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161. Headache

, and no focal neurological signs may have benign intracranial hypertension (pseudotumour cerebri). They should have urgent specialist referral and will need urgent neuroimaging. An intracranial space-occupying lesion should be ruled out prior to lumbar puncture to measure cerebral spinal fluid (CSF) pressure. Further investigation may be required as the differential diagnosis would include cerebral venous sinus thrombosis. EO (GDG) 4. Elderly patient with new headache and subacute cognitive change: Elderly (...) from onset to peak intensity). EO (GDG) Patients presenting with severe headache of sudden onset (thunderclap headache) should be sent to an emergency department with urgent computerized tomography (CT) capability for immediate investigation to exclude subarachnoid hemorrhage. If subarachnoid hemorrhage is not present on head CT scanning, other investigations (e.g., lumbar puncture) may be necessary. Specialist involvement and further neuroimaging may also be necessary, as the differential

2016 Accelerating Change Transformation Team

162. Framework for Pain Services for Cancer and Life-Limiting Disease

. coeliac plexus, lumbar sympathectomy) and intrathecal neurolytic block. Other procedures may be offered within the competency of the Consultant in Pain Medicine and the expertise of staff and local infrastructure such as external spinal infusions e. Determine onward referral to Level 4 (Highly Specialist Pain Management) services for those patients requiring direct referral to Level 4 or not responding to Level 3 pain services and who have a realistic possibility of improvement within Level 4 service (...) with patient goals and preferences. Level 3 services will include local expertise in management of complex analgesic combinations (methadone, ketamine) including high dose opioids, and interventional procedures including peripheral nerve blocks (e.g. coeliac plexus, lumbar sympathectomy) and intrathecal neurolytic block. Other procedures may be offered within the competency of the Consultant in Pain Medicine and the expertise of staff and local infrastructure such as external spinal infusions. Level 3

2018 Faculty of Pain Medicine

163. Standards for Neurologic Critical Care Units

safe and rapid transfer of patients between these areas when required. Level I and Level II units should possess the ability to transfer and accept patients via a designated ambulance bay and/ Table 1 Common neurocritical care diagnoses Ischemic stroke Intracerebral hemorrhage Subarachnoid hemorrhage Acute nontraumatic weakness Traumatic brain and spine injury including epidural and subdural hematoma, diffuse axonal injury Anoxic brain injury Coma Intracranial hypertension Meningitis (...) and encephalitis Spinal cord compression Status epilepticus147 Table 2 Neurocritical care unit recommendations Standards Level I Level II Level III Organization Neuroscience critical care (NCC) Service oversight by physician, nursing and hospital executive leadership R R R Delineation of physician and non-physician privileges R R R Distinct administrative unit R R O Leadership meet regularly to evaluate service needs R R R Leadership meet regularly to evaluate service needs R R R NCC Committee R R O Standing

2020 Neurocritical Care Society

164. 2020 Acute Coronary Syndromes (ACS) in Patients Presenting without Persistent ST-Segment Elevation (Management of) Guidelines Full Text available with Trip Pro

-ST-segment elevation acute coronary syndrome (Supplementary Data) 47 9.1 Lifestyle management (Supplementary Data) 47 9.1.1 Smoking (Supplementary Data) 47 9.1.2 Diet and alcohol (Supplementary Data) 47 9.1.3 Weight management (Supplementary Data) 47 9.1.3 Physical activity (Supplementary Data) 47 9.1.4 Cardiac rehabilitation (Supplementary Data) 47 9.1.5 Psychosocial factors (Supplementary Data) 47 9.1.6 Environmental factors (Supplementary Data) 47 9.1.7 Sexual activity (Supplementary Data) 47

2020 European Society of Cardiology

165. Improving the Lives of People with Complex Chronic Pain: How to Commission Effective Pain Management

approach to support patients effectively. Small incremental positive change is made possible through access to a range of enabling treatments including some specialist treatments. This process is difficult to manage in primary care alone. Initial assessments require time, interprofessional integration and specialist rehabilitation. For patients with complex pain, they need specialists with the training and expertise to manage their care holistically. Patients with complex pain benefit from (...) to contribute to dependency on addictive pain medications and the declining potential for functional rehabilitation [26]. A current consequence of this is the well-publicised ‘opioid crisis’, with a consequent rise in prescription addiction. If there is not a full recognition of these risks of fragmenting care, then an attempt to cut costs will likely have the reverse impact. Costs will rise further as quality of life for this group diminishes with the well- recognised consequence of increased heath care

2020 Faculty of Pain Medicine

166. Medical Cannabinoids

, chemotherapy-induced nausea and vomiting, and spasticity due to multiple sclerosis or spinal cord injury. MANAGEMENT OF PAIN ACUTE PAIN X DO NOT prescribe medical cannabinoids for acute pain management, due to evidence of no benefit and known harms. [Strong recommendation] HEADACHE X DO NOT prescribe medical cannabinoids for headache, due to the lack of evidence and known harms. a [Strong recommendation] RHEUMATOLOGIC PAIN X DO NOT prescribe medical cannabinoids for pain associated with rheumatologic (...) )/SPINAL CORD INJURY X DO NOT prescribe medical cannabinoids as first- or second-line therapy for spasticity in MS/Spinal Cord Injury due to limited evidence and known harms. [Strong recommendation] ? Consider medical cannabinoids for refractory spasticity in MS/Spinal Cord Injury, with the following caveats: [Weak recommendation] o Discuss the benefits and risks of medical cannabinoids for spasticity with the patient. o Patients have had a reasonable therapeutic trial of standard therapies (including

2019 Accelerating Change Transformation Team

167. Cerebral palsy: Scenario: Adult with confirmed cerebral palsy

methods and information resources to take account of the needs and understanding of the person and their family or carers (if appropriate). Adults with cerebral palsy (CP) should ideally be able to access a network of specialist services that (depending on local availability) may include advocacy support, learning disability services, mental health services, orthopaedic surgery (and post-surgery rehabilitation), rehabilitation engineering services (centres that design, develop, and adapt technological (...) solutions to overcome challenges to function, activity, and participation for people with disability), rehabilitation medicine or specialist neurology services, secondary care expertise for managing (such as, respiratory, gastrointestinal and urology services), social care, specialist therapy services (such as, physiotherapy, occupational therapy, speech and language therapy, and dietetics), and wheelchair services. Be aware that some of these services may be provided by charities. Severity of CP

2016 NICE Clinical Knowledge Summaries

168. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement

be documented in the report. Tests done while standing are similar to sitting in studies of adults (28), obesity (29), and children (30). Fowler’s position (elevated head and torso) yields higher values than supine or Crook’s position(knees raised)(31).In moststudies involving healthy subjects or patients with lung, heart, neuromuscular disease, or obesity, FEV 1 and FVC were higher in more erect positions, whereas for subjects with tetraplegic spinal cord injury, FVC and FEV 1 were higher in supine than (...) people for adverse effects of exposure to injurious agents To watch for adverse reactions to drugs with known pulmonary toxicity Disability/impairment evaluations To assess patients as part of a rehabilitation program To assess risks as part of an insurance evaluation To assess individuals for legal reasons Other Research and clinical trials Epidemiological surveys Derivation of reference equations Preemployment and lung health monitoring for at-risk occupations To assess health status before

2020 European Respiratory Society

170. BSRM Core standards for Major Trauma

]: • Diagnosis and medical management of conditions causing complex disability. These include musculoskeletal injuries, limb loss, brain and spinal cord injury arising from trauma itself, and also any pre-existing physical, psychological or mental health conditions. • Anticipation and prevention of physical, psychological and social complications, based on knowledge of a condition’s natural history and prognosis • Evaluation of potential to gain from rehabilitation and prognosis for recovery • Defining (...) 2018; In press. 13. Medical rehabilitation in 2011 and beyond. London: Royal College of Physicians; 2011; Available from: http://www.bsrm.org.uk/downloads/medical-rehabilitation-2011-and-beyond.pdf. 14 NHS Standard Contract for Specialist Rehabilitation for Patients with Highly Complex Needs ( all ages): D02. London 2013; Available from: https://www.england.nhs.uk/wp- content/uploads/2014/04/d02-rehab-pat-high-needs-0414.pdf 15. Turner-Stokes L, Bavikatte G, Williams H, et al. Cost-efficiency

2018 British Society of Rehabilitation Medicine

171. Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury

therapy | volume 50 | number 4 | april 2020 | cpg5 Concussion: Clinical Practice Guidelines Concussion: Clinical Practice Guidelines therapy to the cervical and thoracic spines, as indicated, for pa- tients who have experienced a concussive event. Vestibulo-oculomotor A If BPPV is identified as a potential impairment, physical therapists should use canalith repositioning interventions. B Physical therapists with appropriate expertise in vestibu- lar and oculomotor rehabilitation should implement (...) experi- enced a recent potential concussive event for signs of medical emergency or severe pathology (eg, more serious brain injury, medical conditions, or cervical spine injury) that warrant further evaluation by other health care providers. Referral for fur- ther evaluation should be made as indicated (FIGURE 1). Differential Diagnosis A Physical therapists must evaluate for potential signs and symptoms of an undiagnosed concussion in patients who have experienced a concussive event but have

2020 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

172. EAN guideline on palliative care of people with severe, progressive multiple sclerosis

Notcutt et al.: There was one SAE (pain in hip and thigh and lumbar spinal stenosis) in a patient on nabiximols, which was considered unrelated to study medication. The only AE reported in association with abnormal laboratory values was a mild increase in gamma-glutamyl transferase in one patient on nabiximols. Novotna et al.: 17 patients discontinued the treatment early (7%); 15 were on nabiximols (four due to AEs, 11 due to withdrawal of consent). AEs were overall few and similar between nabiximols (...) to walk 20 m without resting (Expanded Disability Status Scale score > 6.0) or higher disability is referred to. When evidence was lacking for this population, recommendations were formulated using indirect evidence or good practice statements were devised. Results: Ten clinical questions were formulated. They encompassed general and specialist palliative care, advance care planning, discussing with HPs the patient’s wish to hasten death, symptom management, multidisciplinary rehabilitation

2020 European Academy of Neurology

173. Clinical Performance Measures for Neurocritical Care

for performance measure development Acute ischemic stroke Acute non-traumatic weakness Coma Intracerebral hemorrhage Aneurysmal subarachnoid hemorrhage Intracranial hypertension and herniation Meningitis and encephalitis Hypoxic-ischemic encephalopathy and targeted temperature manage - ment Spinal cord compression Status epilepticus Traumatic brain injury Traumatic spinal cord injury Brain death8 The search identified 50,257 citations (Fig. 2). Each document underwent title and abstract review by two writing (...) significant care in other locations such as the pre-hospital or post-acute care rehabilitation set- ting. However, these care periods were not included because of the focus of this initial PM Set. Likewise, children (age less than 18 years) were excluded as were patients who developed neurocritical conditions sub- sequent to an admission for another primary disease condition (e.g., in-hospital stroke following admission for myocardial infarction, or status epilepticus occur- ring after admission

2020 Neurocritical Care Society

174. Chronic obstructive pulmonary disease (COPD)

glucocorticoids did not have an increased risk of any osteoporotic, hip, or clinically symptomatic vertebral fracture compared to non-COPD patients. ? An earlier cross-sectional study (Dubois 2002) suggests that osteoporosis of the lumbar spine was most frequent in patients receiving multiple systemic prednisolone courses > 1,000 mg cumulatively for the treatment of exacerbations of COPD. Inhaled corticosteroids (ICS) ? The reported association between ICS and bone mineral density and fracture risk (...) Chronic obstructive pulmonary disease (COPD) © 2020 Kaiser Foundation Health Plan of Washington. All rights reserved. Chronic Obstructive Pulmonary Disease (COPD) Diagnosis and Treatment Guideline Background 2 Risk Factors 2 Prevention 2 Screening 2 Diagnosis and Assessment 3 Diagnosis of COPD using spirometry 3 Methods for assessing COPD symptoms 3 Additional tests 4 Treatment Goals 4 Non-Pharmacologic Treatment Lifestyle modifications 4 Pulmonary rehabilitation 5 Self-management/Living Well

2020 Kaiser Permanente Clinical Guidelines

177. Clinical practice guideline for evaluation of psychosocial factors influencing recovery from adult orthopaedic trauma

by the Major Extremity Trauma and Rehabilitation Consortium (METRC) in collaboration with the American Academy of Orthopaedic Surgeons (AAOS) 9400 W Higgins Rosemont, IL First Edition Copyright 2019 by the Major Extremity Trauma and Rehabilitation Consortium (METRC) and the American Academy of Orthopaedic Surgeons (AAOS)3 View background material via the PRF CPG eAppendix To View All AAOS and AAOS-Endorsed Evidence-Based clinical practice guidelines and Appropriate Use Criteria in a User-Friendly Format (...) and Rehabilitation Ann Marie Warren, PhD, ABPP Trauma Researcher Todd Swenning, MD, FAAOS Orthopaedic Trauma Association Kelly Cozza, MD American Psychiatric Association David Benedek, MD American Psychiatric Association Wade Gordon, MD, FAAOS Orthopaedic Trauma Association Saloni Sharma, MD American Academy of Physical Medicine and Rehabilitation Peggy Naas, MD, MBA, FAAOS American Academy of Orthopedic Surgeons David Ring, MD, FAAOS Orthopaedic Trauma Association Non-Voting Members 1. Atul Kamath, MD, FAAOS

2020 American Academy of Orthopaedic Surgeons

178. The treatment of distal radius fractures

in peer review of this clinical practice guideline: American Academy of Family Physicians American Academy of Physical Medicine and Rehabilitation American Association for Hand Surgery American College of Occupational and Environmental Medicine American Society for Surgery of the Hand American Society of Plastic Surgeons Individuals who participated in the peer review of this document and gave their consent to be listed as reviewers of this document are: Blair C. Filler, MD M. Felix Freshwater, MD

2009 American Academy of Orthopaedic Surgeons

179. Clinical Practice Guideline on the Diagnosis and Treatment of Osteochondritis Dissecans

of Orthopaedics Rehabilitation University of Rochester 601 Elmwood Avenue Rochester, NY 14642 Guidelines and Technology Oversight Chair William C. Watters III MD 6624 Fannin #2600 Houston, TX 77030 Guidelines and Technology Oversight Vice-Chair Michael J. Goldberg, MD Seattle Children’s Hospital 4800 Sand Point Way NE Seattle, WA 98105 Evidence Based Practice Committee Chair Michael W. Keith, MD 2500 Metro Health Drive Cleveland, OH 44109-1900 AAOS Staff: Charles M. Turkelson, PhD Director of Research

2010 American Academy of Orthopaedic Surgeons

180. Clinical Practice Guideline on Management of Hip Fractures in the Elderly

findings or evidence from a single study for recommending for or against the intervention or diagnostic test or the evidence is insufficient or conflicting and does not allow a recommendation for or against the intervention. 5 ANESTHESIA Strong evidence supports similar outcomes for general or spinal anesthesia for patients undergoing hip fracture surgery. Strength of Recommendation: Strong Description: Evidence from two or more “High” strength studies with consistent findings for recommending (...) Research 254 Results 255 Rehabilitation 258 Sub-Recommendation Summary 258 Risks and Harms of Implementing these Recommendations 258 Future Research 258 Occupational and Physical Therapy 259 Rationale 259 Intensive Physical Therapy 260 Rationale 260 Nutrition 261 Rationale 261 Interdisciplinary Care Program 262 Rationale 262 Results 263 Postoperative MultiModal Analgesia 346 Rationale 346 Risks and Harms of Implementing this Recommendation 346 Future Research 346 Results 347 Calcium and Vitamin D

2014 American Academy of Orthopaedic Surgeons

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