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101. Anabolic Therapies for Osteoporosis in Postmenopausal Women: Effectiveness and Value

of romosozumab. Among the findings summarized was a new safety signal regarding serious cardiovascular adverse events. Amgen has agreed with the FDA that the ARCH data should be considered in the regulatory review prior to the initial marketing authorization, and as a result the company does not expect approval of romosozumab in the US to occur in 2017. Due to this delay, we have removed romosozumab from our network meta-analysis and our economic modeling and will not consider any voting questions (...) and Medicaid Coverage Policies 70 Appendix C. Previous Systematic Reviews and Technology Assessments 71 Appendix D. Ongoing Studies 73 Appendix E. Comparative Clinical Effectiveness Supplemental Information 76 Appendix F. Comparative Value Supplemental Information 86 ©Institute for Clinical and Economic Review, 2017 Page v Evidence Report – Anabolic Therapies for Osteoporosis List of Acronyms Used in this Report ACE American College of Endocrinology ACP American College of Physicians AACE American Academy

2017 California Technology Assessment Forum

102. Palliative Care in the Outpatient Setting

. Evidence Tables 95 A9. Key Informant Interviews 120 A10. Policy Roundtable Participants 121 ©Institute for Clinical and Economic Review, 2016 Page v List of Abbreviations Used in this Report ABMS American Board of Medical Specialties ACA Affordable Care Act ACGME Accreditation Council for Graduate Medical Education ACHPN Advanced Certified Hospice and Palliative Nurse ACHP-SW The Advanced Certified Hospice and Palliative Social Worker AIM Advance Illness Management APN Advanced Practice Nurse ATT (...) Lung Cancer PCLC Palliative Care Leadership Center PC Palliative care PCP Primary Care Physician PHQ-9 Patient Health Questionnaire POM Profile of Mood States PPCHETA Palliative Care and Hospice Education and Training Act PPS Palliative Performance Scale PROMIS Patient Reported Outcomes Measurement Information System PRISMA Preferred Reporting Items for Systematic Reviews QoL Quality of Life QUAL-E Quality of Life at the End of Life RCT Randomized Control Trial TOI The Trial Outcome Index USPSTF

2017 California Technology Assessment Forum

103. Mepolizumab (Nucala, GlaxoSmithKline plc.) for the Treatment of Severe Asthma with Eosinophilia: Effectiveness, Value, and Value-Based Price Benchmarks

therapies for severe asthma include leukotriene inhibitors, theophylline, and omalizumab. Oral corticosteroids are used for short-term therapy to control asthma exacerbations and chronically for severe asthma that cannot be controlled without these drugs. Physicians try to avoid chronic oral corticosteroid therapy because it is associated with many long-term complications including growth suppression in children, osteoporosis, Cushing’s syndrome, adrenal insufficiency, muscle weakness, diabetes (...) aged 12 years and older. Mepolizumab 100 mg must be reconstituted by a healthcare professional, and is administered subcutaneously once every 4 weeks in a physician’s office. 12 Office administration is required in order to monitor patients for hypersensitivity reactions, a common practice following administration of biologic agents. In this review, we sought to assess the comparative clinical effectiveness and comparative value of adding mepolizumab to standard treatment for severe asthma (inhaled

2017 California Technology Assessment Forum

104. Treatment Options for Relapsed or Refractory Multiple Myeloma

Impact Model: Results We used available prevalence data to estimate the number of individuals with MM in the U.S. (approximately 92,000). 44 Data from a claims-based analysis suggested proportions of patients receiving second- and third-line therapy (approximately 37% and 13% respectively). This resulted in candidate population sizes of 33,941 and 11,930 patients. Based on several criteria, we estimated that the theoretical “unmanaged” uptake of these newest regimens would be very high, with 75 (...) % of candidate patients receiving at least one of the regimens of interest by year five following their introduction. Uptake was assumed to be very high because of the gains in progression-free survival that have been demonstrated in available clinical trials as well as acceptable levels of toxicity in most circumstances. Uptake was apportioned equally to the three second-line regimens of interest (i.e., 25% each by year 5) and the four third-line regimens (18.75% each by year 5). Note that this analysis

2017 California Technology Assessment Forum

105. Staff and Associate Specialist Grade Handbook (Third Edition)

come directly from overseas to take up SAS or other middle grade posts. There are many international medical graduate organisations which offer support and guidance for doctors coming from outside the UK to take up posts in the NHS. The support includes mentoring schemes, induction programmes and web forums. Useful websites • British Association of Physicians of Indian Origin • British International Doctors’ Association • Medical Association of Nigerians Across Great Britain • Association (...) of Pakistani Physicians & Surgeons of the UK • Egyptian Medical Society • Sri Lankan Medical and Dental Association in the UK Dr Achuthan Sajayan Former AAGBI SAS Committee Member Consultant Anaesthetist, Heart of England Foundation Trust7 THE SAS HANDBOOK THIRD EDITION 7 THE SAS HANDBOOK THIRD EDITION Empl OymENT ISSuES8 THE SAS HANDBOOK THIRD EDITION Empl OymENT ISSuES 6. mODEl CHARTER FOR SAS GRADES NHS Employers, the Academy of Medical Royal Colleges, Health Education England and the BMA have jointly

2017 Association of Anaesthetists of GB and Ireland

106. Screening for Hepatitis C Virus: A Systematic Review

by searching the following bibliographic databases MEDLINE (1946–) with in-process records and daily updates via Ovid; Embase (1974–) via Ovid; the Cochrane Library via Wiley; and PubMed. The search strategy consisted of both controlled vocabulary, such as the National Library of Medicine’s MeSH (Medical Subject Headings), and keywords. To address the research question related to clinical effectiveness, three separate searches were performed. A broad search for the concept of screening in hepatitis C (...) was performed, and methodological filters were applied to limit the study types to health technology assessments, systematic reviews, meta-analyses, randomized controlled trials (RCTs), and controlled clinical trials. To address the specific concepts of risk- and prevalence-based screening programs, no methodological filters were applied to the search to limit retrieval by study type. To address the research question related to frequency of harms, methodological filters were applied to limit retrieval

2017 CADTH - Health Technology Assessment

107. Routes to emergency medicine practice following a Family Medicine residency

the very northern settlements of Canada to southern border cities, family physicians have been working in emergency departments since their earliest days in Canada. This begs the important question: what is the value added through a recognized college competency in emergency medicine [CCFP(EM)]? 1. For starters, it boosts your job prospects. It is an almost universal requirement at academic emergency departments to have an additional credential in emergency medicine. 2. It standardizes care (...) setting the PGY3 resident has an opportunity to implement emergency skills early so that they are more comfortable working in an emergency department as a consultant. The intended candidate for the practice eligible route is a physician who ‘falls into’ emergency medicine. This is the family physician who provides comprehensive primary care for their community which includes some emergency care. Through the inclusion of emergency care in their practice, the physician may find that they have

2017 CandiEM

108. Improving healthcare providers? face-to-face interactions with clients living with or at-risk for HIV

Improving healthcare providers? face-to-face interactions with clients living with or at-risk for HIV RAPID RESPONSE SERVICE | #111, AUGUST 2016 1 RAPID RESPONSE SERVICE THE ONTARIO HIV TREATMENT NETWORK Question • What face-to-face interventions have proven effective in helping providers educate clients and improve their health literacy? References 1. Price-Haywood EG, Harden- Barrios J, Cooper LA. Comparative effectiveness of audit-feedback versus additional physician communication training (...) interactions include presenting information clearly by using plain language (8), organizing discussion points by priority (the most important information should be discussed first) (9), and using visual aids to support messaging (9-11). • Client-provider interactions can also be improved by framing HIV risk and explaining how risks can change and accumulate over time based on behaviours (8). • Motivational interviewing can enhance one’s understanding and retention of information and can improve adherence

2016 Ontario HIV Treatment Network

109. Dialysis Programs

determined on the basis of interviews with key informants. In the updated survey, questions were included if they focused mainly on nephrologists’ current practices and perspectives about various facilitators and resources as they related to the implementation of the dialysis modalities of interest. The nephrologists were asked about their support for various suggested policies, initiatives, practices, and resources that could play a role in supporting the uptake of home-based dialysis or in-centre self (...) physicians and nephrologists (n = 5 or 14.7%). Nephrologist Survey Of 249 potential respondents, 28 (11.2%) provided information. Responses to all or some of the questions were received from nephrologists in Alberta (n = 4), British Columbia (n = 2), Manitoba (n = 4), New Brunswick (n = 2), Newfoundland and Labrador (n = 1), Nova Scotia (n = 1), Ontario (n = 12), and Quebec (n = 2). No responses were received from nephrologists in the Northwest Territories, Nunavut, Prince Edward Island, Saskatchewan

2016 Canadian Agency for Drugs and Technologies in Health - Environmental Scanning

110. Chronic pain disorder medical treatment guideline.

depending on chronicity, complexity of the problem, and anticipated therapeutic effect. Treatment plans should always be based on a diagnosis utilizing appropriate diagnostic procedures. All treatment plans begin with shared decision making with the patients. Before initiation of any therapeutic procedure, an authorized treating physician, employer and insurer must consider these important issues in the care of the injured worker: Patients undergoing therapeutic procedure(s) should be released (...) the frequency of surgery in the first year after treatment in patients with neurologic compression and corresponding imaging findings who also are strong candidates for surgery and have completed 6 weeks of therapy without adequate benefit. The benefits for the non-surgical group persisted for at least 5 years in most patients, regardless of the type of block given (Design: Randomized clinical trial ). After 6 weeks of conservative therapy for large herniated discs, an epidural injection may be attempted

2017 National Guideline Clearinghouse (partial archive)

111. Communication strategies for the prevention of HIV, STI and hepatitis among MSM in Europe

of interventions against their stated objectives Focus group A group interview method designed to elicit feedback on specific questions Health promotion The process of enabling people to increase control over and improve their health. Health promotion moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions [1]. HIV status/ serostatus Refers to whether an individual is infected with HIV, i.e. HIV is detected in a person’s body or not: HIV positive = HIV (...) body type 31 Tables Table 1: Knowledge questions for messages of HIV, STI, and viral hepatitis prevention 12 Table 2: Prevention messages about knowledge of HIV 13 Table 3: Prevention messages about knowledge of STIs 13 Table 4: Prevention messages about knowledge of viral hepatitis 14 Table 5. Prevention messages about testing 15 Table 6: Prevention messages about using condoms and lubricants 17 Table 7: Prevention messages about avoiding semen in the mouth 18 Table 8: Prevention messages about

2016 European Centre for Disease Prevention and Control - Technical Guidance

112. Screening for Atrial Fibrillation: 2017 European Heart Rhythm Association (EHRA) Consensus Document

), APHRS, and Societad Latinoamericana de Estimulation Cardiaca y Electrofisiologia (SOLAECE). The document was peer-reviewed by official external reviewers representing EHRA, HRS, APHRS, and SOLAECE. Consensus statements are evidence-based, and derived primarily from published data. In contrast with current systems of ranking level of evidence, EHRA has opted for a simpler, perhaps, more user- friendly system of ranking that should allow physicians to easily assess current status of evidence (...) -relatedstrokerisk Atrial fibrillation is a well-known risk factor for stroke, 11 through a cardio-embolic mechanism, but recent studies have highlighted that ischaemic stroke risk in the presence of multiple stroke risk factors is similarly high, whether or not documented AF is present. 12,13 The lat- ter data do not question the benefit that can be derived by investing in screening strategies targeted to detect AF in specific populations at risk. In a cohort of patients with multiple stroke risk factors

2017 Heart Rhythm Society

113. Heart Disease and Stroke Statistics 2017 Update: A Report From the American Heart Association

Use (Chapter 3) • In 2015, among adults =18 years of age, overall rates of tobacco use were estimated to be 15.2% (16.7% of males and 13.7% of females; National Health Interview Survey). • In the United States, substantially higher tobacco use rates are found in low socioeconomic status, Native American, and lesbian, gay, bisexual, or transgender people reporting disability or activ- ity limitations, as well as mentally ill populations. There also is substantial regional variation (...) , more than any major diagnostic group. • The annual direct and indirect cost of CVD and stroke in the United States was an estimated $316.1 billion in 2012 to 2013. This figure includes $189.7 billion in expenditures (direct costs, which include the cost of physicians and other professionals, hospital services, pre- scribed medication, and home health care, but not the cost of nursing home care) and $126.4 billion (indirect costs) in lost future productivity attributed to premature CVD and stroke

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2017 American Heart Association

114. Improving Nasal Form and Function after Rhinoplasty

-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice (...) their motivations for surgery and their expectations for outcomes, should provide feedback on whether those expectations are a realistic goal of surgery, and should document this discussion in the medical record. (2) Clinicians should assess rhinoplasty candidates for comorbid conditions that could modify or contraindicate surgery, including obstructive sleep apnea, body dysmorphic disorder, bleeding disorders, or chronic use of topical vasoconstrictive intranasal drugs. (3) The surgeon, or the surgeon’s

2017 American Academy of Otolaryngology - Head and Neck Surgery

115. Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

. The pathophysiological concept of the expanded cardiogenic shock spiral. eNOS indicates endothelial nitric oxide synthase; iNOS, inducible nitric oxide synthase; LVEDP, left ventricular end-diastolic pressure; NO, nitric oxide; SIRS, systemic inflammatory response syndrome; SVR, systemic vascular resistance; and TNF-α, tumor necrosis factor-α. Adapted from Hollenberg et al with the permission of American College of Physicians, Inc, copyright © 1999, American College of Physicians, all rights reserved; from Hochman (...) ) or recovery. The program consisted of a network of spoke hospitals located within a 250-mile radius of a hub institution. The authors emphasized the need for an early dialogue (within 12 hours of shock) between the referring and accepting centers to determine the viability of the candidate and the suitability for transfer and developed a management algorithm. Implementation of this network was associated with a 66% survival rate, higher than the 25% historical survival rate. The feasibility of a traveling

2017 American Heart Association

116. Chronic Obstructive Pulmonary Disease

specific clinical procedure or treatment must be made by the physician in light of the circumstances presented by the patient. Chronic Obstructive Pulmonary Disease Patient population: Adults with chronic obstructive pulmonary disease (COPD). Objectives: 1. Provide a framework for management of chronic COPD and for the treatment of mild to moderate acute exacerbations. 2. Improve symptoms, quality of life and lung function while reducing morbidity and mortality for patients with COPD. Key Points COPD (...) for predicting prognosis. Multiple dimensions of disease severity (airflow limitation, symptom severity, exacerbation risk) should help guide management. Management Issues Both physicians and patients under-recognize the potential benefits of appropriate disease management for COPD. The lack of a large FEV 1 response to bronchodilation may contribute to a sense of skepticism regarding the benefits of treatment. However, COPD is a chronic inflammatory disease with systemic manifestations that affect patient

2017 University of Michigan Health System

117. Management of Diabetes Mellitus in Primary Care

D. Inpatient Care 41 E. Selected Complications 46 VII. Pharmacological Therapy 52 A. Summary of the Evidence - Monotherapy and Non-Insulin Two-Drug Combination Therapy 54 B. Triple Therapy 56 C. Insulin Therapy 57 D. Cardiovascular Outcomes Trials 61 VIII. Knowledge Gaps and Recommended Research 65 Appendix A: Evidence Review Methodology 67 A. Developing the Scope and Key Questions 67 B. Conducting the Systematic Review 71 VA/DoD Clinical Practice Guideline for the Management of Type 2 Diabetes (...) this Clinical Practice Guideline This guideline represents a significant step toward improving the treatment and management of patients with DM in the VA and DoD. As with other CPGs, however, challenges remain, including evidence gaps, the need to develop effective strategies for guideline implementation and to evaluate the effect of guideline adherence on clinical outcomes. This guideline is intended for VA and DoD healthcare practitioners including physicians, nurse practitioners, nurses, physician

2017 VA/DoD Clinical Practice Guidelines

118. Interventions to Address Sexual Problems in People With Cancer

Interventions to Address Sexual Problems in People With Cancer: American Society of Clinical Oncology Clinical Practice Guideline Adaptation of Cancer Care Ontario Guideline Guideline Question What is the effectiveness of pharmacological interventions, psychosocial counseling, or devices to manage sexual problems after cancer treatment? More specifically, issues in men and in women were examined separately. Target Population This guideline is applicable to adult (≥ 18 years of age) men and women (...) (and their partners) of all sexual orientations living with cancer of any type. For the purposes of this guideline, men and women who were previously treated for a childhood cancer were not included. Target Audience Health care practitioners, such as oncologists, urologists, gynecologists, primary care providers, surgeons, nurses, physiotherapists, social workers, counselors, psychologists, psychiatrists, and sex therapists/counselors, and advanced practice providers, such as physician assistants and nurse

2017 American Society of Clinical Oncology Guidelines

119. Diagnosis and Treatment of Low Back Pain

. Knowledge Gaps and Recommended Research 51 Appendix A: Evidence Review Methodology 53 A. Developing the Scope and Key Questions 53 a. Population(s) 53 b. Intervention(s) 54 c. Comparator(s) 56 d. Outcomes 56 e. Timing 57 f. Setting 57 B. Conducting the Systematic Review 57 a. Criteria for Study Inclusion/Exclusion 59 b. Literature Search Strategy 60 C. Convening the Face-to-face Meeting 61 D. Grading Recommendations 62 E. Recommendation Categorization 65 a. Categorizing Recommendations with an Updated (...) was the third highest out of 155 conditions. In 2013, the estimated spending related to LBP and neck pain was $87.6 billion, an increase of $57.2 billion over the past 18 years.[7] b. Veterans Affairs Population The National Institutes of Health 2014 National Health Interview Survey provided national prevalence estimates of U.S. Veterans with severe pain (including back pain). The survey showed that 33% of Veterans reported significant back pain in the prior three months. The back pain was axial in 20

2017 VA/DoD Clinical Practice Guidelines

120. Dyslipidaemias

to help them maintain this status. Thus the intensity of preventive actions should be tailored to the patient's total CV risk. The strongest driver of total CV risk is age, which can be considered as ‘exposure time’ to risk factors. This raises the issue that most older people in high-risk countries who smoke would be candidates for lipid-lowering drug treatment even if they have satisfactory blood pressure levels. The clinician is strongly recommended to use clinical judgment in making therapeutic

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2016 European Society of Cardiology

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