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81. Narcotics, Benzodiazepines, Stimulants, and Gabapentin: Policies, Initiatives, and Practices Across Canada, 2014

to the prescriber. 2 Additionally, British Columbia PharmaCare monitors the use of benzodiazepines and stimulants for the treatment of attention-deficit hyperactivity disorder (ADHD). Gabapentin is not included on BC’s list of monitored drugs. The province’s prescription-monitoring programs include: PharmaNet – All prescriptions dispensed in the province are entered into PharmaNet, the province-wide network that links all BC pharmacies to a central set of data systems. PharmaNet users include community (...) forgery or illicit prescriptions. In light of reports regarding the misuse of bupropion sustained-release, the PRP is monitoring for misuse and/or harm of this substance, requiring its possible inclusion into the monitored drugs list. ( Rachel Cheruvallath, Ministry of Health, Regina, SK: personal communication, 2014 Jan 15; Doug Spitzig, Prescription Review Program, College of Physicians and Surgeons, Saskatoon, SK: personal communication, 2014 Jan 28). Manitoba In May 2012, changes to Manitoba’s

2015 Canadian Agency for Drugs and Technologies in Health - Environmental Scanning

82. Second Generation Antidepressants for Pediatric patients with Major Depressive Disorder and Anxiety Disorder

of antidepressants based on data provided by the manufacturers. 15 This meta-analysis involved 24 trials: 16 on MDD, four on obsessive compulsive disorder (OCD), three on GAD/social anxiety disorder and one on attention-deficit/hyperactivity disorder. The other was a conventional SR that searched both PubMed and the grey literature extensively to identify placebo-controlled trials on second generation antidepressants in pediatric patients diagnosed with MDD, OCD and non-OCD anxiety disorder. 14 In both (...) . What is the clinical evidence on the safety of second-generation antidepressants for the treatment of pediatric patients with anxiety disorder? KEY FINDINGS The benefits and risks of prescribing second-generation antidepressants in children and adolescents vary by indication. In patients with anxiety disorders, antidepressants have been shown to improve symptomology with no association of suicidal behavior. Although second- generation antidepressants are likely to benefit pediatric patients

2015 Canadian Agency for Drugs and Technologies in Health - Rapid Review

83. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

- tion 9 discusses issues that may warrant special attention pertaining to anxiety and related disorders in children and adolescents, pregnant or lactating women, and the elderly. The last section of these guidelines addresses clinical issues that may arise when treating patients with anxiety and related disorders who are also diagnosed with comorbid psychiatric conditions such as major depressive disorder (MDD), bipolar disorder, or other psychoses, and attention deficit/hyperactivity disorder (ADHD (...) for patients with panic disorder, PTSD [20,24], and GAD [24], even in the absence of a comorbid mood disorder. These data indicate that patients with an anxiety disorder warrant explicit evaluation for suicide risk. The presence of a comorbid mood disorder significantly increases the risk of suicidal behavior [22,25]. Initial assessment of patients with anxiety The management of patients presenting with anxiety symptoms should initially follow the flow of the five main components outlined in Table 3

2014 CPG Infobase

84. Clinical Practice Guidelines on Obesity

are likely to become obese adults. In Singapore, obesity prevalence is also rising from 5.5% in 1992 to 10.8% in 2010, and then dropped to 8.6% in 2013, although it remains one of the world’s lowest. Obesity is a major risk factor for non-communicable diseases such as cardiovascular disease, diabetes, musculoskeletal disorders and some cancers. From the Ministry of Health’s Singapore Burden of Disease Study 2010, high body mass accounted for 12.1% of the total burden of disease in Singapore. Fortunately (...) should aim to facilitate long-term adherence to reduced-calorie diets to achieve sustainable weight loss. Every 24 kcal/ day reduction in energy intake will eventually lead to approximately a 1 kg loss in body weight with half of the weight loss occurring in about one year. (pg 44) Grade C, Level 2 ++ B Physical activity should be recommended in addition to dietary changes as it can contribute to the maintenance of weight loss. (pg 44) Grade B, Level 1 + A Diets that contribute to a calorie deficit

2016 Ministry of Health, Singapore

85. Guidelines for Perioperative Care in Bariatric Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations

recommendations for elements in an evidence-based “enhanced” perioperative protocol. Methods The English-language literature between January 1966 and January 2015 was searched, with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohort studies. Selected studies were examined, reviewed and graded. After critical appraisal of these studies, the group of authors reached a consensus recommendation. Results Although for some elements, recommendations are extrapolated (...) complications [ , , ]. A large retrospective study comprising >300 000 patients undergoing elective surgery (including bariatric surgery) reported that consumption of >2 alcohol equivalents/day within 2 weeks of surgery was an independent predictor of pneumonia, sepsis, wound infection/disruption and length of hospital stay [ ]. Alcohol abstinence for one month has been associated with better outcome after colorectal surgery [ ]. ERAS guidelines for colonic surgery, therefore, recommend alcohol cessation 4

2016 ERAS Society

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

of patient improvement is strongly discouraged. Weak for Reviewed, Amended d. Tinnitus 13. There is no evidence to suggest for or against the use of any particular modality for the treatment of tinnitus after mTBI. N/A Reviewed, New-added e. Visual Symptoms 14. There is no evidence to suggest for or against the use of any particular modality for the treatment of visual symptoms such as diplopia, accommodation or convergence disorder, visual tracking deficits and/or photophobia after mTBI. N/A Reviewed (...) A. Appendix Contents 79 B. Introduction 79 C. Co-occurring Conditions 80 D. Headache 81 E. Dizziness and Disequilibrium 90 F. Visual Symptoms 93 G. Fatigue 94 H. Sleep Disturbance 94 I. Cognitive Symptoms 97 J. Persistent Pain 98 K. Hearing Difficulties 98 L. Smell (Olfactory Deficits) 99 M. Nausea 99 N. Changes in Appetite 99 O. Numbness 100 Appendix C: Mechanism of Injury 101 Appendix D: Evidence Table 104 Appendix E: 2009 Recommendation Categorization 108 Appendix F: Participants List 122 Appendix G

2016 VA/DoD Clinical Practice Guidelines

87. Depression

attention deficit hyperactivity disorder. 10 UMHS Depression Guideline Update, August 2011 (continued from page 1) complaints. Reimbursement restrictions can interfere with comprehensive treatment. Other medical co-morbidities compete for time and attention by both physician and patient. Rationale for Recommendations Definitions Specific criteria for diagnoses of depressive disorders are presented in Table 2. Major depressive disorder (MDD). A severe form of depression that is often accompanied (...) are actually or potentially bipolar. The apathetic, low energy patient. Patients motivated to stop smoking. Helpful for ADHD i . Patient profile least likely to benefit The obese patient with fatigue and hypersomnia. Patients with neutropenia. Patients who are agitated, very anxious and/or panicky. Patients at risk for seizures and/or with history of head trauma, substance abuse, eating disorder, or electrolyte disturbance. Available preparations & doses 7.5, 15, 30, 45 mg tablets; 15, 30, 45 mg unscored

2016 University of Michigan Health System

88. Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice Full Text available with Trip Pro

pharmacological interventions are also available. Varenicline, in combination with two preoperative 15‐minute standardized counselling sessions, started 1 week before surgery and followed up for 12 weeks, was shown to improve long‐term smoking abstinence (RR 1.45, 95% CI 1.01–2.07, P = 0.04) but not reduce postoperative complications in comparison with placebo. However, nausea occurred more frequently in patients treated with varenicline (13.3% vs. 3.7%, P = 0.004). Antidepressants such as bupropion also seem (...) mechanical bowel preparation. In fact, functional intravascular deficit after fasting time, as indicated by guidelines or after 8 h fasting is minimally affected in patients undergoing elective surgeries without mechanical bowel preparation. , Results from two Cochrane meta‐analyses have shown that gastric content of patients following anaesthesia fasting guidelines is the same or lower of the gastric content of patients fasting after midnight. , Imaging studies have further supported the safety

2015 ERAS Society

89. AACE/ACE Clinical Practice Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan

: FPG >92 mg/ dL, 1-hour post-glucose challenge value =180 mg/dL, or 2-hour value =153 mg/dL (grade C; bEl 3). • r5. DM represents a group of heterogeneous metabolic disorders that develop when insu- lin secretion is insufficient to maintain normal plasma glucose levels. T2D is the most common form of DM, accounting for more than 90% of cases, and is typically identified in patients who are overweight or obese and/or have a family his- tory of DM, a history of GDM, or meet the criteria for metabolic (...) their lifestyle, including initial attempts to lose 5 to 10% of body weight if overweight or obese and partici- pate in moderate physical activity (e.g., walking) at least 150 minutes per week (grade b; bEl 3). Physicians should recommend patients partici- pate in organized lifestyle change programs with follow-up, where available, because behavioral support will benefit weight-loss efforts (grade b; bEl 3). • r10. In addition to lifestyle modification, medications including metformin, acarbose, or Table 2

2015 American Association of Clinical Endocrinologists

90. Clinical Practice Guidelines on Anxiety Disorders

abuse ? No disruptive personality disorders ? Non suicidal ? No history of aggressive behaviour ? Not currently receiving clozapine, lithium, valproate, hypnotics (including benzodiazepines, zopiclone, zolpidem) or formal psychotherapy treatment GPP 27 6 All patients should receive education about their disorder, including aetiology, treatment choices, and prognosis. GPP 28 7 As local patients may show higher propensity for initial side effects of antidepressants (e.g. paradoxical excitation (...) disorders from psychiatric to primary care for long-term management if they have the following characteristics: ? Aged 18 or older ? Stabilised for the past 3 months ? No psychiatric hospitalisation in the past 6 months ? No history of forensic or substance abuse ? No disruptive personality disorders ? Non suicidal ? No history of aggressive behaviour ? Not currently receiving clozapine, lithium, valproate, hypnotics (including benzodiazepines, zopiclone, zolpidem) or formal psychotherapy treatment GPP

2015 Ministry of Health, Singapore

91. Use of Antidepressants in Breastfeeding Mothers

is identi?ed as being at risk for PPD, treatment choices must be considered and offered to her. For mild to moderate depression in the breastfeeding mother, psychology/cognitive behavioral therapy, if available, should be considered as ?rst-line therapy. 38 (II-2) Treatment Nonpharmacological Psychologicaltherapy. Psychological therapy is effective for the treatment of major depressive disorder in the post- partum period, and different types of therapy seem equally effective. 39–41 (I) There are three (...) , it may be helpful to arrange for another caregiver to feed the infant once at night, allowing the mother to receive 5–6 hours of uninter- rupted sleep. A caregiver may also bring the infant to the mother to feed at the breast and then assume responsibility for ABM PROTOCOL 291 settling the baby back to sleep, thereby minimizing maternal sleep disruption. (III) Medications If psychological/cognitive behavioral therapy is unavail- able, symptoms are severe, or mothers refuse this therapy

2015 Academy of Breastfeeding Medicine

92. Controversies in Obesity Management

Medicaid Analytic eXtract MBSAQIP Metabolic Bariatric Surgery Accreditation and Quality Improvement Program N/B Naltrexone/bupropion NCD National coverage determination NHANES National Health and Nutrition Examination Survey NICE National Institute for Health and Care Excellence NS Not significant OR Odds ratio P/T Phentermine/topiramate PHQ-9 Patient Health Questionnaire PMPM Per-member per-month QALY Quality-adjusted life year QoL Quality of life RCT Randomized controlled trial RR Risk ratio RYGB (...) ), naltrexone/bupropion extended- release (N/B) (Contrave ® ), and phentermine/topiramate extended-release (P/T) (Qsymia ® ) Other Patients who are overweight or obese (BMI =25) Roux-en-y Gastric Bypass Morbidity Mortality Quality of life Benefits Weight/BMI Comorbidities Adjustable Gastric Banding Vertical Sleeve Gastrectomy Biliopancreatic Diversion (± Duodenal Switch) Intragastric Balloon Duodenal-Jejunal Bypass Liner Vagus Nerve Block Naltrexone/bupropion extended-release Phentermine/topiramate extended

2015 California Technology Assessment Forum

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

and anxiety disorders, eating disorders and childhood behavioural disorders (such as attention defi cit hyperactivity disorder). Current evidence suggests cannabis use is associated with the development of psychotic symptoms and disorders, with an enhanced vulnerability to psychosis linked to disturbances in the endocannabinoid system and genetic variations in the enzymes responsible for dopamine metabolism. In contrast, the development of childhood behavioural disorders likely precedes and might lead (...) ). While the evidence is not as strong regarding other mental health issues, there are possible links between regular cannabis use in youth and increased risk for depression and suicide (Lev-Ran et al., 2013; Silins et al., 2014). 10 Canadian Centre on Substance Abuse SUBSTANCE ABUSE IN CANADA—The Effects of Cannabis Use during Adolescence • Acute cannabis intoxication has been linked to deficits in attentional focus, information processing, motor coordination and reaction time (Hall, 2015), while long

2015 Canadian Centre on Substance Abuse

94. Best Practice Guidelines for Mental Health Disorders in the Perinatal Period

Depression 4. Anxiety Disorders 5. Bipolar Disorder 6. Psychotic Disorders and Postpartum Psychosis 7. Suicide and Infanticide 8. Coping and Support Networks Figure 1: BC Perinatal Mental Health Framework (adapted from the BC PND Framework) 1.0 Introduction12 BC Reproductive Mental Health Program & Perinatal Services BC Abbreviations/definitions used in this guideline: i ADHD Attention Deficit Hyperactivity Disorder aOR adjusted Odds Ratio CBT Cognitive Behavioural Therapy DSM-V Diagnostic (...) psychosis) and/or direct observation or reports (e.g., unusual behavior, racing thoughts, distractible, inflated self-esteem or grandiosity, disorganized thoughts, erratic and impulsive behaviour, rapid speech, difficulty sleeping).9 Mental Health Disorders in the Perinatal Period For women with bipolar disorder, develop an integrated treatment plan which involves the woman and her family supports, psychiatry, obstetrics (obstetrician, family physician, midwife), primary care, and public health nursing

2014 British Columbia Perinatal Health Program

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

hemostasis by averting the activation and consumption of clotting factors and platelets associated with bypass. However, the clotting disorders and platelet dysfunction induced by cardiopulmonary bypass may actually have desirable effects by protecting anastomosis patency and preventing graft thrombosis. Several reports have documented the existence of a relative hypercoagulable state after off-pump surgery, associated with higher levels of postoperative platelet activity and a decrease in platelet (...) renal dysfunction, , infection, stroke, and mortality, , even among patients without elevated lipid profiles before surgery. Some investigators have suggested that preoperative statin treatment may reduce the risk of mortality late after surgery, , but it is also possible that preoperative statin administration simply predicts those who will receive statins after surgery, ultimately leading to improved long-term outcomes. Recently, attention in the cardiology community has turned toward the use

2015 American Heart Association

96. Management of Substance Use Disorder

of 169 b. Categorizing Recommendations with an Updated Review of the Evidence 76 c. Categorizing Recommendations without an Updated Review of the Evidence 77 F. Drafting and Submitting the Final Clinical Practice Guideline 77 Appendix B: Pharmacotherapy for Alcohol Use Disorder and Opioid Use Disorder 79 Appendix C: Psychosocial Interventions 91 A. Behavioral Couples Therapy 91 B. Cognitive-Behavioral Coping Skills Therapy 92 C. Community Reinforcement Approach 92 D. Contingency Management (...) Management of Substance Use Disorder VA/DoD CLINICAL PRACTICE GUIDELINE FOR THE MANAGEMENT OF SUBSTANCE USE DISORDERS Department of Veterans Affairs Department of Defense QUALIFYING STATEMENTS The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best information available at the time of publication. They are designed to provide information and assist decision making. They are not intended to define a standard of care and should not be construed as one

2015 VA/DoD Clinical Practice Guidelines

97. Grief, Bereavement, and Coping With Loss (PDQ®): Health Professional Version

with the deceased while continuing to engage in new relationships.[ ] In this model, the tasks may occur in any order without a fixed progression; however, for successful mourning to occur, the person must be able to achieve all four tasks. Differentiating Normal Grief Reaction From Major Depressive Disorder There is a significant overlap between the behavioral manifestations associated with the grieving process and symptoms of depression such as insomnia, feelings of guilt, ruminations, and lack of motivation (...) —a pattern in which persons experience no, or only a few, signs of overt distress or disruption in functioning. This minimal reaction is thought to occur in approximately 15% of persons during the first year or two after a loss.[ ] This minimal reaction may be particularly apparent in someone who has a mixed relationship with the deceased, or in someone who has intellectual disabilities or emotional expression difficulties, such as autism spectrum disorder.[ ] An observed minimal grief reaction should

2017 PDQ - NCI's Comprehensive Cancer Database

98. Depression (PDQ®): Health Professional Version

disturbance, thought patterns). These are specified in the categorization of psychiatric/behavioral disorders in the Diagnostic and Statistical Manual of Mental Disorders, 4th and 5th editions.[ , ] However, there are a number of pathways that may result in the symptom clusters that lead to the consideration of depression, including disruption in serotonin/dopamine pathways, experience of loss or anticipated loss, direct side effects of chemotherapy medications, presence of tumors in the central nervous (...) ., amphotericin B). - Some chemotherapeutic agents (e.g., procarbazine, L-asparaginase). A survey in England of women with breast cancer showed that among several factors, depression was the strongest predictor of emotional and behavioral problems in their children.[ ] Fear of death, disruption of life plans, changes in body image and self-esteem, changes in social role and lifestyle, and financial and legal concerns are significant issues in the life of any person with cancer, yet serious depression

2017 PDQ - NCI's Comprehensive Cancer Database

99. Chronic Insomnia in Older Adults

is as important as quantity! 1,2,3, 6 • Prevalence of insomnia in the elderly is estimated to be 40%. • Although a mild deterioration in sleep quality may be accepted as normal with aging, a complaint of significantly disrupted nighttime sleep or impaired daytime functioning due to excessive sleepiness should be evaluated. • Older people do not necessarily require less sleep, but they often get less sleep. 7.4 hrs compared to 8.9 hrs in younger adults. • The sleep-wake cycle in the elderly may be fragmented (...) when sleepy Ö Use the bed/bedroom only for sleep & sex do not watch TV Ö Do not stay in bed longer than 15-20 minutes if unable to sleep Sleep-restriction ‡ (limit time in bed that will lead to sleep deprivation to result in ? in homeostatic drive & sleep efficiency) Cognitive therapy (alters faulty beliefs & attitudes about sleep) Relaxation (biofeedback; promotes relaxation & È arousal prior to bed) Ö Relax muscles throughout body, breathing patterns, direct attention from everyday thoughts

2013 RxFiles

100. Suicide Prevention Interventions and Referral/Follow-up Services

• Change in support system • Assess risk Intake form • Risk • assessment Clinical • interview Known risk factor(s)/ warning signs present Depression • Substance Use Disorder • Other mental health • disorder Recent stressors • Family history of suicide • History of suicide • attempt(s) Provide timely and appropriate intervention Pharmacotherapy • (e.g., anti-depressants, mood stabilizers, anti- psychotics, omega-3s, other pharmacotherapy) Psychotherapy (e.g., • Cognitive Behavioral Therapies (...) through November 18, 2011. Though the focus of the report is on suicide prevention, we include as outcomes any type of suicidal self-directed violence, defined as “Behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. There is evidence, whether implicit or explicit, of suicidal intent.” 12, 13 The key questions were: Key Question #1. What is the effectiveness of specific interventions for reducing rates of suicidal self-directed violence in military

2012 Veterans Affairs Evidence-based Synthesis Program Reports

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