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Unintentional Weight Loss Causes

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61. 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

62. Heart Disease and Stroke Statistics Full Text available with Trip Pro

. CVD prevalence excluding hypertension (CHD, HF, and stroke only) is 9.0% overall (24.3 million in 2016). In 2016, 2 744 248 resident deaths were registered in the United States. Ten leading causes accounted for 74.1% of all registered deaths. The 10 leading causes of death in 2016 were the same as in 2015; these include heart disease (No. 1), cancer (No. 2), unintentional injuries (No. 3), chronic lower respiratory diseases (No. 4), stroke (No. 5), Alzheimer disease (No. 6), DM (No. 7), influenza (...) and pneumonia (No. 8), kidney disease (No. 9), and suicide (No. 10). Seven of the 10 leading causes of death had a decrease in age-adjusted death rates. The age-adjusted death rates decreased 1.8% for heart disease, 1.7% for cancer, 2.4% for chronic lower respiratory diseases, 0.8% for stroke, 1.4% for DM, 11.2% for influenza and pneumonia, and 2.2% for kidney disease. The age-adjusted rate increased 9.7% for unintentional injuries, 3.1% for Alzheimer disease, and 1.5% for suicide. In 2016, ≈17.6 million

2019 American Heart Association

63. Chest imaging

unintentional weight loss is to exclude an occult malignancy not detected by initial clinical 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 © 2019. 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

2019 AIM Specialty Health

64. Appropriate Use Criteria: Imaging of the Abdomen and Pelvis

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. 18 Constipation can have both functional and organic causes. When constipation is associated with red flag features such as failure to thrive, unexplained weight loss, or vomiting, referral to a pediatric gastroenterologist should be considered and additional testing (...) Lymphadenopathy 29 Pelvic floor disorders associated with urinary or bowel incontinence 29 Prostate cancer 29 Retroperitoneal conditions 30 Splenic hematoma 30 Splenomegaly 30 Sports hernia (athletic pubalgia) 30 Undescended testicle (cryptorchidism) 31 Imaging of the Abdomen and Pelvis Copyright © 2019. AIM Specialty Health. All Rights Reserved. 4 Nonspecific Signs and Symptoms 31 Abdominal pain 31 Azotemia 32 Lower extremity edema 32 Fever of unknown origin 32 Pelvic pain 32 Weight loss 33 Exclusions 33

2019 AIM Specialty Health

65. Type 2 Diabetes Mellitus and Heart Failure Full Text available with Trip Pro

in the cardiovascular outcomes trials are shown in and . In , clinical vignettes are used to demonstrate the application of these data to guide glucose-lowering medication choice in patients with DM. Table 2. Considerations for Use of Glucose-Lowering Medications Class/Medication Oral/SC Cost Hypoglycemia Impact on Weight Adjustment With CKD FDA Black Box Warnings and Other Considerations Biguanides Metformin Oral Low No Neutral, potential weight loss Contraindicated with eGFR <30 Do not affect progression (...) Rosiglitazone Pioglitazone Oral Low No Weight gain Generally not recommended in CKD because of potential for fluid retention Do not affect progression of kidney disease FDA Black Box Warning: Thiazolidinediones, including rosiglitazone, may cause or exacerbate HF; closely monitor for signs and symptoms of HF, particularly after initiation or dose increases. If HF develops, treat accordingly and consider dose reduction or discontinuation. Not recommended for use in any patient with symptomatic HF. Common

2019 American Heart Association

66. Child Abuse, Elder Abuse, and Intimate Partner Violence

tears and abusive head injury: A cautionary tale. Pediatr Emerg Care. 2007; 23(10): 735-7. 19Best Practices Guidelines for Trauma Center Recognition: Child Abuse BURNS Key Points z Burn injury is both a source and a marker of abuse in children. z The risk of recurrent abuse and mortality is high in children with burn abuse injury unless intervention occurs. z Patterns of scald and contact burn injury help distinguish between unintentional and abuse-related injury. Burn injury causes more than 60,000 (...) :// www.cdc.gov/violenceprevention/pdf/ CM_Surveillance-a.pdf) is recommended to enable more accurate incidence monitoring. Using these definitions supports research to determine the magnitude of child abuse and neglect, examine trends over time, and determine the impact of prevention and screening strategies. 4 z Physical abuse includes physical acts ranging from those leaving no physical mark on the child to those causing permanent disability, disfigurement, or death. It can result from discipline

2019 American College of Surgeons

67. 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)

68. 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

69. 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

70. 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

71. 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

72. 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

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

In-Hospital Management of Diabetes Janine Malcolm MD, FRCPC, Ilana Halperin MD, FRCPC, David B. Miller MD, FRCPC, Sarah Moore RN(EC), BScN, MN, Kara A. Nerenberg MD, FRCPC, Vincent Woo MD, FRCPC, Catherine H. Yu MD, FRCPC S124 Weight Management in Diabetes Sean Wharton MD, FRCPC, PharmD, Sue D. Pedersen MD, FRCPC, David C.W. Lau MD, PhD, FRCPC, Arya M. Sharma MD, PhD, FRCPC S130 Diabetes and Mental Health David J. Robinson MD, FRCPC, FCPA, DFAPA, Michael Coons PhD, CPsych, CBSM, Heidi Haensel MD, FRCPC

2018 Diabetes Canada

75. Tenofovir with emtricitabine for HIV pre-exposure prophylaxis (PrEP)

issues In clinical trials, tenofovir disoproxil with emtricitabine as PrEP has been associated with gastrointestinal side effects, including nausea and vomiting, but most occur in the first month and resolve with continued exposure. Other adverse events reported are headache, arthralgia and unintentional weight loss. In the IPERGAY study, gastrointestinal adverse events occurred in 14% of participants in the TDF-FTC group compared with 5% in the placebo group (p = 0.002), with increases also reported (...) prophylaxis (PrEP), compared with placebo. Adherence to the daily regimen impacts the efficacy of the combination when taken as PrEP. Tenofovir disoproxil with emtricitabine has been associated with gastrointestinal side effects including nausea and vomiting, but most events occur in the first month after initiating therapy and resolve with continued exposure. Elevations in creatinine concentrations and declines in creatinine clearance, as well as loss of bone mineral density (BMD), have also been

2018 National Prescribing Service Limited (Australia)

76. Using Clinical Laboratory Tests to Monitor Drug Therapy in Pain Management Patients

) to classify prescription opioid analgesic abuse as an epidemic. This appears to be due in large part to individuals using a prescription drug non-medically, most often an opioid an- algesic. Drug-induced deaths have rapidly risen and continue to be one of the leading causes of death in Americans. In 2011, the Office of National Drug Control Policy established a multifaceted approach to address prescription drug abuse, including Prescrip- tion Drug Monitoring Programs (PDMPs) that allow practitioners

2018 American Academy of Pain Medicine

77. 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

2018 European Association of Urology

78. 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)

79. 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

80. Evaluation and Treatment of Hirsutism in Premenopausal Women Full Text available with Trip Pro

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

2018 The Endocrine Society

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