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Community Services for the Elderly


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5161. Programmatic management of latent tuberculosis infection in the European Union

which seeks to improve the adherence of people to tuberculosis treatment by having health workers, family members, or community members directly observing the taking of anti-tuberculosis drugs [3]. Education Any programme that improve the knowledge, skills, attitudes, or behaviour of the target group. Education of patients is defined as counselling (see above) while ‘training’ is used for education of healthcare workers (see below). Enablers Things or measures that assist patients in adhering (...) GRADE Grading of Recommendations Assessment, Development and Evaluation HIV Human immunodeficiency virus IGRA Interferon gamma release assay INH Isoniazid LTBI Latent tuberculosis infection MDR TB Multidrug-resistant tuberculosis OR Odds ratio PLHIV People living with human immunodeficiency virus PPD Purified protein derivative PZA Pyrazinamide QFT-Plus QuantiFERON-TB Gold Plus RCT Randomised controlled trial RIF Rifampicin RPT Rifapentine RR Relative risk/risk ratio TB Tuberculosis TNF-alpha Tumour

2019 European Centre for Disease Prevention and Control - Public Health Guidance

5162. Iron deficiency anaemia in adults

affecting an estimated two billion people worldwide (Zimmermann and Hurrell, 2007) and is the most common cause of anaemia seen in primary care. It causes more than 57,000 emergency admissions to hospital each year, at a cost to the NHS of £55.48m (Goddard and Phillips, 2014). Fatigue, weakness and impaired physical function are typical symptoms that can adversely affect an individual’s quality of life and wellbeing and results in a greater demand for health services. Nursing staff in all clinical (...) of the blood to carry oxygen. World Health Organization (WHO) Haemoglobin thresholds used to define anaemia (Pavord et al, 2011) Age or gender group Hb threshold (g/l) Children (0.5 to 5 years) 110 Children (5 to 12 years) 115 Teens (12 to 15 years) 120 Women, non-pregnant (over 15 years) 120 Women, pregnant 110 in first trimester 105 in second and third trimesters 100 post partum (up to six weeks post delivery) Men (over 15 years) 130 The normal range for Hb also varies between different populations

2019 Royal College of Nursing

5163. Heart Failure - Systolic Dysfunction

be made by the physician in light of the circumstances presented by the patient. Clinical Problem and Management Issues Incidence Almost five million Americans currently have HF. An additional 400,000 develop HF annually. Each year 990,000 patients are admitted with HF as the primary diagnosis. Overall, nearly 50% of patients die within five years of the onset of symptoms. The incidence of HF increases with age. HF is the most common cause of hospitalization in older adults. Since the American (...) have heart failure. Narcotics have historically been used for acute symptomatic treatment of patients with end-stage heart failure. Ample anecdotal experience supports this indication for narcotics in end-stage heart failure. Vaccination Influenza vaccination. Influenza vaccination is now recommended by the Centers for Disease Control for all individuals age 6 months and older. Observational studies have demonstrated the general effectiveness of influenza vaccinations in older adults and those

2020 University of Michigan Health System

5164. Management of Type 2 Diabetes Mellitus

patients in the setting of strong family histories of diabetes and in association with other components of the metabolic syndrome. Prevalence. About 8% of the adult U.S population has diabetes, with 95% of these people having type 2 diabetes. The prevalence of diabetes increases with age, with over 25% of the elderly having type 2 diabetes. Non-Caucasians have a prevalence of type 2 diabetes mellitus that is 2 to 6 times greater than that of Caucasians. Increasing obesity in the general population (...) is driving a world-wide epidemic of type 2 diabetes. Obesity is also increasing the prevalence of type 2 diabetes at younger ages. Type 2 diabetes is now present in 3.7% of those aged 20 to 39 years. Obesity is also affecting characteristics that previously distinguished populations likely to have type 2 or type 1 diabetes. Type 2 diabetes typically occurred in patients over 30 years old and weighing = 120% of ideal body weight, while type 1 diabetes occurred in patients under 30 and weighing 135/80

2020 University of Michigan Health System

5165. Vertebroplasty for severely painful osteoporotic vertebral fractures of less than 6 weeks duration

of magnetic resonance imaging (MRI) should be removed from the conservative treatment arm of the model. In summary, ESC noted that the key economic issues related to uncertainty around hospital services as a key driver of incremental cost and the ICER, and suggested that a multiple changes are needed to provide a more appropriate base case. 15. Other significant factors Nil. 21 16. Applicant’s comments on MSAC’s Public Summary Document This application is for elderly patients with severe pain, whose (...) positive. The MSAC has granted equal weighting to three negative trials in a different patient group with older fractures and less severe symptoms which are irrelevant to this application. Elderly inpatients with the worst pain in their life are required to fund vertebroplasty themselves, even despite private health insurance, which is unfair. Further information is available from [ MSAC application 1466]. 17. Further information on MSAC MSAC Terms

2019 Medical Services Advisory Committee

5166. Istradefylline (Nourianz) - Parkinson's disease

of top 3 TEAEs Related to Dizziness, Hypotension or Orthostatic Table 44. Incidence of A Subject Experiencing at Least One TEAE Belonging to the Cardiac SOC Table 47. Treatment-Emergent Adverse Events, Grouped Occurring by Age Group = 65 49.0 (75) 51.3 (446) 47.3 (424) 52.9 (82) 46.6 (471) 48.3 (1564) = 75 8.5 (13) 13.6 (118) 10.2 (91) 12.9 (20) 11.4 (115) 11.4 (369) Race American Indian or Alaska Native 0 0.4 (3) 0.1 (1) 0 0.1 (1) 0.2 (5) Asian 2.6 (4) 29.1 (253) 32.8 (294) 1.9 (3) 28.7 (290) 27.1 (...) : September 6, 2017 for all NDAs and BLAs Reference ID: 4482736 Reference ID: 4484018 21 Clinical Review Natalie Branagan, MD NDA 022075 Nourianz/istradefylline of North America (77%). Pool 8 was similar to Pool 1 with respect to gender and age but was different with respect to race and region. Males made up 50.5% of the population and the median age of the population was 65 years. Asians made up a higher percentage of the population (64.1%). A higher percentage of the population was located outside

2019 FDA - Drug Approval Package

5167. Ustekinumab for the treatment of adult patients with moderately to severely active ulcerative colitis (UC) who have had an inadequate response with, lost response to, or were intolerant to either conventional therapy or a biologic, or have medical contrai

age. The highest annual UC incidence has been reported as 24.3 per 100,000 person-years in Europe, 6.3 per 100,000 person-years in Asia and the Middle East and 19.2 per 100,000 person-years in North America. Standardised mortality rates among patients with UC do not appear to be elevated overall com- pared with the general population. However, elderly patients and those with more comorbidities have a higher risk of mortality. Perioperative and postoperative mortality are also associated (...) , vomiting and fever, are often present. Nearly 70% of patients experience UC symptom flares every few months. Three-quarters of patients (75.6%) have reported that symptoms limit their ability to enjoy leisure activities, while 68.9% have admitted that UC symptoms affect their ability to perform at work. Progression of disease extent is associated with poor prognosis. UC affects approximately the same number of women and men. The peak age for UC onset is between 30 and 40 years, but UC can occur at any

2020 EUnetHTA

5168. CIRSE Standards of Practice on Diagnosis and Treatment of Pulmonary Arteriovenous Malformations (Full text)

of the lung in which abnormally dilated vessels provide a direct capillary-free communication between the pulmonary and systemic circulations with three main clinical consequences: (1) pulmonary arterial blood passing through these right-to-left shunts cannot be oxygenated, which may lead to arterial hypoxemia; (2) the absence of normally filtering capillary bed allows thromboembolic material to reach the systemic circulation (paradoxical embolism), which can result in transient ischaemic attack (...) are asymptomatic and most of the clinical manifestations can be attributed to hypoxia and to right-to-left shunting. Symptoms related to PAVM often develop in patients between the ages of 40 and 60. The incidence of symptoms is higher in patients with multiple and large PAVMs rather than a single PAVM. Patients with diffuse PAVMs are almost always symptomatic [ ]. Incidence of stroke has been reported in about 30% of the patients and brain abscess in 10–20% [ ] with a mortality rate of up to 40

2020 Cardiovascular and Interventional Radiological Society of Europe PubMed abstract

5169. Oral Semaglutide for Type 2 Diabetes: Effectiveness and Value About New England CEPAC The New England Comparative Effectiveness Public Advisory Council (New England CEPAC) – a core program of ICER – provides a public venue in which the evidence on the effectiveness and value of health care services can be discussed with the input of all stakeholders. The New England CEPAC seeks to help patients, clinicians, insurers, and policymakers interpret and use evidence to improve the quality and value of health care. The New (...) Effectiveness Public Advisory Council CHF Congestive heart failure CI Confidence interval CrI Credible interval CKD Chronic kidney disease CMS Centers for Medicare and Medicaid Services CV Cardiovascular CVD Cardiovascular disease CVOT Cardiovascular outcomes trial DPP-4 Dipeptidyl peptidase-4 eCVD Established cardiovascular disease eGFR Estimated glomerular filtration rate evLYG Equal-value life year gained EASD European Association of the Study of Diabetes ESC European Society of Cardiology ESRD End stage

2020 California Technology Assessment Forum

5170. Adapted Value Assessment Methods for High-Impact “Single and Short-Term Therapies” (SSTs)

of alternative assessment approaches. From a procedural standpoint, when beginning the scoping process for a new drug, ICER will review available information in the literature and from stakeholders regarding the nature of the treatment to make a preliminary judgment whether it should be considered as a high-impact SST. ICER will seek consultation during the scoping process with manufacturers, the patient community, clinical experts, and others on the anticipated impact of the treatment. Following formal (...) the base case approach, such as using a different overall perspective (e.g. societal vs. health system), a different age cohort, or a different time horizon. For high-impact SSTs, there may be many dimensions of uncertainty that are relevant for decision- makers. Most often, the one modeling assumption that will have the largest impact on the judgment of long-term value for money will be the duration of benefit. Short-term results must be Adapted Methods for Single and Short-Term Therapies (SSTs) 6

2020 California Technology Assessment Forum

5171. Unsupported Price Increase Assessment

Unsupported Price Increase Report Return to Table of Contents Al-Sawaf O, Bahlo J, Robrecht S, et al. Outcome of patients aged 80 years or older treated for chronic lymphocytic leukaemia. Br J Haematol. 2018 Dec;183(5):727-735. Study design does not meet our criteria for assessing efficacy Jain P, Keating MJ, Wierda WG, et al. Long-term Follow-up of Treatment with Ibrutinib and Rituximab in Patients with High-Risk Chronic Lymphocytic Leukemia. Clin Cancer Res. 2017 May 1;23(9):2154-2158. Study design does (...) Medical care CPI comprises medical care services (professional services, hospital and related services, and health insurance) and medical care commodities (medical drugs, equipment, and supplies). 6 Our intent in choosing the overall medical care CPI and not its subcomponents was to reflect increases in drug prices relative to inflation in the overall price of medical care. The 77 drugs shown in Table 2.2 on the following page had an increase in WAC greater 7.32% over the two-year period; the other 23

2020 California Technology Assessment Forum

5172. Guidelines for Perioperative Care in Cardiac Surgery Enhanced Recovery After Surgery Society Recommendations

for the PREHAB study—Pre-operative Rehabilitation for Reduction of Hospitalization After Coronary Bypass and Valvular Surgery: a randomised controlled trial. BMJ Open . 2015;5(3):e007250. doi: Snowden CP, Prentis J, Jacques B, et al. Cardiorespiratory fitness predicts mortality and hospital length of stay after major elective surgery in older people. Ann Surg . 2013;257(6):999-1004. doi: Valkenet K, van de Port IG, Dronkers JJ, de Vries WR, Lindeman E, Backx FJ. The effects of preoperative exercise therapy (...) . Antifibrinolytic therapy for cardiac surgery: an update. Anesthesiology . 2015;123(1):214-221. doi: Levy JH, Koster A, Quinones QJ, Milling TJ, Key NS. Antifibrinolytic therapy and perioperative considerations. Anesthesiology . 2018;128(3):657-670. doi: Tengborn L, Blombäck M, Berntorp E. Tranexamic acid—an old drug still going strong and making a revival. Thromb Res . 2015;135(2):231-242. doi: Macisaac RJ, Jerums G. Intensive glucose control and cardiovascular outcomes in type 2 diabetes. Heart Lung Circ

2020 ERAS Society

5173. Vitamin D Testing

women age 65 years or older. The US Preventative Services Task Force (2018) concluded that the current evidence is inconclusive to assess the benefits and harms of supplementation with vitamin D alone or in combination with calcium for the primary prevention of factures in community-dwelling postmenopausal women and asymptomatic men. However, considering the strengths and limitations of the analyses, Osteoporosis Canada maintains that individuals with osteoporosis or with risk factors for fractures (...) and Fractures in Older Women: A Randomized Controlled Trial. JAMA. 2010 May 12;303(18):1815. Bolland MJ, Grey A, Avenell A. Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis. Lancet Diabetes Endocrinol. 2018 Nov;6(11):847–58. US Preventive Services Task Force, Grossman DC, Curry SJ, Owens DK, Barry MJ, Caughey AB, et al. Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling

2019 Clinical Practice Guidelines and Protocols in British Columbia

5174. Acute Kidney Injury (AKI)

was further explored in the RISK study, a prospective multicentre cohort study across 72 UK acute medical units collecting data from all patients aged 18 years or older presenting over a 24 hour period [23]. Of the 2,446 patients studied, 384 (16%) sustained an AKI, 25% of which were hospital-acquired (AKI after the first 24 hours of hospital admission). After excluding those with community-acquired AKI, receiving chronic dialysis, or with 25 kg/m 2 ) were associated with an increased risk of AKI (...) renal physician involvement; senior input is intended to ensure that high quality advice has been offered and so may include retrospective but timely discussion of cases referred to non-consultant members of the renal team. (1D) ? transfer protocols should be developed based on the National Early Warning Score (NEWS) to ensure appropriate triage of in-patients with AKI arriving from other hospitals. (1C) ? renal services should work with other specialties and local primary and secondary care

2019 Renal Association

5175. Unmet needs of Indigenous peoples living with HIV

or conducted studies “in a good way”, an expression used by many Indigenous peoples to indicate participation that honors tradition and spirit (31). For example, research done “in a good way” might include culturally appropriate Elder involvement (3), an essential part of Indigenous community-based HIV research (31). Elders are recognized as culturally safe supports who promote positive relationships respecting ceremony and Indigenous ways of knowing (31). Unmet needs among Indigenous peoples living (...) determinants of risk among Indigenous peoples — such as social disadvantage, high rates of injection drug use, poor access to health services, and exposure to stigma and discrimination — need to be addressed. In addition, approaches that focus on empowering and including Indigenous peoples, complemented by leadership that supports and acknowledges HIV and its impact on the community as a whole, are required (9). The following section discusses a selection of primary studies (not captured in the above

2019 Ontario HIV Treatment Network

5176. Treatment of Multiple Myeloma: ASCO and CCO Joint Clinical Practice Guideline

of the medical literature. Recommendations Transplant Eligible Recommendation 1.1. Patients should be referred to a transplant center to determine transplant eligibility (Type: evidence based; Evidence quality: intermediate, bene?t outweighs harm; Strength of recommen- dation: moderate). Recommendation 1.2. Chronologic age and renal function should not be the sole criteria used to determine eligibilityforSCT(Type:evidencebased;Evidencequality:intermediate,bene?toutweighsharm;Strengthof recommendation (...) diagnostic marrow, does not need to be repeated (Type: evidence based; Evidence quality: high, bene?t outweighs harm; Strength of recommendation: strong). Recommendation 8.3. Assessment of other risk factors such as renal insuf?ciency, age, presence of plasma cell leukemia/circulating plasma cells, extramedullary disease, and frailty, should also be considered/ performed (Type: evidence based; Evidence quality: high, bene?t outweighs harm; Strength of recom- mendation: strong). Recommendation 8.4

2019 Cancer Care Ontario

5177. The efficacy of post-exposure prophylaxis (PEP) for HIV

, Fearnley J, McOwan A. High HIV incidence in men who have sex with men attending for postexposure prophylaxis: A service evaluation. Sexually Transmitted Infections. 2017;93(3):214–6. Jain S, Oldenburg CE, Mimiaga MJ, Mayer KH. Subsequent HIV infection among men who have sex with men who used non-occupational post-exposure prophylaxis at a Boston community health center: 1997–2013. AIDS Patient Care and STDs. 2015;29(1):20–5. Raffe SF, Savage C, Perry LA, Patel A, Keith T, Howell R, et al (...) Angeles LGBT Center’s PEP-LA program were prescribed a 28-day course of once daily TDF/FTC (300mg/200mg) PEP between 2011 and 2012 (16). Seven seroconversions occurred within the study period. Among those who seroconverted, the mean time from exposure to first PEP medication dose was 51.5 hours (16). An additional study evaluated a PEP pilot program (P-SQAUD) in two community-based clinics in Los Angeles County (9). Between 2010 and 2011, PEP was offered to 267 individuals with sexual exposure to HIV

2019 Ontario HIV Treatment Network

5178. Valproate Use In Women and Girls Of Childbearing Years

Introduction 8 1. Girls with epilepsy 9 1.1 Females under 10 years 9 1.2 Females aged 10-12 years 10 1.3 Females aged 13-15 years 10 1.4 Females aged 16 years and over 10 2. Girls with bipolar disorder 10 3. Competence to consent to treatment and confidentiality in young women 11 4. Transition of care from paediatric services or CAMHS to adult services 11 5. Women of childbearing potential 12 5.1 Contraception for the PPP 12 5.2 Contraceptive choice in young women 14 5.3 Contraception choice in older women (...) of 19 years or later. All young people with epilepsy, with or without significant ID, should ideally participate in a transition process from the age of 12 years to specifically address the needs of this age group and plan for handover to adult services. This is essential for young women who remain on valproate treatment. In girls with mental illness the transition to adult services will normally occur around 18 years. 5. Women of childbearing potential The MHRA regulations apply to both epilepsy

2019 Royal College of Obstetricians and Gynaecologists

5179. Brexit: RCN priorities overview

age group 3 . We need this younger group of nurses to stay if the service is to remain stable. The UK Government’s decision to cut investment in domestic nursing workforce in England has made England increasingly dependent on EU recruitment. The decision to abolish the English student bursary for example and restrictions on nurse education funding between 2010 and 2018 have made domestic recruitment more and more difficult, leaving employers increasingly dependent on the EU supply 4 . In addition (...) collaborative activities through its various programmes 2 . The RCN is very active, both bilaterally and through umbrella bodies in influencing, developing and implementing changes in policy and practice, as well as working in partnership with nursing organisations for mutual benefit. For example on care in community settings, addressing staffing levels and an ageing workforce. There is a risk of loss of access to the EU’s research funding programme (Horizon 2020 and the subsequent 9th EU Research

2019 Royal College of Nursing

5180. Antimicrobial resistance (AMR): applying All Our Health

the actions that are needed across all sectors to respond to and address the challenges of minimising infections and reducing sets out the World Health Organization’s ( familiarise yourself with the Antibiotic Guardian programmes and to help you have an overview of the subject matter to assist in non-judgmental conversations tailored to individual patients find out about the resources and services in your area that can help people minimize infections, such as local referral pathways (for example travel (...) designed to support is an approach to behaviour change that utilises the millions of day to day interactions that organisations and people have with other people to encourage changes in behaviour that have a positive effect on the health and wellbeing of individuals, communities and populations. Linking All Our Health with Making Every Contact Count and optimising health and wellbeing will reduce the risk of acquiring infections and the demand and need for antibiotics, whilst also empowering

2019 Public Health England

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