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281. Guidelines on HIV self-testing and partner notification

. These guidelines refer to the following groups as key populations: men who have sex with men, people who inject drugs, people in prisons and other closed settings, sex workers and transgender people. Lay provider: any person who performs functions related to health-care delivery and has been trained to deliver these services but has no formal professional or para-professional certification, nor a tertiary education degree. Negative predictive value: the probability that a person with a negative test result

2016 World Health Organisation HIV Guidelines

282. 10 priorities for integrating physical and mental health

issues such as tobacco, alcohol or obesity. Mental health prevention and promotion activities account for less than 0.03 per cent of NHS spending on mental health, and the majority of joint strategic needs assessments (JSNAs) have little or no coverage of mental health and wellbeing. Impact on people Poor mental health is associated with higher rates of smoking, alcohol and drug abuse, lower educational outcomes, poorer employment prospects, lower resilience, decreased social participation and weaker (...) social relationships – all of which leave people at increased risk of developing a range of physical health problems. For most people, mental health problems begin in childhood or adolescence. This can have lifelong effects, and is a major route through which health and social inequalities are transmitted across generations. Impact on the health system Poor mental health is associated with greater resource use within the health system and adds to the burden created by smoking, alcohol and other

2016 The King's Fund

283. 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

2018 NIHR Dissemination Centre

284. Clinics and activities in primary care can reduce heart disease deaths

patients treated over a six year period. Much of what is proposed in the intervention - education, risk factor management and structured use of resources - forms part of current routine general practice in the UK. The review further highlights the need for long term follow up trials and the need for a sustained approach to engaging with hard to reach individuals, particularly those with on-going elevated risk. Carl Heneghan, General Practitioner and Professor of Evidence Based Medicine, University (...) interventions lasted between one and three years and included activities like organising dedicated clinics to monitor and adjust medication to meet recommended blood pressure and cholesterol levels or drop-in sessions to encourage healthy lifestyle. The results are in line with 2012 NICE guidance that encourages organisations to take action to help people with known heart disease take their medicines as prescribed, and reduce risk factors through lifestyle changes. Share your views on the research. Why

2018 NIHR Dissemination Centre

285. Cultural contexts of health: the use of narrative research in the health sector

in the making of a meaningful story by a particular subject, but also in the ways that others understand and retell the story. Both the ability to narrate stories and what have been called storytelling rights (44) are unevenly distributed in society. It is the educated, articulate and culturally enriched who tell stories through novels, speeches, blogs and so on – and who are usually over-represented in research samples.CULTURAL CONTEXTS OF HEALTH: THE USE OF NARRATIVE RESEARCH IN THE HEALTH SECTOR HEALTH (...) CONTEXTS OF HEALTH: THE USE OF NARRATIVE RESEARCH IN THE HEALTH SECTOR HEALTH EVIDENCE NETWORK SYNTHESIS REPORT 12 These four interlinked domains offer opportunities for using narrative evidence productively in health policy. At the individual level, narrative is increasingly used in health communication and education (50). Narratives, as rhetorical devices, are effective in persuasion (51,52), particularly if they capture cultural contexts (53). Health education in which the message is framed

2016 WHO Health Evidence Network

287. Sleep Duration and Quality: Impact on Lifestyle Behaviors and Cardiometabolic Health: A Scientific Statement From the American Heart Association

% of people with insomnia receive a diagnosis. Of note, women and those ≥65 years of age are more likely to report insomnia symptoms, although men and women from lower socioeconomic positions and education levels also tend to complain of insomnia. Recent evidence that habitual sleep duration is a risk factor for cardiometabolic conditions has given rise to multiple epidemiological and surveillance studies. The preponderance of evidence emanating from self-reported data suggests a curvilinear relationship

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2016 American Heart Association

288. Assessing Cardiac Metabolism

Cardiac Metabolism” seeks to provide a collective and curated resource on methods and models used to investigate established and emerging aspects of cardiac metabolism. Some of those methods are refinements of classic biochemical tools, whereas most others are recent additions from the powerful tools of molecular biology. The aim of this statement is to be useful to many and to do justice to a dynamic field of great complexity. Introduction As a biological pump, the heart converts chemical energy (...) by wide interest in the components of cardioprotective diets. As the cardiovascular research community is discovering a plethora of new methods for assessing cardiac metabolism, they are still scattered in the literature, many of them in the appendices of original articles. The present scientific statement seeks to provide a curated resource on methods and models used to assess basic and emerging aspects of cardiac metabolism. Some of these methods are refinements of classic tools in biochemistry

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2016 American Heart Association

292. Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease: A Scientific Statement From the American Heart Association

. * Select statin-drug interactions discussed in the article that do not appear in the table are not considered clinically significant. Overview of DDIs, Cytochrome P-450 Enzymes, and Permeability Glycoprotein The 2 most common pharmacokinetic DDIs involving statins are those mediated by the cytochrome P-450 (CYP450) enzyme system and permeability glycoprotein (P-gp). Pharmacodynamic DDIs with statins may also occur. All DDIs can result in altered low-density lipoprotein cholesterol reductions (...) Association “Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Risk in Adults” states that combination therapy with any statin and gemfibrozil should be avoided. This recommendation is because of concerns for the increased risk for muscle-related toxicity. However, despite these recommendations, a recent analysis of a nationwide register study found that although providers were less likely to prescribe gemfibrozil, the mean dose of statin was substantially higher in those

2016 American Heart Association

293. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

through an end date of December 31, 2013 (including ePub publications). While preference was given to RCTs, other forms of resource material were used to support the response, including nonrandomized cohort trials, prospective observational studies, and retrospective case series. Use of publications was limited to full-text articles available in English on adult humans. For all included RCTs, two readers completed data abstraction forms (DAFs) examining the data and assessing the quality (...) , inappropriate cessation of EN, consumption of nursing time and allocation of healthcare resources, and may adversely affect outcome through reduced volume of EN delivered ( ). Three studies have shown that eliminating the practice

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2016 Society of Critical Care Medicine

294. Evidence-Based Policy Making: Assessment of the American Heart Association?s Strategic Policy Portfolio

Goals The AHA’s 2020 Strategic Impact Goals target a 10-year 20% improvement in the CVH of all Americans and a 20% reduction in deaths from CVDs and stroke. Seven metrics for CVH are specified separately for children (those <20 years of age) and for adults (age ≥20 years) and comprise 4 health behaviors (current smoking, body mass index, physical activity, and healthy diet score), and 3 health factors (total cholesterol, blood pressure [BP], and fasting plasma glucose). The level of each metric can (...) itself is complex, and there is typically a significant lag time before adoption and implementation are achieved. Legislative and regulatory campaigns are implemented by the AHA’s government relations, media advocacy, and grassroots network resources, all supported by policy research. For the AHA, assessing the evidence base is a significant part of the policy development process, translating science into policy solutions that have a measurable health impact. The AHA’s policy research department

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2016 American Heart Association

295. Nutrigenomics, the Microbiome, and Gene-Environment Interactions: New Directions in Cardiovascular Disease Research, Prevention, and Treatment

cholesterol. A growing evidence base that includes millions of participants who have provided detailed dietary and lifestyle data and biological specimens has shaped our understanding of biological pathways for micronutrient and macronutrient metabolism and their effects on disease. Findings from these efforts serve as the foundation for the evolution of contemporary dietary guidelines, which are refined as new technologies and methods permit ever more rigorous standards for defining optimal nutritional (...) interactions with genetic factors on cardiometabolic traits. Second, these GxE SNPs were enriched in adaptation to climatic and geographical features, with implications for energy homeostasis and response to physical activity. Third, a comparison with gene networks responding to plasma cholesterol lowering or regression of atherosclerotic plaques showed that GxE genes have a greater role in those responses, particularly through high-energy diets and fat intake, than do GWAS-identified genes for the same

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2016 American Heart Association

296. Acute Myocardial Infarction in Women

modifiable risk factors (smoking, hypertension, DM, waist-to-hip ratio, dietary patterns, physical activity, alcohol consumption, plasma apolipoproteins, and psychosocial factors) that account for 96% of the population-attributable risk of MI in women. For young women with favorable levels of all 5 major traditional risk factors (smoking, hypertension, DM, serum cholesterol, and body mass index), CHD is a rare event, but unfortunately, only ≈20% of US women <40 years of age meet these low-risk criteria (...) with women with a level of ≤135 mm Hg. Unfortunately, national surveys continue to show low rates of hypertension awareness, treatment, and control among women, although these rates have increased over time. , Dyslipidemia Elevated levels of total cholesterol and low-density lipoprotein cholesterol predict cardiac death in both middle-aged (<65 years) and older (≥65 years) women, but the strength and consistency of these relationships in older women are diminished. Reduced high-density lipoprotein

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2016 American Heart Association

297. Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science

. Women with increased susceptibility to IHD as a result of genetic or environmental risk factors should receive education on how to reduce their risk. Ethnicity and Culture Identification with an ethnic group often implies shared cultural traditions. Although ethnicity is frequently associated with culture, the 2 terms are distinct. Ethnicity refers to ancestry and a person’s country of origin or place of parental or ancestor birth and is used to distinguish racial groups. On the other hand, culture (...) denotes a learned pattern of behavior in which beliefs, values, norms, and practices are shared from 1 generation to the next and influence thoughts and actions of a particular group. Women are influenced by their ethnicity and cultural background and thus are not considered to be a homogeneous group. A woman’s ethnic or culture background creates complex norms and expectations that affect all aspects of life, including marital status, childbearing, caregiving roles, food preparation, educational

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2016 American Heart Association

298. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for the Diagnosis and Treatment of Postmenopausal Osteoporosis

to apply these guidelines must be made in light of local resources and individual patient circumstances.2 AACE/ACE Postmenopausal Osteoporosis CPG, Endocr Pract. 2016;22(Suppl 4) Abbreviations: AACE = American Association of Clinical Endocrinologists; AFF = atypical femur fracture; ASBMR = American Society for Bone and Mineral Research; BEL = best evidence level; BMD = bone mineral density; BTM = bone turnover marker; CBC = complete blood count; CI = confidence interval; DXA = dual-energy X-ray (...) analyses, evidence gaps, alternative physician preferences (dissenting opinions), alternative recommen- dations (e.g., based on resource availability and cultural factors), expert consensus and relevance (i.e., patient-ori- ented evidence that matters) (1 [EL 4; CPG NE]). (Endocr Pract. 2016;22:Suppl4;1-42) 3. EXECUTIVE SUMMARY To guide readers, recommendations are organized into the following questions: • Q1. How is fracture risk assessed and osteoporosis diagnosed? • Q2. When osteoporosis

2016 American Association of Clinical Endocrinologists

299. Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association

evidence demonstrates not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus, but that the addition of CRF to traditional risk factors significantly improves the reclassification of risk for adverse outcomes. The purpose of this statement is to review current knowledge related to the association between CRF and health outcomes, increase awareness of the added value of CRF to improve (...) , it was excluded from the risk calculator. The authors of the guidelines noted that the evidence that CRF would enhance risk classification was inconclusive, and thus, the added contribution of CRF to determine CVD risk was uncertain. There is, however, a large body of epidemiological and clinical evidence demonstrating not only that CRF is a potentially stronger predictor of mortality than established risk factors such as smoking, hypertension, high cholesterol, and type 2 diabetes mellitus (T2DM

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2016 American Heart Association

300. Practice Guidelines for the Diagnosis and Management of Aspergillosis

Recommendations 17. Amphotericin B (AmB) deoxycholate and its lipid derivatives are appropriate options for initial and salvage therapy of Aspergillus infections when voriconazole cannot be administered. However, AmB deoxycholate should be reserved for use in resource-limited settings in which no alternative agents are available. Lipid formulations of AmB should be considered in settings in which azoles are contraindicated or not tolerated (strong recommendation; moderate-quality evidence) . 18. Aerosolized

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2016 Infectious Diseases Society of America

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