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261. Management of Stroke Rehabilitation

when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every healthcare professional making use of these guidelines is responsible for evaluating the appropriateness of applying them in the setting of any particular clinical situation. These guidelines are not intended to represent Department of Veterans Affairs or TRICARE policy. Further, inclusion of recommendations for specific testing (...) and Amy O. Bowles, MD and Lt Col Andrew W. Bursaw, DO from the DoD, as Champions for the 2019 CPG. The Lewin Team, including The Lewin Group, Duty First Consulting, ECRI Institute, and Sigma Health Consulting, LLC, was contracted by the VA and DoD to support the development of this CPG and conduct the evidence review. In February 2018, the contracting officer’s representative (COR), leaders from the VA Office of Quality, Safety and Value and the DoD Office of Evidence Based Practice, and the Champions

2019 VA/DoD Clinical Practice Guidelines

262. Substance use disorders in pregnancy: clinical, ethical, and research imperatives of the opioid epidemic Full Text available with Trip Pro

on epidemiology, prenatal screening, pain management, and treatment modalities of OUD in pregnancy, workshop participants were assigned to 1 of 3 breakout groups to discuss the following key issues in greater depth and to make preliminary recommendations: (1) screening and testing for substance use disorder, including OUD, in pregnancy; (2) pain management during the antepartum, intrapartum, and postpartum periods; and (3) management modalities for pregnant women with OUD. The following key findings emerged (...) from the workshop discussions: • All pregnant women should be screened for substance use at the first prenatal visit with the use of a validated questionnaire, such as the National Institute on Drug Abuse (NIDA) Quick Screen Tool. • Biologic testing, when performed, should be undertaken only with the woman’s informed consent and when its benefits outweigh any potential harms, which include those related to mandatory state reporting laws. • For opioid-naïve women, nonsteroidal anti-inflammatory

2019 Society for Maternal-Fetal Medicine

263. Appropriate prescribing of psychotropic medication for non-cognitive symptoms in people with dementia

of two or three types occurring together. For instance, a person may have both Alzheimer’s disease and vascular dementia at the same time. Moderate symptoms Symptoms that are stressful and upsetting to the person with dementia; may require specific management. Non-cognitive symptoms Non-cognitive symptoms associated with dementia include psychosis (delusions, hallucinations), mood disturbances (depression, euphoria, irritability, anxiety), personality changes (disinhibition, apathy), agitation (...) that may occur following use of certain serotonergic medications. Symptoms can range from mild to severe and can include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhoea. Selective serotonin A class of drugs that are typically used as antidepressants in the treatment reuptake inhibitor of major depressive disorder and anxiety disorders. Severe symptoms Symptoms that are very stressful and upsetting to the person with dementia; typically requires

2019 National Clinical Guidelines (Ireland)

264. Management of Acute ST Segment Elevation Myocardial Infarction (STEMI) – (4th Edition)

with chest pain or chest pain equivalent, a 12 lead ECG should be done and interpreted 0.5 mm (= 1 mm in men 95% as a single test on admission and almost 100% when repeated after 3 hours. 26 Sex-dependent values are recommended for hs-troponin assays. 27-29 MANAGEMENT OF ACUTE ST SEGMENT ELEVATION MYOCARDIAL INFARCTION (STEMI) 2019 50 CK-MB (measured by mass assay) is the next best alternative. It is less tissue- specific than troponins and values differ between the gender. The criterion most commonly (...) grounds, a = 20% increase in the value of either troponins or CK-MB between 2 samples 3-6 hours apart supports the diagnosis. 29-31 To ensure the reliability of these tests, each individual laboratory should maintain high quality laboratory practice and confirm the range of reference values in their specific setting. Total CK measurement is also not recommended owing to its poor specificity and large distribution in skeletal muscles. 29MANAGEMENT OF ACUTE ST SEGMENT ELEVATION MYOCARDIAL INFARCTION

2019 Ministry of Health, Malaysia

265. Management of Heart Failure (4th Edition)

stress 6. DIAGNOSIS40 Signs which are more specific for HF are an elevated jugular venous pulse (JVP), and a third heart sound. These signs are associated with adverse outcomes. 19 A fourth heart sound is due to atrial contraction and is more frequent in patients with HFpEF. It is absent in patients with atrial fibrillation (AF). These signs may be accompanied by a laterally displaced apical impulse and a cardiac murmur. Other supportive signs include peripheral oedema, tachycardia, narrow pulse (...) , evidence of scarring and wall motion abnormalities ? Diastolic function of the heart ? Valvular structure and function ? Congenital cardiac abnormalities ? LV mechanical dyssynchrony ? Pulmonary hypertension. It is the most useful and widely available test to establish the diagnosis in patients suspected of HF. Natriuretic Peptides BNP and NTproBNP are a family of hormones secreted (NP): by the ventricles in response to wall stress. ? Brain natriuretic They are useful in the following situations

2019 Ministry of Health, Malaysia

266. Public Health Planning for Wildfire Smoke

and they should be going to these cleaner air shelters, it is less than declaring a state of emergency, but it is an emergency because you’re trying to do extraordinary steps to protect the public health” Emergency Manager 16 | P a g e assessments; stress testing community infrastructure; and asset mapping to understand how existing community resources might be utilized during an emergency or a smoke event. A few jurisdictions had begun the process of mapping community infrastructure and assessing its (...) with as a basis for decision making. Collecting and analysing data on the mental health impacts of wildfires and wildfire smoke was seen by many as an important and particularly difficult challenge. Occupational health Protection of workers in camps, particularly in northern regions, was raised as a challenging issue. While employees of camps such as cooks and administrators are often covered by occupational health and safety regulations, contracted and temporary workers usually are not. Workers tended

2019 National Collaborating Centre for Environmental Health

267. 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy Full Text available with Trip Pro

, Treatments, and Diagnostic Testing in Patient Care.* Reproduced with permission of the American College of Cardiology and the American Heart Association. x 2 Halperin, J.L., Levine, G.N., Al-Khatib, S.M. et al. Further evolution of the ACC/AHA clinical practice guideline recommendation classification system: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation . 2016 ; 133 : 1426–1428 | | | ---- | ---- Figure 2 Algorithm (...) = one-PDZ and one-LIM domain protein; MLP/CRP3 = muscle LIM protein/cysteine-rich protein 3; FHL2 = four-and-a-half LIM protein 2; MAPRs = muscle ankyrin repeat proteins; MURFs = muscle-specific ring-finger proteins. Modified with permission of the American Physiological Society. x 38 Hoshijima, M. Mechanical stress-strain sensors embedded in cardiac cytoskeleton: Z disk, titin, and associated structures. Am J Physiology Heart Circ Physiol . 2006 ; 290 : H1313–H1325 | | | ---- | ---- Figure 6

2019 International Society for Heart and Lung Transplantation

268. Achieving Health Equity in Preventive Services

Achieving Health Equity in Preventive Services Achieving Health Equity in Preventive Services Comparative Effectiveness Review Number 222 R Comparative Effectiveness Review Number 222 Achieving Health Equity in Preventive Services Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 Contract No. 290-2015-00009-I Prepared by: Pacific Northwest Evidence-based Practice Center Portland (...) health workers for breast cancer. • Evidence is low or insufficient for other interventions due to lack of studies or their limitations. iii This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00009-I). The National Institutes of Health (NIH) Office of Disease Prevention funded the report. The findings and conclusions in this document

2019 Effective Health Care Program (AHRQ)

269. Diagnosis and Treatment of Non-Neurogenic Overactive Bladder (OAB) in Adults

to OAB (e.g., excessive nighttime urine production, sleep apnea). Urgency urinary incontinence is defined as the involuntary leakage of urine, associated with a sudden compelling desire to void. Incontinence episodes can be measured reliably with a diary, and the quantity of urine leakage can be measured with pad tests. However, in patients with mixed urinary incontinence (both stress and urgency incontinence), it can be difficult to distinguish between incontinence subtypes. Therefore, it is common (...) of symptoms and baseline symptom levels, to ensure that symptoms are not the consequence of some other condition and to determine whether the patient constitutes a complex OAB presentation that may require referral. Questions should assess bladder storage symptoms associated with OAB (e.g., urgency, urgency incontinence, frequency, nocturia), other bladder storage problems (e.g., stress incontinence episodes) and bladder emptying (e.g., hesitancy, straining to void, prior history of urinary retention

2019 American Urological Association

270. Incontinence after Prostate Treatment: AUA/SUFU Guideline (2019)

urinary incontinence or urgency predominant mixed urinary incontinence should be offered treatment options per the American Urological Association Overactive Bladder guideline. (Clinical Principle) 11. Prior to surgical intervention for stress urinary incontinence, stress urinary incontinence should be confirmed by history, physical exam, or ancillary testing. (Clinical Principle) 12. Patients with incontinence after prostate treatment should be informed of management options for their incontinence (...) urodynamic testing in a patient prior to surgical intervention for stress urinary incontinence in cases where it may facilitate diagnosis or counseling. (Conditional Recommendation; Evidence Level: Grade C) Treatment Options 16. In patients seeking treatment for incontinence after radical prostatectomy, pelvic floor muscle exercises or pelvic floor muscle training should be offered. (Moderate Recommendation; Evidence Level: Grade B) 17. Artificial urinary sphincter should be considered for patients

2019 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction

271. Comprehensive Systematic Review Summary: Treatment of Tics in People with Tourette Syndrome and Chronic Tic Disorders

Tourette syndrome (TS) is a neurodevelopmental condition that is characterised by the presence of multiple motor tics and at least one vocal tic that persist for at least one year. 1 Motor tics are defined as sudden, rapid, recurrent, and nonrhythmic movements. Not all tics are “jerk-like” (clonic); some may be more sustained (dystonic), may consist of isometric contractions (tonic), are manifested by sudden and transient cessation of movement (blocking), or repetitive movements (stereotypic tics (...) to fluctuate in number, distribution, frequency, and severity over time, exhibiting a characteristic waxing and waning course. In addition to spontaneous fluctuations, both emotional and environmental factors have been shown to modulate tic expression. Psychological stress, tiredness, and boredom are among commonly reported exacerbating factors, whereas relaxation and mental and physical engagement in pleasant tasks can alleviate tics. Tics improve by adulthood in a considerable proportion of individuals

2019 American Academy of Neurology

272. Developing a Value Framework for Genetic Diagnosis: Part I A Systematic Review of Outcomes Hierarchies and Measurement Approaches

as well as oversight of the process. The Chair of the Committee / TEP is Marc Williams, MD, FAAP, FACMG. Linda A Bradley, PhD, FACMG and Glenn E. Palomaki, PhD performed the review. Funding for the review was provided by the ACMG Foundation through a contract with Women & Infants Hospital of Rhode Island. Methods The initial scope of this review was modified during article selection and review to fit available resources, by deferring review of KQ 6 on costs and economics (the denominator of value (...) be controversial, based on views of different stakeholders. Purpose and Scope of the Review This qualitative systematic review was commissioned by the American College of Medical Genetics Foundation for the American College of Medical Genetics (ACMG) Ad Hoc Committee on the Value of Genetic Diagnosis (contracted May 1, 2011). The ACMG Mission Statement is to “Improve Health Through Medical Genetics”, and one of five stated goals is to “Maintain structure and integrity of ACMG and its value to members

2019 American College of Medical Genetics and Genomics

273. Screen-based activities and children and young people’s mental health and psychosocial wellbeing: a systematic map of reviews

(NIHR) Policy Research Programme (PRP) for the Department of Health and Social Care. It was funded through the NIHR PRP contract with the EPPI Centre at UCL (Reviews facility to support national policy development and implementation, PR-R6-0113-11003). The views expressed in this publication are those of the author(s) and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. Funder involvement The Department of Health and Social (...) satisfaction 3 0 3 Social support/social skills 2 0 1 Loneliness 1 0 0 Stress/distress 1 0 0 Peer problems/bullying 1 0 2 Contextual factors Demographics 4 0 3 School factors 2 0 2 Parenting/family factors 1 0 1 *Not mutually exclusive as reviews investigate more than one outcome 3.3.6 Quality of included reviews Ten of the eleven reviews were suitable for critical appraisal 3 . Overall, the reviews were classified as either high (n=8) or medium quality (n=two). None of the reviews were classified as low

2018 EPPI Centre

274. Global Vascular Guidelines for patients with chronic limb-threatening ischemia Full Text available with Trip Pro

CLTI should be referred urgently to a vascular specialist. Accurately staging the severity of limb threat is fundamental, and the Society for Vascular Surgery Threatened Limb Classification system, based on grading of Wounds, Ischemia, and foot Infection (WIfI) is endorsed. Objective hemodynamic testing, including toe pressures as the preferred measure, is required to assess CLTI. Evidence-based revascularization (EBR) hinges on three independent axes: Patient risk, Limb severity, and ANatomic (...) in CLTI. The importance of multidisciplinary teams and centers of excellence for amputation prevention is stressed as a key health system initiative. Keywords: , , , , , , , , GVG Guideline writing group conflict of interest policy: industry relationships I. Introduction The organizations participating in the Global Vascular Guidelines are committed to the precept of developing trustworthy clinical practice guidelines through transparency and full disclosure by those participating in the process

2019 Society for Vascular Surgery

275. Encorafenib (Braftovi) - unresectable or metastatic melanoma with a BRAF V600 mutation

discontinuation. See summary of product characteristics (SPC) for information on dose modifications for adverse events. 1-3 It is recommended that patients continue treatment with encorafenib and binimetinib until patients no longer derive benefit or the development of unacceptable toxicity. Before taking encorafenib and binimetinib, patients must have confirmation of BRAF V600 mutation using a validated test. The efficacy and safety of encorafenib in conjunction with binimetinib has not been established (...) ). For the respective groups, Kaplan-Meier estimates of 1 year event-free probability were 57% and 33%, and for 2 years 32% and 24%. 4, 7, 8 An updated analysis was conducted following a total of 231 PFS events (113 PFS events in the encorafenib plus binimetinib group and 118 PFS events in the vemurafenib group). At a median follow-up of 32.1 months, the HR for PFS was reduced to 0.51 (95% CI: 0.39 to 0.67, p<0.001). 5 A hierarchical statistical testing strategy was applied for the key secondary outcomes

2019 Scottish Medicines Consortium

276. Telehealth for Acute and Chronic Care Consultations

Telehealth for Acute and Chronic Care Consultations Telehealth for Acute and Chronic Care Consultations Comparative Effectiveness Review Number 216 RComparative Effectiveness Review Number 216 Telehealth for Acute and Chronic Care Consultations Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 Contract No. 290-2015-00009-I Prepared by: Pacific Northwest Evidence-based Practice Center Portland (...) reduce heart attack mortality. o Remote consultations for outpatient care likely improve access and clinical outcomes. • More detailed telehealth consultation costs and outcomes data would improve modeling assumptions. • Future research should employ rigorous methods and standardized outcomes for consistent measurement of telehealth consultation effectiveness.iii This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center (EPC) under contract to the Agency

2019 Effective Health Care Program (AHRQ)

277. Management of Infertility

Management of Infertility Management of Infertility Comparative Effectiveness Review Number 217 RComparative Effectiveness Review Number 217 Management of Infertility Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 Contract No. 290-2015-00004-I Prepared by: Duke Evidence-based Practice Center Durham, NC Investigators: Evan R. Myers, M.D., M.P.H. Jennifer L. Eaton, M.D., M.S.C.I. Kara (...) live birth rates but substantially lower reductions in multiple birth rates than multiple-embryo transfer.iii This report is based on research conducted by the Duke Evidence-based Practice Center (EPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00004-I. The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views

2019 Effective Health Care Program (AHRQ)

278. Buprenorphine (Buvidal) - Treatment of opioid dependence

buprenorphine/naloxone for the mean percentage of urine samples with test results negative for illicit opioids. Chairman Scottish Medicines Consortium 2 Indication Treatment of opioid dependence within a framework of medical, social and psychological treatment. Treatment is intended for use in adults and adolescents aged 16 years or over. 1, 2 Dosing Information Buvidal® is intended for subcutaneous (SC) administration only. It should be injected slowly and completely (...) with test results negative for illicit opioids for weeks 1 to 24. For the FDA, the primary outcome was responder rate. A responder was defined as no evidence of illicit opioid use by having a negative urine test result and no self-reported drug use at pre-specified times (in phase 1 at week 12 and for at least 2 of 3 assessments at weeks 9 to 11 and in phase 2 for at least 5 of 6 assessments from weeks 12 to 24, including month 6 (that is weeks 21-24). Urine samples were collected with temperature

2019 Scottish Medicines Consortium

279. Inotersen (Tegsedi) - for the treatment of stage 1 or stage 2 polyneuropathy in adult patients with hereditary transthyretin amyloidosis (hATTR)

about future progress of the disease, which is ultimately fatal. They may experience issues maintaining employment or feel stressed dealing with family commitments while attending to the increasing care needs of the patient. As the condition is hereditary it is possible that more than one family member is affected, which can add to the burden of the patient and carer. It might be that the carer also has hATTR. The hereditary aspect may compound the 4 marked psychological impact of the disease (...) score includes four components (heart rate deep breathing, nerve conduction tests, touch-pressure sensation and heat-pain sensation). 2, 3 The minimum clinically 5 significant difference in mNIS+7 is considered to be 2 points. ? change from baseline to week 66 in total score of Norfolk Quality of Life-Diabetic Neuropathy (QOL-DN) questionnaire which comprises 35 questions (total score ranges from -4 to 136, with higher scores indicating poorer quality of life). There are five subdomains including

2019 Scottish Medicines Consortium

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