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181. The British Society for Rheumatology biologic DMARD safety guidelines in inflammatory arthritis

therapy should be made by a consultant rheumatologist. Following national initiatives and guidance, patients and/or their carers should be actively involved in the decision making processes. (ii) Patients should be provided with education about their treatment to promote self-management (grade 1B, SOA 99%). A Cochrane review in 2002 demonstrated that education had a positive effect in terms of both patient reported outcome and objective measures of clinical response; however, the benefits were (...) not observed during a longer duration of follow-up [ ]. The Department of Health has estimated that the average cost of education and self-management is £125/person and would save costs of £244/person on average [ ]. Rheumatologists should therefore offer patients with IA the opportunity to discuss their condition and the risks and benefits of treatments both at diagnosis and throughout the course of their disease. Patients with IA should be offered verbal and written information to improve

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2018 British Society for Rheumatology

182. Cardiovascular Health in Turner Syndrome: A Scientific Statement From the American Heart Association

years. The specific management of many cardiovascular conditions, both congenital and acquired, is the same as in the general population. For these conditions, established guidelines should be followed. The purpose here is to highlight the instances in which there are unique cardiovascular risks involved in TS and to provide guidance for their monitoring and management. Working Group In July 2016, the Turner Resource Network hosted an international meeting of experts to make recommendations (...) -specific z score of >3 should not participate in any competitive sports. Girls or women with TS who are ≥15 years of age with an ascending ASI >2.3 cm/m 2 should not participate in any competitive sports. Transition Transition is a process to optimize lifelong functioning and potential with high-quality, developmentally appropriate, and uninterrupted health care from adolescence to adulthood. To be successful, this process should attend to the medical, psychosocial, educational, and vocational needs

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2018 American Heart Association

183. Evaluation and Management of Testosterone Deficiency

. Ramanathan, PhD; Ronald W. Lewis, MD Copyright © 2018 American Urological Association Education and Research, Inc.® 2 American Urological Association (AUA) Guideline Statements Diagnosis of Testosterone Deficiency 1. Clinicians should use a total testosterone level below 300 ng/dL as a reasonable cut-off in support of the diagnosis of low testosterone. (Moderate Recommendation; Evidence Level: Grade B) 2. The diagnosis of low testosterone should be made only after two total testosterone measurements (...) Recommendation; Evidence Level: Grade B) Evaluation and Management of Testosterone Deficiency Copyright © 2018 American Urological Association Education and Research, Inc.® 3 14. Patients should be informed that testosterone therapy may result in improvements in erectile function, low sex drive, anemia, bone mineral density, lean body mass, and/or depressive symptoms. (Moderate Recommendation; Evidence Level: Grade B) 15. Patients should be informed that the evidence is inconclusive whether testosterone

2018 American Urological Association

184. Routine Assessment and Promotion of Physical Activity in Healthcare Settings: A Scientific Statement From the American Heart Association

feedback indicates higher likelihood of use if located in the vitals section as opposed to social history or other EHR sections. The organization has an internal Wiki web page that provides resources for the EVS implementation and patient resources for increasing PA. Also desirable is combining the EVS with clinical decision support system features to enable adequate risk stratification and provision of appropriate patient education material tailored to the patient’s clinical diagnosis and preferences (...) impact of regular PA on traditional cardiovascular risk factors explains a significant portion of its salutatory impact. These favorable effects on traditional risk factors include increasing high-density lipoprotein cholesterol, reducing body mass index, improving insulin sensitivity, and reducing blood pressure, which, although often modest, significantly reduce risk at the population level. However, a significant portion of the cardiovascular benefits of habitual PA are independent of its effects

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2018 American Heart Association

185. CRACKCast E172 – Pediatric Gastrointestinal Disorders

is more commonly caused by cholestasis rather than biliary obstruction. Pigment gallstones are more common than cholesterol stones in children. Biliary tract disease is usually diagnosed with right upper quadrant ultrasound imaging; management strategies are similar to those for adults. Rosens in Perspective Gastrointestinal disorders are tough! Non-verbal children can present with virtually any set of symptomatology! It may be helpful to organize these varied gastrointestinal diseases by patient age (...) here at this slideshare resource: [11] Describe the “Rule of 2” for Meckel’s Diverticulum Meckel’s diverticulum traditionally follow so-called the rule of 2’s. The diverticulum is 2 cm wide, 2 cm long, and located within 2 feet of the ileocecal valve. Moreover, the condition occurs in 2% of the population, and only 2% of affected patients ever become symptomatic. Of symptomatic patients, 50% manifest symptoms by the age of 2 years, and most present by the age of 20 years. [12] What are 3 common

2018 CandiEM

186. Neonatal jaundice

clinicians are responsible for: · Providing care within the context of locally available resources, expertise, and scope of practice · Supporting consumer rights and informed decision making, including the right to decline intervention or ongoing management · Advising consumers of their choices in an environment that is culturally appropriate and which enables comfortable and confidential discussion. This includes the use of interpreter services where necessary · Ensuring informed consent is obtained

2018 Queensland Health

187. Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency

other methods ( e.g. , genotyping) to improve the positive predictive value of congenital adrenal hyperplasia screening. (1|⊕⊕○○) Technical remark: Laboratories utilizing liquid chromatography–tandem mass spectrometry should participate in an appropriate quality assurance program. Additionally, clinicians should realize that immunoassays lead to more false-positive results. Thus, if laboratory resources do not include liquid chromatography–tandem mass spectrometry, a cosyntropin stimulation test (...) with congenital adrenal hyperplasia, we recommend educating patients and their guardians and close contacts on adrenal crisis prevention and increasing the dose of glucocorticoid (but not mineralocorticoid) during intercurrent illness. (1|⊕⊕⊕○) 4.11 We recommend equipping every patient with congenital adrenal hyperplasia with a glucocorticoid injection kit for emergency use and providing education on parenteral self-administration (young adult and older) or lay administration (parent or guardian) of emergency

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2018 Pediatric Endocrine Society

188. European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults

not all recommended tests and treatments, or both, might be available. Thus, the recommendations have certainly been interpreted in the context of available resources/treatment in the community, in which the patient is being seen. 3.4 Summary of methods used for guideline development The methods used have been described in more detail previously ( ). In short, the guideline used GRADE (Grading of Recommendations Assessment, Development and Evaluation) as a methodological base. The first step

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2018 European Society of Endocrinology

189. National Clinical Guideline on Adult type 1 diabetes mellitus

Registrar Endocrinologist at start of development process) Margaret Humphreys Clinical Specialist Diabetes Dietitian /National HSE Structured Patient Education Co-ordinator Cathy Breen Senior Dietitian Diabetes Mary Finn Senior Dietitian Diabetes Karen Townsend Clinical Nurse Specialist Diabetes Pauline O’Hanlon Clinical Nurse Specialist Diabetes Mary O’Scannail Clinical Nurse Specialist Diabetes Helen Twamley Clinical Nurse Specialist Diabetes Integrated Care Prof Brian McGuire Professor of Clinical (...) 2.12 Consultation summary 16 2.13 External review 16 2.14 Implementation summary 16 2.15 Summary budget impact analysis 17 2.16 Monitoring, evaluation and audit 18 2.17 Plan to update this National Clinical Guideline 18 Section 3: National Clinical Guideline recommendations 19 3.1 Diagnosis and early care planning 19 3.2 Support and individualised care 21 3.3 Education and information 22 3.4 Dietary management 23 3.5 Physical activity 25 3.6 Blood glucose management 25 3.7 Insulin therapy 28 3.8

2018 HIQA Guidelines

190. Care of Adults with Neurofibromatosis Type 1

available elsewhere. 7 In childhood,NF1 Disclaimer: This practice resource is designed primarily as an educational resource for medical geneticists and other clinicians to help them provide quality medical services. Adherence to this practice resource is completely voluntary and does not necessarily assure a successful medical outcome. This practice resource should not be considered inclusive of all proper procedures and tests or exclusive of other procedures and tests that are reasonably directed (...) ., for cholesterol, colonoscopy, for cervicalcancer)andvaccinationschedulesshouldbefollowed, regardless of NF1 diagnosis. Supplemental Resources lists useful websites and organizations. Although it is important to always consider NF1-associated etiologies for a new sign or symptom, common explanations will remain common (e.g., most hypertension is essential and not pheochromocytoma- related, most back pain will not be due to an MPNST, most headaches will not be tumor-associated). Repeated patient

2018 American College of Medical Genetics and Genomics

191. Improving Quality of Life: Substance Use and Aging

topics. It also emphasizes the need for a complete continuum of age-specific care, including substance use guidelines and treatment services tailored to the specific needs of this demographic, backed by improved training and education on how to detect and assess problematic substance use in older adults. Through the evidence presented in this report, we are hoping to jumpstart a national conversation about substance use by older adults. And as with any conversation, the words we use are critically (...) on Substance Use and Addiction 3 Substance Use In Canada—Improving Quality of Life: Substance Use and Aging About Substance Use in Canada Since 2005, Substance Use in Canada (formerly Substance Abuse in Canada) has shone a spotlight on key contemporary issues related to substance use and identified specific areas for action in both policy and practice. Each report in the series is intended for a broad audience that includes policy makers, program development personnel, researchers, educators and health

2018 Canadian Centre on Substance Abuse

192. Prescribing patterns of dependence forming medicines

of interest Professor Sir John Strang is Head of Department for the Addictions academic activity of the IoPPN (Institute of Psychiatry, Psychology and Neuroscience), Kings College London, which includes conduct of diverse research studies and provision of educational activity in the Addictions. He is also Academic Lead of the Addictions CAG (Clinical Academic Group), within the KHP AHSC (King’s Health Partners Academic Health Sciences Centre). He also holds an honorary consultant appointment

2017 Public Health Research Consortium

193. Interventions to improve adherence to lipid-lowering medication. (PubMed)

/dL (95% CI 8.51 to 30.51; 3 studies; 333 participants; moderate-quality evidence). Over the long term (more than six months) total cholesterol decreased by a mean of 17.57 mg/dL (95% CI 14.95 to 20.19; 2 studies; 127 participants; high-quality evidence). Included studies did not report usable data for health outcome indications, adverse effects or costs/resource use, so we could not pool these outcomes. We assessed each included study for bias using methods described in the Cochrane Handbook (...) intervention (e.g. electronic reminders, pharmacist-led interventions, healthcare professional education of patients) versus usual care over the short term (six months or less), and were pooled in a meta-analysis. Participants in the intervention group had better adherence than those receiving usual care (odds ratio (OR) 1.93, 95% confidence interval (CI) 1.29 to 2.88; 7 studies; 11,204 participants; moderate-quality evidence). A separate analysis also showed improvements in long-term adherence rates (more

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2016 Cochrane

195. Occupational Therapists' Use of Occupation Focused Practice in Secure Hospitals The Royal College of Occupational Therapists is a wholly owned subsidiary of the British Association of Occupational Therapists (BAOT) and operates as a registered charity. It represents the profession nationally and internationally, and contributes widely to policy consultations throughout the UK. The College sets the professional and educational standards for occupational therapy, providing leadership, guidance and information relating to research and development, education, practice (...) Potential impact of the recommendations 45 6 Patient perspectives of the guideline 46 6.1 Patient consultation 2012 46 6.2 Patient consultation 2016 47 7 Implementation of the guideline 49 7.1 Dissemination and promotion 49 7.2 Organisational and financial barriers 49 7.3 Implementation resources 51 8 Recommendations for future research 53 NICE has accredited the process used by the Royal College of Occupational Therapists to produce its practice guidelines. Accreditation is valid for five years from

2018 British Association of Occupational Therapists

196. Diabetes Prevention Programs

Improvement IFG Impaired fasting glucose IGT Impaired glucose tolerance NDEP National Diabetes Education Program NDPP National Diabetes Prevention Program NHANES National Health and Nutrition Examination Survey NIH National Institutes of Health OGTT Oral glucose tolerance test P4P Pay for performance PICOTS Population, Intervention, Comparators, Outcomes, Timing, and Settings PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses PSA Public service advertisement QALY Quality-adjusted (...) Key Resources Examples In-person, individual coaching Lowest Highest 1 Humans, facilities DPP Trial In-person, group coaching Medium Medium 8-15 Humans, facilities Weight Watchers for Prediabetes Y Digital, human coaching (virtual interaction) High Medium 1-24 Humans, technology Omada® (Omada Health, Inc.) Virtual Lifestyle Management (VLM™, Canary Health, Inc.) Digital, fully-automated coaching (based on algorithms) Highest Lowest 1+ † Technology Alive-PD™ (Turnaround Health) *Average costs

2017 California Technology Assessment Forum

197. Nurses and pharmacists can prescribe as effectively as doctors

of nurse or pharmacist prescribing compared with doctor prescribing. Most studies were of chronic disease management in primary care settings in high income countries (25 from the US and six from the UK). Independent and supplementary prescribers in the NHS include not only the nurses and pharmacists, as covered in this review, but also other professions such as podiatrists, optometrists, and physiotherapists. At a time of high demand for NHS resources, with shortages of doctors in some specialties (...) for medical prescribing. Blood pressure: People prescribed drugs by nurses or pharmacists had lower systolic blood pressure than those prescribed drugs by doctors (-5.31mmHg, 95% confidence interval [CI] -6.46 to -4.16; in 12 trials, involving 4,229 participants). Cholesterol: People prescribed drugs by nurses or pharmacists had lower low density lipoprotein cholesterol than those prescribed drugs by doctors (-0.21 mmol/L, 95% CI -0.29 to -0.14; in seven trials, involving 1,469 participants). Blood sugar

2019 NIHR Dissemination Centre

198. Simple approaches to weight management of children and adolescents in primary care may not work

Simple approaches to weight management of children and adolescents in primary care may not work Simple approaches to weight management of children and adolescents in primary care may not work Discover Portal Discover Portal Simple approaches to weight management of children and adolescents in primary care may not work Published on 8 November 2016 doi: Brief education and motivational interventions delivered by primary care professionals in several short consultations had only a marginal effect (...) % of children aged two to 15 are obese and a further 14% are overweight. Children who are overweight or obese can experience bullying and low self-esteem which can lead to anxiety and depression and they are also much more likely to be obese as adults. Obesity can also cause high blood pressure, fatty deposits in arteries and raised cholesterol, which increase the risk of long term conditions, such as type 2 diabetes. Obesity can be hard to treat effectively. National and local strategies set out a range

2019 NIHR Dissemination Centre

199. Clinical practice guidelines for the care of girls and women with Turner syndrome: proceedings from the 2016 Cincinnati International Turner Syndrome Meeting

Translational Sciences, Cincinnati Children’s Hospital Medical Center’s TS Foundation, as well as several advocacy groups (TS Society of the United States, the TS Global Alliance and the Turner Resource Network). The chairs of the consensus working group, Claus H Gravholt and Philippe F Backeljauw, were appointed by the ESE Clinical Committee and PES respectively. Other members of the working and writing group are Niels H Andersen (adult cardiologist), Gerard S Conway (adult endocrinologist), Olaf M Dekkers

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2016 European Society of Human Reproduction and Embryology

200. Exemplar clinical pathways for a stratified approach to cardiovascular disease

, and for stratification of patients along the clinical pathway. ? Building capability through clinical education by embedding the care pathways into specialist and non-specialist training, and developing capacity through additional, focused resources such as trained genetic nurses. ? Raising awareness with both clinicians and patients to facilitate entry onto the right clinical pathway as early as possible, and overcoming clinician and public negative perceptions which may impede patient management. ? Developing (...) should help to achieve this. Embedding FH pathways into clinical education Delegates highlighted the need to integrate FH pathways into clinical training, not only to support an understanding of the pathway but also to propagate a mindset where FH patients are treated as if they already have heart disease, as the high cholesterol from birth places patients at significant risk of coronary artery disease. The low pick up rate on cholesterol levels in primary care needs to be addressed. It was suggested

2016 Academy of Medical Sciences

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