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61. Spondyloarthritis in over 16s: diagnosis and management

Group (ESSG) axial spondyloarthritis criteria: Assessment of Spondyloarthritis International Society (ASAS; axial) Berlin Rome modified New York peripheral spondyloarthritis criteria: ASAS (peripheral) Classification of Psoriatic Arthritis (CASPAR) French Society of Rheumatology (reactive arthritis). 1.2.2 Do not rule out a diagnosis of spondyloarthritis solely on the basis of a negative HLA-B27 result. 1.2.3 Do not rule out a diagnosis of spondyloarthritis if a person's C-reactive protein (CRP (...) is not fully mature, request unenhanced MRI using an inflammatory back pain protocol. Subsequent in Subsequent inv vestigation using MRI estigation using MRI 1.2.7 Radiologists receiving a request for an inflammatory back pain MRI should perform short T1 inversion recovery (STIR) and T1 weighted sequences of the whole spine (sagittal view), and sacroiliac joints (coronal oblique view). 1.2.8 Use the ASAS/Outcome Measures in Rheumatology (OMERACT) MRI criteria to interpret the MRI as follows: If the MRI

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

62. Guidelines on Chronic Coronary Syndromes Full Text available with Trip Pro

tomography-based fractional flow reserve GEMINI- ACS A Study to Compare the Safety of Rivaroxaban Versus Acetylsalicylic Acid in Addition to Either Clopidogrel or Ticagrelor Therapy in Participants With Acute Coronary Syndrome GFR Glomerular filtration rate GLS Global longitudinal strain GOSPEL Global secondary prevention strategies to limit event recurrence after myocardial infarction HbA1c Glycated haemoglobin HF Heart failure ICA Invasive coronary angiography IMR Index of microcirculatory resistance (...) antithrombotic therapy in combination with aspirin 75-100 mg daily in alphabetical order in patients who have a high or moderate risk of ischaemic events, and do not have a high bleeding risk. 34 Table 10 Blood pressure thresholds for definition of hypertension with different types of blood pressure measurement 44 Table 11 Potential treatment options for refractory angina and summary of trial data 47 List of figures Figure 1 Schematic illustration of the natural history of chronic coronary syndromes 7 Figure

2019 European Society of Cardiology

63. Diagnosis and Management of Acute Pulmonary Embolism Full Text available with Trip Pro

weeks post-partum 38 Figure 8 Follow-up strategy and diagnostic workup for long-term sequelae of pulmonary embolism 44 Abbreviations and acronyms AcT Right ventricular outflow Doppler acceleration time AFE Amniotic fluid embolism ALT Alanine aminotransferase AMPLIFY Apixaban for the Initial Management of Pulmonary Embolism and Deep-Vein Thrombosis as First-line Therapy ASPIRE Aspirin to Prevent Recurrent Venous Thromboembolism trial AV Arteriovenous b.i.d Bis in die (twice a day) BNP B-type (...) Plasminogen Activator for Occluded Coronary Arteries HAS-BLED Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (>65 years), Drugs/alcohol concomitantly HERDOO2 Hyperpigmentation, Edema, or Redness in either leg; D-dimer level ≥250 μg/L; Obesity with body mass index ≥30 kg/m 2 ; or Older age, ≥65 years H-FABP Heart-type fatty acid-binding protein HIV Human immunodeficiency virus HR Hazard ratio INR International

2019 European Society of Cardiology

64. Management of Dyslipidaemias Full Text available with Trip Pro

lipoprotein cholesterol levels 25 7.4 Lifestyle recommendations to improve the plasma lipid profile 25 7.4.1 Body weight and physical activity 25 7.4.2 Dietary fat 25 7.4.3 Dietary carbohydrate and fibre 26 7.4.4 Alcohol 26 7.4.5 Smoking 26 7.5 Dietary supplements and functional foods for the treatment of dyslipidaemias 26 7.5.1 Phytosterols 26 7.5.2 Monacolin and red yeast rice 26 7.5.3 Dietary fibre 27 7.5.4 Soy 27 7.5.5 Policosanol and berberine 27 7.5.6 n-3 unsaturated fatty acids 27 8 Drugs (...) diabetes mellitus 29 8.1.4.4 Increased risk of haemorrhagic stroke 29 8.1.4.5 Adverse effects on kidney function 29 8.1.4.6 Interactions 29 8.2 Cholesterol absorption inhibitors 30 8.2.1 Mechanism of action 30 8.2.2 Effects on lipids 30 8.2.3 Effect on cardiovascular morbidity and mortality 30 8.2.4 Adverse effects and interactions 30 8.3 Bile acid sequestrants 30 8.3.1 Mechanism of action 30 8.3.2 Effects on lipids 30 8.3.3 Effect on cardiovascular morbidity and mortality 30 8.3.4 Adverse effects

2019 European Society of Cardiology

65. Guidelines on Diabetes, Pre-Diabetes and Cardiovascular Diseases developed in collaboration with the EASD Full Text available with Trip Pro

Management of blood pressure lowering 20 6.3.2.1 Effects of lifestyle intervention and weight loss 20 6.3.2.2 Pharmacological treatments 20 6.3.2.3 Blood pressure changes with glucose-lowering treatments 20 6.4 Lipids 21 6.4.1 Lipid-lowering agents 21 6.4.1.1 Statins 21 6.4.1.2 Ezetimibe 22 6.4.1.3 Proprotein convertase subtilisin/kexin type 22 6.4.1.4 Fibrates 22 6.5 Platelets 23 6.5.1 Aspirin 23 6.5.1.1 Primary prevention 24 6.5.1.2 Secondary prevention 24 6.6 Multifactorial approaches 24 6.6.1 (...) OGTT Oral glucose tolerance test ORIGIN Outcome Reduction With Initial Glargine Intervention PAD Peripheral arterial disease PCI Percutaneous coronary intervention PEGASUS- TIMI 54 Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin−Thrombolysis In Myocardial Infarction 54 PCSK9 Proprotein convertase subtilisin/kexin type 9 PIONEER 6 A Trial Investigating the Cardiovascular Safety of Oral Semaglutide in Subjects

2019 European Society of Cardiology

66. Management of Poisoning

to nontoxic levels (pg 76). Grade D, Level 4 Urinary pH manipulation D Urine alkalinisation increases the urine elimination of salicylate, chlorpropamide, 2,4-dichlorophenoxyacetic acid (herbicide), di? unisal, ? uoride, mecoprop (herbicide), methotrexate and phenobarbital. High urine ? ow (approximately 600 mL/h) and urine alkalinisation should also be considered in patients with severe 2,4-dichlorophenoxyacetic acid and mecoprop poisoning (pg 76). Grade D, Level 3 D Volume overload may complicate (...) individuals or in those with coronary and cerebral arterial disease (pg 77). Grade D, Level 4 D Urinary acidi? cation (urine pH 4 mL. Grade D, Level 3 C If the accidental ingestion occurred >12 hours (24 hours for enteric-coated tablets) and the patient is asymptomatic, no further evaluation is required (pg 100). Grade C, Level 2+ Mucocutaneous and ocular salicylate exposure D For asymptomatic patients with dermal exposures to methyl salicylate or salicylic acid, the skin should be thoroughly washed

2020 Ministry of Health, Singapore

68. Management of Hyperlactation

production, second revision 2018. Breastfeed Med 2018;13:307–314. 7. Stuebe AM, Meltzer-Brody S, Pearson B, et al. Maternal neuroendocrine serum levels in exclusively breastfeeding mothers. Breastfeed Med 2015;10:197–202. 8. Saleem M, Martin H, Coates P. Prolactin biology and laboratory measurement: An update on physiology and current analytical issues. Clin Biochem Rev 2018;39:3–16. 9. Laws ER, Ezzat S, Asa SL, Rio LM, et al. Pituitary Dis- orders, Diagnosis and Treatment. West Sussex, UK: Wiley

2020 Academy of Breastfeeding Medicine

69. Dietary Cholesterol and Cardiovascular Risk: A Science Advisory From the American Heart Association Full Text available with Trip Pro

/d compared with 0 to 415 mg/d in the referent group. This is equivalent to ≈3 to 7 compared with 0 to 2 eggs per day. In this meta-analysis, the fatty acid composition of the diets was not factored into the analyses. Methodological Issues A relevant issue with regard to the study of dietary cholesterol is the influence of dietary fat type. In many intervention studies, the fatty acid composition of the diets was not matched; likewise, because the majority of observational studies do not adjust (...) for saturated, monounsaturated, and polyunsaturated fat, it can be difficult to distinguish between the independent effects of dietary cholesterol and dietary fat type. Meta-Regression Analyses A recent meta-regression analysis including 55 randomized controlled dietary intervention studies identified a dose-response relationship between dietary cholesterol and LDL cholesterol concentrations after adjustment for dietary fatty acid composition using predicted lipoprotein changes derived from the Mensink et

2020 American Heart Association

70. ASGE review of adverse events in colonoscopy

an OR of 2.69 (95% CI, 1.83 - 3.98) and those 75 years and older had an OR of 5.63 (95% CI, 3.73 -8.49) toward increased early perforation compared with those aged 60 years and younger. Increasing ASA class was also associated with increasing early perforation risk, with patients in ASA Class III and above having greatest risk. Female gender was also a significant independent risk factor (OR 2.00). Any therapy (OR 3.93) and large polyp size (OR 4.14) were highly significant risk factors for early

2020 American Society for Gastrointestinal Endoscopy

71. Clinical Practice Guideline on the Diagnosis and Prevention of Periprosthetic Joint Infections

and neutrophil percentage • Synovial fluid aerobic and anaerobic bacterial cultures • Synovial fluid leukocyte esterase • Synovial fluid alpha-defensin (a-defensin) • Synovial fluid C-reactive protein (CRP) • Synovial fluid nucleic acid amplification testing [e.g., polymerase chain reaction (PCR)] for bacteria Strength of Recommendation: Moderate Description: Evidence from two or more “Moderate” quality studies with consistent findings, or evidence from a single “High” quality study for recommending (...) • Implant sonication fluid aerobic and anaerobic bacterial cultures • Implant sonication fluid nucleic acid amplification testing (e.g., PCR) for bacteria Strength of Recommendation: Moderate Description: Evidence from two or more “Moderate” quality studies with consistent findings, or evidence from a single “High” quality study for recommending for or against the intervention. D. Limited strength evidence supports that periprosthetic tissue nucleic acid amplification testing for bacteria is not useful

2020 American Academy of Orthopaedic Surgeons

72. Diagnosis and Treatment of Low Back Pain

-Utility Section Section Chair: Zoher Ghogawala, MD, FACS Authors: Simon Dagenais, PhD, MSc, DC Jeff rey A. King, DC, MS Paul Park, MD Daniel R. Perry, MPT, MDT Jonathan N Sembrano, MD John E. O’Toole, MD, MS; Stakeholder Representative, American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) Padma Gulur, MD; Stakeholder Representative, Ameri- can Society of Anesthesiologists (ASA) Contributors: Darren R. Lebl, MD Alex Seldomridge, MD, MBA Participating Societies (...) (does not necessarily imply endorsement) ? American Academy of Family Physicians (AAFP) ? American Academy of Orthopaedic Surgeons (AAOS) ? American Academy of Pain Medicine (AAPM) ? American Association of Neurological Surgeons (AANS)/Congress of Neurological Surgeons (CNS) ? American Society of Anesthesiologists (ASA) ? American Society of Regional Anesthesia and Pain Medicine (ASRA) ? American Society of Spine Radiology (ASSR) ? Spine Intervention Society (SIS) Contributing Societies (does

2020 North American Spine Society

74. Recommendations for good practice in Ultrasound: Oocyte retrieval

. There is no evidence suggesting value for FBC or any additional test before OPU with regard to preventing complications. - Taking accurate patient history before OPU is essential to highlight potential comorbidities and take actions to prevent any possible associated complications. Patients should at least be asked about the use of medications - more specifically the use of blood thinning agents (aspirin and others) -, relevant previous surgeries, and any relevant disease or deficit of coagulation factors

2019 European Society of Human Reproduction and Embryology

75. Pregnancy and Renal Disease

to access this MDT (1D). 2. Medication in pregnancy and lactation Guideline 2.1 We recommend that low dose aspirin, low molecular weight heparin, labetalol, nifedipine, methyldopa, prednisolone, azathioprine, ciclosporin, tacrolimus and hydroxychloroquine are safe for use in pregnancy (1B). Guideline 2.2 We recommend concentrations of calcineurin inhibitors (tacrolimus, ciclosporin) are checked throughout pregnancy and immediately postpartum, as blood concentrations may change (1C). Guideline 2.3 We (...) Disease – September 2019 46 7. Hwang JL, Weiss RE. Steroid-induced diabetes: a clinical and molecular approach to understanding and treatment. Diabetes Metab Res Rev. 2014; 30:96-102. 4.3 Pre-eclampsia prophylaxis Guideline 4.3.1 We recommend women with CKD are offered low-dose aspirin (75-150mg) in pregnancy to reduce the risk of pre-eclampsia (1B). Guideline 4.3.2 We suggest kidney donors are offered low dose aspirin (75mg-150mg) to reduce the risk of pre-eclampsia (2D). Rationale Women with CKD

2019 Renal Association

76. Society of Interventional Radiology Quality Improvement Standards on Percutaneous Ablation in Renal Cell Carcinoma Full Text available with Trip Pro

from the American Society of Anesthesiologists ( x 53 American Society of Anesthesiologists and ASA House of Delegates/Executive Committee. ASA physical status classification system. 2014. ( Available at: ) . 53 ). Although IGTA can be safely performed using moderate conscious sedation, monitored anesthesia care, or general anesthesia, this information could help inform the decision. Special attention should also be paid to a history of genitourinary malignancies in either the patient

2020 Society of Interventional Radiology

77. Perioperative

). Consensus ACOG, 2019 (Joint Statement with ASA); ASA, 2016 (Statement); NICE, 2016 (Guideline); Apfelbaum, 2012b (Guideline) Return to Table of Contents Recommendations Tablewww.icsi.org Institute for Clinical Systems Improvement 6 Perioperative Sixth Edition /January 2020 Topic Quality of Evidence Recommendation(s) Strength of Recommendation Relevant Resources Hemostasis (Coagulation) Testing Low Do not routinely perform coagulation tests before surgery unless indicated. Indications for testing may (...) that in routine preoperative tests of serum biochemistry, abnormal levels of sodium or potassium are found in up to 1.4% of patients which rarely led to a change in preoperative management. (Munro, 1997) A 2013 systematic review of five cohort studies found that elevated and low sodium values correlated positively with 30-day mortality in one study in veterans with ASA physical status of one, two or three undergoing elective surgery; however, the other four studies included in the review found no significant

2020 Institute for Clinical Systems Improvement

78. Laboratory diagnosis of G6PD deficiency Full Text available with Trip Pro

haemolysis in G6PD‐deficient subjects. Category of drug Predictable haemolysis Possible haemolysis Antimalarials Dapsone Chloroquine Primaquine Quinine Pamaquin * Not on UK market. Tafenoquine Methylene blue Analgesics/antipyretic Phenazopyridine Aspirin (high doses) † Acceptable up to a dose of at least 1 g daily in most G6PD‐deficient individuals. Paracetamol (Acetaminophen) Antibacterials Cotrimoxazole Sulfasalazine Sulfadiazine Quinolones ‡ Including ciprofloxacin, moxifloxacin, nalidixic acid (...) the Mediterranean countries (the Mediterranean type), parts of Africa (the African type; G6PD A‐) and parts of India and South East Asia (Beutler, ; Grimes, ; Wintrobe, ; Dacie, ). DNA sequence analysis has shown that the vast majority of mutations arise from single amino acid substitutions, mostly leading to a decrease in enzyme stability or to reduced catalytic efficiency. The degrees of enzymatic dysfunction detected in variants have been found to be in accordance with the severity of the clinical

2020 British Committee for Standards in Haematology

79. KDOQI Clinical Practice Guidelines for Nutrition in CKD

- Oral, Enteral, and Parental Nutrition ……………………… ……………………………….. 103 4.2 Nutrition Supplementation - Dialysate………………………………………..…….…… 115 4.3 Long Chain Omega-3 Polyunsaturated Fatty Acids ………………………… 119 Guideline 5: Micronutrients.……………………………………………………….…………. 128 5.0 General Guidance ……………………………………………………………………….. 128 5.1 Folic acid (with and without other B Vitamins) ……..…………………………………… 132 5.2 Vitamin C ………………………………………………………………………………… 137 5.3 Vitamin D ………………………………………………………………………………… 142 5.4 Vitamin E (...) and A ……………………………………………..…………………………… 148 5.5 Vitamin K ………………………………………………………………………………… 155 5.6 Selenium and Zinc………………………………………………………………………………….. 159 Guideline 6: Electrolytes.………………………………………………………………………….……. 164 6.1 Acid-Base ………………………………………………………………………………… 164 6.2 Calcium ………………………………………………………………..…………………… 171 6.3 Phosphorus …………………………………………………………...…………………… 175 6.4 Potassium ……………………………………………………………….………………… 184 6.5 Sodium …………………………………………………………….……………………… 188 Biographic and Disclosure Information…………………………………………………………………. 196

2020 National Kidney Foundation

80. AGA Clinical Practice Guidelines on the Management of Moderate to Severe Ulcerative Colitis

Low 6. In adult outpatients with moderate-severe ulcerative colitis, the AGA suggests early use of biologic agents with or without immunomodulator therapy, rather than gradual step up after failure of 5-aminosalicylates. Comment: Patients, particularly those with less severe disease, who place higher value on the safety of 5-ASA therapy, and lower value on the efficacy of biologic agents or tofacitinib, may reasonably chose gradual step therapy with 5-ASA therapy. Conditional Very low 7. In adult (...) . standard infliximab dosing. No recommendation Knowledge gap Abbreviations 5-ASA 5-aminosalicylates, AGA American Gastroenterological Association, FDA Food and Drug Administration, TNF tumor necrosis factor, UC ulcerative colitis, US United States 35 REFERENCES 1. Singh S, Feuerstein JD, Binion DG, et al. American Gastroenterological Association technical review on the management of mild-moderate ulcerative colits. Gastroenterology 2018. 2. Fumery M, Singh S, Dulai PS, et al. Natural History of Adult

2020 American Gastroenterological Association Institute

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