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Unintentional Weight Loss Causes

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141. Evidence-Based Policy Making: Assessment of the American Heart Association?s Strategic Policy Portfolio Full Text available with Trip Pro

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

2016 American Heart Association

142. 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

143. Gaba Transcatheter Therapy for Hepatic Malignancy: Standardization of Terminology

. Results with conventional chemoembolization should aim to report the type of chemotherapy regimen and rationale for agent selection, the dose (empiric or weight-based) and method of recon- stitution of chemotherapy drugs, the use or omission of ethiodized oil, the method of mixing the chemoembolic solution or emulsion, and the timing of addition of the embolic agents to the chemotherapeutic mixture, and the type, size, and volume of embolic particles used should be included in the description (...) of treatment would infer that both therapies were used based on well-de?ned circumstances (ie, tumor size or distribution). Unintentional combina- tion therapy would infer that one treatment followed failure of another modality (ie, thermal ablation of a small residual component after arterially directed therapy or transarterial therapy of tumor incom- pletely treated by thermal ablation). Fifth, technical details of the ablative component of the procedure should be presented per ablation reporting

2016 Society of Interventional Radiology

144. 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

145. 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

146. 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

147. ERBP Guideline on Management of Older Patients with Chronic Kidney Disease Full Text available with Trip Pro

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

2016 European Renal Best Practice

148. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update

and revascularization is not a viable option (Class IIb, Level of Evidence: C). 1.4.3. Assessment of frailty Assessment of frailty (3 of 5 possible symptoms, including unintentional weight loss ofZ10 pounds within the past year, muscle loss, fatigue, slow walking speed, and low levels of physical activity) could be considered when assessing candidacy (Class IIb, Level of Evidence: C). 1.4.4. Mechanical circulatory support for bridge to candidacy Use of mechanical circulatory support should be considered (...) of frailty in heart failure has recently been investigated and warrants discussion, especially as we move to consider older patients for cardiac transplantation. Recommendation: Assessment of frailty (3 of 5 possi- ble symptoms, including unintentional weight loss of Z10 pounds within the past year, muscle loss, fatigue, slow walking speed, and low levels of physical activity) could be considered when assessing candidacy (Class IIb, Level of Evidence: C). Frailty is a clinically identi?able disorder

2016 International Society for Heart and Lung Transplantation

149. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection

infected and reducing the number of people dying from HIV-related causes over the coming years. The number of people eligible for ART increases from 28 million to all 37 million people currently living with HIV globally. iv Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection Expanding access to treatment is at the heart of a new treatment targets for 2020 with the aim of ending the AIDS epidemic as a public health threat by 2030. The 90–90–90 targets (...) edition of the consolidated guidelines on the use of antiretroviral drugs is being published in a changing global context for HIV and for health more broadly. The goal of providing HIV treatment to 15 million people by the end of 2015 has been achieved. From 2016, countries need to further accelerate efforts to meet the ambitious Fast-Track target for 2020, including achieving major reductions in the number of people dying from HIV related causes and the 90–90–90 treatment target: ensuring that 90

2016 World Health Organisation HIV Guidelines

150. Envarsus - tacrolimus

) expression, induce TGF-ß1 secretion by tumour cells and promoted tumour progression in T-cell, B-cell and NK-cell deficient SCID-beige mice. Reproduction Toxicity Treatment with tacrolimus adversely affected male and female reproduction and caused embryo-foetal toxicity in rats and rabbits (Saegusa et al., 1992, Hisatomi et al, 1996). In the fertility study in rats a higher rate of pre-implantation loss, lower pup viability, increased number of undelivered pups and birth defects were observed in the high (...) of inhibitors or inducers of the hepatic and intestinal microsomal CYP3A isoenzymes may affect tacrolimus metabolism and may cause an increase or decrease of tacrolimus blood level which may impact the efficacy or the toxicity of the compound. Therefore, the monitoring of tacrolimus blood levels is recommended when compounds which have the potential to alter the CYP3A metabolism are used concomitantly and to adjust the dose as appropriate. The potential interactions between tacrolimus and CYP3A inhibitors

2014 European Medicines Agency - EPARs

151. Ledipasvir/Sofosbuvir

-related mild hepatobiliary toxicity signal in mice (not considered adverse and not clearly dose dependent) was noted, with slight increases in alkaline phosphatase and/or ALT associated with increased liver/gallbladder weight (high-dose males only) without correlating histopathology changes. Minimal to slight random foci of hepatocyte necrosis (males) and bile duct hyperplasia (males and females) were noted in rats. These non- adverse hepatobiliary findings were observed at LDV AUC exposure ~8- and 30 (...) development is considered to be 30 mg/kg/day. At 30 and 100 mg/kg/day, LDV AUC exposure is estimated to be ~2 and 3.4-fold higher, respectively, than that in humans at the recommended LDV dose. A slight trend for reduced rat pup body weight (F1 generation) associated with adverse maternal toxicity was observed in pregnant rats following oral LDV administration at 100 mg/kg/day. The NOAEL for maternal toxicity and NOEL for PPND is estimated conservatively to be 30 mg/kg/day. At 30 and 100 mg/kg/day, LDV

2014 FDA - Drug Approval Package

152. 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

153. 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)

154. Acute Pain Medicine in the United States: A Status Report Full Text available with Trip Pro

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

155. Clinical Practice Guidelines on Falls Prevention among Older Adults living in the Community

and with early admission to long-term facilities. Reducing falls risk in older adults is therefore an important public health objective. In Singapore, falls are a leading cause of injury among older adults. According to the National Registry of Diseases Office (NRDO) of Singapore, the crude incidence rate of unintentional falls in year 2012 was 277.7 per 100,000 for adults aged 60 years and older. The incidence rate increases sharply with age. Many of these falls happen at home. Therefore, steps must (...) be taken so that factors which cause a person to fall are reduced or removed. This Clinical Practice Guidelines on Falls Prevention among Older Adults Living in the Community incorporates the best available evidence from the scientific literature and provides practical recommendations relevant to the local context with the aim to assist all healthcare professionals in the identification and prevention of falls in older adults in the community to help improve quality of life. ASSOCIATE PROFESSOR

2015 Ministry of Health, Singapore

156. Secondary Prevention After Coronary Artery Bypass Graft Surgery Full Text available with Trip Pro

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

2015 American Heart Association

157. Practice Advisory on Anesthetic Care for Magnetic Resonance Imaging Full Text available with Trip Pro

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

2015 American Society of Anesthesiologists

158. 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

159. 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

160. 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

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