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Unintentional Weight Loss Causes

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121. 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

122. 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

123. 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

124. 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

125. 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

126. Evaluating the effectiveness of the Glasgow 2014 Commonwealth Games

. The consensus of opinion was that the HIA recommendations and other legacy reports and recommendations have not determined outcomes but rather have prioritised actions, added political weight to, and expedited projects that are and have been in the pipeline. Organisations spoke of using the recommendations and themes within the Framework as a justification for prioritising certain initiatives, and also as a source of additional funding streams. The HIA report in itself was also used by some stakeholders (...) and four Scottish Government themes. The consensus of opinion was that legacy reports and recommendations have not determined outcomes but rather have prioritised actions, added political weight to, and expedited projects that are and have been in the pipeline. Stakeholders suggested the HIA recommendations have been incorporated into policy but this is more likely to be a retro-fit exercise than genuine forethought. In general it is more likely that initiatives (the majority of which are pre-planned

2014 Glasgow Centre for Population Health

127. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada : Diabetes in the elderly

vulnerability. Frailty may have a biological basis and appears to be a distinct clinical syndrome. Many definitions of frailty have been proposed. The most commonly applied definition (Fried's Frailty Phenotype) suggests that a person is frail when 3 or more of the following criteria are present: unintentional weight loss (>4.5 kg in the past year), self-reported exhaustion, weakness (diminished grip strength), slow walking speed and low physical activity . Progressive frailty has been associated (...) this is controversial . Conversely, cognitive dysfunction in older people with diabetes has clearly been identified as a significant risk factor for the development of severe hypoglycemia . Nutrition and physical activity Nutrition education can improve metabolic control in ambulatory older people with diabetes . Although nutrition education is important, weight loss may not be, since moderate obesity is associated with a lower mortality in this population . Amino acid supplementation may improve glycemic control

2013 CPG Infobase

128. Poisoning or overdose

agonists and so-called 'legal highs'. 2,4-dinithrophenol. This is an industrial chemical. It is not a licensed medicine and is sometimes dangerously used for weight loss. There have been 11 deaths associated with this since 2008. Electronic nicotine delivery systems. Many electronic cigarettes (e-cigarettes) and their liquid refills contain nicotine, which is highly toxic. The majority of the reported exposures were accidental, with 37 percent involving children under five. Ingestion was the most (...) situations where poisoning is a possibility and information about toxidromes (the syndrome of signs and symptoms caused by certain classes of substances, usually in overdose) have been added. The assessment of a person who has been poisoned has been revised in line with expert opinion in review articles and in the British National Formulary. The recommendations on when to admit someone who has been poisoned have been revised in line with guidelines from the National Institute for Health and Clinical

2017 NICE Clinical Knowledge Summaries

129. Professor Christopher Exley: The latest darling of the antivaccine movement

high” and “very high,” Exley claims that his research implicates aluminum as an etiological role in autism. Claiming that, before his current research, he had heard of claims that aluminum—or aluminum in vaccines—causes autism but had dismissed the science as not adequately strong to support a link, he then proclaims: I have to change my mind on both of these. I have to change my mind that aluminium has a role in autism and believe it now does…Now I’ve often said when asked “Should we stop using (...) money to fund this type of research. As I’ve before, Claire and Al Dwoskin, who founded the CMSRI, are fanatically antivaccine, and they use their foundation to fund causes related to their belief that vaccines cause autism. The CMSRI funds antivaccine research, and you can bet that the Dwoskins wouldn’t have funded Exley’s work if they didn’t think it would be used to implicate vaccines as a cause of autism and all the diseases and conditions that antivaxers blame vaccines for. England herself, I

2017 Respectful Insolence

130. Substance Abuse in Canada: The Effects of Cannabis Use during Adolescence (Report)

to patterns of heavy, compulsive use of psychoactive drugs and an inability to stop substance use, even though it is leading to severe, clinically relevant problems in multiple domains of a person’s life (e.g., when such use becomes physically hazardous; causes failure to fulfill obligations at work, school or home; or creates legal, social or interpersonal problems). Substance dependence: Also referred to as “drug or alcohol dependence,” substance dependence constitutes a cluster of cognitive (...) , this final section of the report outlines recommendations for research topics that will help improve prevention and treatment outcomes, as well as immediate actions that can be taken to inform cannabis-related policy and help reduce the harms associated with cannabis use during adolescence. While progress continues to be made in recognizing and understanding the causes, mechanisms and long-term effects of cannabis use in youth, many questions still need to be addressed. Future research should focus

2015 Canadian Centre on Substance Abuse

131. 2015 ACC/AHA Focused Update of Secondary Prevention Lipid Performance Measures

.” Unintentional nonadherence is thought to be a passive process on the part of the patient and may involve a lack of understanding of physical problems, resulting in an inability to follow treatment instructions, impaired manual dexterity, poor eyesight, or forgetfulness. In a recent systematic review and meta-analysis, it was noted that there is a statistically significant relationship between health literacy and medication adherence; however, the magnitude of effect was small when compared with other causes (...) reduction in all-cause mortality, which was largely attributable to significant reductions in deaths due to CAD and other cardiac causes. The majority of studies in the aforementioned report included patients with known ASCVD. Of the 26 RCTs included, 5 trials (39 612 subjects, all of whom had CAD) compared more versus less intensive statin regimens. The trials demonstrated that more intensive regimens produced a highly significant 15% further reduction in major vascular events, driven by reductions

2015 American Heart Association

132. Practice Advisory on Anesthetic Care for Magnetic Resonance Imaging

and pregnant non-MRI workers and found no significant difference in the relative risk of early delivery, low birth weight, or spontaneous abortions ( Category B2-E evidence ). Survey Findings. The consultants and ASA members strongly agree that all anesthesiologists should have general safety education on the unique physical environment of the MRI scanner. The ASA members agree and the consultants strongly agree that all anesthesiologists should have specific education regarding the features of individual (...) radiologist, and the device manufacturer). Other implanted electronic devices also pose a hazard in the MRI environment. These devices and associated wiring may transfer energy during the MRI scan, causing tissue damage, malfunction of the device, image artifacts, and device displacement. MRI may be performed on a limited basis for patients with certain implanted electronic devices ( e.g. , deep brain stimulators, vagal nerve stimulators, phrenic nerve stimulators, wire-containing thermodilution catheters

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2015 American Society of Anesthesiologists

133. Secondary Prevention After Coronary Artery Bypass Graft Surgery

of adverse cardiovascular outcomes. Postoperative antiplatelet agents and lipid-lowering therapy continue to be the mainstay of secondary prevention after coronary surgical revascularization. Other opportunities for improving long-term clinical outcomes after CABG include the aggressive management of hypertension and diabetes mellitus, smoking cessation, weight loss, and cardiac rehabilitation (CR). Secondary preventive therapies help maintain long-term graft patency and help patients obtain the highest (...) HDL was found to be a more potent CAD risk factor than high LDL. , Recent studies from the current era have shown that HDL levels are inversely related to cardiovascular events, even among patients receiving statin therapy and those with LDL levels aggressively treated to <70 mg/dL. In addition, moderate increases in HDL appear to be associated with regression of coronary atherosclerosis in statin-treated patients. Smoking cessation, weight loss, exercise, and moderate alcohol intake all modestly

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2015 American Heart Association

134. The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine

information for practitioners of regional anesthesia and pain medicine regarding the etiology, differential diagnosis, prevention, and treatment of neurologic complications.” As before, the current practice advisory focuses on neurologic injuries apart from those caused by hemorrhagic or infectious complications or local anesthetic systemic toxicity, which are the subjects of other ASRA-sponsored practice advisories. This executive summary condenses findings and recommendations from subtopics (...) ) associated risk factors specific to the cohort studied, 4) robustness of data recording (eg, retrospective vs prospective; registries vs quality assurance databases vs insurance company records vs self-report; single institution vs continent-wide); and 5) discriminating the cause of injury (eg, anesthetic vs surgical vs patient vs a combination; transient vs permanent). | Incidence of Neuraxial Injury Neuraxial complications are extremely rare, but when they occur, they often result in life-altering

2015 American Society of Regional Anesthesia and Pain Medicine

135. Gastroesophageal Reflux Disease (GERD)

, aspiration pneumonia • Dysphonia • Recurrent or persistent cough • Gastrointestinal tract bleeding © World Gastroenterology Organization 2015 WGO Global Guidelines GERD 10 • Frequent nausea and/or vomiting • Persistent pain • Iron-deficiency anemia • Progressive unintentional weight loss • Lymphadenopathy • Epigastric mass • New-onset atypical symptoms at age 45–55 years. A lower age threshold may be appropriate, depending on local recommendations. • Family history of either esophageal or gastric (...) ? Lifestyle modifications (diet, weight loss) to minimize symptoms ? Continuous therapy for patients with (a) frequent symptoms, (b) stricture, (c) BE (to control symptoms) ? Consider H. pylori “test-and-treat” for patients on continuous PPI therapy ? Laparoscopic antireflux surgery for structural disease (hiatus hernia) or volume reflux causing regurgitation, aspiration, stricture, or persistent nocturnal symptoms despite PPI b.i.d. High resources ? MR-PPI o.d. for 8–12 weeks, then reassess ? MR-PPI

2015 World Gastroenterology Organisation

136. Acute Pain Management: Scientific Evidence

). ? Placebo effects occur in routine clinical care even when no placebo is given. The outcome of a treatment is attributable to both the treatment itself and the contextual (or placebo) component (N). ? Nocebo effects occur in routine clinical care and are seen as an increased pain response to a painful stimulus or the development of adverse effects not caused by, or separate from, the intervention ( N). ? Ethical harnessing of placebo and minimisation of nocebo effects will improve response to clinical

2015 Clinical Practice Guidelines Portal

137. Acute Pain Medicine in the United States: A Status Report

medicine encompasses the prevention, evaluation, diagnosis, treatment, and rehabilitation of painful disorders and notes that such disorders may arise from “a discrete cause, such as postoperative pain or pain associated with a malignancy, or may be a disorder in which pain constitutes the primary problem, such as neuropathic pain or headache .” By consensus, the panel observed that APM is not restricted to operating room practice and the discipline of APM assumes a diverse and multidisciplinary team (...) of opioid-use disorders following postoperative prescription opioid use is small. However, Wasan et al. and Ballantyne and LaForge conducted more recent reviews of the literature and concluded that the evidence for the earlier assertion was weak and that the real rates following surgery might be as high as 10% . This is particularly important, as prescription opioid abuse is a national crisis , costing in excess of $50 billion dollars per year , and prescription opioid overdose is now the leading cause

2015 American Academy of Pain Medicine

138. Atezolizumab (Tecentriq) - Non-Small-Cell Lung Carcinoma or Transitional Cell Carcinoma

of initial diagnosis, poor performance status (PS), and a history of unintentional weight loss. More than half of the patients with NSCLC are diagnosed with distant metastatic disease, which directly contributes to poor survival prospects. UC The overall 5-year survival rate for patients diagnosed with metastatic UC is approximately 5.5% (Surveillance, Epidemiology, and End Results [SEER] 2015). Poor prognostic factors for survival in patients with metastatic UC include advanced stage of disease (...) indication: Tecentriq is indicated for the treatment of adult patients with locally advanced or metastatic urothelial carcinoma after prior chemotherapy or who are considered cisplatin ineligible. 2.1.2. Epidemiology NSCLC Lung cancer remains the leading cause of cancer deaths worldwide in men and the second leading cause of cancer deaths worldwide in women. It accounted for approximately 13% of all new cancers in 2012 (Torre et al. 2015). Non-small cell lung cancer is the predominant subtype, accounting

2017 European Medicines Agency - EPARs

139. Clinical Handover in Acute and Children’s Hospital Services

associated with clinical handover whether as part of shift or inter-departmental clinical handover or communication of information in relation to the deterioration in a patient’s condition, are similar and include: • Inappropriate or delayed treatment being provided for patients including the delay in critical referrals which threaten the life, health or well being of patients in the acute hospital setting • Loss of trust and confidence amongst staff and patients in the performance of the healthcare (...) review methods with what is planned in the current review and helps avoid unintended and economically wasteful duplication of effort. 1.7 Grading of recommendations All decisions regarding the quality of evidence and the strength of recommendations were based on summaries of evidence from the literature review and the evidence was weighted according to the SIGN (2011) grading criteria. The basis for level of evidence and grade of recommendation are summarised in tables 1.8.1 and 1.8.2. Where existing

2015 National Clinical Guidelines (Ireland)

140. Clinical practice guideline on Systemic Lupus Erythematosus

and side effects of sun filters 312 Appendix 10. Topical corticosteroids 315 Appendix 11. Health needs and priorities of people with System Lupus Erythematosus 316 Appendix 12. Patient information 318 Appendix 13. Glossary 357 Appendix 14. Abbreviations, initials and acronyms 367 References 372CLINICAL PRACTICE GUIDELINE ON SYSTEMIC LUPUS ERYTHEMATOSUS 9 Presentation Documenting the variability of clinical practice, analysing the causes and adopting strategies aimed at eliminating it, have proved (...) suggest multidisciplinary management of pregnant woman with SLE by the obstetrician and the specialist in autoimmune diseases, with the participation of other specialists if considered necessary. v From the medical viewpoint, we suggest making one visit during the first trimster, every 4-6 weeks until week 26 of gestation, and every two weeks from week 27 until birth. This is subject to modifications according to obstetric and medical criteria. v During each visit, we suggest monitoring the weight

2015 GuiaSalud

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