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Cushing Response

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221. Imaging Guidelines

and are not intended as a substitute for the provider’s clinical judgment and experience. The responsible provider must make all treatment decisions based upon his or her independent judgment and the patient’s individual clinical presentation. The ACS and any entities endorsing the Guidelines shall not be liable for any direct, indirect, special, incidental, or consequential damages related to the use of the information contained herein. The ACS may modify the TQIP Best Practices Guidelines at any time without

2018 American College of Surgeons

222. Drug Therapy for Early Rheumatoid Arthritis: A Systematic Review Update

No. 2018-SR-02). 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 of AHRQ or PCORI. Therefore, no statement in this report should be construed as an official position of PCORI, AHRQ, or of the U.S. Department of Health and Human Services. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report (...) group, comparison type, and study design 18 Table 6. Characteristics of included studies 19 Table 7. Disease activity, response, and radiographic progression 29 Table 8. Studies included in KQ 1 network meta-analyses 42 Table 9. Results for patient-reported outcomes, functional status, and quality of life 61 Table 10. Discontinuation rates and adverse events 84 Table 11. Studies included in KQ 3 network meta-analysis 98 Table 12. Summary of findings about benefits and harms of treatments for early

2018 Effective Health Care Program (AHRQ)

223. Hirsutism: Evaluation and Treatment

. Evaluation A thorough history and physical examination plus selected laboratory evaluations will confirm the diagnosis and direct treatment. Treatment Pharmacologic interventions can suppress ovarian or adrenal androgen production and block androgen receptors in the hair follicle. Hair removal methods and lifestyle modifications may improve or hasten the therapeutic response. Outcomes At least 6 to 9 months of therapy are required to produce improvement in hirsutism. Evidence The quality of evidence (...) should be educated regarding the associated health problems or long-term medical consequences of hyperandrogenism, particularly in the context of polycystic ovary syndrome, including obesity, irregular menses, anovulation, infertility, pregnancy-induced hypertension, diabetes, hyperlipidemia, hypertension, and heart disease. Summary Statements 1. The Ferriman-Gallwey score can be used in the assessment of hirsutism to help quantify the problem and help assess response to treatment. A score ≥8

2017 Society of Obstetricians and Gynaecologists of Canada

224. Guideline on the Diagnosis, Treatment, and Follow-up of Patients with Endometrial Cancer

All of these documents will also be available on the websites listedabove. 1.8 Responsibilities 1.8.1 Authorsof theguideline Editorialteam " Prof.Dr.UweWagner(Co-ordinator,DGGG),Uni-Frauenklinik, Baldingerstraße,35043Marburg,Germany " Dr.PhilippHarter(DGGG),KlinikenEssen-Mitte,Henricistraße 92,45136Essen,Germany " PD Dr. Felix Hilpert (DGGG), Universitätsklinikum Schleswig Holstein, Campus Kiel, Klinik für Gynäkologie und Geburt- shilfe,Arnold-Heller-Straße3,Haus24,24105Kiel,Germany " PD Dr. Sven (...) and associations with prognosis in advanced epithelial ovarian cancer: a Gynecologic OncologyGroupstudy.GynecolOncol2007;106:221–232 43 Bellati F et al. Immunology of gynecologic neoplasms: analysis of the prognostic significance of the immune status. Curr Cancer Drug Tar- gets2009;9:541–565 44 CreeIA.Chemosensitivityandchemoresistancetestinginovariancan- cer.CurrOpinObstetGynecol2009;21:39–43 45 Harry VN, Gilbert FJ, Parkin DE. Predicting the response of advanced cervical and ovarian tumors to therapy. Obstet

2018 German Guideline Program in Oncology

225. Neurosurgical emergency

management of an acute neurosurgical emergency is crucial. A CT scan will usually help in identifying such situations. However, it is important to clinically consider the possibility of a neurosurgical emergency even before the CT scan is performed. Useful pointers (but not a comprehensive list): Following trauma A. Rapid loss of consciousness B. Initial lucid interval followed by rapid loss of consciousness C. Unequal pupils D. Cushing’s triad: hypertension, bradycardia and abnormal respiration E. Focal (...) FOR THE DISTRICT GENERAL HOSPITAL Appropriate staff identified Local ambulance service notified State ventilated neurosurgical emergency patient transfer Expect ASAP response time Essential equipment Airway bag (tape, face mask, T piece, ambubag, ETT, laryngoscopes, scissors) Drug bag (Fluid boluses, Mannitol and/or 2.7% saline, fentanyl) Ventilator and oxygen Infusion pumps (sedation, muscle relaxant, vasoactive infusions) Adequate monitoring ECG SpO 2 Blood pressure (NIBP cuff or arterial) End tidal CO 2

2018 Children's Acute Transport Service

226. Atopic Eczema

of Atopic Eczema (8, 9). 14 Data base and literature search 15 For this consensus-based guideline, no systematic literature review has been performed. 16 During the kick-off meeting in Copenhagen in 2015, subgroups of two authors were 17 determined among the expert panel to be responsible for the draft of specific sections of the 18 guideline by virtue of their clinical and scientific expertise (Table R1). Discrepancies between 19 the two respective authors were escalated to the steering committee (...) part I and II final – 24.01.18 (modified 08.05.19) 16 AE management from a patient’s perspective 1 2 Due to the variety of different AE therapies and different individual reactions, patients and 3 their caregivers need clear and easy to understand strategies for their individual needs in 4 therapy, and in order to become comfortable to take over responsibility for the treatment of 5 their chronic condition. Patients and caregivers need to be trained to understand and apply 6 the existing

2018 European Dermatology Forum

227. European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults Full Text available with Trip Pro

of widespread metastatic disease. In these patients, we recommend either mitotane monotherapy or mitotane, etoposide, doxorubicin and cisplatin depending on prognostic parameters. In selected patients with a good response, surgery may be subsequently considered. (vii) In patients with recurrent disease and a disease-free interval of at least 12 months, in whom a complete resection/ablation seems feasible, we recommend surgery or alternatively other local therapies. Furthermore, we offer detailed (...) therapeutic measures (e.g. radiation therapy, radiofrequency ablation, chemoembolization) are of particular value. However, we suggest against the routine use of adrenal surgery in case of widespread metastatic disease. In these patients, we recommend either mitotane monotherapy or mitotane, etoposide, doxorubicin and cisplatin depending on prognostic parameters. In selected patients with a good response, surgery may be subsequently considered. (vii) In patients with recurrent disease and a disease-free

2018 European Society of Endocrinology

228. European Society of Endocrinology Clinical Practice Guidelines for the management of aggressive pituitary tumours and carcinomas Full Text available with Trip Pro

and pituitary carcinomas, following documented tumour growth (++00). R 3.4.2 We recommend first evaluation of treatment response after 3 cycles. If radiological progression is demonstrated, temozolomide treatment should be ceased (++00). R 3.4.3 We recommend use of the standard dosing regimen: 150–200 mg/m 2 for 5 consecutive days every 28 days (+000). R 3.4.4 We recommend monitoring of haematological parameters, liver function tests and careful clinical observation for potential adverse effects during (...) treatment (+++0). R 3.4.5 We suggest, in patients with rapid tumour growth in whom maximal doses of radiotherapy have not been reached, combining temozolomide with radiotherapy (Stupp protocol) (+000). R 3.4.6 We suggest that evaluation of MGMT status by immunohistochemistry by an expert neuropathologist should be performed. High MGMT expression is suggestive of a lack of response; however, there may be exceptions (++00). R 3.4.7 In patients responding to first-line temozolomide, as assessed after 3

2018 European Society of Endocrinology

231. Guidelines for the Use of Laparoscopy during Pregnancy

. Solid Organ Resection Guideline 18: Laparoscopic adrenalectomy, nephrectomy and splenectomy are safe procedures in appropriately selected pregnant patients (+; Weak). Laparoscopic adrenalectomy during pregnancy has proven effective in the management of primary hyperaldosteronism [162] , Cushing’s syndrome [163-166] , and pheochromocytoma [167-173] . Laparoscopic splenectomy has also become an increasingly accepted surgical approach in pregnancy [174-176] . Gravid patients with antiphospholipid

2017 Society of American Gastrointestinal and Endoscopic Surgeons

232. Management of Dyslipidaemia

outcome in individual patient care. Every health care provider is responsible for the management of his/her unique patient based on the clinical presentation and management options available locally. REVIEW OF THE GUIDELINE This guideline is issued in 2017 and will be reviewed in about 5 years or earlier if important new evidence becomes available. CPG Secretariat Health Technology Assessment Unit Medical Development Division Level 4, Block EI, Parcel E Government Offices Complex 62590 Putrajaya (...) ) and triglycerides (TG). ? LDL-C is usually calculated by the Freidewald equation which is not valid in the presence of elevated TG (TG > 4.5 mmol/L). ? Both fasting and non-fasting samples may be used for lipid screening. • Dyslipidaemias may be primary or secondary to nephrotic syndrome, obstructive liver disease, hypothyroidism, Cushing’s syndrome, drugs, alcoholism and insulin resistance states such as T2DM and metabolic syndrome. Treatment of the underlying aetiology can lead to an improvement in the lipid

2017 Ministry of Health, Malaysia

233. Primary & Secondary Prevention of CVD

-morbidities, acceptance of patients towards recommended therapy etc. Every health care provider is responsible to individualise the management of his/her unique patient based on the clinical presentation and management options available locally. REVIEW OF THE GUIDELINE This guideline is issued in 2017 and will be reviewed in 2022 or earlier if important new evidence becomes available. CPG Secretariat Health Technology Assessment Unit Medical Development Division Level 4, Block EI, Parcel E Government (...) of major risk factors for CVD. This is followed by CPGs on the Management of Acute Myocardial Infarction, Heart Failure and Cerebrovascular Accidents. More recently, in 2010, the MOH launched the National Strategic Plan for Non-Communicable Disease (NSP-NCD) in response to the global challenge in combatting NCD in general and CVD in particular. This document is now being updated by the MOH to reflect latest developments in the field and more current global targets set by the World Health Organisation

2017 Ministry of Health, Malaysia

236. Management of Diabetes Mellitus in Primary Care

will inevitably and appropriately occur 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 (...) . The insulin resistance resulting in T2DM is thought to be due to excess adiposity, especially central distribution of adiposity, but can be due to other factors, such as corticosteroid treatment or Cushing’s syndrome. Gestational diabetes (GDM) is DM present during pregnancy. Other more unusual types of DM also exist, such as maturity onset diabetes of the young (MODY), latent VA/DoD Clinical Practice Guideline for the Management of Type 2 Diabetes Mellitus in Primary Care April 2017 Page 6 of 160

2017 VA/DoD Clinical Practice Guidelines

237. Urotrauma

Strength: Grade B) 5. The surgical team must perform immediate intervention (surgery or angioembolization in selected situations) in hemodynamically unstable patients with no or transient response to resuscitation. (Standard; Evidence Strength: Grade B) 6. Clinicians may initially observe patients with renal parenchymal injury and urinary extravasation. (Clinical Principle) 7. Clinicians should perform follow-up CT imaging for renal trauma patients having either (a) deep lacerations (AAST Grade IV-V (...) , especially those with higher grade injuries. Although devitalized parenchyma has been suggested as a risk factor for development of septic complications, evidence supporting intervention for this radiographic finding is inconclusive. Close Guideline Statement 5 The surgical team must perform immediate intervention (surgery or angioembolization in selected situations) in hemodynamically unstable patients with no or transient response to resuscitation. (Standard; Evidence Strength: Grade B) × Discussion

2017 American Urological Association

238. CRACKCast E110 – Thought Disorders

restraint are immediately necessary for patients who demonstrate aggressive and dangerous behavior Appropriate disposition depends on the etiology of the underlying psychosis, response to treatment, and patient and community safety considerations and, more often than not, includes psychiatric consultation. Welcome to the first of six psychiatry chapters! “Patients with a history of mental illness have a higher rate of emergency department (ED) visits then the general population. Patients with at least (...) erythematosus Temporal (giant cell) arteritis ORGAN FAILURE Hepatic encephalopathy Uremia NEUROLOGIC DISORDERS Alzheimer’s disease Cerebrovascular disease Encephalitis (including HIV infection) Encephalopathies Epilepsy Huntington’s disease Multiple sclerosis Neoplasms Normal-pressure hydrocephalus Parkinson’s disease Pick’s disease Wilson’s disease ENDOCRINE DISORDERS Addison’s disease Cushing’s disease Panhypopituitarism Parathyroid disease Postpartum psychosis Recurrent menstrual psychosis Sydenham’s

2017 CandiEM

239. Mepolizumab (Nucala, GlaxoSmithKline plc.) for the Treatment of Severe Asthma with Eosinophilia: Effectiveness, Value, and Value-Based Price Benchmarks

therapies for severe asthma include leukotriene inhibitors, theophylline, and omalizumab. Oral corticosteroids are used for short-term therapy to control asthma exacerbations and chronically for severe asthma that cannot be controlled without these drugs. Physicians try to avoid chronic oral corticosteroid therapy because it is associated with many long-term complications including growth suppression in children, osteoporosis, Cushing’s syndrome, adrenal insufficiency, muscle weakness, diabetes (...) . 15 Studies of mepolizumab dosing and eosinophil response have indicated similar pharmacodynamics between the FDA-approved 100 mg SC dose and the 75 mg IV dose. 16 We searched ClinicalTrials.gov and did not identify any additional trials completed more than two years ago that would have met our inclusion criteria but have not been published. The MENSA trial was a double-blind randomized controlled trial (RCT) of 576 patients ages 12 years and older (mean age 50 years, 57% female, 25% chronic use

2017 California Technology Assessment Forum

240. Glasgow Coma Scale for Field Triage of Trauma: A Systematic Review

(Contract No. 290-2015-00009-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 of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report (...) mild. 14 The 2011 field triage guidelines from the Centers for Disease Control and Prevention (CDC) National Expert Panel recommend transporting patients with tGCS scores of 13 or less to facilities providing the highest level of trauma care. 4 In some circumstances (e.g., trauma victims who are intoxicated, intubated, or whose other injuries influence response) it may not be possible to accurately assess the verbal and eye components of the GCS. In these cases, assessments may be primarily based

2017 Effective Health Care Program (AHRQ)

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