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101. Tympanostomy Tubes in Children with Otitis Media

for Healthcare Research and Quality; May 2017. www.effectivehealthcare.ahrq.gov/reports/final.cfm. doi: https://doi.org/10.23970/AHRQEPCCER185. ii Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of systematic reviews to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. These reviews provide comprehensive, science-based information on common (...) technical and content experts. Broad expertise and perspectives were sought. Divergent and conflicting opinions are common and perceived as healthy scientific discourse that results in a thoughtful, relevant systematic review. Therefore, in the end, study questions, design, methodologic approaches, and/or conclusions do not necessarily represent the views of individual technical and content experts. Technical Experts must disclose any financial conflicts of interest greater than $10,000 and any other

2017 Effective Health Care Program (AHRQ)

102. Epilepsy in Pregnancy

. Introduction and background epidemiology Epilepsy is one of the most common neurological conditions in pregnancy, with a prevalence of 0.5–1%. 3 An estimated 2500 infants are born to WWE every year in the UK. 4 About one-third of WWE are in the reproductive age group. 5 The risk of death is increased ten-fold in pregnant WWE compared with those without the condition. 3 Fourteen maternal deaths that occurred between 2009 and 2012 were attributed to epilepsy in the 2014 MBRRACE-UK (Confidential Enquiries (...) and the puerperium, including the definition of seizures for the obstetrician? The diagnosis of epilepsy and epileptiform seizures should be made by a medical practitioner with expertise in epilepsy, usually a neurologist. Women with a history of epilepsy who are not considered to have a high risk of unprovoked seizures can be managed as low-risk women in pregnancy. Health professionals working with WWE should be aware that the epilepsies are a heterogeneous group of brain diseases with the common feature

2016 Royal College of Obstetricians and Gynaecologists

103. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

, the potential for coronary artery complications was not appreciated. KD is now the most common cause of acquired heart disease in children in developed countries. In the absence of pathognomonic tests, the diagnosis continues to rest on the identification of principal clinical findings and the exclusion of other clinically similar entities with known causes. Timely initiation of treatment with intravenous immunoglobulin (IVIG) has reduced the incidence of coronary artery aneurysms defined from absolute (...) the illness in childhood also supports the contribution of genetic factors. In the continental United States, KD is more common during the winter and early spring, boys with the disease outnumber girls by ≈1.5–1.7:1, and 76% of affected children are <5 years of age. , , From a global perspective, regions in the extratropical northern hemisphere have seasonal peaks in the winter, with low numbers of cases in the late summer and fall. A lack of a seasonal cycle has been noted in the tropics

2017 American Heart Association

104. Management of Patients on Non?Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

. NOACs are substrates for P-glycoprotein (P-gp) trans- port and apixaban and rivaroxaban are substrates for CYP 3A4 metabolism. Therefore, concomitant medica- tions that are inducers or inhibitors of these pathways should be evaluated for the potential to interact (Table 2). Macrolides and nondihydropyridine calcium channel blockers are 2 commonly prescribed classes of medica- tions that impact therapeutic levels of NOACs, although a post hoc analysis of ROCKET AF (Rivaroxaban Once Daily Oral Direct (...) Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation) showed no evidence of differential outcomes between rivaroxaban and warfarin in patients treated with =1 combined P-gp and CYP 3A4 inhibitors. 6 Edoxaban exists in a predominantly unchanged form Figure 1. Clotting cascade and anticoagulants. VKA indicates vitamin K antagonist. Downloaded from http://ahajournals.org by on March 27, 2019Raval et al March 7, 2017 Circulation

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2017 American Heart Association

105. Management of Pregnancy in Patients With Complex Congenital Heart Disease: A Scientific Statement for Healthcare Professionals From the American Heart Association

disturbances, including atrial and ventricular premature beats and reentrant supraventricular tachycardia (SVT). Similarly, ventricular arrhythmias, although rare in labor, have been reported in 5% of normal gravidas. Common changes observed on the ECG are listed in . Table 2. Normal Electrocardiographic Changes Associated With Pregnancy Left axis shift is seen, with the greatest shift in the third trimester caused by elevation of the diaphragm. Shortening of the PR, QRS, and QT intervals may accompany (...) should be organized in an adult CHD center. More recently, a prospective validation study reported that the modified WHO classification of maternal cardiovascular risk was the most reliable predictor of maternal cardiovascular complications, the most common of which are arrhythmias and heart failure. The recommendation to each patient, however, should be individualized. If a reparable lesion or clinical problem is identified at the time of prepregnancy counseling, a recommendation for directed

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2017 American Heart Association

106. Normal birth

and costs incurred for any reason associated with the use of this guideline, including the materials within or referred to throughout this document being in any way inaccurate, out of context, incomplete or unavailable. © State of Queensland (Queensland Health) 2018 This work is licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 Australia. In essence, you are free to copy and communicate the work in its current form for non-commercial purposes, as long as you attribute (...) to enable informed choice 31 and consent 24 o Respect the woman’s right to decline recommended care 2,31,40 o Provide a pathway for women declining recommended care · Provide emotional and physical support to the woman o Use supportive language to build confidence in the woman · Respect and implement birth plan 40,56 [refer to Table 4. Birth preparation] · Involve the woman in clinical handover 57 Professional culture · A culture which includes 58 : o Mutual trust o Clear and respected boundaries o

2017 Queensland Health

107. 2017 Antithrombotic Therapy in Atrial Fibrillation Associated with Valvular Heart Disease: A Joint Consensus Document from EHRA and ESC Working Group on Thrombosis

blood can activate the contact (intrinsic) coagulation pathway. Both intrinsic and extrinsic pathways converge factor X (FX) activation and then the transformation of prothrombin into thrombin (FIIa) and formation of the fibrin mesh. The vitamin K antagonist (VKA), warfarin, by blocking the formation of the vitamin K-dependent clotting FVII, FIX, FX, and FII prevents the activation of the coagulation cascade at the extrinsic and intrinsic pathway levels. In addition to the thrombogenic contribution (...) , and AF in association with valvular heart disease (VHD) is also common. However, management strategies for this group of patients have been less informed by randomized trials, which have largely focused on ‘non-valvular AF’ patients. Thrombo-embolic risk also varies according to valve lesion and may also be associated with CHA 2 DS 2 VASc score risk factor components, rather than only the valve disease being causal. Given marked heterogeneity in the definition of valvular and non-valvular AF

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2017 Heart Rhythm Society

108. AIM Clinical Appropriateness Guidelines for Pharmacogenetic Testing and Genetic Testing for Thrombotic Disorders

of VTE. Because standard of care for evaluation of thrombophilias includes protein assays for common anticoagulants and single-site mutation studies, large NGS panels are not considered medically necessary. Factor V Leiden The Factor V Leiden (FVL) variant (1691G>A; R506Q) in the F5 gene is the most common known inherited risk factor for thrombosis. This mutation leads to reduced inactivation of clotting factor V by PROPRIETARY Guidelines developed by, and used with permission from, Informed Medical (...) individuals in the general US and European population. Prothrombin (F2) The second most common inherited risk factor for VTE is the 20210G>A (G20210A) variant in the F2 gene. This activating mutation leads to higher circulating levels of prothrombin, which results in an increased risk for clot formation. Heterozygous carriers of the F2 mutation have a 2-fold to 4-fold increased risk of VTE compared to non-carriers (Rosendaal 2009). Again, however, the absolute risk of a VTE in heterozygotes remains quite

2017 AIM Specialty Health

109. Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

, leading to 75% clearance within 8 minutes. Like endogenous tPA, alteplase achieves clot lysis by converting inactive endogenous plasminogen to plasmin, mainly in the presence of fibrin. Plasmin, in turn, breaks fibrin into fibrin split products ( ). Its relative fibrin specificity limits systemic fibrinolysis compared with other thrombolytic agents such as streptokinase. Figure 2. Mechanism of action of alteplase and various treatments in patients with thrombolysis-related hemorrhage. In green (...) encountered even without the use of thrombolytic or anticoagulant agents. In a pooled analysis of thrombolytic clinical trials, radiographic evidence of hemorrhage occurred in 24.2% of placebo-treated patients and 32.5% of alteplase-treated patients ; most of these hemorrhages were considered asymptomatic. Thus, it is clear that hemorrhagic infarction occurs as part of the natural history of ischemic stroke. In contrast to the common occurrence of hemorrhagic infarction, parenchymal hematoma is uncommon

2017 American Heart Association

110. Diagnosis and Management of Noncardiac Complications in Adults With Congenital Heart Disease: A Scientific Statement From the American Heart Association

. Multiple signaling pathways communicate between the 2 organ systems, including the renin- angiotensin-aldosterone system, natriuretic peptides, and sympathetic nervous system. Renal disease has long been linked to acquired cardiovascular disease, to common risk factors such as hypertension and DM, and to chronic kidney disease (CKD)–specific risk fac- tors such as chronic anemia, malnutrition, and vascular calcification. 31 These complex cardiac and renal inter- actions have been codified (...) factors can be targeted for preventive intervention. A s survival to adulthood in individuals with congenital heart disease (CHD) has improved, adults with CHD are increasingly at risk for noncardiac com- plications. 1,2 The median age of adults with CHD has increased to 40 years, and the number of adults with CHD >65 years of age is steadily growing. 3–5 As pa- tients age, common adult comorbidities such as diabetes mellitus (DM), coronary artery disease, and hypertension may have an impact on long

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2017 American Heart Association

111. Cardiovascular Health in African Americans: A Scientific Statement From the American Heart Association (PubMed)

are to describe cardiovascular health and the burden of CVD in the population; to discuss the contribution of traditional CVD risk factors and adverse health behaviors to disparities in cardiovascular health between African Americans and whites; to describe the contribution of comorbidities that are overrepresented among African Americans to CVD; to identify and discuss genetic and biological mechanisms that might contribute to the disease pathways leading to CVD in African Americans; to highlight unique (...) of incident intracerebral hemorrhage was 40.1 (95% CI, 17.8–90.4) in African Americans and 65.1 (95% CI, 39.1–108.4) in whites 65 to 74 years old. At ages ≥75 years, the incidence rates were 65.8 (95% CI, 24.4–177.8) in African Americans and 105.0 (95% CI, 64.3–171.3) in whites. Peripheral Arterial Disease Atherosclerotic disease affecting the arteries and vessels outside of the heart, peripheral arterial disease/peripheral vascular disease, is a common geriatric disease with a prevalence of 12% to 20

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2017 American Heart Association

112. Atrial Fibrillation

Concomitant atrial fibrillation surgery 69 11.4.2 Stand-alone rhythm control surgery 71 11.5 Choice of rhythm control following treatment failure 72 11.6 The atrial fibrillation Heart Team 72 12 Hybrid rhythm control therapy 74 12.1 Combining antiarrhythmic drugs and catheter ablation 74 12.2 Combining antiarrhythmic drugs and pacemakers 74 13 Specific situations 74 13.1 Frail and ‘elderly’ patients 74 13.2 Inherited cardiomyopathies, channelopathies, and accessory pathways 75 13.2.1 Wolff–Parkinson–White (...) to the standards for generating recommendations that are common to all ESC guidelines (see preamble), this Task Force discussed each draft recommendation during web-based conference calls dedicated to specific chapters, followed by consensus modifications and an online vote on each recommendation. Only recommendations that were supported by at least 75% of the Task Force members were included in the guidelines. We hope that these guidelines will help to deliver good care to all patients with AF based

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2016 European Society of Cardiology

113. Healthcare performance reporting bodies

. The most common clinical variation indicator type relates to effective or necessary care, as defined by the Center for the Evaluative Clinical Sciences (3). Effective care refers to clinical activities such as tests, investigations or interventions which generally have a good evidence basis and should be routinely provided to a patient at a point in their pathway. Indicators relating to cancer, stroke and cardiovascular disease are the most frequently reported, with maternity and surgery also well (...) information according to their needs. Clinical variation findings • The most common clinical variation indicator type relates to effective or necessary care. • Cancer, stroke and cardiovascular disease are the most commonly reported clinical topics, with maternity and surgery also well represented. • Preference-sensitive data are increasingly reported (although not always) using interactive maps in the style of Dartmouth. • Supply-sensitive clinical variation indicators are less common. • Interesting

2016 Sax Institute Evidence Check

114. Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke

of alteplase is best described as a 2-compartment model. The first consists of a plasma redistribution phase and hepatic clearance and is the dominant mode of elimination (ie, 85% of the area under the curve). The second consists of formation of a complex with plasminogen activator inhibitor-1 followed by hepatic clearance. , The half-life of alteplase is nearly 4 minutes, leading to 75% clearance within 8 minutes. Like endogenous tPA, alteplase achieves clot lysis by converting inactive endogenous (...) evidence of hemorrhage occurred in 24.2% of placebo-treated patients and 32.5% of alteplase-treated patients ; most of these hemorrhages were considered asymptomatic. Thus, it is clear that hemorrhagic infarction occurs as part of the natural history of ischemic stroke. In contrast to the common occurrence of hemorrhagic infarction, parenchymal hematoma is uncommon and occurs much more frequently in the setting of thrombolysis. It has been suggested that hemorrhagic infarction is a result of multifocal

2017 American Academy of Neurology

115. European Society of Endocrinology Clinical practice guidelines for the care of girls and women with Turner syndrome

facial appearance, with neck webbing and lymphedema ( , ), we suggest that the clinical manifestations of TS should be broadened to include other features, such as linear growth failure, ovarian insufficiency (pubertal delay), early sensorineural hearing loss, distinctive congenital cardiovascular, skeletal, digital and renal anomalies, a particular neurodevelopmental profile, and a constellation of other disorders that are more common in TS, including hypothyroidism and celiac disease ( , , ). Table (...) ( ). In contrast, neurocognitive deficits typical of 45,X TS are common in girls with cytogenetically visible deletions of Xp22.3 ( ), although this may not be the case for girls with submicroscopic Xp22.3 deletions detected only by molecular cytogenetic or microarray studies. Females who have a deletion distal to Xq24 frequently have primary or secondary amenorrhea without short stature or other TS features and should be referred to as having premature ovarian failure (POF). Phenotypic males with 45,X/46,XY

2017 European Society of Endocrinology

116. Hepatitis C Screening

be considered in people who have received medical or dental treatment in countries where HCV is common (anti-HCV prevalence = 2%*) and where infection control may be poor. *Please see Appendix 2 for a list of countries with anti-HCV prevalence of = 2%. Quality/level of evidence: low Strength of recommendation: conditional/weak People with tattoos or body piercings Recommendation 12 12.1 Screening for HCV should be considered for all those with a tattoo. Those most at risk of having acquired HCV through (...) : strong Recipients of substances of human origin Recommendation 17 17.1 Recipients of blood or blood components in Ireland prior to October 1991 who have not yet been tested should be offered screening. 17.2 All recipients of anti-D immunoglobulin in Ireland between 1st May 1977 and the end of July 1979, and 1st March 1991 and 18th February 1994 who have not yet been tested should be offered screening. 17.3 Recipients of plasma-derived clotting factor concentrates in Ireland prior to 1992 who have

2017 National Clinical Guidelines (Ireland)

117. Prevention, Diagnosis & Management of infective endocarditis

children and adults. • The trend of IE has evolved to affect older patients with co-morbidities and no known structural heart disease. • Streptococcus species is a common causative microorganism in young patients with pre-existing structural heart disease whilst Staphylococcus aureus (S. aureus) is more common in the older patients and those with healthcare associated IE. Diagnosis • Early and accurate diagnosis of IE is crucial to institute appropriate treatment and prevent complications. A high level (...) and for complications (refer Section 4.1). • Some common complications of IE are (refer Section 4.1.2): > Heart failure: » Commonly associated with valve dysfunction. » Surgery is indicated for those with acute decompensated heart failure due to valvular dysfunction. > Persistent infection and perivalvular extensions: » Monitor for conduction abnormalities e.g. atrioventricular (AV) block. » TEE should be performed to look for perivalvular extensions. > Systemic embolism: » Usually occurs in left-sided IE

2017 Ministry of Health, Malaysia

118. The Diagnosis and Acute Management of Childhood Stroke, Clinical Guideline

medical and-or clinical training is not recommended, unless in consultation with a relevant health professional. Despite the up-most care taken in developing this document the Murdoch Children’s Research Institute cannot accept any liability, including loss or damage resulting from use of content, or for its accuracy, currency and completeness. THE AUSTRALIA AND NEW ZEALAND CHILD NEUROLOGY SOCIETY Endorsed by: Funded by:Australian Childhood Stroke Advisory Committee i CONTENTS 1 PATHWAY OF CARE 1 2 (...) . Imaging pathway for suspected childhood stroke (29 days to 18 years of age) 14 Table 1. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) 4 Table 2. Implications of GRADE recommendations 4 Table 3. National Health and Medical Research Council Level of Evidence Matrix 5 Table 4. Reported risk factors for childhood stroke 7 Table 5. Clinical presentation of stroke and stroke mimics in children 9 Table 6. Recommendations for investigating stroke in children 9 Table 7

2017 Stroke Foundation - Australia

119. Intrapartum care for healthy women and babies

unit Obstetric Obstetric unit unit Babies without serious medical problems 997 997 998 997 Babies with serious medical problems* 3 3 2 3 * Serious medical problems were combined in the study: neonatal encephalopathy and meconium aspiration syndrome were the most common adverse events, together accounting for 75% of the total. Stillbirths after the start of care in labour and death of the baby in the first week of life accounted for 13% of the events. Fractured humerus and clavicle were uncommon (...) Obstetric unit unit Babies without serious medical problems 991 995 995 995 Intrapartum care for healthy women and babies (CG190) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 8 of 89Babies with serious medical problems* 9 5 5 5 * Serious medical problems were combined in the study: neonatal encephalopathy and meconium aspiration syndrome were the most common adverse events, together accounting for 75% of the total

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

120. Bipolar disorder: assessment and management

% of the adult population, and bipolar II disorder (hypomania and depression) affects approximately 0.4% of adults. Bipolar disorder in children under 12 years is very rare. Since the publication of the previous guideline (NICE clinical guideline 38) in 2006, there have been some important advances in our knowledge of the care pathway and treatment approaches that are most likely to benefit people with bipolar disorder. All areas of NICE clinical guideline 38 have been updated. This guideline covers (...) specific recommendations about other mental disorders that commonly coexist with bipolar disorder. Safeguarding children Remember that child maltreatment: is common can present anywhere, such as emergency departments, primary and secondary care and community settings (such as the child's home). Bipolar disorder: assessment and management (CG185) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 6 of 46Be aware

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

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