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241. Prevention of Acute Exacerbations of COPD

t ; SGR Q 5 S t. G e o r g e ’ s Resp ira t o r y Questio nna ir e ; WH O 5 W o rld H e al t h Or ga niza tio n ; WMD 5 w eig h t ed me a n diff e r e n c e [ Evidence-Based Medicine ] 895 journal.publications.chestnet.org S umma r y o f Reco mmenda tio n s PICO 1: Do Nonpharmacologic Treatments and Vaccinations Prevent/Decrease Acute Exacerbations of COPD? 1. In patients with COPD, we suggest administering the 23-valent pneumococcal vaccine as part of overall medical management but did not fi (...) the risk of acute exacerbations of COPD together with the comparative small benefi ts of a short-acting muscarinic 898 Evidence-Based Medicine [ 147#4 CHEST APRIL 2015 ] antagonist plus a short-acting b 2 -ag o nist im p r o v in g quality of life, exercise tolerance, and lung function compared with short-acting b 2 -agonist alone. This recommendation also acknowledges that there are no significant differences in serious adverse events with the use of a short-acting muscarinic antagonist plus a short

2015 American College of Chest Physicians

242. Acute Pain Management: Scientific Evidence

Acute Pain Management: Scientific Evidence ACUTE PAIN MANAGEMENT: SCIENTIFIC EVIDENCE Fourth Edition 2015 Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine Edited by: Stephan A Schug Greta M Palmer David A Scott Richard Halliwell Jane T rinca© Australian and New Zealand College of Anaesthetists 2015 ISBN Print: 978-0-9873236-7-5 Online: 978-0-9873236-6-8 This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced (...) Pharmacological treatment 352 8.8.5 Guillain-Barre syndrome 354 8.8.6 Procedure-related pain 354 8.9 Acute pain management in emergency departments 355 8.9.1 Systemic analgesics 355 8.9.2 Analgesia in specific conditions 357 8.9.3 Nonpharmacological management of pain 359 8.10 Prehospital analgesia 360 8.10.1 Assessment of pain in the prehospital environment 361 8.10.2 Systemic analgesics 361 8.10.3 Anxiolytics 364 8.10.4 Regional analgesia 364 8.10.5 Nonpharmacological management of pain 364 8.10.6 Analgesia

2015 Clinical Practice Guidelines Portal

243. SMFM State of Pregnancy Monograph

SMFM State of Pregnancy Monograph SMFM State of Pregnancy MonographF irst recognized by the American Board of Obstetrics and Gynecologists in 1973, the subspecialty of Maternal-Fetal Medicine (MFM) grew from a need to care for increasingly complicated pregnancies and from emerging technologies that provided greater opportunity to evaluate and treat problems involving the fetus. MFM subspecialists are the leaders in high- risk obstetric care and serve as consultants to other obstetric care (...) and postpartum care and its complications (Table 1). As with other obstetric care providers, the MFM subspecialist also provides education and research within the field concerning the most recent approaches and treatments for obstetrical problems. An MFM subspecialist can help promote and deliver optimal and evidence- based care for these complicated pregnancies. MATERNAL-FETAL MEDICINE An MFM subspecialist is an obstetrician-gynecologist who has completed 2-3 years of additional formal education

2015 Society for Maternal-Fetal Medicine

244. Anamorelin (Adlumiz) - Anorexia, Cachexia, Non-Small-Cell Lung Carcinoma

’ or ‘single dose’ SE standard error (of the mean) SEA simplified evaluation of appetite (comprises 4 appetite/eating-related questions within the A/CS domain of the FAACT) SEF simplified evaluation of fatigue (comprises 4 fatigue/activity-related questions, 3 from the fatigue subscale of the FACIT-F + 1 from PWB subscale of the FACT-G) SMQ Standardized MedDRA query SWB social/family well-being (domain/subscale of the FACT-G) t 1/2 Elimination half-life TBM total body mass TEAE Treatment-emergent adverse (...) for marketing authorisation to the European Medicines Agency (EMA) for Adlumiz, through the centralised procedure under Article 3 (2) (a) of Regulation (EC) No 726/2004. The eligibility to the centralised procedure was agreed upon by the EMA/CHMP on 25 July 2013. The applicant applied for the following indication: Treatment of anorexia, cachexia or unintended weight loss in adult patients with non-small cell lung cancer (NSCLC). The legal basis for this application refers to: Article 8.3 of Directive 2001

2017 European Medicines Agency - EPARs

245. Ribociclib (Kisqali) - breast cancer

units CHMP Committee for Medicinal Products for Human Use CI confidence interval Cmax maximum (peak) plasma drug concentration CTCAE Common Terminology Criteria for Adverse Events CU Content uniformity CYP cytochrome P450 DDI drug-drug interaction DILI drug-induced liver injury EC European Commission ECG electrocardiogram ECOG Eastern Cooperative Oncology Group EORTC QLQ-C30 European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 EQ-5D-5L EuroQol five (...) September 2016 an application for marketing authorisation to the European Medicines Agency (EMA) for Kisqali, through the centralised procedure falling within the Article 3(1) and point 3 of Annex of Regulation (EC) No 726/2004. The eligibility to the centralised procedure was agreed upon by the EMA/CHMP on 23 April 2015. The applicant applied for the following indication: Kisqali in combination with letrozole is indicated for the treatment of postmenopausal women with hormone receptor (HR)-positive

2017 European Medicines Agency - EPARs

246. Systematic review of the cost-effectiveness of influenza immunization programs: A Canadian perspective

evaluations were reviewed. Subgroups emerged from the literature, including pregnant and post-partum women, children, and healthy adults. Generally, from the societal and healthcare system perspective, vaccination was cost- effective. For pregnant and post-partum women, vaccinating all versus only high risk was cost- effective. For children (6 months to18 years), vaccinating all versus only high risk was cost effective, especially for infants, toddlers, and adolescents. For healthy working age adults (19 (...) with seasonal influenza can face a range of health effects, from less severe symptoms such as general malaise, upper respiratory illness, and transient muscle pain, to more complications such as pneumonia and worsening of underlying medical conditions. Severe problems can result in physician office visits, emergency department visits, hospitalizations, and death. Whether minor symptoms or severe problems, influenza infection results in negative health outcomes that cause loss of productivity. Absences, time

2015 SickKids Reports

247. Clinical Handover in Acute and Children’s Hospital Services

of children as part of clinical handover, to ensure that a treatment plan is readily explained and understood. Note: • Dealing with emergency/crisis situations will always take precedence. The facility to undertake shift clinical handover should be provided for staff involved in the emergency/ crisis situation when the emergency/crisis situation has been dealt with. 1.3.1 Expected outcomes All clinical handover between healthcare staff in acute and children’s hospital services will be conducted using (...) ) 2013a) and that staff need to be made fully aware that responsibility is transferred along with information (Department of Health (Western Australia) 2013). New South Wales Health (NSW Health 2009) indicates that signing over of clinical handover sheets may be a strategy to achieve clarity around responsibility. The Emergency Medicine Programme Handover Protocol (HSE 2013) clarifies the point at which responsibility for patient care has passed to the receiving ED staff, stipulating that this has

2015 National Clinical Guidelines (Ireland)

248. Management of Venous Leg Ulcers: Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum

interventional therapies to prevent venous leg ulcer. [GRADE - 2; LEVEL OF EVIDENCE - C] Rationale for Venous Leg Ulcer Guidelines Guidelines present a synthesis of evidence-based recommendations for the diagnosis and treatment of a specific medical condition. x 1 Committee on Clinical Practice Guidelines, Institute of Medicine. Guidelines for clinical practice: From development to use. National Academy Press , Washington, DC ; 1992 The value of a guideline is that it provides consistency among treatment (...) | In the ambulatory setting, the direct cost of this care is related to (1) technical (facility) costs and professional reimbursement (physicians); (2) labor costs (nurses and paramedical personnel) for wound care treatments, which are the major driver of costs; and (3) medications as well as specialized wound dressings and compression garments. A key determinant of the costs of treating VLU is the effectiveness of treatment—not only how rapidly the ulcer heals, but also whether the ulcer recurs. For example

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2014 American Venous Forum

249. The Looming Co-epidemic of TB-Diabetes: A Call to Action

-epidemic set it apart from TB-HIV? One obstacle that was not a factor in the TB-HIV case is that, while TB and HIV treatments are both free for patients, diabetes treatment usually isn’t free. Oftentimes people living where TB is common simply can’t afford the medicine and care they need to manage their diabetes. And in a lot of countries, diabetes treatment isn’t available, period. So we need to make diabetes treatment widely accessible and affordable. We are grappling with a diabetes epidemic (...) the evidence in the world, but we also need to proactively convince and inspire others who we need to act. It takes time to direct resources and train health workers, build supply chains for medicines, set up robust data monitoring systems and do the things necessary to respond to a modern epidemic. We’re witnessing a convergence of two terrible diseases. We need to move quickly. The Looming Co-epidemic of TB-Diabetes 14 Tuberculosis-Diabetes THE WAY FORWARD We have a framework in place to guide a response

2014 International Union Against TB and Lung Disease

250. Guidelines for the prevention of stroke in women

research, internal medicine, obstetrics/gynecology, cardiology, pharmacology, nursing, epidemiology, and public policy. The panel reviewed relevant articles on adults using computerized searches of the medical literature through May 15, 2013. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology and supplementary AHA Stroke Council methods of classifying the level of certainty and the class and level of evidence (...) for which there is evidence for and/or general agreement that the procedure or treatment is useful and effective. Class II Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment. Class IIa The weight of evidence or opinion is in favor of the procedure or treatment. Class IIb Usefulness/efficacy is less well established by evidence or opinion. Class III Conditions for which there is evidence and/or general agreement

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2014 American Academy of Neurology

251. Tinnitus

nonbothersome tinnitus? • What are the best methods/instruments for evaluating the severity of tinnitus and the effects of treatment? • How should patients be triaged according to tinnitus severity? • When should a patient with tinnitus be referred for specialty evaluation (mental health, audiology, emergency care, or otolaryngology)? • What is the natural history of recent onset tinnitus? What should patients expect? • How should clinicians distinguish primary tinnitus (tinnitus that is idiopathic (...) in managing persistent, bothersome tinnitus? • What is the effectiveness of cognitive behavioral therapy for persistent, bothersome tinnitus? • What is the role of hearing aids and other forms of sound therapy (maskers, modulated music) in the treatment of tinnitus with and without associated hearing loss? • What is the role of complementary and alternative medicine in managing tinnitus? • What is the role of over-the-counter therapies in managing tinnitus? • What is the effectiveness of Ginkgo biloba

2014 American Academy of Otolaryngology - Head and Neck Surgery

252. Pharmacologic Therapy for Pulmonary Arterial Hypertension in Adults

-acting agent at a center with experience in the performance and interpretation of vasoreactivity testing (Grade CB) . Remark: Contraindications to acute vasoreactivity testing include a low systemic blood pressure, low cardiac output or the presence of FC IV symptoms. Acute vasoreactiv- ity testing may be complicated by hypotension, and the misinterpretation of results may result in the inappro- priate exposure of patients to the risks of a treatment trial with calcium channel blockers (CCBs) without (...) the addition of inhaled iloprost to improve WHO FC (Grade CB) and delay the time to clinical worsening (Grade CB) . Patients With WHO FC IV Symptoms: For treatment naive P AH patients in WHO FC IV , we advise initiation of monotherapy with a parenteral prostanoid agent. More specifi cally in these patients: 452 Evidence-Based Medicine [ 146#2 CHEST AUGUST 2014 ] 52-54. We suggest continuous IV epoprostenol to improve WHO FC (Grade CB) , improve 6MWD (Grade CB) , and improve cardiopulmonary hemodynamics. 55

2014 American College of Chest Physicians

253. Status of Cardiovascular Disease and Stroke in Hispanics/Latinos in the United States

Medicaid eligibility to adults with incomes up to 138% of the federal poverty level. Although millions of uninsured US Hispanics will be eligible for coverage under the 2010 Patient Protection and Affordable Care Act, undocumented immigrants will continue to be ineligible for coverage under its provisions. Noncitizens or undocumented immigrants who lack continuous, comprehensive, and preventive care will continue to depend on episodic or emergency healthcare services. Not only are Hispanics (...) likely to receive preventive health services. Spanish-speaking Hispanics were far less likely to be knowledgeable of heart attack and stroke symptoms than English-speaking Hispanics, NHBs, and NHWs. Language and Health Literacy There is an important role for health literacy, because it influences the ability to negotiate health systems, understand and act on health treatment and advice, and seek timely and appropriate health care. , Lower health literacy predicted increased all-cause mortality among

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2014 American Heart Association

254. Guidelines for the Prevention of Stroke in Patients With Stroke and Transient Ischemic Attack

among survivors of ischemic stroke or TIA. The current average annual rate of future stroke (≈3%–4%) represents a historical low that is the result of important discoveries in prevention science. These include antiplatelet therapy and effective strategies for treatment of hypertension, atrial fibrillation (AF), arterial obstruction, and hyperlipidemia. Since the first of these therapies emerged in 1970, when results of the Veterans Administration Cooperative Study Group trial of hypertension therapy (...) delivery is planned, it is reasonable to discontinue LMWH ≥24 hours before induction of labor or cesarean section (Class IIa; Level of Evidence C ). New recommendation In the presence of a low-risk situation in which antiplatelet therapy would be the treatment recommendation outside of pregnancy, UFH or LMWH, or no treatment may be considered during the first trimester of pregnancy depending on the clinical situation (Class IIb; Level of Evidence C ). New recommendation Breastfeeding In the presence

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2014 American Heart Association

255. The Role of Worksite Health Screening

Care Act (ACA), health screenings will be associated with monitoring progress toward the achievement of health standards and, often, screening results will be connected to incentives that encourage employee participation in worksite health and wellness programs. Research suggests that the healthcare costs avoided from delaying or preventing the onset of noncommunicable diseases justify the upfront investments made in identifying and reducing existing health risks. Whether through prevention or risk (...) consider using this biometric measure categorization model for worksite health screenings to help illustrate current health status to employees, individualize health and wellness programming, and establish goals for improvement or health maintenance. In addition, the recently released AHA/American College of Cardiology cholesterol screening guidelines, the Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, and the 2013 AHA

2014 American Heart Association

256. MASCC/ISOO Clinical Practice Guidelines for the Management of Mucositis Secondary to Cancer Therapy

in patients receiving high-dose chemotherapy for HSCT with or without total body irradiation, 34 and a suggestion for LLLT in the prevention of oral mucositis in patients receiving H&NRT without concomitant chemotherapy (Table 4). 35 No guideline was possible related to the use of LLLT in any other treatment setting, or related to the use of other emerging light modalities such as light- emitting diodes and visible light. 27 Cryotherapy A total of 22 eligible studies examined the placement of ice chips (...) Cancer. 2004;4: 277-284. 12. Al-Dasooqi N, Sonis ST, Bowen JM, et al. Emerging evidence on the pathobiology of mucositis. Support Care Cancer. 2013;21:2075- 2083. 13. Rubenstein EB, Peterson DE, Schubert M, et al;Mucositis Study Sec- tion of the Multinational Association for Supportive Care in Cancer;- International Society for Oral Oncology. Clinical practice guidelines for the prevention and treatment of cancer therapy-induced oral and gastrointestinal mucositis. Cancer. 2004;100(suppl 9):2026-2046

2014 International Society for Oral Oncology

257. Standards of Practice for Superficial Femoral and Popliteal Artery Angioplasty and Stenting

is the proposed treatment of choice in the majority of patients with IC or CLI on the basis of its reduced perioperative morbidity and mortality, and reduced in-hospital stay [5, 6]. To date, several new technologies, such as bare metal stents made from nitinol, drug-eluting stents (DES), covered stents, and drug-coated balloons (DCB), have emerged with the aim to improve long-term patency outcomes following angioplasty of the femoral and popliteal arteries [7–11]. A literature review was performed (...) treatment for PAD patients remains controversial and may depend on local practice, other cardiovascular comorbidities, severity of leg symptoms, and anatomical extent of the disease. Emerging evidence from the CHARISMA clinical trial suggests that a combination of aspirin and clopidogrel is more bene?cial in reducing adverse vascular events and may be offered to high-risk PAD patients who are at low risk for bleeding [29, 30]. Recommended best medical therapy for PAD is summarized in Table 2 [20, 23, 24

2014 Cardiovascular and Interventional Radiological Society of Europe

258. The Management of Upper Extremity Amputation Rehabilitation (UEAR)

Amputation 123 Surgical Muscle Balancing Strategies and Wound Closure Techniques 123 Appendix H: Emerging Technology 125 Targeted Muscle Reinnervation (TMR) 125 Osseo-integration 125 Upper Limb Transplant 125 VA/DoD Evidence-Based Clinical Practice Guideline for the Management of Upper Extremity Amputation Rehabilitation Page 6 of 149 Appendix I: Control Strategies for Body-Powered and Externally Powered Prostheses 126 Control of a Body-Powered Prosthesis 126 Control of an Externally Powered Prosthesis (...) , interdisciplinary approach is used at each follow up regardless if the patient continues prosthetic use or not. The patient’s functional independence is maximized through the use of available rehabilitation VA/DoD Evidence-Based Clinical Practice Guideline for the Management of Upper Extremity Amputation Rehabilitation Page 12 of 149 services and emerging technologies in upper limb amputation rehabilitation. This is the focus of each routine follow up assessment. About This Clinical Practice Guideline Methods

2014 VA/DoD Clinical Practice Guidelines

259. Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

and the AHA’s Manuscript Oversight Committee. Multiple disciplines are represented, including neurology, neuroscience research, internal medicine, obstetrics/gynecology, cardiology, pharmacology, nursing, epidemiology, and public policy. The panel reviewed relevant articles on adults using computerized searches of the medical literature through May 15, 2013. The evidence is organized within the context of the AHA framework and is classified according to the joint AHA/American College of Cardiology (...) of Recommendation and Level of Evidence Table 2. Definition of Classes and Levels of Evidence Used in AHA/ASA Recommendations Class I Conditions for which there is evidence for and/or general agreement that the procedure or treatment is useful and effective. Class II Conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment. Class IIa The weight of evidence or opinion is in favor of the procedure or treatment. Class IIb Usefulness

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2014 American Heart Association

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

. Because most of the patients with PAH also had poor metabolic control, achieving good meta- bolic control may prevent PAH. If PAH is detected, pursuing effective treatment methods such as treatment with Bosentan and Sildenafil in consultation with a physician experienced in managing PAH is recommended. GENERAL MEDICAL CARE All patients with GSD should have a primary-care provider (“medical home”) specializing in pediatrics, adolescent, or internal medicine depending on the patient’s age (Box 7 (...) in patients with neutropenia. When the intercurrent illness causes decreased dietary intake, the patient’s specialist should be contacted. In such cases more frequent monitoring of BG and additional doses of CS may be indicated. Patients who cannot main- tain normal dietary intake/CS treatment or who have eme- sis should proceed to the nearest emergency department for evaluation and i.v. glucose treatment. The patient’s specialist should be made aware and, ideally, should contact the emer - gency

2014 American College of Medical Genetics and Genomics

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