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E/M Established Outpatient Visit


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81. Diagnosis and Treatment of Low Back Pain

Treatment Section Section Chair: Christopher M. Bono, MD Authors: Paul Dougherty, DC Gazanfar Rahmathulla, MD, MBBS Christopher K. Taleghani, MD Terry Trammell, MD Randall P. Brewer, MD; Stakeholder Representative, American Academy of Pain Medicine (AAPM) Ravi Prasad, PhD; Stakeholder Representative, American Academy of Pain Medicine (AAPM) Contributor: John P. Birkedal, MD Physical Medicine & Rehabilitation Section Section Chair: Charles A. Reitman, MD Authors: R. Carter Cassidy, MD Dennis E. Enix, DC (...) or treatment is to be made by the physician and patient in light of all circumstances presented by the patient and the needs and resources particular to the locality or institution. 3 Surgical T reatment Section Section Chair: William C. Watters III, MD, MS Authors: Thiru M. Annaswamy, MD Steven W. Hwang, MD Cumhur Kilincer, MD, PhD Richard J. Meagher, MD Anil K. Sharma, MD Kris E. Radcliff, MD; Stakeholder Representative, American Academy of Orthopaedic Surgeons (AAOS) Contributor: Jordan Gliedt, DC Cost

2020 North American Spine Society

82. Palliative Care for Adults Institute for Clinical Systems Improvement 14 Palliative Care for Adults Sixth Edition /January 2020 Debility/Failure to Thrive • Greater than three chronic conditions in patient over 75 years old • Functional decline • Weight loss • Patient/family desire for low-yield therapy • Increasing frequency of outpatient visits, emergency department visits, hospitalizations Cancer • Uncontrolled symptoms due to cancer or treatment • Introduced at time of diagnosis – if disease likely incurable (...) Palliative Care for Adults Sixth Edition January 2020 Copyright © 2020 by Institute for Clinical Systems Improvement 1 Health Care Guideline: Palliative Care for Adults Text in blue in this algorithm indicates a linked corresponding annotation. Does patient choose hospice, and is hospice available? Patient presents with new or established diagnosis of a serious illness Initiate palliative care discussion 1 Assess patient’s palliative care needs based on the speci?ed domains

2020 Institute for Clinical Systems Improvement

83. Prenatal Care

, intrauterine growth restriction, and low birth weight. Established parameters for weight gain are based on pre- pregnancy body mass index (BMI). ACOG, IOM, and AAP recommend the following: Pre-pregnancy BMI (kg/m 2 ) Recommended Weight Gain 29 5.0-9.1 kg (11-20 lbs) Women with a BMI = 40 may benefit from lesser amount of weight gain or even weight loss during pregnancy. Behavioral counseling and dietary education have been shown to be beneficial for women with BMI 10,000 feet [3,000 meters]) is suggested (...) /90 mm/Hg for patients 60 - 85 years of age without diabetes. (HEDIS, BCBSM, BCN, CMS) BMI Screening: The percentage of members 18–74 years of age who had an outpatient visit and whose body mass index (BMI) was documented during the measurement year or the year prior to the measurement year. (HEDIS, BCBSM, BCN) Chlamydia Screening: The percentage of women 16–24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement year. (HEDIS

2020 University of Michigan Health System

84. Clinical Practice Guideline on the Management of Rotator Cuff Injuries

Practice Guidelines and Appropriate Use Criteria in a User-Friendly Format, Please Visit the OrthoGuidelines Website at or by downloading the free app to your smartphone or tablet via the Apple and Google Play stores! View background material via the RC CPG eAppendix 1 View data summaries via the RC CPG eAppendix 2 4 Table of Contents Summary of recommendations 7 Management of Small to Medium Tears 7 Long Term Non-Operative Management 7 Operative Management 7 Acromioplasty (...) treatment, reverse shoulder arthroplasty for unrepairable tears with glenohumeral joint arthritis can improve patient reported outcomes. Strength of Recommendation: Consensus DEVELOPMENT GROUP ROSTER Gregory A. Brown, MD, PhD – Oversight Chair American Academy of Orthopaedic Surgeons Stephen Weber, MD Co-Chair Arthroscopy Association of North America Jaskarndip Chahal, MD Co-Chair American Orthopaedic Society for Sports Medicine Shafic A. Sraj, MD American Academy of Orthopaedic Surgeons Jason M

2020 American Academy of Orthopaedic Surgeons

85. Promonitor for monitoring response to biologics in rheumatoid arthritis

making and included: costs for non-optimal treatment; outpatient and specialist visits, laboratory costs; cost of resources; and societal costs. Key outcomes The Markov model shows that after 3 years, 40% of people having adalimumab and 50% of people having infliximab would need drug treatment modifications. Costs incurred from non-optimal treatment were €1,471 per month and accumulated on clinical follow-up visits. The authors suggest that drug levels should be monitored regularly for all people (...) Promonitor for monitoring response to biologics in rheumatoid arthritis Promonitor for monitoring response to biologics Promonitor for monitoring response to biologics in rheumatoid arthritis in rheumatoid arthritis Medtech innovation briefing Published: 27 October 2017 pathways Summary Summary The technology technology described in this briefing is Promonitor. It is used to monitor response to biologic therapies. The inno innovativ vative aspect e aspect

2017 National Institute for Health and Clinical Excellence - Advice

86. Deprescribing benzodiazepine receptor agonists

if considering deprescribing Continue AP Good practice recommendation Stop AP Bjerre LM, Farrell B, Hogel M, Graham L, Lemay G, McCarthy L, et al. Deprescribing antipsychotics for behavioural and psychological symptoms of dementia and insomnia. Evidence-based clinical practice guideline. Can Fam Physician 2018;64:17-27 (Eng), e1-12 (Fr). or visit for more information. Figure 1 Algorithme de déprescription des antipsychotiques (AP) Octobre 2016 Suivi toutes les une (...) , McCarthy L, et al. Deprescribing antipsychotics for behavioural and psychological symptoms of dementia and insomnia. Evidence-based clinical practice guideline. Can Fam Physician 2018;64:17-27 (Eng), e1-12 (Fr). or visit for more information. Algorithme de déprescription des antipsychotiques (AP) Octobre 2016 Suivi toutes les une à deux semaines pendant la réduction graduelle Bjerre LM, Farrell B, Hogel M, Graham L, Lemay G, McCarthy L, Raman Wilms L, Rojas

2018 CPG Infobase

87. Pharmacological management of migraine

Abbreviations 34 Annexes 35 References 42 Pharmacological management of migraine Pharmacological management of migraine| 1 1 Introduction 1.1 THE NEED FOR A GUIDELINE Headache is common, with a lifetime prevalence of over 90% of the general population in the United Kingdom (UK). 1 It accounts for 4.4% of consultations in primary care and 30% of neurology outpatient consultations. 1-4 Headache disorders are classified as either primary or secondary. 5 Primary headache disorders are not associated (...) and Therapeutics Committees about the status of all newly-licensed medicines, all new formulations of existing medicines and new indications for established products. NHSScotland should take account of this advice and ensure that medicines accepted for use are made available to meet clinical need where appropriate. SMC advice relevant to this guideline is summarised in section 8.4. Pharmacological management of migraine| 5 2 Key recommendations The following recommendations were highlighted by the guideline

2018 SIGN

88. Management of opioid use disorders: a national clinical practice guideline

, prescription opioid, and illicitly made fentanyl overdoses: challenges and innovations responding to a dynamic epidemic. Int J Drug Policy 2017;46:172-9. 2. Canadian Institute for Health Information, Canadian Centre on Substance Abuse. Hospitalizations and emergency department visits due to opioid poison- ing in Canada. Ottawa: Canadian Institute for Health Information; 2016. 3. Bruneau J, Roy E, Arruda N, et al. The rising prevalence of prescription opioid injection and its association with hepatitis C (...) management (without transition to opioid agonist treatment) is pursued, provide supervised slow (> 1 mo) opioid agonist taper (in an outpatient or residential treatment setting) rather than a rapid (< 1 wk) taper. During opioid-assisted withdrawal management, patients should be transitioned to long-term addiction treatment† to help prevent relapse and associated health risks. Moderate Strong 8. For patients with a successful and sustained response to opioid agonist treatment who wish to discontinue

2018 CPG Infobase

89. Diagnosis and management of epilepsy in adults

indications for established products. SMC advice relevant to this guideline is summarised in section 11.4. Diagnosis and management of epilepsy in adults 1 • Introduction 4 | 2 Key recommendations The following recommendations were highlighted by the guideline development group as the key clinical recommendations that should be prioritised for implementation. The grade of recommendation relates to the strength of the supporting evidence on which the recommendation is based. It does not reflect (...) time for the patient and by an appropriate healthcare professional (consultant neurologist, physician with an interest in epilepsy, specialist registrar, or epilepsy nurse specialist). 2.7 MODELS OF CARE D A structured management system for patients with epilepsy should be established in primary care. As with other chronic diseases, an annual review is desirable. Diagnosis and management of epilepsy in adults 2 • Key recommendations6 | 3 Diagnosis 3.1 WHO SHOULD MAKE THE DIAGNOSIS OF EPILEPSY

2018 SIGN

90. What helps to support people affected by Adverse Childhood Experiences? A Review of Evidence

of this report. Contributions The opinions expressed in this publication are not necessarily those of the EPPI-Centre or the funders. Responsibility for the views expressed remains solely with the authors. This report should be cited as: Lester S, Lorenc T, Sutcliffe K, Khatwa M, Stansfield C, Sowden A, Thomas J (2019) What helps to support people affected by Adverse Childhood Experiences? A Review of Evidence. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College (...) synthesis 90 Studies not obtained in time (n=7) 90 Studies excluded on title and abstract (n=166) 90 Studies excluded on full text (n=34) 100 Studies excluded following quality and relevance appraisal (n=10) 102 Appendix E: Evidence tables for studies included in the views synthesis (n=21) 103 Appendix F: Results of Quality Appraisal (overview) 119 Appendix G: Evidence Tables (overview) 126 Appendix H: Lists of Excluded Studies (overview) 180 Studies excluded from the best-evidence synthesis on account

2019 EPPI Centre

91. Public health service provision by community pharmacies: a systematic map of evidence

: This report should be cited as: Stokes G, Rees R, Khatwa M, Stansfield C, Burchett H, Dickson, K, Brunton G, Thomas J (2019) Public health service provision by community pharmacies: a systematic map of evidence. London: EPPI-Centre, Social Science Research Unit, Institute of Education, University College London. Funding This report is independent research commissioned by the National Institute for Health Research (NIHR) Policy Research Programme (PRP) for the Department of Health and Social Care (DHSC (...) with a global agenda for improving healthy life expectancy through accessible, multi-disciplinary networks of community-based healthcare professionals (World Health Organization 2004; DH 2008). It is estimated there are 11,619 community pharmacies across England. It is estimated that 1.6 million people visit a pharmacy every day and that 1.2 million of these visits are for health-related reasons. (LGA 2013; PSNC 2013a). Community pharmacies are easily accessible to people seeking local healthcare (PHE 2014

2019 EPPI Centre

92. Opioid Use Disorder - Diagnosis and Management in Primary Care

a specific meaning within the addiction medicine community. It describes the short-term process commonly known as detoxification or “detox” and does not simply refer to the management of withdrawal symptoms. Withdrawal management (inpatient or outpatient) often involves use of a short-term opioid agonist taper but does not include transition to stable, long-term opioid agonist treatment. In this guideline, “withdrawal management alone” refers to a short-term detox (days or weeks) typically administered (...) in an inpatient or intensive outpatient program, which does not bridge to long-term continuing addiction treatment. Due to serious safety risks, including increased risk of relapse, and increased high risk behaviours that may lead to serious harms and overdose death, withdrawal management alone is not recommended . 2–4 Opioid Agonist Treatment may also be called “opioid replacement therapy” or “opioid substitution therapy”. Opioid agonist treatment includes the use of buprenorphine/naloxone, methadone, slow

2018 Clinical Practice Guidelines and Protocols in British Columbia

93. Treating Opioid Use Disorder During Pregnancy: Guideline Supplement

to comprehensive specialist pregnancy and prenatal care • If applicable, access to postpartum and neonatal care, as well as onsite accommodation or visitation provision for patient’s child(ren). 61 Keeping mothers and children together should be among primary considerations when selecting a treatment setting for this population. Effective discharge planning is also crucial to ensure positive long-term residential treatment outcomes. 59,62 The residential facility should communicate outpatient care providers (...) , education and training, and clinical care guidance. With the support of the province of British Columbia, the BCCSU aims to help establish world leading educational, research and public health, and clinical practices across the spectrum of substance use. Although physically located in Vancouver, the BCCSU is a provincially networked resource for researchers, educators, and care providers as well as people who use substances, family advocates, support groups, and the recovery community. Perinatal

2018 British Columbia Perinatal Health Program

94. Peramivir (Alpivab) - Influenza, Human

. There are no licensed intravenous presentations of neuraminidase inhibitors in the EU although these may be available for compassionate use in severely ill patients, in whom their efficacy has not been established. Otherwise, treatment for severe influenza is supportive and may involve the need for assisted ventilation, circulatory support and antibacterial agents to treat or prevent secondary bacterial infections, such as staphylococcal pneumonia. In some countries amantadine and rimantadine (the adamantanes (...) 7 days 200 d C0 e 913140 308616 19.8x 3.1x IV continuous Infusion 2 weeks 1152 69277 h NC 1.51x NC IV bolus 4 weeks 120 g 675125 383234 14.8x 3.8x IV continuous Infusion 30-31 days 1440 NC 1975000 14.8x 3.8x Rabbit IV bolus 7 day 100 C0 e 159000 219000 3.4x 2.1x IV bolus 7 day 100 C0 e 454159 337718 9.9x 3.3x Monkey IM 2 weeks 54 197875 287193 4.3x 2.8x 52 weeks 54 206917 239176 4.5x 2.3x IV bolus 2 weeks 45 375000 249000 8.2x 2.4x 4 weeks 90 485000 541580 10.6x 2.5x IV continuous Infusion 30-31

2018 European Medicines Agency - EPARs

95. Multimorbidity: a priority for global health research

meeting, ‘Multiple morbidities as a global health challenge’, held on 7 October 2015. 16 This workshop recognised that multimorbidity was likely to be a global health challenge, and acknowledged that realisation of the Sustainable Development Goals, 17 and other broader development targets, is likely to require more research on multimorbidity. On this basis, an international working group project was established to explore in greater depth the challenges and evidence gaps associated

2018 Academy of Medical Sciences

96. The Patient Centred Medical Home: barriers and enablers to implementation

time allocated to undertake comprehensive assessments and holistic interventions. • Recognition of the time it takes to make changes • Separate visits for preventive care • The use of electronic medical records (provided they have a user-friendly interface). Health information technology: Benefits of health information technology are widely • Time, effort and other resources for implementation. • Available technology is inadequate to support quality initiatives • Training, specifically, • Applied (...) to real cases • Delivered over a period of time 11 THE PATIENT CENTRED MEDICAL HOME: BARRIERS AND ENABLERS TO IMPLEMENTATION | SAX INSTITUTE Component of change and why it’s important Barriers/challenges Enablers documented and are central to supporting PCMH functions. • May lead to worse performance on adoption • Ability to be used as a substitute for face-to-face visits. • Recognition of the time it takes to make changes by organisations providing grants/supporting change • Development

2018 Sax Institute Evidence Check

97. Accountable care organisations

in the first three performance years ( 2% and 13% reporting losses of >2%. Higher expenditure benchmarks were weakly associated with savings in US Medicare programs. However, overall there were few clear predictors of what types of ACOs were making savings, which is possibly indicative of the early stages of implementation of these models in most settings. • Quality: Quality of care outcomes focused on hospital admissions/re-admissions, unnecessary emergency department visits, outpatient clinic services (...) reported outcomes on quality of care (Figure 3). Outcomes included hospital admissions/ readmissions, unnecessary emergency department visits, outpatient clinic services, processes of care, patient adherence rates to treatment plans, disease management and lowering mortality rates (Table 2.) Only nine models reported on mortality outcomes, with six reporting reductions in mortality rates or improvements in life expectancy and three reporting no difference. Five of these models had a matched control

2018 Sax Institute Evidence Check

98. Bictegravir / emtricitabine / tenofovir alafenamide / fumarate (Biktarvy) - HIV Infections

inhibitor resistant IPC In-process control IQ inhibitory quotient IQ95 inhibitory quotient of 95% IR Infrared ISE Integrated Summary of Efficacy ISS Integrated Summary of Safety IV intravenous KF Karl Fischer titration LC-MS/MS liquid chromatography/tandem mass spectrometry LDH lactate dehydrogenase LDL low-density lipoprotein LLOQ lower limit of quantitation LOCF last observation carried forward LSM least-squares mean M = E missing = excluded M = F missing = failure MedDRA Medical Dictionary (...) coefficient of variation 3TC lamivudine ABC abacavir AE adverse event AIDS acquired immunodeficiency syndrome ALT alanine aminotransferase ANOVA analysis of variance anti-HBe antibody against hepatitis B e antigen anti-HBs antibody against hepatitis B surface antigen ART antiretroviral therapy ARV antiretroviral ATV atazanavir AUC area under the concentration versus time curve AUClast area under the concentration versus time curve from time zero to the last quantifiable concentration AUCtau area under

2018 European Medicines Agency - EPARs

99. Recommendations for the Delivery of Psychosocial Oncology Services in Ontario

to PSO services for patients and their families across Ontario. JOANNE M. Patient and Family Advisor, Chair of the PSO PFA Committee 4 | Executive Summary Executive Summary RECOMMENDATIONS FOR THE DELIVERY OF PSYCHOSOCIAL ONCOLOGY SERVICES IN ONTARIO one ORGANIZATION, STRUCTURE AND PHILOSOPHY OF THE PSO PROGRAM 1.1 Psychosocial Oncology is reflected as a distinct program within the internal organizational structures of all Regional Cancer Programs in order to enhance cohesion and communicate (...) Regional Cancer Programs continue to consistently use symptom screening tools as a component of the screen for PSO needs. 2.2 All sites develop an inter-professional approach for responding to clinically significant screening for all issues and/ or elevated symptom screen scores. Teams consider secondary assessment tools for elevated scores. 2.3 Symptom screens be addressed routinely at clinic visits; the symptom scores should be acknowledged followed by assessment, interventions and referral

2018 Cancer Care Ontario

100. Creating a Rapid-learning Health System in Ontario

, based on the best available research evidence and systematically elicited citizen values and stakeholder insights. We aim to strengthen health systems – locally, nationally, and internationally – and get the right programs, services and drugs to the people who need them. Authors John N. Lavis, MD PhD, Director, McMaster Health Forum; Professor, McMaster University; and Adjunct Visiting Professor, University of Johannesburg François-Pierre Gauvin, PhD, Senior Scientific Lead, Citizen Engagement (...) that arise in a rapid-learning health system and it grouped the 67 distinct ethical issues within four phases of the rapid-learning health system: (10) o designing activities: the risk of negative outcomes (e.g., reducing the quality and usability of results) from designing learning activities less rigorously so they are not classified as research, and the risk of inadequate engagement of stakeholders (which can affect the success of the learning activity due to a lack of established trust and support

2018 McMaster Health Forum

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