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121. Clinical Appropriateness Guidelines: Radiation Oncology Brachytherapy, intensity modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT) and stereotactic radiosurgery (SRS) treatment guidelines

10 Bone Metastases 12 Breast Cancer 19 Central Nervous System Cancers 29 Colorectal and Anal Cancers 38 Gastrointestinal Cancers, Non-Colorectal 42 Genitourinary Cancers 49 Gynecologic Cancers 54 Head and Neck Cancers 60 Lung Cancers: Small Cell and Non-Small Cell 64 Lymphoma: Hodgkin and non-Hodgkin 71 Other Tumor Types: Sarcoma, Thymoma and Thymic Carcinoma, Pediatric Tumors, Other Malignancies 76 Prostate Cancer 82Description and Application of the Guidelines | Copyright © 2018. AIM Specialty (...) and SRS. When highly tailored dose distributions such as IMRT and stereotactic radiotherapy are not being utilized, sub-centimeter precision is not generally needed 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

2018 AIM Specialty Health

122. Induced Pluripotent Stem Cells for Cardiovascular Disease Modeling and Precision Medicine: A Scientific Statement From the American Heart Association

rates and exposure to ultraviolet radiation. This could be particularly relevant when deriving iPSCs from older donors, because mutations and other abnormalities appear to occur with increasingly higher frequency with increased age. The second choice to make is the method by which to deliver the Yamanaka factors into the cell type. Initial efforts to generate iPSCs entailed the use of an integrating virus (eg, retrovirus or lentivirus) to introduce the factors as DNA transgenes. This led to concerns (...) for a frameshift mutation in PKP2 . Although the iPSC-CMs from these patients exhibited subtle molecular defects in standard differentiation conditions, they did not fully manifest ARVC-related phenotypes until they were exposed to conditions that resulted in metabolic aging, namely, treatment with a cocktail of 5 adipogenic factors, whereupon they displayed increased lipogenesis and apoptosis, as well as abnormal calcium handling. In another study, iPSC-CMs from 2 patients heterozygous for different PKP2

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2018 American Heart Association

123. I heard a snap! Clay Shoveler’s Fracture

rotation, flexion, and extension. He also has exquisite, sharp tenderness on palpation over the C6 vertebrae. Initial Impression and Investigations While on history you had suspected a cervical sprain or strain, due to his midline tenderness over C6 and age you decide to obtain a x-ray of his cervical spine. Uh-oh, what happened to Reginald? Image courtesy of: Dr Chris O’Donnell ( Clay Shoveler’s Fracture (...) these fractures when the heavy clay that they tossed over their shoulder was stuck to their long-handled shovel causing a sudden flexion force on the neck and back muscles 2 . Exam and Investigations Patients with this injury present with sharp pain between the shoulder blades that is worsened with palpation. They may also have pain with neck movement and unilateral upper back pain 3 . The Clay Shoveler fracture can usually be seen on plain film lateral radiograph. CT can be performed if clinical suspicion

2018 CandiEM

124. Shoulder Conditions Diagnosis and Treatment Guideline

tendonitis is still unknown. It does, however, affect up to 10-20% of the population between the ages of 30-50 [56-58] . Diagnosis and Treatment The diagnosis of calcific tendonitis is typically made with conventional plain films alone. Calcific tendonitis is not always symptomatic. When calcific tendonitis is symptomatic, non- operative treatment of the condition is typically successful [56, 59] . If symptoms continue after 12 weeks of conservative management then debridement of the calcified tendon (...) motion Tenderness over the AC joint AND Documented pain relief with an anesthetic injection MRI (radiologist interpretation) reveals: ? Moderate to severe degenerative joint disease of AC joint, or ? Distal clavicle edema, or ? Osteolysis of distal clavicle OR Bone scan is positive OR Radiologist’s interpretation of x-ray reveals moderate to severe ac joint arthritis Conservative care* for at least 6 weeks (if done in isolation) Surgery is not indicated before 6 weeks. Washington State Department

2018 Washington State Department of Labor and Industries

125. Good practice paper on the diagnosis and investigation of patients with mantle cell lymphoma

or if clinical stage 1A disease is present and radiotherapy with curative intent is planned. Where endoscopy is performed, biopsies of any suspicious lesions, and also macroscopically normal areas, should be taken for histological examination. Pregnancy testing in women of childbearing age prior to chemotherapy. Staging The modified Ann Arbor staging system (Lister et al , ) is used. As most patients with MCL have blood and bone marrow involvement at presentation, clinical stage in isolation is not of great (...) blood tests including full blood count and film, and biochemical tests including lactate dehydrogenase should be performed Virological testing for hepatitis B, hepatitis C and human immunodeficiency virus is recommended prior to immunochemotherapy Patients should undergo staging bone marrow aspirate and trephine biopsy unless there is peripheral blood involvement; trephine may be avoided if flow cytometry is carried out on aspirate sample Patients should undergo clinical staging with computed

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2018 British Committee for Standards in Haematology

126. Investigation and management of Transient Leukaemia of Down Syndrome

and/or of quantitative assessment of the size of any residual GATA1‐ mutant clone in TL‐DS or silent TL‐DS has yet been demonstrated. (Grade 2B). All children with previous TL‐DS or silent TL‐DS should be monitored for progression to ML‐DS with 3 monthly clinical review and FBC and film until the age of 2 years. If the FBC and film are normal and there are no clinical features of ML‐DS, monitoring should continue 6 monthly until the age of 4 years. Abnormal blood counts should prompt early bone marrow aspirate (...) marrow examination is not generally useful in TL‐DS: blast cells are believed to originate in the liver and marrow blasts are variable and less prevalent than in peripheral blood. Bone marrow involvement does not correlate with disease severity (Massey et al , ; Klusmann et al , ; Gamis et al , ). Figure 1 Typical appearances of TL‐DS in peripheral blood of a neonate with Down syndrome. Photomicrograph from a blood film of a neonate with transient leukaemia of Down syndrome showing blast cells

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2018 British Committee for Standards in Haematology

127. A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology

specimen-based approach, and includes bloodstream and cardiovascular system infections, central nervous system infections, ocular infections, soft tissue infections of the head and neck, upper and lower respiratory infections, infections of the gastrointestinal tract, intra-abdominal infections, bone and joint infections, urinary tract infections, genital infections, and other skin and soft tissue infections; or into etiologic agent groups, including arthropod-borne infections, viral syndromes (...) . Ocular Infections IV. Soft Tissue Infections of the Head and Neck V. Upper Respiratory Tract Bacterial and Fungal Infections VI. Lower Respiratory Tract Infections VII. Infections of the Gastrointestinal Tract VIII. Intra-abdominal Infections IX. Bone and Joint Infections X. Urinary Tract Infections XI. Genital Infections XII. Skin and Soft Tissue Infections XIII. Arthropod-Borne Infections XIV. Viral Syndromes XV. Blood and Tissue Parasite Infections Contents Introduction and Executive Summary I

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2018 Infectious Diseases Society of America

128. BHIVA/BASHH guidelines on the use of HIV pre-exposure prophylaxis (PrEP)

(PEPSE) 65 6.4.2 HIV testing 65 6.4.3 Acute HIV infection 65 6.4.4 Assessment of renal function 65 6.4.5 STI screen 66 6.4.6. Assessment of viral hepatitis status 66 6.4.7 References 68 6.5 Other considerations 70 6.5.1 Women who are pregnant or trying to conceive 70 6.5.2 Bone health 70 6.5.3 References 70 6.6 Prescribing PrEP 71 6.6.1 What to use 71 6.6.2 Lead-in period 71 6.6.3 Frequency of dosing to attain benefit 71 6.6.4 On-demand dosing 71 6.6.5 Indications for post-exposure prophylaxis (...) following suboptimal adherence to PrEP 72 6.6.5 References 73 BHIVA/BASHH guidelines on the use of PrEP 4 7 Clinical follow-up and monitoring on treatment 75 7.1 Overview 75 7.2 Continued prescribing 75 7.3 Assessing adherence and adverse events 75 7.4 Management of short-term side effects 75 7.5 Monitoring on PrEP 77 7.5.1 HIV testing 77 7.5.2 Management of HIV seroconversion 77 7.5.3 STI screening 78 7.5.4 Viral hepatitis 78 7.5.5 Renal monitoring 78 7.5.6 Pregnancy testing 79 7.5.7 Bone monitoring 79

2018 British Association for Sexual Health and HIV

129. Use of Imaging Prior to Referral to a Musculoskeletal Oncologist

is understandably stressful both for the patient and healthcare provider, and some guidance on appropriate early management, in particular ensuring that imaging is not over or underutilized, is needed. PATIENT POPULATION This report is relevant to the initial evaluation of any patient with a bone or soft tissue tumor of unknown etiology and biological significance regardless of age, sex, race, ethnicity, education, and socioeconomic status. BURDEN OF DISEASE Sarcoma, the principal primary malignancy (...) of reliable evidence, the guideline development group is making a recommendation based on their clinical opinion. Consensus statements are published in a separate, complimentary document. 7 PLAIN RADIOGRAPHS A. Moderate evidence supports using conventional radiographs in the initial evaluation of a bone tumor of unknown etiology. Strength of Recommendation: Moderate Description: Evidence from two or more “Moderate” strength studies with consistent findings, or evidence from a single “High” quality study

2018 American Academy of Orthopaedic Surgeons

130. Investigation and management of a raised serum ferritin

or treatment (e.g. blood transfusion or iron infusion) that lead to a genuine increase in RES iron stores. Upper limit of the normal range for serum ferritin Most UK laboratories simply report 300–400 μg/l as the upper limit of normal for SF in adult males and 150–200 μg/l as the upper limit of normal for adult females (Association for Clinical Biochemistry, ; Worwood et al , ). There is however considerable variation in SF values in response to age, ethnic origin and sex. Mean SF values in neonates (...) are high (around 200 μg/l) and remain so for about 2 months. From 2 to 12 years mean values approximate 30 μg/l for both boys and girls (Worwood, ). Within this age group values >100 μg/l are only seen in the context of inflammatory disease, malignant disease or juvenile hereditary haemochromatosis. Mean SF values at 18 years are significantly higher in males (60–80 μg/l) than in females (25–30 μg/l) (White et al , ; Wiedemann & Jonetz‐Mentzel, ; Custer et al , ; Milman et al , ). Thereafter, in males

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2018 British Committee for Standards in Haematology

131. Shoulder Pain - Atraumatic

. Fluoroscopy, CT, or ultrasound (US) can be used to guide needle placement for arthrography. Nuclear Medicine In the setting of atraumatic shoulder pain, nuclear medicine studies are rarely used. Sometimes a PET scan is used in conjunction with CT and MRI in the workup of soft-tissue tumors, bone tumors, and metastases. Otherwise, in the setting of atraumatic shoulder pain, bone scintigraphy, gallium, and indium scans have been largely replaced by MRI and CT. CT CT plays an important role in the evaluation (...) surface defects, even though the therapeutic impact of these subtle irregularities may be limited [21,22]. CT arthrography is helpful in the preoperative planning of total shoulder arthroplasty. Evaluation of potentially irreparable rotator cuff disease is critical in determining arthroplasty type (conventional versus reverse). CT provides important osseous detail in the evaluation of glenoid morphology, version, and extent and location of glenoid bone loss. This information is critical

2018 American College of Radiology

132. Management of Vertebral Compression Fractures

), are helpful for detecting acute fractures, identifying fracture clefts, and differentiating synchronous fractures [43,44]. MRI is also useful in distinguishing recent from chronic vertebral fractures in patients with multiple deformities and confusing clinical examinations [45,46]. However, vertebral body edema is not a precise measure of compression fracture age because the duration after an osteoporotic compression fracture is often not known with certainty. Bone marrow edema typically resolves within 1 (...) Criteria ® : Osteoporosis and Bone Mineral Density. Available at: Accessed September 30, 2018. 4. Kim DH, Vaccaro AR. Osteoporotic compression fractures of the spine; current options and considerations for treatment. Spine J 2006;6:479-87. 5. Lane NE. Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol 2006;194:S3-11. 6. Siris ES, Brenneman SK, Barrett-Connor E, et al. The effect of age and bone mineral density on the absolute

2018 American College of Radiology

133. Diagnosis and management of polycythaemia vera

, mutation, JAK 2, MPL , CALR , bone marrow, red cell mass, erythropoietin, risk, management, treatment, cytoreduction, venesection, hydroxyurea, interferon, busulfan, pipobroman, radioactive phosphorus, aspirin, anagrelide, ruxolitinib, thrombosis, haemorrhage, pregnancy, pruritus, surgery and management. The search covered the period from 2005, the date of last version of the guideline (McMullin et al , ), to February week 3 2017. Exclusions included articles not in English, studies not in humans (...) Recommended diagnostic criteria for PV JAK2‐positive polycythaemia vera (requires both criteria) A1 High haematocrit (>0·52 in men, >0·48 in women) OR raised red cell mass (>25% above predicted) A2 Mutation in JAK 2 JAK2‐negative polycythaemia vera (requires A1‐A4 plus another A or two B criteria) a This is a very rare clinical entity. A1 Raised red cell mass (>25% above predicted) OR haematocrit ≥0·60 in men, ≥0·56 in women A2 Absence of mutation in JAK 2 A3 No cause of secondary erythrocytosis A4 Bone

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2018 British Committee for Standards in Haematology

134. Imaging Guidelines

treatment 9delay and definitively identifying presence or absence of ongoing bleeding that warrants intervention. Part 3: Sedation Key Points z Agitated adult trauma patients may require intubation with sedation and chemical paralysis to expedite radiographic work- up and ensure adequate quality. Short acting drugs are preferred along with careful monitoring of cardiac and respiratory status. z Consider physiologic parameters (heart rate, blood pressure, and other existing injuries) and the child’s age (...) , size, and cognitive level to provide safe sedation administration. z Patient age and cognitive developmental stage can significantly affect the amount and type of sedation administered. z A dedicated provider and resuscitation equipment must be with the sedated patient at all times. Sedation for Adult Patient Imaging Adult trauma patients may require light to moderate sedation to obtain adequate CT and MRI images. Agitated patients may require intubation with sedation and chemical paralysis

2018 American College of Surgeons

135. Regorafenib (Stivarga) indicated as monotherapy for the treatment of adult patients with hepatocellular carcinoma (HCC) who have been previously treated with sorafenib treatment

and treatment of physical, psychological, social, and spiritual dimensions of suffering [5]. Table 3.1 provides an overview of the technology. Table 3.1: Features of the intervention and comparators Technology Comparator Non-proprietary name Regorafenib No active comparator is available Proprietary name STIVARGA ® Active substance Regorafenib Galenic Form 40 mg film-coated tablets ATC code L01XE21 Abbreviations: ATC=anatomical therapeutic chemical; EMA=European Medicines Agency. Source: EMA 2013 (...) of coffee or tea (520 calories, 2 g fat). No active comparator is available Description of packaging 28 film-coated tablets in bottle 84 film-coated tablets (3 x 28) in bottle Total volume contained in packaging for sale 28-tablet package of 40 mg regorafenib formulation 112-tablet package of 40 mg regorafenib formulation Dosing Recommended daily dose is 160 mg (4 tablets of 40 mg) taken once daily. Dose interruptions and/or dose reductions may be required based on individual safety and tolerability

2018 EUnetHTA

136. Paediatric Urology

of the indications and morbidity of circumcision in children. Eur Urol, 1985. 11: 184. 37. Morris, B.J., et al. A ‘snip’ in time: what is the best age to circumcise? BMC Pediatr, 2012. 12: 20. 38. Ross, J.H., Circumcision: Pro and con., in Pediatric urology for the general urologist, J.S. Elder, Editor. 1996, Igaku-Shoin: New York. 39. Weiss, H.A., et al. Complications of circumcision in male neonates, infants and children: a systematic review. BMC Urol, 2010. 10: 2. 40. Homer, L., et al. Meatal stenosis in boys (...) surgery may improve the fertility index in undescended testes: a prospective randomized trial. J Urol, 2005. 173: 974. 72. Cortes, D., et al. Hormonal treatment may harm the germ cells in 1 to 3-year-old boys with cryptorchidism. J Urol, 2000. 163: 1290. 73. Ritzen, E.M. Undescended testes: a consensus on management. Eur J Endocrinol, 2008. 159 Suppl 1: S87. 74. Kollin, C., et al. Surgical treatment of unilaterally undescended testes: testicular growth after randomization to orchiopexy at age 9 months

2018 European Association of Urology

138. Urological Trauma

evidence to recommendations. BMJ, 2008. 336: 1049. 10. Soreide, K. Epidemiology of major trauma. Br J Surg, 2009. 96: 697. 11. Middleton, P., The trauma epidemic. In: Major Trauma. Smith, J., Greaves, I., Porter, K. (2010) Oxford University Press: Oxford. 12. Thornley, S., et al. Alcohol intake, marijuana use, and sleep deprivation on the risk of falls occurring at home among young and middle-aged adults: a case-crossover study. N Z Med J, 2014. 127: 32. 13. Moore, E.E., et al. Organ injury scaling (...) , CLASSIFICATION & GENERAL MANAGEMENT PRINCIPALS 3.1. Definition and Epidemiology Trauma is defined as a physical injury or a wound to living tissue caused by an extrinsic agent. Trauma is the sixth leading cause of death worldwide, accounting for 10% of all mortalities. It accounts for approximately five million deaths each year and causes disability to millions more [ , ]. About half of all deaths due to trauma are in people aged 15-45 years; trauma is the leading cause of death in this age group [ ]. Death

2018 European Association of Urology

139. Guidelines for the Investigation and Management of Transient Leukaemia of Down Syndrome

for the persistence of the GATA1 mutation and/or of quantitative assessment of the size of any residual GATA1-mutant clone in TL-DS or silent TL-DS has yet been demonstrated. (Grade 2B). • All children with previous TL-DS or silent TL-DS should be monitored for progression to ML-DS with 3 monthly clinical review and FBC and film until the age of 2 years. If the FBC and film are normal and there are no clinical features of ML-DS, monitoring should continue 6 monthly until the age of 4 years. Abnormal blood counts (...) is driven by mutations in the haematopoietic transcription factor gene GATA1 and is only seen in conjunction with trisomy 21, either constitutional or acquired. TL- DS may present with overt clinical features but some cases are only identified through examination of the blood film and/or by GATA1 mutation analysis (Klusmann et al, 2008; Roberts et al, 2013). Although many cases resolve without treatment, TL-DS results in early death in 15? 23% cases and 20?23% of survivors will develop acute myeloid

2018 British Association of Perinatal Medicine

140. Required hospital capacity in 2025 and criteria for rationalisation of complex cancer surgery, radiotherapy and maternity services

and foreign patients 112 1.7.4 Summary of baseline forecast results 116 1.8 PROJECTION RESULTS SCENARIO WITH ACCELERATED SUBSTITUTION TO DAY CARE ... 124 1.8.1 Methodology 125 1.8.2 Results 130 1.9 PROJECTION RESULTS SCENARIO WITH ACCELERATED POPULATION AGEING 135 1.9.1 Methodology 135 1.9.2 Results 137 2 HOSPITAL USE BY PATIENTS WITH DEMENTIA 145 2.1 BACKGROUND AND AIM OF THE STUDY 145 2.2 METHOD 147 2.2.1 Literature review 147 2.2.2 Analysis of Belgian hospital registry data 148 2.3 RESULTS (...) 445 8.5.2 Costs savings 445 8.5.3 Occupancy rate 448 8.5.4 Volume and outcome 448 8.5.5 Access / Distance 449 DISCUSSION AND CONCLUSION 450 ? APPENDICES 451 ? REFERENCES 503 KCE Report 289 Required hospital capacity and criteria for rationalisation 9 LIST OF FIGURES Figure 1 – Population projections for Belgium 38 Figure 2 – Overview of projection model in the report Cannoodt 43 Figure 3 – Projected and observed Belgian population by age, 2005-2015 47 Figure 4 – Projected and observed number

2017 Belgian Health Care Knowledge Centre

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