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E/M Established Outpatient Visit

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2841. Ostomy Care & Management

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Purpose and Scope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Summary of Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Interpretation of E vidence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Development Panel Members 12 Stakeholder Acknowledgement (...) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Background C ontext 17 C ore Recommendations 19 Practice Recommendations 26 Education Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Organization & Policy Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Research Gaps and F uture Implications 49 E valuation/Monitoring of Guideline

2009 Registered Nurses' Association of Ontario

2842. Remote monitoring for implantable cardiac devices

cardiac devices require regular visits to outpatient clinics so that practitioners can check on device performance and monitor for instances of cardiac arrhythmia. Unscheduled visits may also be necessary to investigate device dysfunction, or symptoms that may or may not be related to the implanted device. The main disadvantage of intermittent visits to an outpatient clinic is that device dysfunctions are often identified slowly, which can lead to possible emergency situations. Changes (...) device, a patient may also need to make an extra unscheduled visit to the outpatient clinic. Evaluations often involve device interrogation by radio telemetry, which requires the expertise of an experienced programmer. Remote monitoring: February 2006 3 The main disadvantage of periodic evaluations is the overall lack of efficiency in the follow-up of patients. Device dysfunction may be identified weeks or months after the event, changes to medication schedules may be delayed, and patients may

2008 Australia and New Zealand Horizon Scanning Network

2843. Guideline for the Use of General Anaesthesia (GA) in Paediatric Dentistry

guideline. May 2008 final 4 7. Treatment planning. Comprehensive planning aims at ensuring that all the treatment required is carried out under a single GA. The practice of extracting the most grossly carious and/or symptomatic teeth and leaving restorable teeth for future visits as an outpatient using LA with or without sedation is to be deprecated. This has been shown to result in a high rate of repeat GA (9). The inability of the child to accept treatment using LA is an important factor (...) surgical removal or exposure. • Biopsy of a hard or soft tissue lesion. • Debridement and suturing of orofacial wounds. • Established allergy to local anaesthesia. • Post operative haemorrhage requiring packing and suturing. • Examination under GA, including radiographs, for a special needs child where clinical evidence exists that there is a dental problem which warrants treatment under GA. Severe pulpitis and acute infection are by far the most common conditions treated under GA (3,4). May 2008 final

2008 Royal College of Surgeons of England

2844. Assessment and Management of Acute Pain in Adult Medical Inpatients

established to identify priority topics and to ensure the quality of final reports. Comments on this evidence report are welcome and can be sent to Susan Schiffner, ESP Program Manager, at Susan.Schiffner@va.gov. VA-ESP April 2008 ii Assessment and Management of Pain in Inpatients EXECUTIVE SUMMARY BACKGROUND Poor pain management in surgical settings is known to be associated with slower recovery, greater morbidity, longer lengths of stay, lower patient satisfaction, and higher costs of care, suggesting (...) intensity measures in the outpatient, postsurgical, and palliative care settings. However, this evidence is not likely to be applicable to medical inpatients. In the emergency department, patients who have mild to moderate pain that is not due to malignancy or coronary disease receive less timely, and less effective treatment than other patients. This finding is likely to be relevant to inpatients as well. Potential risk factors for delayed or inadequate analgesia include female sex, less severe pain

2008 Veterans Affairs Evidence-based Synthesis Program Reports

2845. CPG on Prevention and Treatment of Childhood/Adolescent Obesity

Practice Guideline and it is subject to updating. This CPG has been funded via an agreement entered into by the Carlos III Health Institute, an autonomous body within the Spanish Ministry for Science and Innovation, and the Catalan Agency for Health Technology Assessment, within the framework for cooperation established in the Quality Plan for the Spanish National Healthcare System of the Spanish Ministry for Health and Social Policy. This guideline must be cited: Working Group of the Guideline (...) National Healthcare System (SNHS) created a project known as GuíaSalud. This aims to improve clinical decisions based on scientific evidence via training activities and by establishing a register of CPGs within the SNHS. Since then, the GuíaSalud project has evaluated dozens of CPGs according to ex- plicit criteria established by its scientific committee, and it has registered them and dissemi - nated them via the Internet. In early 2006, the Management Body of the Quality Agency of the SNHS developed

2009 GuiaSalud

2846. Defending Dignity - Challenges and opportunities for nursing

Hospital) However, most respondents cited at least one environmental barrier to dignified care, with many listing a range of problems encountered related to the physical environment, for example: Our war d is cr amped, old fashioned, badly designed with p o o r r e s o u r c e s a n d p o o r m a i n t e n a n c e . C u p b o a r d s w i t h d r a w e r s t h a t d o n ’ t o p e n s o t h a t p a t i e n t s h a v e n o w h e r e t o p u t t h e i r b e l o n g i n g s , n o s t i m u l a t i o n , n o (...) t e l e v i s i o n s o r p o o r l y p o s i t i o n e d T V s ( s m a l l , p l a c e d h i g h o n t h e w a l l , r e c e i v e o n l y 1 c h a n n e l ) , c u r t a i n s t h a t d o n ’ t r u n p r o p e r l y o r h a n g o f f . N o s h o w e r s o n l y o l d b a t h s t h a t n e c e s s i t a t e t h e p a t i e n t t o b e h o i s t e d i n e v e n i f t h e y d o n ’ t w a n t t o . . . I c o u l d g o o n a n d y e s i t i s a n N H S t r u s t a n d n o I d o n ’ t w o r k i n t h

2008 Royal College of Nursing

2847. Natural History of Individuals With Immune System Problems That Lead to Fungal Infections

, children, and siblings of this group. Healthy volunteers not related to the first two groups. Design: This long-term study may last for up to 10 years. Those in the study may need to provide new information about every 6 months. The procedures for each person may vary with the particular diagnosis and the extent of fungal infection. Healthy volunteers may have only one or two visits. At the first visit, those in the study will have a full medical history and physical exam. They will also provide blood (...) . Research procedures may include the following: Saliva, urine or stool testing Mouthwash collection for DNA testing Collection of cheek cells, nail clippings, or vaginal fluid Tests of leftover tissue or body fluid from previous medical procedures Skin or oral mucous membrane biopsy Collection of white blood cells Followup visits will involve a physical exam and updated medical history. Blood, saliva, urine, or nail clipping samples may be taken for ongoing studies. Any additional tests or exams

2011 Clinical Trials

2848. Clinical Guideline on the Treatment of Carpal Tunnel Syndrome

(region-specific; hand/wrist) • PEM (region-specific; hand) • SF-12 or SF-36 Short Form Health Survey (generic; physical health component for global health impact) (Grade B, Level I, II, and III) vii Work Group Panel Michael Warren Keith, MD (Chair) 2500 Metro Health Drive Cleveland, OH 44109-1900 Orthopaedic Hand Surgeon Victoria Masear, MD (Co-Chair) 48 Medical Park E Dr Ste 255 Birmingham, AL 35235-3411 Orthopaedic Hand Surgeon Kevin Chung, MD University of Michigan Medical Center 1500 East Medical (...) Grand Rapids, MI 49525 Orthopaedic Surgery Brent Graham MD University of Toronto 399 Bathurst St. 425-2 East Wing Toronto, ON M5T 2S8 Canada Orthopaedic Hand Surgeon/Microsurgery Guidelines Oversight Chair: William C. Watters, III MD 6624 Fannin #2600 Houston, TX 77030 Orthopaedic Spine Surgeon AAOS Staff: Charles M. Turkelson, PhD AAOS Research Director 6300 N River Road Rosemont, IL 60018 Robert H. Haralson III, MD, MBA AAOS Medical Director 6300 N River Road Rosemont, IL 60018 Orthopaedic Surgeon

2008 Congress of Neurological Surgeons

2849. Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache

Headache: Jonathan A. Edlow, MD (Chair) Peter D. Panagos, MD Steven A. Godwin, MD Tamara L. Thomas, MD Wyatt W. Decker, MD Members of the American College of Emergency Physicians Clinical Policies Committee (Oversight Committee): Andy S. Jagoda, MD (Chair 2003-2006, Co-Chair 2006- 2007) Wyatt W. Decker, MD (Co-Chair 2006-2007, Chair 2007- 2008) Deborah B. Diercks, MD Barry M. Diner, MD (Methodologist) Jonathan A. Edlow, MD Francis M. Fesmire, MD John T. Finnell, II, MD, MSc (Liaison for Emergency (...) Medical Informatics Section 2004-2006) Steven A. Godwin, MD Sigrid A. Hahn, MD John M. Howell, MD J. Stephen Huff, MD Eric J. Lavonas, MD Thomas W. Lukens, MD, PhD Donna L. Mason, RN, MS, CEN (ENA Representative 2004-2006) Edward Melnick, MD (EMRA Representative 2007-2008) Anthony M. Napoli, MD (EMRA Representative 2004- 2006) Devorah Nazarian, MD AnnMarie Papa, RN, MSN, CEN, FAEN (ENA Representative 2007-2008) Jim Richmann, RN, BS, MA(c), CEN (ENA Representative 2006-2007) Scott M. Silvers, MD Edward

2008 Congress of Neurological Surgeons

2850. Diagnosis of Cushing's Syndrome

mobile search navigation Article navigation 1 May 2008 Article Contents Article Navigation The Diagnosis of Cushing's Syndrome: An Endocrine Society Clinical Practice Guideline Lynnette K. Nieman 1Program on Reproductive and Adult Endocrinology (L.K.N.), National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892 Search for other works by this author on: Beverly M. K. Biller 2Neuroendocrine Unit/Massachusetts General Hospital (B.M.K.B.), Boston (...) , Massachusetts 02114 Search for other works by this author on: James W. Findling 3Medical College of Wisconsin (J.W.F.), Milwaukee, Wisconsin 53226 Search for other works by this author on: John Newell-Price 4University of Sheffield (J.N.-P.), Sheffield S102JF, United Kingdom Search for other works by this author on: Martin O. Savage 5William Harvey Research Institute, Queen Mary, University of London (M.O.S.), London EC1M6BQ, United Kingdom Search for other works by this author on: Paul M. Stewart

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2008 The Endocrine Society

2851. Evidence Behind the 4-Hour Rule for Initiation of Antibiotic Therapy in Community-Acquired Pneumonia

Affiliations Emergency Medicine Residency Program, New York Presbyterian Hospital, New York, NY Correspondence Address for correspondence: Kenneth T. Yu, MD, MBA, 525 E 68th St, Box 301, New York, NY 10021 , MD, MBA a , , x Kenneth T. Yu Affiliations Emergency Medicine Residency Program, New York Presbyterian Hospital, New York, NY Correspondence Address for correspondence: Kenneth T. Yu, MD, MBA, 525 E 68th St, Box 301, New York, NY 10021 , x Peter C. Wyer Affiliations Emergency Medicine Residency Program (...) in the last decade in recognizing the need to prioritize the care of patients with conditions such as ST-elevation myocardial infarction and acute ischemic stroke. In these conditions, timing is critical in determining outcome because the window for revascularization is limited. x 1 Marler, J.R., Tilley, B.C., Lu, M. et al. Early stroke treatment associated with better outcome: the NINDS rt-PA Stroke Study. Neurology . 2000 ; 55 : 1649–1655 | | | , x 2 McNamara, R.L., Wang, Y., Herrin, J. et al. Effect

2008 Evidence-Based Emergency Medicine

2852. Comorbidity of mental disorders and substance use

current stage in the Stage of Change. In the model the patient is at one of several stages relevant to changing their behaviour. The stages are: • P r ec on t empla tion: the pa tien t is not in t ending t o change . • C on t empla tion: the pa tien t is think ing about chang ing . • D et er mina tion: the pa tien t has decided t o change . • A c tion: the pa tien t is tak ing ac tiv e st eps t o w ar ds chang ing . • M ain t enanc e: the changed beha viour has been established . • R elapse: the pa (...) method should be used to establish rapport and develop a common understanding of the problems and an agreed management plan. 2.1 Detection The most common questions include: • Ho w t o iden tify the pr esenc e of possible pr oblems . • W hich pr oblem t o f ocus on first . • W hether/ho w t o addr ess both pr oblems c oncur r en tly 3 . Failure to detect all issues may contribute to poor treatment retention and outcomes 3 . When a patient presents with either a substance-use 1 related problem

2008 Clinical Practice Guidelines Portal

2853. Eating disorders toolkit, a practice based guide to the inpatient management of adolescents with eating disorders, with special reference to regional and rural areas

? To facilitate consultation with specialist staff ? To provide clarity regarding effectiv e treatment approaches for clinicians ? To improve consistency in practice across NSW It is important to note that hospital admissions are only one part of a lengthy treatment process for young people with an eating disorder. As such, admissions are not viewed as “curative”, but necessary at times to restore healthy mental, physical and social functioning to enable continued treatment in the community. Eating Disorders (...) THE MOST APPROPRIATE SITE FOR TREATMENT Factors to Consider When Making a Referral Nature of the Problem ? Is the presentation predominantly an eat ing disorder or another mental health issue? ? What are the main aims of treatment? ? Is this something that can be m anaged within your current team? ? What type of health service or professional would best meet the needs of this individual? Severity of the Illness ? Is the young person at ri sk of medical instability? ? Is the young person psychologically

2008 Clinical Practice Guidelines Portal

2854. Guidelines for the management of hypertensive disorders of pregnancy 2008

, Dekker G, Gatt S, McLintock C, McMahon L, Mangos G, Moore MP, Muller P, Paech M, Walters B. These are the recommendations of a multidisciplinary working party convened by the Society of Obstetric Medicine of Australia and New Zealand. They reflect current medical literature and the clinical experience of members of the working party. 1. Definition of hypertension in pregnancy Normal pregnancy is characterized by a fall in blood pressure, detectable in the first trimester and usually reaching a nadir (...) . Measurement of blood pressure should be undertaken in both arms at the initial visit to exclude rare vascular abnormalities such as aortic coarctation, subclavian stenosis and aortic dissection. Gener- ally the variation in blood pressure between the upper limbs should be less than 10 mmHg. The systolic blood pressure is accepted as the first sound heard (K1) and the diastolic blood pressure the disap - pearance of sounds completely (K5)(8-10). Where K5 is absent, K4 (muffling) should be accepted. Correct

2008 Clinical Practice Guidelines Portal

2855. Pharmacologic-based strategies for smoking cessation: clinical and cost-effectiveness analyses

) Vancouver, British Columbia Jed E. Rose, PhD Professor, Duke University Medical Center Durham, North Carolina Authorship Khai Tran, research lead, coordinated the research project; selected studies; extracted, tabulated and analyzed data; and wrote the clinical sections of the report. Keiko Asakawa, lead for the economic section, selected articles; extracted data for the economic review; performed the economic modelling, and population and budget impact analyses; wrote the economic, budget impact (...) Administration warns that a risk of suicidality is associated with the use of bupropion, but no causal relationship has been established. 25,26 The most commonly observed adverse events with the use of bupropion for smoking cessation are dry mouth and insomnia. 1.2.3 Varenicline Varenicline tartrate (Champix, Chantix) is a prescription drug that is used to help adults stop smoking. 27 Varenicline helps to relieve the craving and withdrawal symptoms that are associated with smoking cessation. Smokers

2010 EvidenceUpdates

2856. Intranasal Naloxone for acute opiate overdose: Reducing needle stick risk, improving time to medication delivery

prevalence of blood born pathogens such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) accidental needle stick injury may pose a life-changing and possibly life-ending event for affected health care workers. This risk is higher in the prehospital environment where a combination of patient and environmental factors make needle stick injury more likely.[10] Marcus et al found an HIV seroprevalence rate of 4.1 to 8.9 per 100 patient visits in three inner-city ED (...) but difficult to quantify efficacy due to difficult follow-up. [52] Dahlem et al provide insights into developing a take home IN naloxone program at a homeless shelter. They found this program effective and safe and recommend implementation in clinical practice.[53] Han et al noted that introducing home IN naloxone programs to outpatient centers provides an intervention that makes the doctors and providers more satisfied with their interactions with this difficult patient population. [60] As of 2017

2010 Therapeutic Intranasal Drug Delivery

2857. Intranasal Medications in Hospice and Palliative care

issues discussed will be treatment of breakthrough pain, sedation of the acutely agitated patient and home therapy of seizures in the hospice setting. All three of these topics are covered in great detail for all patient populations in other sections of this web site and you are encouraged to visit the pain, sedation and seizure therapy sections of this web site by simply clicking on the appropriate tab in the upper left margin of this web page. As of 2014 this topic has been overwhelmingly (...) for treating pain either in the hospice setting or in other painful situations ( ).[19] A comprehensive review of transmucosal fentanyl was posted on in August of 2009 and readers with interest should visit and download this document (090916_Fentanyl August 2009_2).[20] It describes the literature to date regarding oral transmucosal fentanyl, sublingual fentanyl and intranasal fentanyl in the setting of chronic pain. The document points out that intranasal fentanyl is superior to oral transmucosal fentanyl

2010 Therapeutic Intranasal Drug Delivery

2858. Intranasal midazolam for acute seizure therapy

. 398-9. 9. Fisgin, T., et al., Effects of intranasal midazolam and rectal diazepam on acute convulsions in children: prospective randomized study. J Child Neurol, 2002. 17 (2): p. 123-6. 10. Holsti, M., et al., Prehospital intranasal midazolam for the treatment of pediatric seizures. Pediatr Emerg Care, 2007. 23 (3): p. 148-53. 11. Lahat, E., et al., Comparison of intranasal midazolam with intravenous diazepam for treating febrile seizures in children: prospective randomised study. Bmj, 2000. 321 (...) -7. 18. Holsti, M, et al: Intranasal midazolam versus rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy. Arch Pediatr Adolesc Med 2010;164(8):747-753. ( ) 19. McMullan J, Sasson C, Pancioli A, Silbergleit R. Midazolam versus diazepam for the treatment of status epilepticus in children and young adults: a meta-analysis. Acad Emerg Med 2010;17(6):575-82. 20. de Haan GJ, van der Geest P, Doelman G, Bertram E, Edelbroek P. A comparison of midazolam nasal

2010 Therapeutic Intranasal Drug Delivery

2859. Carglumic acid (Carbaglu)

Carglumic acid (Carbaglu) CENTER FOR DRUG EVALUATION AND RESEARCH APPLICATION NUMBER: 22-562 MEDICAL REVIEW(S) CLINICAL REVIEW Application Type NDA Application Number(s) 22-562 Priority or Standard Priority Submit Date(s) 17-June-2009 Received Date(s) 18-June-2009 PDUFA Goal Date 13-March-2010 Division / Office Gastroenterology Products/ODE 3 Reviewer Name(s) Virginia Elgin, M.D. Helen Sile, M.D. Review Completion Date February 18, 2010 Established Name carglumic acid (Proposed) Trade Name (...) carglumic acid exposure Patient Baseline Average Post-Baseline Average Paired Difference (Post-baseline vs Baseline) 47 10 -37 12 16 3.9 105 46 -58.9 1.5.3 Safety The retrospective case series and study IND 68,185 have established a favorable safety and tolerability profile for carglumic acid 100 to 250 mg/kg/day oral for the treatment of hyperammonemia associated with NAGS deficiency. Despite the small sample size that may limit the identification of potential safety signals, 91% of the patients

2010 FDA - Drug Approval Package

2860. Glycopyrrolate oral solution

/2010CLINICAL REVIEW Application Type NDA Application Number(s) 22-571 Priority or Standard S Submit Date(s) September 26, 2009 Received Date(s) September 28, 2009 PDUFA Goal Date July 28, 2010 Division / Office Division of Dermatology and Dental Products, ODE III Reviewer Name(s) Fred Hyman, DDS, MPH Review Completion Date May 28, 2010 Established Name Glycopyrrolate (Proposed) Trade Name TBD Therapeutic Class Xerostomic Agent (6030503) Applicant Shionogi Formulation(s) Oral Solution 1 mg/5 mL Dosing (...) Treatment-Emergent Adverse Events 63 Table 17: Severe AE's 65 Table 18: Treatment Emergent Adverse Events Associated with Disorders in Hepatic, Renal, or Pancreatic Function: Open Label and Controlled Trials 67 Table 19: AERS Search Results for Glycopyrrolate: 1979 - present 75 Table 20: Dose Titration Schedule 78 Clinical Review Fred Hyman, DDS, MPH NDA 22-751 Glycopyrrolate Oral Solution 1 mg/5 mL 6 Table of Figures Figure 1: mTDS Responders 34 Figure 2: mTDS Scores by Visit 35 Figure 3: Results

2010 FDA - Drug Approval Package

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