Summary : This flowchart provides a stepwise clinical algorithm for the evaluation and management of well-appearing infants aged 22 to 28 days with fever (temperature ≥38.0°C) and no evident source of infection, based on laboratory findings and clinical decision points. flowchart: # Nodes : • Start (rectangle): "22 to 28 days old, well-appearing, no evident source of infection, and temperature ≥38.0°C" • Process (rectangle): "Obtain urinalysis, blood culture, and IMD" • Decision (diamond): "Positive urinalysis result?" • Process (rectangle): "Send bladder catheterization or SPA urine culture" • Decision (diamond): "Abnormal IMs?" • Process (rectangle): "Perform LP" • Decision (diamond): "CSF obtained?" • Decision (diamond): "CSF pleocytosis or uninterpretable?" • Process (rectangle): "1. Administer parenteral antimicrobials 2. Observe in hospital" • Process (rectangle): "Treat infection" • Decision (diamond): "May perform LP?" • Decision (diamond): "LP performed?" • Decision (diamond): "CSF obtained?" • Decision (diamond): "CSF pleocytosis or traumatic?" • Decision (diamond): "Will observation be at home?" • Process (rectangle): "1. Administer parenteral antimicrobials 2. Observe at home 3. Reassess in 24 hours" • Process (rectangle): "1. May administer parenteral antimicrobials 2. Observe in hospital" • Process (rectangle): "Discontinue antimicrobials, discharge hospitalized infant if all cultures negative at 24 to 36 hours and HSV PCR is negative if sent. 2. Follow for duration of illness." • Process (rectangle): "Pathogen or source identified?" # Connectors : • Arrows indicate the flow from one node to the next, with branches at each decision diamond for "Yes" and "No" responses. • The flow begins at the top with patient presentation, proceeds through laboratory testing, and branches based on test results (e.g., urinalysis, IMs, CSF findings). • Multiple decision points determine whether to perform lumbar puncture (LP), administer antimicrobials, observe in hospital or at home, or discontinue treatment. • The flow merges at points where similar management is indicated regardless of the path taken (e.g., observation, reassessment, or discharge). # Layout : • The flowchart is arranged vertically, starting from the top with the initial patient presentation and moving downward through sequential decision points. • Branches split horizontally at each decision diamond, with "Yes" and "No" paths leading to different subsequent nodes. • Some branches reconverge after parallel processes (e.g., after observation or treatment). • Explanatory footnotes and references are included at the bottom, clarifying criteria and recommendations. # Analysis : • The flowchart provides a structured, evidence-based approach for clinicians to evaluate febrile infants aged 22 to 28 days. • Key decision points are based on laboratory findings (urinalysis, IMs, CSF analysis) and clinical feasibility (e.g., ability to observe at home). • The algorithm emphasizes early identification of serious bacterial infection, appropriate use of antimicrobials, and safe discharge criteria. • The process allows for flexibility based on test availability and clinical judgment, with clear guidance for both inpatient and outpatient management.

Summary : This flowchart provides a decision-making algorithm for clinicians to determine whether to test for influenza and/or start empiric antiviral treatment in patients presenting with respiratory symptoms, based on symptomatology, risk factors, and hospital admission status. flowchart: # Nodes : • "Does the patient have signs and symptoms suggestive of influenza? (eg, fever with cough or other suggestive respiratory symptoms, often with myalgias or headache. Note that some persons may have atypical presentations - especially elderly, infants, immunocompromised)" – (top-level decision node) • "Does the patient have atypical signs and symptoms or complications associated with influenza? (atypical or less common or less specific presentations; eg, unexplained fever only or afebrile with any respiratory symptoms especially in immunocompromised or high-risk patients; or complications of influenza such as pneumonia or others; or exacerbation of chronic conditions such as asthma, COPD, HF)" – (right branch from top node) • "Is the patient being admitted to hospital?" – (left branch from top node) • "Test for influenza; start empiric antiviral treatment while results are pending" – (left branch from "Is the patient being admitted to hospital?" if Yes) • "Will influenza testing results influence clinical management?" – (right branch from "Is the patient being admitted to hospital?" if No) • "Influenza clinically diagnosed; start empiric antiviral treatment if the patient is in a high-risk group for influenza complications, has progressive disease, discharge home" – (left branch from "Will influenza testing results influence clinical management?" if Yes) • "Influenza testing not indicated; consider other etiologies and treatments, discharge home" – (right branch from "Does the patient have atypical signs and symptoms or complications associated with influenza?" if No) • "Influenza testing not indicated; consider other etiologies and treatments, discharge home" – (right branch from "Will influenza testing results influence clinical management?" if No) # Connectors : • Top node splits into two branches: Yes (left) and No (right). • "Yes" from top node leads to "Is the patient being admitted to hospital?". • "No" from top node leads to "Does the patient have atypical signs and symptoms or complications associated with influenza?". • "Yes" from "Is the patient being admitted to hospital?" leads to "Test for influenza; start empiric antiviral treatment while results are pending". • "No" from "Is the patient being admitted to hospital?" leads to "Will influenza testing results influence clinical management?". • "Yes" from "Will influenza testing results influence clinical management?" leads to "Influenza clinically diagnosed; start empiric antiviral treatment if the patient is in a high-risk group for influenza complications, has progressive disease, discharge home". • "No" from "Will influenza testing results influence clinical management?" leads to "Influenza testing not indicated; consider other etiologies and treatments, discharge home". • "Yes" from "Does the patient have atypical signs and symptoms or complications associated with influenza?" leads back to "Is the patient being admitted to hospital?" (loop). • "No" from "Does the patient have atypical signs and symptoms or complications associated with influenza?" leads to "Influenza testing not indicated; consider other etiologies and treatments, discharge home". # Layout : • The flowchart is organized in a top-down manner, starting with the main decision node at the top. • Branches split left and right based on Yes/No answers. • There is a loop from the right branch ("Does the patient have atypical signs...") back to the hospital admission question. • Terminal nodes are at the bottom, indicating either testing/treatment or discharge home. # Analysis : • The flowchart prioritizes testing and empiric antiviral treatment for patients with typical influenza symptoms who are being admitted to hospital, or for those whose test results would influence management. • Patients with atypical symptoms or complications are considered for testing/treatment if they are high-risk or being admitted. • If neither typical nor atypical symptoms are present, or if testing would not influence management, the recommendation is to consider other diagnoses and discharge home. • The algorithm emphasizes risk stratification and resource stewardship in influenza testing and treatment decisions.

Summary : This flowchart provides a comprehensive management algorithm for adults with atopic dermatitis, detailing baseline management, topical therapies, phototherapy, and systemic therapies, including FDA-approved and recommended treatments, maintenance strategies, and escalation steps for inadequate control. flowchart: # Baseline Management : • Severity Assessment: Assessment of signs of disease, severity of symptoms, comorbidities, and impact on quality of life (QOL). • Exacerbating Factor Avoidance: Identify trigger factors (allergens, irritants, etc.) and counsel patients on avoidance. • Baseline Therapy: Moisturizers/Emollients (strong recommendation), Bathing Practices (conditional recommendation). # Initial Pathways : • Mild to Severe: Proceed to Topical Therapies. • Moderate to Severe: Proceed to Phototherapy & Systemic Therapy. # Topical Therapies : ## Optimized Topical Therapy for Inflamed Areas : • TCS (Topical corticosteroids) (FDA, strong recommendation) • TCIs (Topical calcineurin inhibitors) (FDA, strong recommendation) • Crisaborole ointment (FDA, strong recommendation) • Ruxolitinib cream (FDA, strong recommendation) • Wet Dressings (strong recommendation) ## Ongoing Maintenance with Topical Therapies : • Reactive or proactive application for maintenance. • Shared decision-making for long-term treatment. • Consider patient satisfaction and adherence. ## Inadequate Control : • If topical therapy and basic management optimized, consider alternative diagnoses. • Consider additional treatment with phototherapy and/or systemic agents. # Phototherapy & Systemic Therapy : • Topical agents can be used concurrently with phototherapy or systemic agents for maintenance, rescue, or flares. # Phototherapy : • No specific agents listed; included as a treatment option for moderate to severe cases. # Systemic Therapies : ## Biologics : • Dupilumab (FDA, strong recommendation) • Tralokinumab (FDA, strong recommendation) ## JAK Inhibitors : • Upadacitinib (FDA, strong recommendation) • Abrocitinib (FDA, strong recommendation) • Baricitinib (strong recommendation) ## Immunosuppressants : • Methotrexate (strong recommendation) • Azathioprine (strong recommendation) • Cyclosporine (strong recommendation) • Mycophenolate mofetil (strong recommendation) • Systemic corticosteroids (FDA, strong recommendation against use) # Key : • Green circle: Strong recommendation in favor. • Yellow circle: Conditional recommendation in favor. • Red circle: Strong recommendation against. • Orange circle: Conditional recommendation against. • FDA: Indicated for atopic dermatitis. # Abbreviations : • QOL: Quality of Life • FDA: Food and Drug Administration • TCS: Topical corticosteroids • TCI: Topical calcineurin inhibitor # Layout : • The flowchart is organized from baseline management at the top, splitting into two main pathways (mild to severe and moderate to severe), with further branches into topical, phototherapy, and systemic therapies. • Maintenance and escalation steps are included for ongoing management and inadequate control. # Analysis : • The algorithm emphasizes starting with baseline management and topical therapies, escalating to phototherapy and systemic therapies for more severe or refractory cases. • Strong recommendations are visually highlighted for first-line agents, with systemic corticosteroids strongly discouraged. • FDA-approved options are clearly marked, supporting evidence-based decision-making. • The flowchart supports a stepwise, patient-centered approach, integrating maintenance and escalation strategies.