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21. Choosing Wisely Canada recommendation - Don’t routinely do screening mammography for average risk women aged 40 – 49. Individual assessment of each woman’s preferences and risk should guide the discussion and decision regarding mammography screening in th

all cases are viral. Though cases of bacterial sinusitis can benefit from antibiotics, evidence of such cases does not typically surface until after at least seven days of illness. Not only are antibiotics rarely indicated for upper respiratory illnesses, but some patients experience adverse effects from such medications. Don’t order screening chest X-rays and ECGs for asymptomatic or low risk outpatients. There is little evidence that detection of coronary artery stenosis in asymptomatic patients (...) . Don’t advise non-insulin requiring diabetics to routinely self-monitor blood sugars between office visits. While self-monitoring of blood glucose (SMBG) for patients with diabetes is recommended by certain groups to help monitor glycemic control, for most adults with type II diabetes who are not using insulin, many studies have shown that routine SMBG does little to control blood sugar over time. Don’t order thyroid function tests in asymptomatic patients. The primary rationale for screening

2019 CPG Infobase

22. Testosterone Testing - Protocol

and Determinants of Testosterone, Dihydrotestosterone, and Estradiol Levels Measured using Liquid Chromatography-Tandem Mass Spectrometry in a Population-Based Cohort of Older Men. J Clin Endocrinol Metab. 2012 Nov;97(11):4030–9. Kannenberg F, Fobker M, Schulte E, Pierściński G, Kelsch R, Zitzmann M, et al. The Simultaneous measurement of serum testosterone and 5α-dihydrotestosterone by gas chromatography–mass spectrometry (GC–MS). Clin Chim Acta. 2018 Jan;476:15–24. Locke J, Flannigan R, Etminan M, Tavokoli H (...) frequently receive prescriptions for testosterone replacement without first having a serum testosterone test to confirm low levels. This practice is not appropriate, as biochemical confirmation of a low for age serum total testosterone (or cBAT) is necessary to confirm the clinical impression of hypogonadism. In the absence of this biochemical confirmation, a re-visitation or verification of the original empiric diagnosis will be very difficult since prolonged androgen therapy will result in suppression

2019 Clinical Practice Guidelines and Protocols in British Columbia

23. Short message service (SMS) appointment reminders: A Rapid Review

Reminder Systems/ 20. exp "Appointments and Schedules"/ 21. exp Patient Compliance/ 22. Outpatients/ 23. Outpatient Clinics, Hospital/ut [Utilization] 24. Case Management/ 25. Office Visits/ 26. 8 or 9 or 10 or 11 or 12 or 13 or 14 27. 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 28. 26 and 27 29. exp animals/ not 30. 28 not 29 Study Selection Titles and abstracts identified were exported to EndNote X7 (Thompson, Reuters, Carlsbad, California, USA). Papers identified were (...) Preference and Adherence. 2017;11:141. 9. Downing SG, Cashman C, McNamee H, Penney D, Russell DB, Hellard ME. Increasing chlamydia test of re- infection rates using SMS reminders and incentives. Sexually Transmitted Infection. 2013 Feb 1;89(1):16-9. 10. Koshy E, Car J, Majeed A. Effectiveness of mobile-phone short message service (SMS) reminders for ophthalmology outpatient appointments: observational study. BMC Ophthalmology. 2008 Dec;8(1):9. 11. Strandbygaard U, Thomsen SF, Backer V. A daily SMS

2019 Monash Health Evidence Reviews

24. Informing best practice in writing discharge summaries

details Y Sick note Y Support to relatives Y Religious/cultural concepts about disease/death Y Complimentary/alternativ e medicines y Pain relief Y Resuscitation status Y Optional nursing comments Y Reminder to bring documentation to next visit Y Psychosocial support Y Clinical trial involvement Y Excluded references 1. Amy J.H. Kind. Documentation of Mandated Discharge Summary. Components in Transitions from Acute to Subacute Care. 2012. Available online from: (...) associated with a discharge summary. There is currently no standardised template for a discharge summary used within Monash Health. Well-defined criteria for the quality of a discharge summary is lacking [1] . However, reviews of literature agree that good quality discharge summaries should avoid error, efficiently communicate information necessary for the ongoing care of a patient, and increase the quality of care of a patient [1-2] . Time pressure in hospitals, outpatient clinics and GP practices does

2019 Monash Health Evidence Reviews

25. Public health guidance on screening and vaccination for infectious diseases in newly arrived migrants within the EU/EEA

advisory group that was established to support the development of this guidance. The advisory group included the ad hoc scientific panel as well as experts and observers as follows: Karin Taus (Austria) Cliona M Cheallaigh (Ireland), Núria Serre Delcor (Spain), Sally Hargreaves (United Kingdom), Hilary Kirkbride (United Kingdom), Alison Crawshaw (United Kingdom), Isabel De La Mata (European Commission), Ludovica Banfi (European Union Agency for Fundamental Rights), Olga Gorbacheva and Jenna Iodice (...) the development of this guidance: Holger Schunemann, Elie Akl, Pablo Alonso-Coello, Peter Tugwell, Robin Christensen, Vivian Welch and Joerg Meerpohl. ECDC would like to acknowledge the support and guidance provided by members of the ECDC ad hoc scientific panel established to support the development of this guidance: Angel Kunchev (Bulgaria), Gabrielle Jones (France), Anna Kuehne (Germany), Andreas Gilsdorf (Germany), Agoritsa Baka (Greece), Lelia Thornton (Ireland), Francesco Castelli (Italy), Silvia

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

26. Public health guidance on HIV, hepatitis B and C testing in the EU/EEA

users to send emails, e-cards or text messages to inform partners anonymously. Post-exposure prophylaxis (PEP): Use of antiretroviral therapy following exposure to HIV infection to try to prevent establishment of infection. Prevalence: Prevalence measures proportion of individuals in defined population with specific disease (or specific characteristic) at certain point in time. High, intermediate and low prevalence rates may be defined for HCV, HBV and HIV to guide testing strategies after taking (...) or belong to local migrant communities known to have high prevalence or incidence of HBV/HCV/HIV. Opt-out testing: Testing modality where patients are informed they will be tested as part of routine care, but may decline testing by raising an objection to the test. Outpatient department: Hospital department that diagnoses and treats patients without requiring an overnight stay. Outreach: Type of health service that mobilises health workers to provide services to a population away from location where

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

27. Handbook on designing and implementing an immunisation information system

28 4.1. High-level considerations 28 Fundamental differences between different European contexts exist in terms of legal regulations, IIS management, and user incentives. 29 4.1.1. A ‘top-down’ centralized approach 29 4.1.2. A ‘bottom-up’ approach 31 4.2. System-level considerations 33 4.2.1. Recording immunisation event data 33 4.2.2. Data elements 36 4.2.3. Establishing the denominator 43 4.2.4. Ensuring data quality 44 4.2.5. Storing data 46 4.2.6. User access 47 4.2.7. Linkage to other (...) . 2018: Proposed council recommendation on strengthened cooperation against vaccine-preventable diseases [18]. 1.5. Information technology, e-health, and IIS E-health in the EU Ehealth is a priority of the European Commission, and is therefore at the forefront of policies and directives related to widespread digitalisation of services in the EU [1] [19]. The definition and goals of eHealth, as per the EU Directorate General on Health, are given in Box 4. Box 4. Definition and goals of eHealth

2019 European Centre for Disease Prevention and Control - Technical Guidance

28. France has delisted anti-dementia agents

France has delisted anti-dementia agents MED CHECK - TIP December 2018/ Vol.4 No.12 · Page 29 -The Informed Prescriber C N o 12 M ED HECK D e ce m b e r 2 0 1 8 Dying Cochrane: Could it be resuscitated? Herpes zoster subunit vaccine Shingrix: Baloxavir (Xofluza®) for Influenza: No Value No difference from Tamiflu in efficacy, and suppresses immunity Cochrane review on HPV vaccine should be revised: Due to missing trials, adjuvant toxicity, mortality and healthy user bias Editorial Dying (...) while three resigned in protest. The remaining one is Dr. Gøtzsche. Among the five appointed officers, two remained, and one resigned in protest followed by resignation of another officer who opposed the decision. The other one abstained from voting, but later resigned so that there would be less appointed members in the board. This means that six members were in favor of the expulsion while the other six, including Dr. Gøtzsche, were against it. By excluding Dr. Gøtzsche from the Editorial C M ED

2019 Med Check - The Informed Prescriber

29. Organizational Guidance for the Care of Patients with Head and Neck Cancer in Ontario

Organizational Guidance for the Care of Patients with Head and Neck Cancer in Ontario Guideline 5-3ORG Version 2 A Quality Initiative of the Program in Evidence-Based Care (PEBC), Cancer Care Ontario (CCO) Organizational Guidance for the Care of Patients with Head and Neck Cancer in Ontario J. Irish, J. Kim, J. Waldron, A. Wei, E. Winquist, J. Yoo, A. Boasie, M. Brouwers, E. Meertens, S. McNair, C. Walker-Dilks and the Expert Panel on Organizational Guidance for the Care of Patients with Head (...) and Neck Cancer in Ontario This document is an update of the organizational guidance portion of the 2009 version of the guideline (Evidence-Based Series 5-3 The Management of Head and Neck Cancer in Ontario). Report Date: April 25, 2019 For information about this document, please contact Dr. Jon Irish, the lead author, through the PEBC via: Phone: 905-527-4322 ext. 42822 Fax: 905 526-6775 E-mail: For information about the PEBC and the most current version of all reports, please visit

2019 Cancer Care Ontario

30. Systematic Review - Relationship of Deployment-related Mild Traumatic Brain Injury to Posttraumatic Stress Disorder, Depressive Disorders, Substance Use Disorders, Suicidal Ideation, and Anxiety Disorders

of TBI to Psychiatric Conditions Evidence Synthesis Program i PREFACE The VA Evidence Synthesis Program (ESP) was established in 2007 to provide timely and accurate syntheses of targeted healthcare topics of importance to clinicians, managers, and policymakers as they work to improve the health and healthcare of Veterans. These reports help: · Develop clinical policies informed by evidence; · Implement effective services to improve patient outcomes and to support VA clinical practice guidelines (...) , Spoont M, Taylor B, MacDonald R, McKenzie L, Rosebush C, Wilt TJ. Relationship of Deployment-related Mild Traumatic Brain Injury to Posttraumatic Stress Disorder, Depressive Disorders, Substance Use Disorders, Suicidal Ideation, and Anxiety Disorders: A Systematic Review. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-009; 2019. Available at: https

2019 Veterans Affairs Evidence-based Synthesis Program Reports

31. Strategies to link people with undiagnosed HIV infection to HIV testing, care, and prevention services

analysis in New Zealand examined missed opportunities among adults presenting to a hospital offering risk-based screening (12). Results showed that nearly 34% of individuals who were newly diagnosed over a seven-year period had had contact with medical services prior to diagnosis, and within their estimated window of HIV infection. They also showed that these patients could have been diagnosed earlier by a median of 12 months. Furthermore, more than half of these missed opportunity visits were (...) % of non-infected controls (13). Results also showed that these patients frequently visited a general practitioner before their HIV diagnosis (13). Similarly, a retrospective cohort data linkage study in Australia showed that sexually transmitted infections (STIs) and certain hospital admissions were common among people estimated to be living with undiagnosed HIV; gonorrhea diagnosis was 18 times higher among people living with undiagnosed HIV (15). Despite this, the rate of missed opportunities

2019 Ontario HIV Treatment Network

32. Recommendations for good practice in Ultrasound: Oocyte retrieval

evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. The aim of clinical practice guidelines and good practice recommendations is to aid healthcare professionals in everyday clinical decisions about appropriate and effective care of their patients. However, adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish (...) . - An appropriate protocol for transducer disinfection should be established, in accordance with manufacturer’s instructions. OPU operators and assistants should be familiar with the disinfection technique and keep detailed documentation of the disinfection procedure. - The transducer should be designed for easy application of a specific sterile cover, incorporating a good quality sonographic gel on the tip of the transducer. - An appropriate transducer cover should be used, powder-free and compatible

2019 European Society of Human Reproduction and Embryology

33. Undernutrition in Chronic Kidney Disease

outpatient visit, taking account of changes in fluid balance and recent changes in the amount of food being eaten. People with progressive stage 4 CKD are likely to benefit from education from specialist renal dietitians in terms of advice about energy, salt, potassium and phosphate intake even if they do not flag as a concern on nutritional screening tests 15 . We suggest that established patients on dialysis should be screened every 2-3 months. If concerns arise due to intercurrent illness, screening (...) Summary 277 4 1. Introduction Background “ M aln u tri tio n ” describes both over and undernutrition. In the UK, the National Institute for Health and Care Excellence (NICE) define malnutrition as “a state in which a deficiency of nutrients such as energy, protein, vitamins and minerals causes measurable adverse effects on body composition, function or clinical o u tc o m e” in their Clinical Guideline (CG 32) 1 and Quality Standard (QS24) 2 . These guidelines suggest that patients at high risk

2019 Renal Association

34. Evidence Brief - Barriers and Facilitators to Use of Medications for Opioid Use Disorder

by the Substance Abuse and Mental Health Services Administration (SAMHSA). 9 OTPs can exist in multiple settings including intensive outpatient programs, residential programs, and hospital settings. OTPs are highly regulated, with requirements that patients receive psychosocial supports, complete frequent urine drug tests, and receive a limited number of take-home medications (thereby requiring frequent visits). 4 As of 2018, VHA operated 32 OTPs nationwide, but also contracts with an unknown number of OTPs (...) Mackey, MD, MPP Stephanie Veazie, MPH Johanna Anderson, MPH Donald Bourne, MPH Kim Peterson, MS Evidence Synthesis Program Evidence Brief: Barriers and Facilitators to Use of Medications for OUD Evidence Synthesis Program i PREFACE The VA Evidence Synthesis Program (ESP) was established in 2007 to provide timely and accurate syntheses of targeted healthcare topics of importance to clinicians, managers, and policymakers as they work to improve the health and healthcare of Veterans. These reports help

2019 Veterans Affairs Evidence-based Synthesis Program Reports

35. Guidelines on Chronic Coronary Syndromes

Cardiovascular Society 12 Table 5 Pre-test probabilities of obstructive coronary artery disease in 15 815 symptomatic patients according to age, sex, and the nature of symptoms in a pooled analysis of contemporary data 16 Table 6 Definitions of high event risk for different test modalities in patients with established chronic coronary syndromes 21 Table 7 Lifestyle recommendations for patients with chronic coronary syndromes. 23 Table 8 Healthy diet characteristics 24 Table 9 Treatment options for dual (...) in asymptomatic apparently healthy subjects (primary prevention) and patients with established chronic coronary syndromes (secondary prevention) 21 Figure 7 The five As of smoking cessation 24 Figure 8 Suggested stepwise strategy for long-term anti-ischaemic drug therapy in patients with chronic coronary syndromes and specific baseline characteristics 28 Figure 9 Decision tree for patients undergoing invasive coronary angiography 36 Figure 10 Proposed algorithm according to patient types commonly observed

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2019 European Society of Cardiology

36. Guidelines on Diabetes, Pre-Diabetes and Cardiovascular Diseases developed in collaboration with the EASD

, Gerasimos Filippatos, Diederick E Grobbee, Tina Birgitte Hansen, Heikki V Huikuri, Isabelle Johansson, Peter Jüni, Maddalena Lettino, Nikolaus Marx, Linda G Mellbin, Carl J Östgren, Bianca Rocca, Marco Roffi, Naveed Sattar, Petar M Seferović, Miguel Sousa-Uva, Paul Valensi, David C Wheeler, ESC Scientific Document Group, 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: The Task Force for diabetes, pre-diabetes, and cardiovascular (...) works by this author on: , Victor Aboyans France Search for other works by this author on: , Clifford J Bailey United Kingdom Search for other works by this author on: , Antonio Ceriello Italy Search for other works by this author on: , Victoria Delgado Netherlands Search for other works by this author on: , Massimo Federici Italy Search for other works by this author on: , Gerasimos Filippatos Greece Search for other works by this author on: , Diederick E Grobbee Netherlands Search for other works

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2019 European Society of Cardiology

37. Preventing and Managing Infectious Diseases Among People who Inject Drugs in Ontario

to care for infectious diseases at all levels. Specifically, those who are homeless or marginally housed often have difficulty affording transportation to and from points of access for health and social services, lack the identification needed to access health and social services, and regularly move locations where they may not know how to access care, which may disrupt any trust or continuity in care that has been established with a previous provider. Finally, as noted earlier, those who are homeless

2019 McMaster Health Forum

38. Learning from the Experience of Accountable Care Organizations in the U.S.

, but changes are often small and metrics such as hospital readmissions or care for specific disorders may not be affected; 2) results for improving health were mixed with some evaluations of ACOs finding improvements in the health of patients receiving care from them and other evaluations finding no improvements or poorer population health outcomes; 3) ACOs may help to reduce costs without reducing quality, and the cost reductions may be largely attributable to savings in outpatient expenses among the most (...) system in the U.S. as a means of meeting the Triple (now Quadruple) Aim of improving patient experiences and health outcomes while reducing per capita costs, and achieving positive provider experience.(4) An ACO is a sponsored a mix of providers and organizations who work together to deliver care through their network to a defined population group. ACOs vary significantly in their structure and leadership and may be physician (or practice)-led, hospital-led, have joint leadership, or be established

2019 McMaster Health Forum

39. A Case Management Tool for TB Prevention, Care and Control in the UK

month of medication (see Appendix 1: Form 3). Patient to be notified on TB surveillance system. One week Make contact with patient either by telephone or home visit (clinically assess patient and the environment and complete contact list within five working days). Visiting the patient in their own environment enhances the assessment of their needs and contact identifying. Two weeks Seen by case manager as an outpatient or in the community. One month Seen by case manager as an outpatient (...) clinical action 60 13. Simple guide to information sharing 61 ContentsROYAL COLLEGE OF NURSING 7 Glossary 62 References 65 Further reading 68A CASE MANAGEMENT TOOL FOR TB PREVENTION, CARE AND CONTROL IN THE UK 8 Purpose of this document This is a practical manual for any clinical or non-clinical professional involved in the case management of suspected and confirmed TB cases. It aims to: • promote standardisation of protocols and procedures • ensure accountability for delivery • establish clear

2019 Royal College of Nursing

40. Addressing unwarranted variation in healthcare

patient-related and non-patient related factors in thoracic aortic disease, predictors of variation in outpatient physician visits, and variation in readmission, mortality, costs and multiple process indicators in acute coronary syndrome patients. 24, 27, 28 Through combining a process of systematic review, process and structure questionnaires of cardiac surgery units and an analysis of hospital episode statistics and cardiac surgery audit data, Bottle et al (2017) 24 determined substantial regional (...) currently organised. 24 Johannsen et al (2018) 27 utilised data from 21 Swedish county councils to understand the degree of regional variation in outpatient physician visits that was explained by demand factors such as health, demography and socioeconomic indicators. Regional mortality, as a proxy for population health, and demography explained around 50% of regional variation in visits to outpatient specialists, but did not explain variation in visits to primary care physicians. Variation in primary

2019 Sax Institute Evidence Check

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