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142. Hypertension - Diagnosis and Management

level - the first appearance of a clear tapping sound (phase I Korotkoff) - and the diastolic level (the point at which the sounds disappear (phase V Korotkoff)). If Korotkoff sounds persist as the level approaches 0 mm Hg, then the point of muffling of the sound is used (phase IV) to indicate the diastolic pressure. Leaving the cuff partially inflated for too long will fill the venous system and make the sounds difficult to hear. • For those with an arrhythmia: additional readings with auscultation

2015 Clinical Practice Guidelines and Protocols in British Columbia

143. Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death (Full text)

. Palpitations related to ventricular tachycardia (VT) are usually of a sudden onset/offset pattern and may be associated with presyncope and/or syncope. Episodes of sudden collapse with loss of consciousness without any premonition must raise the suspicion of bradyarrhythmias or VA. Syncope occurring during strenuous exercise, while sitting or in the supine position should always raise the suspicion of a cardiac cause, while other situational events may indicate vasovagal syncope or postural hypotension. 92 (...) . An electrophysiological study (EPS) with PVS has been used to document the inducibility of VT, guide ablation, assess the risks of recurrent VT or SCD, evaluate loss of consciousness in selected patients with arrhythmias suspected as a cause and assess the indications for ICD therapy. The yield of EPS varies fundamentally with the kind and severity of the underlying heart disease, the presence or absence of spontaneous VT, concomitant drug therapy, the stimulation protocol and the site of stimulation. The highest

2015 European Society of Cardiology PubMed abstract

145. Urinary Incontinence

, L., et al. Pad stress tests with increasing load for the diagnosis of stress urinary incontinence. Neurourol Urodyn, 2014. 33: 1135. 78. Richter, H.E., et al. Demographic and clinical predictors of treatment failure one year after midurethral sling surgery. Obstet Gynecol, 2011. 117: 913. 79. Sato, Y., et al. Simple and reliable predictor of urinary continence after radical prostatectomy: serial measurement of urine loss ratio after catheter removal. Int J Urol, 2014. 21: 647. 80. Ward, K.L., et (...) for overactive bladder in women. BJU Int, 2010. 105: 1680. 140. Hunskaar, S. A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women. Neurourol Urodyn, 2008. 27: 749. 141. Subak, L.L., et al. Weight loss to treat urinary incontinence in overweight and obese women. N Engl J Med, 2009. 360: 481. 142. Nygaard, I., et al. Prevalence of symptomatic pelvic floor disorders in US women. JAMA, 2008. 300: 1311. 143. Chen, C.C., et al

2018 European Association of Urology

146. Decision-making and mental capacity

their consent to any proposed intervention how and when to have potentially difficult conversations about loss of autonomy, advance care planning or death required communication skills for building trust and working with people who may lack capacity clarity on roles and responsibilities the advantages, challenges and ethics of advance care planning, and how to discuss these with the person and their carers, family and friends the processes and law surrounding advance decisions to refuse treatment (...) decision in question it should be supported by tools such as visual materials, visual aids, communication aids and hearing aids, as appropriate. Decision-making and mental capacity (NG108) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 9 of 411.1.6 Record and update information about people's past and present wishes, beliefs and preferences in a way that practitioners from multiple areas (for example care and support

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

147. CCS/CPCA Position Statement on Pulse Oximetry Screening in Newborns to Enhance Detection of Critical Congenital Heart Disease (Full text)

schedule for appropriate utilization of resources. Some centres coordinate pulse oximetry screening with newborn hearing assessment, the first bath, or other routinely scheduled evaluations. Pulse oximetry screening protocols for hospital discharges occurring before 24 hours, or freestanding birthing centres and births occurring at home, require additional consideration. Accommodations made to manage early discharges for existing newborn screening tests could apply to pulse oximetry screening (...) , well communicated, and have a tracking system in place to ensure no loss to follow-up screening. Recommendation 3. We recommend that pulse oximetry screening should be performed between 24 to 36 hours of age (Strong Recommendation; Moderate-Quality Evidence). Values and preferences. This recommendations places emphasis on reducing false positive rates by performing screening after 24 hours compared with screening before 24 hours. Practical tip. For early discharges and home births, consider

2016 Canadian Cardiovascular Society PubMed abstract

148. Complex regional pain syndrome in adults. UK guidelines for diagnosis, referral and management in primary and secondary care 2018 (2nd edition)

and is often associated with limb dysfunction and psychological distress. For those in whom pain persists, psychological symptoms (anxiety, depression), and loss of sleep are likely to develop, even if they are not prominent at the outset. Therefore, an integrated interdisciplinary treatment approach is recommended, tailored to the individual patient. The primary aims are to reduce pain, preserve or restore function, and enable patients to manage their condition and improve their quality of life. The four

2018 British Society of Rehabilitation Medicine

149. Practice Guideline Update Systematic Review Summary: Disorders of Consciousness

the conservative numbers (as death would be a common reason for loss to follow-up in this cohort), a random-effects meta-analysis of these 2 studies suggests 80% survival at 3 months (95% CI 67%–93%, I 2 = 59). No information on 3-month outcomes other than survival was identified. In one of these studies, by 6 months, 20/100 (20%, 95% CI 12%–28%) of patients with nontraumatic VS/UWS had recovered consciousness, e46 with recovery rates differing by etiology (cardiorespiratory disease 14.7%, stroke 20.6 (...) consciousness before 6 months, e46 no additional patients recovered consciousness after that time (0/80, 0%, 95% CI 0%–5%). Of the 80 patients who did not recover consciousness, 68 died within 72 months post injury, 5 were lost to follow- up after transfers to other medical facilities, and 7 remained alive at the time of last evaluation. e46 In the study reporting only survival with substantial loss to follow-up, e56 at least 12 of 28 survived greater than 12 months (43%, 95% CI 27%–61%; 3 known deaths, so

2018 American Academy of Neurology

150. Cardiovascular Health in Turner Syndrome: A Scientific Statement From the American Heart Association (Full text)

and with their families should start as early as 12 years of age and should be age and developmentally appropriate. , The topics discussed should be documented in the medical record and shared with the primary care provider and other subspecialists to ensure that the individual and family hear consistent information and that this information is reinforced by all providers. During this transition period, the importance of preparation for adulthood cardiovascular care is emphasized with the aim of ensuring guideline

2018 American Heart Association PubMed abstract

151. Stroke in childhood - clinical guideline for diagnosis, management and rehabilitation

functions • Assess vision and hearing as part of the multidisciplinary assessment. • Treat all pain actively, using appropriate measures including positioning, handling and medication. xxiv Dysphagia • Refer for speech and language therapy (SLT) assessment and advice if parents/carers have concerns about coughing or choking on eating and drinking, frequent chest infections, or failure to move through the typical stages of eating and drinking development. Communication, speech and language functions

2017 Royal College of Paediatrics and Child Health

152. CCS and CPCA Position Statement on the Approach to Syncope in the Pediatric Patient (Full text)

, 2016 Accepted: September 28, 2016 ; Received: September 13, 2016 ; | ---- Figure 1 Clinical pathway for pediatric syncope patients. ECG, electrocardiogram; VVS, vasovagal syncope. ---- | ---- Figure 2 History and physical examination. ECG, electrocardiogram; LOC, loss of consciousness; LQTS, long QT syndrome. ---- | ---- Figure 3 ECG findings in syncope. “Red light” might suggest malignant arrhythmia in certain contexts; “yellow light” might require a nonurgent evaluation in cardiology; “green (...) , and Evaluation (GRADE) methodology. Most syncope is vasovagal, which is benign and does not require extensive investigation. This Position Statement presents recommendations to encourage an efficient and cost-effective disposition for the many patients with a benign cause of syncope, and highlights atypical or concerning clinical findings associated with other causes of transient loss of consciousness. The prodrome and the circumstances around which the event occurred are the most important aspects

2016 Canadian Cardiovascular Society PubMed abstract

153. 2014 CHEST-CTS Guideline: Prevention of Acute Exacerbation of COPD

exacerbations. However, clinicians prescribing macrolides need to consider in their individual patients the potential for prolongation of the QT interval and hearing loss as well as bacterial resistance. The duration and exact dosage of macrolide therapy is unknown. 27. For patients with an acute exacerbation of COPD in the outpatient or inpatient setting, we suggest that systemic corticosteroids be given orally or intravenously to prevent hospitalization for subsequent acute exacerbations of COPD (...) prescribing this medication need to advise their patients of the potential side effects of weight loss and diarrhea. Patients may have to discontinue the therapy because of side effects. The decision to prescribe this medication should also be informed by the fact that there is limited data for supplemental effectiveness in patients concurrently using inhaled therapies. 30. For stable patients with chronic obstructive pulmonary disease, we suggest treatment with oral slow-release theophylline twice daily

2014 Canadian Thoracic Society

154. Monitoring and Management of Pediatric Patients Before, During, and After Sedation for Diagnostic and Therapeutic Procedures

to reduce morbidity. 11,23,24,27, 30–33,35,39,41,44,47,51,74–84 These practice recom- mendations are proffered with the awareness that, regardless of the intended level of sedation or route of drug administration, the sedation of a pediatric patient represents a continuum and may result in respiratory depression, laryngospasm, impaired airway patency, apnea, loss of the patient’s protective airway reflexes, and cardiovascular instability. 38,43,45,47,48,59,62,63,85–112 Procedural sedation of pediatric (...) is adequate. Cardiovascular function is usually main- tained. The caveat that loss of consciousness should be unlikely is a particularly important aspect of the definition of moderate sedation; drugs and techniques used should carry a margin of safety wide enough to render unintended loss of consciousness unlikely. Because the patient who receives moderate sedation may progress into a state of deep sedation and obtundation, the practitioner should be prepared to increase the level of vigil- ance

2016 American Academy of Pediatric Dentistry

155. Recommendation for Informed Consent

parents in the decision-making process. 11 Also, to assure a person who is deaf or hearing impaired can consent, a dentist carefully should consider the patient’s self-assessed communication needs before any treatment. Practitioners may need to provide access to translation services (e.g., in person, by telephone, by subscription to a language line) and sign language services. 14 Practitioners who receive federal funding, as well as those in a significant number of states, are mandated to provide

2015 American Academy of Pediatric Dentistry

156. Telepsychiatry With Children and Adolescents

review of patient medical records ITV consultations resulted in substantial changes and additions to diagnoses; for a subtest of patients, repeated ITV consultations led to improved health behaviors, weight maintenance, and/or weight loss Witmans et al., 2008 55 89 children (age 1e18 y; mean 7.5 y) sleepdiary,childhoodsleephabits, PQoL, client satisfaction patientswereverysatis?edwiththe delivery of multidisciplinary pediatric sleep medicine services over ITV Mulgrew et al., 2011 56 25 youth (age (...) beespeciallysuitedforadolescentswhoarefamiliarwiththe technology and might respond to the feeling of control allowed by ITV. 40,124 Appropriateness is determined in part by weighing need versus resources. The psychiatrist should assess site appro- priateness, including adequate space, visual and auditory privacy, and trained staff, to assist the youth in safely JOURNAL OF THE AMERICAN ACADEMY OF CHILD & ADOLESCENT PSYCHIATRY VOLUME 56 NUMBER 10 OCTOBER 2017 www.jaacap.org 883 AACAP OFFICIAL ACTIONengaging in the session alone

2017 American Academy of Child and Adolescent Psychiatry

157. Recommendation for Record-Keeping

, and outcome General Complications during pregnancy and/or birth Prematurity Congenital anomalies Cleft lip/palate Inherited disorders Nutritional deficiencies Problems of growth or stature Head, ears, eyes, nose, throat Lesions in/around mouth Chronic adenoid/tonsil infections Chronic ear infections Ear problems Hearing impairments Eye problems Visual impairments Sinusitis Speech impairments Apnea/snoring Mouth breathing Cardiovascular Congenital heart defect/disease Heart murmur Infective endocarditis (...) High blood pressure Rheumatic fever Rheumatic heart disease Respiratory Asthma—medications, triggers, last attack, hospitalizations Tuberculosis Cystic fibrosis Frequent colds/coughs Respiratory syncytial virus Reactive airway disease/breathing problems Smoking Gastrointestinal Eating disorder (e.g., anorexia, bulimia, pica) Ulcer Excessive gagging Gastroesophageal/acid reflux disease Hepatitis Jaundice Liver disease Intestinal problems Prolonged diarrhea Unintentional weight loss Lactose

2017 American Academy of Pediatric Dentistry

158. Depression: Adult and Adolescent

questions (ADQs) (on back of Annual BH Questionnaire) Next steps Bipolar disorder ADQ #1: At any point in your life, have you gone through periods when you felt the opposite of being depressed—very “high” or “speeded up,” with lots of energy? Didn’t need to sleep? Felt you could do anything? If yes, consider referral to BHS. Psychosis, including postpartum psychosis ADQ #2: In the past 2 weeks, have you occasionally heard or seen things that other people couldn’t see or hear, things that might (...) not really be there? If yes, consider referral to BHS. Abuse/violence ADQ #3: Have you, within the past 1 to 2 years, been the victim of threats, physical hurting, or forced sexual contact? If yes, follow up with open- ended, non-leading questions to encourage self-disclosure. Bereavement and adjustment disorders ADQ #4: Have you recently experienced some stressful event or life change, like the death of a friend or family member, loss of job, or relationship problems? If yes, counsel or refer

2017 Kaiser Permanente Clinical Guidelines

159. Behavior Guidance for the Pediatric Dental Patient

subjective process that becomes an extension of the personality of the dentist. Associated with this process are the specific techniques of pre-visit imagery, direct observation, tell-show-do, ask-tell- ask, voice control, nonverbal communication, positive rein- forcement, distraction, and memory restructuring. The dentist should consider the cognitive development of the patient, as well as the presence of other communication deficits (e.g., hearing disorder), when choosing specific communicative (...) ques- tions about the dental procedure in a safe environment. • Indications: May be used with any patient. • Contraindications: None. T ell-show-do • Description: The technique involves verbal explanations of procedures in phrases appropriate to the developmental level of the patient (tell); demonstrations for the patient of the visual, auditory, olfactory, and tactile aspects of the procedure in a carefully defined, nonthreatening setting (show); and then, without deviating from the explanation

2015 American Academy of Pediatric Dentistry

160. Developmental follow-up of children and young people born preterm.

(for example, autism spectrum disorder) Epilepsy that is currently being treated The presence of a hearing impairment, defined as profound deafness or impairment severe enough to need hearing aids or cochlear implant Results of national orthoptic vision screening. Record routine educational measures at Key Stage 2 (including special educational needs and disability [SEND]) on an operational delivery network-wide basis, to allow educational outcomes at 11 years to be linked to neonatal information (...) and carers of preterm babies about: Universal services and national recommendations for assessing the development of all children through screening (for example, newborn hearing screening) and surveillance (including social, emotional, behavioural and language development) (At the time of publication [August 2017], these universal screening and surveillance services are delivered through the in England) and Whether their baby will also be offered enhanced developmental support and surveillance (see

2017 National Guideline Clearinghouse (partial archive)

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