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481. Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation

NAPICU Guidelines 14 Central & North West London NHS Foundation Trust, London, UK 15 CALM Training Ltd, Menstrie, UK 16 Oxleas NHS Foundation Trust, Dartford, UK 17 South London and Maudsley NHS Foundation Trust, London, UK and Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK 18 South London and Maudsley NHS Foundation Trust, London, UK 19 Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK 20 Maudsley Hospital, South London (...) a quality improvement programme in mental health services addressing RT in the context of the pharmacological management of acute disturbance (POMH-UK, 2017). A total of 58 specialist mental health Trusts or healthcare organisations participated in the baseline clinical audit and submitted data on 2172 episodes of acute disturbance in patients on acute adult (n = 1455), psychi- atric intensive care (n = 444) or low, medium or high secure wards (n = 273) (POMH-UK, 2017). Being the largest audit

2018 British Association for Psychopharmacology

482. Diarrhoea in Adult Cancer Patients: ESMO Clinical Practice Guidelines

of neutropaenic enterocolitis. Abdominal ultrasonography can identify thickening of the bowel wall. A study showed that the neutropaenic enterocolitis-related mortality rate was higher in patients with pathological wall thick- ening (29.5% versus 0%); moreover, a thickness>10 mm had a signi?cantly higher mortality rate (60%) than those with bowel wall thickness 10 mm (4.2%) [32]. Ultrasound is useful as a follow-up tool to assess the gradual decrease in bowel wall thicken- ing [V, A]. Additionally, signs (...) Withactiveoncologicaltreatment(ChT,targeted agents) There are no speci?c data about the incidence of diarrhoea in eld- erly cancer patients. In a self-reported cohort study involving people> 65 years of age during ChT, in a 5.6 month follow-up period, 74% of patients reported diarrhoea [33]. In this frailer population, diarrhoea could more frequently lead to dehydration, electrolyte imbalance, renal function decline, malnutrition or pressure ulcer formation. The most common causes of diarrhoea are ChT and targeted agents

2018 European Society for Medical Oncology

483. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope Full Text available with Trip Pro

recommendation be supported by limited text (ideally, <250 words) and hyperlinks to supportive evidence summary tables. Ongoing efforts to further limit text are underway. Recognizing the importance of cost–value considerations in certain guidelines, when appropriate and feasible, an analysis of the value of a drug, device, or intervention may be performed in accordance with the ACC/AHA methodology. To ensure that guideline recommendations remain current, new data are reviewed on an ongoing basis, with full (...) and Evidence Review Committees When developing recommendations, the writing committee uses evidence-based methodologies that are based on all available data. Literature searches focus on randomized controlled trials (RCTs) but also include registries, nonrandomized comparative and descriptive studies, case series, cohort studies, systematic reviews, and expert opinion. Only key references are cited. An independent evidence review committee (ERC) is commissioned when there are 1 or more questions deemed

2017 American Heart Association

484. Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Guideline For the Management of Patients With

OR SUSPECTEDVA ... .. e105 4.1. History and Physical Examination ... . e105 4.2. Noninvasive Evaluation . e106 4.2.1. 12-lead ECG and Exercise Testing .. e106 4.2.2. Ambulatory Electrocardiography .. e107 4.2.3. Implanted Cardiac Monitors . .. e108 4.2.4. Noninvasive Cardiac Imaging .. e108 4.2.5. Biomarkers . .. e109 4.2.6. Genetic Considerations in Arrhythmia Syndromes . .. e109 4.3. Invasive Testing . e110 4.3.1. Invasive Cardiac Imaging: Cardiac Catheterization or CT Angiography .. .. e110 4.3.2 (...) Review Committees When developing recommendations, the writing com- mittee uses evidence-based methodologies that are based on all available data (P-4—P-7). Literature searches focus on randomized controlled trials (RCTs) but also include registries, nonrandomized comparative and descriptive studies, case series, cohort studies, systematic reviews, and expert opinion. Only key references are cited. An independent evidence review committee (ERC) is commissioned when there are $1 questions deemed

2017 American College of Cardiology

485. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society Full Text available with Trip Pro

patients in this document is intended to direct healthcare providers to exercise clinical judgment, which is often required during the evaluation and management of patients with syncope. When a recommendation is made to refer a patient to a specialist with expertise for further evaluation, such as in the case of autonomic neurology, adult congenital heart disease (ACHD), older populations, or athletes, the writing committee agreed to make Class IIa recommendations because of the paucity of outcome data (...) guideline format delineates that each recommendation be supported by limited text (ideally, <250 words) and hyperlinks to supportive evidence summary tables. Ongoing efforts to further limit text are underway. Recognizing the importance of cost–value considerations in certain guidelines, when appropriate and feasible, an analysis of the value of a drug, device, or intervention may be performed in accordance with the ACC/AHA methodology. To ensure that guideline recommendations remain current, new data

2017 American Heart Association

486. Shaken baby syndrome or non-accidental head injury caused by shaking

of the state of the art and scientific data at a given time, described in the evidence report. They do not exempt the health professional from exercising discretion in the patient's treatment; this must be the treatment considered to be most appropriate depending on their own findings and the patient’s preferences. This good practice guideline has been developed according to the method summarised in the evidence report and in the HAS methodology guide available online: Development of good practice (...) ; ? Multifocal SDH, pericerebral SDH, SDH of the falx cerebri and/or the tentorium cerebelli; ? Blood clots at the vertex evidencing ruptures of the bridging veins; ? Cerebral lacerations Shaken baby syndrome HAS/Guidelines department/SOFMER/July 2017 16 2. Causal mechanism of the lesions To determine the diagnostic criteria for shaking, the 2011 public hearing relied on data that could not be questioned: ? on the one hand, the type of lesions observed in the context of SBS: the occurrence of SDH (almost

2017 HAS Guidelines

487. Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

with a 63% mediation of the magnitude of estimated increased risk of stroke in African Americans <65 years of age. , Physical Inactivity Current physical activity recommendations state that adults should engage in 150 min/wk of moderate-intensity aerobic physical activity or 75 minutes of vigorous-intensity aerobic physical activity and ≥2 d/wk of muscle-strengthening activities. Data suggest that adherence to the recommended activity levels is particularly low among African Americans. Fewer than 5 (...) % of all adults engaged in 30 minutes of moderate-intensity physical activity on most days of the week. Data from the CARDIA cohort show that more than one third of African American men and women report watching ≥4 hours of television per week, and this behavior is inversely associated with physical activity. When accelerometry is used to assess physical activity levels and sedentary behavior, patterns by race/ethnicity are less clear. In the NHANES study, there were no differences in minutes per day

2017 American Heart Association

488. Syncope: Guideline For Evaluation and Management of Patients With

terms are provided in Table 3. 2.2. Epidemiology and Demographics Syncope has many causes and clinical presentations; the incidence depends on the population being evaluated. Estimates of isolated or recurrent syncope may be inac- curate and underestimated because epidemiological data have not been collected in a consistent fashion or because aconsistentde?nitionhasnotbeenused.Interpretationof the symptoms varies among the patients, observers, and healthcare providers. The evaluation is further (...) , laughing, swallowing, micturition, or defecation. These syncope events are closely associated with speci?c physical functions. Postural (orthostatic) tachycardia syndrome (POTS) A clinical syndrome usually characterized by all of the following: 1) frequent symptoms that occur with standing (e.g., lightheadedness, palpitations, tremulousness, generalized weakness, blurred vision, exercise intolerance, and fatigue); and 2) an increase in heart rate of$30 bpm during a positional change from supine

2017 American College of Cardiology

489. Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association Full Text available with Trip Pro

statistically significant changes but few clinically significant improvements in BP. In systematic reviews 42,96 and meta-analyses, 31,33,42,96 both diastolic and systolic BP readings were statistically improved when SMBP was used; however, BP improvements were not clinically significant. Improve- ments in BP were often associated with reported increases in hypertensive medication use and other recommended lifestyle behaviors (eg, diet modification, physical activity). 33,42 Out- comes from an RCT using (...) in adoption of lifestyle behaviors to reduce CAD (eg, diet modification, increased exercise, decreased smoking). A positive affect and self-affirmation intervention increased physical activity for PCI patients (n=242), with the majority (54.9%) able to increase activity to expend =336 kcal/week at 12 months after PCI. 50 Thomson et al 58 (2007) RCT N=109 I=51 C=54 Clinic I=2 types of decision aids randomized: computerized decision aid C=Evidence-based paper guidelines via direct advice by physician Shared

2017 American Heart Association

490. Management of Opioid Therapy (OT) for Chronic Pain

ui d el i n e f o r O p ioid T h e r a p y for Ch r on ic Pa in February 2017 Page 4 of 198 B. Risk Mitigation 46 51 70 71 75 75 75 80 81 81 88 99 100 105 105 110 116 116 120 122 C. Type, Dose, Duration, Follow-up, and Taper of Opioids D. Opioid Therapy for Acute Pain Appendix A: VA Signature Informed Consent Appendix B: Urine Drug Testing A. Benefits of Urine Drug Testing B. Types of Urine Drug Testing Appendix C: Diagnostic and Statistical Manual of Mental Disorders for Opioid Use Disorders (...) beliefs and expectations about chronic pain and its treatment.[36] Patients with chronic pain may also experience worsened quality of life, mental health, immune system function, physical function, sleep, employment status, and impaired personal relationships.[3,42-44] Worsening of some of these factors (e.g., quality of life, change in employment status) seems to also be associated with pain severity and the presence of psychiatric comorbidities.[45,46] Patients with chronic pain report psychological

2017 VA/DoD Clinical Practice Guidelines

491. Use of Larynx-Preservation Strategies in the Treatment of Laryngeal Cancer Full Text available with Trip Pro

, and quality of life. Additional information is available at and . INTRODUCTION Section: Laryngeal cancer is a significant clinical problem that affects nearly 100,000 people in the United States. It is estimated that there were 13,430 new cases and 3,620 deaths attributed to cancer of the larynx in 2016. With public awareness of tobacco and alcohol use as major predisposing factors, the incidence of laryngeal cancers has decreased 2.4% each year over the past 10 years. Based on SEER data for the period (...) of 2006 to 2012, the estimated overall 5-year survival rate for patients with laryngeal cancer was only 60.7% and has not changed appreciably over the past several decades. When analyzed by tumor stage, cure rates for patients diagnosed with limited disease (T1, T2) are excellent ranging from 80% to 90%. Unfortunately, a majority of patients are still diagnosed with locally advanced (T3, T4) disease or regional nodal metastases, where survival rates generally are < 50%. SEER data also show

2017 American Society of Clinical Oncology Guidelines

492. Screening for Atrial Fibrillation: 2017 European Heart Rhythm Association (EHRA) Consensus Document

studied, both prevalence and incidence are higher in men than in women and in- crease with age. 6 The AF diagnosis requires at least 30 s of absolutely irregular RR intervals and no discernable, distinct P waves on electrocardiogram (ECG). 5 AF is associated with an increased mortality, increased inci- dence of heart failure with an increased hospitalization rate, and a higher risk of thrombo-embolic events, including strokes. 7 It can also be associated with a reduced exercise capacity and an altered (...) document aimed to summarize the available data, discuss the different strategies and highlight the importance of implicating all stakeholders from the various health systems. Evidencereview Members of the Task Force were invited by the European Heart Rhythm Association (EHRA) board to perform a detailed literature review of screening for AF, weigh the strength of evidence for or against particular treatments or procedures, and include estimates of expected health outcomes where data exist. Patient

2017 Heart Rhythm Society

493. Arrhythmias in Congenital Heart Disease: A Position Paper of EHRA, AEPC, and ESC Working Group on Grown-up Congenital Heart Disease

for or against a particular treatment or procedure, and include estimates of expected health outcomes where data exist. Patient-specific modifiers, comorbidities, and issues of patient preference that might influence the choice of particular tests or therapies were considered, as are frequency of follow-up and cost effectiveness. In controversial areas, or with regard to issues without evidence other than usual clinical practice, a consensus was achieved by agreement of the expert panel after discussions (...) was peer-reviewed by official external reviewers representing EHRA, ESC WG on Grown up Congenital Heart Disease, AEPC, PACES, HRS, APHRS, and SOLAECE. Consensus statements are evidence based, and derived primarily from published data. However, some statements in a consensus document are ‘experienced based’ and relate to a low level of evi- dence (LE). Furthermore, as in our article, evidence based data from ‘the regular adult population’ are frequently extrapolated to ‘CHD patients’. In contrast

2017 Heart Rhythm Society

494. NASPGHAN Clinical Practice Guideline for the Diagnosis and Treatment of Nonalcoholic Fatty Liver Disease in Children: Recommendations from the Expert Committee on NAFLD (ECON) and the North American Society of Pediatric Gastroenterology, Hepatology and Nu

at baseline, but among those that did, there was a promising response to exercise with both hepatic fat reduction and improvement in total and visceral fat. There are clear comprehensive health benefits to a healthier diet and increasing physical activity (102) and these remain the first line approach to treatment of NAFLD in children (Fig. 2). Recommendation 10. Lifestyle modifications to improve diet and increase physical activity are recommended as the first-line treatment for all children with NAFLD (...) at baseline and at 2-year follow-up (19). All 3 arms received nutrition and physical activity (lifestyle) advice. In the placebo cohort, 28% had resolution of NASH, 40% improved fibrosis, 40% improved stea- tosis, and 43% improved lobular inflammation. Progression of disease was seen in 25%. The mean change in ALT from baseline to week 96 was 35 (57 to 14). Longitudinal studies in adults demonstrate that patients with NAFLD have increased mortality compared with matched control populations (20

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

495. Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer Guideline

with patients how they are coping with their bladder cancer diagnosis and treatment and should recommend that patients consider participating in cancer support groups or consider receiving individual counseling. (Expert Opinion) 34. Clinicians should encourage bladder cancer patients to adopt healthy lifestyle habits, including smoking cessation, exercise, and a healthy diet, to improve long-term health and quality of life. (Expert Opinion) VARIANT HISTOLOGY 35. In patients diagnosed with variant histology (...) publications) were determined to meet inclusion criteria and were included in this review. A supplemental search of Ovid MEDLINE and Cochrane Central Register of Controlled Trials was conducted to capture additional published literature through February 2, 2016. Data Extraction and Data Management. The methodology team extracted the following information into evidence tables: study design; setting; inclusion and exclusion criteria; dose and duration of treatment for experimental and control groups

2017 American Society for Radiation Oncology

496. Obesity in Adolescents

and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. Endocrine Society. . Epidemiologic data suggest exercise may be beneficial in preventing gestational diabetes in pregnant women with a BMI greater than 33. The American Diabetes Association has endorsed physical activity as a safe and effective therapy for glucose management in women with gestational diabetes ( ). Contraception Although no evidence suggests that any contraceptive method is ineffective in obese (...) be replaced by sedentary activities like social networking. Girls, specifically, have a significant drop in physical activity during adolescence ( ). As adolescents transition into adulthood, they experience additional changes that affect weight ( ). Girls who were active in high school sports may stop these activities as they enter college or the workforce. Food availability, cooking skills, and alcohol intake can affect the nutrition of young adults as they enter college or leave the home. During

2017 American College of Obstetricians and Gynecologists

497. Practice Parameters for the Clinical Evaluation and Treatment of Circadian Rhythm Sleep Disorders

, melatonin administration prior to daytime sleep after night work shift improved daytime sleep quality and duration, caused a shift in circadian phase in some but not all subjects, but failed to en- hance alertness at night. Melatonin doses in these studies ranged from 0.5 to 10 mg. From these data, effectiveness did not appear to correlate with dosage strength or form. However, both level 1 simulation studies showed a positive effect on sleep quality and used dosages ranging from 1.8 to 3 mg. 3.2.1.5 (...) relevant published evidence retrieved 2084 articles, and is described in detail in the review paper. 1 Abstracts of these articles were reviewed by task force members to determine if they met inclusion criteria. Initial data extraction, preliminary evidence grading in accordance with the standards in Table 1, and initial data entry into evidence tables were performed by professionals con- tracted by the SPC to expedite the review process. All evidence table entries were reviewed by at least one other

2017 American Academy of Sleep Medicine

498. Treatment of Non-Metastatic Muscle-Invasive Bladder Cancer

consider participating in cancer support groups or consider receiving individual counseling. (Expert Opinion) Clinicians should encourage bladder cancer patients to adopt healthy lifestyle habits, including smoking cessation, exercise, and a healthy diet, to improve long-term health and quality of life. (Expert Opinion) Variant Histology In patients diagnosed with variant histology, clinicians should consider unique clinical characteristics that may require divergence from standard evaluation (...) of abstracts and titles, 295 articles were selected for full-text dual review, and 39 studies (in 41 publications) were determined to meet inclusion criteria and were included in this review. A supplemental search of Ovid MEDLINE and Cochrane Central Register of Controlled Trials was conducted to capture additional published literature through February 2, 2016. Data Extraction and Data Management. The methodology team extracted the following information into evidence tables: study design; setting

2017 American Urological Association

499. The 2017 hormone therapy position statement of The North American Menopause Society

balance through decreases in resting energy expenditure and physical activity. 137 Reviewsofpreclinicalstudiesandlimitedclinicalstudiesof HTinpostmenopausalwomensuggestabenefitonmaintaining or increasing muscle mass and related connective tissue, improving strength and improving posttraumatic or postatro- phy muscle recovery when combined with exercise. 138-140 Key points Development of frailty with aging is a health risk. Sarcopenia and osteoporosis are related to aging, estrogen depletion (...) reflectiveofprematureaging.Theyalsohaveahigherriskof digestive tract cancer but a decreased risk of mortality from breast,uterine,andendometrialcancer. 94,96,97 Effectiveman- agement may include appropriate doses of HT along with calcium,vitaminD,exercise,andscreeningstodetectmedical issues.AlthoughhigherdosesofHTappeartoprovidethebest bone benefits, 29,98,99 oral contraceptives with an estrogen patch during the placebo week may be used if needed for psychological benefit in younger women. Key points Women with early menopause and POI have

2017 The North American Menopause Society

500. Integrating Tobacco Interventions into Daily Practice

, MSc (A) Former Nursing Policy Analyst Registered Nurses’ Association of Ontario Toronto, Ontario Gurjit K. Toor, RN, MPH Data Quality Analyst Registered Nurses’ Association of Ontario Toronto, Ontario Megan Bamford, RN, MScN Program Manager Registered Nurses’ Association of Ontario Toronto, Ontario Irmajean Bajnok, RN, MScN, PhD Former Director, International Affairs and Best Practice Guidelines Centre Registered Nurses’ Association of Ontario Toronto, Ontario Valerie Grdisa, RN, MS, PhD Director (...) , DFASAM Expert Panel Co-chair Professor, Departments of Family & Community Medicine and Psychiatry, and Dalla Lana School of Public Health, University of Toronto Full Member, Institute of Medical Sciences, School of Graduate Studies, University of Toronto Director, Medical Education and Clinician Scientist Addictions Division, Centre for Addiction and Mental Health (CAMH) Toronto, Ontario Shelley Walkerley, NP-PHC, PhD Expert Panel Co-chair Assistant Professor, Nurse Practitioner Program

2017 Registered Nurses' Association of Ontario

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