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81. 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

82. 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

83. 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

84. 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

85. 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

86. 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

87. 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

88. Evidence-Based Policy Making: Assessment of the American Heart Association?s Strategic Policy Portfolio

the systematic reviews for a particular policy priority, the most recent review incorporating the latest scientific evidence was given foremost consideration. Table 1. AHA Evidence Grading Levels of Evidence Class I: There is evidence for and/or general agreement that the intervention is beneficial, useful, and effective. The intervention should be performed. Class II: There is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of the intervention. Class IIa: The weight (...) of evidence/opinion is in favor of usefulness/efficacy. It is reasonable to perform the intervention. Class IIb: Usefulness/efficacy is less well established by evidence/opinion. The intervention may be considered. Class III: There is evidence and/or general agreement that the intervention is not useful/effective and in some cases may be harmful. The weight of evidence in support of the recommendation Level of Evidence A: Data are derived from multiple randomized clinical trials or, given the nature

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2016 American Heart Association

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

. Question: What is the best method for determining energy needs in the critically ill adult patient? A3a. We suggest that indirect calorimetry (IC) be used to determine energy requirements, when available and in the absence of variables that affect the accuracy of measurement. [Quality of Evidence: Very Low] A3b. Based on expert consensus, in the absence of IC, we suggest that a published predictive equation or a simplistic weight‐based equation (25–30 kcal/kg/d) be used to determine energy requirements (...) and underweight patients. ‐ Equations derived from testing hospital patients (Penn State, Ireton‐Jones, Swinamer) are no more accurate than equations derived from testing normal volunteers (Harris‐Benedict, Mifflin St Jeor). The poor accuracy of predictive equations is related to many nonstatic variables affecting energy expenditure in the critically ill patient, such as weight, medications, treatments, and body temperature. The only advantage of using weight‐based equations over other predictive equations

2016 American Society for Parenteral and Enteral Nutrition

90. Clinical Practice Guidelines for Sustained Neuromuscular Blockade in the Adult Critically Ill Patient

agents . 9) We suggest that clinicians not use actual body weight and instead use a consistent weight (ideal body weight or adjusted body weight) when calculating neuromuscular-blocking agents doses for obese patients. 10) We suggest that neuromuscular-blocking agents be discontinued at the end of life or when life support is withdrawn. In situations in which evidence was lacking or insufficient and the study results were equivocal or optimal clinical practice varies, the Task Force made (...) no recommendation concerning the use of one measure of consistent weight over another when calculating neuromuscular-blocking agent doses in obese patients. 8) We make no recommendation on the use of neuromuscular-blocking agents in pregnant patients. 9) We make no recommendation on which muscle group should be monitored in patients with myasthenia gravis receiving neuromuscular-blocking agents . Finally, in situations in which evidence was lacking or insufficient but expert consensus was unanimous, the Task

2016 Society of Critical Care Medicine

91. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

and obesity? Q2.2. What are the best anthropomorphic criteria for defining excess adiposity in the diagnosis of overweight and obesity in the clinical setting? 34 Q2.3. Does waist circumference provide information in addition to body mass index (BMI) to indicate adiposity risk? 34 Q2.4. Do BMI and waist circumference accurately capture adiposity risk at all levels of BMI, ethnicity, gender, and age? 34 Q3. What are the weight-related complications that are either caused or exacerbated by excess adiposity (...) incontinence 52 Q3.14. Gastroesophageal reflux disease (GERD) 52 Q3.15. Depression 56 Q4. Does BMI or other measures of adiposity convey full information regarding the impact of excess body weight on the patient’s health? 56 Q5. Do patients with excess adiposity and related complications benefit more from weight loss than patients without complications, and, if so, how much weight loss would be required? 58 Q5.1. Is weight loss effective to treat diabetes risk (i.e., prediabetes, metabolic syndrome

2016 American Association of Clinical Endocrinologists

92. Depression

, post-induced or spontaneous abortion, or emotional, physical, or sexual abuse Table 2. Depressive Symptoms and Diagnostic Criteria for Depressive Disorders Core Depressive Symptoms • Depressed mood • Anhedonia or markedly diminished interest or pleasure in all, or almost all, activities • Significant unintentional weight loss or gain • Insomnia or hypersomnia • Psychomotor agitation or retardation • Fatigue or loss of energy • Feelings of worthlessness or excessive or inappropriate guilt (...) Upon titration, dosage should not exceed 40 mg/d. 12.5 mg/d P.O. Qam. May increase dose up to 50 mg/d. 12.5-25 mg P.O. Qam. Titrate to desired effect. Lower doses generally required. a If a patient fails one SSRI class of antidepressants, another SSRI may tried (don't try a third SSRI). During the initial phase of treatment all SSRI's may produce one or all of the following: Increased arousal (agitation), insomnia, nausea, diarrhea (due to increased GI motility), initial weight loss and subsequent

2016 University of Michigan Health System

93. Management of Concussion-mild Traumatic Brain Injury (mTBI)

Injury February 2016 Page 6 of 133 II. Background A traumatic brain injury (TBI) is defined as a traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force and is indicated by new onset or worsening of at least one of the following clinical signs immediately following the event:[2,3] • Any period of loss of or a decreased level of consciousness • Any loss of memory for events immediately before or after the injury (posttraumatic amnesia (...) ) • Any alteration in mental state at the time of the injury (e.g., confusion, disorientation, slowed thinking, alteration of consciousness/mental state) • Neurological deficits (e.g., weakness, loss of balance, change in vision, praxis, paresis/plegia, sensory loss, aphasia) that may or may not be transient • Intracranial lesion External forces may include any of the following events: the head being struck by an object, the head striking an object, the brain undergoing an acceleration/deceleration

2016 VA/DoD Clinical Practice Guidelines

94. Obinutuzumab for untreated advanced follicular lymphoma

sites, especially if lymph nodes cause problems because of their location, or if people have fever, night sweats or unintentional weight loss. The committee concluded that people with symptomatic disease reflect the relevant population to consider in this appraisal. Obinutuzumab for untreated advanced follicular lymphoma (TA513) © NICE 2018. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 6 of 25Rituximab plus chemother (...) of this submission by the evidence review group (ERG). See the committee papers for full details of the evidence. Clinical need in advanced follicular lymphoma P People with follicular lymphoma want further options for treatment eople with follicular lymphoma want further options for treatment 3.1 Follicular lymphoma progresses slowly over many years, often without symptoms. The patient experts noted that, despite this, knowing that the disease will eventually progress can cause considerable distress. People

2018 National Institute for Health and Clinical Excellence - Technology Appraisals

95. Power Threat Meaning Framework: innovative and important? #PTMFramework

solved the problem of psychiatric diagnosis; the DSM is, after all, not a static document. No decent mental health professional would say that the aetiology of mental health disorders is understood. We are in a reverse-therapeutic gap of sorts: we know what might work for certain conditions; but we don’t know the causes yet. And, just because biomarkers for psychiatric diagnoses have not yet been located, that does not mean they do not exist, or that we should stop looking for them. It is also (...) strange that both evidence-based medicine and outdated philosophies such as psychoanalysis and Foucauldian discourse are given the same weight in the Framework. Evidence-based medicine is just that: statistics have shown that it is effective for a high enough percentage of people to be useful. The same sorts of statistics can never be gathered for psychoanalysis. In terms of narratives, I agree that they can be useful. Looking at what happened can be helpful, up to a point. Many of us, however, find

2018 The Mental Elf

96. 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

97. Physical activity: walking and cycling

- motorised transport an easier option.) National actions to support walking and cycling, such as fiscal measures and other policy interventions to alter the balance between active and motorised travel in terms of cost and convenience. Measures to reduce the risk of unintentional injuries from walking and cycling. (See NICE's guidance on strategies to prevent unintentional injuries among under-15s.) Who is this guidance for? The guidance is for commissioners, managers and practitioners involved (...) with limited mobility. The Chief Medical Officers' 2011 report notes: 'there is a clear causal relationship between the amount of physical activity people do and all-cause mortality. While increasing the activity levels of all adults who are not meeting the recommendations is important, targeting those adults who are significantly inactive (that is, engaging in less than 30 minutes of activity per week) will produce the greatest reduction in chronic disease' (Chief Medical Officers of England, Scotland

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

98. Genetics of Breast and Gynecologic Cancers (PDQ®): Health Professional Version

), (associated with Cowden syndrome), (associated with diffuse gastric and lobular breast cancer syndrome), and (associated with Peutz-Jeghers syndrome), confer a risk to either or both of these cancers with relatively high penetrance. Inherited endometrial cancer is most commonly associated with , a condition caused by inherited pathogenic variants in the highly penetrant mismatch repair genes MLH1 , MSH2 , MSH6 , PMS2 , and EPCAM . Colorectal cancer (and, to a lesser extent, ovarian cancer and stomach (...) in a separate window. ] [ Note: A concerted effort is being made within the genetics community to shift terminology used to describe genetic variation. The shift is to use the term “variant” rather than the term “mutation” to describe a genetic difference that exists between the person or group being studied and the reference sequence. Variants can then be further classified as benign (harmless), likely benign, of uncertain significance, likely pathogenic, or pathogenic (disease causing). Throughout

2018 PDQ - NCI's Comprehensive Cancer Database

99. The Role of Bariatric Surgery in Improving Reproductive Health

banding (LAGB), silastic ring gastroplasty (SRG), vertical banded gastroplasty (VBG) and sleeve gastrectomy (SG). An example of a malabsorptive bariatric procedure is biliopancreatic diversion (BPD); Roux-en-Y gastric bypass (RYGB) is both a restrictive and malabsorptive procedure. Bariatric surgery results in a loss of up to 15–25% of body weight that is sustained in the long term, as well as significant reductions in healthcare costs and comorbidities associated with obesity, such as diabetes (...) . 24 Complications include bleeding, anastomotic leak with peritonitis, deep vein thrombosis and internal hernias. In SG, a partial gastrectomy is performed to reduce stomach volume while maintaining the normal anatomy of the rest of the gastrointestinal tract. Originally performed to aid initial weight loss prior to a duodenal switch, it has gained popularity as a stand-alone operation. The metabolic effects and weight loss appear similar in the first few years to RYGB surgery, 25–28 but RYGB

2015 Royal College of Obstetricians and Gynaecologists

100. Bariatric Surgery in Improving Reproductive Health, The Role of

banding (LAGB), silastic ring gastroplasty (SRG), vertical banded gastroplasty (VBG) and sleeve gastrectomy (SG). An example of a malabsorptive bariatric procedure is biliopancreatic diversion (BPD); Roux-en-Y gastric bypass (RYGB) is both a restrictive and malabsorptive procedure. Bariatric surgery results in a loss of up to 15–25% of body weight that is sustained in the long term, as well as significant reductions in healthcare costs and comorbidities associated with obesity, such as diabetes (...) . 24 Complications include bleeding, anastomotic leak with peritonitis, deep vein thrombosis and internal hernias. In SG, a partial gastrectomy is performed to reduce stomach volume while maintaining the normal anatomy of the rest of the gastrointestinal tract. Originally performed to aid initial weight loss prior to a duodenal switch, it has gained popularity as a stand-alone operation. The metabolic effects and weight loss appear similar in the first few years to RYGB surgery, 25–28 but RYGB

2015 Royal College of Obstetricians and Gynaecologists

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