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101. Radiology and Nuclear Medicine Studies in Lactating Women Full Text available with Trip Pro

of circumstances do not require interruption of breastfeeding, certain exceptions do exist and will be reviewed. A summary of recommendations is provided in . Table 1. Common Nuclear Medicine Imaging Agents and Recommendations for Breastfeeding Imaging agent Breastfeeding interruption Noncontrast radiographs No Nonvascular administration of iodinated contrast No CT with iodinated intravenous contrast No MRI with gadolinium-based intravenous contrast No Nuclear medicine imaging PET No Bone scan No Thyroid (...) sources for recommendations regarding unintended health care exposures include and Recommendations Breast imaging Several organizations, including the American College of Radiology (ACR), have made recommendations regarding breast imaging in pregnant and lactating women. Screening The ACR states that initiation or continuation of screening mammography should be considered dependent on the patient's individual risk and expected duration of lactation. This includes average risk women of age ≥40 years

2019 Academy of Breastfeeding Medicine

102. Surveillance, Diagnosis and Management of Clostridium Difficile Infection in Ireland

. These estimates are consistent with other studies.(17) The total costs for recurrent CDI has been shown to be approximately three-fold higher than for a primary episode of CDI.(16) In Europe, estimates suggest that the potential costs associated with the management of CDI are in the region of €3,000 million. This figure is likely to rise in line with an ageing population: by 2050 more than 134 million Europeans will be aged 65 years or older.(14) In the UK, NICE has estimated the impact of a 5%, 10% and 15 (...) the AIG category was dissolved and CDI became a notifiable infectious disease in its own right, as new or recurrent CDI. Table 1.1 summarises CDI cases notified to the Computerised Infectious Disease Reporting (CIDR) system from 4th May 2008 to 31st December 2013. The majority of cases were reported from patients aged 65 years or older. 1 http://www.hpsc.ie/A-Z/Gastroenteric/Clostridiumdifficile/Publications/9 A National Clinical Guideline Clostridium difficile Infection in Ireland Table 1.1: CDI

2019 National Clinical Guidelines (Ireland)

103. Pharmacological Management of Osteoporosis in Postmenopausal Women Full Text available with Trip Pro

is operationally defined as a temporary discontinuation of bisphosphonate for up to 5 years. This period may be longer depending on the bone mineral density and clinical circumstances of the individual patient. The evidence is stronger for retention of benefits during a holiday for alendronate and zoledronic acid where there are randomized extension trials. A shorter reassessment period of 3 years is more appropriate for annual intravenous zoledronic acid (5 mg) based on evidence from research control trials (...) showing residual effects after 3 years of annual use. Once a bisphosphonate holiday is initiated, reassess fracture risk at 2- to 4-year intervals and consider reinitiating osteoporosis therapy earlier than the 5-year suggested maximum if there is a significant decline in bone mineral density, an intervening fracture, or other factors that alter the clinical risk status. Denosumab 3.1 In postmenopausal women with osteoporosis who are at high risk for osteoporotic fractures, we recommend using

2019 The Endocrine Society

104. Encorafenib (Braftovi) - unresectable or metastatic melanoma with a BRAF V600 mutation

and males respectively in Scotland, and the incidence is rising. 11 Ultra violet (UV) light exposure (both natural and artificial sunlight) is considered to be the main risk factor for cutaneous melanoma. It has a relatively young age distribution and often affects people of working age. About 90% of melanoma cases are diagnosed as primary tumours, with no evidence of metastasis. 12 These cases can be cured if recognised and treated with surgery at an early stage. However, for patients with advanced (...) symptoms as secondary tumours can spread to the brain, lung, and bones. It can also have a psychological toll, causing stress, anxiety and depression. Advanced melanoma affects a disproportionate number of younger patients, who may be parents and/or providing care for older members of their family. The diagnosis can therefore have a considerable emotional, psychological, and financial impact on the family. 8 • Treatment options are limited in advanced melanoma. Encorafenib plus binimetinib would offer

2019 Scottish Medicines Consortium

105. ACR–ASNR–SPR Practice Parameter for the Performance of Myelography and Cisternography

should be emphasized.) 4. Indications for myelography and cisternography and indications for alternative imaging studies, including MRI. 5. Preprocedural assessment of the patient. 6. Conduct of the myelographic examination. This includes spinal puncture, patient positioning, and fluoroscopic and filming techniques. 7. Conduct of the postmyelogram CT examination. This includes timing, patient positioning, and technical factors. 8. Postprocedural patient management, especially the recognition (...) , fluoroscopic beam limitation, and methods of applying safe physical restraint during table tilting. Continuing education programs and on-the-job training under the supervision of qualified physicians should be available. IV. EQUIPMENT SPECIFICATIONS A. Myelographic Facility The suggested specifications for the facility are: 1. High-quality radiographic/fluoroscopic imaging equipment with a capability for film or digital recording of selected portions of the examination. A tilt table and a proper support

2019 American Society of Neuroradiology

106. Overweight, Obesity and Contraception

. If a guideline is updated, the FSRH replace the version on its website and the BMJ Sexual & Reproductive Health (BMJ SRH) journal will ensure old versions of guidelines will clearly signpost the newer version. iii Copyright ©Faculty of Sexual & Reproductive Healthcare 2019 FSRH guideline: Overweight, Obesity and Contraception Abbreviations used BMD bone mineral density BMI body mass index CEU Clinical Effectiveness Unit CHC combined hormonal contraception/contraceptive CI confidence interval COC combined (...) use and venous thromboembolism (VTE). D Whilst obesity alone does not restrict the use of DMPA (UKMEC 1), DMPA use becomes a UKMEC 3 when obesity is one of multiple risk factors for cardiovascular disease (e.g. smoking, diabetes and hypertension). B DMPA use appears to be associated with some weight gain, particularly in women under 18 years of age with a BMI =30 kg/m 2 . Clinical recommendation ü For women with obesity: ? If using intramuscular DMPA or norethisterone enanthate injectable

2019 Faculty of Sexual & Reproductive Healthcare

107. Venetoclax (Venclyxto) - chronic lymphocytic leukaemia (CLL)

Venetoclax (Venclyxto) - chronic lymphocytic leukaemia (CLL) 1 Published 12 August 2019 1 SMC2166 venetoclax 10mg, 50mg, and 100mg film-coated tablets (Venclyxto®) AbbVie Ltd 5 July 2019 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHSScotland. The advice is summarised as follows: ADVICE: following a full submission considered under the orphan equivalent process (...) between one and three prior lines of therapy for CLL, an Eastern Cooperative Oncology Group (ECOG) performance status of 0 or 1, and adequate bone marrow, renal and hepatic function. Patients required treatment in the opinion of the investigator, and patients who had previously received bendamustine were required to have had a duration of response of greater than 24 months. Patients were randomised equally to receive venetoclax 400mg orally once daily (following a 5- week dose titration phase) plus

2019 Scottish Medicines Consortium

108. BSG and UK-PSC guidelines for the diagnosis and management of primary sclerosing cholangitis

of maternal and fetal compli- cations, patients should have preconception counselling 3 Chapman MH, et al. Gut 2019;66:1–23. doi:10.1136/gutjnl-2018-317993 Guidelines and specialist monitoring (strength of recommendation: STRONG; quality of evidence: LOW). 30. We recommend that patients with PSC should be encour- aged to participate in patient support groups (strength of recommendation: STRONG; quality of evidence: VERY LOW). igG4-related sclerosing cholangitis (igG4-sC) 1. We recommend that elevated

2019 British Society of Gastroenterology

109. ACR–ASNR–ASSR–SIR–SNIS Practice Parameter for the Performance of Vertebral Augmentation

]. Vertebral compression fractures are a leading cause of nursing home admission and mortality [57]. Open surgical fixation is rarely used to treat these fractures unless there is neurological compromise. The poor quality of bone at the adjacent unfractured levels does not provide a good anchor for surgical hardware, and the advanced age of most affected patients increases the morbidity and mortality risks of major surgery. Initial success with vertebroplasty for treating aggressive hemangiomas [4,15 (...) bodies. The more common ones are vertebroplasty, which involves injecting surgical bone cement; balloon kyphoplasty, which involves inflation of a balloon in the fractured vertebral body to attempt fracture reduction before cement is injected; and/or radiofrequency ablation (RFA) and coblation techniques [1]. Other less common procedures include mechanical void creation with an osteotome, injection of bone graft material or bone substitutes, and insertion of materials and/or implants in an attempt

2019 American Society of Neuroradiology

110. Pediatric Endoscopy and High-risk Patients: A Clinical Report From the NASPGHAN Endoscopy Committee

Lack of production: bone marrow failure, post bone marrow transplant Sequestration: portal hypertension and hypersplenism Destruction: hemolytic uremic syndrome, autoimmune diseases Coagulopathy Congenitaldisordersofcoagulation:factorde?ciencies,vonWillebrand’s Hepatobiliarydisease:factorsynthesisdysfunction,vitaminKde?ciency Hematologic malignancies or chemotherapy related Disseminated intravascular coagulation Vitamin K de?ciency (malnutrition, cholestasis, exocrine pancreatic insuf?ciency, short (...) decubitus film. Abdominal x-rays or computerized tomography scans are likely to demonstrate extraluminal free air. Presentation of large perforations is immediate, and patients will likely have peritoneal signs. To minimize perforation risks, it is important to minimize large loop formation. In the sigmoid colon, reduction is most commonly required of an ‘‘alpha loop,’’ which can typically be performed with clockwise torque on the insertion tube and pulling back on the endoscope, whereas a ‘‘reverse

2019 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

111. Health technology assessment of a PrEP programme for populations at substantial risk of sexual acquisition of HIV

of 10.3 per 100,000 population. Just over half (53%) of all diagnoses in 2017 were in the gay, bisexual and other men who have sex with men (MSM) group (the MSM group accounts for approximately 4% of the male population over the age of 17 in Ireland). In terms of geographical differences in notification rate, HSE East (counties Dublin, Wicklow and Kildare) consistently reports higher rates than other regions. In 2017, notifications in HSE East region were almost twice the national rate (...) . Just over half of diagnoses in 2017 were in MSM, while this group only accounts for approximately 4% of the overall male population aged 17 and above. In terms of geographical differences in notification rate, HSE East (counties Dublin, Wicklow and Kildare) consistently reports higher rates than other regions. In 2017, notifications in this region were almost twice the national rate. Migration plays an important role in the changing epidemiology of HIV in Ireland. Overall, 63% of the notifications

2019 Health Information and Quality Authority

112. What is the evidence on the role of the arts in improving health and well-being? A scoping review

or expression (either conforming or diverging) (1–3). These criteria provide the boundaries for deciding what constitutes art, but the specific types of art within these boundaries are diverse and fluid. In relation to health research, engagement with the arts has been proposed as consisting of five broad categories (4): • performing arts (e.g. activities in the genre of music, dance, theatre, singing and film); • visual arts, design and craft (e.g. crafts, design, painting, photography, sculpture (...) and textiles); • literature (e.g. writing, reading and attending literary festivals); • culture (e.g. going to museums, galleries, art exhibitions, concerts, the theatre, community events, cultural festivals and fairs); and • online, digital and electronic arts (e.g. animations, film-making and computer graphics). These categories combine both active and receptive engagement and, importantly, also transcend cultural boundaries and contain flexibility to allow new art forms to develop (as evidenced

2019 WHO Health Evidence Network

113. Olaparib (Lynparza) - advanced (FIGO stages III and IV) BRCA1/2-mutated (germline and/or somatic) high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer

Olaparib (Lynparza) - advanced (FIGO stages III and IV) BRCA1/2-mutated (germline and/or somatic) high-grade epithelial ovarian, fallopian tube or primary peritoneal cancer Published 09 December 2019 1 SMC2209 olaparib 100mg and 150mg film-coated tablets (Lynparza®) AstraZeneca UK Limited. 8 November 2019 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHSScotland (...) after chemotherapy but a CA-125 level above the upper limit of the normal range). Patients had an Eastern Cooperative Oncology Group (ECOG) performance status 0 or 1, normal organ and bone- marrow function. 3 Following completion of platinum-based chemotherapy, patients were centrally randomised, in a 2:1 ratio to receive olaparib 300mg orally twice daily or placebo. Randomisation was stratified according to clinical response after platinum-based chemotherapy (complete or partial). 3 Patients were

2019 Scottish Medicines Consortium

114. Management of Blunt Force Bladder Injuries

the same sensitivity and specificity at detecting bladder injury as the criterion standard plain film cystography. The committee recommends that the clinician may choose either imaging modality to diagnose bladder injury based on patient condition, imaging requirements for other associated injuries, and equipment availability. Interpreting CT cystography could be less affected by overlying bone fragments caused by pelvic fracture, spine boards, or military antishock trousers that may be present (...) published from January 1975 to July 2016 using the medical subject headings and keywords listed (Figure, Supplemental Digital Content 1, ). All randomized controlled trials, observational studies, and retrospective studies were considered. Studies of adult patients (age, ≥18 years) sustaining blunt abdominal/pelvic trauma were included. Letters to the editor, book chapters, reviewed articles, studies on pediatric patients, penetrating trauma, and case series of less than 20 patients were excluded. Three

2019 Eastern Association for the Surgery of Trauma

115. Cabozantinib (Cabometyx) - advanced renal cell carcinoma (RCC)

Cabozantinib (Cabometyx) - advanced renal cell carcinoma (RCC) 1 Published 11 February 2019 1 SMC2136 cabozantinib 20mg, 40mg, and 60mg film-coated tablets (Cabometyx®) Ipsen Ltd UK 11 January 2019 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHSScotland. The advice is summarised as follows: ADVICE: following a resubmission considered under the end of life process (...) , including vascular endothelial growth factor (VEGF), and hepatocyte growth factor receptor protein (MET). Inhibition of these kinases may inhibit tumour growth, angiogenesis, metastatic progression and pathological bone remodeling. 1, 2 The indication under review is an extension to the licensed indication for the treatment of renal cell carcinoma (RCC). Cabozantinib has previously been accepted by the SMC for the treatment of advanced RCC in adults following prior VEGF-targeted therapy. CABOSUN

2019 Scottish Medicines Consortium

116. Spine imaging

noted, “adult” refers to persons age 19 and older, and “pediatric” refers to persons age 18 and younger. Where separate indications exist, they are specified as Adult or Pediatric. Where not specified, indications and prerequisite information apply to persons of all ages. See the Coding section for a list of modalities included in these guidelines. Technology Considerations Computed tomography (CT) is the preferred imaging modality for bony abnormalities of the spine when radiographs do not provide (...) syndrome ? Grisel syndrome ? Skeletal dysplasia IMAGING STUDY - Radiographs required - CT or MRI cervical spine when radiographs are not sufficient to guide treatment Scoliosis Advanced imaging of the spine is considered medically necessary in ANY of the following scenarios: ? Evaluation of scoliosis following initial radiographs in the following groups: o Congenital scoliosis o Idiopathic scoliosis with ANY of the following atypical features: ? Early onset (prior to 10 years of age) ? Unusual

2019 AIM Specialty Health

117. Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV

Emergency Plan for AIDS Relief (PEPFAR), the United States Centers for Disease Control and Prevention, the United States Agency for International Development and Unitaid provided funding for developing these guidelines. viii SUMMARY OF KEY TERMS Age groups and populations The following definitions for adults, adolescents, children and infants are used in these guidelines for the purposes of implementing recommendations for specific age groups. It is acknowledged that countries may have other definitions (...) under national laws: An adult is a person older than 19 years of age. An adolescent is a person aged 10–19 years of age. A child is a person 1–9 years of age. An infant is a child younger than one year of age. A neonate is an infant younger than four weeks of age. Adolescent girls and women of childbearing potential Adolescent girls and women of childbearing potential are defined as premenopausal females capable of becoming pregnant. Nuceloside Reverse Transcriptase Inhibitor (NRTI) Antiretroviral

2019 World Health Organisation HIV Guidelines

118. AIM Clinical Appropriateness Guidelines for Radiation Oncology

www.aimspecialtyhealth.com Copyright © 2019. AIM Specialty Health. All Rights Reserved. Table of Contents | Copyright © 2019. AIM Specialty Health. All Rights Reserved. 2 Table of Contents Description and Application of the Guidelines 3 Radiation Oncology Guidelines 4 Image Guidance in Radiation Oncology 4 Special Treatment Procedure and Special Physics Consult 11 Bone Metastases 13 Breast Cancer 20 Central Nervous System Cancers 30 Colorectal and Anal Cancers 39 Gastrointestinal Cancers, Non-Colorectal 43 Genitourinary (...) and accurate patient setup is achieved with other techniques. These include patient immobilization with custom treatment devices like body molds or thermoplastic masks, placement of tattoos aligned to a 3-dimentional laser array in the treatment room and offline review of port verification films. Small daily setup uncertainties exist and these are taken into account in the target expansion process where an additional margin is added to the gross tumor volume (GTV) to create the clinical target volume (CTV

2019 AIM Specialty Health

119. Appropriate Use Criteria: Imaging of the Abdomen and Pelvis

Original effective date Imaging of the Abdomen and Pelvis Copyright © 2019. AIM Specialty Health. All Rights Reserved. 8 Imaging of the Abdomen and Pelvis General Information/Overview Scope These guidelines address advanced imaging of the abdomen and pelvis in both adult and pediatric populations. For interpretation of the Guidelines, and where not otherwise noted, “adult” refers to persons age 19 and older, and “pediatric” refers to persons age 18 and younger. Where separate indications exist (...) , they are specified as Adult or Pediatric. Where not specified, indications and prerequisite information apply to persons of all ages. See the Coding section for a list of modalities included in these guidelines. Technology Considerations Ultrasound is the initial imaging modality of choice for many conditions of the abdomen and pelvis, including hepatobiliary, urinary tract, and gynecologic conditions. While ultrasound is operator dependent and image quality may be impacted by obesity and bowel gas, accuracy

2019 AIM Specialty Health

120. Ertugliflozin (Steglatro) - type 2 diabetes mellitus

Ertugliflozin (Steglatro) - type 2 diabetes mellitus 1 Published 14 January 2019 1 SMC2102 ertugliflozin 5mg, 15mg film-coated tablet (Steglatro®) Merck Sharp & Dohme 7 December 2018 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and advises NHS Boards and Area Drug and Therapeutic Committees (ADTCs) on its use in NHSScotland. The advice is summarised as follows: ADVICE: following a full submission ertugliflozin (Steglatro ® ) is accepted (...) for restricted use within NHSScotland. Indication under review: in adults aged 18 years and older with type 2 diabetes mellitus as an adjunct to diet and exercise to improve glycaemic control: ? As monotherapy in patients for whom the use of metformin is considered inappropriate due to intolerance or contraindications. ? In addition to other medicinal products for the treatment of diabetes. SMC restriction: ertugliflozin is accepted for use as monotherapy and as add-on therapy. When used as monotherapy

2019 Scottish Medicines Consortium

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