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81. Heart Failure - Systolic Dysfunction

daily-tid $23-146 $26-308 Ethacrynic acid Edecrin 25 mg daily 25 – 200 mg daily-bid n/a $605 Furosemide Lasix 40 mg daily 40 – 400 mg daily-tid $4-30 $27-218 Torsemide Demadex 20 mg daily 20 – 100 mg daily-bid $8-59 $98-329 Inotrope b Digoxin Lanoxin 0.125 mg daily 0.125 – 0.375 mg daily $35 $233 a Cost =For brand drugs, Average Wholesale Price minus 10%. AWP from Red Book Online 1/5/16. For generic drugs, Maximum Allowable Cost plus $3 from BCBS of Michigan MAC List, 1/1/16. Prices calculated (...) in patients who are frequently hospitalized for fluid accumulation. Torsemide’s rate of absorption is not significantly altered when patients become decompensated unlike furosemide. Changes in drug absorption may be one of the factors that lead to frequent hospitalizations with individual patients. • Ethacrynic acid is an option for patients with allergies to furosemide, bumetanide and torsemide due to lack of sulfur moieties. Combining a loop diuretic with a thiazide diuretic increases diuretic effect

2020 University of Michigan Health System

82. Management of Type 2 Diabetes Mellitus

programs and use of alternative nicotine delivery systems or pharmacologic therapies. Aspirin. The ADA and most other organizations recommend use of aspirin in all patients with diabetes who have known coronary artery disease. Recent data suggest that aspirin may not be as effective as previously believed in people without coronary artery disease, even in those with diabetes. Current recommendations suggest that aspirin use for primary prevention be reserved for those with a greater than 10% 10-year (...) and aspirin is generally considered safe; however, megavitamin therapy should be discouraged. Relaxation therapy, yoga, and spiritual healing are helpful to individuals and can be encouraged. Interventions that are potentially harmful or have no real evidence of efficacy clearly should be discouraged. Patients should be commended, however, on their self-determination and encouraged to direct their efforts in areas that have proven benefits. When to Consider Endocrine Consultation or Referral Consider

2020 University of Michigan Health System

83. Curriculum for endoscopic submucosal dissection training in Europe

, metachronous lesions, surgery because of non-curative resec- tion or because of recurrence, and medications that can inter- fere with outcomes (such as proton pump inhibitors, aspirin, nonsteroidal anti-inflammatory drugs [NSAIDs], and anti- coagulants). A clinical database suggested by ESGE for ESD training is available on the ESGE website (https://www.esge. com/esd-training-curriculum/). Givenalltheavailableevidenceandpublishedmeta-analyses [72,73,77], ESGE recommends that the goal of every endos- copist

2020 European Society of Gastrointestinal Endoscopy

84. Guidelines for Perioperative Care in Cardiac Surgery Enhanced Recovery After Surgery Society Recommendations

Lima PRL, de Cerqueira Borges D, et al. Preoperative carbohydrate load and intraoperatively infused omega-3 polyunsaturated fatty acids positively impact nosocomial morbidity after coronary artery bypass grafting: a double-blind controlled randomized trial. Nutr J . 2017;16(1):24. doi: Breuer JP, von Dossow V, von Heymann C, et al. Preoperative oral carbohydrate administration to ASA III-IV patients undergoing elective cardiac surgery. Anesth Analg . 2006;103(5):1099-1108. doi: Hibbard JH, Greene J (...) blood conservation clinical practice guidelines. Ann Thorac Surg . 2011;91(3):944-982. doi: Pagano D, Milojevic M, Meesters MI, et al. 2017 EACTS/EACTA Guidelines on patient blood management for adult cardiac surgery. Eur J Cardiothorac Surg . 2018;53(1):79-111. doi: Myles PS, Smith JA, Forbes A, et al; ATACAS Investigators of the ANZCA Clinical Trials Network. Tranexamic acid in patients undergoing coronary-artery surgery. N Engl J Med . 2017;376(2):136-148. doi: Koster A, Faraoni D, Levy JH

2020 ERAS Society

85. Ovarian Stimulation for IVF/ICSI

DEHYDROEPIANDROSTERONE (DHEA) 73 8.5 ASPIRIN 74 8.6 INDOMETACIN 75 8.7 SILDENAFIL 75 REFERENCES 76 [5] 9. Non-conventional start of ovarian stimulation 78 KEY QUESTION: WHAT IS THE SAFETY AND EFFICACY OF NON-CONVENTIONAL START STIMULATION COMPARED TO STANDARD EARLY FOLLICULAR PHASE STIMULATION? 78 9.1 NON-CONVENTIONAL START 78 9.2 LUTEAL PHASE STIMULATION 78 9.3 DOUBLE STIMULATION 80 REFERENCES 81 10. Ovarian stimulation for fertility preservation 82 KEY QUESTION: WHAT IS THE PREFERRED STIMULATION PROTOCOL (...) responders following IVF treatment. SoF table 28 8 37 Use of aspirin before and/or during ovarian stimulation is not recommended in the general IVF/ICSI population and for poor responders. Strong ? ? ? ? The existing evidence suggests that adjuvant aspirin before and/ or during ovarian stimulation does not improve ovarian response in terms of number of oocytes retrieved and clinical outcomes of clinical or ongoing pregnancy, or live birth rates following IVF treatment. SoF table 29 8 38 Use of sildenafil

2019 European Society of Human Reproduction and Embryology

86. National Adult Diabetes Clinician Guide

• Simultaneous use of an ACEI, ARB, and/or renin inhibitor is potentially harmful and is not recommended. • Do not prescribe ACEIs/ARBs, to women of childbearing potential, unless there is a compelling indication. Additional Details CLINICAL PRACTICE GUIDELINES | NATL February 2019 • For additional details, see KP Blood Pressure guideline. CHOLESTEROL THERAPY • See Cholesterol and Cardiovascular Risk guideline. ASPIRIN THERAPY • See Integrated Cardiovascular Health Clinical Leads interim guidance on aspirin

2019 Kaiser Permanente National Guideline Program

88. Recommendations for Follow-Up After Colonoscopy and Polypectomy: A Consensus Update by the US Multi-Society Task Force on Colorectal Cancer

will reduce risk. Since 2012, several studies have been published on che- mopreventive strategies for reducing risk for recurrent neoplasia. A large, well-done randomized controlled trial found that supplementation with calcium or vitamin D (alone or in combination) was not associated with reduced risk for recurrent neoplasia, 82 and a small study that included intervention with calcitriol, aspirin, and calcium also found no bene?t on risk for recurrent neoplasia. 83 A prospective cohort study reported (...) . Newly published work has con?rmed that aspirin and exposure to nonsteroidal anti-in?ammatory medications may reduce risk for adenoma recurrence, but optimal dose, mechanism of action, and characteristics of patients most likely to bene?t have not been well established. 87,88 While there is insuf?cient evidence to support routine recommendation of aspirin for cancer and adenoma prevention in patients with baseline adenoma, the overall impact of aspirin on cardiovascular disease (CVD) and CRC risk

2020 American Society for Gastrointestinal Endoscopy

89. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group

pylori eradication and required con- tinued antiplatelet therapy (acetylsalicylic acid [ASA]) (88). A meta-analysis of 2 trials showed that PPIs plus ASA reduced rebleeding rates versus clopidogrel alone (RR, 0.07 [CI, 0.01 to 0.34]) in patients with pre- vious ASA-associated ulcer bleeding who did not have H pylori infection or who had it successfully eradicated (90, 91). In patients with previous ASA-associated ulcer bleeding, trials found no difference between PPIs and eradication treatment (...) in those with H pylori infection (89), or between PPIs and H 2 RAs in patients without H pylori infection or those in whom H pylori infection was eradicated (92). Two trials found no differences in mor- tality rates between PPI and placebo groups (88) or be- tween PPIs plus ASA versus clopidogrel (89). The evidence was downgraded, primarily for very serious imprecision (small studies, very low number of events). Dual-antiplatelet therapy (DAPT): No randomized trials were found assessing the use of PPIs

2020 Canadian Association of Gastroenterology

90. Drug-Induced Liver Injury

characteristicsofthedrugareimportant,particularlylipophilic- ity and drug biotransformation. This exposes the liver to reac- tive metabolites which can covalently bind to proteins, induce oxidative stress, activate signal transduction pathways (e.g. mitogen-activated protein (MAP) kinases) and result in orga- nelle stress (e.g. mitochondrial or endoplasmic reticulum (ER) stress), interfere with bile acid transport and either lead to lethal consequences (necrosis or apoptosis) or induce adaptive responses which dampen (...) in patients with DILI caused by germander. Several recent reports have underlined the hepatotoxicity of dietary supplements including a cocktail of products, usnic acid with other product (yohimbine, caffeine, dihydrothyrone, nore- phedrine) in various preparations: Lipokinetic , UPC-1 , Lipo- liz , particularly associated with acute hepatocellular hepatitis. Other products reported to cause DILI include OxyE- LITE containing several ingredients (dimethylamylamine, aegeline) for weight loss and muscle

2019 European Association for the Study of the Liver

91. Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care: Diagnosis and Treatment of Low Back Pain

of Orthopaedic Surgeons (AAOS) Contributor: Jordan Gliedt, DC Cost-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

2020 American Academy of Pain Medicine

92. MASAC Recommendations Concerning Products Licensed for the Treatment of Hemophilia and Other Bleeding Disorders

hamster cell lines, baby hamster kidney (BHK) and Chinese hamster ovary (CHO), that have been transfected with the gene for human FVIII (F8). (1, 2) Two newer rFVIII products are produced in human embryonic kidney (HEK) cell lines. In some products, the rFVIII is full length, while in other products the B-domain is largely deleted. Either 14 amino acids (Xyntha, Eloctate), 16 amino acids (Nuwiq), or 21 amino acids (NovoEight) of the B-domain remain in the rFVIII. (3) First generation rFVIII contains (...) by recombinant technology and thus theoretically do not transmit human viruses. Moreover, methods of viral inactivation (dry heat, pasteurization, solvent-detergent treatment, immunoaffinity purification) have resulted in a reduced risk of HIV and hepatitis B and C transmission with plasma-derived factor VIII concentrates (5-6, 10-12). Despite donor screening by nucleic acid testing (NAT) for HIV, HBV, and HCV, cryoprecipitate might still be infectious. The current estimate for the risk of HIV or HCV

2020 National Hemophilia Foundation

93. Pharmacological Agents for Procedural Sedation and Analgesia

or alcohol Previous anaesthetic Yes No ASA grade (please circle) ASA I ASA II ASA III ASA IV ASA V Difficult Airway? no concern/ mild concern/significant concern Features to consider: BMV ventilation: beard, no teeth, obesity, trauma, cachexia LMA: Laryngoscopy: Crithyroidotomy: Consent: sedation verbal written lacks capacity procedure verbal written lacks capacity Preprocedural ECG: Y N Pain before procedure mild (0-3) severe (7-10) Pain post-procedure mild (0-3) severe (7-10) moderate (4-6) moderate (4 (...) of Anaesthetologists. Continuum of depth of sedation definition of levels of general anaesthesia, sedation/analgesia ASA; 2014 [updated 15/10/2014; cited 2015 26/08/2015]. 4. Frank RL. Procedural Sedation in Adults. In: Post TW, editor. UpToDate. 2015. Waltham, MA: UpToDate; 2015. 5. HSu DC, Cravero, J.P. Procedural Sedation in Children Outside the Operating Room. In: Post TW, editor. UpToDate. Waltham, MA: UpToDate; 2014. 6. Godwin SA, Burton JH

2019 Royal College of Emergency Medicine

94. Emergency Department Out of Hours Discharge Medications

. Local pathways and meeting the needs of local population In order to be responsive to the local needs it is helpful to monitor what drugs patients are given FP10s for or returning to the pharmacy for. Examples may be aspirin and clopidogrel for TIA clinics. Any new guideline advising a medication to be given out should lead to a review of the TTO cupboard contents. In rural areas patients may have to travel considerable distances to return to a hospital for medication. A large TTO cupboard (...) (or any other brand) 4-6 packs Should have a trainer device in cupboard to teach patient how to use. V rare a Paediatric anaphylaxis discharged from the ED so likely no need to stock smaller size. Chlorphenamine 4mg x 28 And 2mg/5ml 100ml bottle Medium (10-20 packs) for tablets, 2-3 bottles for children Can also be purchased OTC Gastrointestinal Omeprazole 20mg x 28 tablets Medium (10 packs) Can also be purchased OTC Cardiovascular Aspirin 75mg x 28 and 300mg x 28 Low (<5 packs each) 75mg tablets

2019 Royal College of Emergency Medicine

96. Clinical Performance Measures for Neurocritical Care

. Strong recom - mendations were prioritized as most guideline methodol- ogies give stronger ranking to recommendations with the highest quality of evidence to support the recommenda- tion. Examples would include a Strong recommendation if the GRADE methodology [10] was used or a Class I rec- ommendation of the American Heart Association/Ameri- can Stroke Association (AHA/ASA) methodology [11] was used. Lesser recommendations were not considered for development into PMs. The most recent iterations (...) , disease registries, or admission surveillance logs are recommended. If none exist, then primary discharge diagnosis from chart review of hospital records should be used. Brief Summary of the Neurocritical Care Performance Measure Set Table 2 lists the full Neurocritical Care Performance Measure Set. The set consists of 21 PMs: Six that are similar or the same as stroke measures developed by the AHA/ASA and/or TJC, five that are similar or the same as the American Academy of Neurology (AAN) Inpatient

2020 Neurocritical Care Society

97. Temporary Emergency Guidance to U.S. Stroke Centers During the COVID-19 Pandemic Full Text available with Trip Pro

Pandemic On Behalf of the AHA/ASA Stroke Council Leadership and On Behalf of the AHA/ASA Stroke Council Leadership Originally published 1 Apr 2020 Stroke. ;0:null Abstract During this unprecedented time of extraordinary stress on the US healthcare system, the AHA/ASA Stroke Council—as individuals in our localities and together as an entity at the national level—acknowledge the mounting concern regarding optimal stroke care during the COVID-19 pandemic among vascular neurologists and those clinicians

2020 American Heart Association

98. Options for Peripartum Anticoagulation in Areas Affected by Shortage of Unfractionated Heparin

rupture of membranes, vaginal bleeding, or both. Gestational age should be an important consideration in decision making surrounding delivery and, if medical management of anticoagulation is the isolated factor driving delivery planning, delivery for that indication alone need not occur before 39 weeks of gestation unless extenuating circumstances exist. Please contact with any questions. *Since this document has neither been presented to nor approved by either the ASA Board of Directors or House

2020 American College of Obstetricians and Gynecologists

100. Covid-19: Joint Statement on Multiple Patients Per Ventilator

Covid-19: Joint Statement on Multiple Patients Per Ventilator AMERICAN ASSOCIATION FOR RESPIRATORY CARE 9425 N. MacArthur Blvd, Suite 100, Irving, TX 75063-4706 (972) 243-2272, Fax (972) 484-2720, E-mail: Contact: Heather Willden, (972) 406-4657 FOR IMMEDIATE RELEASE March 26, 2020 Joint Statement on Multiple Patients Per Ventilator SCCM, AARC, ASA, APSF, AACN, and CHEST Share Unified Message (IRVING, TX – March 26, 2020) – The Society of Critical Care Medicine (...) (SCCM), American Association for Respiratory Care (AARC), American Society of Anesthesiologists (ASA), Anesthesia Patient Safety Foundation (APSF), American Association of Critical -Care Nurses (AACN), and American College of Chest Physicians (CHEST) issue this consensus statement on the concept of placing multiple patients on a single mechanical ventilator. The above -named organizations advise clinicians that sharing mechanical ventilators should not be attempted because it cannot be done safely

2020 American Association for Respiratory Care


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