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101. RCTs of cholesterol lowering agents of different classes were cancelled in succession

with higher LDL cholesterol level may live longer. A systematic review which was published in June 2016 revealed that people aged 60 years and older with higher LDL cholesterol lived longer almost without exception (abstract on p10). It was the article which was read most frequently for five months following the month of the publication on the BMJ Open Journal. It shows that the public has high interest in this issue. On the other hand, scholars insisting on the "cholesterol=devil" hypothesis (...) counterattack fiercely against this article. The prime example is the joint guideline by the European Society of Cardiology and European Atherosclerosis Society (ESC/EAS). Editorial C M ED HECK -The Informed Prescriber Translated from the Editorial in Med Check-TIP (in Japanese) Jan 017 ; 17 (69) The guideline recommend that in people at very high cardiovascular risk, LDL-cholesterol should be lowered to <1.8 mmol/L (70 mg/dL), or in people whose baseline cholesterol level is between 1.8 and 3.5 mmol/L (70

2017 Med Check - The Informed Prescriber

102. Local Endometrial Trauma (Endometrial Scratch): A Treatment Strategy to Improve Implantation Rates

) in the rates of implantation, clinical pregnancy and live births (27.7%, 66.7% and 48.9%, respectively) compared with control subjects who did not have an endometrial biopsy (14.2%, 30.3% and 22.5%, respectively). Similarly, a further prospective nonrandomised study 6 identified a favourable influence of local injury to the endometrium in intracytoplasmic sperm injection patients with high-order implantation failure. Two systematic reviews and meta-analyses 7,8 have shown a beneficial effect of local (...) , Strassburger D, Bern O, Ron-El R, Friedler S. Favorable influence of local injury to the endometrium in intracytoplasmic sperm injection patients with high-order implantation failure. Fertil Steril 2007;87: 198–201. 7. El-Toukhy T, Sunkara S, Khalaf Y . Local endometrial injury and IVF outcome: a systematic review and meta-analysis. Reprod Biomed Online 2012;25:345–54. 8. Potdar N, Gelbaya T, Nardo LG. Endometrial injury to overcome recurrent embryo implantation failure: a system atic review and meta

2017 Royal College of Obstetricians and Gynaecologists

103. Dental Management of Pediatric Patients Receiving Chemotherapy, Hematopoietic Cell Transplantation, and/or Radiation Therapy

be gently flossed daily. If pain or exces - sive bleeding occurs, the patient should avoid the affected area, but floss the other teeth. 1 Patients with poor oral hygiene and/or periodontal disease may use chlorhexidine rinses daily until the tissue health improves or mucositis develops. 13 The high alcohol content of commercially-available chlorhexidine mouthwash may cause discomfort and dehydrate the tissues in patients with mucositis; thus, an alcohol-free chlorhexidine solution is indicated (...) in this situation. Diet: Dental practitioners should discuss the importance of a healthy diet to maintain nutritional status with an empha- sis on foods that do not promote caries. Patients and parents should be advised about the high cariogenic potential of di- etary supplements rich in carbohydrates and oral pediatric medications rich in sucrose. 6 They should also be instructed that sharp, crunchy, spicy, and highly acidic foods and alcohol should be avoided during chemotherapy, radiation, and HCT. 1

2018 American Academy of Pediatric Dentistry

104. Surveillance of healthcare-associated infections and prevention indicators in European intensive care units: HAI-Net ICU protocol, version 2.2

hours after prescription ? prevention of pneumonia in intubated patients: control of cuff pressure, oral decontamination, patient position ? CVC maintenance care: catheter site dressing is not damp, loose or visibly soiled. Patient data (standard surveillance option only): addition of a variable allowing to select a second severity score (from a list, in addition to SAPS II) and enter its value, deletion of: APACHE II, date of hospital admission, coronary care, site of previous surgery, parenteral (...) WBC/high-power field of unspun urine ? organisms seen on Gram stain of unspun urine ? at least two urine cultures with repeated isolation of the same uropathogen (Gram-negative bacteria or S. saprophyticus) with = 10 2 colonies/ml urine in non-voided specimens ? = 10 5 colonies/ml of a single uropathogen (Gram-negative bacteria or S. saprophyticus) in a patient being treated with effective antimicrobial agent for a urinary infection ? physician diagnosis of a urinary tract infection ? physician

2017 European Centre for Disease Prevention and Control - Technical Guidance

105. Diabetes Type 1

health conditions—such as high blood pressure, heart disease, arthritis, and stroke, as well as diabetes—increases with body mass index (BMI) of 25 or higher. (BMI = weight in kilograms divided by height in meters squared [kg/m 2 ].) Overweight is defined as a BMI of 25 to 29.9, obesity as a BMI of 30 or higher. While most overweight or obese adults can lose weight by eating a healthy diet or increasing physical activity, doing both is most effective. See the Weight Management guidelines (for adults (...) sensation, and 5.07 monofilament touch sensation performed by a provider qualified to determine the level of risk for foot ulcers Patients at very high risk 2 should be seen every 3 months by a wound care nurse. Patients at increased risk 2 and average risk 2 should be screened annually. Microalbuminuria Microalbumin/creatinine ratio 1 Annually. Retinopathy Dilated eye exam by a trained eye services professional or Nondilated digital photography followed by a comprehensive exam for those who test

2017 Kaiser Permanente Clinical Guidelines

106. Study of MP0112 Intravitreal Injection in Patients With Wet Age Related Macular Degeneration

or intraocular pressure above 22 mmHg in the study eye despite treatment Inability to obtain fundus photographs or fluorescein angiogram of sufficient quality to be analyzed and graded by the central reading center History of idiopathic or autoimmune-associated uveitis in either eye Infectious conjunctivitis, keratitis, scleritis, or endophthalmitis in either eye Aphakia or absence of the posterior capsule in the study eye Presence of a non-healing wound, ulcer, fracture or any other medical condition (...) Study of MP0112 Intravitreal Injection in Patients With Wet Age Related Macular Degeneration Study of MP0112 Intravitreal Injection in Patients With Wet Age Related Macular Degeneration - Full Text View - Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record Detail Saved Studies Save this study Warning You have reached the maximum number of saved studies (100). Please remove one or more

2010 Clinical Trials

107. Umbilical Cord Mesenchymal Stem Cells Injection for Diabetic Foot

Therapy Any therapy for diabetic foot which is routinely practiced and accepted in China Drug: Standard Therapy Any thing directed to improve blood perfusion in the limb example.Heparin,Antiplatelet agents etc Other Name: Drug therapy Outcome Measures Go to Primary Outcome Measures : Angiographic evaluation of angiogenesis at ischemic limb [ Time Frame: 6 months ] Secondary Outcome Measures : Pain [ Time Frame: 3 months ] Ankle-Brachial pressure index [ Time Frame: 3 months ] Wound healing (wound size (...) for six weeks. No surgical or radiological interventional option for revascularisation as confirmed by a vascular surgeon and an interventional radiologist Signed informed consent Absence of life-threatening complications from the ischemic limb Life expectancy more than 2 years Negative pregnancy test when applicable Exclusion Criteria: Diabetic retinopathy History of neoplasm or hematological disease Uncontrolled high blood pressure (>180/110) Severe cardiac insufficiency (New York Heart Association

2010 Clinical Trials

108. CRACKCast E146 – Radiation Injuries

in plastic bags – soap and water to wash down skin will help further. High pressure, repeat cleaning methods may be required Universal precautions, including rubber gloves, shoe covers, and respirators if airborne contamination is suspected, are effective in protecting personnel and the work area from contamination. The only variation is to wear two sets of gloves and to change the outer pair when appropriate to avoid cross-contamination. Assess for Local and Acute Radiation syndrome Local radiation (...) CRACKCast E146 – Radiation Injuries CRACKCast E146 – Radiation Injuries - CanadiEM CRACKCast E146 – Radiation Injuries In , by Adam Thomas January 22, 2018 This Episode of CRACKCast covers Rosen’s Chapter 138, Radiation Injuries. While this is not a commonly seen presentation, we need to know how to diagnose and manage radiation injuries when they occur! Shownotes: Rosens in Perspective: Don’t let this chapter give you PTSD – as you rack your brain to remember high school physics! Let’s get

2018 CandiEM

109. Outcome Measures Framework: Information Model Report

classified. The existence of one of the desired components produced a definition of low availability. If an outcome contained two components but additional information has to be sought elsewhere, the outcome was deemed to have medium data availability. The existence of all three components was identified as a measure with high data availability. Depression Eighteen depression registries were evaluated, with 84 outcomes. Of the 84 outcomes, 31 (37%) were ascribed to primary outcomes, and 53 (63%) were (...) medium availability, while only 4% met the criteria for high availability of outcome detail. Asthma Seventeen registries were evaluated in the asthma-specific analyses. Within these 17 registries, 57 outcomes were noted within the entries. Of the 57 outcomes, 21 were noted as primary outcomes and 36 were secondary outcomes. The level of data availability within was evaluated by the existence of three components: an outcome definition (e.g., asthma severity

2018 Effective Health Care Program (AHRQ)

110. WHO recommendations: intrapartum care for a positive childbirth experience

heart rate FIGO International Federation of Gynecology and Obstetrics GBS group B streptococcus GDG Guideline Development Group GRADE Grading of Recommendations Assessment, Development and Evaluation GRC Guidelines Review Committee GREAT Guideline-driven, Research priorities, Evidence synthesis, Application of evidence, and Transfer of knowledge HIC high-income country HIE hypoxic-ischaemic encephalopathy HIV human immunodeficiency virus HRP UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme (...) . In addition, the increasing use of labour interventions in the absence of clear indications continues to widen the health equity gap between high- and low-resource settings. This guideline addresses these issues by identifying the most common practices used throughout labour to establish norms of good practice for the conduct of uncomplicated labour and childbirth. It elevates the concept of experience of care as a critical aspect of ensuring high-quality labour and childbirth care and improved woman

2018 World Health Organisation Guidelines

111. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy

immunosorbent assay serum testing). If negative, under the guidance of dermatology, sending the patient serum for indirect immunofluorescent testing to rule out other autoimmune blistering diseases could be considered. Recommendation 1.2b – Management. If blisters are < 10% body surface area (BSA), asymptomatic, and noninflammatory (eg, the case with friction blisters or pressure blisters), cessation of ICPi is not necessary, and only observation and/or local wound care is warranted. Once a blister (...) grade 3 toxicities as follows: Should hold ICPi therapy and consult with dermatology. Should treat skin with topical emollients and other petrolatum emollients, oral antihistamines, and high-strength topical corticosteroids. Dimethicone may also be offered as an alternative to petrolatum. Administer IV (methyl)prednisolone (or equivalent) at doses of 1 to 2 mg/kg and taper over at least 4 weeks. Admit to burn and/or consult wound services with attention to supportive care, including fluid

2018 American Society of Clinical Oncology Guidelines

112. The Society for Vascular Surgery practice guidelines on the care of patients with an abdominal aortic aneurysm

mortality 33 Perioperative morbidity 33 Endoleak 34 Access site complications 34 Acute limb thrombosis 34 Postimplantation syndrome 34 Ischemic colitis 34 Role of elective EVAR in the high-risk and unfit patient 34 OSR 35 Indications 35 Surgical approach 35 Aortic clamping 35 Graft type and configuration 36 Maintenance of pelvic circulation 37 Management of associated intra-abdominal vascular disease 37 Management of associated intra-abdominal nonvascular disease 38 Perioperative outcomes of open AAA (...) APPENDIX: SEARCH STRATEGY Summary of guidelines for the care of patients with an abdominal aortic aneurysm Physical examination In patients with a suspected or known abdominal aortic aneurysm (AAA), we recommend performing physical examination that includes an assessment of femoral and popliteal arteries. In patients with a popliteal or femoral artery aneurysm, we recommend evaluation for an AAA. Level of recommendation 1 (Strong) Quality of evidence A (High) Assessment of medical comorbidities

2018 Society for Vascular Surgery

113. Practice Guidelines for Moderate Procedural Sedation and Analgesia

forms of bidirectional communication during procedures performed with moderate sedation/analgesia ; (2) monitoring patient ventilation and oxygenation, including ventilatory function, by observation of qualitative clinical signs, capnography, and pulse oximetry; (3) hemodynamic monitoring, including blood pressure, heart rate, and electrocardiography; (4) contemporaneous recording of monitored parameters; and (5) availability/presence of an individual responsible for patient monitoring. Literature (...) of the patient, procedure, or equipment; (3) monitor all patients by pulse oximetry with appropriate alarms; (4) determine blood pressure before sedation/analgesia is initiated unless precluded by lack of patient cooperation; (5) once moderate sedation/analgesia is established, continually monitor blood pressure and heart rate during the procedure unless such monitoring interferes with the procedure; (6) use electrocardiographic monitoring during moderate sedation in patients with clinically significant

2018 American Society of Anesthesiologists

114. Spontaneous Coronary Artery Dissection: Current State of the Science: A Scientific Statement From the American Heart Association

atherosclerotic myocardial infarction. High rates of recurrent SCAD; its association with female sex, pregnancy, and physical and emotional stress triggers; and concurrent systemic arteriopathies, particularly fibromuscular dysplasia, highlight the differences in clinical characteristics of SCAD compared with atherosclerotic disease. Recent insights into the causes of, clinical course of, treatment options for, outcomes of, and associated conditions of SCAD and the many persistent knowledge gaps are presented (...) modulators β-hCG injections, corticosteroid injections, clomiphene hCG indicates human chorionic gonadotropin; NR, not reported; and SCAD, spontaneous coronary artery dissection. The average age of women with SCAD ranges from 45 to 53 years, but examples of patients presenting with SCAD in their second through eighth decades of life have been reported. , , , , , , , One study reported that men presented with SCAD at a slightly younger age than women (mean age, 48.6 [SD, 9.8] years versus 52.3 [SD, 9.2

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2018 American Heart Association

115. Perineal care

and intrapartum risk reduction measures History of FGM? · Refer to clinician *experienced in FGM · Assess degree of FGM · Consider deinfibulation History of OASIS? · Refer/consult with obstetrician · Counsel about mode of birth at: o First visit o Around 36 weeks · Inform of risk factors for recurrence: o High grade of previous tear o Birth weight > 4 kg o Instrumental birth · Indications for elective CS: o Current symptoms of anal incontinence o Psychological and/or sexual dysfunction o Sonographic evidence (...) of anal sphincter defect (e.g. defect > 30 degrees) o Low anorectal manometric pressures (e.g. incremental squeeze pressure 4 kg · OP position · Instrumental birth · Shoulder dystocia · Prolonged second stage · Midline episiotomy · Previous OASIS Woman elects vaginal birth? Elective CS Yes Yes No No Yes *Experienced clinician: The clinician best able to provide the required clinical care in the context of the clinical circumstances and local and HHS resources and structure. May include clinicians

2018 Queensland Health

116. Postpartum Pain Management

analgesia is preferred because of greater analgesic efficacy and higher patient satisfaction (24, 28). Women who undergo cesarean birth may benefit from local anesthetics delivered by wound infiltration or transversus abdominis plane block (24, 29, 30). A trans- versus abdominis plane block involves using a blunt-tip needle to inject 20–30 mL of anesthetic in the plane between the internal oblique and transversus abdominis muscles to target the peripheral nerves innervating the lower abdomen; the block (...) ),butthereisnosignificantdifferenceat6hours after birth (18). Because NSAIDs have an analgesic and antiinflammatory ceiling effect, increasing the dose does not improve analgesia and increases the risk of adverse effects (19–21). Nonsteroidal antiinflammatory drugs are associatedwithgastrointestinalcomplicationssuchasdys- pepsia, ulcer, and gastrointestinal bleeding, and may be associated with increased blood pressure, although recent data have questioned the association between NSAIDs and hypertension (22, 23). When a standard dose

2018 American College of Obstetricians and Gynecologists

117. Consensus Guidelines on the Use of Intravenous Ketamine Infusions for Chronic Pain

, and other mechanisms. Parameters such as heart rate, blood pressure, cardiac output, and myocardial oxygen consumption increase even with subanesthetic doses. In the pulmonary system, ketamine causes bronchodilation that appears to be due to circulating catecholamines. Pharyngeal and laryngeal reflexes are mostly preserved, as is respiratory function, and there are increased secretions. The speed of injection may play a role in maintenance of respiratory function, implying that subanesthetic infusions (...) , and Cochrane Database of Systematic Reviews, as well as by examination of the reference sections of all manuscripts. Articles considered for inclusion were animal and experimental studies, systematic and other types of reviews, meta-analyses, clinical trials, and, for certain sections in which high-grade evidence was lacking (eg, treatment, complications), case reports and series. Key words used for the review section included “ketamine,” “ N -methyl-D-aspartate receptor,” “central sensitization,” whereas

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2018 American Society of Regional Anesthesia and Pain Medicine

118. A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology

of genomics and proteomics in microbiology, interpretation of results still depends on the quality of the specimens received for analysis whether one is suspecting a prokaryote or a eukaryote as the etiologic agent, both of which are featured in this document. Microbes tend to be uniquely suited to adapt to environments where antibiotics and host responses apply pressures that encourage their survival. A laboratory instrument may or may not detect those mutations, which can present a challenge to clinical (...) that the laboratory report “everything that grows.” This can provide irrelevant information that could result in inaccurate diagnosis and inappropriate therapy. “Background noise” of commensal microbiota must be avoided where possible. Many body sites have normal, commensal microbiota that can easily contaminate the inappropriately collected specimen and complicate interpretation. Therefore, specimens from sites such as lower respiratory tract (sputum), nasal sinuses, superficial wounds, fistulae, and others

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2018 Infectious Diseases Society of America

119. End-of-Life Care for People Experiencing Homelessness

Worksheet Appendix G. Palliative Care in Recovery Appendix H. Values Worksheet Appendix I. Sample Will Appendix J. Cultural Aspects of Death and Dying Health Care for the Homeless Clinicians’ Network ADAPTING YOUR PRACTICE Recommendations for End-of-life Care for People Experiencing Homelessness 1 INTRODUCTION Homeless populations have diverse and complex end-of-life needs (McNeil, Guirguis-Younger, & Dilley, 2014). Chronic diseases and mortality rates are high in the United States, especially (...) adults in Boston, investigators found that death most often occurred in a hospital or residential dwelling; exposure to cold caused only 4 of 606 deaths (Rousseau, 1998). There are high mortality rates among people experiencing homelessness, who often die of conditions that are more easily treated in people with stable housing, such as pneumonia, influenza, HIV/AIDS, liver disease, renal disease, cold-related injuries, and cardiac arrhythmias (Hwang et al., 2001). Because they lack access to health

2018 National Health Care for the Homeless Council

120. Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

were similar, they were significantly higher among nurses (vs patients) for position change, subcutaneous injection, blood sugar testing, and blood pressure (BP) measurement ( ). No statistical measure of agreement between nurse and ICU patient scores was reported. Finally, compared with seriously ill patients’ self-reports, surrogates correctly identified pain presence 74% of the time and pain severity 53% of the time, with a tendency to overestimate pain intensity ( ). There are families who may (...) engagement and empowerment bundle adoption). Dr. Bosma received funding from the Canadian Institutes of Health Research (CIHR) where she is the primary investigator of an industry partnered research grant with Covidien as the industry partner of the CIHR for a study investigating proportional assist ventilation versus pressure support ventilation for weaning from mechanical ventilation. Dr. Brummel participates in the ATS (Aging and Geriatrics Working Group Co-Chair) and ArjoHuntleigh (advisory board

2018 Society of Critical Care Medicine

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