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Unintentional Weight Loss Causes

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41. Diagnosis and Treatment of Non-Neurogenic Overactive Bladder (OAB) in Adults

. Guideline Statements Diagnosis 1. The clinician should engage in a diagnostic process to document symptoms and signs that characterize OAB and exclude other disorders that could be the cause of the patient's symptoms; the minimum requirements for this process are a careful history, physical exam, and urinalysis. Clinical Principle 2. In some patients, additional procedures and measures may be necessary to validate an OAB diagnosis, exclude other disorders and fully inform the treatment plan (...) prevalence and severity tend to increase with age. 11-12, 15 A proportion of OAB cases (37-39%) remit during a given year, but the majority of patients have symptoms for years. 15, 16 To date, no population-based studies have directly examined epidemiologic differences across racial/ethnic groups. Patient-Reported Outcomes (PROs) and OAB. Since OAB is a symptom-based diagnosis, the QOL impact of the symptoms is a critical aspect of the condition. The degree of bother caused by OAB symptoms directly

2019 American Urological Association

42. BSG consensus guidelines on the management of inflammatory bowel disease in adults

100 4.9.8 Defunctioning stoma formation 101 4.10 Post-surgical management of Crohn’s disease 102 4.10.1 Disease recurrence following ileocolonic resection 102 4.10.1.1 Investigation for symptomatic recurrence following ileocolonic resection 102 4.10.1.2 Non-inflammatory causes of diarrhoea after ileocolonic resection 103 4.10.1.2.1 Bile salt malabsorption 103 4.10.1.2.2 Small intestinal bacterial overgrowth 104 4.10.1.2.3 Other causes of recurrent symptoms following ileocolonic surgery 104 4.10.2 (...) thiopurines with allopurinol 122 5.2.2.7 Thiopurine toxicity 123 5.2.3 Drug use: methotrexate 124 5.2.3.1 Methotrexate and pregnancy 125 5.2.4 Drug management: anti TNF including biosimilars 126 5.2.4.1 Choice of anti-TNF agent 126 5.2.4.2 Biosimilar anti-TNF drugs 127 5.2.4.3 Assessment after anti-TNF induction therapy 128 5.2.4.4 Drug levels of infliximab and adalimumab 129 5.2.4.5 Primary non-response to anti-TNF therapy 130 5.2.4.6 Secondary loss of response to anti-TNF therapy 130 5.2.4.7 Annual

2019 British Society of Gastroenterology

43. Treatment of Adult Obstructive Sleep Apnea with Positive Airway Pressure

disease that rarely resolves except with substantial weight loss or successful corrective surgery. As with other chronic diseases, periodic follow-up by a qualified clinician (eg, physician or advanced practice provider) is necessary to confirm adequate treatment, assess symptom resolution, and promote continued adherence to treatment. Initial treatment of OSA requires close monitoring and early identification of difficulties with PAP use, as adherence over the first few days to weeks has been shown (...) therapy with good symptom control and no change in clinical status (eg, significant weight loss or upper airway surgery) is considered low value care. CLINICAL PRACTICE RECOMMENDATIONS The following clinical practice recommendations are based on a companion systematic review, which evaluated the evidence using the GRADE methodology and should be read concurrently with this clinical practice guideline. The recommendations in this guideline define principles of practice that should meet the needs

2019 American Academy of Sleep Medicine

44. 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

45. 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

46. 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

48. 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)

49. 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)

50. 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

51. 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

52. 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

53. 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

54. 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

55. 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)

56. 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

57. 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

58. 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

59. 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

60. 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

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