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41. WHO Guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents

, intervention, comparator and outcome PO by mouth PR per rectum p.r.n. as needed q1h every hour q4h every 4 hours q6h every 6 hours q8h every 8 hours q12h every 12 hours RCT randomized controlled trial RR relative risk SC subcutaneous SEAR South-East Asia Region SRE skeletal-related event TD transdermal WHO World Health Organization WPR Western Pacific Region9 EXECUTIVE SUMMARY INTRODUCTION Cancers are among the leading causes of morbidity and mortality worldwide, respon- sible for 18.1 million new cases (...) the evidence base. This pertains to antidepressants, anticonvulsants, opioid rotation and clinical regimens currently in established practice, but for which evidence of efficacy for cancer pain is lacking.14 WHO GUIDELINES FOR THE PHARMACOLOGICAL AND RADIOTHERAPEUTIC MANAGEMENT OF CANCER PAIN IN ADULTS AND ADOLESCENTS WHO GUIDELINES FOR THE PHARMACOLOGICAL AND RADIOTHERAPEUTIC MANAGEMENT OF CANCER PAIN IN ADULTS AND ADOLESCENTS 1. INTRODUCTION Cancers are among the leading causes of morbidity and mortality

2019 World Health Organisation Guidelines

42. Concise practice guidance on the prevention and management of accidental awareness during general anaesthesia

in cardiovascular instability, whereas dosing to lean body weight better preserves haemodynamic stability but increases the risk of AAGA. Dosing to adjusted body weight may offer a suitable compromise [24,25], supplemented by titrating the dose to hypnotic effect, aided by depth of anaesthesia monitoring where practical. At induction, the anaesthetist should always confirm loss of consciousness before administering NMBDs or before airway instrumentation by the following (notwithstanding RSI as discussed below (...) paralysis (interpreted as AAGA) associated with considerable distress and sequelae [2]. Syringes should be labelled, and managed in a way that prevents mis-identification [20]. Anaesthetists should ensure there are systematic processes in their own practice to prevent administration of NMBDs before induction of anaesthesia. If there is a near miss or actual maladministration in their own practice or in the department, they should manage the case expectantly (see below), reflect on the root causes

2019 Association of Anaesthetists of GB and Ireland

43. Risk factors for breast cancer: A review of the evidence 2018

—progestogen only 76 4.6.3 Menopausal hormone therapy—combined 77 4.6.4 Menopausal hormone therapy—oestrogen only 80 4.6.5 Hormonal infertility treatment 82 4.6.6 DES in utero 84 4.6.7 DES maternal exposure 86 4.7 Lifestyle factors 88 4.7.1 Adiposity 88 4.7.2 Adiposity—weight gain 91 4.7.3 Adiposity—weight loss 92 4.7.4 Alcohol consumption 94 4.7.5 Bras 96 4.7.6 Coffee, tea, caffeine 97 4.7.7 Diet—calcium 99 4.7.8 Diet—dairy 101 4.7.9 Diet—dietary fibre 102 4.7.10 Diet—fruit 104 4.7.11 Diet—vegetables 106 (...) Adiposity and risk of breast cancer 327 Table D.36 Adiposity—weight gain and risk of breast cancer 332 Table D.37 Adiposity—weight loss and risk of breast cancer 334 Table D.38 Alcohol consumption and risk of breast cancer 336 Table D.39 Bras and risk of breast cancer 340 Table D.40 Coffee, tea, caffeine and risk of breast cancer 342 Table D.41 Diet—calcium and risk of breast cancer 346 Table D.42 Diet–dairy and risk of breast cancer 348 Table D.43 Diet—dietary fibre and risk of breast cancer 351 Table

2018 Cancer Australia

44. Examining the Impact of Decriminalizing or Legalizing Cannabis for Recreational Use

in chemotherapy patients, treatment of acute epilepsy in children, and treatment of anorexia associated with weight loss in AIDS patients.(55) In Canada, the Task Force on Cannabis Legalization and Regulation has recommended maintaining a separate system for medical cannabis, where a physician prescription would be required.(1) Currently, medical cannabis is not covered by provincial health insurance plans, but there is coverage for select derivatives from public drug programs such as the coverage of Nabilone (...) on prevalence of injuries and accidents One primary study found that the decriminalization of cannabis has resulted in a 52 per cent increase in emergency department visits across all states in the U.S., and a 31 per cent increase in calls made to poison control centres due to cannabis-related causes in states that had decriminalized cannabis between 2005 and 2011.(31) This is compared to states in which cannabis has not been legalized, where no change was observed during the same time period. One

2017 McMaster Health Forum

45. Frailty in Older Adults - Early Identification and Management

frailty, so it is important to conduct a further review. Table 1: Possible warning signs of frailty 1,7,15,19,20 Signs indicated with bold * may raise a higher level of suspicion of frailty. Medical: unintentional weight loss* (esp. if ≥ 10lbs/4.5kg over past year) incontinence* loss of appetite loss of muscle/strength (sarcopenia) osteoporosis impaired vision/hearing chronic pain repeated ER visits/hospitalization Psychological: delirium* cognitive impairment/ dementia* depression irrational fears (...) with the patient and/or family/caregivers/representatives, and with other key care providers. Initiate advance care planning discussions for patients with frailty or vulnerable to frailty. Definition Frailty is broadly seen as a state of increased vulnerability and functional impairment caused by cumulative declines across multiple systems. 1–4 Frailty has multiple causes and contributors 5 and may be physical, psychological, social, or a combination of these. Frailty may include loss of muscle mass

2017 Clinical Practice Guidelines and Protocols in British Columbia

47. Outcome Measures Framework: Information Model Report

of the category description. Within survival, case-specific mortality was prominent in the review of included registries. It represents a specific type of mortality measure attributable to a specific cause which was recommended to be specifically named in the OMF. The Disease Response category was renamed to “Clinical Response” to more broadly cover outcomes for non-disease conditions or after trauma. Exacerbation and Improvement were added 13 to Recurrence as examples that demonstrate the range of outcomes

2018 Effective Health Care Program (AHRQ)

48. Physiologic Predictors of Severe Injury: Systematic Review

of Evidence Appendix I. Meta-Analysis Results for Studies of Predictive Utility in the Emergency Room Setting ES-1 Evidence Summary Background Unintentional injury is the fourth leading cause of death in the United States, the leading cause for people 1 to 44 years of age, 1 and the reason for millions of emergency department (ED) visits. 2 Trauma is the primary reason emergency medical services (EMS) transport people to the hospital. 3 Out-of-hospital care includes the early interventions and life

2018 Effective Health Care Program (AHRQ)

49. Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy

of function, comorbidity, falls, depression, cognition, and nutrition. The Panel recommends instrumental activities of daily living to assess for function, a thorough history or validated tool to assess comorbidity, a single question for falls, the Geriatric Depression Scale to screen for depression, the Mini-Cog or the Blessed Orientation-Memory-Concentration test to screen for cognitive impairment, and an assessment of unintentional weight loss to evaluate nutrition. Either the CARG (Cancer and Aging (...) Scale (GDS) to screen for depression, the Mini-Cog or the Blessed Orientation-Memory-Concentration test (BOMC) to screen for cognitive issues, and assessment of unintentional weight loss to evaluate nutrition. Either the Cancer and Aging Research Group (CARG) or Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) tool is best used to obtain specific estimates on risk of chemotherapy toxicity, while short tools such as Geriatric-8 or Vulnerable Elders Survey-13 (VES-13) can help

2018 American Society of Clinical Oncology Guidelines

50. Exam Series: Guide to the Knee Exam

, tender to palpation. May mimic a joint effusion or a septic knee. Ultrasound may help differentiate between bursitis and a joint effusion. Aspiration is required if there is any suspicion of infection. Systemic disease (ex. Rheumatoid Arthritsi) Known history of disease of systemic symptoms including fever, chills, night sweats, fatigue, or unintentional weight loss. Insidious onset pain with morning stiffness. Often associated with effusions and Baker’s cysts. Bony erosions, typically first seen (...) to form an overall impression of the case. History of Presenting Illness: Understanding the mechanism of injury is essential in the assessment of knee pain. An acute and traumatic etiology suggests a structural cause of pain. It is also important to determine whether the patient has been able to weight bear, as this guides imaging decisions. Pain characteristics: Identify the onset, position (anterior vs. posterior, medial vs. lateral), quality, radiation, severity, and duration of the pain

2018 CandiEM

51. Atherosclerotic Cardiovascular Disease in South Asians in the United States: Epidemiology, Risk Factors, and Treatments: A Scientific Statement From the American Heart Association

studies using BMI versus waist-to-hip ratio (WHR). One limitation of relying on BMI is that it does not take into account the distribution of body fat differentials, which may be better assessed with WHR. The MASALA study done in the United States showed that compared with NHWs, South Asians were less physically active and had lower adiponectin and higher resistin levels. South Asians had lower BMI, body weight, and waist circumference compared with all other racial/ethnic minority groups except (...) , although variations across the genome and patterns within that variation are complex and different in these subgroups, the majority of studies have suggested that the underlying biological pathways are actually similar. Thus, although the genetics of CVD in ethnic subpopulations can be characterized by allelic heterogeneity (in which different variants in the same genetic locus cause the same phenotype), the genes and resulting biology are common, with differences in risk reflecting differences

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2018 American Heart Association

52. Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement From the American Heart Association

in relation to obesity and diet. Community- and school-based educational programs provide avenues for educating youth in communities vulnerable to limited health literacy. The life course impact of limited health literacy on obesity merits examination. Making weight loss, exercise, and diet education programs accessible and available to individuals with limited health literacy is essential. Interventions and programs that incorporate mobile health offer novel opportunities but must be developed so (...) had adjusted IRR of 0.73 (95% CI, 0.39–1.36) favoring multisession vs single-session group. Wu et al Multisite RCT 595 S-TOFHLA Ambulatory Hospitalization, mortality 12 mo Limited HL, all-cause hospitalization and mortality IRR of 1.43 (95% CI, 1.00–2.05). Mixon et al Prospective cohort 471 S-TOFHLA Hospitalization Medication errors NA Higher HL (OR, 0.84; 95% CI, 0.74–0.95) and subjective numeracy (OR, 0.77; 95% CI, 0.63–0.95) reduced medication error. McNaughton et al Retrospective, hospital

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2018 American Heart Association

53. Evaluation and Treatment of Hirsutism in Premenopausal Women

therapy) resulted in weight loss, a decrease in serum testosterone and fasting insulin concentrations, and a small improvement in Ferriman–Gallwey scores when compared with minimal or no treatment—mean difference, −1.19 [95% confidence interval (CI) (−2.35 to −0.03)] ( ). However, lifestyle changes should not be considered a primary therapy for hirsutism, as their impact is not clinically significant, particularly when compared with OCs ( ). Our approach is consistent with the Endocrine Society (...) of at least 6 months before making changes in dose, switching to a new medication, or adding medication. (2 |⊕OOO) 3.8. In patients with severe hirsutism causing emotional distress and/or in those women who have used oral contraceptives in the past and have not experienced sufficient improvement, we suggest initiating combination therapy with an oral contraceptive and antiandrogen (2 |⊕⊕OO). However, we suggest against combination therapy as a standard first-line approach. (2 |⊕⊕OO) Other drug therapies

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2018 The Endocrine Society

54. Breastfeeding Programs and Policies, Breastfeeding Uptake, and Maternal Health Outcomes in Developed Countries

or breastfeeding for longer durations may be associated with lower rates of breast cancer, epithelial ovarian cancer, hypertension, and type 2 diabetes, but not fractures. Because of heterogeneity and inconsistent results, we found insufficient evidence on whether breastfeeding is associated with postpartum depression, cardiovascular disease, or postpartum weight change. x Conclusions. The body of evidence for breastfeeding programs and policies was diverse in terms of interventions and settings. Current (...) cannot determine cause-and-effect relationships. xi Contents Evidence Summary 1 Chapter 1. Introduction 1 Background 1 Existing Guidelines 2 Rationale for Evidence Review 3 Key Questions 3 Analytic Framework 4 Organization of This Report 4 Chapter 2. Methods 5 Protocol Review 5 Literature Search Strategy 5 Search Strategy 5 Inclusion and Exclusion Criteria 5 Study Selection 7 Data Extraction 7 Risk of Bias Assessment of Individual Studies 8 Risk of Bias Assessment of Systematic Reviews 8 Data

2018 Effective Health Care Program (AHRQ)

55. Imaging Guidelines

patients presenting with an altered or depressed mental status, a history of loss of consciousness, or significant post-traumatic amnesia need a head CT scan. z A negative initial head CT scan in a patient not on anticoagulant therapy has a negative predictive value of greater than 99.97 percent for the need of any subsequent neurosurgical intervention, allowing safe discharge from the emergency department (ED). z A repeat head CT is needed in 6-12 hours when a patient of any age has a persistently (...) altered mental status. Urgent repeat head CT scanning is needed for the patient of any age with any worsening changes on neurologic exam. z Patients with supra-therapeutic international normalized ratio (INR) or thrombocytopenia may benefit from repeat head CT, despite a normal initial head CT, if they take oral anticoagulant or antiplatelet drugs. z Indications for head CT in children should follow the PECARN decision guide. Children with non-frontal soft tissue hematoma or brief loss

2018 American College of Surgeons

56. Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions

contributed to an estimated death of 1825 students through unintentional injuries (eg, motor vehicle collisions), , and about 1 in 4 students report that alcohol use contributes to missing or falling behind in classes, low grades, and poor performance on examinations and papers. , In 2010, excessive alcohol use cost the United States an estimated $249 billion in loss in workplace productivity, health care expenses, criminal justice expenses, and motor vehicle collisions. Alcohol use during pregnancy can (...) result in preterm birth and low birth weight. It is a major preventable cause of birth defects and developmental disabilities, including fetal alcohol spectrum disorders, and affects development of the fetal brain, endocrine system, gastrointestinal tract, heart, kidney, and liver. The 2011-2013 Behavioral Risk Factor Surveillance System survey shows that 1 in 10 pregnant women aged 18 to 44 years reported consuming alcohol in the previous month, and 3.1% participated in binge drinking. Scope

2018 U.S. Preventive Services Task Force

57. Evaluation and Treatment of Hirsutism in Premenopausal Women

therapy) resulted in weight loss, a decrease in serum testosterone and fasting insulin concentrations, and a small improvement in Ferriman–Gallwey scores when compared with minimal or no treatment—mean difference, −1.19 [95% confidence interval (CI) (−2.35 to −0.03)] ( ). However, lifestyle changes should not be considered a primary therapy for hirsutism, as their impact is not clinically significant, particularly when compared with OCs ( ). Our approach is consistent with the Endocrine Society (...) of at least 6 months before making changes in dose, switching to a new medication, or adding medication. (2 |⊕OOO) 3.8. In patients with severe hirsutism causing emotional distress and/or in those women who have used oral contraceptives in the past and have not experienced sufficient improvement, we suggest initiating combination therapy with an oral contraceptive and antiandrogen (2 |⊕⊕OO). However, we suggest against combination therapy as a standard first-line approach. (2 |⊕⊕OO) Other drug therapies

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2018 The Endocrine Society

58. Management of Pregnancy

schedules. Federal laws addressing breastfeeding in the workplace exist but are relatively new.[ ] 11 In contrast, the infant mortality rate has declined 15% between 2005 and 2015, from 6.86 infant deaths per 1,000 live births to 5.82.[ ] The Centers for Disease Control and Prevention (CDC) indicated the following were the five leading causes of infant death in 2014:[ ] 12 13 • Birth defects • Preterm birth or low birth weight • Maternal complications of pregnancy • Sudden infant death syndrome (SIDS (...) ) • Unintentional injuries (e.g., accidental suffocation) From 2005 to 2014, congenital malformations remained the leading cause of infant death, although congenital malformations declined by 11% during that period. Preterm birth rates rose over 20% from 1990 (10.6%) through 2006 (12.8%). The preterm birth rate then declined from 2007 through 2014 from 10.4% to 9.6%, but increased slightly to 9.6% in 2015. Increases in preterm births were seen among non- Hispanic black and Hispanic women.[ ] 14 Cesarean birth

2018 VA/DoD Clinical Practice Guidelines

59. Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

with prior opioid exposure. Such findings emphasize the importance of preprocedural pain assessment and preemptive analgesia, when appropriate, for procedures known to cause pain . Indeed, severe procedural pain is associated with severe adverse events (e.g., tachycardia, bradycardia, hypertension, hypotension, desaturation, bradypnea, and ventilator distress) ( ) that may be prevented with appropriate pain assessment and preemptive analgesia. Evidence Gaps: Future research should include the following (...) in Supplemental Table 5 (Supplemental Digital Content 7, ), and the psychometric scores and the quality of evidence supporting each pain scale are described in Supplemental Table 6 (Supplemental Digital Content 8, ). The CPOT and the BPS remain the most robust scales for assessing pain in critically ill adults unable to self-report. Each has very good psychometric properties with scores of 16.7 and 15.1, respectively. The BPS-NI obtained a psychometric weighted score of 14.8. Although both the BPS

2018 Society of Critical Care Medicine

60. When and how to treat hyponatremia in the ED

polydipsia, and water intoxication (intentional or unintentional). In infants and children, GI fluid loss and unintentional ingestion of excessive water are most common 5 . Besides thiazide and SSRIs, medications that can cause hyponatremia include other anti-depressants, anti-psychotics, anti-epileptics, and NSAIDs 1 . Why does this matter? Pathophysiology and Complications of Hyponatremia Left untreated, hyponatremia can be a life-threatening condition. Hypotonic plasma leads to a shift of water from (...) Additional testing can be performed to identify whether the hyponatremia is hypo-, hyper-, or euvolemic. which is crucial in identifying the underlying etiology and guide treatment. Failure to identify the underlying cause of hyponatremia can lead to therapy that harms the patients 4 . Hypovolemic Euvolemic Hypervolemic Definition Loss of sodium and relatively lesser loss of body water Normal total body sodium and excess total body water Increased sodium with relatively greater increase in body water

2018 CandiEM

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