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141. Delirium, Dementia, and Depression in Older Adults: Assessment and Care, Second Edition

to Appendices B and C. Use of the Term “BPSD” in This Guideline Terminology in the field of dementia care continues to evolve. The expert panel has chosen to use the term behavioural and psychological symptoms of dementia (BPSD) to describe the way a person with dementia expresses his/her needs and exhibits symptoms of dementia—for example, through changes in mood, delusions, apathy, agitation, wandering, calling out, repetitive questioning, and sexual disinhibition (Moniz Cook et al., 2012). Other terms (...) & Seniors North Bay Regional Health Centre North Bay, Ontario Robin Hurst, RN, BScN, MN, GNC, CPMHN Advanced Practice Consultant, Seniors and Mental Health Saint Elizabeth Health Care Toronto, Ontario Rona Khudayar Fourth Y ear Nursing Student Ryerson University Toronto, Ontario Kim Kurschinski, RN, BScN Psychogeriatric Resource Consultant The Scarborough Hospital and the Regional Geriatric Program of Toronto Toronto, Ontario Chase Everett McMurren, MD, CCFP Physician Lead, PrimaryCare@Home Program

2016 Registered Nurses' Association of Ontario

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

. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances. From 1 Professor and Chair, Department of Nutrition Sciences, University of Alabama at Birmingham, Director, UAB Diabetes Research Center, GRECC Investigator & Staff Physician, Birmingham VA Medical Center, Birmingham, Alabama; 2 Director, Metabolic Support, Clinical Professor of Medicine, Division (...) Summary 4-30 Evidence Base 30 Post-hoc Question: By inductive evaluation of all evidence-based recommendations, what are the core recommendations for medical care of patients with obesity? 30 Q1. Do the 3 phases of chronic disease prevention and treatment (i.e., primary, secondary, and tertiary) apply to the disease of obesity? 31 Q2. How should the degree of adiposity be measured in the clinical setting? 33 Q2.1. What is the best way to optimally screen or aggressively case-find for overweight

2016 American Association of Clinical Endocrinologists

143. Overtesting American doctors: The toxic pressure of board exams

to ; and many are left exhausted, burnt out, and questioning the wisdom of pursuing a career in medicine. This comes at a time when American medicine is grappling with a crisis of trainee burnout. Medical students are to suffer from depressive symptoms than members of the general population. These burnt out trainees are at risk of becoming burnt out physicians, who are , , and . Tragically, burnout also . Two fixes would go a long way. Firstly, the NBME should report only if applicants have passed or failed (...) has broken out about whether we need to reform this exam process in the US, following the publication of a . The commentary and argue that an overemphasis on the test’s results has created a pernicious “Step 1 climate,” which harms trainees and reduces the quality of medical education. As physicians in training, we’ve directly seen the untold depression, anxiety, and toxic stress that Step 1 causes. And against this backdrop, we think it is time for a reexamination of the impact of Step 1

2019 The BMJ Blog

144. Recommendations on screening for cognitive impairment in older adults

to go see a physician for cognitive impairment screen- ing, 26%) and other things that are more impor- tant for them than screening (36%). 38 Because these participants were relatives of people with a diagnosis of cognitive impairment, it is uncertain whether the findings are generaliz- able to the broader population of candidates for population screening. Suggested performance measures Given that the task force has recommended against screening, a suggested performance mea- sure for this guideline (...) by the recommended course of action. • Practitioners should consider cognitive assessment for patients with signs and symptoms of impairment or when family members or patients express concerns about potential cognitive decline. Key points CMAJ podcasts: author interview at https://soundcloud.com/cmajpodcasts/141165-guide See also www.cmajopen.ca/content/3/4/E419 Early release, published at www.cmaj.ca on November 30, 2015. Subject to revision.Guidelines 2 CMAJ cognitive impairment (scores of 10–17) and severe

2015 CPG Infobase

145. Diagnosis and management of testosterone deficiency syndrome in men: clinical practice guideline

with testosterone deficiency syndrome who have cardiovascular disease or are at risk of cardiovascular disease. • Hypogonadal men with successfully treated prostate cancer may be candidates for testosterone supplementation; these patients require referral to a specialist, because treatment involves close monitoring by a physician with expertise in the risks and benefits of testosterone therapy. • Regular monitoring for clinical and biochemical response, and for adverse effects, to testosterone replacement (...) . However, hypogonadal men with success- fully treated prostate cancer may be candidates for testosterone supplementation. These patients require referral to a specialist, because treatment involves close monitoring by a physician with expertise in the risks and benefits of testosterone therapy. For more information, see Appendix 1. Implementation The Canadian Men’s Health Foundation is developing a communications plan for the guide- line among its public campaigns to increase awareness of testosterone

2015 CPG Infobase

146. Diagnosis and management of iliofemoral deep vein thrombosis: clinical practice guideline

, whereas select patients with iliofemoral DVT are candidates for endovascular thrombus removal to prevent sequelae of post-thrombotic syndrome. • Compression therapy may be considered for the treatment of established post-thrombotic syndrome, but it is unlikely to prevent development of the syndrome. Key points CMAJ Podcasts: author interview at: https://soundcloud.com/cmajpodcasts/141614-guide Early release, published at www.cmaj.ca on September 28, 2015. Subject to revision.Guidelines 2 CMAJ Panel (...) , are resource intensive and have their own potential complications. Scope This guideline is intended to assist Canadian pri- mary care physicians in the assessment and man- agement of patients with iliofemoral DVT. We include guidance as to which patients may bene- fit from early triage and transfer to tertiary care institutions for clot removal and reduction, a crit- ical aspect in the management of this condition. Methods This consensus guideline provides recommenda - tions on the diagnosis and management

2015 CPG Infobase

147. Reducing pain during vaccine injections

of Recommendations Assessment, Development and Evaluation) system provided the general framework for the formulation of recommendations and the synthesis of the research evidence. • We rated candidate clinical questions; a two-thirds majority was set as the cut-off for inclusion in the guideline. • We ranked the importance of each outcome on a scale of 1 to 9. Outcomes with scores from 7 to 9 were classified as critically important, those with scores from 4 to 6 were classified as important, and those (...) and are part of good vaccination clinical practice. • This guideline includes recommendations for pain mitigation based on five domains of pain management interventions (procedural, physical, pharmacologic, psychological and process): the “5P” approach. Key points CMAJ Podcasts: author interview at soundcloud.com/cmajpodcasts/150391-guide Early release, published at www.cmaj.ca on August 24, 2015. Subject to revision.Guidelines 2 CMAJ mendations Assessment, Development and Evalu- a tion) (www.grade working

2015 CPG Infobase

148. Recommendations for growth monitoring, prevention and management of overweight and obesity in children and youth in primary health care 2015

in children and youth aged 2 to 17 years. Methods The Canadian Task Force on Preventive Health Care is an independent panel of clinicians and methodologists that makes recommendations about clinical manoeuvres aimed at primary and secondary prevention (www.canadiantaskforce .ca). Work on each set of recommendations is led by a workgroup of two to six members of the task force. Each workgroup establishes the research questions and analytical framework for the guide- line, which are incorporated (...) of current members of the Canadian Task Force on Preventive Health Care is available at canadiantask force.ca/about-us/members. Correspondence to: Canadian Task Force on Preventive Health Care, info@canadiantaskforce.ca CMAJ 2015. DOI:10.1503 /cmaj.141285 CMAJ Podcasts: author interview at soundcloud.com/cmajpodcasts/child-obesity-guideline See also pages 387 and 389 as well as www.cmaj.ca/lookup/doi/10.1503/cmaj.150117, www.cmaj.ca/lookup/doi/10.1503/cmaj.150259, CMAJ Open www.cmajopen.ca/content/3/1

2015 CPG Infobase

149. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

]. These guidelines were developed to assist clinicians, including primary care physicians and psychiatrists, as well as psychologists, social workers, occupational thera- pists, and nurses with the diagnosis and treatment of anxiety and related disorders by providing practical, evidence-based recommendations. This guideline docu- ment is not focused on any individual type of clinician but rather on assessing the data and making recommen- dations. Subsequent “user friendly” tools and other initiatives are planned (...) ]. Asking patients if they are feeling nervous, anxious or on edge, or whether they have uncontrollable worry, can be useful to detect anxiety in patients in whom the clini- cian suspects an anxiety or related disorder [7]. The DSM-5 suggests the questions shown in Table 4 for the identification of anxiety-related symptoms; items scored as mild or greater may warrant further assessment [26]. If anxiety symptoms are endorsed, they should be explored in more detail by including questions about the onset

2014 CPG Infobase

150. Genetics of Skin Cancer (PDQ®): Health Professional Version

; the granular cell layer; and the keratinized outer layer, or stratum corneum. The true cytologic origin of BCC remains in question. BCC and basal cell keratinocytes share many histologic similarities, as is reflected in the name. Alternatively, the outer root sheath cells of the hair follicle have also been proposed as the cell of origin for BCC.[ ] This is suggested by the fact that BCCs occur predominantly on hair-bearing skin. BCCs rarely metastasize but can invade tissue locally or regionally

2018 PDQ - NCI's Comprehensive Cancer Database

151. Treatment-Related Nausea and Vomiting (PDQ®): Health Professional Version

is identified, the more likely treatment will be effective; thus, early screening and referral are essential. However, physicians and nurses underestimate the incidence of chemotherapy-induced N&V.[ ][ ] Clearly, the most important aspect of ANV is prevention of acute and delayed N&V associated with chemotherapy. Most antiemetics have not shown benefit for the treatment of ANV, but the use of antiemetics during chemotherapy may have a dramatic effect in decreasing the incidence of ANV. The only class

2018 PDQ - NCI's Comprehensive Cancer Database

152. Genetics of Prostate Cancer (PDQ®): Health Professional Version

prostatic hyperplasia and prostate cancer have been found to influence perceived risk of prostate cancer. Studies conducted before the availability of genetic testing for prostate cancer susceptibility showed that factors found to positively influence men’s hypothetical interest in genetic testing included the advice of their primary care physician, a combination of the emotional distress and concern about prostate cancer treatment effects, and having children. Several small studies have examined (...) these genes.) (GWAS) are another methodology used to identify candidate associated with prostate cancer. Genetic variants identified from GWAS typically are common in the population and have low to modest effect sizes for prostate cancer risk. The clinical role of markers identified from GWAS is an active area of investigation. Case-control studies are useful in validating the findings of linkage studies and GWAS as well as for studying candidate gene alterations for association with prostate cancer risk

2018 PDQ - NCI's Comprehensive Cancer Database

153. Cancer Genetics Risk Assessment and Counseling (PDQ®): Health Professional Version

that the guidelines are intended to maximize appropriate referral of at-risk individuals for cancer genetic consultation but are not meant to provide genetic testing or treatment recommendations. Tools to Identify Candidates for Genetic Counseling and Genetic Testing Identification of patients at moderate to high risk of hereditary cancer for genetic services is recommended by all major societies. Primary care physicians have a number of tools available to triage patients. In addition to the published categorical (...) genetics risk assessment and genetic counseling, with hyperlinks to detailed sections below that describe the evidence on each topic. Identification of Individuals for Cancer Genetics Risk Assessment and Counseling Individuals are considered to be candidates for cancer risk assessment if they have a personal and/or family history (on the maternal or paternal side) or clinical characteristics with . These features vary by type of cancer and specific hereditary syndrome. Criteria have been published

2018 PDQ - NCI's Comprehensive Cancer Database

154. Genetics of Colorectal Cancer (PDQ®): Health Professional Version

.[ ] Microsatellite-unstable, CIMP-high colorectal tumors were significantly more associated with BRAF V600E pathogenic variants, proximal site, older patient age, and absence of KRAS2 pathogenic variants than were microsatellite unstable, CIMP-low tumors.[ ] There was a significantly greater presence of BRAF V600E pathogenic variants in CIMP-high colorectal tumors regardless of MSI.[ ] Thus, unlike a previous study that questioned the biological significance of CIMP once unstable colorectal tumors were excluded

2018 PDQ - NCI's Comprehensive Cancer Database

155. Genetics of Breast and Gynecologic Cancers (PDQ®): Health Professional Version

cancer is unclear. Preliminary data suggest that increased sensitivity to radiation could be a cause of cancer susceptibility in carriers of BRCA1 or BRCA2 pathogenic variants,[ - ] and in association with germline ATM and TP53 variants.[ , ] The possibility that genetic susceptibility to breast cancer occurs via a mechanism of radiation sensitivity raises questions about radiation exposure. It is possible that diagnostic radiation exposure, including mammography, poses more risk in genetically

2018 PDQ - NCI's Comprehensive Cancer Database

156. BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment

Psychiatrist, Greater Manchester West Mental Health NHS Foundation Trust, Salford, UK 9 Consultant Physician, Leighton and Macclesfield Hospitals, Cheshire, UK 10 Research Fellow, University of Manchester, Manchester, UK 11 Professor in Diabetes and Endocrinology, Human Development and Health Academic Unit, University of Southampton, Southampton, UK 12 Professor of Addiction Biology, Imperial College, London, UK 13 Consultant Psychiatrist, CNWL NHS Foundation Trust, London, UK 14 Professor of Psychiatric (...) by the general practitioner or a specialist physician, where necessary, as per existing NICE guidelines (S). • Dyslipidaemia, especially in the context of a person with diabetes, should be actively managed according to exist- ing NICE guidelines for the general population (S). There is no contraindication to the prescription of a statin in people prescribed antipsychotics. • Hypertension should be managed according to standard NICE guidelines. Practitioners should be aware of possi- ble increased hypotensive

2016 British Association for Psychopharmacology

157. Evidence-based guidelines for treating bipolar disorder

the validity and gener- alizability of any conclusions (Leon et al., 2006). Finally, outcomes in acute treatment studies are often rating scale scores, which are arbitrary counts of symptoms and their severity. These are measures rarely used by clinicians because they are tedious to obtain by interview. They are intermediate measures suspended between biomarkers, which can prove a drug has had the predicted pharmacological effect, and real outcomes relevant to patients (for example return to work). Real (...) of the same coin? Relapse prevention studies have been interpreted in that way in previous BAP guidelines. However, it is recognized that much of the difference between active treatment arms and pla- cebo are due to early events, and drop-out rates tend to be very high. Retention of patients in a 1–2-year study may be as low as 10%. Hence, interpretation of such studies, except in relation to acute efficacy, may be questionable. It may also be objected that such studies are ‘enriched’ with patients who

2016 British Association for Psychopharmacology

158. Prostate Cancer Treatment (PDQ®): Health Professional Version

(intermediate) outcomes, such as PSA rise or pathologic surgical findings, and subjective endpoints, such as the physician's perceived need for additional therapy. In addition, the nomograms may be affected by changing methods of diagnosis or neoadjuvant therapy.[ ] Follow-up After Treatment The optimal follow-up strategy for men treated for prostate cancer is uncertain. Men should be interviewed and examined for symptoms or signs of recurrent or progressing disease, as well as side effects of therapy

2018 PDQ - NCI's Comprehensive Cancer Database

159. Evidence-based Guidelines for Treating Bipolar Disorder

the validity and gener- alizability of any conclusions (Leon et al., 2006). Finally, outcomes in acute treatment studies are often rating scale scores, which are arbitrary counts of symptoms and their severity. These are measures rarely used by clinicians because they are tedious to obtain by interview. They are intermediate measures suspended between biomarkers, which can prove a drug has had the predicted pharmacological effect, and real outcomes relevant to patients (for example return to work). Real (...) of the same coin? Relapse prevention studies have been interpreted in that way in previous BAP guidelines. However, it is recognized that much of the difference between active treatment arms and pla- cebo are due to early events, and drop-out rates tend to be very high. Retention of patients in a 1–2-year study may be as low as 10%. Hence, interpretation of such studies, except in relation to acute efficacy, may be questionable. It may also be objected that such studies are ‘enriched’ with patients who

2016 British Association for Psychopharmacology

160. Patient safety in primary healthcare: a review of the literature

, and analytic when the aim was to determine factors associated with risks. 1.2 Studies included in the literature that evaluated the effect of interventions to minimise risks to patient safety required experimental designs. These included randomised control trials and quasi-experimental study designs. 1.3 Studies that addressed questions on the evidence of risk associated with patient safety in primary healthcare used a range of qualitative methods (for example focus groups and semi-structured interviews (...) Analytic Experimental Randomised controlled trial Quasi experimental Observational Cohort Study Cross-sectional (Analytic) Case-control study 17 PATIENT SAFETY IN PRIMARY HEALTHCARE | SAX INSTITUTE Question 1: What was the aim of the study? If the aim of the research was to simply describe a population (P) or outcome (O), then it was a descriptive study. These were often surveys or qualitative studies, for example using focus groups or semi-structured interviews. A study that describes the nature

2015 Sax Institute Evidence Check

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