trigeminal neuralgia and persistent idiopathic facial pain (Adult only) 20 Perioperative/Periprocedural Imaging 20 Lumbar puncture risk assessment 20 Signs and Symptoms 20 Dizziness or vertigo 21 Headache 21 Hearing loss 25 Papilledema 25 Syncope 26 Tinnitus (Adult only) 26 Visual disturbance (...) of the posterior fossa and brainstem structures. Standard anatomic coverage of head MRI is from the base of the skull to the vertex, covering the entire calvarium and intracranial contents, including the internal auditory canals. Coverage may vary depending on the specific clinical indication. The presence of implantable devices such as pacemakers or defibrillators, a potential need for sedation in pediatric patients, and claustrophobia are the main limitations of MRI. Infusion of gadolinium may also confer

2019 AIM Specialty Health

135. Cerebral palsy in adults

or or a neurosurgical or orthopaedic procedure is being considered that may affect their ability to carry out their usual daily activities. 1.1.2 Recognise that reassessment by the multidisciplinary team may be needed by adults with cerebral palsy at different points in their lives to ensure that their changing needs are met (for example, pregnancy and parenting, decreased mobility due to hip arthritis, and loss of care and support from a parent). 1.1.3 Commissioners and service providers should develop pathways (...) with time and social circumstances. 1.2.2 At every review, ask adults with cerebral palsy (and their families and carers, if agreed) about any changes in their hearing, speech and communication. 1.2.3 Explore with the person with cerebral palsy who has communication difficulties whether they have a potential need for alternative and augmentative communication systems. 1.2.4 Ensure that training is provided for people with cerebral palsy using alternative and augmentative communication systems

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

136. Syphilis in pregnancy

§ Signs can include: cranial nerve dysfunction, hearing loss, tinnitus, diminished vision, meningitis, stroke (acute), mental status changes/alteration and loss of vibration sense o Cardiovascular disease (cardiosyphilis) § Signs can include: aortic root dilatation, aortic regurgitation and/or coronary ostial lesions 34,35 o Gummatous lesions (gumma) Queensland Clinical Guideline: Syphilis in pregnancy Refer to online version, destroy printed copies after use Page 13 of 31 3 Antenatal screening Women (...) expenses, losses, damages and costs incurred for any reason associated with the use of this guideline, including the materials within or referred to throughout this document being in any way inaccurate, out of context, incomplete or unavailable. © State of Queensland (Queensland Health) 2018 This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives V4.0 International licence. In essence, you are free to copy and communicate the work in its current form for non-commercial

2019 Queensland Health

137. The Prevention of glucocorticoid?induced osteoporosis in patients with immune thrombocytopenia receiving steroids: Good Practice Paper Full Text available with Trip Pro

with ITP and make treatment recommendations. Prevention of osteoporosis in all patients receiving glucocorticoids Fragility fractures, particularly vertebral fractures, occur in up to 30–50% of adults receiving long term glucocorticoids (Rizzoli et al , ). Loss of bone mineral density (BMD) is most rapid in the first 3–6 months but continues to decline at a slower rate with continued use (Buckley et al , ). This is associated with an increased fracture risk. A meta‐regression analysis of randomised (...) controlled trials found that the annual incidence of vertebral fracture was 5·1% in patients who had commenced oral glucocorticoids ≤6 months previously vs. 3·2% if commenced >6 months ago (Amiche et al , ). Loss of BMD appears partially reversible after withdrawal of glucocorticoids and withdrawal leads to a reduction in fracture risk (Rizzoli et al , ) although a residual increased risk persists (Kanis et al , ). Fracture in patients receiving glucocorticoids is not solely dependent on bone loss (Kanis

2019 British Committee for Standards in Haematology

138. Bronchiectasis (non-cystic fibrosis), acute exacerbation: antimicrobial prescribing

, which may mean fewer effective antibiotics for future exacerbations the possible adverse effects of long-term antibiotics, such as: diarrhoea, cardiac events, hearing loss or tinnitus with macrolide antibiotics bronchospasm with inhaled antibiotics the possible interactions of macrolide antibiotics with other medicines the need to regularly review prophylaxis. T o find out why the committee made the recommendations on preventing acute exacerbations of bronchiectasis, see the rationales (...) of antibiotics for reducing exacerbations, but also the harms of long-term antibiotics. There is an increased risk of resistance with long-term antibiotics, which impacts at both a population and an individual level, and people should be advised that this can mean fewer antibiotics may work for their exacerbations in the future. People should also be advised about possible adverse effects. With macrolides, diarrhoea is common but there are also less common cardiac events, hearing loss and tinnitus

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

139. Local Anaesthesia in Ophthalmic Surgery

. ? ? Blood pressure (to be repeated if abnormal). ? ? Hearing, comprehension and co-operation. ? ? Tremor and abnormal body movements. The following should be included when clinically indicated. ? ? If there is respiratory distress or breathlessness present, the respiratory rate should be measured, the oxygen saturation measured by pulse oximetry recorded and the patient should be reviewed by a clinician. Local Anaesthesia for Ophthalmic Surgery 2012 12 ? ? The patient’s ability to lie flat and still (...) information may be supplied by locally developed leaflets or that produced by the Royal College of Anaesthetists and the Association of Anaesthetists of Great Britain and Ireland, and the Royal College of Ophthalmologists. 29,30 Prepare the patient and carers for the day of surgery by discussing what will happen on the day and during the operation. In particular, transport, what to wear, time of arrival and discharge, food and drink, the wearing of dentures and hearing aids during the operation, concerns

2012 Royal College of Ophthalmologists

140. Management of Incidental Findings Detected During Research Imaging

these abnormalities appropriately, but for several reasons, the bulk of imaging research is conducted without any input from radiologists (and is likely to continue in this way). The effects of incidentally discovered pathology on the individual can be complex and far-reaching. 13–15 Some may require medical intervention and many need to be handled sensitively to avoid causing unnecessary alarm. 16,17 The personal financial implications, including loss of insurance, may be huge. Indeterminate incidental findings

2011 Royal College of Radiologists

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