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261. Screening, Monitoring, and Treatment of Stage 1-3 Chronic Kidney Disease: A Clinical Practice Guideline from the American College of Physicians

clinical practice guidelines grading system. Recommendation 1: ACP recommends against screening for chronic kidney disease in asymptomatic adults without risk factors for chronic kidney disease. (Grade: weak recommendation, low-quality evidence) Recommendation 2: ACP recommends against testing for proteinuria in adults with or without diabetes who are currently taking an angiotensin-converting enzyme inhibitor or an angiotensin II–receptor blocker. (Grade: weak recommendation, low-quality evidence (...) albuminuria, as indicated by a urinary albumin–creatinine ratio of 3 mg/mmol or greater [≥30 mg/g]) or a glomerular filtration rate (GFR) less than 60 mL/min/1.73 m 2 for 3 or more months. Traditionally, CKD is categorized into 5 stages that are based on disease severity defined by GFR ( ); stages 1 to 3 are considered to be early-stage CKD. People with early stages of the disease are typically asymptomatic, and the diagnosis is made by using laboratory tests or imaging. In 2013, KDIGO revised CKD staging

2013 American College of Physicians

262. Cardiovascular Function and Treatment in ß-Thalassemia Major Full Text available with Trip Pro

. Diagnostic Strategies for Cardiac Involvement in TM 3.1 Basic Tests New-onset electrocardiographic abnormalities are usually evident in TM patients with HF and may include supraventricular arrhythmias, electrocardiographic findings that suggest right-sided heart involvement (S 1 Q 3 pattern and right-axis deviation), new-onset T-wave inversion beyond lead V 1 , and a consistent decrease in QRS height. In patients without HF, an abnormal ECG was found in 46% (T-wave abnormalities in 34% and right bundle (...) . CMR with late gadolinium enhancement should be considered in any patient who has a positive test result for hepatitis C, has abnormal cardiac function in the absence of cardiac iron, or has other known cardiovascular risk factors, such as chronic diabetes mellitus. Diastolic cardiac function is measured in clinical practice by echocardiography, and CMR is not generally used for this assessment despite the fact that it provides absolute peak filling rates from the volume-time curves

2013 American Heart Association

263. Heart Failure: Guideline For the Management of

; Frederick A. Masoudi, MD, MSPH, FACC, FAHAy#; Patrick E. McBride, MD, MPH, FACC**; John J. V. McMurray, MD, FACC*y; Judith E. Mitchell, MD, FACC, FAHAy; Pamela N. Peterson, MD, MSPH, FACC, FAHAy; Barbara Riegel, DNSc, RN, FAHAy; Flora Sam, MD, FACC, FAHAy; Lynne W. Stevenson, MD, FACC*y; W. H. Wilson Tang, MD, FACC*y; Emily J. Tsai, MD, FACCy; Bruce L. Wilkoff, MD, FACC, FHRS*yy *Writingcommitteemembersarerequiredtorecusethemselvesfromvotingonsectionstowhichtheirspeci (...) this writing effort. This document was approved by the American College of Cardiology Foundation Board of Trustees and the American Heart Association Science Advisory and Coordinating Committee in May 2013. The American College of Cardiology Foundationrequests that this documentbe citedas follows: Yancy CW,Jessup M, BozkurtB, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel

2013 American College of Cardiology

264. 2013 ACC/AHA Guideline for the Management of ST-Elevation Myocardial Infarction - Focused Update

THROMBOCYTOPENIA .e111 9.7.2. Bleeding Complications .e111 9.7.2.1. TREATMENT OF ICH .e112 9.7.2.2. VASCULAR ACCESS SITE BLEEDING .e112 9.8. Acute Kidney Injury .e112 9.9. Hyperglycemia .e112 10. Risk Assessment After STEMI .e113 10.1. Use of Noninvasive Testing for Ischemia Before Discharge: Recommendations . .e113 10.2. Assessment of LV Function: Recommendation .e114 10.3. Assessment of Risk for SCD: Recommendation .e114 11. Posthospitalization Plan of Care .e114 11.1. Posthospitalization Plan of Care (...) are asked to perform a formal literature review; weigh the strength of evidence for or against particular tests, treatments, or procedures; and include estimates of expected outcomes where such data exist. Patient-speci?c modi?ers, comorbidities, and issues of patient preference that may in?uence the choice of tests or therapies are considered. When available, information from studies on cost is consid- ered, but data on ef?cacy and outcomes constitute the primary basis for the recommendations contained

2013 Society for Cardiovascular Angiography and Interventions

265. Treatment and recommendations for homeless people with Diabetes Mellitus

and patterns including nutrition status, weight history, and food sources (e.g., soup kitchens). Ask patients if they are able to follow an appropriate diabetic diet. Many food sources supply only one meal a day so that the homeless person must visit multiple places for food. Some shelters are able to provide alternatives to persons with special dietary needs. ? Determine if/where patients are getting medical help, advice, syringes, and test strips. Home glucose meters can often be obtained at no cost from (...) companies as samples. In addition, many stores carry lancets and test strips at very affordable prices. These options should be researched and recommended as appropriate. ? Assess for medical and mental health comorbidities and associated medications. ? Explore the use of tobacco, alcohol and illicit drugs, and the frequency and route of use. Past Medical History ? Ask patients if they have ever had foot sores or ulcers or any problems with their feet. ? Assess and often reassess how much walking

2013 National Health Care for the Homeless Council

266. Treatment and Recommendations for Homeless Patients with Chlamydial or Gonococcal Infections

. ADAPTING YOUR PRACTICE Treatment & Recommendations for Homeless Patients with Chlamydial/Gonococcal Infections Health Care for the Homeless Clinicians’ Network 7 Table of Contents Summary of recommended practice adaptations 9 Introduction 14 CHLAMYDIAL OR GONOCOCCAL INFECTIONS IN ADULTS AND ADOLESCENTS Case Study: Homeless Adolescent with Chlamydia 18 Case Study: Homeless Young Adult with Gonorrhea 19 Diagnosis and Evaluation History 20 Physical examination 21 Diagnostic tests 22 Plan and Management (...) Education/self-management 23 Medications 24 Associated problems/complications 25 Follow-up 26 CHLAMYDIAL/GONOCOCCAL INFECTIONS IN INFANTS AND CHILDREN UNDER 3 YEARS OF AGE Case Study: Homeless Infant with Chlamydia 27 Diagnosis and Evaluation History 28 Physical examination 28 Diagnostic tests 28 Plan and Management Education/self-management 29 Medications 29 Associated problems/complications 29 Follow-up 29 ADAPTING YOUR PRACTICE Treatment & Recommendations for Homeless Patients with Chlamydial

2013 National Health Care for the Homeless Council

267. Guidelines for the Management of Absolute Cardiovascular Disease Risk

: In adults at low absolute risk of CVD, blood test results within five years may be used for review of absolute cardiovascular risk unless there are reasons to the contrary. Treatment Lifestyle modification PP 9: All adults should be supported to follow the current Dietary Guidelines for Australian Adults. PP 10: All smokers should be offered advice about methods to aid smoking cessation, including counselling services, and if assessed as nicotine dependent, nicotine replacement therapy or other (...) a normal level. A result of 5.5–6.0 mmol/L may be normal but some people will show diabetes or impaired glucose tolerance in an oral glucose tolerance test (OGTT). A value of = 6.1 mmol/L but = 6.9 mmol/L is diagnostic of impaired fasting glucose and requires an OGTT to confirm diabetes or impaired glucose tolerance. A value of = 7.0 mmol/L on two separate occasions is diagnostic of diabetes and does not require an OGTT. When a fasting sample is not possible non-fasting glucose can be measured

2012 Stroke Foundation - Australia

268. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease: Executive Summary

or Statements 2571 1.6. Magnitude of the Problem 2571 1.7. Organization of the Guideline 2571 1.8. Vital Importance of Involvement by an Informed Patient: Recommendation 2572 2. Diagnosis of SIHD: Recommendations 2572 2.1. Clinical Evaluation of Patients With Chest Pain 2572 2.1.1. Clinical Evaluation in the Initial Diagnosis of SIHD in Patients With Chest Pain 2572 2.1.2. Electrocardiography 2572 2.1.2.1. RESTING ELECTROCARDIOGRAPHY TO ASSESS RISK 2572 2.1.3. Stress Testing and Advanced Imaging for Initial (...) Diagnosis in Patients With Suspected SIHD Who Require Noninvasive Testing 2572 2.1.3.1. ABLE TO EXERCISE 2572 2.1.3.2. UNABLE TO EXERCISE 2572 2.1.3.3. OTHER 2574 3. Risk Assessment: Recommendations 2574 3.1. Advanced Testing: Resting and Stress Noninvasive Testing 2574 3.1.1. Resting Imaging to Assess Cardiac Structure and Function 2574 3.1.2. Stress Testing and Advanced Imaging in Patients With Known SIHD Who Require Noninvasive Testing for Risk Assessment 2575 3.1.2.1. RISK ASSESSMENT IN PATIENTS

2012 Society for Cardiovascular Angiography and Interventions

269. 2012 KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD

demonstrating a positive reagent strip test for albuminuria/proteinuria or quantitative albuminuria/proteinuria test 57 Figure 17. GFR and albuminuria grid to reflect the risk of progression 63 Figure 18. Distributionoftheprobabilityofnonlinearitywiththreeexampletrajectoriesdemonstratingdifferentprobabilities of nonlinearity 69 Figure 19. Summary estimates for risks of all-cause mortality and cardiovascular mortality associated with levels of serum phosphorus, PTH, and calcium 86 Figure 20. Prevalence (...) International Supplements (2013) 3,5–14 summary of recommendation statements3.3:CKD METABOLIC BONE DISEASE INCLUDING LABORATORY ABNORMALITIES 3.3.1: We recommend measuring serum levels of calcium, phosphate, PTH, and alkaline phosphatase activity at least once in adults with GFRo45ml/min/1.73 m 2 (GFR categories G3b-G5) in order to determine baseline values and inform prediction equations if used. (1C) 3.3.2: We suggest not to perform bone mineral density testing routinely in those with eGFRo45ml/min/1.73 m

2012 National Kidney Foundation

270. KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for Management of Blood Pressure in CKD

the drug classes of agents tested, to test drug combinations and add-on therapy ap- proaches, and to provide guidance for situations such as obesity, for which drug metabolism/distribution may be different. Certainly, the expanding numbers with diabetes and diabetic CKD would make this Box4.KDIGORecommendationsforBloodPressureManage- mentinCKDNDPatientsWithDiabetesMellitus 4.1: WerecommendthatadultswithdiabetesandCKDND withurinealbuminexcretion30mgper24hours(or equivalent*)whoseof

2012 National Kidney Foundation

271. ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease (SIHD)

or Statements 2571 1.6. Magnitude of the Problem 2571 1.7. Organization of the Guideline 2571 1.8. Vital Importance of Involvement by an Informed Patient: Recommendation 2572 2. Diagnosis of SIHD: Recommendations 2572 2.1. Clinical Evaluation of Patients With Chest Pain 2572 2.1.1. Clinical Evaluation in the Initial Diagnosis of SIHD in Patients With Chest Pain 2572 2.1.2. Electrocardiography 2572 2.1.2.1. RESTING ELECTROCARDIOGRAPHY TO ASSESS RISK 2572 2.1.3. Stress Testing and Advanced Imaging for Initial (...) Diagnosis in Patients With Suspected SIHD Who Require Noninvasive Testing 2572 2.1.3.1. ABLE TO EXERCISE 2572 2.1.3.2. UNABLE TO EXERCISE 2572 2.1.3.3. OTHER 2574 3. Risk Assessment: Recommendations 2574 3.1. Advanced Testing: Resting and Stress Noninvasive Testing 2574 3.1.1. Resting Imaging to Assess Cardiac Structure and Function 2574 3.1.2. Stress Testing and Advanced Imaging in Patients With Known SIHD Who Require Noninvasive Testing for Risk Assessment 2575 3.1.2.1. RISK ASSESSMENT IN PATIENTS

2012 Society for Cardiovascular Angiography and Interventions

272. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease

Standardization (COGS) checklist for reporting clinical practice guidelines 322 FIGURES Figure 1. Receiver operating characteristic (ROC) curves, examining the utility of iron status tests to distinguish iron deficient from nondeficient study patients 293 Figure 2. Sensitivity and specificity of TSAT and serum ferritin and their combination (TSAT + ferritin) and bone marrow iron (BM iron) to identify correctly a positive erythropoietic response (Z1-g/dl [Z10-g/l] increase in Hb [DHb]) to intravenous iron (...) in 100 nondialysis patients with CKD (areas under the ROCs) 294 Figure 3. Lymphocytotoxic antibody reactivity against random donor test panel in relation to the number of blood transfusions 313 Figure 4. Algorithms for red cell transfusion use in CKD patients 315 Additional information in the form of supplementary materials can be found online at http://www.kdigo.org/clinical_practice_guidelines/anemia.php http://www.kidney-international.org contents & 2012 KDIGO Kidney International Supplements

2012 National Kidney Foundation

273. KDOQI US Commentary on the 2012 KDIGO Clinical Practice Guideline for Anemia in CKD Full Text available with Trip Pro

Outcomes) clinical practice guideline for anemia in chronic kidney disease (CKD) was published in 2012. x 1 KDIGO Anemia Work Group. KDIGO Clinical Practice Guideline for Anemia in Chronic Kidney Disease. Kidney Int Suppl . 2012 ; 2 : 279–335 | | An international group of experts, led by John J.V. McMurray and Patrick S. Parfrey, with the assistance of an evidence review team from Tufts Medical Center in Boston, created comprehensive, evidence-based guidance for the treatment of anemia in CKD, tempered (...) those that the work group thought required comment or qualification are reproduced here. All material is reproduced with permission of KDIGO. Guideline Statements and Commentary Testing for Anemia Frequency of testing for anemia 1.1.1: For CKD patients without anemia (as defined … in Recommendation 1.2.1 for adults and Recommendation 1.2.2 for children), measure Hb concentration when clinically indicated and ( Not Graded ): • at least annually in patients with CKD 3 • at least twice per year

2012 National Kidney Foundation

274. Management of Atrial Fibrillation

of Thromboembolism xiii6.1 Risk Stratification For Stroke 6.2 Strategies for Thromboembolic Prophylaxis 6.3 Antithrombotic Therapy 6.3.1 Anticoagulation With Vitamin K Antagonists 6.3.2 Optimal International Normalized Ratio 6.3.2.1 Point-of-care testing and self-monitoring of anticoagulation 6.3.3 Anticoagulation With Direct Thrombin Inhibitors 6.3.4 Investigational Agents 6.3.5 Antiplatelet Agent Aspirin 6.3.6 Aspirin And Clopidogrel Combination 6.4 Anticoagulation In Special Circumstances 6.4.1 Peri-operative (...) (e.g. AF terminates within 24 – 48 h). After the initial management of symptoms and complications, underlying causes of AF should be sought. A TTE is useful to detect ventricular, valvular, and atrial disease as well as rare congenital heart disease. Thyroid function tests, a full 7 Table 5 : EHRA score of AF-related symptoms AF = atrial fibrillation; EHRA = European Heart Rhythm Association. Table 5 : EHRA score of AF-related symptoms AF = atrial fibrillation; EHRA = European Heart Rhythm

2012 Ministry of Health, Malaysia

275. Management of bleeding in patients on antithrombotic agents Full Text available with Trip Pro

‐life and length of functional defect induced by the drug Assess the source of bleeding Request full blood count, prothrombin time, activated partial thromboplastin time, thrombin time, fibrinogen concentration, creatinine concentration If available, request a specific laboratory test to measure the antithrombotic effect of the drug Correct haemodynamic compromise with intravenous fluids and red cell transfusion Apply mechanical pressure, if possible Use endoscopic, radiological or surgical measures (...) of the anticoagulant activity of LMWH lasts approximately 4 h. The mechanism of action of LMWH and differences from UFH were recently reviewed (Gray et al , ). LMWH activity may be monitored with the anti‐Xa test. Although LMWH may also prolong the APTT, this test should not be used to assess the extent of drug effect. Protamine reverses approximately 60% of LMWH based on data from animal studies (Bang et al , ; Lindblad et al , ; Van Ryn‐McKenna et al , ) and healthy human volunteers (Holst et al , ). The largest

2012 British Committee for Standards in Haematology

276. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction Full Text available with Trip Pro

STEMI e397 10.1. Use of Noninvasive Testing for Ischemia Before Discharge: Recommendations e397 10.2. Assessment of LV Function: Recommendation e398 10.3. Assessment of Risk for SCD: Recommendation e398 11. Posthospitalization Plan of Care e399 11.1. Posthospitalization Plan of Care: Recommendations e399 11.1.1. The Plan of Care for Patients With STEMI e399 11.1.2. Smoking Cessation e399 11.1.3. Cardiac Rehabilitation e399 11.1.4. Systems of Care to Promote Care Coordination e399 12. Unresolved (...) in the subject under consideration are selected by the ACCF and AHA to examine subject-specific data and write guidelines in partnership with representatives from other medical organizations and specialty groups. Writing committees are asked to perform a formal literature review; weigh the strength of evidence for or against particular tests, treatments, or procedures; and include estimates of expected outcomes where such data exist. Patient-specific modifiers, comorbidities, and issues of patient preference

2012 American Heart Association

277. Oral antithrombotic agents for the prevention of stroke in nonvalvular atrial fibrillation

and the prevention of stroke in patients with stroke or transient ischemic attack (TIA), 5 we review recent trials testing the safety and effi- cacy of a thrombin inhibitor (dabigatran) and 2 factor Xa inhibitors (rivaroxaban and apixaban) in preventing stroke in patients with AF, and we revise management recom- mendations. 4,5 Recommendations follow the AHA’s and the American College of Cardiology’s methods of classifying the level of certainty of the treatment effect and the class of evidence (Table 1 (...) ), RIETE (Registro Informatizado de la Enfermedad Tromboemb´ olica), and ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) scores have been developed A recommendation with Level of Evidence B or C does not imply that the recommendation is weak. Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials. Although randomized trials are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful

2012 American Academy of Neurology

278. ST-Elevation Myocardial Infarction: Guideline For the Management of

. Hyperglycemia .e112 10. Risk Assessment After STEMI .e113 10.1. Use of Noninvasive Testing for Ischemia Before Discharge: Recommendations . .e113 10.2. Assessment of LV Function: Recommendation .e114 10.3. Assessment of Risk for SCD: Recommendation .e114 11. Posthospitalization Plan of Care .e114 11.1. Posthospitalization Plan of Care: Recommendations .e114 11.1.1. The Plan of Care for Patients With STEMI .e114 11.1.2. Smoking Cessation .e116 11.1.3. Cardiac Rehabilitation .e116 11.1.4. Systems of Care (...) evidence to develop balanced, patient-centric rec- ommendations for clinical practice. Experts in the subject under consideration are selected by the ACCF and AHA to examine subject-speci?c data and write guidelines in partnership with representatives from other medical organizations and specialty groups. Writing committees are asked to perform a formal literature review; weigh the strength of evidence for or against particular tests, treatments, or procedures; and include estimates of expected

2012 American College of Cardiology

279. Recommendations for the Use of Mechanical Circulatory Support: Device Strategies and Patient Selection Full Text available with Trip Pro

walk test, with the majority (83%) of patients in New York Heart Association (NYHA) functional class I or II. Improvement in quality of life was also recorded in patients treated as BTT. This device showed improved durability, with pump replacement required in only 4% of patients. The MicroMed DeBakey, a continuous, axial-flow pump, is not approved by the FDA for use in adults but is available for use in children 5 to 16 years of age. Because of its small size, the MicroMed DeBakey provides (...) clinical trial and the later HeartMate II DT clinical trial supported the use of DT. In addition to improved survival, the majority of patients experience significant improvement in both functional status (NYHA classification and 6-minute walk tests) and quality of life (Minnesota Living With Heart Failure questionnaire and Kansas City Cardiomyopathy questionnaire) after MCS. In the HeartMate II DT clinical trial, 80% of patients had NYHA class I or II symptoms at 24 months and a doubling of the mean

2012 American Heart Association

280. Decision Making in Advanced Heart Failure

). ? Benefits and risks of noncardiac procedures should be reviewed in the context of competing risks for death and functional limitation attributable to heart failure (eg, hip replacement, repair of asymptomatic aortic aneurysm, or screening tests). ? Decisions for major cardiac and noncardiac interventions should include consideration of “what if” situations of unanticipated adversity. ? Referral to a palliative care team should be considered for assistance with difficult decision making, symptom man

2012 American Heart Association

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