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Orthopedic surgery should be reserved only for muscular contracture or impending joint dislocation skin care videos purchase decadron 1 mg online. Orthopedic surgery is best 10 for children 4-7 years old 302 skincare discount decadron 0.5mg, especially soft-tissue releases acne with mirena cheap decadron 1 mg with mastercard. Per consensus recommendations acne brand buy decadron 0.5mg amex, spastic quadriparesis plus severe cognitive impairment is better served by orthopedic 1 procedures alone, although they also respond well to intrathecal baclofen. Tendon lengthening is the preferred method of managing soft-tissue manifestations of spasticity, as opposed to tenotomy or 10 tendon release. Tendon releases are an excellent option in teenagers with moderate to severe contractures of the hamstrings and crouch gait, 8 and it is likely that these patients will not require a repeat lengthening procedure since they are essentially finished growing. There are a number of different operative techniques and there is no consensus on treatment for thumb-in-palm deformities. There are questions of influence 67 of age, intelligence, and sensibility for overall result of operation. Selection criteria include some voluntary motor control and cognitive ability and motivation to rehabilitate. Adductor muscle release with or without obturator neurectomy has been used for spastic hip disease. Additionally, anterior branch obturator neurectomy is added in nonambulatory children that are very 10 spastic but is contraindicated in ambulatory children. Framework A: Spasticity (continued) Issue Examples Variations in interventions Neurosurgical Interventions. There is some evidence to show decreased spasticity from passive stretching but this is not carried over into functional activities like walking. There is conflicting evidence on whether passive stretching can increase the range of motion in a joint. Framework A: Spasticity (continued) Issue Examples Variations in interventions Strength Training. Studies report increases in strength, 69 improvements in activity, and improvement in self-perception. Non-Treatment Strategies: 7 Because spasticity can be functional, treatment of spasticity may not always be indicated. In some cases, imaging is necessary to follow the musculoskeletal changes that accompany spasticity. It is recommend that children who cannot walk more than 10 steps by 30 months have a hip radiograph to measure migration percentage of each hip, and repeat every 6-12 months until age of 7 years or when further deformity is unlikely. If the migration percentage is more than 14% at 30 months, then postural management at night and ongoing radiological monitoring are 4 recommended. There are variations in the specific types of specialist and subspecialist involved in longitudinal care. A primary care medical 6 home should work with parents, medical specialists, and community agencies. Variations in target outcomes Variation in target outcomes includes differences like functional outcomes versus anatomical outcomes. In a systematic review of the upper limb dysfunction included assessments of—upper limb function, self-care, and individualized outcomes: Melbourne Assessment of Unilateral Upper Limb Function; Erhardt Developmental Prehension Test; Pediatric Motor Activity Log—amount of use; Pediatric Motor Activity Log—quality of use; Emerging Behavior Scale; Jebsen, 17 Jebsen Taylor Test of Hand Function; and the Assisting Hand Assessment. Variations in service delivery There are variations in the service delivery models. Framework A: Spasticity (continued) Issue Examples Variations in management There are variations in management strategies. Multiple oral medications are used to treat spasticity but have limited efficacy in most patients due to unacceptable side effects. Placement of a pump to allow the delivery of baclofen directly to the spinal cord is more effective at reducing spasticity and dystonia without the cognitive side effects that are frequently seen with oral administration of the drug. Furthermore, there is a recommendation that patients without easy access but with sustained sensorimotor challenges, and/or needs for specialized intervention. Other: Recommend database of children needing postural management for results of radiological surveillance, intervention, 4 and assessments. Private: None Public: None Variations in treatment rates and None availability of care E-19 Table E-2. There are multiple ways to measure spasticity, as seen in the Park systematic review where studies used the Ashworth Scale, Modified Ashworth Scale, wrist resonance frequency, and Tardieu method. Computerized gait analysis may be able to regarding outcomes (continued) determine the quality of the gait in a reproducible way. Studies are limited by the reliability and validity of muscle tone measurements (e. The problems just described are common in sequels of stroke, but rare in patients with spastic equinus foot and were not described in any patient of the series analyzed in the present work. Uncertainty/controversy None regarding concept Uncertainty/controversy Tools to measure spasticity are the Ashworth scale and Modified Ashworth scale, which measure neural and mask factors of regarding diagnosis non-velocity-dependent hypertonia in addition to spasticity. The most 15 effective adjunct therapies, including frequency and intensity of delivery, also requires investigation. Framework A: Spasticity (continued) Issue Examples Uncertainty/controversy Antibody Development for Intramuscular Botulinum Toxin. Non-Treatment Strategies: 7 There is uncertainty regarding the differentiation of functional spasticity from spasticity that is non-functional. Prevention and Surveillance: 6 There are uncertainties about the specific types and timing of involving specialist and subspecialists. Uncertainty/controversy There are no comparative studies of cost effectiveness and outcome of orthopedic releases vs. Gabapentin has been used for multiple sclerosis, hemifacial spasm, and spinal cord injury in adults with improvement in 12 spasticity. Therapeutic touch is also used, with treatment with movement, treatment with proprioceptive input, etc. There are a number of approaches that include different combinations 13 of active and sensory techniques. According to the guidelines, sessions should also incorporate active participation of the patient to 80 attain functional goals. Physical therapists are encouraged to use direct resistive exercises in 2- 3 weekly sessions for 6-10 weeks at 65 percent of maximum isometric strength or 3-10 79,80 repetitions maximum. Guidelines for physical therapists indicate that assistive technologies such as orthoses, wheelchairs, walkers, or crutches may be effective, as well as other strengthening exercises including electrical stimulation, bike riding, aquatics, and 79,80 hippotherapy. Guidelines recommend that certain programs should not be used; including an exercise program comprised primarily of passive stretching delivered by a therapist (parents or patients can be instructed to carry out these exercises themselves. Current outcome measurements specifically for gait parameters include stride length, stride cadence, self-selected walking velocity, endurance, gait kinetics and 78, 83, 85, 89, 90 kinematics, and computer gait analysis. There is variation in the goals of physical therapy, including goals of increased strength, aerobic activity/cardiovascular function, as 71, 74-77, 81,94 well as primarily gait-related parameters. Variations in service None delivery models Variations in management None strategies E-25 Table E-3. Framework B: Gait and physical therapy (continued) Issue Examples Variations in clinical practice There are significant variations in clinical practice. Variations include which populations require intervention, the timing of the onset of intervention, the type of interventions. Variations in provision of Organizations: None services Professionals: None 5 Specialty, Primary: A multidisciplinary rehabilitation team is recommended. Other: None Private: None Public: None Variations in treatment rates and None availability of care Uncertainty/controversy There is uncertainty regarding appropriate instruments to measure short-term outcomes in physiotherapy. Questions also exist 5 regarding outcomes about the utility of video recording of gait and posture. There is also uncertainty about the use of functional evaluation scales to evaluate outcomes such as walking, running, gait efficiency, self-perceptions, self-worth, self-confidence, and quality of 75,76 life. Uncertainty/controversy None regarding methodology Uncertainty/controversy None regarding concept Uncertainty/controversy None regarding diagnosis E-26 Table E-3. The possible long-term gains in motor function after 74 discontinuation of therapy are also uncertain. Different treatment paradigms for use of orthotics in the literature can limit ability to determine efficacy. Also, limited data exists 24,90 in the literature on the relationship of patient functional status and the evaluation of orthotics.
Does not respond to his or her name with increasing consistency from 6-12 months 5 acne 25 buy generic decadron 1mg. Repeatedly stiffens arms acne 4 dpo buy discount decadron line, hands acne-fw13c purchase cheap decadron on-line, legs or displays unusual body movements such as rotating the hands on the wrists acne keloidalis order decadron on line, uncommon postures or other repetitive behaviors 9. A 33 % delay and/or atypical development in at least one area (gross motor, fine motor, communication, social, self-help, cognition) 2. Treatment Tips • Practice and repetition • Demonstrate • Be actively involved (participate in the activity, dont sit back and watch) • Be at childs level, practice safe guarding • Use peers or family members when possible • Guided Movement (hands on, progressing to hands off) • Use Music Communication Tips • Be age appropriate • Yes/no questions versus open ended questions • Use clear and concise instruction • Choose quiet/closed environments when introducing a new skill • “This first, then • Give positive feedback! Therapeutic Exercise • Think out of the box when thinking about exercising with kids: choose activities that require strength and flexibility to work on strength and flexibility! Therapeutic Exercise • Strengthening • Flexibility • Any functional and/or • Any functional and/or play activities that play activities that require moving, lifting, make you reach, carrying, pushing, bend, stretch, move pulling, or using force your body in different positions • Theraband, weighted balls, playdough, • Range of motion resistive toys (pop- exercises beads, leggos, etc. Carry over sheet Monarch School of New England: 2015-2016 School Year / Related Services Carryover Goals Student Name: Alec Physical Therapy: (Erica Mann) 1. Alec should wear his hand splints most of the day, given a break at lunch and/or during messy activities. He should wear his index finger extenders when he is using his communication device. When staff help him remove or put on his splints, Alec can be encouraged to relax his muscle tone by asking him to straighten his elbows. When removed, Alecs hand splints will always be strapped in the same manner as if he were wearing them. Adaptive Ski Definition:Adaptive skiing uses special adapted equipment to allow people with a wide range of disabilities to take to the snow and experience the freedom of snow sports in the least restrictive manner possible. It creates an ideal environment for treating patients with a wide range of impairments and functional levels • controlled reduction of weight bearing • reduce injury to staff/patient • increased efficiency • facilitate proper gait • work on symmetry/weight shifting • control weight bearing and posture • train coordination without balance concerns • manually assist limb placement • Etc. Find a mentor or advanced training and join the team of professionals making a difference in the lives of children and families! Review date: December 2022 Queensland Clinical Guidelines Steering Committee Endorsed by: Statewide Maternity and Neonatal Clinical Network (Queensland) Email: guidelines@health. The information has been prepared using a multidisciplinary approach with reference to the best information and evidence available at the time of preparation. No assurance is given that the information is entirely complete, current, or accurate in every respect. The guideline is not a substitute for clinical judgement, knowledge and expertise, or medical advice. Variation from the guideline, taking into account individual circumstances, may be appropriate. This guideline does not address all elements of standard practice and accepts that individual clinicians are responsible for: · Providing care within the context of locally available resources, expertise, and scope of practice · Supporting consumer rights and informed decision making, including the right to decline intervention or ongoing management · Advising consumers of their choices in an environment that is culturally appropriate and which enables comfortable and confidential discussion. This includes the use of interpreter services where necessary · Ensuring informed consent is obtained prior to delivering care · Meeting all legislative requirements and professional standards · Applying standard precautions, and additional precautions as necessary, when delivering care · Documenting all care in accordance with mandatory and local requirements Queensland Health disclaims, to the maximum extent permitted by law, all responsibility and all liability (including without limitation, liability in negligence) for all expenses, losses, damages and costs incurred for any reason associated with the use of this guideline, including the materials within or referred to throughout this document being in any way inaccurate, out of context, incomplete or unavailable. In essence, you are free to copy and communicate the work in its current form for non-commercial purposes, as long as you attribute Queensland Clinical Guidelines, Queensland Health and abide by the licence terms. Refer to online version, destroy printed copies after use Page 2 of 40 Queensland Clinical Guideline: Neonatal jaundice Flow Chart: Management of neonatal jaundice All babies Risk factors · Assess for risk factors Maternal · Examine for jaundice-visual/TcB · Blood group O · RhD negative No · Red call antibodies · Genetic–family history, East Asian, Mediterranean Baby appears jaundiced Athetoid cerebral Cerebral palsy with abnormal involuntary movements associated with damage to the palsy basal ganglia. Bilirubin 5 Acquired metabolic encephalopathy caused by unconjugated hyperbilirubinaemia. Measured as greater hyperbilirubinaemia 4,6 than 25 micromols/L direct bilirubin of total bilirubin level Coombs test See Direct Antiglobulin Test. Less common blood group associated with causing severe haemolytic disease of the Minor blood type 12 newborn. Opisthotonus Severe hyperextension causing backward arching of the head, neck, and spine. Spasmodic torticollis (abnormal, asymmetrical head or neck position) where the Retrocollis 13 head is drawn back. Sensorineural hearing Acquired permanent hearing loss caused by damage to the cochlear nuclei and loss central auditory pathways. Standard Phototherapy provided by light source(s) with irradiance of 25–30 microW cm-2 nm-1 phototherapy over the waveband interval 460–490 nm-1. Conjugated bilirubin is water soluble and able to be eliminated via urine and faeces. Mild jaundice may persist past the first week to 10 days of life without any underlying cause. However, early onset jaundice (detectable clinically before 24 hours of age) is a risk factor for severe hyperbilirubinaemia requiring treatment. When jaundice has a high peak level regardless of the cause, treatment is required to prevent brain damage. In addition, some underlying causes of hyperbilirubinaemia are serious or even life- threatening illnesses that require urgent treatment. Investigations are warranted to determine the underlying cause of jaundice in any of the following: · Early onset with a high peak level21 · Elevated conjugated bilirubin component23 · Persists after the normal time for jaundice to resolve4 · Present in a baby with other clinical illness or abnormalities Refer to online version, destroy printed copies after use Page 7 of 40 Queensland Clinical Guideline: Neonatal jaundice 2 Risk factors for clinically significant hyperbilirubinaemia 2. Maternal risk factors Aspect Comment · Blood group O Blood group · Rhesus D (RhD) negative · Red cell antibodies—D,C,c,E,e and K and certain others24 Previous jaundiced · Required phototherapy or other treatment baby23 23 · High red cell mass in baby where maternal diabetes is poorly controlled Diabetes diabetes (any type. Neonatal risk factors Aspect Comment · Breast milk: o glucuronidase in breast milk increases the breakdown of conjugated bilirubin to unconjugated bilirubin in the gut4 o Lipoprotein lipase (a water-soluble enzyme) and nonesterified fatty Feeding acids in breast milk may inhibit normal bilirubin metabolism25,26 · Factors that delay normal colonisation with gut bacteria resulting in high concentration of bilirubin in the gut) · Low breast milk (may be due to delayed milk production) or formula intake leading to dehydration and increased enterohepatic circulation4,27 · Factors causing haemolysis (immune or non-immune)4 Haematological18,23,28 · Polycythaemia · Haematoma or bruising Gastrointestinal29 · Bowel obstruction · Infection Other4,23 · Prematurity · Male Refer to online version, destroy printed copies after use Page 8 of 40 Queensland Clinical Guideline: Neonatal jaundice 3 Causes of jaundice Jaundice peaking on the third to fifth day of life is likely to be caused by normal newborn physiology. However, a pathological cause of jaundice may coexist with physiological jaundice24,30 There are a number of causes of neonatal jaundice. The following information is not exhaustive and includes the more common causes that place the baby at risk of developing hyperbilirubinaemia requiring treatment. Jaundice incidence is higher in the first 24 hours of life in babies between 35 and 36 weeks gestation. Common causes of pathological jaundice Pathogenesis Cause · Blood extravasation o Bruising/birth trauma · Haemorrhage. Others, such as pyloric stenosis are much more likely to cause late onset jaundice. Alagille Syndrome, Decreased choledochal cyst excretion of · Increased enterohepatic bilirubin recirculation bilirubin4,23,25 o Bowel obstruction, pyloric stenosis o Meconium ileus or plug, cystic fibrosis Refer to online version, destroy printed copies after use Page 10 of 40 Queensland Clinical Guideline: Neonatal jaundice 3. It is present in 15-40% of well, breastfed babies at 2 weeks of age and 9% of well, breast fed babies at 4 weeks of age. All jaundiced babies require an assessment including history and a full clinical examination. If there are other signs of conjugated hyperbilirubinaemia present including dark urine and pale stools immediate referral to a tertiary service for urgent investigation and treatment,14,25,38,43 is required to prevent secondary complications. An unwell baby requires more urgent investigation and treatment as the underlying aetiology can be associated with a variety of diseases. Refer to Appendix A Nomogram: Jaundice management for baby greater than 38 weeks gestation. Phototherapy treatment] · Gold standard for diagnosing hyperbilirubinaemia49 · Point of care (e. A baby who is thriving and feeding well requires fewer investigations than an unwell baby who is not thriving. Initial investigations for jaundice (first 24 hours of age) Aspect Comment · Check maternal antenatal screening for: o Blood group History o RhD type o Red cell antibodies · Refer to Table 8. It was also noticed that exposure of a blood tube with pre-exchange transfusion blood sample to sunlight resulted in a lower level of bilirubin than the unexposed sample. Background Aspect Comment · Rapid decrease in bilirubin exposed to daylight, sunlight and artificial light · Initial findings published in 1958 and supported by a randomised controlled trial in 196869 68 · Phototherapy first coined in 1960 Context · Significant reduction in the number of exchange transfusions · Between 0. Most babies with significant haemolysis recycle iron from their own red cells, so there may be a greater risk of iron overload than iron deficiency. Discuss folic acid and ferrous sulfate supplementation with paediatrician or neonatologist before babys discharge. There is necrosis of neurons in the basal ganglia resulting in irreversible neuro-disabilities. Emerging research Aspect Comment · Lowers serum bilirubin · May have an effect on the rate of exchange transfusion Prophylactic 102 oNote: Commence phototherapy early in babies with significant phototherapy alloimmune haemolytic disease (e. Management of hyperbilirubinaemia in the newborn infant 35 weeks or more of gestation.
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Since the complications of this disease-related drugs are normally causing drowsiness and some weakness skin care quotes order decadron 1mg otc. Taking medication is the faster way but it causes some side effects skin care sk ii buy decadron with amex, treatment such as surgery can be applied as well skin care facts purchase decadron 1 mg otc. As known skin care routine quiz decadron 0.5 mg without a prescription, spasticity is actually due to imbalance signal transmission between the central nervous system and the muscle. So, the surgery can be carried out to carefully test the sensory nerves to find the problem. As the malfunction nerves found, it will be cut to prevent it from interrupting the message loop. Besides that, there is a therapy that can be used to help spastic cerebral palsy patient named occupational therapy. The patient undergoes this therapy will be trained to accomplish the goal of living as independently as possible, no matter with or without the help of adaptive equipment. However, this therapy is only workable for a patient who is able to follow directions and only having spasticity in a certain area of the body such as wrist, forearm or thumb controlling muscle. This is because this therapy is meant to improve patients ability to perform personal care related activities. It is important to carry out the daily range of motion exercise as it tends to prevent and delay contractures due to the spasticity. Beyond the exercises included previously, there are many exercises and training that can be held to help the spastic patient. By using age-appropriate adaptive toys and devices which are meant for the particular purposes, the patient may find the treatment to be fun rather than miserable. Full cooperation can then be expected from the children if they started to think the therapy is interesting, hence achieving the best outcomes of the therapy. Physical therapy is also known as physiotherapy, which is a type of rehabilitation practices that normally come first when treating cerebral palsy. This rehabilitation practices can be carried out with different ways as told in previous 6 part. By practising physical therapy, the movement and physical function can be restored, maintained and promoted optimally. In addition, gradually help relieve pain, muscle stiffness and improve the overall mobility of the children. This type of treatment offers benefits from improving mobility to preventing contractures and joint dislocations, as it provides training that maintaining the body robust and flexible (Cerebral palsy, no date. Initially, we are required to collect information by studied several related journal or article in order to get appropriate and relate information to support our statement. From the literature review, we discover some existing problem that we need to solve in our project, for example, most of the rehabilitation device existed are not suitable for children in term of tension and physical size. Based on the information we collected, we are able to define our problem statement and objective. From the problem statement and objective, we required to come out a conceptual design that is able to solve the problem and achieve the objectives. In the mechanical part which refers to the position of the motor, the dimension of the wheel and bone construction but we focus more on the safety feature. Besides that, in the electronic part which refers to the electronic components used to construct the control system for this project which ranging from the small electronic components like resistors and capacitors to big components like the motor used to run the cycle and the power supply of the whole system. Each component to be used will be checked and studied for matching the problem statements of the project. Moreover, in the programming part which refers to the training algorithm will be customised and specially for children which mean the speed level will be studied according to the suitable speed range referring to any similar commercial product. The exercising time will be decided based on a suggestion from suitable studies as well. Cerebral palsy occurred due to damage to part of the brain cell and it causes unstable signal transmission between the brain and the particular muscle (Wikipedia, 2017. Moreover, Cerebral palsy is a permanent disease to the development of motor function and impairment of communication between central nerves system and muscle causing movement disorder and imbalance posture. Cerebral Palsy patients have posture limitation that occurred in the developing brain during early childhood. Cerebral palsy is muscle function impairment disease characterised by spasticity, weakness or other motor function, affecting upper or lower limbs. In fact, cerebral palsy can be classified into several categories like spastic, dyskinesia and etc. This classification system is form based on their severity in gross motor function and limb involvement. Cerebral Palsy are often describing by disturbances of cognition, communication, sensation, behaviour and perception, with musculoskeletal and epilepsy problems (Rosenbaum, 2007. The estimated cerebral palsy patient in the general population is 2 out of 1000 (Odding, et al. Cerebral Palsy disease brings a lots activity limitation such as unbalance posture and movement deficiencies. Cerebral palsy patients not only affected by movement disorder or unbalance posture along the time but they will be affected badly due to skeleton and muscle deformations because different compensation mechanisms happen in their limb at the time. In addition, Although the damage in a cerebral patient is not continuous or become worse but disability and deficiency may progressive (Butler, 2001. The main disorder happens in all types of cerebral palsy patients is motor disorders together with cognitive and sensorial problems (Tirosh & Rabino, 1989. The reason causes of muscle impairment are developmental retardation in early childhood. Besides that, cerebral palsy might appear with combination disorders such as both dyskinesia and spasticity. According to the cerebral palsy guidance website (Cerebral palsy guidance, no date), it stated that there have approximate 80% of cerebral palsy patients are fall in this categories. Spastic cerebral palsy is a movement disorder caused by damage to the part of the brain cell which is cerebral cortex during early childhood or during birth. The task for cerebral cortex in the brain is control of movement and motor function. When cerebral cortex of the brain is badly damaged, it will cause a stiff muscles symptom known as spastic cerebral palsy. Cerebral cortex damage affects the motor function and control movement which indirectly influences the spinal cord and nerves reactions to muscle control (Cerebral palsy guidance, no date. Moreover, the frequency of positioning or movement for upper or lower limb depends on spasticity (Kerkovich, 2008. Spastic cerebral palsy patient has some abnormal movements such as jerky movements and joint stiffness. The cerebral palsy disease causes the abnormal development of limb movement and result of lots of activity limitation. Spastic cerebral palsy often makes daily tasks become impossible to complete such as self- balancing, picking up small objects and walking. Some spastic cerebral palsy patient also develops co-occurring conditions result from their brain injury (Cerebral palsy guide, 2017. The effect of Spastic cerebral palsy effect on the lower limbs (Cerebral Palsy Alliance, no date): 1) Bend at the hip. According to the special care advocates in dentistry journal, there is approximate 20% of cerebral palsy patients fall in this categories. Dyskinesia cerebral palsy happens due to the damage of the basal ganglia in the brain (Kerkovich, 2008. The basal ganglia in brains function as switches for interpreting the messages between the muscle and the spinal cord which is responsible for interpreting a conscious action or voluntary movements. The different type of dyskinesia result from severity damage to the basal ganglia in the brain. Dyskinesia movements can be classified into three ways which are repetitive and twisting movements known as dystonia, stormy or slow movements known as athetosis and unpredictable or irregular movements known as chorea (Cerebral Palsy Alliance, no date. Chorea movements result from irregular contractions which are shaking and jerky along with the writhing and twisting.
Outcomes of suction curettage and 490 mifepristone abortion in the United States: A prospective comparison study skin care lab buy decadron toronto. Use of pH/whiff test or QuickVue Advanced pH and Amines 497 test for the diagnosis of bacterial vaginosis and prevention of postabortion pelvic 498 inflammatory disease skin care qvc generic decadron 0.5 mg without prescription. First trimester medical termination of 500 pregnancy: An alternative for New Zealand women skin care 1 month before marriage decadron 1 mg free shipping. Low-dose fentanyl and midazolam in outpatient 503 surgical abortion up to 18 weeks of gestation acne 4 days before period purchase discount decadron on line. Safety of aspiration abortion performed by nurse 505 practitioners, certified nurse midwives, and physician assistants under a California legal 506 waiver. Can we safely avoid fasting before 508 abortions with low-dose procedural sedation A retrospective cohort chart review of 509 anesthesia-related complications in 47,748 abortions. Investigation of the prophylactic effect of tinidazole on the postoperative 513 infection rate of patients undergoing vacuum aspiration. Prophylactic antibiotics in first-trimester 519 abortions: A clinical, controlled trial. A clinical double-blind study on 521 the effect of prophylactically administered single dose tinidazole on the occurrence of 522 endometritis after first trimester legal abortion. Significance of cervical chlamydia trachomatis 524 infection in postabortal pelvic inflammatory disease. Dilatation of the cervix with laminaria tents prior to 526 vacuum aspiration abortion in primigravidae. Prophylaxis with lymecycline in induced 528 first-trimester abortion: A clinical, controlled trial assessing the role of chlamydia 529 trachomatis and mycoplasma hominis. Effect of prophylactic administration of sulbactam/ampicillin on the rate of 531 postoperative endometritis after first-trimester abortion. The role of vaginal secretory 536 immunoglobulin a, gardnerella vaginalis, anaerobes, and chlamydia trachomatis in 537 postabortal pelvic inflammatory disease. Reduced incidence of postoperative endometritis by 541 the use of laminaria tents in connection with first trimester abortion. Chlamydia trachomatis: Is it possible to reduce the number of 544 infections after abortions Preoperative dilatation of the cervix at legal abortion with a 546 synthetic, fast-swelling hygroscopic tent. The influence of cervical dilatation by 548 laminaria tent and with Hegar dilators on the intrauterine microflora and the rate of 549 postabortal pelvic inflammatory disease. Postabortal infectious morbidity after antibiotic treatment of 551 chlamydia-positive patients. Early termination of pregnancy: Medical induction with 553 prostaglandins versus surgical aspiration under local anesthetic. General anaesthesia, a risk factor for 556 complication following induced abortion No effect of single dose ofloxacin on postoperative 558 infection rate after first-trimester abortion. A randomised controlled trial of 561 prophylaxis of post-abortal infection: Ceftriaxone versus placebo. The value of peroperative ultrasound examination in first 564 trimester legally induced abortion. A randomized comparison of medical abortion and 566 surgical vacuum aspiration at 10-13 weeks gestation. The use of oral misoprostol for pre- 571 abortion cervical priming: A randomised controlled trial of 400 versus 200 microg in first 572 trimester pregnancies. Is oxytocin given during surgical 576 termination of first trimester pregnancy useful Screening for chlamydia trachomatis 579 using self-collected vaginal swabs at a public pregnancy termination clinic in France: 580 Results of a screen-and-treat policy. Outpatient termination of pregnancy: 585 Experience in a family practice residency. The frequency and management of uterine 587 perforations during first-trimester abortions. A randomized comparison of propofol and 589 methohexital as general anesthetics for vacuum abortion. Manual versus electric vacuum aspiration for 592 early first-trimester abortion: A controlled study of complication rates. A randomized clinical trial of prophylaxis for vacuum abortion: 3 595 versus 7 days of doxycycline. The safety of deep sedation without intubation 597 for abortion in the outpatient setting. Uterine perforation during surgical abortion: A review of 599 diagnosis, management and prevention. Comparison of four perioperative 601 misoprostol regimens for surgical termination of first trimester pregnancy. Immediate complications after medical compared 610 with surgical termination of pregnancy. Antibiotics at the time of induced 614 abortion: the case for universal prophylaxis based on a meta-analysis. Local versus general anesthesia: Which is 617 safer for performing suction curettage abortions Mortality of induced abortion, other 620 outpatient surgical procedures and common activities in the us. Studies of complications from first-trimester aspiration abortion included in the systematic review Author, year Study design, Study population Gestational Antibiotic Level of sedation location age prophylaxis Office-based clinics Marshall et al. Excludes women who had an abortion performed by physician assistants (n=546) or who were 13 weeks gestation (n=19. Excludes women 13 weeks gestational age (n=178) or who were missing information on gestation age (n=6. Excludes women who had an abortion performed by advanced practice clinicians (n=5,675. Excludes women who received 4mm Dilapan tent at home for 16-20 hours (n=50) or who received 3mm Dilapan tent at the hospital for 3-4 hours (n=25. Excludes chlamydia positive women (n=69) who were age-matched to the chlamydia negative women. Excludes women 11 weeks gestation (n=1,485) since no upper gestational age limit was reported in the study. Excludes women who expressed a preference for medical abortion (n=15) or were randomized to medical abortion (n=188. Excludes medical abortions (n=680) and women who did not undergo manual vacuum aspiration (n=899) s. Excludes abortions performed between 1971-1975 since complications were defined differently in that study period. Excludes medical abortions (n=11,319) and second-trimester or later procedures (n=8,837. Major interventions for uterine perforation include hospitalization or surgical repair. This patient was excluded from the overall sample because she underwent manual and later electric vacuum aspiration. Magnetic resonance status of ultrasound imaging of patients with rheumatolog- provides a more uniform and reproducible image for long- ical disorders of the hands and feet. There is increasing evidence that ultrasound detects synovitis that is silent to clinical examination. Detection and classification of syno- Introduction vitis and the early detection of bone erosions are important in clinical decision making. Ultrasound has many advan- the small joints of the hands and feet play a central role in tages over other imaging techniques with which it is the diagnosis and classification of arthropathy. The ability to can be used to assess involvement in areas that are carry out a rapid assessment of many widely spaced joints, clinically occult as well as determine the precise structures coupled with clinical correlation, the ability to move and involved. Whilst a systematic approach should include a stress musculoskeletal structures and the use of ultrasound full examination of extra-articular structures, including to guide therapy accurately are principal amongst these. Contrast-enhanced magnetic resonance provides a better measure of capillary perme- ability and extracellular fluid than does ultrasound.