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41. Placenta Praevia and Placenta Accreta: Diagnosis and Management

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

42. 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

43. 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)

44. 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

45. Treatment of Diabetes in Older Adults

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

46. 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

47. Treatment for Acute Pain: An Evidence Map

input to this report follows: Roger Chou, M.D. Division of General Internal Medicine and Geriatrics Oregon Health Sciences University Portland, OR Erin Krebs, M.D.* Minneapolis Veterans Affairs Medical Center Minneapolis, MN Corey Leinum, Pharm. D., BCPS* Fairview Pharmacy Services Minneapolis, MN Christina Mikosz, M.D., M.P.H.* Division of Unintentional Injury Prevention National Center for Injury Prevention and Control Centers for Disease Control and Prevention Atlanta, GA Steven Stanos, D.O (...) . Musculoskeletal pain, including back and neck pain, is frequently seen in a variety of settings. Back problems and headaches (including migraines) are two of the most common reasons people visit their healthcare providers. 33 Treating musculoskeletal pain appropriately requires identifying the cause (pain pathway). • KIs agreed on the importance of the acute pain conditions in the statement of work, but mentioned other conditions not as thoroughly addressed in available research, including compression

2019 Effective Health Care Program (AHRQ)

48. Urological Trauma

., et al. Terrorism in America. An evolving threat. Arch Surg, 1997. 132: 1059. 22. Frykberg, E.R. Medical management of disasters and mass casualties from terrorist bombings: how can we cope? J Trauma, 2002. 53: 201. 23. Jacobs, L.M., Jr., et al. An emergency medical system approach to disaster planning. J Trauma, 1979. 19: 157. 24. Eberle, B.M., et al. Thromboembolic prophylaxis with low-molecular-weight heparin in patients with blunt solid abdominal organ injuries undergoing nonoperative (...) fracture urethral injuries. Urology, 2014. 83: S48. 214. Barratt, R.C., et al. Pelvic fracture urethral injury in males-mechanisms of injury, management options and outcomes. Transl Androl Urol, 2018. 7: S29. 215. Mundy, A.R., et al. Urethral trauma. Part I: introduction, history, anatomy, pathology, assessment and emergency management. BJU Int, 2011. 108: 310. 216. Mundy, A.R., et al. Pelvic fracture-related injuries of the bladder neck and prostate: their nature, cause and management. BJU Int, 2010

2019 European Association of Urology

49. 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

50. 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 Investigation for symptomatic recurrence following ileocolonic resection 102 Non-inflammatory causes of diarrhoea after ileocolonic resection 103 Bile salt malabsorption 103 Small intestinal bacterial overgrowth 104 Other causes of recurrent symptoms following ileocolonic surgery 104 4.10.2 (...) thiopurines with allopurinol 122 Thiopurine toxicity 123 5.2.3 Drug use: methotrexate 124 Methotrexate and pregnancy 125 5.2.4 Drug management: anti TNF including biosimilars 126 Choice of anti-TNF agent 126 Biosimilar anti-TNF drugs 127 Assessment after anti-TNF induction therapy 128 Drug levels of infliximab and adalimumab 129 Primary non-response to anti-TNF therapy 130 Secondary loss of response to anti-TNF therapy 130 Annual

2019 British Society of Gastroenterology

51. 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

52. 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

53. 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

54. BTS/SIGN British Guideline on the Management of Asthma

, predominant cough Gastro-oesophageal reflux Orthopnoea, paroxysmal nocturnal dyspnoea, peripheral oedema, pre- existing cardiac disease Cardiac failure Crackles on auscultation Pulmonary fibrosis With airflow obstruction Significant smoking history (ie, >30 pack-years), age of onset >35 years COPD Chronic productive cough in the absence of wheeze or breathlessness Bronchiectasis*; inhaled foreign body*; obliterative bronchioitis; large airway stenosis New onset in smoker, systemic symptoms, weight loss (...) treatment Severe/life-threatening asthma attack Severe/life-threatening asthma attack ‘Red flags’ and indicators of other diagnoses Prominent systemic features (myalgia, fever, weight loss) Failure to thrive Unexpected clinical findings (eg crackles, clubbing, cyanosis, cardiac disease, monophonic wheeze or stridor) Unexplained clinical findings (eg focal signs, abnormal voice or cry, dysphagia, inspiratory stridor) Persistent non-variable breathlessness Symptoms present from birth or perinatal lung

2019 British Thoracic Society

55. 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

56. 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

57. 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

59. 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)

60. 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)

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