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81. Consolidated guideline on sexual and reproductive health and rights of women living with HIV

assessing conditions that may be caused or complicated by intimate partner violence, in order to improve diagnosis/identification and subsequent care. Strong recommendation, indirect evidence Strong recommendation, indirect evidence 1. Reference for this and all the existing recommendations in the next section on integration of services: Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach, second edition

2017 World Health Organisation Guidelines

82. Influencing the trajectories of ageing

; and psychosocial factors such as social vulnerability. 21 A recent innovation has been the development of an electronic frailty index that can be calculated from routine data in primary care. In contrast, the phenotype approach identifies physical frailty in individuals with three out of five criteria: unintentional weight loss; exhaustion; low physical activity; reduced grip strength; and slow gait speed. 22 The first three items are self-reported whilst grip strength and gait speed are usually measured (...) and pharmacological – to slow the trajectory of ageing and maintain health in later life. A report by the Academy highlighted the urgent need to understand the connections between underlying processes of ageing and the causes of age-related disease, and identified a range of strategic priorities for ageing research in the UK. 1 One of the report’s five recommendations was to develop interventions in ageing and age-related diseases. In addition, the Academy’s recent report ‘Improving the health of the public

2016 Academy of Medical Sciences

83. Screening and Diagnosis of Obstructive Sleep Apnea

. Clinical symptoms for OSA include unintentional sleep episodes during wakefulness, daytime sleepiness, unrefreshing sleep, fatigue, insomnia, and snoring. If other causes have been ruled out (for example, thyroid disease, gastroesophageal reflux disease, or other respiratory diseases), further evaluation for OSA may be warranted in patients with daytime sleepiness, which is the clinically relevant OSA symptom most responsive to treatment. Evidence is lacking on the effect of CPAP on improving other (...) prediction rules can be used to effectively predict OSA diagnosis, the applicability of these rules to the general population cannot be determined from the existing literature, adds the ACP. Areas of Difference Screening The ACP recommends that clinicians target their assessment of OSA to individuals with unexplained daytime sleepiness, the clinically relevant OSA symptom most responsive to treatment. Additional common presenting symptoms cited by the developer include unintentional sleep episodes during

2017 National Guideline Clearinghouse (partial archive)

84. Alcohol: Adult Unhealthy Drinking

Advantages Disadvantages ? Useful for decreasing heavy drinking in patients with a goal of reducing drinking. ? Not FDA-approved for this indication. ? Tapering up to effective dose, which is required to minimize side effects, takes 6–10 weeks. ? Potential side effects include dizziness, ataxia, somnolence, memory difficulties, depression, anxiousness, confusion, nystagmus, weight loss, and nausea. ? Many patients cannot tolerate. ? Avoid in patients with history of renal calculi. Disulfiram Advantages (...) alcohol consumption accounts for 10% of deaths among working-age adults in the United States (Stahre 2014). Recommended drinking limits differ for men and women. Women become more impaired than men do after drinking the same amount of alcohol, even when differences in body weight are taken into account. Alcohol is water soluble, so women typically achieve higher blood-alcohol concentration (BAC) because they have less body water. Although some evidence from observational studies indicates that light

2016 Kaiser Permanente Clinical Guidelines

85. Considerations on glycaemic control in older and/or frail individuals with diabetes and advanced kidney disease

].Oldageanddiabetesare the two most important causes of decline in renal function [4]. Inolderindividualswithchronickidneydisease(CKD)anddia- betes,theriskoffrailtyisconsiderable[5].Frailtycanherebybe definedasaclinicalsyndromeinwhichthreeormoreofthefol- lowing criteria are present: unintentional weight loss (10 lbs in the past year), self-reported exhaustion, weakness (grip strength), slow walking speed and low physical activity [6]. A major characteristic of the frailty diathesis is an increased sus- ceptibility (...) was different in this regard, with a mean age of 66 years [10]. Observational stud- ies suggested that, in patients with diabetes and more than 75 years old, an HbA 1c below 6.9% can be protective when comparedwiththegeneralpopulation[11].However,ifCKD is one of the comorbidities, then all-cause mortality can increaseinthediabetesgroupfrom37%upto333%,depend- entontheestimatedglomerularfiltrationrate(eGFR)[11]. However, in patients over 75 years old with CKD (eGFR 7% for peo- ple with limited life expectancy

2017 European Renal Best Practice

86. Management of Dyslipidaemia

& Head, Department of Cardiology, Hospital Pulau Pinang Prof Dr Tilakavati Karupaiah Professor & Head of Dietetics Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia Dr Wardati Mazlan Kepli, Phd Clinical Pharmacist Pharmacy Department Hospital Serdang Edition of Clinical Practice Guidelines 5 th5 RATIONALE AND PROCESS OF GUIDELINE DEVELOPMENT Rationale: In Malaysia, cardiovascular disease (CVD) is the leading cause of death in both men and women 1 . CVD includes coronary heart (...) C: Comparison: ? Therapeutic lifestyle intervention vs placebo ? Pharmacological therapy vs lifestyle intervention O: Outcome: ? Reduction in Cardiovascular Disease- Events, vascular mortality ? Reduction in All cause mortality 7Edition of Clinical Practice Guidelines 5 th Type of Question- Involves: ? Therapy – Lipid lowering ? Harm – Increase in Cardiovascular Event Rate, Adverse effects due to Lipid lowering and/or Pharmacotherapy ? Prognosis – Cardiovascular Risk Reduction ? Prevention

2017 Ministry of Health, Malaysia

87. Heart Disease and Stroke Statistics 2017 Update: A Report From the American Heart Association

14) • When considered separately from other CVDs, stroke ranks No. 5 among all causes of death, behind dis- eases of the heart, cancer, chronic lower respiratory disease, and unintentional injuries/accidents. • Globally, in 2013 there were 6.5 million stroke deaths, making stroke the second-leading cause of death behind ischemic heart disease. • Approximately 795 000 strokes occur in the United States each year. On average, every 40 seconds, someone in the United States has a stroke (...) , and other government agencies, brings together in a single document the most up- to-date statistics related to heart disease, stroke, and the factors in the AHA’s Life’s Simple 7 (Figure 1 ), which include core health behaviors (smoking, physical activity [PA], diet, and weight) and health factors (cholesterol, blood pressure [BP], and glucose control) that contribute to cardiovascular health. The Statistical Update represents a critical resource for the lay public, policy makers, media professionals

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2017 American Heart Association

88. Constipation in older adults: Stepwise approach to keep things moving

for alarm features ( ) that require additional investigations to rule out structural diseases (eg, colon cancer). , Mrs N.M. does not have any alarm features. Box 2. Alarm features of constipation Most important questions to ask your patient: Have you had any fever, had unintentional weight loss, had blood in or on your stool, felt any masses (abdominal or rectal), had night symptoms, or had any other unexplained symptoms? Are you vomiting? Do you have a lot of abdominal pain? Are you still passing gas (...) to reduce constipation. (In this article, PEG 3350 is without electrolytes, unless otherwise stated.) Three months ago she fell in her bungalow and fractured a rib. She is now living in a seniors’ apartment building and gets help from her daughter who lives nearby. Today, upon questioning, Mrs N.M. describes her bowel movements as infrequent (2 to 3 times per week), with hard lumpy stools and some straining. She denies having any nausea, vomiting, blood in the stool, rectal bleeding, fever, weight loss

2016 RxFiles

89. Management of Type 2 Diabetes Mellitus

, a fasting plasma glucose (FPG) or oral glucose tolerance test (OGTT) may also be used to diagnose diabetes. The diagnosis can be made if a fasting glucose level is greater than or equal to 126 mg/dL (7.0 17 UMHS Management of Type 2 Diabetes Mellitus June, 2017 mmol/l), but should be confirmed on a separate day. Diabetes may also be diagnosed on the basis of symptoms (polydipsia, polyuria, unintentional weight loss) and elevated glucose level (= 200 mg/dL), but should also be confirmed on a separate day (...) diet, exercise, and weight loss), acarbose, and metformin have all been shown to reduce the progression of pre-diabetes to diabetes. Diagnosis. The American Diabetes Association (ADA) has added HbA1c as a screening as well as diagnostic test for diabetes. While some disagreement exists concerning the specific level that defines type 2 diabetes, the current ADA definition is that diabetes is diagnosed if A1c is 6.5% or higher. This cut point is specific but not sensitive and thus individuals

2017 University of Michigan Health System

90. Management of Opioid Therapy (OT) for Chronic Pain

prescriptions were still written in 2012.[11] The increase in opioid prescribing is matched by a parallel increase in morbidity, mortality, opioid-related overdose death rates, and substance use disorders (SUD) treatment admissions from 1999 to 2008.[12,13] In 2009, drug overdose became the leading cause of injury-related death in the U.S., surpassing deaths from traffic accidents.[14] In 2014, 1.9 million Americans were affected by an OUD related to non-medical use of prescription pain relievers,[15 (...) associated with changes in the central nervous system (CNS) known as central sensitization.[38] Whereas acute and subacute pain are thought to involve primarily nociceptive processing areas in the CNS, chronic pain is thought to be associated with alterations in brain centers involved with emotions, reward, and executive function as well as central sensitization of nociceptive pathways across several CNS areas.[39-41] There are many causes of chronic pain. Pain arising from persistent peripheral

2017 VA/DoD Clinical Practice Guidelines

91. An update to the Greig Health Record: Preventive health care visits for children and adolescents aged 6 to 17 years ? Technical report

and in school. Parents and children need to know the basic rules for safer Internet use. The periodic health visit is an ideal opportunity to talk with patients about protecting their hearing during especially loud activities (e.g., a rock concert) and by keeping the volume down on personal music devices. Permanent hearing loss is caused by loudness and length of exposure to noise. Rock concerts and personal music players can reach an intensity of 110 to 120 dB. Using appropriately fitting earbuds (...) . Sequelae of sleep deprivation Getting inadequate sleep may be harmful. Insomnia is common, affecting an estimated 10% of U.S. adolescents and 6% of European adolescents. Chronic sleep loss in adults is associated with a greater risk of mortality. There is fair evidence that short sleep duration over time is associated with subsequent weight gain and increased risk of concurrent and adult obesity. - The combination of short sleep duration and variable sleep patterns is associated with adverse metabolic

2016 Canadian Paediatric Society

92. Prioritizing Functional Capacity as a Principal End Point for Therapies Oriented to Older Adults With Cardiovascular Disease

ability to tolerate physiological stresses, including reduced or delayed ability to recover from a stressor. Frailty is also associated with increased incidence of CVD through interrelating inflammatory pathways. Although many different measures of frailty exist, physical frailty is conceptually distinctive from the frailty index , , and relates more directly to functional attributes. , Physical frailty is usually defined as a phenotype that includes 5 domains (unintentional weight loss, exhaustion (...) and strength also decline, with proportionately greater impact as age, disease, and sedentariness synergistically escalate. , Age-associated loss of skeletal muscle mass, called sarcopenia, involves both loss of muscle fibers and reduced fiber size. Whereas muscle mass constitutes 30% of body weight in younger adults, it decreases to ≈15% of body weight by 75 years of age. The loss of strength that accompanies the loss of muscle mass and function in older adults typically leads to the need for greater

2017 American Heart Association

93. Guidance on the clinical management of deliberate self-harm (DSH) and on the organisation and delivery of services

%). Important adverse outcomes associated with hospital-treated DSH include repetition of non- fatal DSH, suicide, all-cause mortality, mental health morbidity (e.g. anxiety, depression, substance use), impaired quality of life and impairment of functioning in physical, psychological and social domains. Rates of suicide and repetition of DSH are considered to be the key clinical outcomes for hospital-treated DSH (Carroll et al., 2014). At the time of the previous RANZCP DSH CPG (Boyce et al., 2003; RANZCP (...) in which the individual deliberately causes self-injury or ingests a substance in excess of any prescribed or generally recognised therapeutic dosage’ (Kreitman, 1979). Following the World Health Organization (WHO) multicentre study of parasuicide (De Leo et al., 2006), unifying terminologies were proposed, but these have not been universally adopted. The National Institute for Health and Care Excellence (NICE) 1 guidelines (National Collaborating Centre for Mental Health, 2004) do not use the term DSH

2016 Royal Australian and New Zealand College of Psychiatrists

94. Psychosis and schizophrenia in adults: prevention and management

benefits and possible side effects of each drug, including: metabolic (including weight gain and diabetes) extrapyramidal (including akathisia, dyskinesia and dystonia) cardiovascular (including prolonging the QT interval) hormonal (including increasing plasma prolactin) other (including unpleasant subjective experiences). [2009; amended 2014] [2009; amended 2014] Psychosis and schizophrenia in adults: prevention and management (CG178) © NICE 2019. All rights reserved. Subject to Notice of rights (...) ethnic and cultural backgrounds using explanatory models of illness for people from diverse ethnic and cultural Psychosis and schizophrenia in adults: prevention and management (CG178) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 11 of 55backgrounds explaining the causes of psychosis or schizophrenia and treatment options addressing cultural and ethnic differences in treatment expectations and adherence addressing

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

95. 2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation

(Strong Recommendation, High-Quality Evidence). 2. When OAC is indicated in the presence of CAD, we suggest a NOAC in preference to warfarin for NVAF (Conditional Recommendation, Low-Quality Evidence). Values and preferences. The suggestion for use of a NOAC rather than warfarin places relatively greater weight on the ease of use of NOACs vs warfarin and on the data from RCTs of NOACs vs warfarin for NVAF, showing equal or greater reduction of stroke, equal or less major bleeding, less intracranial (...) bleeding, and no net increase in CAD outcomes. It places relatively less weight on the absence of long-term data on the effect of NOACs on coronary outcomes as opposed to the data for efficacy of warfarin. Practical tip. When CAD is present, some expert clinicians prefer a combination of a NOAC and ASA rather than a NOAC alone in preference to warfarin alone for patients perceived to be at higher risk of coronary events and low risk of major bleeding and might choose a NOAC alone as a reasonable option

2016 Canadian Cardiovascular Society

96. The Impact of the Welfare Reform and Work Bill

: These are the commonest cause of death in children aged 5-9 in the UK and a major area of socioeconomic inequality. Children from disadvantaged backgrounds are more likely to experience unintentional injury. 44 Road traffic accidents are the main cause of death in this age-group and are strongly related to socioeconomic status. For example, child pedestrians in the lowest socioeconomic group are five times more likely to be killed on the roads than those in the highest group. For deaths due to fire this differential (...) in that year (and every year thereafter). 8 It also included a further duty on the Secretary of State to publish a child poverty strategy triennially. 13. In the Conservative Manifesto 2015, a commitment to “work to eliminate child poverty and introduce better measures to drive real change in children’s lives by recognising the root causes of poverty: entrenched worklessness, family breakdown, problem debt, and drug and alcohol dependency” was included. 9 14. The Welfare Reform and Work Bill will repeal

2016 Faculty of Public Health

97. Treatment of HIV-1-positive adults with antiretroviral therapy (interim update)

with an expert source (e.g. www.hiv-druginteractions.org). ? We suggest that if abacavir is to be used with ribavirin, the ribavirin should be weight-based dose- adjusted (2C) 8.3 HIV-related cancers 8.3.1 When to start ART 8.3.1.1 AIDS-defining malignancies BHIVA guidelines for the treatment of HIV-1-positive adults with ART 2015 (2016 interim update) August 2016 20 ? We recommend that all patients with AIDS-defining malignancies should start ART promptly (1B). 8.3.1.1.1 Kaposi sarcoma (KS) ? We recommend (...) their consultation style appropriately. They should also consider how to make information accessible and understandable to PLWH (e.g. with pictures, symbols, large print and different languages) [1], including addressing linguistic and cultural issues. Youth is consistently associated with lower adherence to ART, loss to follow-up and other negative healthcare behaviours [27] and some studies have found an independent association between poorer adherence and attendance and female gender [28], so information

2017 British HIV Association

98. Daily iron supplementation in postpartum women

in which there is too little haemoglobin, which is carried by red blood cells, thereby decreasing the capacity of the blood to carry sufficient oxygen to meet physiological needs. There are a number of causes of anaemia, including blood loss, iron deficiency and other micronutrient deficiencies (e.g. vitamin A, folate, vitamin B 12 and riboflavin), inherited haemoglobin disorders (e.g. sickle-cell disease and thalassaemias), parasitic infections and other acute and chronic infections that cause (...) little iron is excreted through breast milk (9, 10). Nevertheless, one of the strongest predictors of postpartum anaemia is anaemia during pregnancy, as iron stores tend to remain low for several months after childbirth, especially if there is significant blood loss during the delivery and additional iron is not consumed in sufficient quantities (11–13). Worldwide, there are limited data on the prevalence of postpartum anaemia. Studies conducted in high-income countries have reported that 10–30

2016 World Health Organisation Guidelines

99. ERBP Guideline on Management of Older Patients with Chronic Kidney Disease

not attach any consequences to the stated interests, but insisted on transparency. All members of the guideline development group were allowed to participate in discussions and had equal weight in formulation of the statements. All were allowed equal involvement in data extraction and writing the rationales. 4.2. Guideline development group declaration of interest The updated declaration of interest forms are available from and are updated on a regular basis. None of the guideline development group (...) outcomes Survival/mortality QoL/patient satisfaction Progression to ESKD/deterioration of residual renal function Functional status Highly important outcomes Hospital admissions Major morbid events Myocardial infarction Stroke Amputation Loss of vision Infection Pain Moderately important outcomes (surrogate outcomes) None Question specific outcomes For 1.1: Bias [median difference between eGFR and measured GFR] Precision (SD of Bias) Accuracy (root mean square error of eGFR–mGFR difference) Correlation

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2016 European Renal Best Practice

100. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

predictive equation or a simplistic weight-based equation (25–30 kcal/kg/day) be used to determine energy requirements. (See section Q for obesity recommendations.) Rationale: Clinicians should determine energy requirements in order to establish the goals of nutrition therapy. Energy requirements may be calculated either through simplistic formulas (25–30 kcal/kg/day), published predictive equations, or IC. The applicability of IC may be limited at most institutions by availability and cost. Variables (...) , such as weight, medications, treatments, and body temperature. The only advantage of using weight-based equations over other predictive equations is simplicity. However, in critically ill patients following aggressive volume resuscitation or in the presence of edema or anasarca, clinicians should use dry or usual body weight in these equations. Additional energy provided by dextrose-containing fluids and lipid-based medications such as propofol should be accounted for when deriving nutrition therapy regimens

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2016 Society of Critical Care Medicine

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