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Life-Threatening Drug-Induced Rashes

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181. Management of Dyslipidaemias

lipoprotein cholesterol levels 25 7.4 Lifestyle recommendations to improve the plasma lipid profile 25 7.4.1 Body weight and physical activity 25 7.4.2 Dietary fat 25 7.4.3 Dietary carbohydrate and fibre 26 7.4.4 Alcohol 26 7.4.5 Smoking 26 7.5 Dietary supplements and functional foods for the treatment of dyslipidaemias 26 7.5.1 Phytosterols 26 7.5.2 Monacolin and red yeast rice 26 7.5.3 Dietary fibre 27 7.5.4 Soy 27 7.5.5 Policosanol and berberine 27 7.5.6 n-3 unsaturated fatty acids 27 8 Drugs (...) hypercholesterolaemia 41 9.1.2.3 Familial hypercholesterolaemia in children 41 9.1.3 Familial dysbetalipoproteinaemia 41 9.1.4 Genetic causes of hypertriglyceridaemia 41 9.1.4.1 Action to prevent acute pancreatitis in severe hypertriglyceridaemia 41 9.1.5 Other genetic disorders of lipoprotein metabolism 42 9.2 Women 42 9.2.1 Effects of statins in primary and secondary prevention 42 9.2.2 Non-statin lipid-lowering drugs 42 9.2.3 Hormone therapy 42 9.3 Older people 42 9.3.1 Effects of statins in primary

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2019 European Society of Cardiology

182. Systemic Adjuvant Therapy for Adult Patients at High Risk for Recurrent Melanoma

toxicity, and altered laboratory findings (hematologic parameters, hypertriglyceridemia). These AEs often have a profound negative effect on quality of life, and may be life-threatening. With careful monitoring, supportive care, and dose modifications, most AEs are manageable. Other IFN Trials Short-term IFN The Hellenic Cooperative Oncology Group (HeCOG) trial [145] compared IFN-a2b for 4 weeks versus 52 weeks, while the larger E1697 trial [148] compared HD-IFN-a2b for 4 weeks versus observation (...) which of these is more effective. These agents were evaluated in different trials [1-3] (see Table 4-4) and have not been directly compared Guideline 8-1 version 5 Section 1. Recommendations Page 2 in the adjuvant setting. For nivolumab and pembrolizumab, treatment-related adverse events (AEs) tended to be mild and manageable, and occurred in 85% and 78% of patients, respectively, with the most common being fatigue, skin reactions (rash, pruritus), diarrhea, nausea, and endocrine disorders. Rates

2019 Cancer Care Ontario

183. Systemic Therapy for Advanced or Recurrent Endometrial Cancer and Advanced or Recurrent Uterine Papillary Serous Carcinoma

with advanced or recurrent endometrial cancer: ? Combination chemotherapy is favoured over single agent chemotherapy because of higher response rates. ? Paclitaxel in combination with cisplatin/doxorubicin chemotherapy improves both response rate and median survival; however, the use of this three-drug combination is associated with increased toxicity. ? Hormonal therapy may be a therapeutic option for those patients with minimal symptoms or non-life threatening advanced or recurrent endometrial cancer (...) option for those patients with minimal symptoms or non-life threatening advanced or recurrent endometrial cancer. For women with UPSC: ? Evidence supporting or refuting various chemotherapy regimens for UPSC is limited. ? Patients should be encouraged to participate in randomized trials. Qualifying Statements: ? The decision to use the three-drug combination, consisting of cisplatin/doxorubicin/paclitaxel, should be made in consultation with the patient. Consideration needs to be given to both

2019 Cancer Care Ontario

184. Management of Cancer Medication-Related Infusion Reactions

with a drug’s mechanism of action. 1,2 The incidence of IRs varies depending on the anticancer agent used. In some cases, the incidence of reactions may be low but the risk for potentially life-threatening reactions exists. 2,3 Most IRs occur within the first hour of either the first or second administration of an intravenous anticancer medication; therefore, careful monitoring during infusion initiation is necessary to detect potential IRs and manage accordingly. 3 In cases where IRs may be prevented (...) , the administration of prophylactic medications is key. Appropriate clinical assessment of IRs is necessary to ensure optimal management. Anticancer medications causing reactions should be discontinued in patients who are likely to experience a severe, potentially life-threatening reaction upon re-challenge. 2–5 In some cases, equally effective alternatives are available, and treatment can be switched. In other cases, it may be safe to re-challenge with the offending agent at reduced rates, with additional pre

2019 Cancer Care Ontario

185. Vandetanib for treating medullary thyroid cancer

treatment 6 Clinical trial evidence 6 Other subgroups 8 Clinical trial results 8 Indirect treatment comparison 11 Adverse events 12 Economic models 13 Costs 14 Utility values 15 Cost-effectiveness estimates 15 Uncaptured benefits 16 End of life 16 Cancer Drugs Fund 17 Conclusions 18 4 Appraisal committee members and NICE project team 21 Appraisal committee members 21 NICE project team 21 Vandetanib for treating medullary thyroid cancer (TA550) © NICE 2018. All rights reserved. Subject to Notice (...) compared with either best supportive care or cabozantinib are much higher than what NICE normally considers an acceptable use of NHS resources. Vandetanib does not meet NICE's end-of-life or Cancer Drugs Fund criteria. Therefore, it cannot be recommended as a cost-effective use of NHS resources. Vandetanib for treating medullary thyroid cancer (TA550) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 4 of 222 2

2018 National Institute for Health and Clinical Excellence - Technology Appraisals

186. Trastuzumab (Ogivri) - breast cancer or stomach cancer

occurs first; extending treatment in EBC beyond one year is not recommended (see section 5.1). Dose reduction No reductions in the dose of trastuzumab were made during clinical trials. Patients may continue therapy during periods of reversible, chemotherapy-induced myelosuppression but they should be monitored carefully for complications of neutropenia during this time. Refer to the SmPC for paclitaxel, docetaxel or aromatase inhibitor for information on dose reduction or delays. 5 If left (...) to the bioactive metabolites (e.g. 5-FU) of capecitabine was not affected by concurrent use of cisplatin or by concurrent use of cisplatin plus trastuzumab. However, capecitabine itself showed higher concentrations and a longer half-life when combined with trastuzumab. The data also suggested that the pharmacokinetics of cisplatin were not affected by concurrent use of capecitabine or by concurrent use of capecitabine plus trastuzumab. Pharmacokinetic data from Study H4613g/GO01305 in patients with metastatic

2019 European Medicines Agency - EPARs

187. Cabozantinib for treating medullary thyroid cancer

The committee recognised that medullary thyroid cancer is rare, and that cabozantinib is 1 of only 2 targeted treatments available in this indication. However, it heard from the clinical experts that the survival benefit of both drugs is unknown, and so treatment aims to delay disease progression and improve quality of life. The committee acknowledged that although cabozantinib may work well for some people, for many others there may be a substantial side-effect burden. It therefore concluded (...) that there are no additional health-related quality-of-life benefits not already captured in the QAL Y calculations. End of life Cabozantinib meets the end-of-life criterion for e Cabozantinib meets the end-of-life criterion for extension to life xtension to life 3.13 The committee considered the advice about life-extending treatments for people with a short life expectancy in NICE's Cancer Drugs Fund technology Cabozantinib for treating medullary thyroid cancer (TA516) © NICE 2018. All rights reserved. Subject to Notice

2018 National Institute for Health and Clinical Excellence - Technology Appraisals

188. Public health service provision by community pharmacies: a systematic map of evidence

drugs QALY Quality adjusted life year How to read this report Public health service provision by community pharmacies: a systematic map of evidence 1 How to read this report Because this is the technical report of a systematic map that uses transparent methods, some sections of the report are necessarily detailed. Without compromising on the transparency that is expected of a systematic map, we have structured this report to help those who are more concerned with the findings than the methods. Part (...) The included studies 88 9.3 Alcohol 88 9.4 Services for people who inject drugs 91 10 Obesity and weight management 98 10.1 Introduction 98 10.2 Included studies 98 11 Other health conditions 103 11.1 Introduction 103 11.2 Bowel disease and gastrointestinal conditions 106 11.3 Early cancer awareness 108 11.4 Chronic kidney disease (CKD) and renal impairment 112 11.5 Dementia and cognitive impairment 113 11.6 Depression 114 11.7 Low back pain 115 11.8 Migraine and headache 116 Public health service

2019 EPPI Centre

189. Nivolumab for adults with Hodgkin's lymphoma (a rapid review using the software RobotReviewer). (PubMed)

certainty evidence).One trial (243 participants) reported drug-related grade 3 or 4 adverse events (AEs) only after a median follow-up of 18 months (IQR 15 to 22 months); these were fatigue (23%), diarrhoea (15%), infusion reactions (14%) and rash (12%). The other two trials (40 participants) reported 23% to 52% grade 3 or 4 AEs after six months' follow-up (very low certainty evidence). Only one trial (243 participants) reported drug-related serious AEs; 2% of participants developed infusion reactions (...) range of malignancies. Nivolumab is an anti-(PD)-1 monoclonal antibody and currently approved by the US Food and Drug Administration (FDA) for the treatment of melanoma, non-small cell lung cancer, renal cell carcinoma and, since 2016, for classical Hodgkin's lymphoma (cHL) after treatment with ASCT and brentuximab vedotin.To assess the benefits and harms of nivolumab in adults with HL (irrespective of stage of disease).We searched CENTRAL, MEDLINE, Embase, International Pharmaceutical Abstracts

2018 Cochrane

190. Overview of pregnancy complications

turn spontaneously to a cephalic presentation before birth. Mothers sensitised to Rh factor in their first pregnancy may have problems when pregnant with a second Rh-positive child. Symptoms in the infant can range from mild to life-threatening hyperbilirubinaemia. In addition to immediate post-birth resuscitation, efforts to reduce excessive oxygen exposure, hyperventilation, hypothermia, and hypoglycaemia must be made. Escobedo M. Moving from experience to evidence: changes in US Neonatal (...) : a review. Obstet Gynecol Surv. 2005;60:741-745. http://www.ncbi.nlm.nih.gov/pubmed/16250922?tool=bestpractice.com Possible risk factors include multiple previous pregnancies, Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005;192:1458-1461. http://www.ncbi.nlm.nih.gov/pubmed/15902137?tool=bestpractice.com Zhou W, Nielsen GL, Larsen H, et al. Induced abortion and placenta complications in the subsequent pregnancy. Acta Obstet Gynecol Scand. 2001;80

2018 BMJ Best Practice

191. Overview of meningitis

. http://www.ncbi.nlm.nih.gov/pubmed/12751260?tool=bestpractice.com Children with acute-onset rash accompanied by fever or systemic signs require urgent evaluation and treatment. One of the most life-threatening differentials is meningococcal septicaemia. Other infectious diseases presenting with skin rash in children that can result in meningitis as a complication include, for example, roseola infantum (sixth disease). Tuberculous meningitis results from haematogenous spread of Mycobacterium (...) causative pathogens in both adults and children. Rapid assessment and prompt antimicrobial therapy are essential. Meningococcal infection may progress rapidly to septic shock with hypotension, acidosis, and disseminated intravascular coagulation. Prompt evaluation and treatment are essential, as the case fatality rate is high. A progressive, life-threatening, chronic or subacute meningitis that is most commonly caused by Cryptococcus species. Chayakulkeeree M, Perfect JR. Cryptococcosis. Infect Dis Clin

2018 BMJ Best Practice

192. Systemic lupus erythematosus

the skin and joints, although serositis, nephritis, haematological cytopenias, and neurological manifestations may occur during the course of the disease. Earlier diagnosis and better management have resulted in a lower prevalence of life-threatening disease. History and exam malar (butterfly) rash photosensitive rash discoid rash fatigue weight loss fever oral ulcers alopecia arthralgia/arthritis fibromyalgia Raynaud's phenomenon chest pain and shortness of breath hypertension signs of nephrosis (e.g (...) serositis or arthritis include hydroxychloroquine, non-steroidal anti-inflammatory drugs, or corticosteroids. Treatments for more severe disease may include cyclophosphamide, mycophenolate, or tacrolimus plus corticosteroids. Definition Systemic lupus erythematosus (SLE) is a chronic multi-system disorder that most commonly affects women during their reproductive years. It is characterised by the presence of antinuclear antibodies. In addition to constitutional symptoms, it most frequently involves

2018 BMJ Best Practice

193. Overview of dermatitis

be reserved for severe cases and avoided in infants and children. [Figure caption and citation for the preceding image starts]: Seborrhoeic dermatitis, glabella, with scaling and mild erythema Personal collection of Dr Robert A. Schwartz [Citation ends]. Primarily an irritant contact dermatitis, nappy rash is inflammation of the skin in the area of the body covered by a nappy. It is most common in the first 1 to 2 years of life, but can occur in any person who routinely wears nappies. Recalcitrant nappy (...) ):157-68. http://www.ncbi.nlm.nih.gov/pubmed/21815450?tool=bestpractice.com Seborrhoeic dermatitis occurs in 2 age groups: infants (beginning before age 2 months) and adolescents. In adolescents, sebaceous secretions are altered by the normal skin flora, which induces dermatitis in the affected areas. Waldroup W, Scheinfeld N. Medicated shampoos for the treatment of seborrheic dermatitis. J Drugs Dermatol. 2008 Jul;7(7):699-703. http://www.ncbi.nlm.nih.gov/pubmed/18664167?tool=bestpractice.com

2018 BMJ Best Practice

194. Overview of dermatitis

be reserved for severe cases and avoided in infants and children. [Figure caption and citation for the preceding image starts]: Seborrhoeic dermatitis, glabella, with scaling and mild erythema Personal collection of Dr Robert A. Schwartz [Citation ends]. Primarily an irritant contact dermatitis, nappy rash is inflammation of the skin in the area of the body covered by a nappy. It is most common in the first 1 to 2 years of life, but can occur in any person who routinely wears nappies. Recalcitrant nappy (...) ):157-68. http://www.ncbi.nlm.nih.gov/pubmed/21815450?tool=bestpractice.com Seborrhoeic dermatitis occurs in 2 age groups: infants (beginning before age 2 months) and adolescents. In adolescents, sebaceous secretions are altered by the normal skin flora, which induces dermatitis in the affected areas. Waldroup W, Scheinfeld N. Medicated shampoos for the treatment of seborrheic dermatitis. J Drugs Dermatol. 2008 Jul;7(7):699-703. http://www.ncbi.nlm.nih.gov/pubmed/18664167?tool=bestpractice.com

2018 BMJ Best Practice

195. Anaphylaxis

is clinical. Allergy testing is helpful only for secondary prophylaxis. Securing the airway and initiating prompt treatment with epinephrine (adrenaline) may save lives. Comorbidities (e.g., coronary artery disease and COPD) may pose a treatment challenge and warrant expert consultation Definition Anaphylaxis is an acute, severe, life-threatening allergic reaction in pre-sensitised individuals, leading to a systemic response caused by the release of immune and inflammatory mediators from basophils (...) Anaphylaxis Anaphylaxis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Anaphylaxis Last reviewed: February 2019 Last updated: March 2019 Summary Sudden onset of respiratory or cardiovascular compromise, usually with a history of allergen exposure in sensitised individuals. Skin rash, wheezing and inspiratory stridor, hypotension, anxiety, nausea, and vomiting are the cardinal signs and symptoms. The diagnosis

2018 BMJ Best Practice

196. Overview of pregnancy complications

turn spontaneously to a cephalic presentation before birth. Mothers sensitised to Rh factor in their first pregnancy may have problems when pregnant with a second Rh-positive child. Symptoms in the infant can range from mild to life-threatening hyperbilirubinaemia. In addition to immediate post-birth resuscitation, efforts to reduce excessive oxygen exposure, hyperventilation, hypothermia, and hypoglycaemia must be made. Escobedo M. Moving from experience to evidence: changes in US Neonatal (...) : a review. Obstet Gynecol Surv. 2005;60:741-745. http://www.ncbi.nlm.nih.gov/pubmed/16250922?tool=bestpractice.com Possible risk factors include multiple previous pregnancies, Wu S, Kocherginsky M, Hibbard JU. Abnormal placentation: twenty-year analysis. Am J Obstet Gynecol. 2005;192:1458-1461. http://www.ncbi.nlm.nih.gov/pubmed/15902137?tool=bestpractice.com Zhou W, Nielsen GL, Larsen H, et al. Induced abortion and placenta complications in the subsequent pregnancy. Acta Obstet Gynecol Scand. 2001;80

2018 BMJ Best Practice

197. Dornase alfa for cystic fibrosis. (PubMed)

trials compared dornase alfa to placebo or no dornase alfa (2447 participants); two compared daily dornase to hypertonic saline (32 participants); one compared daily dornase alfa to hypertonic saline and alternate day dornase alfa (48 participants); one compared dornase alfa to mannitol and the combination of both drugs (38 participants). Trial duration varied from six days to three years.Dornase alfa compared to placebo or no treatmentDornase alfa improved forced expiratory volume at one second (...) at one month (four trials, 248 participants), three months (one trial, 320 participants; moderate-quality evidence), six months (one trial, 647 participants; high-quality evidence) and two years (one trial, 410 participants). Limited low-quality evidence showed no difference between groups for changes in quality of life. There was a decrease in pulmonary exacerbations with dornase alfa in trials of up to two years (moderate-quality evidence). One trial that examined the cost of care, including

2018 Cochrane

198. Quality indicators for the management of head and neck squamous cell carcinoma

versus standard radiotherapy for HNC (C-ART); combined hypofractionated stereotactic body radiotherapy with immunomodulating systemic therapy for inoperable recurrent HNC: detection of the maximum tolerated dose; SPECT-CT lymphoscintigraphy for individualized superselective prophylactic nodal irradiation in cN0 HNSCC: a phase I/II study; self-administration of buccal low-level laser therapy (LLLT) in oropharyngeal and buccal mucositis induced by (chemo)RT of HNC); Lisa Licitra (Several studies as PI

2019 Belgian Health Care Knowledge Centre

199. Acupuncture for symptomatic gastroparesis. (PubMed)

Acupuncture for symptomatic gastroparesis. Gastroparesis, a state of delayed gastric emptying in the absence of mechanical obstruction of the stomach, has a substantial impact on people's daily function and quality of life when symptomatic. Current treatment options are based on limited evidence of benefits. Acupuncture is widely used to manage gastrointestinal disorders, although its role in people with symptomatic gastroparesis is unclear. We therefore undertook a systematic review (...) gastroparesis of any aetiology (i.e. surgical, diabetic, or idiopathic). Trials reporting outcomes at least four weeks from baseline (short-term outcomes) were eligible. We defined long-term outcomes as those measured after 12 weeks from baseline. The primary outcome was improvement of gastroparesis symptoms in the short term. Secondary outcomes were: improvement of symptoms measured after three months, change in the rate of gastric emptying, quality of life, use of medication, and adverse events

2018 Cochrane

200. African trypanosomiasis

African trypanosomiasis African trypanosomiasis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  African trypanosomiasis Last reviewed: February 2019 Last updated: December 2018 Summary Fatal without treatment. All of the recommended drugs are available free of charge from the World Health Organization. Definite diagnosis is based on microscopic evidence of the trypanosome in body fluids. Disease staging is based (...) on cerebrospinal fluid exam. Aim of treatment is to cure the disease. The approach depends on parasite subspecies and disease stage, but all drugs have severe side effects and are complex to use. The card agglutination test is used for population screening in endemic regions. Definition A fatal disease caused by extracellular parasites (genus Trypanosoma ), which are transmitted by tsetse flies (genus Glossina ). Two morphologically indistinguishable Trypanosoma brucei subspecies cause disease in humans

2018 BMJ Best Practice

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