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21. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

or negative data with respect to each question) because these studies would predominate in scoring the strength-of-evidence. The writing team mem- bers also identified relevant nonrandomized interventions, cohort studies, and case-control trials, as well as cross- sectional studies, surveillance studies, epidemiologic data, case series, and pertinent studies of disease mechanisms. In the absence of RCTs, recommendations would necessarily rely on lower levels of evidence, which would in turn affect (...) . References numerically cited in the text were then scored for strength-of-evidence using definitions provided in Table 1 (24 [EL 4; NE]). There are 4 intuitive levels of evidence based on study design and data quality: 1 = strong, 2 = intermediate, 3 = weak, and 4 = no clinical evidence. Where appropriate, comments were appended to the evidence level regarding judgments or factors that could influence the subsequent grading process (Table 2) (24 [EL 4; NE]). Reference citations in the document text

2016 American Association of Clinical Endocrinologists

22. Unusual Cancers of Childhood Treatment (PDQ®): Health Professional Version

patients.[ , ] However, less than 10% of children and adolescents with nasopharyngeal carcinoma presented with distant metastases at diagnosis.[ - ] Prognosis The overall survival of children and adolescents with nasopharyngeal carcinoma has improved over the last four decades; with state-of-the-art multimodal treatment, 5-year survival rates exceed 80%.[ , , , - ] After controlling for stage, children with nasopharyngeal carcinoma have significantly better outcomes than do adults.[ , ] However (...) and analyzed by genome-wide DNA methylation profiling, copy number analysis, immunohistochemistry, and next-generation panel sequencing. Unsupervised hierarchal clustering analysis of DNA methylation data identified the following four distinct clusters:[ ] The largest cluster, which comprised 64% of the samples, had classical histologic features of olfactory neuroblastoma and 10% had recurrent DNMTA3 and TP53 mutations. A second cluster consisted of seven cases with a hypermethylator phenotype and IDH2

2018 PDQ - NCI's Comprehensive Cancer Database

23. Public Health Interventions to Reduce the Secondary Spread of Measles

and reported from Australia, Canada, Spain, Switzerland, and the United Kingdom (UK). ? With respect to vaccinating susceptible contacts with measles-containing vaccine, five studies met the inclusion criteria. Four studies showed a benefit from the intervention, although only two reached statistical significance; one study showed no benefit from the intervention. ? With respect to administration of Ig to susceptible contacts, one study was reviewed that showed a reduced risk of contracting measles (...) , in which a statistically significant reduced risk of contracting measles was observed for the infants who were immunized as compared with those who were not immunized. Conclusions and Implications for Decision- or Policy-Making Although a small number of studies were included for each research question, together evidence from seven observational studies offers support for inclusion of four of the five interventions in a public health intervention strategy for reducing the secondary spread of measles

2015 Canadian Agency for Drugs and Technologies in Health - Rapid Review

24. Paediatric trauma protocols

radiation burden. ? An example of a suitable contrast and timings calculator is included (see the Camp Bastion contrast wheel, Appendix 2). ? A hand injection of contrast is appropriate in very small children and babies. ? There are no mechanisms of injury which mandate abdominal CT as an isolated factor. Decisions to perform abdominal CT should be made on the basis of the clinical history and examination. 29 ? Where there is an isolated head injury, a reduced Glasgow Coma Scale (GCS) score should (...) –16 1% 6% 4% 11% 55% 23% Sites: all UK hospitals; Date range: 01/04/2012–31/03/2013. Admission type: Direct; Age limit: 15 Other hospitals ISS 159 Figure 2. Percentage of all directly admitted patients with CT within four hours of emergency department arrival that had a full body scan in this timeframe 2 The hospital data submitted to TARN shows that in the majority of paediatric cases injuries were mainly of the extremities, and to a lesser extent the head and cervical spine

2014 Royal College of Radiologists

25. Diagnosis and Management of Acute Pulmonary Embolism

and biomarkers . . . . . . . . . . . . . . . .3049 4.3.1 Markers of right ventricular dysfunction . . . . . . . . .3049 4.3.2 Markers of myocardial injury . . . . . . . . . . . . . . . .3049 4.3.3 Other (non-cardiac) laboratory biomarkers . . . . . .3050 4.4 Combined modalities and scores . . . . . . . . . . . . . . . .3051 4.5 Prognostic assessment strategy . . . . . . . . . . . . . . . . .3051 5. Treatment in the acute phase . . . . . . . . . . . . . . . . . . . . . .3052 5.1 Haemodynamic and respiratory (...) the segmental level. 131 –133 The PIOPED II trial observed a sensitivity of 83% and a speci?city of 96% for (mainly four-detector) MDCT. 134 PIOPED II also highlighted the in?uence of clinical probability on the predictive value of MDCT. In patients with a low or intermediate clinical prob- ability of PE as assessed by the Wells rule, a negative CT had a high negative predictive value for PE (96% and 89%, respectively), whereas this was only 60% in those with a high pre-test probability. Conversely

2014 European Society of Cardiology

26. Patient Dignity (Formerly: Patient Modesty): Volume 94

of the patient on the belt (entry into the doctor's office, for example) through to the 10 minute history taking and onward to the exam room with its structural and other attending issues of privacy and then perhaps a procedure with the attending assistants and so forth. The "conveyor belt", as in the NEJM article is there starting up actually even before the patient arrived at the major hospital to "prepare" for the "endpoint". The "belt" is for efficiency and meeting some goals set by the profession (...) to financial aspects of medical care but the other misbehaviors toward their patients. What do you think? ..Maurice. At , Anonymous said... Not much preservation of patient dignity at this facility: REL At , said... This Comment was attempted to be posted today on Volume 86 of course closed to further comments but I thought it was worthy of publishing it here on Volume 94. ..Maurice. At Wednesday

2019 Bioethics Discussion Blog

27. Clinical guidance for responding to suffering in adults with cancer

on the instru- ments/tools available to assess suffering, its synonyms, and/or its symptoms; and 42 articles evaluating the effec- tiveness of interventions to alleviate the suffering of people diagnosed with cancer. The systematic review provided the evidence base for this guidance and was further supplemented by the clinical expertise of Cancer Australia's Cancer suffering and spirituality issues multidisciplinary working group. This guidance provides further information and vignettes relating to four key (...) follow-up care. 8, 13, 43 Understanding the possible emotional and spiritual responses that patients may have at different stages of cancer can help healthcare professionals anticipate when individual patients are likely to need more support. 9 For exam- ple, studies have shown that acknowledging a terminal prognosis earlier rather than later ultimately contributes to relief of suffering. 4 The recognition of death can offer a shift in perspective from small concerns to a deep appre- ciation of life

2014 Cancer Australia

28. Delirium

) asking about: The onset, nature, and course of the behaviour change — acute behaviour change (developing over hours or days) which fluctuates is suggestive of delirium. Baseline functional and cognitive state. If possible carry out a cognitive screening test (for example the General Practitioner Assessment of Cognition [GPCOG] test) and if available, compare the current score with a previous score to help differentiate acute and chronic cognitive changes — for more information on cognitive screening (...) oximetry — to identify fever, hypoperfusion, hyperglycaemia, hypoglycaemia, or hypoxia. Carry out a general examination to identify such as: Respiratory conditions, for example chest infection, pulmonary embolus, heart failure, or chronic obstructive pulmonary disease. Cardiovascular conditions, for example myocardial infarction and heart failure. Abdominal conditions, for example acute abdomen, constipation, faecal loading (carry out a rectal exam if possible if impaction is suspected), urinary

2017 NICE Clinical Knowledge Summaries

30. Cervical Spine Collar Clearance in the Obtunded Adult Blunt Trauma Patient

Eligibility Our PICO question and protocol were registered with the PROSPERO international prospective register of systematic reviews [7][8] on August 23, 2013 (Registration Number: CRD42013005461) and last revised on June 18, 2014. Inclusion criteria consisted of adult blunt trauma patients 16 years or older, who underwent C-spine CT with axial thickness of less than 3 mm and who were obtunded with any author-specified definition of this term (Glasgow Coma Scale [GCS] score < 15, unconscious, intubated (...) reassessment, cervical collar complication (e.g., pressure ulcer), and time to cervical collar clearance. The term obtunded required an operationalized definition using the terms Glasgow Coma Scale , altered , intoxicated , intubated , unconscious , and/or u nreliable exam . Unstable injuries were identified primarily using the system delineated by White and Punjabi and the three-column model of Denis. [9–11] C-spine instability required either a fracture or fractures involving contiguous columns or levels

2015 Eastern Association for the Surgery of Trauma

31. Management of Orthopaedic Trauma

minimizes infection. J Orthop Trauma. 2015;29:1-6. Damage Control Orthopaedic Surgery Townsend RN, Lheureau T, Protech J, Riemer B, Simon D. Timing fracture repair in patients with severe brain injury (Glasgow Coma Scale score <9). J Trauma. 1998 Jun;44(6):977-982; discussion 982-983. Damage Control Orthopaedics. Roberts CS, Pape HC, Jones AL, et al. J Bone Joint Surg Am. 2005 Feb;87(2):434-449. Nicola R. Early Total Care versus Damage Control: Current Concepts in the Orthopaedic Care of Polytrauma (...) deficit or lactate, might be more accurate to inform decision- making. A retrospective review of 10traditionally resuscitated patients with an injury severity score (ISS) of > 18 and a femur fracture stabilized within 24 hours of admission found that patients with a lactate of >2.5 had a higher pulmonary and infectious complication rate when compared with those with a normal lactate. Additionally, patients with severe traumatic brain injury proceeding to definitive fixation are less likely to have

2015 American College of Surgeons

32. Management of Multiple Sclerosis

of development. Adherence to these guidelines may not necessarily guarantee the best outcome in every case. Every healthcare provider is responsible for the management of his/her unique patient based on the clinical picture presented by the patient and the management options available locally. These guidelines were issued in 2015 and will be reviewed in a minimum period of four years (2019) or sooner if new evidence becomes available. When it is due for updating, the Chairman of the CPG or National Advisor (...) hours to days; recovery begins within two to four weeks and visual acuity (VA) recovers to 6/6 or better by one month in 75% of patients with MS ? progression of visual loss beyond two weeks or lack of any improvement after four weeks should prompt the consideration of other differential diagnoses and the appropriate investigations • ocular assessment reveals evidence of optic neuropathy ? reduced VA between 6/6 to “No Perception to Light (NPL)” ? presence of relative afferent pupillary defect

2015 Ministry of Health, Malaysia

33. Recommendations for the Management of Cerebral and Cerebellar Infarction with Swelling

dysarthria, neglect, gaze preference, and a visual field defect. 4 Pupillary abnormalities are a reflection of significant brainstem shift, typically not expected on initial presenta- tion, and develop within the first 3 to 5 days. An early Horner syndrome may point to an acute carotid artery occlusion or dissection. 4 The initial National Institutes of Health Stroke Scale score is often >20 with dominant hemispheric infarction and >15 with nondominant hemispheric infarction, although this clinical (...) predictor has not undergone rigorous prospective validation. 31–33 The initial score is a reflection of stroke sever - ity and infarct volume, not a marker of tissue swelling, and although sensitive, it is not highly specific. The most specific sign of significant cerebral swelling after stroke is a decline in the level of consciousness attrib- utable to brain edema shifting the thalamus and brainstem, where major components of the ascending arousal system are situated. 34 Although right hemisphere

2014 Congress of Neurological Surgeons

34. Treatment and recommendations for homeless people with Opioid Use Disorders

for comorbidities that are strongly associated with opioid use disorders, including polysubstance use and sexually transmitted/ bloodborne infections. ? Evaluate findings from the clinical history, physical exam, and diagnostic testing to determine diagnosis and severity of opioid use disorder; identify any contraindications to medication-assisted treatment or acute conditions requiring a higher level of care. PLAN OF CARE ? Work collaboratively with patients to develop realistic, attainable, short-term goals (...) and transgender persons are among those at highest risk for sexual and physical assault (Kushel 2003). Elicit information about a history of trauma/ abuse: Has anyone ever hurt you? Are you safe now? Have you had to have sex in exchange for drugs? Inquire about head injuries, falls, assaults, accidents, participation in military combat or contact sports, and if the patient has ever been knocked unconscious or been in a coma. Did you ever hit your head or pass out? Do you have bad dreams? If so, inquire about

2014 National Health Care for the Homeless Council

35. General practice management of type 2 diabetes 2014-15

at www.racgp. Four of these indicators are relevant to diabetes care: Indicator number Description 1 Practice infrastructure to support safety and quality of patient care 5 Assessment of absolute cardiovascular risk 12 Screening for retinopathy in patients with diabetes 13 Screening for nephropathy in high-risk patients (including diabetes) Use of clinical indicators to assess care is advised but entirely voluntary.10 General practice management of type 2 (...) Assessment Tool (AUSDRISK, www.ausdrisk. (Appendix C) was developed in 2007 and agreed on as a national type 2 diabetes risk assessment tool by the Federal and all state and territory governments. AUSDRISK calculates the risk of developing diabetes over a 5-year period. Patients with scores of 12 or more are considered at high risk.General practice management of type 2 diabetes 11 According to AUSDRISK research: • For scores of 12–15, approximately one person in every 14 will develop diabetes

2014 Clinical Practice Guidelines Portal

36. Royal Flying Doctor Service Western Operations Clinical manual part 1.Clinical guidelines

blood count CNS Central nervous system FFP Fresh frozen plasma CPAP Continuous positive airway pressure FHR Foetal heart rate RFDS Western Operations Version 6.0 Clinical Manual Issue Date: January 2013 Part 1 - Clinical Guidelines Abbreviations & Measures ii FM Foetal movements NGT nasogastric tube GCS Glasgow coma score NIBP Non-invasive blood pressure GIT Gastrointestinal tract NIV Non invasive ventilation GPS Global positioning system NM Neuromuscular GTN Glyceryl trinitrate NSAIDS Non-steroidal (...) and clinical acumen to determine risk of deterioration, many of these parameters also form the basis of the more complex scoring systems. The measures available to us are more closely aligned to MET call or EWS scores and indeed less well resourced locations would have retrieval of the patient as part of their escalation process. With this in mind the following limits are reminders of what may require an escalation in care. Table 1. Physiological Predictors of Deterioration 60 50 40 30 30 30 180 180 160

2014 Clinical Practice Guidelines Portal

37. Safety and quality issues associated with the care of patients with cognitive impairment in acute care settings

hospitalisation including increased mortality, more complications, longer hospital stays, increased system costs as well as functional and cognitive decline. 4To improve the care of patients with CI in hospital, best practice guidelines have been developed, of which sixteen recent guidelines/position statements/standards were identified in this review (Table 2). Four guidelines described standards or quality indicators for providing optimal care for the older person with CI in hospital, in general, while (...) following hospitalisation Patients with dementia have an increased risk of institutionalisation (RR = 6.9). Patients with dementia and delirium have an even higher risk (RR = 9.3). 23 Dementia has been shown to be an independent predictor of institutionalisation following hospitalisation. In one study, patients with dementia were two to four times more likely to be institutionalised following hospitalisation and the risk increased the more severe the dementia. 24 Delirium is associated with high rates

2013 Sax Institute Evidence Check

38. Clinical practice guideline for care in pregnancy and puerperium

Technologies Assessment Agency (AETSA), Seville. Rocío García-Aguilar. Diploma in Nursing, Andalusian Health Technologies Assessment Agency (AETSA), Seville Laura Martínez-García. Specialist in Preventive Medicine and Public Health, Iberoamerican Cochrane Centre, Santa Creu i Sant Pau Hospital, Barcelona. Maria de las Nieves Respaldiza-Salas. Specialist in Immunology, Andalusian Health Technologies Assessment Agency (AETSA), Seville. David Rigau-Comas. Specialist in Clinical Pharmacology, Iberoamerican (...) , Appendix 5) should be used to confirm the diagnosis of postpartum depression in women who have answered ‘yes’ to the previous questions. v A score of over 12 points in the EPDS should be taken as a reference point for the diagnosis of postpardum depression Weak We suggest the use of the EPDS scale in the first six weeks after childbirth to ensure that the risk of depression in women is correctly discriminated. Support groups during the puerperium v Puerperium support groups should be created in primary

2014 GuiaSalud

39. Head CT Guidelines Following Concussion among the Youngest Trauma Patients: Can We Limit Radiation Exposure Following Traumatic Brain Injury? (PubMed)

, head injury characteristics, clinical indicators for head CT scan (severe mechanism, physical exam findings of basilar skull fracture, non-frontal scalp hematoma, Glasgow Coma Scale score, loss of consciousness, neurologic deficit, altered mental status, vomiting, headache, amnesia, irritability, behavioral changes, seizures, lethargy), CT results, and hospital course were collected.One-hundred thirty-three patients (78.2%) received a head CT scan, 7 (5.3%) of which demonstrated fractures (...) Head CT Guidelines Following Concussion among the Youngest Trauma Patients: Can We Limit Radiation Exposure Following Traumatic Brain Injury? Recent studies have provided guidelines on the use of head computed tomography (CT) scans in pediatric trauma patients. The purpose of this study was to identify the prevalence of these guidelines among concussed pediatric patients.A retrospective review was conducted of patients four years or younger with a concussion from blunt trauma. Demographics

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2018 Kansas Journal of Medicine

40. Treating Severe Brain-injured Patients With Apomorphine

to receive a 4-weeks regimen of daily subcutaneous infusions of apomorphine hydrochloride. Patients will be monitored for four weeks before the initiation of the therapy, closely during treatment and they will undergo a 4-weeks inpatient follow-up after washout, as well as a two-year long-term remote follow-up. Shortly before and after the treatment regimen, the subjects will receive a multimodal assessment battery including neuroimaging exams. Primary outcome will be determined as behavioral response (...) ), Communication (0-2 points), Arousal (0-3 points). The subscores are summed to calculate a total score ranging from 0 to 23 points. Higher scores indicate better functions. More importantly, it provides the patient's diagnosis (coma, UWS, MCS-, MCS+, EMCS) based on the presence of specific items in different subscales (regardless of total score). Analyses will look for changes of diagnosis, changes of total score and changes of each subscore before, during and after apomorphine treatment. Secondary Outcome

2018 Clinical Trials

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