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Unintentional Weight Loss Causes

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101. 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

102. 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

103. 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

104. 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

105. 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

106. 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

107. 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

108. 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

109. 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

110. 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

111. 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

112. 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

113. 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

114. Prevention, Diagnosis and Management of Colorectal Anastomotic Leakage

. There is experimental evidence of increased risk of AL for several immunosuppressant drugs used in patients who have undergone organ transplantation. This is consistent with reports of a higher AL rate in immunosuppressed patients after renal transplantation 20 .10 Table 1. Medication associated with increased risk of AL. Nutrition and Hypoalbuminaemia Malnutrition (defined as an unintentional loss of weight of >10% in the preceding 6 months), and a serum albumin concentration of 10% unintentional weight loss (...) . While the technique may not be supported by sufficient weight of clinical evidence (and clearly cannot provide reassurance regarding leakage caused by excessive tension or ischaemia), it seems sensible to recommend that all rectal anastomoses (and probably all left sided colonic anastomoses) for which a defunctioning proximal stoma is not being undertaken should routinely be tested for immediate “technical” defects by air insufflation (or a similar technique). The use of a defunctioning stoma

2016 Association of Coloproctology of Great Britain and Ireland

115. 2018 UPDATE: Relative Energy Deficiency in Sport (RED-S)

forward. In dance or sports where being light weight confers a performance or aesthetic advantage, how can a coach/teacher distinguish between athletes who have this type of physique “naturally” and those who have disordered eating and are at risk of RED-S? Equally, low energy availability could be a result either of intentional nutrition restriction to control body weight and composition, or an unintentional consequence of not matching an increase in energy expenditure (due to increased training load (...) ), with a corresponding increase in energy intake. Performance effects Performance is paramount to any athlete or dancer. Apart from physical ability, being driven and determined are important characteristics to achieve success. If weight loss is perceived as achieving a performance advantage, then this can become a competitive goal in its own right: in terms of the individual and amongst teammates. This underlies the interactive effect of in the development and progression in the severity of RED-S. There is both

2018 British Journal of Sports Medicine Blog

116. Raising Awareness of RED-S in Male and Female Athletes and Dancers

as relative to fat free mass (FFM). The exact value of EA to maintain health will vary between genders and individuals, roughly equivalent to resting metabolic rate of the individual. LEA for an athlete or dancer will result in the body going into “energy saving mode” which has knock on effects for many interrelated body systems, including readjustment to lower the resting metabolic rate in the longer term. So although loss in body weight may be an initial sign, body weight can be steady in chronic LEA (...) due to physiological energy conservation adaptations. Homeostasis through internal biological feedback loops in action. The most obvious clinical sign of this state of LEA in women is cessation of menstruation (amenorrhea). LEA as a cause of amenorrhoea is an example of functional hypothalamic amenorrhoea (FHA). In other words, amenorrhoea arising as a result of an imbalance in training load and nutrition, rather than an underlying medical condition per se, which should be excluded before arriving

2018 British Journal of Sports Medicine Blog

117. Nutrition in Cancer Care (PDQ®): Health Professional Version

can vary at presentation and through the continuum of cancer care. Many patients experience unintentional weight loss leading to a diagnosis of cancer.[ , ] Studies have reported malnutrition in 30% to 85% of patients with cancer.[ , ] Because there has previously been no universal definition of malnutrition, reports of malnutrition occurrence vary and may be under- or overreported in different populations. Historically, weight loss, low body mass index (BMI), and serum albumin levels have been (...) used as surrogate markers for malnutrition.[ , ] Emerging evidence supports that loss of lean body mass (sarcopenia) in patients with cancer is an independent risk factor for poorer outcomes; and that in the setting of obesity, unlike in other diseases where weight loss may be welcomed, inappropriate loss of weight may lead to loss of muscle mass and poorer outcomes.[ , , , ] However, there is no universal definition of sarcopenia, and there are no simple methods to identify the condition, limiting

2017 PDQ - NCI's Comprehensive Cancer Database

118. Cancer Pain (PDQ®): Health Professional Version

. (Refer to the section of this summary for more information). Is the pain acute or chronic? Is it secondary to cancer, cancer treatment, other causes, or a combination? Is it somatic, visceral, neuropathic, or mixed? Is there an incidental component? Is there breakthrough pain? Determining whether the pain requires pharmacologic and/or other modalities of treatment. Pain is often multifactorial in nature, so factors that may modulate pain expression, such as psychological distress and substance use (...) , with exacerbations rated as high as 7. Causes of Cancer Pain: Cancer, Cancer Treatments, and Comorbidities A study evaluating the characteristics of patients (N = 100) with advanced cancer presenting to a palliative care service found the primary tumor as the chief cause of pain in 68% of patients.[ ] Most pain was somatic, and pain was as likely to be continuous as intermittent. Pain can be caused by cancer therapies, including surgery, radiation therapy, chemotherapy, targeted therapy, supportive care

2017 PDQ - NCI's Comprehensive Cancer Database

119. Towards a better managed off-label use of drugs

to which it could reasonably be expected that the product would be put”. It is unlikely, however, that the producer will be held liable if the patient was sufficiently informed on the possible risks by the package leaflet and by the physician and if the injury was not caused by a defect inherent to the product or an error in the leaflet. ? Pharmacists can be held liable for damage caused by a defective magistral formula. They are responsible for the quality of the magistral formula: correct weighing (...) for a (too) limited treatment duration or because the authorised alternative is in short supply (e.g. insufficient stocks) or because the treating physician feels that it is less suitable than the off-label product. The use of generic drugs can also lead to unintentional off-label use. Often, generics of one and the same molecule list different applications on the leaflet. Even between countries, applications for one and the same generic can differ. Doctors are usually not aware of this. In countries

2015 Belgian Health Care Knowledge Centre

120. Management of Hepatitis C

in children and infants 12 6.3 Natural history of HCV infection in children 13 6.4 Treatment of children with hepatitis C 13 7 Acute hepatitis C 14 7.1 Natural history 14 7.2 Post-exposure prophylaxis 14 7.3 Treatment of patients with acute hepatitis C 14 8 Assessment of liver disease 16 8.1 Clinical assessment 16 8.2 Fibrosis markers 16 8.3 Liver biopsy 16 9 Progression of untreated disease 18 9.1 Age, gender and ethnicity 18 9.2 Body weight 18 9.3 Tobacco smoking 19 9.4 Alcohol 19 9.5 Alanine (...) for treatment with pegylated IfN and weight-based ribavirin with the addition of a protease inhibitor as triple therapy. A All treatment-experienced patients infected with HCV genotype 1 should be considered for treatment with pegylated IfN and weight-based ribavirin with the addition of a protease inhibitor as triple therapy. B Treatment-naive patients co-infected with HIV and HCV genotype 1 who are unsuitable for treatment with a regimen which includes HCV protease inhibitors should be considered

2013 SIGN

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