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E/M Medical Decision Making

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121. Proof of Concept Study of EMBalance Decision Support System to Evaluate Balance Disorders

College, London Study Director: Linda M Luxon, CBE BSc FRCP FRCPE Royal College of Physicians More Information Go to Additional Information: Publications: Royal College of Physicians, Hearing and Balance Disorders, Report of a working party (2007) Available at: https://www.rcplondon.ac.uk/sites/default/files/documents/hearing-and-balance-disorders.pdf. [Accessed 29 September 2008] Keen, P. & Morton, M. S. (1978). Decision Support Systems: An Organizational Perspective, Addison-Wesley Eom, S. & Kim, E (...) intervention: V1: appointment with a non-specialist doctor with the support of the DSS V2: appointment with an overseeing expert V3: DSS Customised Vestibular Physiotherapy V4: follow-up visit with the overseeing expert Other: Decision Support System (DSS) The EMBalance DSS is a program which summarises and structures clinical information. The structuring of medical information is based on algorithms that have been developed and are employed via the DSS platform. The non-specialist doctors who use the DSS

2016 Clinical Trials

122. Systematic review of needs for medical devices for ageing populations

Systematic review of needs for medical devices for ageing populations Systematic review of needs for medical devices for ageing populations Commissioned to the Australian Safety and Ef? cacy Register of New Interventional Procedures – Surgical (ASERNIP-S) by the World Health Organization (WHO) Department of Essential Medicines and Health Products World Health Organization 20 Avenue Appia CH-1211 Geneva 27 Switzerland Tel: +41 22 791 21 11 E-mail: medicaldevices@who.int http://www.who.int (...) a foundation for future decisions, a detailed mapping of the need for medical devices for older people in the region is to be conducted. This will determine the technological needs for diagnosis and treatment of the diseases of this population. Further research and surveys will be conducted at a country-by-country level to ascertain the availability and affordability of these devices. For low-income countries and low- resource settings, needs of priority core devices will be defined, especially for devices

2015 ASERNIP-S

123. Medical schools should be prioritising nutrition and lifestyle education

professional training, Am J Clin Nutr 2014 ajcn.073544; First published online March 19, 2014. doi:10.3945/ajcn.113.073544 [2] Reported by the BBC in 2010 and again by The Guardian in 2016: , [accessed Aug 23 2017] [3] Adams, K., Kohlmeier, M. and Zeisel, S. (2010). Nutrition Education in U.S. Medical Schools: Latest Update of a National Survey. Academic Medicine , [online] 85(9), pp.1537-1542. Available at: [Accessed 3 Mar. 2017]. [4] Chung, M., van Buul, V., Wilms, E., Nellessen, N. and Brouns, F. (2014 (...) for pharmaceutical decision-making, but rarely empirical data about the impacts of nutrition or exercise (of course, there is also the problem that less evidence in this field is available). This undervaluation of nutritional knowledge continues when it comes to professional expectations. It is rightly required that doctors stay up to date with the continuously revised NICE guidelines in specialties such as oncology. This ongoing learning is seen as a mark of medicine’s progress. But changes in nutritional

2017 The BMJ Blog

124. Does Female Genital Mutilation Have Health Benefits? The Problem with Medicalizing Morality

identity, and personal experience all factor into their decision. In a separate , Freedman stated that he had circumcised his own son on his parents’ kitchen table. “But I did it for religious, not medical reasons,” he wrote. “I did it because I had 3,000 years of ancestors looking over my shoulder.” Arguing that it is “not illegitimate” for parents to consider such social and spiritual “realms [in] making this nontherapeutic, only partially medical decision,” Freedman went on to say that “protecting (...) international , 83 (S1), 22-27. Gruenbaum, E. (1996). . Medical Anthropology Quarterly , 10 (4), 455-475. Hammond, T., & Carmack, A. (2017). . The International Journal of Human Rights , 21 (2), 189-218. Hodges, F. (1997). . In Sexual Mutilations (pp. 17-40). New York: Springer US. Hodžić, S. (2013). . Cultural Anthropology , 28 (1), 86-109. Johnsdotter, S., & Essén, B. (2010). . Reproductive Health Matters , 18 (35), 29-37. Johnson, M. (2010). Ethnicities , 10 (2), 181-207. Lightfoot-Klein, H., Chase, C

2017 Journal of Medical Ethics blog

125. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 15: Legal Aspects of Medical Eligibility and Disqualification Recommendations

that the exclusion or disqualification of an individual was individualized, reasonably made, and based upon competent medical evidence. . . . [W]e wish to make clear that we are not saying Northwestern’s decision is necessarily the right decision. We say only that it is not an illegal one under the Rehabilitation Act.” The court recognized that one of the factors a physician may rely on is then-current consensus medical guidelines: “Although the Bethesda Conferences were not convened by public health officials (...) to exclude Knapp from its basketball team was legally justified: “We do not believe that, in cases where medical experts disagree in their assessment of the extent of a real risk of serious harm or death, Congress intended that the courts—neutral arbiters but generally less skilled in medicine than the experts involved—should make the final medical decision. Instead, in the midst of conflicting expert testimony regarding the degree of serious risk of harm or death, the court’s place is to ensure

2015 American Heart Association

126. Medical eligibility criteria for contraceptive use

Medical eligibility criteria for contraceptive use Department of Reproductive Health and Research World Health Organization Avenue Appia 20, CH-1211 Geneva 27 Switzerland Fax: +41 22 791 4171 E-mail: reproductivehealth@who.int www.who.int/reproductivehealth For more information, please contact: COCs Barrier methods IUDs Fertility awareness-based methods Lactational Coitus interruptus Copper IUD for amenorrhoea Patch Female surgical sterilization Intrauterine devices CICs emergency contraception (...) characterstics; primarily, whether the contraceptive method worsens the medical condition or creates additional health risks, and secondarily, whether the medical circumstance makes the contraceptive method less effective. The safety of the method should be weighed along with the benefits of preventing unintended pregnancy. This fifth edition of the MEC is divided into two parts. Part I describes how the recommendations were developed and Part II contains the recommendations and describes how to use them

2015 World Health Organisation Guidelines

127. Improving Adherence to Therapy and Clinical Outcomes While Containing Costs: Opportunities From the Greater Use of Generic Medications: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians

in the management of chronic disease, yet physicians and other providers frequently treat patients with more expensive brand-name products even when equally effective, well-proven, and less expensive generic therapies are available ( ). The purpose of this article is to help guide internists and other clinicians in making high-value, cost-conscious decisions about the use of generic drugs. This review sought to address 5 questions: 1) How commonly are brand-name medications used when a generic version (...) in the prescription of generics and medications in the lowest cost-sharing tier of the plans' incentive formularies. Further, an interrupted time-series analysis of a decision-support tool introduced by a large academic medical center into an e-prescribing system specifically to promote generic substitution found an absolute increase in generic drug use of more than 20% that was sustained for more than 2 years after the intervention went into effect ( ). Interactive forms of continuing medical education

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2015 American College of Physicians

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

ASA (aspirin), the platelet effects of these drugs are directly related to systemic plasma drug concentrations and influenced by the pharmacokinetic clearance of these medications. Once steady-state concentrations have been achieved, terminal half-life is a predictive time parameter to guide decision making. For NSAIDs, terminal half-lives and half-lives are interchangeable and equivalent. Because NSAIDs are well absorbed and absorption is not the limiting factor, half-life is more dependent (...) syndrome. Because of the lack of effect on platelet function with COX-2 selective inhibitors and perioperative bleeding risks, these medications do not need to be stopped. | Summary recommendation for aspirin A patient- and procedural-specific strategy is recommended when deciding whether to continue or discontinue aspirin in the perioperative period for interventional pain procedures. Decision making should include an understanding of the reason for aspirin utilization, vascular anatomy surrounding

2015 American Society of Regional Anesthesia and Pain Medicine

129. A Practice Guideline from the American College of Medical Genetics and Genomics and the National Society of Genetic Counselors: Referral Indications for Cancer Predisposition Assessment

of Genetic Counselors (NSGC) are developed by members of the ACMG and NSGC to assist medical geneticists, genetic counselors, and other health-care providers in making decisions about appropriate management of genetic concerns, including access to and/or delivery of services. Each practice guideline focuses on a clinical or practice-based issue and is the result of a review and analysis of current professional literature believed to be reliable. As such, information and recom- mendations within the ACMG (...) by qualified clinicians has been associated with negative patient and societal outcomes such as misinterpretation of genetic test results, inappropriate medical management, lack of informed decision making, viola- tion of established ethical standards, adverse psychosocial out- comes, and costly, unnecessary genetic testing. 1–3 Cancer genetic consultation is an important aspect of the care of individuals at increased risk of a hereditary cancer syn- drome. 4–8 Yet, several patient, clinician, and system

2015 American College of Medical Genetics and Genomics

130. What do you want from your psychiatric medication?

of each drug, as discussed in this . One thing above all is abundantly clear from this review. There is a lot more work to be done; decision aids need to be created and future stated preference studies need to involve services users in the design process. There’s a big gap in the evidence here. We just don’t know what value mental health service users place on medication-associated outcomes. Links Primary paper Eiring O, Landmark BF, Aas E, Salkeld G, Nylenna M, Nytrøen K. (2015) . BMJ Open 2015;5 (...) What do you want from your psychiatric medication? What do you want from your psychiatric medication? Search National Elf Service Search National Elf Service » » » » What do you want from your psychiatric medication? Apr 15 2016 Posted by The NHS is changing and patient choice has never been more important. In order to make an informed choice about treatments it is important to understand the risks and benefits that are involved. Benefits and outcomes associated with taking a medication

2016 The Mental Elf

131. Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures

should be discharged into the care of a responsible adult to whom written instructions should be given, including advice about eating and drinking, pain relief, and resumption of normal activities, as well as about making legally-binding decisions, driving, or operating machinery. 12.5 A system should be in place to enable safe transfer of the patient to appropriate medical care should the need arise. 13. TRAINING IN PROCEDURAL SEDATION AND/OR ANALGESIA FOR NON- ANAESTHETIST MEDICAL PRACTITIONERS (...) Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures PS09 2014 Page 1 PS09 2014 Australian and New Zealand College of Anaesthetists (ANZCA) Faculty of Pain Medicine The following organisations have endorsed this document: Australasian College for Emergency Medicine College of Intensive Care Medicine of Australia and New Zealand Gastroenterological Society of Australia New Zealand Society for Gastroenterology Royal Australasian College

2014 Australian and New Zealand College of Anaesthetists

132. Efficacy and safety of medical marijuana in selected neurologic disorders

Sciences Center, Albuquerque; the Department of Neurology (G.G.), University of Kansas School of Medicine, Kansas City; and the Department of Neurology (D.G.), Geisinger Health System, Danville, PA. Systematic review: Efficacy and safety of medical marijuana in selected neurologic disorders Barbara S. Koppel , John C.M. Brust , Terry Fife , Jeff Bronstein , Sarah Youssof , Gary Gronseth , David Gloss Neurology Apr 2014, 82 (17) 1556-1563; DOI: 10.1212/WNL.0000000000000363 Citation Manager Formats Make (...) with seizure disorders, e4 concluded there is sufficient evidence to prescribe CBDs or recommend self-treatment with smoked marijuana. ADVERSE EFFECTS In looking at marijuana-related AEs, we excluded studies that reanalyzed earlier studies, used a single dose of medication, or had Class IV evidence or unclear information about AEs. , , , ,e2,e3 See table e-6 for details. Overall, 1,619 patients were treated with cannabinoids for less than 6 months. Meta-analysis of simple proportions yielded 6.9% (95% CI

2014 American Academy of Neurology

133. Medical therapies to reduce chronic kidney disease progression and cardiovascular risk: anti-hypertensive/anti-proteinuric agents

Canadian Medical Association Journal. 2008; 179: 1154-62. 29. National Vascular Disease Prevention Alliance, Guidelines for the management of absolute cardiovascular disease risk. 2012: Melbourne, Victoria. 30. Escape Trial Group, Wuhl E, Trivelli A et al. Strict blood-pressure control and progression of renal failure in children. New England Journal of Medicine. 2009; 361: 1639-50. 31. Agha A, Amer W, Anwar E et al. Reduction of microalbuminuria by using losartan in normotensive patients with type 2 (...) and overt nephropathy. Nephrology Dialysis Transplantation. 2008; 23: 3174-83. 34. Makino H, Haneda M, Babazono T et al. Microalbuminuria reduction with telmisartan in normotensive and hypertensive Japanese patients with type 2 diabetes: a post-hoc analysis of The Incipient to Overt: Angiotensin II Blocker, Telmisartan, Investigation on Type 2 Diabetic Nephropathy (INNOVATION) study. Hypertension Research - Clinical & Experimental. 2008; 31: 657-64. 35. Burgess E, Muirhead N, Rene de Cotret P et al

2013 KHA-CARI Guidelines

134. Medical therapies to reduce chronic kidney disease progression and cardiovascular risk: lipid lowering therapy

)[37] (SHARP Study) Simvastatin+E 131/ 4630 174/ 4620 0.75 [0.60, 0.94] -0.01 [-0.02, -0.00] Critical Methodological quality, consistency across studies and directness of the evidence (generalisability/applicability). ** The GRADE system uses the following 3 categories to rank the importance of end points: critical for decision making important but not critical for decision making not important for decision making (of lower importance to patients) * NA – not applicable (...) Tonelli et al (2004) [39] *NA NA NA Methodological quality, consistency across studies and directness of the evidence (generalisability/applicability). ** The GRADE system uses the following 3 categories to rank the importance of end points: critical for decision making important but not critical for decision making not important for decision making (of lower importance to patients) * NA – not applicable

2013 KHA-CARI Guidelines

135. Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures

should be discharged into the care of a responsible adult to whom written instructions should be given, including advice about eating and drinking, pain relief, and resumption of normal activities, as well as about making legally-binding decisions, driving, or operating machinery. 12.5 A system should be in place to enable safe transfer of the patient to appropriate medical care should the need arise. 13. TRAINING IN PROCEDURAL SEDATION AND/OR ANALGESIA FOR NON- ANAESTHETIST MEDICAL PRACTITIONERS (...) Guidelines on Sedation and/or Analgesia for Diagnostic and Interventional Medical, Dental or Surgical Procedures PS09 2014 Page 1 PS09 2014 Australian and New Zealand College of Anaesthetists (ANZCA) Faculty of Pain Medicine The following organisations have endorsed this document: Gastroenterological Society of Australia Royal Australasian College of Surgeons Australasian College for Emergency Medicine College of Intensive Care Medicine of Australia and New Zealand Royal Australian and New

2014 Australian and New Zealand College of Anaesthetists

136. Medical Management of First-Trimester Abortion

D. Creinin, MD and Daniel A. Grossman, MD. The information is designed to aid practitioners in making decisions about appropriate obstetric and gynecologic care. These guidelines should not be construed as dictating an exclusive course of treatment or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice. Medical Management of First-Trimester Abortion Over the past three decades (...) comparison of misoprostol 6 to 8 hours versus 24 hours after mifepristone for abortion. MOD Study Trial Group. 7 von Hertzen H, Huong NT, Piaggio G, Bayalag M, Cabezas E, Fang AH, et al. Misoprostol dose and route after mifepristone for early medical abortion: a randomised controlled noninferiority trial. WHO Research Group on Postovulatory Methods of Fertility Regulation. 8 Creinin MD, Vittinghoff E, Schaff E, Klaisle C, Darney PD, Dean C. Medical abortion with oral methotrexate and vaginal misoprostol

2014 American College of Obstetricians and Gynecologists

137. Medical Management of Kidney Stones

Medical Management of Kidney Stones Kidney Stones: Medical Mangement Guideline - American Urological Association advertisement Toggle navigation About Us About the AUA Membership AUA Governance Industry Relations Education AUAUniversity Education Products & Resources Normal Histology and Important Histo-anatomic Structures Urinary Bladder Prostate Kidney Renovascular Diseases Andrenal Gland Testis Paratesticular Tumors Penis Retroperitoneum Cytology Online Learning For Medical Students Exams (...) Safety and Quality of Care Accreditations and Reporting Patient Education Medical Management of Kidney Stones (2014) Published 2014 The purpose of the clinical guideline on Medical Management of Kidney Stones is to provide a clinical framework for the diagnosis, prevention and follow-up of adult patients with kidney stones based on the best available published literature. Topics covered include evaluation, diet therapy, pharmacologic therapy, and follow-up. [pdf] Panel Members Margaret Sue Pearle, MD

2014 American Urological Association

138. Diagnosis and management of glycogen storage disease type I: a practice guideline of the American College of Medical Genetics and Genomics

of Endocrinology, Boston Children’ s Hospital, Boston, Massachusetts, USA; 8 American College of Medical Genetics and Genomics, Bethesda, Maryland, USA. Correspondence: Michael S. W atson (mwatson@acmg.net) Diagnosis and management of glycogen storage disease type I: a practice guideline of the American College of Medical Genetics and Genomics Priya S. Kishnani, MD 1 , Stephanie L. Austin, MS, MA 1 , Jose E. Abdenur, MD 2 , Pamela Arn, MD 3 , Deeksha S. Bali, PhD 1 , Anne Boney, MED, RD 1 , Wendy K. Chung, MD (...) and hyponatremia in the setting of i.v. glucose administration. 145,146 In addition, the use of a fibrinolytic inhibitor, such as e-aminocaproic acid (Amicar), can be used as an adjunctive medication if there is mucosal-associated bleeding. For oral hemorrhage, Amicar can be given as a solution to “swish for 30 seconds and spit” at a dose of 1.25?g four times daily. For more severe mucosal-associated bleeding, an i.v. bolus of 4?g in 250?ml of D5W/NS infused over 1 hour followed by a drip of 1?g/h (50?ml/h

2014 American College of Medical Genetics and Genomics

139. Optimal Arrangements for Neonatal Intensive Care Units in the UK including guidance on their medical staffing

provided in many local units in each region which is not the case in many other developed countries. Following the DH review of Neonatal Intensive Care in 2003 [6], there was a move to provide this service within regional networks. This decision was made because of the need to provide better services for babies 4 and families, improve outcomes and make the best use of available resources. Some evidence of the improved outcomes of larger units compared with smaller ones was considered in making (...) Optimal Arrangements for Neonatal Intensive Care Units in the UK including guidance on their medical staffing BRITISH ASSOCIATION OF PERINATAL MEDICINE Optimal Arrangements for Neonatal Intensive Care Units in the UK including guidance on their Medical Staffing A Framework for Practice June 2014 2 Members of the working group Chair: Dr Steve Jones, Consultant Neonatologist, Bath (appointed by BAPM’s Executive Committee) Members (self-nominated from BAPM membership and approved by Executive

2014 British Association of Perinatal Medicine

140. Prevention of Acute Nausea and Vomiting due to Antineoplastic Medication in Pediatric Cancer Patients

, PhD Erin O’Shaughnessy RN, MScN, CPHON Lillian Sung MD, PhD Recommended citation: Dupuis LL, Boodhan S, Holdsworth M, Robinson PD, Hain R, Portwine C, O’Shaughnessy E and Sung L. Guideline for the Prevention of Acute Nausea and Vomiting due to Antineoplastic Medication in Pediatric Cancer Patients. Pediatric Oncology Group of Ontario; Toronto. 2012. 2 Version date: February 28, 2013 The Pediatric Oncology Group of Ontario (POGO) Guideline for the Prevention of Acute Nausea and Vomiting due (...) Literature Search for Pediatric Studies 14 • Search Strategy 14 • Selection Criteria and Appraisal 14 • Meta-analysis 14 Decision-making Process for Formulation of the Recommendations 14 Evidence Synthesis and Recommendations 16 Identification and Appraisal of Existing Guidelines 16 Primary Literature Review of Pediatric Oncology Studies 16 Health Question #1: How is optimal control of acute AINV defined? 17 • Recommendation • Evidence Summary and Discussion Health Question #2a: What pharmacological

2013 SickKids Supportive Care Guidelines

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