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

for testing and proficiency in genetic variant interpretation, in order to maximize the genetic testing experience for patients and their healthcare providers. The genetic counseling informed consent process also educates and empowers patients to consider the psychological, financial, employment, disability, and insurance implications of genetic testing and results (Al-Khatib et al. 2018). Patients who receive genetic counseling report increased knowledge, understanding, and satisfaction regarding (...) encephalopathy (onset before three years of age) for which likely non-genetic causes of epilepsy (e.g. environmental exposures; brain injury secondary to complications of extreme prematurity, infection, trauma) have been excluded 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

2020 AIM Specialty Health

182. European Academy of Neurology guideline on the management of medication-overuse headache

, primary headache, tension-type headache, therapy, treatment Received 2 March 2020 revision requested 6 April 2020 Accepted 9 April 2020 European Journal of Neurology 2020, 0: 1–15 doi:10.1111/ene.14268 Abstract Background: The frequent use of medication to treat migraine attacks can lead to an increase in migraine frequency and is called medication- overuse headache (MOH). Methods: Based on the available literature in this guideline, the ?rst step in patient management is education and counselling (...) . Results: Patients with MOH should be managed by a multidisciplinary team of neurologists or pain specialists and behavioral psychologists. Patients in whom education is not e?ective should be withdrawn from overused drugs and should receive preventive treatment with drugs of proven e?cacy. Patients with MOH in whom preventive treatment is not e?ective should undergo drug withdrawal. Drug intake can be abruptly terminated or restricted in patients overusing simple analgesics, ergots or triptan

2020 European Academy of Neurology

183. EAN guideline on palliative care of people with severe, progressive multiple sclerosis

?ered the opportunity to learn clean intermittent self- catheterization. If self-catheterization is not possi- ble, a patient carer can be trained to catheterize the patient. 4) If clean intermittent (self-)catheterization is no longer possible, a long-term indwelling catheter (preferably suprapubic) might be o?ered. 5) Patients with severe MS in whom antimuscarinic drugs have proved to be ine?ective or poorly tol- erated might be o?ered intradetrusor injections of botulinum toxin (...) to walk 20 m without resting (Expanded Disability Status Scale score > 6.0) or higher disability is referred to. When evidence was lacking for this population, recommendations were formulated using indirect evidence or good practice statements were devised. Results: Ten clinical questions were formulated. They encompassed general and specialist palliative care, advance care planning, discussing with HPs the patient’s wish to hasten death, symptom management, multidisciplinary rehabilitation

2020 European Academy of Neurology

184. Consensus Practice Guidelines on Interventions for Lumbar Facet Joint Pain from a Multispecialty, International Working Group Full Text available with Trip Pro

no correlation between any historical or provocative examination sign and immediate or prolonged response to injections. A prospective study by Lilius et al assessed work and disability in 109 patients with LBP who had no signs of radicular pain following an IA injection with either cortisone and LA; a pericapsular injection of the same mixture; or an IA saline injection. They found that psychosocial factors significantly influenced outcome. Schwarzer et al conducted a prospective study attempting (...) -group response rate to MBBs was statistically significant (p<0.05). In a third study, an observational, open-label design was used to compare the outcomes of MBB in patients with chronic LBP (n=30) with and without facet joint-positive SPECT scans. The primary outcome measure was >50% pain reduction on the visual analog scale (VAS) at weeks 2 and 4 following the MBB. A secondary outcome measure was the Oswestry Disability Index (ODI) score. All MBB were performed using ultrasound guidance

2020 American Society of Regional Anesthesia and Pain Medicine

185. Unhealthy Drug Use: Screening

relievers (2.1% and 1.3%, respectively) and opioids (1.2% and 0.7%, respectively). In both age groups, less than 1% reported use of heroin, cocaine, hallucinogens, inhalants, or methamphetamines in the last month. An estimated 8 million persons 12 years or older met diagnostic criteria for drug dependence or abuse of drugs in the past year. Drug use is one of the most common causes of preventable death, injuries, and disability. , In 2017, unhealthy drug use caused more than 70,000 fatal overdoses. Drug (...) use can cause many serious health effects that vary by drug type, administration mode, amount, and frequency of use, as well as pregnancy status. Opioid use can cause drowsiness, slowed breathing, constipation, coma, and fatal overdose. Stimulants such as cocaine can cause arrhythmias, myocardial infarction, seizures, and other complications. Marijuana use is associated with slowed reaction time; problems with balance, coordination, learning, and memory; and chronic cough and frequent respiratory

2020 U.S. Preventive Services Task Force

186. The use of prophylactic factor replacement for children and adults with Haemophilia A and B Full Text available with Trip Pro

of factor VIII (FVII) or factor IX (FIX). Without prophylaxis, nearly all men with SHA (<1 iu/dl) and most of those with moderate haemophilia A (MHA) who have levels between 1 and 3 iu/dl will have at least one target joint and some degree of disability due to joint bleeds. , For those with MHA, a measured FVIII of 1–2 iu/dl has been associated with the highest risk of bleeding: median (interquartile range [IQR]) 2·9 (1·4–7·2) joint bleeds per year, despite prophylaxis in 40% compared to 1·4 (0·5–3·4 (...) ‐long prophylaxis should be the standard of care and should be encouraged. Grade 1C If an adult discontinues prophylaxis, then it should be recommenced in the event of a spontaneous haemarthrosis or any bleeding that interferes with education or employment or quality of life. Grade 2C Monitoring the effectiveness of factor replacement therapy in the laboratory The aim of laboratory monitoring is twofold: to look for inhibitor development as per published guidelines and to facilitate determination

2020 British Committee for Standards in Haematology

187. Vital Signs in Anaesthesia A guide for anaesthetists seeking help and advice during the COVID crisis

of mind- set to being ‘good enough’ which will be difficult for the perfectionist. Training in teams (skills and drills) will be invaluable. Learning lessons, training and development are highly developed skills of an anaesthetist and having a simple mechanism for feeding back about practical issues (for example, access to food) and clinical issues that occur will help alleviate stress. Peer support and clear signposting to support services will be essential. Mental hygiene On a good day, working (...) . Our world-class conferences, journals and online resources educate and inform, and our respected guidelines continually improve standards of patient safety. We preserve and learn from the history of anaesthesia. We use that to inform the present, and facilitate vital research and innovation into its future. As an independent organisation, we speak up freely and openly for the interests of anaesthetists and their patients. We influence policy, raise public awareness and are at the forefront

2020 Association of Anaesthetists of GB and Ireland

188. Cardiac arrhythmias in coronary heart disease

and is applicable to guidance produced using the processes described in SIGN 50: a guideline developer’s handbook, 2015 edition (www.sign.ac.uk/guidelines/fulltext/50/ index.html). More information on accreditation can be viewed at www.nice.org.uk/ accreditation Healthcare Improvement Scotland (HIS) is committed to equality and diversity and assesses all its publications for likely impact on the six equality groups defined by age, disability, gender, race, religion/belief and sexual orientation. SIGN guidelines (...) Psychosocial assessment and screening New 7.4 Psychosocial interventions Updated 8 Provision of information Updated 9 Implementing the guideline Updated 1.3 STATEMENT OF INTENT This guideline is not intended to be construed or to serve as a standard of care. Standards of care are determined on the basis of all clinical data available for an individual case and are subject to change as scientific knowledge and technology advance and patterns of care evolve. Adherence to guideline recommendations

2018 SIGN

189. Pharmacological management of migraine

produced using the processes described in SIGN 50: a guideline developer’s handbook, 2015 edition (www.sign.ac.uk/guidelines/fulltext/50/ index.html). More information on accreditation can be viewed at www.nice.org.uk/ accreditation Healthcare Improvement Scotland (HIS) is committed to equality and diversity and assesses all its publications for likely impact on the six equality groups defined by age, disability, gender, race, religion/belief and sexual orientation. SIGN guidelines are produced using (...) headache with a global prevalence of around one in seven people. 8 The Global Burden of Disease study ranks migraine as the seventh most common cause of disability worldwide, rising to the third most common cause in the under 50s. 9 It is estimated that migraine costs the UK around £3 billion a year in direct and indirect costs, taking into consideration the costs of healthcare, lost productivity and disability. 10 Twice as many women as men are affected. 11 This is considered to be due to changes

2018 SIGN

190. Screening for impaired vision in community-dwelling adults aged 65 years and older in primary care settings

to deter- mine the quality of evidence and strength of recommendation (Box 1). The evidence-to-decision framework is provided in Appendix 2 (available at www.cmaj.ca/lookup/suppl/doi:10.1503/ cmaj.171430/-/DC1). The Knowledge Translation team at St. Michael’s Hospital (Toronto, Ontario) engaged members of the public on behalf of the task force at two stages of guideline development. In the first phase, 15 participants aged 58 to 78 years rated outcomes to inform the systematic review, by means (...) , based on how likely further research is to change our confidence in the estimate of effect. 15GUIDELINE E590 CMAJ | MAY 14, 2018 | VOLUME 190 | ISSUE 19 74 years were asked to provide their perspective on the guideline recommendations. 17 A knowledge translation tool for the guideline was informed by feedback from clinicians and patients and is provided on the task force website (www.canadiantaskforce.ca). The recommendation was approved by the entire task force and underwent external review

2018 CPG Infobase

191. Practice guideline: joint CCMG-SOGC recommendations for the use of chromosomal microarray analysis for prenatal diagnosis and assessment of fetal loss in Canada

, was approved by the CCMG Board of Directors (5 June 2017) and the SOGC Board of Directors (on 19 June 2017). The CCMG is a Canadian organisation responsible for certifying medical geneticists and clinical laboratory geneticists and for establishing professional and ethical standards for clinical genetics services in Canada. The SOGC is a Canadian organisation which produces national clin- ical guidelines for both public and medical, education and clin- ical practice, on important women’s health issues (...) with an NT =3.5 mm, prenatal CMA should be offered (II-2 B). The working group recognises that, in some instances, local resources allow for prenatal chromosomal microarray analysis to be available for all invasive prenatal specimens, outside of the above indications. While an approximate 1.7% risk of abnormal findings has been documented, 15 there is also the impact of inci- dental findings and variants of unknown significance (VOUS) in a broad population (the so-called ‘toxic knowledge

2018 CPG Infobase

192. Management of stable angina

in SIGN 50: a guideline developer’s handbook, 2015 edition (www.sign.ac.uk/guidelines/fulltext/50/ index.html). More information on accreditation can be viewed at www.nice.org.uk/ accreditation Healthcare Improvement Scotland (HIS) is committed to equality and diversity and assesses all its publications for likely impact on the six equality groups defined by age, disability, gender, race, religion/belief and sexual orientation. SIGN guidelines are produced using a standard methodology that has been (...) Perioperative revascularisation 33 6.3 Drug therapy in patients undergoing non-cardiac surgery 34 7 Psychological health 38 7.1 How does angina affect quality of life? 38 7.2 Improving symptom control with behavioural interventions 39 7.3 The effect of health beliefs on symptoms and functional status 40 8 Provision of information 41 8.1 Information and education about surgery and other interventions 41 8.2 Cardiac waiting times 42 8.3 Follow up in patients with angina 42 8.4 Checklist for provision

2018 SIGN

193. Simplified guideline for prescribing medical cannabinoids in primary care

recommend long-term monitoring of medical cannabinoids to further assess potential individual and societal benefits and harms. Dr Allan is Professor of Evidence-Based Medicine in the Department of Family Medicine at the University of Alberta in Edmonton. Mr Ramji, Ms Perry, and Dr Ton are Knowledge Translation Experts in the Physician Learning Program with the Alberta Medical Association and in Lifelong Learning and the Department of Family Medicine at the University of Alberta. Dr Beahm is Research (...) Physicians. Dr Noël is Health Innovation Studio Lead and Human-centred Knowledge Designer for Lifelong Learning in the Faculty of Medicine and Dentistry at the University of Alberta. Dr Lindblad is Knowledge Translation and Evidence Coordinator for the Alberta College of Family Physicians and Associate Clinical Professor in the Department of Family Medicine at the University of Alberta. 120 Canadian Family Physician | Le Médecin de famille canadien ? Vol 64: FEBRUARY | FÉVRIER 2018 CLINICAL PRACTICE

2018 CPG Infobase

194. Canadian stroke best practice recommendations: secondary prevention of stroke, sixth edition practice guidelines

cause of adult neuro- logical disability, with over 400,000 Canadians living with its e?ects, and it ranks as the third leading cause of death. 1 Stroke costs the Canadian economy more than $3.6 billion a year in physician services, hospital costs, lost wages, and decreased productivity. 2 The impact of stroke can be seen even among persons who have sustained seemingly minor strokes or transi- entischemicattacks(TIA).Canadiandataindicatethat evenindividualsfreeofpost-strokecomplicationsinthe short (...) and management strategies. 1.1 Timing of initial assessment Table T wo summarizes the triage categories and target times for initial assessment of patients with transient ischemic attack and non-disabling ischemic stroke. 1.1.1 VERY HIGH Risk for Recurrent Stroke (Symptom onset within last 48 hours) i. Patients who present within 48 hours of a suspected transient ischemic attack or non- disabling ischemic stroke with the following symptoms are considered at highest risk of first or recurrent stroke

2018 CPG Infobase

195. Diagnosis and management of epilepsy in adults

disability. C The diagnosis of epilepsy should be made by an epilepsy specialist. ? The diagnosis of epilepsy is most appropriately delivered in the setting of a dedicated first-seizure or epilepsy clinic. Appropriate patient information should be given (see section 10). An epilepsy specialist has been defined as a trained doctor with expertise in epilepsy as demonstrated by training and continuing education in epilepsy, peer review of practice and regular audit of diagnosis. Epilepsy must (...) epilepticus 23 4.11 Patients with recurrent prolonged or serial seizures in the community 26 4.12 Drugs which exacerbate epileptic seizures 27 4.13 Management of patients with epilepsy in the perioperative period 27 4.14 Management of older people with epilepsy 27 4.15 Management of people with learning disability and epilepsy 29 5 Epilepsy and women’s health 31 5.1 Contraception 31 5.2 Preconceptual counselling 35 5.3 Risks of inheriting epilepsy 36 5.4 Pregnancy 38 5.5 Labour and birth 40

2018 SIGN

197. Canadian Urological Association guideline for the diagnosis, management, and surveillance of neurogenic lower urinary tract dysfunction

Canadian’s living with SB, which is the leading cause of disabling birth defect within the country. 11 12,14 In Canada, 86 000 people are living with SCI and 4300 new cases of SCI occur each year. 15 These numbers are pro- jected to increase to 121 000 individuals, with 5800 new cases a year by 2030. 15 Trauma is the most frequent cause of SCI in Canada and most commonly affects men in the 20–29-year age group. 15 Compared to international etiol- ogy, where the majority of SCI is the result of motor (...) , and 70–84% in SCI. 19 A recent Canadian study looking at the impact of bladder, bowel, and sexual dysfunction in 51 community-dwelling individuals with traumatic SCI reported that 59% of these individuals had bladder dysfunction. 20 Neurological conditions often result in physical disability requiring the need for assistance with activities of daily liv- ing, including assistance with or requiring devices to manage NLUTD. Giesbrecht et al reported that of Canadians living at home with a physical

2019 Canadian Urological Association

198. Guidance on the clinical management of anxiety disorders, specifically focusing on diagnosis and treatment strategies

capacity to think, plan and do complex tasks that also need attention in difficult situations. It is normal for a person’s current level of anxiety to affect their ability to perform. However, people with anxiety disorders experience very pronounced states of anxiety, often against a background of constant fear and worry. These severe states of anxiety can be disabling. Anxiety disorders involve unhelpful thinking patterns Having an anxiety disorder is not just a matter of being too anxious. People (...) with anxiety disorders have fears and wor- ries about ‘what might happen if ...’, and those fears and worries persist on and off for months and years, causing distress and disability. It is the months or years of distress and disability that drive people to treatment. The continuing fears and worries, which most patients recognise as somewhat irrational but nevertheless dread, are the basis for making a diagnosis of an anxiety disorder (Figure 1) and prescribing treatment. Each of the anxiety disorders

2018 Royal Australian and New Zealand College of Psychiatrists

199. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU

Tumors Penis Retroperitoneum Cytology Online Learning For Medical Students Exams/LLL/Certifications Exam Prep Research Research Funding AUA Funding Research Education & Events Online Research Education Courses Research Resources Biorepositories and Other Resources Research Publications Research Career Opportunities Advocacy Scholar & Fellowship Programs Comment Letters & Resources International International Opportunities Annual Meeting Membership Collaborations Academic Exchanges Giving Back (...) agreed upon by urologists or other clinicians for which there may or may not be evidence in the medical literature. Expert Opinion refers to a statement, achieved by consensus of the Panel, that is based on members' clinical training, experience, knowledge, and judgment for which there is no evidence. Table 2: AUA Nomenclature Linking Statement Type to Level of Certainty, Magnitude of Benefit or Risk/Burden, and Body of Evidence Strength Evidence Strength A (High Certainty) Evidence Strength B

2019 Canadian Urological Association

200. Human Papillomavirus (HPV), Cervical Screening and Cervical Cancer

if they have completed a recognised training programme and every registrant has a professional duty to inform their employer if they require training. • In October 2017, the NCSP in England launched a refresher e-learning resource. It has been designed to meet the three-yearly updated requirements of registrants and is free to access for sample takers working in the programme. The resource is available at: www.e-lfh.org.uk/programmes/nhs- screening-programmes • In Northern Ireland the Public Health Agency (...) chaotic life events/environments which preclude them from attending a clinic or understanding the importance of regular screening checks. It is equally important to be aware of women who may have learning difficulties or mental health issues, as well as physical disabilities which may require particular consideration. In addition, when caring for women under the age of 25 it is important to convey the rational for not routinely screening, as this is a recurring concern among some young women (DH, 2010

2018 Royal College of Nursing

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