Prostatitis - chronic - Management
|
|
- Marjory Lester
- 5 years ago
- Views:
Transcription
1 Prstatitis - chrnic - Management Scenari: Diagnsis f chrnic prstatitis Hw shuld I diagnse chrnic prstatitis? Diagnse chrnic prstatitis if: The man has pain in the perineum r pelvic flr and lwer urinary tract symptms: The mst prminent symptm is pain. It is ften described as an ache (deep, relentless, grinding, r gnawing) and can fluctuate frm day t day. It can be experienced in the perineum, lwer abdmen, penis (especially at the tip), testis, rectum, and lwer back, but it can be very nn-specific and may be described mre as a general ache within the pelvis. Pain r discmfrt can ccur with ejaculatin. Urinary symptms include dysuria, frequency, hesitancy, urgency, and pr stream. Other symptms include fatigue, arthralgia, and myalgia. On digital rectal examinatin, the prstate is nrmal r diffusely tender. Symptms have been present fr at least 3 mnths. Other cnditins have been excluded, fr example: Urinary tract infectin, including urethritis, epididym-rchitis, and epididymitis. Benign prstatic hypertrphy. Cancer f the prstate, bladder, r cln. Urethral stricture. Obstructive calculus in the urinary tract, r a freign bdy. Pudendal neuralgia. Urine culture shuld be dne t exclude urinary tract infectin (urine dipstick tests are negative and are unlikely t change management). Prstatic massage (t btain prstatic secretins t test fr infectin in the prstate) is nt usually dne in primary care. 1
2 Serum prstate-specific antigen (PSA) test shuld nly be cnsidered if prstate cancer is suspected, fr example if there are unexplained inflammatry r bstructive lwer urinary tract symptms, r the prstate is abnrmal n digital rectal examinatin. PSA test Serum prstate-specific antigen (PSA) test Digital rectal examinatin and a PSA test shuld be perfrmed (after cunselling) fr men with unexplained inflammatry r bstructive lwer urinary tract symptms. Urinary infectin shuld be excluded befre PSA testing. Befre having a PSA test, men shuld nt have: An active urinary tract infectin (wait at least 1 mnth after treatment). Had a digital rectal examinatin (within the previus week). Had vigrus exercise (within the previus 48 hurs). Had a prstate bipsy (within the previus 6 weeks). If the PSA test is psitive, infrm the man that this des nt necessarily mean he has cancer f the prstate. At least tw thirds f men with a raised PSA d nt have cancer. He will need t cnsult a urlgist fr specialist examinatin and further tests t make a definitive diagnsis. [Austker and Kirby, 2009] Basis fr recmmendatin These recmmendatins are based n UK natinal guidelines fr the specialist management f chrnic bacterial prstatitis and chrnic prstatitis/chrnic pelvic pain syndrme (CP/CPPS) [Luzzi, 2002; BASHH, 2008]. Prstatic massage Diagnstic prstatic massage is nt recmmended in primary care because it is nt practical and is rarely dne [BASHH, 2008]. Hwever, guidelines fr specialists recmmend that infectin f the 2
3 prstate be further assessed by culturing the urine bth befre and after massage f the prstate in an attempt t lcalize infectin t the prstate. Serum prstate-specific antigen (PSA) test Althugh the PSA level may be raised in bacterial prstatitis, it is neither specific nr sensitive fr this. It is therefre nt recmmended as a rutine investigatin r when the prstate is tender, but shuld be cnsidered if prstate cancer is suspected [BASHH, 2008]. The Natinal Institute fr Health and Clinical Excellence (NICE) recmmends using a PSA test t exclude prstate cancer in men with unexplained inflammatry r bstructive lwer urinary tract symptms [NICE, 2005]. 3
4 Prstatitis - chrnic - Management Scenari: Prstatitis - chrnic Hw shuld I manage a man with chrnic prstatitis? Assess the severity f pain, urinary symptms, and impact n quality f life. The infrmatin will guide management (and the assessment may have therapeutic value in itself). Reassure that chrnic prstatitis is nt cancer and is nt a sexually transmitted infectin, althugh the cause is nt understd. Althugh the cnditin is chrnic and treatment is difficult, in mst cases the trend is fr symptms t imprve ver mnths r years. Refer t urlgy fr specialist assessment and management (which will ften include a trial f an alpha-blcker fr at least 3 mnths). If defecatin is painful, ffer a stl sftener such as lactulse r dcusate see the CKS tpic n Cnstipatin. Cnsider a trial f paracetaml r a nnsteridal anti-inflammatry drug (NSAID) fr 1 mnth see the CKS tpic n NSAIDs - prescribing issues. If there is a histry f urinary tract infectin (r an episde f acute prstatitis) within the last 12 mnths, cnsider a single curse f antibitic treatment with a quinlne while waiting fr the specialist appintment. Optins include: Ciprflxacin 500 mg twice a day fr 28 days, r Levflxacin 500 mg nce a day fr 28 days, r Oflxacin 200 mg twice a day fr 28 days, r Nrflxacin 400 mg twice a day fr 28 days. If quinlnes are nt suitable, treat with trimethprim while waiting fr specialist review. Trimethprim 200 mg twice a day fr 28 days. If the respnse t management recmmended by the urlgist is inadequate, cnsider referral t a chrnic pain specialist. 4
5 Assessment Assessing pain, urinary symptms, and quality f life Pain is likely t be the mst imprtant symptm. The Natinal Institutes f Health Chrnic Prstatitis Symptm Index, NIH-CPSI (pdf), is recmmended in guidelines fr specialists, and is widely used in research fr assessing the severity f pain, urinary symptms, and lss f quality f life [Nickel, 2000]. The NIH-CPSI scre can be useful in demnstrating that treatment has resulted in an bjective imprvement even if the man feels there has been n subjective imprvement. Hwever, it may nt be practical fr rutine use in primary care. Basis fr recmmendatin These recmmendatins are in line with guidelines published by the British Assciatin fr Sexual Health and HIV (BASHH) [BASHH, 2008]. Assessment: Althugh the NIH-CPSI questinnaire is widely used in research and is recmmended in guidelines fr specialists, its usefulness in primary care has nt been assessed, and it is therefre nt recmmended fr rutine use. Trial f simple analgesics: Althugh a trial f simple analgesics is nt cnsidered in the BASHH guideline [BASHH, 2008], a Eurpean guideline n chrnic pelvic pain recmmends (n the basis f expert pinin) a trial f NSAIDs [Fall et al, 2008]. Little research has been cnducted n the effects f NSAIDs in chrnic prstatitis, but there is sme evidence f limited clinical benefit. There are n clinical trials n the use f paracetaml fr chrnic prstatitis. Referral: There are n studies r guidelines n referral fr chrnic prstatitis. The recmmendatins reflect the pinin f CKS n what is cnsidered t be gd clinical practice. Antibitics fr chrnic bacterial prstatitis: 5
6 UK and Eurpean guidelines recmmend antibitics fr chrnic bacterial prstatitis n the basis f weak evidence [BASHH, 2008; Eurpean Assciatin f Urlgy, 2008]. There are n placeb-cntrlled, randmized cntrlled trials (RCTs) f antibitics fr bacterial prstatitis. Three RCTs cmparing different antibitics suggest that between 70% and 98% f men with bacterial prstatitis will be cured r imprved when treated with a quinlne. There is n evidence frm these trials t suggest that any quinlne is mre effective r safer than any ther quinlne. There is n gd evidence n ther classes f antibitics. Quinlnes are preferred t trimethprim because they are effective against a wider range f urinary pathgens. Other antibitics either d nt penetrate the prstate as well, r are less effective against urinary pathgens. There is n evidence t suggest that any particular quinlne is mre effective r mre hazardus than any ther. CKS recmmendatins f ciprflxacin, levflxacin, flxacin r nrflxacin are cnsistent with thse made by the British Assciatin fr Sexual Health and HIV (BASHH) [BASHH, 2008]. The benefits f treatment utweigh the risk f precipitating an antibitic-induced infectin with Clstridium difficile r meticillin-resistant Staphylcccus aureus (MRSA), and the risk f prmting resistance t quinlnes. CKS recmmends empirical treatment with a quinlne fr men with a histry f urinary tract infectin because it is mre likely that the presenting symptms are caused by chrnic infectin, and because diagnstic prstatic massage (t cnfirm infectin) is nt practical in primary care. Antibitics fr abacterial prstatitis: BASHH guidelines d nt recmmend antibitics fr abacterial prstatitis, but bserve that they are widely used [BASHH, 2008]. Very weak evidence supprts the use f antibitics fr chrnic abacterial prstatitis. One small RCT fund weak evidence that levflxacin may be mre effective than dxazsin (and as effective as a cmbinatin f the tw). Imprvements were nt significant 2 weeks after treatment, but were significant 6 weeks after treatment. Participants had nt previusly been treated with antibitics and had been symptmatic fr less than a year n average. Tw RCTs fund that quinlnes were nt effective in men wh had experienced symptms fr 6 years n average and had previusly had a number f treatments including antibitics. 6
7 Sme urlgists recmmend that all men with chrnic prstatitis be treated with an antibitic [Nickel, 2008a; Nickel et al, 2008]. Hwever, thers have raised the cncern that, under this plicy, many men withut infectin are being treated unnecessarily and bacterial resistance may be prmted [Taylr et al, 2008]. Eurpean guidelines recmmend treatment f chrnic pelvic pain syndrme with antibitics if infectin is strngly suspected [Eurpean Assciatin f Urlgy, 2008]. As all men with chrnic prstatitis shuld be referred t a urlgist wh can exclude infectin (fr example with cultures f urine bth befre and after prstatic massage), CKS recmmends that antibitics are nt prescribed in primary care fr men wh have chrnic prstatitis (unless, as explained abve, infectin is suggested by a histry f urinary tract infectin). Prescriptins Fr infrmatin n cntraindicatins, cautins, drug interactins, and adverse effects, see the electrnic Medicines Cmpendium (emc) ( r the British Natinal Frmulary (BNF) ( 1st-line antibitics (histry f UTI): quinlnes Age frm 16 years nwards Nrflxacin tablets: 400mg twice a day Nrflxacin 400mg tablets Take ne tablet twice a day fr 28 days. Supply 56 tablets. Age frm 18 years nwards Ciprflxacin tablets: 500mg twice a day Ciprflxacin 500mg tablets Take ne tablet twice a day fr 28 days. Supply 56 tablets. Oflxacin tablets: 200mg twice a day Oflxacin 200mg tablets Take ne tablet twice a day fr 28 days. Supply 56 tablets. Levflxacin tablets: 500mg nce a day 7 Age: frm 16 years nwards NHS cst: Age: frm 18 years nwards NHS cst: 3.34 Age: frm 18 years nwards NHS cst: 43.85
8 Levflxacin 500mg tablets Take ne tablet nce a day fr 28 days. Supply 28 tablets. Age: frm 18 years nwards NHS cst: Alternative antibitic (histry f UTI): trimethprim Age frm 16 years nwards Trimethprim tablets: 200mg twice a day Trimethprim 200mg tablets Take ne tablet twice a day fr 28 days. Supply 56 tablets. Age: frm 16 years nwards NHS cst: 3.60 Analgesia: use when required Age frm 16 years nwards Paracetaml tablets: 1g up t fur times a day Paracetaml 500mg tablets Take tw tablets every 4 t 6 hurs when required fr pain relief. Maximum f 8 tablets in 24 hurs. Supply 100 tablets. Ibuprfen tablets: 400mg up t three times a day Age: frm 16 years nwards NHS cst: 1.56 Ibuprfen 400mg tablets Take ne tablet three times a day when required fr pain relief. D nt exceed the stated dse. Supply 84 tablets. Age: frm 16 years nwards NHS cst: 2.38 OTC cst: 4.08 Stl sfteners: dcusate r lactulse Age frm 16 years nwards Dcusate capsules: 100mg t 200mg nce r twice a day Dcusate 100mg capsules Take ne t tw capsules nce r twice a day when required. Supply 100 capsules. 8 Age: frm 16 years nwards NHS cst: 8.00 OTC cst: 13.80
9 Lactulse slutin: 15ml twice a day Lactulse g/5ml ral slutin Take three 5ml spnfuls twice a day. Supply 1000 ml. Age: frm 16 years nwards NHS cst: 5.80 OTC cst:
Bedfordshire and Hertfordshire DRAFT Priorities forum statement Number: Subject: Prostatism Date of decision: January 2010 Date of review:
Bedfrdshire and Hertfrdshire DRAFT Pririties frum statement Number: Subject: Prstatism Date f decisin: January 2010 Date f review: Referral criteria Mst men with lwer urinary tract symptms due t benign
More informationUrinary tract infection (lower) - women - Management
Urinary tract infectin (lwer) - wmen - Management Scenari: Cystitis in wmen wh are nt pregnant Hw shuld I manage a wman with suspected cystitis? Cnvey a psitive apprach and reassure the wman that cystitis
More informationLower urinary tract symptoms in men, age-related (including symptoms of benign prostatic hyperplasia/hypertrophy) - Management
Lwer urinary tract symptms in men, age-related (including symptms f benign prstatic hyperplasia/hypertrphy) - Management Scenari: Initial assessment f lwer urinary tract symptms (LUTS) Hw shuld I characterize
More informationdecreased when the man lies down. The varicocele cannot usually be palpated lying down.
Variccele - Management View full scenari Hw d I knw my patient has a variccele? The man may present with cncern abut scrtal swelling r scrtal pain, r a variccele may be an incidental finding n physical
More informationPain relief after surgery
Pain relief after surgery Imprtant infrmatin fr patients www.mchft.nhs.uk We care because yu matter This leaflet is designed t help yu cntrl any pain yu may have at hme fllwing yur peratin. Please read
More informationFrequently Asked Questions: IS RT-Q-PCR Testing
Questins 1. What is chrnic myelid leukemia (CML)? 2. Hw des smene knw if they have CML? 3. Hw is smene diagnsed with CML? Frequently Asked Questins: IS RT-Q-PCR Testing Answers CML is a cancer f the bld
More informationDRAFT Policy for the Management of Ear Wax
Clinical Cmmissining Grup (CCG) Treatment Plicy NHS Birmingham and Slihull Clinical Cmmissining Grup NHS Sandwell and West Birmingham Clinical Cmmissining Grup DRAFT Plicy fr the Management f Ear Wax 1
More informationBreast Cancer Awareness Month 2018 Key Messages (as of June 6, 2018)
Breast Cancer Awareness Mnth 2018 Key Messages (as f June 6, 2018) In this dcument there are tw sectins f messages in supprt f Cancer Care Ontari s Breast Cancer Awareness Mnth 2018: 1. Campaign key messages
More informationCONSENT FOR KYBELLA INJECTABLE FAT REDUCTION
CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION INSTRUCTIONS This is an infrmed cnsent dcument which has been prepared t help yur Dctr infrm yu cncerning fat reductin with an injectable medicatin, its risks,
More informationTOP TIPS Lung Cancer Update Dr Andrew Wight Consultant respiratory Physician - WUTH
Tpic Circulatin list In case f query please cntact Executive Summary TOP TIPS Lung Cancer Update Dr Andrew Wight Cnsultant respiratry Physician - WUTH All Wirral GP s JaneFletcher2@nhs.net Dear Clleagues,
More informationSignificance of Chronic Kidney Disease in 2015
1 Significance f Chrnic Kidney Disease in 2015 There is still a requirement within QOF t keep a register f peple with CKD stages 3-5. The ther CKD QOF targets have been retired. This is because CKD care
More informationHuman papillomavirus (HPV) refers to a group of more than 150 related viruses.
HUMAN PAPILLOMAVIRUS This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice r discussin between
More informationReferral Criteria: Inflammation of the Spine Feb
Referral Criteria: Inflammatin f the Spine Feb 2019 1 5.7. Inflammatin f the Spine Backgrund Ankylsing spndylitis and axial spndylarthrpathy are fund in arund 0.3-1.2% f the ppulatin. Spndylarthritis encmpasses
More informationThis clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data.
abcd Clinical Study Synpsis fr Public Disclsure This clinical study synpsis is prvided in line with Behringer Ingelheim s Plicy n Transparency and Publicatin f Clinical Study Data. The synpsis which is
More informationUS Public Health Service Clinical Practice Guidelines for PrEP
Webcast 1.3 US Public Health Service Clinical Practice Guidelines fr PrEP P R E S ENTED BY: M A R K T H R U N, M D A S S O C I AT E P R O F E S S O R, U N I V E R S I T Y O F C O L O R A D O, D I V I S
More informationCancer Association of South Africa (CANSA)
Cancer Assciatin f Suth Africa (CANSA) Fact Sheet and Psitin Statement n Cannabis in Suth Africa Intrductin Cannabis is a drug that cmes frm Indian hemp plants such as Cannabis sativa and Cannabis indica.
More informationWHAT IS YOUR DIAGNOSIS?
WHAT IS YOUR DIAGNOSIS? A 10 year ld female neutered Brder Cllie was presented t the R(D)SVS Canine Medicine Service fr investigatin f lethargy, inappetance and weight lss. She had been inappetant fr apprximately
More informationSwindon Joint Strategic Needs Assessment Bulletin
Swindn Jint Strategic Needs Assessment Bulletin Swindn Diabetes 2017 Key Pints: This JSNA gives health facts abut peple with diabetes r peple wh might get diabetes in Swindn. This helps us t plan fr medical
More informationAnnex III. Amendments to relevant sections of the Product Information
Changes t the Prduct infrmatin as apprved by the CHMP n 13 Octber 2016, pending endrsement by the Eurpean Cmmissin Annex III Amendments t relevant sectins f the Prduct Infrmatin Nte: These amendments t
More informationRelated Policies None
Medical Plicy MP 3.01.501 Guidelines fr Cverage f Mental and Behaviral Health Services Last Review: 8/30/2017 Effective Date: 8/30/2017 Sectin: Mental Health End Date: 08/19/2018 Related Plicies Nne DISCLAIMER
More informationHealth Screening Record: Entry Level Due: August 1st MWF 150 Entry Year
Health Screening Recrd: Entry Level MIDWIFERY EDUCATION PROGRAM HEALTH SCREENING REQUIREMENTS (Rev. June 2017) 1. Hepatitis B: Primary vaccinatin series (3 vaccines 0, 1 and 6 mnths apart), plus serlgic
More informationShared Care Protocol for the prescribing and monitoring of maintenance doses of azathioprine in Inflammatory Bowel Disease
Bedfrdshire and Lutn Jint Prescribing Cmmittee Shared Care Prtcl fr the prescribing and mnitring f maintenance dses f azathiprine in Inflammatry Bwel Disease This prtcl applies t patients under the care
More informationHealth for Life Chiropractic At Cloverdale Mall Unit # The East Mall Etobicoke, ON, M9B 3Y
Health fr Life Chirpractic At Clverdale Mall Unit #143-250 The East Mall Etbicke, ON, M9B 3Y8 416-232-1822 416-232-0060 Child and Adlescent Health Questinnaire Name:_ Birth date: Address:_ Telephne: Medical
More informationObesity/Morbid Obesity/BMI
Obesity/mrbid besity/bdy mass index (adult) Obesity/Mrbid Obesity/BMI Definitins and backgrund Diagnsis cde assignment is based n the prvider s clinical judgment and crrespnding medical recrd dcumentatin
More informationDental Benefits. Under the TeamstersCare Plan, you and your eligible dependents have three basic options when you need dental care.
Dental Benefits Under the TeamstersCare Plan, yu and yur eligible dependents have three basic ptins when yu need dental care. Optin #1: TeamstersCare Dentists. Yu can use ur in-huse Charlestwn, Chelmsfrd,
More informationIschemic heart disease (angina/chest pain)
Ischemic heart disease (angina/chest pain) External resurces Stable angina: management NICE guidelines [CG126] Updated :Aug 2016 https://www.nice.rg.uk/guidance/cg126 Chest pain f recent nset [CG95] Nvember
More informationQ 5: Is relaxation training better (more effective than/as safe as) than treatment as usual in adults with depressive episode/disorder?
updated 2012 Relaxatin training Q 5: Is relaxatin training better (mre effective than/as safe as) than treatment as usual in adults with depressive episde/disrder? Backgrund The number f general health
More informationHPV VACCINATION IN SANDYFORD SERVICES
HPV VACCINATION IN SANDYFORD SERVICES 1. General infrmatin n HPV Vaccinatin 2. HPV vaccinatin in females 3. Yung Wmen Only 4. HPV vaccinatin in MSM 1. General infrmatin General Infrmatin fr clinicians
More informationRequest for Prior Authorization for Click here to enter text. Website Form Submit request via: Fax
Request fr Prir Authrizatin fr Click here t enter text. Website Frm www.highmarkhealthptins.cm Submit request via: Fax - 1-855-476-4158 Updated: 05/2018 DMMA Apprved: 05/2018 All requests fr Intravenus
More informationLEVEL OF CARE GUIDELINES: INTENSIVE BEHAVIORAL THERAPY/APPLIED BEHAVIOR ANALYSIS FOR AUTISM SPECTRUM DISORDER HAWAII MEDICAID QUEST
OPTUM LEVEL OF CARE GUIDELINES: INTENSIVE BEHAVIORAL THERAPY / APPLIED BEHAVIOR ANALYSIS FOR AUTISM SPECTRUM DISORDER HAWAII MEDICAID QUEST LEVEL OF CARE GUIDELINES: INTENSIVE BEHAVIORAL THERAPY/APPLIED
More informationYou may have a higher risk of bleeding if you take warfarin sodium tablets and:
MEDICATION GUIDE Warfarin (WAR-far-in) Sdium (SO-dee-um) Tablets USP The 7.5 mg tablets cntain FD&C Yellw N. 5 (tartrazine), which may cause allergic-type reactins (including brnchial asthma) in certain
More informationBRCA1 and BRCA2 Mutations
BRCA1 and BRCA2 Mutatins ROBERT LEVITT, MD JESSICA BERGER-WEISS, MD ADRIENNE POTTS, MD HARTAJ POWELL, MD, MPH COURTNEY LEVENSON, MD LAUREN BURNS, MSN, RN, WHNP OBGYNCWC.COM v Cancer is a cmplex disease
More informationPennsylvania Guidelines on the Use of Opioids to Treat Chronic Noncancer Pain
Pennsylvania Guidelines n the Use f Opiids t Treat Chrnic Nncancer Pain Chrnic pain is a majr health prblem in the United States, ccurring with a pintprevalence f abut ne-third f the US ppulatin.(1) Mre
More informationHead and neck cancers are often treated with radiotherapy. Radiotherapy can lead to faster rates of tooth decay and poor healing in the mouth.
DENTAL EXTRACTION This infrmatin aims t help yu understand the peratin, what is invlved and sme cmmn cmplicatins that may ccur. It may help answer sme f yur questins and help yu think f ther questins that
More informationLyme Disease Surveillance in North Carolina
Lyme Disease Surveillance in Nrth Carlina 2008-2014 Carl Williams DVM Megan Sanza MPH Cmmunicable Disease Branch Divisin f Nrth Carlina Public Health Lyme Disease Surveillance in Nrth Carlina 2008-2014
More informationVaccine Information Statement: PNEUMOCOCCAL CONJUGATE VACCINE
Vaccine Infrmatin Statement: PNEUMOCOCCAL CONJUGATE VACCINE Many Vaccine Infrmatin Statements are available in Spanish and ther languages. See www.immunize.rg/vis. Hjas de Infrmacián Sbre Vacunas están
More informationKent and Medway Policy Recommendation and Guidance Committee Policy Recommendation
Kent and Medway Plicy Recmmendatin and Guidance Cmmittee Plicy Recmmendatin Plicy: PR 2017-11: Surgery fr haemrrhids Issue date: July 2017 Review date: July 2020 The Kent and Medway Plicy Recmmendatin
More informationAppendix 1 Example of Homely Remedy Policy
Appendix 1 Example f Hmely Remedy Plicy Hmely Remedy Plicy - EXAMPLE This plicy applies t (insert name f Care Hme) Definitin A hmely (r husehld) remedy is a medicinal prduct fr the shrt-term treatment
More informationWhat is Asthma? A collaborative effort of Children s Hospital of Pittsburgh of UPMC and The Pennsylvania Child Welfare Resource Center
A cllabrative effrt f Children s Hspital f Pittsburgh f UPMC and The Pennsylvania Child Welfare Resurce Center What is Asthma? Jennifer E. Wlfrd, DO, MPH, FAAP Children s Hspital f Pittsburgh, Divisin
More informationContinuous Positive Airway Pressure (CPAP) and Respiratory Assist Devices (RADs) including Bi-Level PAP
Cntinuus Psitive Airway Pressure (CPAP) and Respiratry Assist Devices (RADs), Including Bi-Level PAP Benefit Criteria t Change fr Texas Medicaid Effective March 1, 2017 Overview f Benefit Changes Benefit
More informationTick fever is a cattle disease caused by any one of the following blood parasites:
Tick fever Tick fever is a cattle disease caused by any ne f the fllwing bld parasites: Babesia bvis Babesia bigemina Anaplasma marginale These parasites are all transmitted by the cattle tick (Bphilus
More informationTendon problems can happen in people of all ages who take levofloxacin. Tendons are tough cords of tissue that connect muscles to bones.
Medicatin Guide LEVOFLOXACIN (LEE ve FLOX a sin) INJECTION, 25 mg/ml and LEVOFLOXACIN (LEE ve FLOX a sin) INJECTION in 5% Dextrse fr Intravenus Use Read this Medicatin Guide befre yu start taking levflxacin
More informationWHAT IS HEAD AND NECK CANCER FACT SHEET
WHAT IS HEAD AND NECK CANCER FACT SHEET This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice
More informationImmunisation and Disease Prevention Policy
Immunisatin and Disease Preventin Plicy Quality Area 2: Children s Health and Safety 2.1 Each child s health is prmted 2.1.4 Steps are taken t cntrl the spread f infectius diseases and t manage injuries
More informationINFERTILITY DIAGNOSIS
INFERTILITY Infertility is the inability t cnceive after 12 mnths f unprtected intercurse. There are multiple causes f infertility and a systematic way t evaluate the cnditin. Let s lk at sme f the causes.
More informationAssessment, History and Physical. Renal Ultrasound
UROLITHIASIS ALGORITHM Assessment, Histry and Physical Orders Labs- UA, cnsider RFP, CBC, Urine Culture, and UPT Pain meds (see therapeutics chart) IV fluids Imaging Renal Ultrasund Inclusin Criteria:
More informationAdult Preventive Care Guidelines
Adult Preventive Care Guidelines Gundersen is yur partner fr better health. We want t wrk with yu t make sure that yu and yur family are as healthy as pssible. That can be accmplished best if we wrk tgether
More informationStructural renal tract disease, renal calculi, or benign prostatic hypertrophy.
Chrnic kidney disease - nt diabetic - Management Scenari: Testing fr chrnic kidney disease Definitin Chrnic kidney disease is said t be present when there is persistent impairment f kidney functin, r evidence
More informationPolicy Guidelines: Genetic Testing for Carrier Screening and Reproductive Planning
Plicy Guidelines: Genetic Testing fr Carrier Screening and Reprductive Planning Cntents Overview... 1 Cverage guidelines... 2 General cverage guidelines... 2 Rutine carrier screening... 2 Carrier screening
More informationInternational Myeloma Working Group Guidelines on Imaging Techniques in the Diagnosis and Monitoring of Multiple Myeloma 1
Internatinal Myelma Wrking Grup Guidelines n Imaging Techniques in the Diagnsis and Mnitring f Multiple Myelma 1 Up t 90% f myelma patients develp stelytic lesins, a majr cause f mrbidity and mrtality,
More information2. How are screening and diagnostic mammograms different?
Mammgrams cmprises public dmain material frm the Natinal Cancer Institute at the Natinal Institutes f Health, an agency f the U.S. Department f Health and Human Services. Mammgrams Key Pints A mammgram
More informationSafety of HPV vaccination: A FIGO STATEMENT
FIGO Statement n HPV Vaccinatin Safety, August 2nd, 2013 Safety f HPV vaccinatin: A FIGO STATEMENT July, 2013 Human papillmavirus vaccines are used in many cuntries; glbally, mre than 175 millin dses have
More informationINTRAVENOUS FLUID THERAPY CLINICAL CARE RECOMMENDATIONS
INTRAVENOUS FLUID THERAPY CLINICAL CARE RECOMMENDATIONS Clinical Assessment Vital signs n admissin Evaluate hydratin status clinically Mnitring Vital signs per nursing prtcl Dcument intake and utput Onging
More informationSasan Dabiri, MD, Assistant Professor
Sasan Dabiri, MD, Assistant Prfessr Department f Otrhinlarynglgy Head & Neck Surgery Amir Alam Hspital Tehran University f Medical Sciences March 2016 s - d a b i r i @ t u m s. a c. i r Backgrund Diagnsis
More informationShared Care Protocol for the prescribing and monitoring of maintenance doses of azathioprine in Inflammatory Bowel Disease
Apprved by the Bedfrdshire and Lutn Jint Prescribing Cmmittee (JPC) December 2013, Review date December 2016 Bedfrdshire and Lutn Jint Prescribing Cmmittee Shared Care Prtcl fr the prescribing and mnitring
More informationThe research question: What was discovered in the 1940s that could treat syphilis?
Psychlgy B30 Human Sexuality Sexually Transmitted Infectins Tuskegee Syphilis Experiment Ppulatin: The research questin: What was discvered in the 1940s that culd treat syphilis? Hw many men died f syphilis
More informationA Phase I Study of CEP-701 in Patients with Refractory Neuroblastoma NANT (01-03) A New Approaches to Neuroblastoma Therapy (NANT) treatment protocol.
SAMPLE INFORMED CONSENT A Phase I Study f CEP-701 in Patients with Refractry Neurblastma NANT (01-03) A New Appraches t Neurblastma Therapy (NANT) treatment prtcl. The wrd yu used thrughut this dcument
More informationCardiac Rehabilitation Services
Dcumentatin Guidance N. DG1011 Cardiac Rehabilitatin Services Revisin Letter A 1.0 Purpse The Centers fr Medicare and Medicaid Services (CMS) has detailed specific dcumentatin requirements fr Cardiac Rehabilitatin
More informationITP typically presents with the sudden appearance of a petechial rash, spontaneous bruising and/or bleeding in an otherwise well child.
Acute Immune Thrmbcytpenia Purpura (ITP) Backgrund Primary immune thrmbcytpenia (ITP) is an acquired immune mediated disrder characterised by islated thrmbcytpenia, defined as a peripheral bld platelet
More informationMale patients with pain, swelling or erythema please refer to the Acute Painful Scrotum pathway Female patients
UNDESCENDED TESTICLE ALGORITHM Unilateral undescended testicle OR Bilateral palpable undescended testicle Inclusin Criteria: Male patients w/ unilateral r bilateral undescended testicle(s) Exclusin Criteria:
More informationSeeking and Appraising Evidence
EWMA Educatinal Develpment Prgramme Curriculum Develpment Prject Educatin Mdule: Seeking and Appraising Evidence Latest review: August 2012 Educatin Mdule: Seeking and Appraising Evidence ABOUT THE EWMA
More informationPediatric and adolescent preventive care and HEDIS *
Pediatric and adlescent preventive care and HEDIS * * HEDIS is a registered trademark f the Natinal Cmmittee fr Quality Assurance (NCQA). UniCare Health Plan f West Virginia, Inc. Healthcare Effectiveness
More informationOpioid Analgesics PA Request Provider Checklist
WVP Health Authrity Updated 05-12-2015 Opiid Analgesics PA Request Prvider Checklist *** If pssible, please include the fllwing infrmatin with PA requests fr piid analgesics. Including the requested infrmatin
More informationImplementation of G6PD testing and radical cure in P. vivax endemic countries: considerations
Implementatin f G6PD testing and radical cure in P. vivax endemic cuntries: cnsideratins Malaria Plicy Advisry Cmmittee Geneva, Switzerland 16-18 September 2015 1 WHO Guidelines n Radical Cure WHO guidelines
More informationCONSENT FORM - TESTOSTERONE FOR TRANSGENDER CLIENTS
CONSENT FORM - TESTOSTERONE FOR TRANSGENDER CLIENTS Yu want t take teststerne t masculinize yur bdy. Befre taking it, there are several things yu need t knw abut. They are the pssible advantages, disadvantages,
More informationImaging tests allow the cancer care team to check for cancer and other problems inside the body.
IMAGING TESTS This infrmatin may help answer sme f yur questins and help yu think f ther questins that yu may want t ask yur cancer care team; it is nt intended t replace advice r discussin between yu
More informationFrequently asked questions: Influenza A (H1N1)v
July 30 th 2009 V1.0 Frequently asked questins: Influenza A (H1N1)v (Swine Flu) infrmatin fr parents The fllwing advice is fr parents f children in all educatinal institutins, including crèches, childcare,
More informationNew Exception Status Benefits
FEBRUARY 2019 Nva Sctia Frmulary Updates New Exceptin Status Benefits Prcysbi (cysteamine bitartrate) Nucala (meplizumab) Ocaliva (betichlic acid) Ravicti (glycerl phenylbutyrate) Taltz (ixekizumab) Criteria
More informationCLINICAL MEDICAL POLICY
Plicy Name: Plicy Number: Respnsible Department(s): CLINICAL MEDICAL POLICY Supervised Exercise Therapy fr Peripheral Artery Disease (PAD) MP-077-MD-DE Medical Management Prvider Ntice Date: 01/15/2019
More informationMedication Guide MORPHINE SULFATE (mor-pheen) Oral Solution (CII)
Medicatin Guide MORPHINE SULFATE (mr-pheen) Oral Slutin (CII) IMPORTANT: Keep Mrphine Sulfate Oral Slutin in a safe place away frm children. Accidental use by a child is a medical emergency and can cause
More informationOsteoporosis Fast Facts
Osteprsis Fast Facts Fast Facts n Osteprsis Definitin Osteprsis, r prus bne, is a disease characterized by lw bne mass and structural deteriratin f bne tissue, leading t bne fragility and an increased
More informationChronic Fatigue Syndrome
Chrnic Fatigue Syndrme (Als knwn as Myalgic encephalmyelitis/encephalmyelpathy) What is CFS/ME? CFS/ME cmprises a range f symptms that include fatigue, malaise, headaches, sleep disturbances, difficulties
More informationEvidence Dossier to support COPD formulary decision making and guideline development
Evidence Dssier t supprt COPD frmulary decisin making and guideline develpment Prescribing and adverse event reprting infrmatin can be fund n the final pages f this dcument. Anr and Ellipta Trademarks
More informationMEDICATION GUIDE Levofloxacin (lee-voe-flox-a-sin) Tablets, USP 250 mg Tablets, 500 mg Tablets, and 750 mg Tablets
MEDICATION GUIDE Levflxacin (lee-ve-flox-a-sin) Tablets, USP 250 mg Tablets, 500 mg Tablets, and 750 mg Tablets Read this Medicatin Guide befre yu start taking levflxacin tablets and each time yu get a
More informationAnnex III. Amendments to relevant sections of the product information
Annex III Amendments t relevant sectins f the prduct infrmatin Nte: These amendments t the relevant sectins f the prduct infrmatin are the utcme f the referral prcedure. The prduct infrmatin may be subsequently
More informationPROVIDER ALERT. Comprehensive Diagnostic Evaluation (CDE) Guidelines to Access the Applied Behavior Analysis (ABA) Benefit.
Cmprehensive Diagnstic Evaluatin (CDE) Guidelines t Access the Applied Behavir Analysis (ABA) Benefit May 5, 2017 Clinical infrmatin that utlines medical necessity is required t supprt the need fr initial
More informationALCAT FREQUENTLY ASKED QUESTIONS
1. Is fasting required befre taking the Alcat Test? N. It is recmmended t drink water and t avid stimulants like caffeine prir t the test. 2. With regard t testing children, must a child be a certain age
More informationDiabetes Mellitus Lab Tests (Screening, Diagnosis & Monitoring)
Rule Categry: Medical ` Ref: N: 2013-MN-0012 Versin Cntrl: Versin N. 1.1 Effective Date: December 2013 Revisin Date: December 2014 Diabetes Mellitus Lab Tests (Screening, Diagnsis & Mnitring) Adjudicatin
More informationA foot x-ray series is required only if there is pain in the midfoot zone and any one of the following:
RADIOGRAPHY OF THE ANKLE AND FOOT (OTTAWA ANKLE RULES) Clinical Practice Guideline January 2007 This guideline has been adapted frm the Ottawa Ankle Rules develped by Dr. Ian Stiell et al. Dr. Stiell received
More informationUnderstanding back pain
Understanding back pain What yu need t knw abut yur wn back Patricia Zheng, MD Assistant Prfessr Nnperative Spine and Physiatry Department f Orthpedic Surgery 2 Graphics: ;https://www.facebk.cm/auntyacid/;
More informationThis table cannot be relied upon in the absence of: PA Medical Directive #8 - Gastroenterology
Title and Number f Directive: Order Table PA-8: Gastrenterlgy This table cannt be relied upn in the absence f: PA Medical Directive #8 - Gastrenterlgy 1. OVERALL CONDITIONS - The PA may evaluate and prvide
More informationBEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE (JPC)
BEDFORDSHIRE AND LUTON JOINT PRESCRIBING COMMITTEE (JPC) June 2017 Review: June 2020 Bulletin 251: The Management f Hyperhidrsis Bedfrdshire and Hertfrdshire INTERIM Pririties Frum Guidance JPC Recmmendatins:
More informationDATA RELEASE: UPDATED PRELIMINARY ANALYSIS ON 2016 HEALTH & LIFESTYLE SURVEY ELECTRONIC CIGARETTE QUESTIONS
DATA RELEASE: UPDATED PRELIMINARY ANALYSIS ON 216 HEALTH & LIFESTYLE SURVEY ELECTRONIC CIGARETTE QUESTIONS This briefing has been specifically prepared fr the Ministry f Health t prvide infrmatin frm this
More informationNational Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ s) For PA Health & Wellness Providers
Natinal Imaging Assciates, Inc. (NIA) Frequently Asked Questins (FAQ s) Fr PA Health & Wellness Prviders Questin GENERAL Why is PA Health & Wellness implementing a Medical Specialty Slutins Prgram? Answer
More informationInfluenza (Flu) Fact Sheet
Influenza (Flu) Fact Sheet What is the flu? The flu is a cntagius respiratry illness caused by influenza viruses. It can cause mild t severe illness, and at times can lead t death. Sme peple, such as lder
More informationIn adolescents, consider endometriosis if pain is unresponsive to the combined oral contraceptive pill and to nonsteroidal anti-inflammatory drugs.
Endmetrisis - Management Scenari: Diagnsis f endmetrisis When shuld I suspect endmetrisis? Suspect endmetrisis in wmen wh present with: Secndary dysmenrrhea (which may be severe) usually befre r during
More informationIntravenous Vancomycin Use in Adults Intermittent (Pulsed) Infusion
Intravenus Vancmycin Use in Adults Intermittent (Pulsed) Infusin Backgrund This plicy cvers the use f intravenus vancmycin prescribed as an intermittent (pulsed) infusin. This can be used fr treatment
More informationIntravenous Vancomycin Use in Adults Intermittent (Pulsed) Infusion
Backgrund This plicy cvers the use f intravenus vancmycin prescribed as an intermittent (pulsed) infusin. This can be used fr treatment r prphylaxis. Evidence supprting this guidance is detailed belw.
More informationIowa Early Periodic Screening, Diagnosis and Treatment Care for Kids Program Provider Training
Iwa Early Peridic Screening, Diagnsis and Treatment Care fr Kids Prgram Prvider Training The Early Peridic Screening, Diagnsis and Treatment (EPSDT) Care fr Kids prgram is Iwa s Medicaid prgram fr children.
More informationTriumeq (abacavir, dolutegravir and lamivudine) Product Backgrounder for US Media
Triumeq (abacavir, dlutegravir and lamivudine) Prduct Backgrunder fr US Media What is Triumeq and wh is Triumeq fr? Triumeq (abacavir 600mg, dlutegravir 50mg and lamivudine 300mg) is the first dlutegravir-based
More informationContinuous Quality Improvement: Treatment Record Reviews. Third Thursday Provider Call (August 20, 2015) Wendy Bowlin, QM Administrator
Cntinuus Quality Imprvement: Treatment Recrd Reviews Third Thursday Prvider Call (August 20, 2015) Wendy Bwlin, QM Administratr Gals f the Presentatin Review the findings f Treatment Recrd Review results
More informationEXECUTIVE SUMMARY INNOVATION IS THE KEY TO CHANGING THE PARADIGM FOR THE TREATMENT OF PAIN AND ADDICTION TO CREATE AN AMERICA FREE OF OPIOID ADDICTION
EXECUTIVE SUMMARY INNOVATION IS THE KEY TO CHANGING THE PARADIGM FOR THE TREATMENT OF PAIN AND ADDICTION TO CREATE AN AMERICA FREE OF OPIOID ADDICTION The Bitechnlgy Innvatin Organizatin (BIO) and ur member
More informationMethadone Maintenance Treatment for Opioid Dependence
POLICY STATEMENT Methadne Maintenance Treatment fr Opiid Dependence APPROVED BY COUNCIL: May 2010 PUBLICATION DATE: Dialgue, Issue 2, 2010 Disclaimer: As f May 19, 2018 physicians n lnger require an exemptin
More informationBariatric Surgery FAQs for Employees in the GRMC Group Health Plan
Bariatric Surgery FAQs fr Emplyees in the GRMC Grup Health Plan Gergia Regents Medical Center and Gergia Regents Medical Assciates emplyees and eligible dependents wh are in the GRMC Grup Health Plan (Select
More informationPACKAGE LEAFLET: INFORMATION FOR THE USER
(Sanfi-Aventis France), NT001 Suppliers submissin f the SRA apprved text Octber 2016 Name f the medicinal prduct Text bx PACKAGE LEAFLET: INFORMATION FOR THE USER NOTEZINE 100 mg, scred tablets Diethylcarbamazine
More informationRituxan (rituximab) Effective Date: 10/01/2015. Line(s) of Business: HMO; PPO; QUEST Integration Akamai Advantage
Rituxan (rituximab) Line(s) f Business: HMO; PPO; QUEST Integratin Akamai Advantage Effective Date: 10/01/2015 POLICY A. INDICATIONS The indicatins belw including FDA-apprved indicatins and cmpendial uses
More informationKey Points Enterovirus D68 in the United States, 2014 Note: Newly added information is in red.
Key Pints Entervirus D68 in the United States, 2014 Nte: Newly added infrmatin is in red. Over the last several mnths, the United States has experienced a natinwide utbreak f entervirus D68 (EV- D68) assciated
More informationRoActemra (tocilizumab) for Giant Cell Arteritis (GCA) subcutaneous (SC) formulation
RActemra (tcilizumab) fr Giant Cell Arteritis (GCA) subcutaneus (SC) frmulatin What yu shuld knw abut RActemra This brchure prvides key infrmatin t assist in the patient s understanding f the benefits
More informationGuideline Number: NIA_CG_301 Last Revised Date: October 2014 Responsible Department: Implementation Date: October 2014 Clinical Operations
Natinal Imaging Assciates, Inc. Clinical guidelines PARAVERTEBRAL FACET JOINT INJECTIONS OR BLOCKS CPT Cdes: Cervical Thracic Regin: 64490 (+ 64491, +64492), 0213T (+0214T, +0215T) Lumbar Sacral Regin:
More informationFTD RESEARCH: The Value of Studies and Opportunities for Involvement
FTD RESEARCH: The Value f Studies and Opprtunities fr Invlvement Sarah Lawrence, MS Research Prgram Manager Ann Fishman, MBA Sr. Research Crdinatr Weiyi Mu, ScM Genetic Cunselr Suzanne Dana Spuse/Caregiver
More information