Guidelines

48 entries

NDOH Standard Treatment Guidelines and clinical protocols

VL Monitoring Algorithm for Clients on TLD Click here to open the above PDF Click here for Routine HIV VL Monitoring on ART Click here for Enhanced Adherence Support Click here for Drug Dosing Chart Click here for Drug Interactions with DTG and Rifampicin-containing TB Treatment Click here for ABCDE assessment of an Elevated Viral Load Click here for Management of Confirmed Virological Failure on TLD 2023 ART ClinicaOther→
VL Non-Suppression Algorithm for Pregnant and Breastfeeding Women on TLD Click on the image to enlarge. The shorter 4-week interval between doing the first VL above 50 and the repeat VL is preferred wherever possible. However, if the first elevated VL is the delivery-VL, the next visit may only occur at the 6-week post-natal visit. Due to their high genetic barrier, resistance to a first-line DTG-containing (TLD1) regimen is extremely rare. If other reasons forOther→
VTE During Pregnancy and the PuerperiumDescription Medicine Treatment Referral/Consultation During Pregnancy O22.2-3/O87.0-1/O87.9/O88.3 DESCRIPTION The risk of VTE is substantially increased in pregnancy and is an important cause of maternal morbidity and mortality. MEDICINE TREATMENT Prophylaxis Risk Assessement A risk assessment should be done in pre/early pregnancy and repeated if the woman is admitted to hospital for any reason,EML (Adult)→
Vaccines for Routine AdministrationThe contents of this chapter are based on the current recommendations from the National Advisory Group on Immunisation (NAGI). BCG ( Bacillus calmette-guerin ) Hexavalent (DTaP-IPV-HB-Hib) vaccine Tdap (Tetanus, reduced diphtheria and acellular pertussis vaccine) bOPV (Oral polio vaccine) RV (Rotavirus vaccine) PCV (Pneumococcal conjugated vaccine) Measles/Rubella Vaccine and FormPrimary Care→
Vaccines for Umrah & Hajj: Updated May 2018Vaccines for Umrah & Hajj: Updated May 2018Other→
Vaginal BleedingAbnormal vaginal bleeding during reproductive years Post-menopausal bleeding Note: Women should receive regular screening for cervical cancer after the age of 30 years. Any opportunity to perform screening should be taken; this includes taking pap smears during pregnancy. ABNORMAL VAGINAL BLEEDING DURING REPRODUCTIVE YEARS N92.0-2/3-6 DESCRIPTION Increased vaginal blood flow in either volume, durPrimary Care→
Vaginal Bleeding in a ChildSurgery depends on the cause, e.g. myomectomy or hysterectomy for fibroids (below), or hysterectomy for persistent excessive bleeding not responding to drug treatment. N.B. a small submucous fibroid may lead to heavy bleeding and may be resected by hysteroscope. Endometrial ablation can be considered in some units for bleeding from a normal uterus – i.e. when the uterus is of normal size and no specific cause is found. If there is marked dysmenorrhoea there is less satisfaction with ablation. Many different types of ablation exist. Pregnancy after ablation is contra-indicated, and specified as such in consent. Uterine artery embolisation may be offered in some units. Pregnancy after is cautiously allowed. Catheterisation and occlusion of both uterines is achieved via the femoral artery. A watery blood stained discharge follows, which is very rarely associated with overwhelming sepsis. MANAGEMENT OF MULTIFIBROID UTERUS Drug treatment (as for excessive vaginal bleeding) may control haemorrhage sufficiently to avert hysterectomy, at least in the short term. 1. Do not force a hysterectomy an unwilling patient 2. Consider myomectomy. Consent for a myomectomy must include specific mention of proceeding to hysterectomy if there are intraoperative problems 3. Consider alternatives: Uterine artery embolization(UAE) or High Intensity Focused Ultrasound(HIFU) for suitable patients who want to preserve their fertility. UAE may shrink the uterus by 50%. Pregnancy Following UAE may have complications(IUGR, prem labour, placenta accreta). This should enter consent. HIFU has not to date been used much on the larger uterus(the current limit is 18 weeks size). Always discuss with a consultant. 4. Where fertility is an issue, consider other causes. N.B. if, for a person with bleeding, there is a delay while awaiting an operation or a procedure and that person is not maintained on progestagens and haematinics, when the procedure is due there will be anaemia and it will be cancelled.Other→
Vaginal DischargeThis booklet is intended as a practical guide to patient care for registrars, medical officers, interns and medical students attached to the gynaecology units at the University of the Witwatersrand Academic Hospitals. Anyone can use it.Other→
Vaginal Discharge (PVD)Infection Vaginal Discharge (PVD) Brief outline/clinical setting PVD does not necessarily mean there is PID or bacterial vaginosis. Detailed history and clinical examination is warranted to exclude sinister causes of PVD like Ca Cervix. If infective cause-ALWAYS treat partner/s All PVD in prepubertal girls and children (below age of consent) to be discussed with an ED-CONSULTANT and REFERRED to GOther→
Vaginal Discharge Syndrome (VDS)Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 EditionEML (Adult)→
Vaginal Discharge Syndrome (VDS)Vaginal Discharge Syndrome (VDS)Primary Care→
Vaginal Discharge and Vaginal Discharge SyndromeVaginal Discharge and Vaginal Discharge SyndromeOther→
Vaginal Ulcers *New*See Genital ulcer syndrome (GUS) . Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, Updated for the 2023 EditionPrimary Care→
Vaginal discharge/lower abdominal pain in women *New*See: Vaginal discharge syndrome (VDS) and Lower abdominal pain (LAP) Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, Updated for the 2023 EditionPrimary Care→
Valid Informed Consent to Sedation and Analgesia for Medical or Dental ProceduresValid informed consent ( Appendix 3 ) is a complex process. The General Dental Council (GDC), UK, provides valuable principles and standards for the dental team regarding consent for dental procedures. 6 It should be documented that appropriate consent was obtained from the patient, or a responsible person (parent/caregiver), according to local and international requirements. Before the process cOther→
Valvular Heart Disease and Congenital Structural Heart DiseaseValvular Heart Disease and Congenital Structural Heart DiseasePrimary Care→
Varicella (Chicken Pox)Varicella (Chicken Pox)Other→
Varicella (Chicken Pox)Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: B01 DESCRIPTION An acute, highly contagious, viral disease caused by herpes varicella-zoster. It spreads by infective droplets or fluid from vesicles. One attack confers permanent immunity. Varicella is contagious from about 2 days before the onset of the rash until all lesions crusted.PEML (Paeds)→
Varicella (Chickenpox), ComplicatedGeneral measures Medicine treatment ICD-10 code: B01.1-2† + (G02.0*/G05.1*+J17.1*)/B01.8 GENERAL MEASURES Cool, wet compresses or tepid water baths. Body hygiene to prevent secondary infection. Advise against scratching. MEDICINE TREATMENT Antiviral therapy is required in complicated cases, e.g.: chickenpox pneumonia, pregnancy, neurological involvement, and chickenpox in immunocompromised patienEML (Adult)→
VariousDeferasirox Folinic acid, intravenous Lanthanum carbonate, Sevelamer Mesna ATC Code V03AC03 Medicine Deferasirox ( film-coated and dispersible tablets considered equivalent ) Indication Treatment of transfusional iron overload NEMLC Recommendation Approved Added as an oral alternative to deferoxamine Review Indicators n/a Date Ratified 30 November 2023 Film-coated tablet update ( PreviouslOther→
Venous Thrombo-Embolic DiseaseDescription Diagnostic criteria General and supportive measures Referral ICD-10 code: I82 DESCRIPTION An occlusive or non-occlusive thrombus in the venous circulation, with or without pulmonary embolus. Associated risk factors include central venous catheters, venous stasis, endothelial damage and hypercoaguable states, e.g. nephrotic syndrome. Causes include protein C and S deficiency, facPEML (Paeds)→
Venous ThromboembolismDescription Venous Thrombo-embolism Prophylaxis Venous Thrombo-embolism Acute Treatment I26.0/I26.9/I80.0-3/I80.8-9/I81/I82.0-3 DESCRIPTION Venous thromboembolism (VTE) can occur at different sites, ranging from calf deep venous thrombosis (DVT) to pulmonary thrombo-embolism (PE). For VTE in pregnancy, see: VTE during pregnancy and the puerperium . Differential diagnosis includes: cellulitis supeEML (Adult)→
Venous Thromboembolism (VTE) ProphylaxisVenous Thromboembolism (VTE) ProphylaxisOther→
Venous Umbilical CatheterisationManagement guidelines for students, interns and registrars on a variety of routine and emergency situations in our neonatal service at Tygerberg Children’s Hospital. Published in 2014.Other→
Ventilation Concepts: OverviewVentilation ConceptsOther→
Ventilation Specifics: Normal Lungs / Lung Injury (Pneumonia/ARDS)Ventilation is frequently commenced in the Emergency Centre following intubation. The following suggested principles for specific medical conditions are based on the pathophysiology of the condition and settings should be tailored to each patient individually.Other→
Ventilation Specifics: Obstructive Lung Disease (COPD / Asthma)Ventilation is frequently commenced in the Emergency Centre following intubation. The following suggested principles for specific medical conditions are based on the pathophysiology of the condition and settings should be tailored to each patient individually.Other→
Ventilator Associated PneumoniaVAP BundlesOther→
Vertigo, AcuteStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 EditionEML (Adult)→
Vincent’s AnginaInfection Vincent’s angina Brief outline/clinical setting Vincent’s angina refers to acute necrotizing ulcerative lesions of the oral mucosal membranes and tonsils, with bleeding inflammation and halitosis Aetiologies/organisms Organisms involved are polymycrobial but often include Fusobacterium necrophorum, Treponema, Selenomonas, Prevotella Optimal antimicrobial selection AmoxicilliOther→
Viral Haemorrhagic Fever (VHF)Description General Measures Management Referral ICD-10 codes: A98.0-5/ A98.8/A99/A91 Note: notifiable medical conditions. Consult the most recent Viral Haemorrhagic Fever Guidelines from the National Department of Health. DESCRIPTION Viral haemorrhagic fevers (VHF) are uncommon conditions in South Africa. They may present with non-specific signs or with signs strongly suggestive of VHPrimary Care→
Viral InfectionsStandard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Adults 2019 EditionEML (Adult)→
Viral Load Monitoring ScheduleClick on the image to enlarge. Click here for VL Non-Suppression Algorithm . Click here for Management of a High Maternal Viral Load after Delivery . Click here for the pdf . South African National Department of Health, Guideline for Vertical Transmission Prevention of Communicable Infections, Version 2_August 2023Other→
Visit Schedule for Adults, Adolescents and Children 5 Years and Older on ARTClick here to open the above PDF Click here for Baseline Clinical Assessments Click here for Baseline Lab Assessments Click here for Monitoring of ART Click here for Annexure 3 - Enhanced Adherence Counselling 2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates June 2023 Version 4 Upload date: 04/08/2023Other→
Visit Schedule for Integrated Care for Clients already on ART when diagnosed with Drug-sensitive TBClick here to Visit Schedule for Integrated Care for Clients already on ART when diagnosed with Drug-sensitive TB 2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates June 2023 Version 4 Upload date: 04/08/2023Other→
Visit Schedule for Integrated Care for the Mother-baby Pair Living with HIVVisit Schedule for Integrated Care for the Mother living with HIV and her HIV-exposed Infant (HEI) The principles are as follows: Wherever possible, try to align the mother’s ART, VL monitoring, and contraception visits with that of the child’s visit schedule so the mother-baby pair need only attend the facility once for both consultations on the same day Wherever possible, allow the mother and bOther→
Visit Schedule for Integrated Care for the Mother-baby Pair Living with HIVClick here to view the Visit Schedule for Integrated Care for the Mother-baby Pair Living with HIV 2023 ART Clinical Guidelines for the Management of HIV in Adults, Pregnancy and Breastfeeding, Adolescents, Children, Infants and Neonates June 2023 Version 4 Upload date: 04/08/2023Other→
Visual ProblemsEye ConditionsPrimary Care→
Vitamin A deficiency *New*ICD-10 codes: E50.0 , E50.1 , E50.2 , E50.3 , E50.4 , E50.5 , E50.6 , E50.7 , E50.8 , E50.9 Description General measures Medicine treatment Referral DESCRIPTION A condition predominantly affecting the skin, mucous membranes and the eyes. It is most common in children of 1 - 5 years of age. If associated with measles and diarrhoea there is an increased risk of illness and death. If not identPrimary Care→
Vitamin B1/thiamine deficiency (Wernicke encephalopathy and beriberi) *New*ICD-10 codes: E51.1 , E51.2 / E51.8 , E51.9 Description General measures Medicine treatment Referral DESCRIPTION Clinical features include: confusion. short-term memory loss. paralysis of one or more of the ocular muscles or ophthalmoplegia. nystagmus. ataxia. peripheral neuropathy. cardiac failure. Alcoholics may present with Wernicke encephalopathy, neuropathies or cardiac failure associated wiPrimary Care→
Vitamin B3/nicotinic acid deficiency (pellagra) *New*ICD-10 code: E52 Description General measures Medicine treatment Referral DESCRIPTION Pellagra is a condition associated with nicotinic acid deficiency. It is usually accompanied by other vitamin deficiencies. Clinical features include: diarrhoea. dementia. dermatitis with darkening of sun-exposed skin. GENERAL MEASURES Lifestyle adjustment including discouraging of alcohol abuse. Dietary advice.Primary Care→
Vitamin B6/pyridoxine deficiency *New*ICD-10 code: E53.1 Description General measures Medicine treatment Referral DESCRIPTION Commonly presents as signs of peripheral neuropathy including: tingling sensation. burning pain or numbness of the feet. Pyridoxine deficiency is related to: malnutrition. alcoholism. isoniazid or combination TB therapy. GENERAL MEASURES Dietary advice: Increase intake of pyridoxine rich foods such as: Liver,Primary Care→
VitiligoVitiligoPrimary Care→
Volatile SolventsDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T53 DESCRIPTION Inhalants include: spray-paint, glue and paint thinners that may contain hydrocarbons such as toluene and/or n-Hexane. If these are ingested, hydrocarbon poisoning with possible chemical pneumonitis must also be considered. DIAGNOSTIC CRITERIA distinctive odour, euphoria,PEML (Paeds)→
Voluntary Sterilisation, Male and FemaleZ30.2 Female sterilisation Also known as tubal occlusion or tubal ligation. This is a permanent, surgical contraceptive method for women who do not intend to have more children. Women who opt for sterilisation should be adequately counselled and referred. Male sterilisation Also known as vasectomy. This is a permanent surgical contraceptive method for men who do not intend to have more children.Primary Care→
Von Willebrand DiseaseDescription Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: D68.0 DESCRIPTION Von Willebrand disease is the most common congenital bleeding disorder and is due to reduced amounts or abnormal forms of von Willebrand factor. DIAGNOSTIC CRITERIA Clinical Recurrent epistaxis, prolonged bleeding from lacerations, easy bruising or gum bleeds, menorrhagPEML (Paeds)→
Vulval Skin Problems, Dysplasias & VulvodyniaThis booklet is intended as a practical guide to patient care for registrars, medical officers, interns and medical students attached to the gynaecology units at the University of the Witwatersrand Academic Hospitals. Anyone can use it.Other→
Vulvar CancerThis guideline is intended as a practical guide to patient care for registrars, medical officers, interns and medical students attached to the gynaecology units at the University of the Witwatersrand Academic Hospitals. Anyone can use it.Other→