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181. VA/DoD clinical practice guideline for the management of type 2 diabetes mellitus in primary care.

decision-making to enhance patient knowledge and satisfaction. ( Strong for; Reviewed, New-added ) The Work Group recommends that all patients with diabetes should be offered ongoing individualized diabetes self-management education via various modalities tailored to their preferences, learning needs and abilities based on available resources. ( Strong for; Reviewed, New-replaced ) The Work Group suggests offering one or more types of bidirectional telehealth interventions (typically health (...) of 8.0% to 9.0% for patients with type 2 diabetes with life expectancy <5 years, significant comorbid conditions, advanced complications of diabetes, or difficulties in self-management attributable to, e.g., mental status, disability or other factors such as food insecurity and insufficient social support (see Table 2 in the original guideline document). ( Weak for; Reviewed, New-replaced ) The Work Group suggests that providers be aware that HbA1c variability is a risk factor for microvascular

2017 National Guideline Clearinghouse (partial archive)

182. Mental health of adults in contact with the criminal justice system.

of a learning disability or any acquired cognitive impairment Other communication difficulties (for example, language, literacy, information processing or sensory deficit) The nature of any coexisting mental health problems (including substance misuse) Limitations on prescribing and administering medicine (for example, in-possession medicine) or the timing of the delivery of interventions in certain settings (for example, prison) The development of trust in an environment where health and care staff may (...) adjustments to the assessment that take into account any suspected neurodevelopmental disorders (including learning disabilities), cognitive impairments, or physical health problems or disabilities. Seek advice or involve specialists if needed. Identification and Assessment throughout the Care Pathway Be vigilant for the possibility of unidentified or emerging mental health problems in people in contact with the criminal justice system, and review available records for any indications of a mental health

2017 National Guideline Clearinghouse (partial archive)

183. Developmental follow-up of children and young people born preterm.

, periventricular leukomalacia, infarct) Necrotising enterocolitis that needed surgery Neonatal sepsis Severe retinopathy of prematurity. Be aware that there is an increased prevalence of developmental coordination disorder in children born preterm compared with the general population. Learning Disability (Intellectual Disability) Be aware that children born preterm are at increased risk of learning disability (intellectual disability), and that: The following are independent risk factors: Grade 3 or 4 (...) . At each face-to-face follow-up visit and developmental assessment for a child born preterm who is having enhanced developmental surveillance, check for signs and symptoms of developmental problems and disorders as appropriate, such as: Cerebral palsy (see recommendation below) Global developmental delay and learning disability (intellectual disability) Autism spectrum disorder (see recommendation below) Visual impairment Hearing impairment Feeding problems Sleep problems, including sleep apnoea Speech

2017 National Guideline Clearinghouse (partial archive)

184. Eating disorders: recognition and treatment.

or disabilities Healthcare professionals assessing people with an eating disorder (especially children and young people) should be alert throughout assessment and treatment to signs of bullying, teasing, abuse (emotional, physical and sexual) and neglect. For guidance on when to suspect child maltreatment, see the National Institute for Health and Care Excellence (NICE) guideline on . Communication and Information When assessing a person with a suspected eating disorder, find out what they and their family (...) the eating problem Explain the risks of malnutrition and being underweight Enhance self-efficacy Include self-monitoring of dietary intake and associated thoughts and feelings Include homework, to help the person practice in their daily life what they have learned MANTRA for adults with anorexia nervosa should: Typically consist of 20 sessions, with: Weekly sessions for the first 10 weeks, and a flexible schedule after this Up to 10 extra sessions for people with complex problems Base treatment

2017 National Guideline Clearinghouse (partial archive)

185. Alcohol: Adult Unhealthy Drinking

for the questions should be the last 3 months rather than the last year. o The threshold for “binge drinking” in the third question is 4 or more drinks on one occasion. • Pregnant women should be screened for alcohol use disorder (AUD) using the Alcohol Symptom Checklist if: o They score a 3 or greater on the AUDIT-C, or o They are currently drinking at any level since learning of their pregnancy, regardless of their AUDIT-C score. • Pregnant women who are negative for AUD should receive brief behavioral (...) , such as frozen breast milk or formula (WHO 2014). Role of Primary Care Primary care physicians (PCPs) and their teams have two key roles to play in addressing and minimizing disability due to alcohol use: prevention and treatment. • Prevention: Brief interventions are recommended by the U.S. Preventive Services Task Force (USPSTF) because they decrease drinking in patients who screen positive for unhealthy drinking. Many patients with positive screens do not have alcohol use disorder, but can benefit from

2016 Kaiser Permanente Clinical Guidelines

186. Clinical Practice Guideline for the Care of Women with Decreased Fetal Movements

on the care of women with concerns of decreased fetal movements (DFM), and to enhance consistency in information and care provided to women. This guideline has been developed to help reduce the risk of adverse pregnancy outcomes, including perinatal death or disability and maternal anxiety. This guideline is not intended to be prescriptive. It is designed to provide the best available information, enabling integration of the best evidence, clinicians’ judgement and individual choice in arriving (...) at decisions about care. Clinical practice guidelines are considered as generally- recommended practice. Due to the lack of high-quality evidence, recommendations in this guideline are mainly consensus-based, following consideration of the available evidence. E-learning program An eLearning program has been developed to familiarise clinicians with the guidelines. Please contact the Centre of Research Excellence in Stillbirth to request access. Further review and information: This guideline will remain

2017 Clinical Practice Guidelines Portal

188. Recommendations for the Use of Mechanical Circulatory Support: Ambulatory and Community Patient Care: A Scientific Statement From the American Heart Association

the patient develops increased functional capacity, appetite, and nutrient absorption. Poor glucose control influences a patient’s transplantation candidacy. Psychosocial, Behavioral, and Cognitive Problems Patients may be evaluated for MCS implantation as an outpatient or while hospitalized. Evaluation includes a rigorous clinical and psychosocial/behavioral assessment. Patients also learn more about their diagnosis and prognosis, MCS risks (eg, adverse events) and benefits (eg, lengthening life (...) referral for psychiatric medication management, counseling, or cognitive behavioral therapy. Whether patients with MCS have psychosocial or behavioral comorbidities, they experience psychosocial challenges related to MCS self-care and returning home. Modifications to activities of daily living are required. Patients and caregivers can experience significant stress. , Early after implantation, patients are often grateful for the device, but they may experience anxiety related to learning

2017 American Heart Association

190. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

AS at intermediate surgical risk. See Online Data Supplements 5 and 9 (Updated From 2014 VHD Guideline) In the PARTNER II (Placement of Aortic Transcatheter Valve II) RCT, 62 which enrolled symptomatic patients with severe AS at intermediate risk (STS score =4%), there was no difference between TAVR and surgical AVR for the primary endpoint of all-cause death or disabling stroke at 2 years (HR: 0.89; 95% CI: 0.73 to 1.09; P=0.25). All-cause death occurred in 16.7% of those randomized to TAVR, compared with 18.0 (...) % of those treated with surgical AVR. Disabling stroke occurred in 6.2% of patients treated with TAVR and 6.3% of patients treated with surgical AVR. 62 In an observational study of the SAPIEN 3 valve, 63 TAVR was performed in 1077 intermediate-risk patients with severe symptomatic AS, with the transfemoral approach used in 88% of patients. At 1 year, the rate of all-cause death was 7.4%, disabling stroke occurred in 2%, reintervention was required in 1%, and moderate or severe paravalvular aortic

2017 American Heart Association

191. Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

and disabling neurological deficits, although this is rare. The latter phenomenon has been attributed to local tissue ischemia from either arterial steal or venous outflow obstruction leading to venous hypertension. , This physiology may also contribute to the risk of seizures. Finally, headaches are a common complaint in patients with bAVMs. Hemorrhage Risk An individual patient data meta-analysis of 2525 patients with 141 ICHs during 6074 person-years of follow-up in a variety of population- and hospital

2017 American Heart Association

193. Clinical Practice Parameters for Hemodynamic Support of Pediatric and Neonatal Septic Shock

participates in ASAIO (editor) and ELSO (committee member). Dr. Odetola participates as a member of the Sub-Board of Critical Care Medicine, American Board of Pediatrics. Dr. Parbuoni participates in the American Society of Health-System Pharmacists and California Society of Health-System Pharmacists. Dr. Reuter-Rice received funding from J & B Learning (textbook royalties). She received grant funding from RWJK. She participates in PNCB-IPN, AAN, and ISONG. Dr. Schnitzler participates in Sociedad Argentina

2017 Society of Critical Care Medicine

194. Safe Medication Use in the ICU

, accountable, and safe. Therefore, hospitals and ICUs must transform into high-reliability organizations (HROs) ( ). HROs (e.g., aviation, nuclear power generation plants) are capable of maintaining a state of near failure-free operations in complex and hazardous environments ( ). These HROs balance reliable processes with a capacity to learn from experience and adapt to changing circumstances by enacting five high-level values ( ): 1) sensitivity to system operations and failures no matter how trivial; 2 (...) ) avoiding overly simplistic explanations of failure; 3) learning from near misses to improve the system; 4) deference to expertise of each team member; and 5) resilience. Although the provision of healthcare is highly complex and different from other high-risk industries, HRO principles have been applied effectively ( , ) to achieve significant and sustained reductions in preventable harm and mortality from healthcare-associated infections ( ). Additional research is needed to evaluate if HRO principles

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2017 Society of Critical Care Medicine

195. Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU

of the significant impact that critical illness has on family members of the critically ill. Stressful decision making often falls to family members because most patients in the ICU are too ill to participate in decision making ( ). Furthermore, family members bear a significant burden of caregiving to the more than 50% of critical illness survivors who have postdischarge disability ( , ). Approximately one quarter to one half of family members of critically ill children or adults experience psychological (...) . The observational studies ( ) are of low quality. One study used a program to teach parents how to do exercises with their preterm children and found that the parents performed the exercises on most days (93%) and made few errors ( ). A positive parent education program found that the family was able to gain perspective on the situation and learn key concepts and find resources ( ). A training program with families of children with tracheostomy found high satisfaction with the training ( ). Data from existing

2017 Society of Critical Care Medicine

197. Intestinal Rehabilitation Programs in the Management of Pediatric Intestinal Failure and Short Bowel Syndrome

, improved patient and family education, earlier treatment of complications, and learning from the accumulated patient databases. Quality assurance and research collaboration among centers are also goals of many of these programs. The combined and coordinated talents and skills of multiple types of health care practitioners have the potential to ameliorate the impact of intestinal failure and improve health outcomes and quality of life. Key Words: adaptation, intestinal failure, intestinal rehabilitation (...) of absorptive surface area, whereas IF is a lack of satisfactory absorption. Therefore, patients who have SBS may have IF, whereas patients who have IF may not have SBS. This article focuses on SBS with associated IF. Some SBS patients with global bowel dysfunction from massive intestinal loss are at risk for irreversible, chronic intestinal failure, a highly disabling condition. Definitions of SBS-associated IF have included 2 important concepts: a shortened length of intestine and a need for prolonged PN

2017 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

198. AIM Clinical Appropriateness Guidelines for Whole Exome and Whole Genome Sequencing

impact clinical decision-making and/or clinical outcome • A genetic etiology is the most likely explanation for the phenotype as demonstrated by the following: • Multiple abnormalities affecting unrelated organ systems or two of the following four criteria: • Abnormality affecting a single organ system • Significant intellectual disability or severe psychological/psychiatric disturbance (e.g. self-injurious behavior, reversed sleep-wake cycles) • Family history strongly implicating a genetic etiology (...) Jun 2;98(6):1067-76. 2 Auer PL, Reiner AP, Wang G, et al. Guidelines for large-scale sequence-based complex trait association studies: lessons learned from the NHLBI Exome Sequencing Project. Am J Hum Genet. 2016 Oct 6;99(4):791-801. 3 Best S, Wou K, Vora N, et al. Promises, pitfalls and practicalities of prenatal whole exome sequencing. Prenat Diagn. Forthcoming 2017. 4 Chang YS, Huang HD, Yeh KT, et al. Evaluation of whole exome sequencing by targeted gene sequencing and Sanger sequencing. Clin

2017 AIM Specialty Health

200. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

and disability-adjusted life years worldwide. In the United States, hypertension (see Section 3.1 for definition) accounted for more CVD deaths than any other modifiable CVD risk factor and was second only to cigarette smoking as a preventable cause of death for any reason. In a follow-up study of 23 272 US NHANES (National Health and Nutrition Examination Survey) participants, >50% of deaths from coronary heart disease (CHD) and stroke occurred among individuals with hypertension. Because of the high

2017 American Heart Association

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