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Unintentional Weight Loss Causes

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41. Drug-Induced Liver Injury

in patients with DILI caused by germander. Several recent reports have underlined the hepatotoxicity of dietary supplements including a cocktail of products, usnic acid with other product (yohimbine, caffeine, dihydrothyrone, nore- phedrine) in various preparations: Lipokinetic , UPC-1 , Lipo- liz , particularly associated with acute hepatocellular hepatitis. Other products reported to cause DILI include OxyE- LITE containing several ingredients (dimethylamylamine, aegeline) for weight loss and muscle (...) hepatotoxicity is important as it is the most common cause of acute liver failure (ALF) in the US and parts of Europe. It is a prototype of intrinsic DILI.Itaccountsformorethan50%ofcasesofALF.Halfthecases are due to single overdoses but half are unintentional cases, usually resulting from individuals taking acetaminophen over several days at daily doses in the range of 4–10g/day, although a number of cases have been reported at doses ranging from 2–4g/day. 7,8 Factorssuchasconcomitantdrugs,fasting,systemic

2019 European Association for the Study of the Liver

42. Managing Chronic Cough as a Symptom in Children and Management Algorithms: CHEST Guideline and Expert Panel Report

. For patients with cough suspected to have pulmonary TB and at high risk of drug- 218 resistant TB, we suggest that XpertMTB/RIF assay, where available, replace sputum 219 microscopy but sputum mycobacterial cultures, drug susceptibility testing and CXRs 220 should be performed when feasible and where resources allow (Ungraded Consensus- 221 Based Statement). 10 222 34. For patients with cough with or without fever, night sweats, hemoptysis, and/or weight 223 loss, and who are at risk of pulmonary TB (...) are not presumed to be common causes in children and (b) their age and 88 the clinical settings (e.g. country and region) are taken into consideration when 89 evaluating and managing their chronic cough (Grade 1B). 2 90 3. For children aged =14-years with chronic cough, we recommend using pediatric-specific 91 cough management protocols or algorithms (Grade 1B). 1 92 4. For children aged =14-years with chronic cough, we recommend taking a systematic 93 approach (such as using a validated guideline

2020 American College of Chest Physicians

43. Opioid Treatments for Chronic Pain

of addiction, 22 overdose, 22 fractures, 23-25 falls 24,26 and cardiovascular events; 27 a new study also found an association between opioid use and risk of all-cause mortality. 27 New observational studies were also consistent with the 2014 AHRQ report in finding associations between higher doses of opioids and risks of overdose, addiction, and endocrinological adverse events; 22,23,26-29 new studies also found an association between higher dose and increased risk of incident or refractory depression (...) . 30,31 Effects of longer duration of opioid exposure varied across outcomes, from increasing risk (all-cause mortality, depression) to decreasing risk. Limited evidence indicated an association between co-prescription of gabapentinoids 32-34 or benzodiazepines 35-37 and increased risk of overdose, with most pronounced risk occurring soon after initiation of these medications. This update also expanded upon the 2014 AHRQ report by including short-term randomized trials that directly compared opioids

2020 Effective Health Care Program (AHRQ)

44. Practice Guidelines for Central Venous Access 2020: An Updated Report by the American Society of Anesthesiologists Task Force on Central Venous Access

, and severe or lethal airway obstruction) when unintentional arterial cannulation occurs with large-bore catheters (Category B4-H evidence ). An RCT comparing a thin-wall needle technique versus a catheter-over-the-needle for right internal jugular vein insertion in adults reports equivocal findings for first-attempt success rates and frequency of complications (Category A3-E evidence ) ; for right-sided subclavian insertion in adults an RCT reports first-attempt success more likely and fewer (...) and verification. This algorithm compares the thin-wall needle ( i.e. , Seldinger) technique versus the catheter-over-the needle ( i.e. , modified Seldinger) technique in critical safety steps to prevent unintentional arterial placement of a dilator or large-bore catheter. The variation between the two techniques reflects mitigation steps for the risk that the thin-wall needle in the Seldinger technique could move out of the vein and into the wall of an artery between the manometry step and the threading

2020 American Society of Anesthesiologists

45. Chest imaging

evaluation and testing, usually in patients with abnormalities on baseline testing. Screening with CT is of limited value. Instead, diagnostic testing should be directed toward areas of concern based on the history and physical examination. 31 Age appropriate screening for malignancy (mammogram, pap smear) should also be encouraged. 32 The most common cause of malignancy in patients with unintentional weight loss is gastrointestinal primary (47%), and gastrointestinal causes account for 45 (...) % of nonmalignant organic etiologies. 33 Therefore, endoscopy and/or colonoscopy should be considered for initial evaluation when there is evidence of a GI source. Imaging of the Chest Copyright © 2020. AIM Specialty Health. All Rights Reserved. 20 CT with contrast is sensitive for the detection of lymphoma, lung and genitourinary cancers, which are the next most common causes of malignancy in patients with unintentional weight loss. Abnormal Test Findings Imaging abnormalities Advanced imaging is considered

2020 AIM Specialty Health

46. Abdominal and pelvic imaging

Signs and Symptoms 36 Abdominal and/or pelvic pain, undifferentiated 36 Fever of unknown origin 38 Lower extremity edema 39 Weight loss 39 References 39 Codes 46 History 46 Imaging of the Abdomen and Pelvis Copyright © 2020 AIM Specialty Health ® All Rights Reserved. 5 Description and Application of the Guidelines The AIM Clinical Appropriateness Guidelines (hereinafter “the AIM Clinical Appropriateness Guidelines” or the “Guidelines”) are designed to assist providers in making the most appropriate (...) and/or pelvis - MRI abdomen and/or pelvis Rationale Constipation is a common problem in children and largely a clinical diagnosis. While a commonly performed practice, there is conflicting evidence that abdominal radiography substantially aids the diagnosis of constipation with at best small likelihood ratios (1-1.2) based on well designed studies. 29 Constipation can have both functional and organic causes. When constipation is associated with red flag features such as failure to thrive, unexplained weight

2020 AIM Specialty Health

47. Type 2 diabetes in adults

/Supplement_1/S1 History and exam presence of risk factors asymptomatic candidal infections skin infections urinary tract infections fatigue blurred vision polydipsia polyphagia polyuria paraesthesias nocturia unintentional weight loss acanthosis nigricans older age overweight/obesity gestational diabetes pre-diabetes family history of type 2 diabetes African, Hispanic, or Native American ancestry physical inactivity polycystic ovary syndrome hypertension dyslipidaemia cardiovascular disease Diagnostic (...) antihyperglycaemic therapy for most patients. Glycaemic goals and treatment choices are individualised. Blood pressure control, lipid management, smoking cessation, and glycaemic management reduce the risk of macrovascular complications such as heart attack and stroke. Glycaemic control and blood pressure management reduce the risk of microvascular complications (neuropathy, nephropathy, retinopathy). Selected glucose-lowering drugs reduce all-cause and cardiovascular mortality. Definition Type 2 diabetes

2018 BMJ Best Practice

48. Severe sialorrhoea (drooling) in children and young people with chronic neurological disorders: oral glycopyrronium bromide

with a neurological disorder, such as cerebral palsy. Chronic drooling is the unintentional loss of saliva from the mouth. Although drooling is normal in infants, it usually stops by 15 to 18 months, and is Severe sialorrhoea (drooling) in children and young people with chronic neurological disorders: oral glycopyrronium bromide (ES5) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 34considered pathological if it is present (...) . Adverse effects were common with glycopyrronium bromide, mostly due to its anticholinergic action. The most commonly reported adverse effects include dry mouth, constipation, urinary retention, reduced bronchial secretions and flushing. The SPC advises that glycopyrronium bromide can cause thickening of secretions, which may increase the risk of respiratory infection and pneumonia. Glycopyrronium bromide should be used with caution in people with heart problems due to its potential increase in heart

2017 National Institute for Health and Clinical Excellence - Advice

49. Placenta Praevia and Placenta Accreta: Diagnosis and Management Full Text available with Trip Pro

with placenta praevia or a low‐lying placenta as for any pregnant woman. Grade of recommendation: D General procedures for discussing and obtaining consent for caesarean section are described in detail in RCOG Consent Advice No. 7: Caesarean section . Evidence level 4 Women having a caesarean section for placenta praevia are at increased risk of blood loss of more than 1000 ml compared with women having a caesarean section for other indications (RR 3.97 #bib95% CI 3.24–4.85). Women with anterior placenta (...) are at increased risk of blood loss. Placenta praevia covering the internal cervical os and anterior placentation are independent risk factors (OR 4.1 and OR 3.5, respectively) for massive haemorrhage during caesarean section. A US case–control study from the National Institute of Child Health and Human Development (NICHD) Maternal‐Fetal Medicine Units (MFMU) Network Cesarean Section Registry has shown that maternal haemorrhagic morbidity is more common in women with praevia (19% versus 7%, adjusted RR 2.6

2018 Royal College of Obstetricians and Gynaecologists

50. Fatigue

having tiredness lasting 1 month or longer, and 1.5% of people consult their GP with a new (...) symptom of tiredness each year. Tiredness can have a negative impact on work, family life, and social relationships. Red flags or alarm features in an adult with tiredness include: Significant unintentional weight loss (5% of body weight in 6–12 months). Lymphadenopathy suggestive of malignancy. Other symptoms and signs of malignancy, such as haemoptysis, dysphagia, rectal bleeding, breast lump (...) questions please contact us via jon.brassey@tripdatabase.com Top results for fatigue 1. Tiredness / fatigue in adults Tiredness / fatigue in adults - NICE CKS Clinical Knowledge Summaries Share Tiredness / fatigue in adults - Summary Tiredness (or fatigue ) is often described as a lack of, or decreased, energy, and physical or mental exhaustion . Tiredness may be due to psychological, psychosocial, physical, or physiological causes or a combination of these. Between 10–18% of people in the UK report

2018 Trip Latest and Greatest

51. Hydralazine

, and unintentional weight loss. Five had polyarthralgias and 8 had lower extremity petechiae. All 12 patients were both ANA and ANCA positive 2018 7. Hydralazine Top results for hydralazine - Trip Database or use your Google+ account Liberating the literature My query is: English Français Deutsch Čeština Español Magyar Svenska ALL of these words: Title only Anywhere in the document ANY of these words: Title only Anywhere in the document This EXACT phrase: Title only Anywhere in the document EXCLUDING words (...) Randomized Clinical Trial of Labetalol Versus Hydralazine for Severe Hypertension in Obstetric Patients (...) : No changes posted Full Text View Purpose Severe Hypertension in pregnancy demands urgent treatment because of high mortality & morbidity in obstetric patients. Hydralazine , the most commonly used agent, causes sudden hypotension and tachycardia. Labetalol because of combined α and β blocking effects lacks these side effects. Cochrane systematic review could include only three trials

2018 Trip Latest and Greatest

52. Comprehensive Care - Older people with frailty in hospital

as a result of risk assessments. A current randomised study is exploring whether high specification foam mattresses provide the same benefits. » Medication errors in prescription and administration can cause problems and pharmacist review of medicines within 24 hours of admission has been found to reduce inappropriate medication usage. DISCHARGE PLANNING » Researchers found that hospital staff need more support and training to assess the mental capacity of older people with cognitive impairment before (...) their discharge. » Research co-produced with patients found that poor discharge planning caused considerable stress to families, and they recommend a mutually agreed written discharge plan. » There appears to be little difference in the cost or functional outcomes between older people’s rehabilitation schemes (although not stroke rehabilitation where a difference has been shown) in hospitals, care homes or a person’s own home, although researchers have found it difficult to compare different types

2018 Publication 4887694

53. Guidelines For Professional Ultrasound Practice

://www.rcr.ac.uk/publication/standards-provision-ultrasound-service It provides guidance on topics that were not included in the joint RCR/SCoR Standards document and provides further detailed advice on some areas of practice that were. There can be overlap between the terms ‘Standards’, ‘ Guidelines’ and ‘Protocols’ and this can cause confusion. For the purposes of this document, the definitions used are the same as those in the above 2014 Royal College of Radiologists (RCR) and Society and College (...) THE HIGH BMI PATIENT Prevention and management of Work Related Musculo-Skeletal Disorders Work related musculo-skeletal disorders (WRMSD) are known to be associated with ultrasound practice. There are several causative factors including high workloads, increasing body mass index of patients, poor equipment and room design and poor posture when scanning. It is important that ultrasound practitioners take care of themselves and their working environment whilst scanning. Employers have a legal duty

2018 British Medical Ultrasound Society

54. Diagnosis and Treatment of Non-Neurogenic Overactive Bladder (OAB) in Adults: an AUA/SUFU Guideline

in literature released since the initial publication of the Guideline. The current document reflects relevant literature published through October 2018. See text and algorithm for definitions and detailed diagnostic, management and treatment frameworks. 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 (...) examined epidemiologic differences across racial/ethnic groups. Patient-Reported Outcomes (PROs) and OAB. Since OAB is a symptom-based diagnosis, the quality of life (QOL) impact of the symptoms is a critical aspect of the condition. The degree of bother caused by OAB symptoms directly affects OAB care-seeking, treatment intensity and satisfaction with treatment. Therefore, assessment of patient-reported outcomes (PROs) can be a critical component of OAB management. Numerous questionnaire instruments

2019 American Urological Association

55. Assessment and Management of Patients at Risk for Suicide

episodes and chronic substance use disorder (SUD).[13] Recently released data from the U.S. Centers for Disease Control and Prevention (CDC), which include Service Members and Veterans as well as the remainder of the general population, continue to identify suicide as one of the top 10 causes of death among U.S. residents, accounting for 44,965 deaths in CY 2016 alone.[14] Among those between 10 and 34 years old, suicide is the second most common cause of death, with only unintentional injuries (...) . However, there was no increase in the prevalence of suicide attempts between 2016 and 2017 for this age group. SAMHSA notes that this increase in suicide-related behavior over the past 10 years co-occurs with a similar increase in the prevalence of mental health VA/DoD Clinical Practice Guideline for the Assessment and Management of Patients at Risk for Suicide May 2019 Page 8 of 142 conditions that cause significant impairment in daily life functioning, especially the occurrence of major depressive

2019 VA/DoD Clinical Practice Guidelines

56. Understanding the Health Effects of Recreational Cannabis Use: A Focused Practice Question

include maternal anaemia, low birth weight and preterm delivery. For a full list of health outcomes, see page 94 in Appendix C. The authors searched for articles published between 2006 and April 2018. Eleven articles were included within the review of reviews; six systematic reviews (three with meta-analyses) and five guidelines. Critical appraisal of included documents was completed using the Health Evidence TM Quality Assessment Tool for systematic reviews and AGREE II appraisal tool for guidelines (...) . All included systematic reviews and guidelines were strong or moderate quality. Within the systematic reviews, component studies ranged from moderate to very low quality. 8 Synthesis of Findings In synthesizing evidence from the three included documents, 4,5,7 greater weighting was placed on the National Academies of Sciences, Engineering and Medicine (2017) report. 4 It was the most comprehensive and closely aligned to the research question. It also provided graded conclusion statements for each

2019 Peel Health Library

57. 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

58. Telehealth for Acute and Chronic Care Consultations

services utilization Insufficient Cost (KQ1) 32 Most studies report cost saving with telehealth but calculations vary and most are dependent on patient avoided travel and loss of time Low Intermediate Outcomes: Access (KQ2) 35 Access in terms of time to, or comprehensiveness of, service is improved with telehealth Moderate Intermediate Outcomes: Management and Utilization (KQ2) 31 Mixed results with majority finding some benefit in terms of avoiding visits and similar diagnosis or management

2019 Effective Health Care Program (AHRQ)

59. Treatment of Diabetes in Older Adults Full Text available with Trip Pro

caregiver can be involved in decision-making and management of medication. Treatment of hyperglycemia Setting glycemic targets and goals 4.1 In patients aged 65 years and older with diabetes, we recommend that outpatient diabetes regimens be designed specifically to minimize hypoglycemia. (1|⊕⊕⊕O) Technical remark: Although evidence for specific targets is lacking, glycemic targets should be tailored to overall health and management strategies ( e.g. , whether a medication that can cause hypoglycemia (...) treatment of hyperglycemia. (1|⊕⊕⊕⊕) Nutrition 4.4 In patients aged 65 years and older with diabetes, we recommend assessing nutritional status to detect and manage malnutrition. (1|⊕⊕⊕⊕) Technical remark: Nutritional status can be assessed using validated tools such as the Mini Nutritional Assessment and Short Nutritional Assessment Questionnaire. 4.5 In patients aged 65 years and older with diabetes and frailty, we suggest the use of diets rich in protein and energy to prevent malnutrition and weight

2019 The Endocrine Society

60. Doravirine for the treatment of HIV-1 in adults

there may be no specific signs or symptoms of HIV for a number of years. As the virus continues to destroy cells in the immune system, people with HIV may develop mild infections or other signs and symptoms, including fever, fatigue and weight loss. If untreated, HIV progresses to AIDS, which is characterised by certain conditions such as tuberculosis, cytomegalovirus, candidiasis, cryptococcal meningitis, toxoplasmosis, cryptosporidiosis, and different types of cancer, particularly Kaposi’s sarcoma (...) to acquired immunodeficiency syndrome (AIDS), which is the collective name given to several life-threatening illnesses that can develop when the immune system has become severely damaged by HIV. HIV is transmitted through the body fluids of a person with a detectable level of the virus. Most people have flu-like illness several weeks after infection. After this, HIV may not cause any symptoms for a number of years, but it will still damage the immune system. There is currently no cure for HIV

2019 NHS England

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