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181. Best Practice Guide: Continuous subcutaneous insulin infusion (CSII) A clinical guide for adult diabetes services

such as depression due to disease burden from hypoglycaemia or poor control may actually respond well to CSII and there is evidence that CSII can be safely used in this patient cohort (Rodrigues et al 2005) 6. Cognitive, visual and physical impairments may require a care partner to be co-trained in pump therapy, and should ideally be managed at more experienced centres, but should not be a contraindication to pump therapy. The MDT should continue to support people with diabetes who are unable to proceed (...) 8 Starting insulin pump therapy 11 Basal insulin 14 Bolus insulin 17 Calculating the ICR/ISF 18 Download interpretation 20 CSII and specific scenarios 21 Management of unexplained hyperglycaemia 21 Sick day rules 22 Problematic hypoglycaemia 23 CSII discontinuation 25 Transition 25 Exercise 26 Conclusions 27 References 28 Appendix 1: Basal rate testing protocol 30 Appendix 2: Gold score for hypoglycaemia awareness 30 Appendix 3: Clarke hypoglycaemia awareness questionnaire 31 03 CLINICAL

2018 Association of British Clinical Diabetologists

182. Practical Management of Hyperglycaemic Hyperosmolar State (HHS) in children

started, underlying or precipitating causes of HHS (such as infection) must be identified and treated at the same time. Precipitating causes of HHS include infection, undiagnosed diabetes and substance abuse. A full clinical assessment should be carried out, including possible risk factors: ? history from family/patient ? physical examination looking for acanthosis nigricans, obesity, signs of trauma or infection ? mental state ? neurological state ? renal function assessment ? family history etc (...) insulin is initiated ? Monitor potassium levels 2-3 hourly with blood gases ? ECG monitoring is required to recognise early signs of potassium derangement. Phosphate Phosphate should be checked every 2-3 hours as severe hypophosphataemia can contribute to rhabdomyolysis, haemolytic uraemia, muscle weakness and paralysis. There are no studies on the use of phosphate therapy for HHS and the beneficial effect of phosphate therapy is purely theoretical. ? If replacement required, give a 50:50 mix

2018 British Society for Paediatric Endocrinology and Diabetes

183. Heavy menstrual bleeding: assessment and management

is it for? 4 Recommendations 5 1.1 Impact of heavy menstrual bleeding (HMB) on women 5 1.2 History, physical examination and laboratory tests 5 1.3 Investigations for the cause of HMB 6 1.4 Information for women about HMB and treatments 9 1.5 Management of HMB 10 Recommendations for research 17 1 Hysteroscopy compared with ultrasound or empiric pharmacological treatment in the diagnosis and management of heavy menstrual bleeding (HMB) 17 2 Effectiveness of the progestogen-only pill, injectable progestogens (...) Recognise that heavy menstrual bleeding (HMB) has a major impact on a woman's quality of life, and ensure that any intervention aims to improve this rather than focusing on blood loss. [2007] [2007] 1.2 History, physical examination and laboratory tests History History 1.2.1 T ake a history from the woman that covers: the nature of the bleeding related symptoms, such as persistent intermenstrual bleeding, pelvic pain and/or pressure symptoms, that might suggest uterine cavity abnormality, histological

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

184. Attention deficit hyperactivity disorder: diagnosis and management

an assessment of the person's needs, Attention deficit hyperactivity disorder: diagnosis and management (NG87) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 11 of 62coexisting conditions, social, familial and educational or occupational circumstances and physical health. For children and young people, there should also be an assessment of their parents' or carers' mental health. [2008, amended 2018] [2008, amended 2018 (...) (see recommendation 1.5.4) Attention deficit hyperactivity disorder: diagnosis and management (NG87) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 18 of 62a baseline assessment has been carried out (see recommendation 1.7.4). See the recommendations on medication. [2018] [2018] 1.5.14 Consider a course of cognitive behavioural therapy (CBT) for young people with ADHD who have benefited from medication but whose

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

185. Management of opioid use disorders: a national clinical practice guideline

to recommendations can be found in Appendices 1 and 2. Special considerations Pregnant women Opioid agonist treatment has long been the standard therapy for opioid use disorder in pregnant women. 75,76 Abundant supporting evidence has rendered methadone the most frequently prescribed opioid agonist during pregnancy; however, more recent research suggests that buprenorphine (monoproduct) may be similarly safe and effective for the treatment of opioid use disorder in pregnant women. 75,77–79 We suggest that care (...) interviewing, long-term monitoring of substance use, provision of comprehensive primary care, and referrals to psy- chosocial treatment interventions and psychosocial supports as appropriate, with specialist care as required, to optimize physical and mental wellness as the patient progresses in recovery. Withdrawal management (formerly “detoxification”) without linkage to long-term addiction treatment is to be avoided, and patients desiring such approach should be informed of risks and encouraged toward

2018 CPG Infobase

186. Management of Anaemia and Iron Deficiency in Patients With Cancer: ESMO Clinical Practice Guidelines

, anaemia is associated with fatigue, impaired physical function and reduced quality of life (QoL) [4–7]. Consequences of anaemia may include impaired response to cancer treatment and reduced overall survival (OS), even though a causal direct relationship has not yet been established [8, 9]. These new ESMO Clinical Practice Guidelines provide tools to evaluate anaemia, also in patients with myelodysplastic syn- dromes (MDS), and include recommendations on how to safely manage chemotherapy-induced (...) and disturbed iron homeostasis, can be consequences of increased release of in?ammatory cytokines due to the underlying cancer and/or tox- icity of cancer therapy. Furthermore, vitamin B12 and folate de?- ciency are relatively rare causes of anaemia in cancer patients. Notably, also more than half of patients with MDS are charac- terised by a haemoglobin (Hb) level 80% of these patients require RBC transfusions [14–17]. However, ESAs were not approved by the European Medicines Agency (EMA) for use in MDS

2018 European Society for Medical Oncology

187. ABCD position statement on standards of care for management of adults with type 1 diabetes - this has been superseded by the 2017 version - see above

Immediate treatment 1.4 Autoimmune conditions associated with type 1 diabetes 2. Initial management 2.1 Education 2.2 Nutritional advice 2.3 Physical activity and exercise 3. Follow up consultations and ongoing support 3.1 Consultation process 3.2 Annual review 3.3 Psychological support 4. Treatment, targets and monitoring 4.1 Treatment 4.2 Targets 4.3 Monitoring 4.4 Unexplained or unpredictable blood glucose results 5. Long term complications:screening and management 5.1 Screening and treatment (...) conditions o Failure to respond to oral therapy o Positive antibody test (anti-GAD, insulin autoantibodies (IAA ) and islet cell antibodies (ICA) most commonly used) o Urine C-peptide:creatinine ratio less than 0.5nmol/l The presence of one or more of these clues may point to a diagnosis of type 1 diabetes but absence does not exclude it. Pancreatic autoantibodies Pancreatic autoantibodies e.g. anti GAD, IAA, ICA are present at the time of diagnosis in 60-70% of people but the antibody titre declines

2016 Association of British Clinical Diabetologists

188. Collaborative Framework for Care and Control of Tuberculosis and Diabetes

and tuberculosis treatment outcomes 3. Summary of studies on screening for tuberculosis in diabetes patients and screening for diabetes in tuberculosis patients, and studies on tuberculosis preventive therapy in patients with diabetes 34 35 iv Acknowledgements The development of this framework was coordinated by Anthony D. Harries and Knut Lönnroth, who also wrote the first draft. The Guideline Group also consisted of (in alphabetical order): Meghan A Baker, Mauricio Barreto, Nils Billo, Richard Brostrom, Ib (...) that the prevalence of diabetes will reach 438 million by 2030 and that 80% of prevalent cases will occur in the developing world (7). The increase is mainly driven by changes in diet and levels of physical activity (8). In the poorest countries, diabetes is more common among the better-off, but economic development quickly reverses this trend so that people from lower socioeconomic groups are more affected by diabetes; sequelae are worse among the poor in all countries (9). People from lower socioeconomic groups

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2011 International Union Against TB and Lung Disease

189. Guidelines for the Clinical and Operational Management of Drug-Resistant Tuberculosis

medicines 230 Importation of drug-resistant tuberculosis medicines 231 Storage and distribution in-country 231 Rational use 231 References 232 Appendices 233 CONTENTS viiAbbreviations 2LI second-line injectable drug AFB acid-fast bacillus Am amikacin Amx/Clv amoxicillin/clavulanate ART antiretroviral therapy ARV antiretroviral (drug) ATS American Thoracic Society AUC24 area under the concentration-time curve from 0 to 24 h BTS British Thoracic Society CD4 cells CD4+T lymphocytes Cf clofazimine Cfx cipro (...) FDC ? xed-dose combination FLD ? rst-line drug FQ ? uoroquinolone GDF Global Drug Facility GFATM The Global Fund to Fight AIDS, Tuberculosis and Malaria Gfx gati? oxacin GLC Green Light Committee (WHO) H isoniazid HAART highly active antiretroviral therapy HEPA ? lter high-ef? ciency particulate air ? lter HIV human immunode? ciency virus IC infection control ICF intensi? ed case ? nding IPT intermittent preventive treatment Km kanamycin MDR-TB multidrug-resistant tuberculosis; Mycobacterium

2013 International Union Against TB and Lung Disease

190. Postpartum Hemorrhage

and for longer periods of time than matched controls. The relationship between amount and duration of oxytocin and risk of severe PPH persisted after controlling for confounding variables. After controlling for race, BMI, admission hematocrit, induction status, magnesium therapy and chorioamnionitis, oxytocin continued to predict severe PPH and an increase in oxytocin exposure during labour resulted in an adjusted OR of 1.58 (95% CI, 1.05-2.57, p = .026) for PPH secondary to uterine atony. (55)12 AOM (...) breastfeeding. (63,66) Hastie and Fahy’s model of “Midwifery Guardianship” proposes additional criteria for “holistic psychophysiological” third-stage care provided in a physical and emotional environment conducive to sensations of calmness, mindfulness, and safety. They theorize that environmental conditions that facilitate feelings of relaxation, skin-to-skin contact and early breastfeeding optimize processes that encourage oxytocin release and uptake and uterine contraction and retraction. (64,65) Hastie

2016 Ontario Midwives

191. ABCD position statement on the risk of diabetic ketoacidosis with the use of sodium-glucose cotransporter-2 inhibitors

in urinary glucose loss and, therefore, fat dependent metabolism may persist for several days. Preventing DKA in high risk patients taking SGL T-2 inhibitors 1. Avoid or stop SGLT-2 inhibitors in situations likely to shift metabolism to a catabolic state rather than anabolic state i.e. at least 24 hours prior to a major elective surgery, planned invasive procedures or an anticipated severe stressful physical or mental activity such as running a marathon. The effect on glycosuria may persist for a few (...) diabetes: a randomized, double-blind, placebo-controlled pilot study. Diabetes Care. 2015;38:412-419. 12. Tamez HE, Tamez AL, Garza LA, et al. Dapagliflozin as an adjunct therapy to insulin in the treatment of patients with type 1 diabetes mellitus. J Diabetes Metab Disord. 2015;14:78. 13. Perkins BA, Cherney DZ, Partridge H, et al. Sodium glucose cotransporter 2 inhibition and glycemic control in type 1 diabetes: results of an 8-week open-label proof-of concept trial. Diabetes Care. 2014;37:1480-1483

2016 Association of British Clinical Diabetologists

192. Desk guide for diagnosis and management of TB in children - Africa

pulmonary TB 2. Guidance for the diagnosis of children who present with symptoms suggestive of TB 3. Strict symptom criteria 4. Indications requiring hospitalization/referral Tables 1. Recommended treatment regimens for new patients 2. Recommended dosages according to weight 3. Numbers of tablets by weight band for FDC 4. Recommended dosages and regimens for preventive therapy 6 7 8 9 11 12 13 14 15 16 17 19 19 21 22 23 24 27 28 29 30 31 32 33 34 35 36 36 20 20 21 256 This guide is based on NTP and WHO (...) is similar to that for HIV-uninfected children. CHECK WEIGHT, RECORD WEIGHT AND COMPARE TO PREVIOUS WEIGHTS Typical symptoms • Cough especially if persistent and not improving • Weight loss or failure to gain weight • Fever and/or night sweats • Fatigue, reduced playfulness, less active Especially if symptoms persist (>2-3 weeks) without improvement following other appropriate therapies (e.g. broad-spectrum antibiotics for cough; anti-malarial treat- ment for fever; or nutritional rehabilitation

2016 International Union Against TB and Lung Disease

193. Desk guide for diagnosis and management of TB in children - Asia

pulmonary TB 2. Guidance for the diagnosis of children who present with symptoms suggestive of TB 3. Strict symptom criteria 4. Indications requiring hospitalization/referral Tables 1. Recommended treatment regimens for new patients 2. Recommended dosages according to weight 3. Numbers of tablets by weight band for FDC 4. Recommended dosages and regimens for preventive therapy 6 7 8 9 11 12 13 14 15 16 17 19 19 21 22 23 24 27 28 29 30 31 32 33 34 35 36 36 20 20 21 256 This guide is based on NTP and WHO (...) is similar to that for HIV-uninfected children. CHECK WEIGHT, RECORD WEIGHT AND COMPARE TO PREVIOUS WEIGHTS Typical symptoms • Cough especially if persistent and not improving • Weight loss or failure to gain weight • Fever and/or night sweats • Fatigue, reduced playfulness, less active Especially if symptoms persist (>2-3 weeks) without improvement following other appropriate therapies (e.g. broad-spectrum antibiotics for cough; anti-malarial treat- ment for fever; or nutritional rehabilitation

2016 International Union Against TB and Lung Disease

194. The Looming Co-epidemic of TB-Diabetes: A Call to Action

-Diabetes 12 Economic Impact Both TB and diabetes exact significant economic costs on society, including both the direct costs of healthcare and indirect costs of disability, lost productivity, forgone investment in human and physical capital, and death. No assessments have been carried out to date on the economic impact of TB-diabetes, though assessments have been conducted on the economic impact of each disease individually. An estimated 75 percent of people who develop TB are between the ages of 15 (...) in infectious diseases and tropical medicine and spent over 20 years living and working in sub-Saharan Africa. He is an honorary professor at the London School of Hygiene and Tropical Medicine and the author of hundreds of published papers on TB, HIV/AIDS, tropical medicine and the impact of operational research. In Malawi he served the Ministry of Health as National Advisor on both TB and HIV, with responsibility for scaling up antiretroviral therapy there. In 2002 Professor Harries was appointed Officer

2014 International Union Against TB and Lung Disease

195. Implementing Collaborative TB-HIV Activities: A Programmatic Guide

the burden of HIV in TB patients 3 2.1 How to make the diagnosis of HIV infection in TB services 3 2.2 Providing cotrimoxazole preventive therapy for HIV-positive TB patients 9 2.3 Starting antiretroviral treatment for HIV-positive TB patients 11 3 Decreasing the burden of TB in people living with HIV 23 3.1 The role of infection control in making health facilities safe 23 3.2 What are the basic TB infection control issues in the laboratory? 31 3.3 Role of intensi? ed TB case-? nding in reducing TB (...) burden in people with HIV 32 3.4 Role of isoniazid preventive therapy for people living with HIV 37 4 Monitoring TB-HIV care 41 4.1 Why is it important to monitor TB-HIV care? 41 4.2 Is a new recording and reporting system needed to monitor TB-HIV care? 41 4.3 How should the monitoring of TB-HIV care be organised? 41 4.4 Who should perform TB-HIV recording and reporting? 42 4.5 Which HIV-related data should be included in the TB recording and reporting system to monitor TB-HIV care? 43 4.6 Which TB

2012 International Union Against TB and Lung Disease

196. Management of Tuberculosis: A Guide to the Essentials of Good Clinical Practice

We, as Union consultants, also express our admiration and respect for Drs Annik Rouillon and Karel Styblo, from whom we learned the basics of our knowledge of this work.Glossary AFB acid-fast bacilli AIDS acquired immunodeficiency syndrome ART antiretroviral treatment BCG bacille Calmette-Guérin BMU basic management unit CPT cotrimoxazole preventive therapy CTM cotrimoxazole DOTS originally an acronym for directly observed treatment, short course, DOTS became the term used to describe (...) to as mono- therapy), or administration of powerful drugs to a patient harbour- ing tuberculosis micro-organisms resistant to all but one of the drugs given to the patient. Micro-organisms with resistance to at least the two most important drugs, isoniazid and rifampicin, are termed multidrug-resistant (MDR). The majority of patients with this type of resistance cannot be treated effec- tively with regimens that use only ? rst-line drugs. They need to be treated with the so-called second-line drugs

2010 International Union Against TB and Lung Disease

197. Guideline on the management of premature ovarian insufficiency

Interventions for improving quality of life in women with POI 87 10. Sexual and genito-urinary function in women with POI 91 10.1 POI and consequences for sexuality 91 10.2 Interventions for sexuality in POI 93 10.3 Genito-urinary symptoms in POI 95 11. Neurological function in women with POI 99 11.1 POI and consequences for neurological function 99 11.2 Interventions for improving neurological function in POI 101 12. Hormone replacement therapy 107 12.1. Indications for HRT 107 12.2 Risks of HRT 109 12.2 (...) with POI and endometriosis 123 12.5.d Women with POI and other medical issues 123 12.6. Treatment with androgens 127 12.6.a Indications 128 12.6.b Risks of androgen therapy 129 12.6.c Routes of administration, dose, duration, monitoring 129 13. Puberty induction 138 14. Complementary treatments in POI 144 Appendix 1: Abbreviations 148 Appendix 2: Glossary 150 Appendix 3: Guideline group 152 Appendix 4: Research recommendations 154 Appendix 5: Methodology 156 Appendix 6: Reviewers of the guideline draft

2015 European Society of Human Reproduction and Embryology

198. Routine psychosocial care in infertility and medically assisted reproduction ? A guide for fertility staff

Needs, 2008). Why was this guideline produced? The World Health Organization defines health as a ‘state of complete physical, mental and social well- being and not merely the absence of disease or infirmity’ (World Health Organization, 2007). This definition highlights the many dimensions (anatomical, physiological, and mental) of health and the importance of providing adequate care to address them all and not only to treat the disease. In infertility care, this is especially important for several (...) professionals (e.g., infertility counselling, individual/couple psychological therapy, sex therapy) were not considered. These may be described in future ESHRE Guidelines. Two important clarifications need to be made regarding the above definitions. First, the fact that psychosocial care components do not require the active intervention of a mental health professional does not mean that they cannot deliver them. This will depend on how psychosocial care is organized at clinics. What is considered is whether

2015 European Society of Human Reproduction and Embryology

199. Weakness / Fatigue

conservation/restoration consider a self-management plan set priorities, delegate tasks pace activities and attend to one activity at a time schedule activities at times of peak energy and conserve energy for valued activities eliminate non-essential activities occupational therapy referral for advice on minimising energy expenditure and appropriate aids/equipment. Physical activity and exercise An appropriate level of exercise can reduce fatigue and should be recommended. Consider physiotherapy referral (...) disease. The severity and impact of fatigue may change in the course of the disease trajectory. It is frequently regarded as more distressing than pain by patients. It is often under-recognised by professionals. Fatigue may be unrelated to level of activity and not fully alleviated by rest or sleep. It is multidimensional affecting physical function, cognitive ability, social, emotional and spiritual wellbeing. Reduced physical function limits participation in preferred activities and activities

2015 Scottish Palliative Care Guidelines

200. Nausea and Vomiting

are distinct entities, principally representing behavioural adaptive mechanisms to avoid the ingestion of toxins. However, there are clearly other physical (eg vestibular upset) and psychological (eg fear, anticipation) triggers that can lead to the experience of nausea, vomiting or both. As there may be several potential contributory factors to consider in any one individual, it may be useful to parallel the approach taken with pain management in palliative care and consider the concept of ‘total nausea (...) ’. Anti-emetic drug therapy is primarily for the control of nausea so that it is often inappropriate to treat every episode of vomiting. All anti-emetics have the potential to produce significant side effects, eg hyoscine hydrobromide crosses the blood brain barrier and may cause sedation, agitation or confusion. Anti-dopaminergics should be avoided in patients with Parkinsons Disease. As well as managing the actual nausea and vomiting, it is essential that the consequences are considered. Individuals

2015 Scottish Palliative Care Guidelines

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