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41. Low Back Pain, Adult Acute and Subacute

published the importance of the biopsychosocial approach to low back pain over 30 years ago (Waddell, 1987). Psychosocial indicators (yellow flags) include a patient’s attitudes, emotions, behaviors, and family and workplace factors. They may lead to an increased risk of progression to long-term distress and disability. In patients with low back pain up to six months duration, fear-avoidant beliefs negatively impacted pain and/or disability as well as return to work (W ertli, 2014). Further, high levels (...) Low Back Pain, Adult Acute and Subacute Health Care Guideline: Adult Acute and Subacute Low Back Pain www.icsi.org Copyright © 2017 by Institute for Clinical Systems Improvement 1 Diagnosis Algorithm Text in blue in this algorithm indicates a linked corresponding annotation. Adult patient present with acute or subacute low back pain History and exam: • Pain characteristics • Sensory and strength changes • Prior treatment and response yes Complete assessment tools for pain and function

2018 Institute for Clinical Systems Improvement

42. Paediatric Urology

study of an objective scoring system for evaluating cosmetic appearance in hypospadias patients. J Pediatr Urol, 2013. 9: 1006. 257. Weber, D.M., et al. The Penile Perception Score: an instrument enabling evaluation by surgeons and patient self-assessment after hypospadias repair. J Urol, 2013. 189: 189. 258. Haid, B., et al. Penile appearance after hypospadias correction from a parent’s point of view: Comparison of the hypospadias objective penile evaluation score and parents penile perception

2018 European Association of Urology

43. Low back pain and radicular pain: development of a clinical pathway

-medicalisation and medical over-consumption 4 . Moreover, a lot of caregivers are involved in the management of low back and radicular pain, from the first line to second or third line and a large practice variation is noticed, also in a small country as Belgium. 5 A lack of integration is also suspected between the modes of care and settings (e.g. inpatient, outpatient, emergency department, pain clinics) with a risk of duplicate exams and improper treatments. KCE Report 295 Low back pain and radicular pain (...) 2017 6 . However, to support the implementation of the clinical recommendations into the clinicians’ daily practices, it appeared that the organizational aspects of care have also to be taken into account, by identifying each clinical step and its accordant therapeutic interventions from the hyperacute phase onwards. Also the role of each type of care professional involved in the management of patients with low back pain should be defined. The initial objective of this study was to define one

2017 Belgian Health Care Knowledge Centre

44. Burnout- The Hot Topic in Medicine (Full text)

, the development of negative, cynical attitudes and feelings towards one’s clients (in the case of physicians, the patient is the client). This dehumanized perception is further described as one that could lead some to view their clients as somehow deserving of their troubles. The third scale is decreased personal accomplishment, in which people have a sense of futility and do not believe their actions make an impact. Maslach, a social psychologist, observed this syndrome of emotional exhaustion and cynicism (...) associated with lower In-Training Exam scores. 3 At the attending physician level, a 2012 JAMA original investigation entitled “Burnout and Satisfaction with Work-Life Balance Among US Physicians Relative to the General US Population” not only compared physicians across medical specialties but also compared them to the general workforce population. It was found that of the 7,288 physicians surveyed, 45.8% reported at least 1 symptom of burnout. Of note, there were substantial differences by specialty

2017 Clinical Correlations PubMed

45. Responding to children and adolescents who have been sexually abused

providers with court appearances on behalf of survivors; supporting health-care providers to prevent and cope with burnout and vicarious trauma; strengthening referrals and linkages with other support/allied services, to facilitate a multidisciplinary and multisectoral approach to care; making available tools or job aids (e.g. protocols or clinical care pathways) to guide the systematic provision of care; conducting monitoring and evaluation of care provision. 7 1. Background A. The magnitude

2017 World Health Organisation Guidelines

47. Gynecological Conditions: Periodic Screening With the Pelvic Examination

to determine which women might benefit from a pelvic examination. Research is needed to clarify which indications primary care clinicians are currently using the screening pelvic examination for in asymptomatic patients and which components of the pelvic examination are performed most frequently. Studies exploring women’s attitudes toward pelvic examinations, the outcomes women value from these examinations, and how pelvic examinations affect women’s decisions to seek and obtain care are also needed (...) University, Boston, Massachusetts); Melissa A. Simon, MD, MPH (Northwestern University, Evanston, Illinois); Albert L. Siu, MD, MSPH (Mount Sinai Hospital, New York, New York, and James J. Peters Veterans Affairs Medical Center, Bronx, New York); Chien-Wen Tseng, MD, MPH, MSEE (University of Hawaii, Manoa). Copyright and Source Information Source: This article first appeared in JAMA on March 7, 2017. Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure

2017 U.S. Preventive Services Task Force

48. Evidence for Therapeutic Patient Education Interventions to Promote Cardiovascular Patient Self-Management: A Scientific Statement for Healthcare Professionals From the American Heart Association

In prior studies, investigators have reported the positive impact of TPE on knowledge, behavioral, psychosocial, and health outcomes 6–11 ; however, there is a gap in understanding how TPE mechanisms impact specific self-management outcomes (eg, cardiac condition or disease clinical indicators and health behaviors). Furthermore, it is unclear what strategies are useful to address TPE barriers (eg, health literacy, cognition). 10,12 These gaps in evidence related to TPE underscore the need to exam- ine (...) -up In-person session Phone F/U 1 mo after discharge 40-min session Improvements in knowledge (P<0.001), attitude (P=0.003), and beliefs about ACS (P<0.001) Peterson et al 50 (2012) PCI RCT N=242 I=124 C=118 Outpatient Culturally tailored education workbook with positive affect Pedometer Behavioral contracts Workbook Telephone F/U at 2, 4, 6, 8, 10, and 12 mo Duration not specified 1 in person Greater physical activity and energy expenditure (P=0.007) Changes in positive and negative affect

2017 American Heart Association

49. Management of Diabetes Mellitus in Primary Care

of major clinical trials of intensive therapy, as well as advances in physiological, behavioral, nutritional, and pharmacological research have led to the emergence of new strategies to manage and treat patients with DM. Consequently, a recommendation to update the 2010 DM CPG was made and the update to the 2010 DM CPG was initiated in 2015. The updated CPG includes evidence-based recommendations and additional information on the management of DM. It is intended to assist healthcare providers in all (...) systems (e.g., telephone, internet).[38,41,42] Pillay et al. concluded that the greater the time spent with the patient was associated with improved outcomes and there is a need to provide DSME, DSMS, and/or behavioral programs to assist with lifestyle change.[40] DSME-DSMS may be provided individually or in a group, based on available resources. Group-based DSME-DSMS is cost-effective and provides foundational support for individuals with diabetes to meet and discuss common issues.[34,36] Individual

2017 VA/DoD Clinical Practice Guidelines

50. Diagnosis and Treatment of Low Back Pain

to remain active, and providing information about self-care options. Strong for Reviewed, Amended 7. For patients with chronic low back pain, we suggest adding a structured education component, including pain neurophysiology, as part of a multicomponent self-management intervention. Weak for Reviewed, New-added C. Non-pharmacologic and Non-invasive Therapy 8. For patients with chronic low back pain, we recommend cognitive behavioral therapy. Strong for Reviewed, New-replaced 9. For patients with chronic (...) , treatment goals, and challenges is essential and should be guided by evidence-based information tailored to the patient’s needs. An empathetic and non- judgmental approach to communication with a patient is highly recommended in order to build trust and facilitate frank discussions relating to the social, economic, emotional, and cultural factors that influence patients’ perceptions, behaviors, and decision making. The information that patients are given about treatment and care should be culturally

2017 VA/DoD Clinical Practice Guidelines

51. An update to the Greig Health Record: Preventive health care visits for children and adolescents aged 6 to 17 years ? Technical report

% of students reporting hazardous or harmful drinking combined with symptoms of anxiety or depression. While the use of selective serotonin reuptake inhibitors (SSRIs) has raised concern in the past regarding suicidal ideation and suicidal risk, they are now recommended for children and adolescents with MDD and anxiety as the benefits appear to outweigh the risks. Evaluation and close monitoring for adverse effects and suicidal ideation and behaviours are still required. A recent Cochrane review offers some (...) primary care-relevant behavioural interventions to prevent smoking in children and adolescents. - One meta-analysis showed a 19% risk reduction for smoking initiation. However, there was no effect on smoking cessation using either behavioural approaches or treatment with bupropion. Incentive programs to prevent smoking initiation do not appear to work. While e-cigarettes containing nicotine are not approved for use or sale in Canada, some are sold with nicotine-free cartridges that may be replaced

2016 Canadian Paediatric Society

52. Endocrine Treatment of Gender-Dysphoric/Gender-Incongruent Persons: An Endocrine Society Clinical Practice Guideline (Full text)

. Gender variance: See “gender incongruence” Gender reassignment: This refers to the treatment procedure for those who want to adapt their bodies to the experienced gender by means of hormones and/or surgery. This is also called gender-confirming or gender-affirming treatment. Gender-reassignment surgery (gender-confirming/gender-affirming surgery): These terms refer only to the surgical part of gender-confirming/gender-affirming treatment. Gender role: This refers to behaviors, attitudes (...) /gender-affirming treatment. Gender role: This refers to behaviors, attitudes, and personality traits that a society (in a given culture and historical period) designates as masculine or feminine and/or that society associates with or considers typical of the social role of men or women. Sex designated at birth: This refers to sex assigned at birth, usually based on genital anatomy. Sex: This refers to attributes that characterize biological maleness or femaleness. The best known attributes include

2017 Pediatric Endocrine Society PubMed

53. Persistent Pain with Breastfeeding

and gestational age at birth B Birth weight, weight gain, and general health B Behavior at the breast (pulling, squirming, biting, coughing, shortness of breath, excessive sleepiness) B Fussiness B Gastrointestinal problems (re?ux symptoms, bloody stools, mucous stools) B Medical conditions/syndromes B Previous diagnosis of ankyloglossia; frenotomy B Medications Examination should include the following: Mother B General appearance (pale [anemia], exhaustion) B Assessment of nipples (skin integrity (...) Liebert, Inc. DOI: 10.1089/bfm.2016.29002.pjb 1 B Expression of milk, frequency, hand expression, and/ or type of pump B Mother’s attitudes toward breastfeeding and her breastfeeding goals Pain history B Onset postpartum B Early nipple trauma (abrasions, cracks, bleeding) B Context (with latch, during breastfeeding, between breastfeeds, with milk expression) B Location (nipple and/or breast; super?cial versus deep) B Duration (timing, intermittent, or constant) B Character (burning, itching, sharp

2016 Academy of Breastfeeding Medicine

54. Use of Antipsychotics to Treat Agitation or Psychosis in Patients With Dementia

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Overview of the Development Process . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Rating the Strength of Research Evidence and Recommendations . . . . 1 Proper Use of Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Guidelines and Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Guideline Statements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Assessment of Behavioral/Psychological (...) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Balancing of Benefits and Harms in Rating the Strength of Recommendations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Limitations of the Evidence in Assessing Benefits and Harms . . . . . . . . . . . . 12Implementation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Assessment of Behavioral/Psychological Symptoms of Dementia . . . . . . . . .13 Development of a Comprehensive Treatment Plan

2016 American Psychiatric Association

55. Depression

for increased suicidality. Patients treated with antidepressants should be closely observed for possible worsening of depression and suicidality, or unusual behavior, especially at the beginning of therapy or with dosage changes. (Footnotes continue) 7 UMHS Depression Guideline Update, August 2011 Table 5. Matching Antidepressants to Patients: Selection Dosing and Cost (page 2 of 4) Mechanisms of action Serotonin Selective Reuptake Inhibitors a Generic name (Brand Name) paroxetine (generic available) (Paxil (...) to immediate release. Major metabolite of venlafaxine with similar side effect profile. Side effects are similar to those common to all SSRIs with more nausea. Can increase blood pressure as well as triglycerides and LDL cholesterol. Similar to SSRIs and venlafaxine; nausea (dose-dependent) and constipation most troublesome, but, unlike venlafaxine, does not appear to produce sustained hypertension. NOT TO BE PRESCRIBED if concurrent heavy alcohol use and/or evidence of chronic liver disease. Sexual

2016 University of Michigan Health System

56. Management of Concussion-mild Traumatic Brain Injury (mTBI)

such as cognitive behavioral therapy specific for insomnia (CBTi), dietary modification, physical activity, relaxation and modification of the sleep environment (for specific components for each symptoms see Appendix B: Clinical Symptom Management) c. Pharmacologic interventions as appropriate to aid in sleep initiation and sleep maintenance Weak for Reviewed, Amended g. Behavioral Symptoms 16. We recommend that the presence of psychological or behavioral symptoms following mTBI should be evaluated and managed (...) criteria obtained during a history and physical exam (see Algorithms for definition). Symptoms associated with mTBI are identified while conducting the history of present illness. The signs and symptoms associated with mTBI are evaluated through physical examination and history and are treated in accordance with this guideline. This recommendation was not reviewed in the recent literature review; however, the strength of this recommendation is strong. The content of the 2009 mTBI CPG was reviewed

2016 VA/DoD Clinical Practice Guidelines

57. Guidelines for adult stroke rehabilitation and recovery

are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/Copyright- Permission-Guidelines_UCM_300404_Article.jsp. A link to the “Copyright Permissions Request Form” appears on the right side of the page. © 2016 American Heart Association, Inc. Stroke is available at http://stroke.ahajournals.org DOI: 10.1161/STR.0000000000000098 AHA/ASA Guideline by guest on May 5, 2016 http (...) . The end of formal rehabilitation (commonly by 3–4 months after stroke) should not mean the end of the restorative process. In many respects, stroke has been managed medically as a temporary or transient condi- tion instead of a chronic condition that warrants monitoring after the acute event. Currently, unmet needs persist in many domains, including social reintegration, health-related qual- ity of life, maintenance of activity, and self-efficacy (ie, belief in one’s capability to carry out a behavior

2016 American Academy of Neurology

58. Medical Training to Achieve Competency in Lifestyle Counseling: An Essential Foundation for Prevention and Treatment of Cardiovascular Diseases and Other Chronic Medical Conditions: A Scientific Statement From the American Heart Association

interventions targeted at the individual, sociocultural, and environmental or policy levels for each such behavior. The individual, whose attitudes, beliefs, and habits many psychological interventions target, is embedded in a complex system that either promulgates or discourages heart-healthy behaviors. Individuals are nested within a sociocultural context in which others convey norms, models, reinforcement, and inclusion when behaviors match their expectations. At an even more macroscopic level (...) and Other Chronic Medical Conditions: A Scientific Statement From the American Heart Association , MD, MMSc, FAHA, Chair , PhD, PT, FAHA , MD , PhD, FAHA , MD, MPH, FAHA , PhD, FAHA , PhD, FAHA , PhD , and PhD, FAHA MD, FAHAOn behalf of the American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic Health; the Behavior Change Committee, a joint committee of the Council on Lifestyle and Cardiometabolic Health and the Council on Epidemiology and Prevention

2016 American Heart Association

59. AHA/ASA Guidelines for Adult Stroke Rehabilitation and Recovery

reintegration, health-related quality of life, maintenance of activity, and self-efficacy (ie, belief in one’s capability to carry out a behavior). Apathy is manifested in >50% of survivors at 1 year after stroke ; fatigue is a common and debilitating symptom in chronic stroke ; daily physical activity of community-living stroke survivors is low ; and depressive symptomology is high. By 4 years after onset, >30% of stroke survivors report persistent participation restrictions (eg, difficulty with autonomy (...) continence have shown consistent associations with poststroke outcomes, and stroke severity is associated with acute discharge disposition, final discharge disposition, and functional level. In recent years, lengths of stay in IRFs have decreased significantly, but in survivors with mild to moderate stroke, patient satisfaction does not appear to be diminished, and recovery actually may be faster. In the United States, data after the initiation of prospective payment for rehabilitation in 2002 suggest

2016 American Heart Association

60. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

osteoarthritis? How much weight loss would be required? 81 Q5.13. Is weight loss effective to treat urinary stress incontinence? How much weight loss would be required? 82 Q5.14. Is weight loss effective to treat gastroesophageal reflux disease (GERD)? How much weight loss would be required? 83 Q5.15. Is weight loss effective to improve symptoms of depression? How much weight loss would be required? 89 Q6. Is lifestyle/behavioral therapy effective to treat overweight and obesity, and what components (...) of lifestyle therapy are associated with efficacy? 91 Q6.1. Meal plan and macronutrient composition 92 Q6.2. Physical activity 93 Q6.3. Behavior interventions 96 Q7. Is pharmacotherapy effective to treat overweight and obesity? 102 Q7.1. Should pharmacotherapy be used as an adjunct to lifestyle therapy? 102 Q7.2. Does the addition of pharmacotherapy produce greater weight loss and weight-loss maintenance than lifestyle therapy alone? 102 Q7.3. Should pharmacotherapy only be used in the short term to help

2016 American Association of Clinical Endocrinologists

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