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61. Choice of therapy for Adults With Hypertension Without Compelling Indications for Specific Agents

. In recognition of the need for multidrug therapy, combination and add-on therapy trials are emerging. For example, at the end of the 5-year follow-up in ALLHAT, 63% of patients required at least two antihypertensive agents . Also, evidence supports the recommendation that combination therapy should be used if there is only a partial response to standard-dose monotherapy (Grade B). In a meta-analysis of 50 placebo-controlled trials testing drugs of two different categories separately and in combination (...) :2534-44. Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: Population-based estimates. Am J Cardiol 1998;82:2N-9N. Jibrini MB, Molnar J, Arora RR. Prevention of atrial fibrillation by way of abrogation of the renin-angiotensin system: A systematic review and meta-analysis. Am J Ther 2008;15:36-43. Stewart S, Hart CL, Hole DJ, McMurray JJ. A population-based study of the long-term risks associated with atrial fibrillation

2018 Hypertension Canada

62. Treatment of Hypertension in Association With Ischemic Heart Disease

from some but not all cohort studies . The only clinical trial to test this hypothesis in a prospective randomized fashion is the Hypertension Optimal Treatment (HOT) trial . In the HOT trial, 18,790 patients with diastolic hypertension were randomly allocated to three different DBP targets: 90 mm Hg, 85 mm Hg, or 80 mm Hg. During the trial, DBP was reduced by 20.3 mm Hg, 22.3 mm Hg, and 24.3 mm Hg in these three target groups, respectively. Among the 3080 patients with CAD at baseline, the number (...) . Safety of nifedipine in angina pectoris. A meta- analysis. Hypertension 1999;33:24-31. Mann JF, Schmieder RE, McQueen M, et al. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): A multicentre, randomised, double-blind, controlled trial. Lancet 2008;372:547-53. McMurray JJV, Ostergren J, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin converting

2018 Hypertension Canada

63. Treatment of Hypertension in Association With Heart Failure

. Should clinicians choose to use this combination, they should closely monitor serum potassium and creatinine . In reference to thiazides, in the absence of placebo-controlled trials testing thiazides in patients with hypertension who have systolic dysfunction, the recommendation supporting use of thiazides was based on extrapolation from multiple thiazide-based antihypertensive trials showing reductions in stroke, MI and death rates (and thus Grade B) . 2. An ARB is recommended if ACE inhibitors (...) clinical trials. J Am Coll Cardiol 1997;30:27-34. Doughty RN, Rodgers A, SharpeN, MacMahon S. Effects of beta-blocker therapy on mortality in patients with heart failure. Eur Heart J 1997;18:560-5. Packer M, Bristow MR, Cohn JN, et al., for the US Carvedilol Heart Failure Study Group. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 1996;334:1349-55. Zannad F, McMurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild

2018 Hypertension Canada

64. Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada

12: Monofilament Testing in the Diabetic Foot S323 Appendix 13: Diabetes and Foot Care: A Checklist S324 Appendix 14: Diabetic Foot Ulcers—Essentials of Management S325 Appendix 15: Glycated Hemoglobin Conversion ChartCan J Diabetes 42 (2018) A6–A16 Contents lists available at ScienceDirect Canadian Journal of Diabetes journal homepage: Executive Committee Ron Goldenberg MD FRCPC FACE Sub-Group Chair, Diagnosis & Classification Consultant Endocrinologist North

2018 Diabetes Canada

65. Systematic guideline search and appraisal, as well as extraction of relevant recommendations, for a DMP "chronic heart failure"

DMP relevant). 4.4.4 Monitoring A total of 6 guidelines provide recommendations on the monitoring of heart failure. One guideline provides the recommendation that stable patients should be reassessed by a medical doctor every 6 months or after shorter intervals in the event of necessary treatment adaptations or a deterioration of their condition (recommendation is potentially DMP relevant). As examinations within the framework of monitoring, 3 guidelines recommend blood and urine tests, control (...) :// 09_Langfassung_Herzinsuffizienz_1_E002BIndex.pdf. 6. Bundesärztekammer, Kassenärztliche Bundesvereinigung, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften. Nationale VersorgungsLeitlinie: chronische Herzinsuffizenz; Langfassung; Version 7 [online]. 08.2013 [accessed: 08.12.2014]. URL: lang.pdf. 7. McMurray JJV

2017 Institute for Quality and Efficiency in Healthcare (IQWiG)

66. Sacubitril/valsartan - Addendum to Commission A15-60

: For a detailed description of the outcome “NMQ hypotension”, see dossier assessment A15-60 [1]. c: Institute’s calculation, Cochran’s Q test. CI: confidence interval; HR: hazard ratio; MedDRA: Medical Dictionary for Regulatory Activities; N: number of analysed patients; n: patients with (at least) one event; NC: not calculable; ND: no data; NMQ: Novartis MedDRA Query; RCT: randomized controlled trial; RR: relative risk; vs.: versus Mortality There was proof of an effect modification by the characteristic (...) - 21_Modul4A_Sacubitril-Valsartan.pdf. 5. Gemeinsamer Bundesausschuss. Stenografisches Wortprotokoll der mündliche Anhörung gemäß 5. Kapitel, § 19 Abs. 2 Verfahrensordnung des Gemeinsamen Bundesausschusses zum Wirkstoff Sacubitril/Valsartan vom 09.05.2016 [online]. [Accessed: 20.05.2016]. URL: Valsartan.pdf. 6. McMurray JJ, Packer M, Desai AS, Gong J, Lefkowitz MP, Rizkala AR et al. Angiotensin- neprilysin inhibition versus enalapril

2017 Institute for Quality and Efficiency in Healthcare (IQWiG)

67. Atrial Fibrillation Full Text available with Trip Pro

diagnosed AF. Low Strong A thyroid stimulating hormone (TSH) test should be undertaken in patients with newly diagnosed AF but should be delayed in acutely ill patients. Moderate Strong Detection and management of risk factors and concomitant diseases Intercurrent risk factors and comorbidities—including hypertension, diabetes, heart failure, valvular heart disease and alcohol excess—should be identified and their management considered an important component of treatment in patients with AF. Low Strong (...) : a Swedish nationwide long-term case–control study. Eur Heart J . 2013 ; 34 : 1061–1067 | | | , x [4] Ball, J., Carrington, M.J., McMurray, J.J.V., and Stewart, S. Atrial fibrillation: profile and burden of an evolving epidemic in the 21st century. Int J Cardiol . 2013 ; 167 : 1807–1824 | | | | | , x [5] Schnabel, R.B., Yin, X., Gona, P., Larson, M.G., Beiser, A.S., McManus, D.D. et al. Fifty-year trends in atrial fibrillation: prevalence, incidence, risk factors, and mortality in the community. Lancet

2018 Cardiac Society of Australia and New Zealand

68. Heart Failure Full Text available with Trip Pro

) with late gadolinium enhancement (LGE) may be considered in patients with heart failure who have a low-to-intermediate pretest probability of coronary artery disease, to distinguish ischaemic and non-ischaemic causes of ventricular dysfunction. Weak FOR Low Non-invasive functional testing—stress echocardiography, single-photon emission CT scan (SPECT), positron emission tomography (PET) and CMR with LGE—may be considered in patients with heart failure and established coronary artery disease (...) with increased LV wall thickness that remains unexplained following clinical evaluation, including a 12-lead ECG and echocardiogram to identify infiltrative cardiomyopathies. Weak FOR Low BNP and NT proBNP levels may be considered in patients with an established diagnosis of heart failure for prognostic stratification. Weak FOR High Genetic testing may be considered in patients with dilated cardiomyopathy (DCM) associated with conduction disease, for prognostic stratification and to guide management

2018 Cardiac Society of Australia and New Zealand

69. Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies Full Text available with Trip Pro

differences in paediatric management. Early versions were discussed among the Working Party and our multidisciplinary colleagues, and were tested using high‐fidelity medical simulation at local bespoke meetings using faculty and volunteers. Key steps were designed to address contributing factors to poorly managed emergencies, which include lack of access to information or emergency algorithms, loss of situational awareness and poor communication , . We recognised the role that simulation could play (...) in further refining the algorithm key steps and have previously described testing versions of the algorithm in over 450 volunteer healthcare professional encounters at national and international meetings, where the algorithm was also formally presented . We were able to demonstrate significant improvements in performance metrics when multidisciplinary responders followed the algorithm in similar scenarios. Scenarios were completed more quickly, the simulated children were less hypoxic and more candidates

2018 Association of Paediatric Anaesthetists of Great Britain and Ireland

70. Stable Coronary Artery Disease (2nd Edition)

Biochemistry 35 5.3 Resting ECG 36 5.4 Echocardiography (at rest) 36 5.5 Chest radiography 37 6. OTHER NON-INVASIVE INVESTIGATIONS FOR THE DIAGNOSIS OF CAD 38 6.1 Principles of diagnostic testing 38 6.2 Functional Tests for Myocardial ischemia in the Diagnosis of CAD 41 6.2.1 Diagnostic Accuracy of Exercise stress ECG 41 6.2.2 Stress testing in combination with imaging in the detection of myocardial ischemia and diagnosis of CAD 46 6.3 Anatomical testing in the Diagnosis of CAD 49 6.3.1 Coronary Calcium (...) Score (CAC) 49 6.3.2 Diagnostic Accuracy of Computed Tomography Angiography (CTA) 50 6.3.3 Diagnostic Accuracy of Invasive Coronary Angiography (ICA) 51 7. RISK STRATIFICATION IN STABLE CAD 53 7.1 Risk Stratification of Stable CAD by Clinical Evaluation 54 7.2 Risk Stratification of Stable CAD by Resting ECG 55 7.3 Risk Stratification of Stable CAD by Left Ventricular Function 55 7.4 Risk Stratification of Stable CAD by Non-invasive Testing 55 7.5 Risk Stratification of Stable CAD by Anatomic

2018 Ministry of Health, Malaysia

71. The British Society for Rheumatology biologic DMARD safety guidelines in inflammatory arthritis Full Text available with Trip Pro

* Monitoring Monitor* Test* Connective tissue disease Drug induced vasculitis Drug AND induced AND lupus Drug induced lupus Haematological disorders Anaemia Neutropenia Pancytopenia Aplastic anaemia Lymphopeni* Thrombocytopeni* Psoriasis Drug induced psoriasis Peri-operative period Postoperative infection Surgery + infection Other terms Elderly Geriatric* Care of the elderly Mortality Safety Topic Search terms used in addition to either: ‘Rheumatoid + arthritis’, ‘Ankylosing spondylitis’, ‘Seronegative (...) Ischaemic heart disease Ischemic heart disease Myocardial infarct* Coronary artery bypass graft NSTEMI STEMI Acute coronary syndrome Respiratory disease Interstitial lung disease Fibrosis Pulmonary fibrosis Uveitis Uveitis Drug induced uveitis Demyelinating disease Demyelinat* Neuro* Optic neuritis Multiple sclerosis Diverticular disease Diverticul* Vaccinations Vaccin* Vaccine Pneumococcal vacc* Influenza vacc* Singles vacc* Hepattiis vac* Monitoring Monitor* Test* Connective tissue disease Drug

2018 British Society for Rheumatology

72. Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU Full Text available with Trip Pro

when tested in its original English version and 12 other languages among 3,851 critically ill adults from 28 countries ( ). This is less than reported for either the BPS or the CPOT because the feasibility and impact of its use once implemented in clinical practice remain to be investigated. By the time this implementation research is complete, it may be of use in countries/languages where neither the BPS nor CPOT has been validated ( ). Each of the other scales considered (i.e., the Face, Legs (...) 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

2018 Society of Critical Care Medicine

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

Medical Director Oncology/Palliative Care Providence Health and Services Portland, OR Health Care for the Homeless Clinicians’ Network ADAPTING YOUR PRACTICE: Recommendations for End-of-Life Care for People Experiencing Homelessness vii Table of Contents INTRODUCTION 1 Summary of Major Recommendations 3 Patient Assessment and Evaluation History 9 Physical Examination 14 Assessment, Screening, and Diagnostic Testing 18 Plan and Management Goals of Care 25 Advance Care Planning 29 Pain and Symptom (...) walks, assess his or her gait, stability and risk for falls, ability to sit and stand, general strength, and nutritional status. Assess if the patient needs assistive devices, such as a cane, walker, or wheelchair. Perform focused exams as indicated. Consider the use of validated exams to evaluate strength or risk of falls, such as i. Get Up and Go Test: ii. Physical Performance Test (9 items): content/uploads

2018 National Health Care for the Homeless Council

74. Evaluation and Management of Right-Sided Heart Failure

. The purpose of this scientific statement is to provide guidance on the assessment and management of RHF. Methods: The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science (...) is common in people with HFpEF, and those with evidence of RVD have lower New York Heart Association classification. In an exercise comparison between 50 patients with HFpEF and 24 control subjects, those with HFpEF had impaired RV systolic and diastolic functional enhancement measured by invasive cardiopulmonary exercise testing and simultaneous echocardiography. Increased left- and right-sided filling pressures and limitations in CO reserve correlated with abnormal augmentation in biventricular

2018 International Society for Heart and Lung Transplantation

76. Antiocoagulation - oral

the management of people receiving apixaban, dabigatran, edoxaban, rivaroxaban, and warfarin treatment in primary care, including brief advice about the place of self-testing and self-management of warfarin. This Prodigy topic does not cover the management of acenocoumarol or phenindione and does not cover secondary care management. There are separate Prodigy topics on , , , , and . The target audience for this Prodigy topic is healthcare professionals working within the NHS in the UK, and providing first (...) to include recommendations and supporting evidence on the place of self-testing and self-management of warfarin. Advice on the management of the drug interaction between selective serotonin reuptake inhibitors (SSRIs) and warfarin has also been added. July 2009 — updated to include target INRs and duration of treatment for all indications for warfarin. A change to the recommendation concerning management of potential drug interaction between warfarin and macrolide antibiotics has also been made. December

2017 Prodigy

77. Enhancing Equitable Access to Assistive Technologies in Canada

. Road traffic crashes: operationalizing equity in the context of health sector reform. Injury Control and Safety Promotion 2003;10(1-2): 11–12). It is being tested by the Cochrane Collaboration Health Equity Field as a means of evaluating the impact of interventions on health equity. McMaster Health Forum 9 Evidence >> Insight >> Action Categorizations for assistive technologies for the following functions includes but are not limited to those for: • personal use in daily living and self care

2017 McMaster Health Forum

78. Diagnosis and Treatment of Peripheral Arterial Diseases Full Text available with Trip Pro

testing 770 4.1.4 Diagnostic methods for PADs 770 4.2 Treatment approach 771 4.2.1 Smoking cessation 772 4.2.2 Lipid-lowering drugs 772 4.2.3 Antithrombotic drugs 772 4.2.4 Antihypertensive drugs 772 5. Antithrombotic drugs in PADs 773 5.1 Antithrombotic treatment in carotid artery disease 773 5.1.1 Single antiplatelet therapy 773 5.1.2 Dual antiplatelet therapy 773 5.2 Antithrombotic therapy in lower extremity artery disease 774 5.2.1 Single antiplatelet therapy 774 5.2.2 Dual and triple antiplatelet (...) Prognosis 788 9.6 Treatment 788 9.6.1 Medical therapy 788 9.6.2 Revascularization 788 10. Lower extremity artery disease 789 10.1. Clinical presentation and natural history 789 10.2 Diagnostic tests 790 10.2.1 Ankle-brachial index 790 10.2.2 Treadmill test 790 10.2.3 Imaging methods 790 10.2.4 Other tests 791 10.3 Medical treatment 791 10.4 Revascularization options: general aspects 791 10.5 Management of intermittent claudication 791 10.5.1 Exercise therapy 791 10.5.2 Pharmacotherapy to decrease

2017 European Society of Cardiology

79. 2017 Focused update on Dual Antiplatelet Therapy (DAPT) Full Text available with Trip Pro

DES for Treatment of Coronary Revascularization INR International normalized ratio ISAR Intracoronary Stenting and Antithrombotic Regimen ISAR-SAFE Intracoronary Stenting and Antithrombotic Regimen: Safety and Efficacy of 6 Months Dual Antiplatelet Therapy After Drug-Eluting Stenting ISAR-TRIPLE Intracoronary Stenting and Antithrombotic Regimen–Testing of a 6-Week Versus a 6-Month Clopidogrel Treatment Regimen in Patients With Concomitant Aspirin and Oral Anticoagulant Therapy Following Drug (...) Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome TRILOGY ACS Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes TRITON-TIMI 38 Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel–Thrombolysis in Myocardial Infarction TROPICAL-ACS Testing Responsiveness to Platelet Inhibition on Chronic Antiplatelet Treatment For Acute Coronary Syndromes Trial VA Veterans

2017 European Society of Cardiology

80. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

activity by 95% ± 4%. Repeated dosing results in a significant reduction in the required ASA platelet inhibitory dose. The 50% inhibitory dose decreased from 26 mg (single dose) to 3.2 mg after repeated dosing. After daily dosing with 20 to 40 mg of ASA, 92% to 95% of COX activity is inhibited over 6 to 12 days. Antiplatelet effects have also been studied in healthy volunteers through platelet aggregation tests including optical aggregometry and ASA reaction units (ARUs). Aspirin reaction units (...) is a whole blood assay test to aid in the detection of platelet inhibition, and ARU is calculated as a function of the rate and extent of platelet aggregation. In individuals not taking ASA, ARUs are 550 or greater. When examining ARU changes following administration of 4 ASA dosing regimens (enteric-coated 81 mg, uncoated 81 mg, enteric-coated 325 mg, and uncoated 325 mg in normal volunteers), the maximal reductions in ARUs ranged from 37% to 41% from baseline values. When examining the induced

2018 American Society of Regional Anesthesia and Pain Medicine

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