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E/M Medical Decision Making


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61. Breast Cancer: Medication Use to Reduce Risk

and the Breast Cancer Surveillance Consortium Risk Calculator are based on models tested in US populations and are publicly available for clinicians and patients to use as part of the process of shared, informed decision-making about taking risk-reducing medications for breast cancer. Both tools have been calibrated in US populations, but their discriminatory accuracy of predicting which women will develop breast cancer may be more limited and there is no single cutoff for defining increased risk for all (...) a net benefit with risk-reducing medications. Instead, the current recommendation acknowledges the uncertainty around relying on a specific threshold calculated by risk assessment tools to identify women who may benefit from risk-reducing medications and offers an alternative approach to risk assessment of women, which includes clinician consideration of clinical risk factors. Some comments also expressed concern that the USPSTF was no longer recommending “shared, informed decision making

2019 U.S. Preventive Services Task Force

62. MASCC/ISOO/ASCO Clinical Practice Guideline: Medication-Related Osteonecrosis of the Jaw (MRONJ)

. Conservative measures comprise the initial approach to MRONJ treatment. Ongoing collaboration among the dentist, dental specialist, and oncologist is essential to optimal patient care. INTRODUCTION Section: Medication-related osteonecrosis of the jaw (MRONJ) is defined as exposed bone or bone that can be probed through an intraoral or extra oral fistula(e) in the maxillofacial region and that does not heal within 8 weeks and that occurs in a patient who has received a bone-modifying agent (BMA (...) be used in clinical practice to describe the response of the MRONJ lesion to treatment? Recommendation 6. During the course of MRONJ treatment, the dentist/dental specialist should communicate with the medical oncologist the objective and subjective status of the lesion–resolved, improving, stable, or progressive. The clinical course of MRONJ may affect local and/or systemic treatment decisions with respect to cessation or recommencement of BMAs (Type: formal consensus; Evidence quality: insufficient

2019 International Society for Oral Oncology

63. Immediate postpartum long-acting reversible contraception for women at high risk for medical complications

, and appropriatelybillforservices.Expandingtherangeofhealth- careprofessionalswhoaretrainedtocounselwomenandto insertLARCdevicescouldreducetheburdenonphysicians. ProgramstotrainnursesormidwivesinLARCcounselingas wellasplacementmaybeamodelthatcanbeintegratedinto busy outpatient and inpatient settings. The MFM subspe- cialist can serve as consultant for these teams to help with contraceptive decision making for women with complex medical conditions. Having obstetric care provider cham- pionscanleadtoimplementationofsustainableprogramsin (...) Immediate postpartum long-acting reversible contraception for women at high risk for medical complications SocietyforMaternal-FetalMedicine(SMFM) ConsultSeries#48:Immediatepostpartum long-actingreversiblecontraceptionforwomen athighriskformedicalcomplications Society for Maternal-Fetal Medicine (SMFM); Laura K. Vricella, MD; Lori M. Gawron, MD, MPH; Judette M. Louis, MD, MPH The Society of Family Planning (SFP) endorses this document. The American College of Obstetricians and Gynecologists

2019 Society for Maternal-Fetal Medicine

64. PEER Simplified Guideline: Medical Cannabinoids

PEER Simplified Guideline: Medical Cannabinoids PEER SIMPLIFIED GUIDELINE: MEDICAL CANNABINOIDS Clinical Practice Guideline | January 2018 These recommendations are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. They should be used as an adjunct to sound clinical decision making. OBJECTIVE Primary care physicians can incorporate medical cannabinoids into their prescribing practices by being (...) informed with best available evidence and using a simplified, shared decision-making approach with their patients. TARGET POPULATION Adults (i.e., 18 years of age and older) EXCLUSIONS Children RECOMMENDATIONS See recommendations summary algorithm in Appendix A. GENERAL RECOMMENDATION X DO NOT prescribe medical cannabinoids for most medical conditions. There is a lack of evidence of benefit, and known harms. [Strong recommendation] Note: Possible exceptions are described elsewhere in this document

2018 Toward Optimized Practice

65. Canadian Association of Gastroenterology Clinical Practice Guideline for the Medical Management of Pediatric Luminal Crohn’s Disease

. No consensus E: In patients with mild to moderate CD, the consensus group does not make a recommendation (for or against) regarding the use of antibiotics to maintain clinical remission. No consensus F: In male patients with CD the consensus group does not make a recommendation (for or against) regarding a thiopurine to maintain remission. No consensus G: In patients with mild to moderate CD, the consensus group does not make a recommendation (for or against) regarding methotrexate monotherapy to induce (...) it with a thiopurine to maintain a durable clinical remission. No consensus L: In patients with CD who have achieved a clinical remission with anti-TNF therapy, the consensus group does not make a recommendation (for or against) regarding assessment for mucosal healing within the first year to determine the need to modify therapy. No consensus M: In patients with moderate to severe CD who fail to achieve or maintain clinical remission with an anti-TNF–based therapy, the consensus group does not make

2019 Canadian Association of Gastroenterology

66. Shared decision making in antipsychotic prescribing: the perspective of psychiatrists

Shared decision making in antipsychotic prescribing: the perspective of psychiatrists Shared decision making in antipsychotic prescribing Search National Elf Service Search National Elf Service » » » » Shared decision making in antipsychotic prescribing: the perspective of psychiatrists Jul 11 2014 Posted by Despite the growth in psychosocial interventions for people with psychosis (specifically cognitive behavioural therapy and family interventions), antipsychotic medication remains (...) management as a collaborative process between prescriber and service user. This was developed into a manualised intervention that mental health practitioners could be trained to deliver, known as Medication Management (Gray, 2004), which had shared decision-making at it’s core. Indeed, the Recovery movement in mental health is driving the need for all mental health practitioners to work in collaboration, developing a shared understanding of the issues, and working together to solve problems

2014 The Mental Elf

67. Do barcode medication administration systems reduce expressed breast milk administration errors? A Rapid Review

Interventions 3 Computerised Physician Order Entrv (CPOE) is a healthcare information technology application that allows providers to directly enter medical orders into a computer system. It is the most investigated healthcare information technology intervention in neonates. CPOE has the potential to decrease prescribing errors by requiring information entry, constraining choices regarding medication dose or route, providing dosing decision support, and by performing calculations. Overall (...) for logging metrics such as administration times, volume, near-miss data, etc. References 1. Peters, M. D., McArthur, A., & Munn, Z. (2016). Safe management of expressed breast milk: A systematic review. Women and Birth, 29(6), 473-481. 2. Shea, B. J., Grimshaw, J. M., Wells, G. A., Boers, M., Andersson, N., Hamel, C. & Bouter, L. M. (2007). Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Medical Research Methodology, 7(1), 10. 3. Melton, K. R., Ni

2017 Monash Health Evidence Reviews

68. A decision aid for women considering further chemotherapy for refractory or resistant ovarian cancer

multidisciplinary team and your family about the options available to you. It is another resource you can use to ensure that you are making a decision that is right for you. The following sections discuss recurrent, resistant and refractory ovarian cancer and treatment options. They contain a lot of medical information and new terms. If you are ? nding it dif? cult to read all at once, it may be helpful to come back and re-read it again at another time. There is also a glossary of terms on page 62.REFRACTORY (...) . Medical professionals also use the terms “resistant” or “refractory” to distinguish between different types of recurrent ovarian cancer based on the time when the cancer returned. Time to recurrence is the time between when your last chemotherapy cycle ? nished and the diagnosis of recurrent ovarian cancer. MAKING A DECISION THAT’S RIGHT FOR YOU 9 TYPES OF RECURRENT OV ARIAN CANCER Refractory: When cancer continues to grow during chemotherapy. Resistant: When cancer returns in less than 6 months from

2015 SickKids Supportive Care Guidelines

69. Minimally Invasive Prostatic Vapor Ablation for the Treatment of BPH in Large Prostates (Rezūm XL)

unless these studies might clinically interfere with the current study endpoints (e.g., limit use of study-required medication, etc.). Any significant medical history that would pose an unreasonable risk or make the subject unsuitable for the study. Inability to provide a legally effective "Informed Consent Form" and/or comply with all the required follow-up requirements. Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor (...) Investigator: Micheal F. Darson, MD Sub-Investigator: Erik E. Alexander, MD United States, Indiana First Urology Recruiting Jeffersonville, Indiana, United States, 47130 Contact: Elizabeth Burks, CRC, MA 812-206-8162 Principal Investigator: James L. Bailen, MD Sub-Investigator: Charles Goodwin, MD United States, Maryland Chesapeake Urology Associates, LLC Recruiting Towson, Maryland, United States, 21204 Contact: Jacqueline Burmer 443-471-5750 Principal Investigator: Richard M. Levin, MD Sub-Investigator

2018 Clinical Trials

70. Non-medical Prescription Stimulant Use among Post-secondary Students

academic performance. Increasing the awareness of post-secondary students of the evidence of the effects of stimulants and potential harms associated with non- medical prescription stimulant use will help equip them with the knowledge they require to make informed decisions about use. This review also identified populations for whom prevention efforts could be focused or tailored (e.g., for sorority and fraternity members, students experiencing high levels of stress, etc.). There is a general lack (...) review. Non-medical Prescription Stimulant Use among Post-secondary Students Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 14 References American College Health Association (2016). National college health assessment II: Canadian reference group data report. Hanover, Md.: Author. Arria, A. M., Caldeira, K. M., Kasperski, S. J., O’Grady, K. E., Vincent, K. B., Griffiths, R. R., & Wish, E. D. (2010). Increased alcohol consumption

2018 Canadian Centre on Substance Abuse

71. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

. Decision making should include an understanding of the reason for ASA utilization, the vascular anatomy surrounding the target area, the degree of invasiveness of the procedure, and the potential sequelae associated with perioperative bleeding ( ). In addition, a complete review of the patient's medical record should occur to identify additional medications that may heighten ASA's anticoagulant effect (eg, selective serotonin norepinephrine reuptake inhibitors [SNRIs] and dipyridamole). If ASA is being (...) for randomized trials, concluded that when ASA is used for primary prophylaxis in individuals without previous cardiovascular disease decision making should involve balancing the unclear value of utilization with the increased risk of major bleeds. Future studies are required to determine ASA's role in primary prevention and prophylaxis for cardiovascular events. | Discontinuation of ASA and Restoration of Platelet Function The return of platelet function after discontinuation is affected by multiple factors

2018 American Society of Regional Anesthesia and Pain Medicine

72. QTc Prolongation and Psychotropic Medications

have shown that induction with buprenorphine was still followed by an increase in QTc interval (125). Special Population: Children and Adolescents Our workgroup has chosen to limit our review to studies involving adults over the age of 18. While psychotropic medications can cause QTc interval prolongation in children and adolescents, there are few studies evaluating these effects. Importantly, additional research is necessary within this population to guide clinical decision-making and avoid (...) prolongation, the uncorrected QT interval may be a better predictor of clinical events (12). Table 1. Bazett-corrected QTc interval measurements (6, 10). Rating Adult men (ms) Adult women (ms) Normal 470 > 480 Technical Aspects of Recording and Measuring QT interval on the ECG Since the QT interval is, by definition, an ECG measurement, a properly recorded and measured ECG must be the basis for clinical decision making regarding QTc interval prolonging drugs. Interpretation of the ECG, including

2018 American Psychiatric Association

73. Gene expression profiling and immunohistochemistry tests for personalised management of adjuvant chemotherapy decisions in early breast cancer ? a Rapid Assessment

referral page as the current document. 1 INTRODUCTION AND SCOPE Gene expression profiling (GEP) and expanded immunohistochemistry (IHC) tests aim to improve decision-making relating to adjuvant chemotherapy for women with early breast cancer. The RIZIV/INAMI was contacted by breast cancer specialists to evaluate the options of reimbursement for these tests. After a pre-assessment of the literature, it became clear that no randomized trials are available yet, and the RIZIV/INAMI asked the KCE to provide (...) to give additional prognostic information and guide the decision on whether or not to offer chemotherapy. Some tests require samples to be sent away for central review following surgery which make cause a delay of up to a few weeks. 5 3.2 Gene expression profiling (GEP) Gene expression profiling tests assess the identity and number of messenger ribonucleic acid (mRNA) transcripts in a specific tissue sample. Gene expression profiling gives information about the activity of genes that give rise

2015 Belgian Health Care Knowledge Centre

74. Impact of childhood sexual abuse on antiretroviral medication adherence, sexual risk behaviours and overall health among men who have sex with men

and bisexual men in Los Angeles who had a history of childhood sexual abuse was able to decrease sexual risk behaviours at six-month follow-up; however, there were no significant differences in the number of sex partners or depressive symptoms (11). The authors highlight the importance in addressing sexual decision-making while being sensitive to histories of childhood sexual abuse and sexual minority status (11). The EXPLORE study, conducted with HIV-negative gay men in six U.S. cities over 48 months (...) dysfunction, paraphilias and their relationship to childhood abuse in men who have sex with men. International Journal of Sexual Health 2009;(2):79-86. Springer A, Dushaj A, Azar M. The impact of DSM-IV mental disorders on adherence to combination antiretroviral therapy among adult persons living with HIV/AIDS: A systematic review. AIDS & Behavior 2012;16(8):2119-43. Suggested citation Rapid Response Service. Impact of childhood sexual abuse on antiretroviral medication adherence, sexual risk behaviours

2016 Ontario HIV Treatment Network

75. Medical Tourism

facilities and medical evacuation to their home country may need to be considered, including adequate insurance to cover such possibilities. ADVICE FOR MEDICAL PRACTITIONERS Medical practitioners should inform prospective patients seeking medical interventions outside Australia and New Zealand of the potential difficulties they may encounter in order to ensure that patients are able to make informed decisions as to the advisability of such a course of action. Approved by: Professional Development (...) . Australian Government - Department of Human Services (DHS) 2016 ‘Reciprocal Health Care Agreements’ . Gaines, J & Nguyen, DB 2016, ‘Medical Tourism’, Yellow Book, CDC health information for international travel 2016 - Centers for Disease Control and Prevention (CDC, USA), . Holliday, R, Bell, D, Jones, M, Probyn, E, & Sanchez Taylor, J 2014, ‘Sun, Sea, Sand and Silicone: Mapping Cosmetic Surgery Tourism’, Economic & Social Research Council-University of Leeds, . Leggat, P 2015, ‘Medical Tourism


76. Economic Evaluation of Unfractionated Heparin Versus Low-Molecular-Weight Heparin to Prevent Venous Thromboembolism in General Medical and Non Orthopedic Surgical Patients

is an important decision, both from a hospital formulary and a clinical perspective. In order to inform decision-making within provincial and territorial regional health authorities (RHAs) and hospitals, a health technology assessment (HTA) of anticoagulants for the prevention of VTE in the hospital setting was undertaken. This HTA project was a collaboration between the Drug Safety and Effectiveness Network (DSEN) of the Canadian Institute of Health Research and CADTH. A research group affiliated with DSEN (...) in the sensitivity analysis. Discount Rate Costs and benefits were discounted at 5%, and rates of 0% and 3% were tested in the sensitivity analysis. 3 Modelling A combination of a decision tree and a Markov model was created to examine the two cohorts: hospitalized medical patients and hospitalized non-orthopedic surgical patients who are at risk for VTE and require VTE prevention therapy. The decision tree captured events during index hospitalization, and the Markov model considered health states after

2017 CADTH - Plasma Products

77. The effect of mental health issues on sexual risk behaviours and antiretroviral medication adherence among men who have sex with men

social isolation and mental health issues for older sexual minority men. For two hours a week over the course of six weeks, participants met with a trained peer facilitator and one another over dinner, discussing topics such as decision-making, safer sex, activity scheduling, problem solving, partner communication and support networks. The researchers observed statistically significant changes post-intervention including fewer negative psychosocial outcomes and more self-efficacy in condom use (...) into Action The OHTN Rapid Response Service offers quick access to research evidence to help inform decision making, service delivery and advocacy. In response to a question from the field, the Rapid Response Team reviews the scientific and grey literature, consults with experts, and prepares a brief fact sheet summarizing the current evidence and its implications for policy and practice. Suggested Citation Rapid Response Service. The effect of mental health issues on sexual risk behaviours

2016 Ontario HIV Treatment Network

78. Safe Medication Use in the ICU

Practice Guideline: Safe Medication Use in the ICU Email to a Colleague Colleague's E-mail is Invalid Your Name: (optional) Your Email: Colleague's Email: Separate multiple e-mails with a (;). Message: Thought you might appreciate this item(s) I saw at Critical Care Medicine. Send a copy to your email Your message has been successfully sent to your colleague. Some error has occurred while processing your request. Please try after some time. Article Tools Share this article on: Email to a Colleague (...) on capnography, presented at American Association of Critical Care Nurses National Training Institute May 2016. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: The landmark report “To Err Is Human” increased the awareness of unacceptably high rates of medical errors and sentinel events in U.S. hospitals with about 44,000–98,000 deaths annually attributed to these preventable mishaps ( ). It is important

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2017 Society of Critical Care Medicine

79. American College of Rheumatology/American Association of Hip and Knee Surgeons Guideline for the Perioperative Management of Antirheumatic Medication in Patients with Rheumatic Diseases Undergoing Elective Total Hip or Total Knee Arthroplasty

on low- or moderate-quality evidence. Conclusion. This guideline should help decision-making by clinicians and patients regarding perioperative antirheu- matic medication management at the time of elective THA or TKA. These conditional recommendations re?ect the paucity of high-quality direct randomized controlled trial data. INTRODUCTION Although the wide utilization of disease-modifying antirheu- matic drugs (DMARDs) and biologic agents has improved the quality of life for patients with rheumatoid (...) , WebMD, and UBM LLC (less than $10,000 each), research grants from Takeda andSavientandwasprincipalinvestigatorforaninvestigator- initiated study funded by Horizon through a grant to Dinora (morethan$10,000). Address correspondence to Susan M. Goodman, MD, Hospital for Special Surgery/Weill Cornell, 535 East 70th Street, New York, NY 10021. E-mail: Submitted for publication September 26, 2016; accepted in revised form April 28, 2017. 1112 Goodman et al?are when the medications

2017 American College of Rheumatology

80. Folic Acid for the Prevention of Neural Tube Defects: Preventive Medication

. The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Rationale Importance Neural tube defects are major birth defects of the brain and spine that occur early in pregnancy due to improper closure (...) University, Durham, North Carolina); Alex H. Krist, MD, MPH (Fairfax Family Practice Residency, Fairfax, Virginia, and Virginia Commonwealth University, Richmond); Ann E. Kurth, PhD, RN, MSN, MPH (Yale University, New Haven, Connecticut); C. Seth Landefeld, MD (University of Alabama at Birmingham); Carol M. Mangione, MD, MSPH (University of California, Los Angeles); William R. Phillips, MD, MPH (University of Washington, Seattle); Maureen G. Phipps, MD, MPH (Brown University, Providence, Rhode Island

2017 U.S. Preventive Services Task Force

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