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181. Cardiovascular Disease: Primary Prevention

the preferred cholesterol tests. Updated blood pressure targets: • 190 mg/dL, or diabetes. • Aspirin not recommended for patients with 190 mg/dL. • Statins not recommended for patients with 50%. • Cerebrovascular disease, such as transient ischemic attack, ischemic stroke, and carotid artery stenosis > 50%. • Peripheral artery disease, such as claudication. • Aortic atherosclerotic disease, such as abdominal aortic aneurysm and descending thoracic aneurysm. Primary prevention refers to the effort to prevent (...) participants based on an elevated LDL-C level, a diabetes diagnosis, or at least one CVD risk factor. The pooled results of the trials showed that the use of low- or moderate-dose statins was associated with a reduced risk of all- cause mortality (RR 0.86; 95% CI, 0.80–0.93), cardiovascular mortality (RR, 0.69; 95% CI, 0.54–0.88), ischemic stroke (RR 0.71; 95% CI, 0.62–0.82), heart attack (RR 0.64; 95% CI, 0.57–0.71), and a composite cardiovascular outcome (RR 0.70; 95% CI, 0.63–0.78).The relative risk

2018 Kaiser Permanente Clinical Guidelines

182. Oral Health Care for the Pregnant Adolescent

significant morbidity (e.g., hemorrhagic stroke) or mortality. 17 The diet of the pregnant adolescent can affect the health of the child. A healthy diet is necessary to provide adequate amounts of nutrients to the mother-to-be and the unborn child. Recommended dietary allowances during pregnancy and lactation are tabulated as absolute figures rather than additions to the basic allowances. 18 Nutrients of particular importance include folate (folic acid), calcium, magnesium, zinc, and vitamins K, C, B-6 (...) affected more than posterior teeth. 45 These findings are exacerbated by poor plaque control and mouth breathing. 46 From a periodontal perspective, the effects of hormonal levels on the gingival status of pregnant women may be accompanied by increased levels of progesterone and estrogen which contribute to increased vascularity, permeability, and possible tissue edema. 47,48 Evidence shows a relationship of periodontal disease and gestational AMERICAN ACADEMY OF PEDIATRIC DENTISTRY RECOMMENDATIONS

2016 American Academy of Pediatric Dentistry

183. Professional Practice Guidelines for Integrating the Role of Work and Career Into Psychological Practice

, Herbig, Dragano and Angerer (2013) concluded that long-term unemployment, defined as having been out of work for more than one year, is both a cause and effect of physical and mental illness. They found that long-term unemployed individuals were twice as likely to have a mental illness, had higher risks of heart attack and stroke, and had higher mortality rates than employed individuals. Interestingly, most of the current research examining long-term unemployment is being completed with samples (...) of rehabilitation psychology (Szymanski, 2000). This becomes a particular concern for individuals with disabling conditions as the U.S. Bureau of Labor Statistics (2015) reported that, in 2014, Guidelines for Integrating the Role of Work and Career Into Professional Psychology Practice only 17.1 percent of persons with a disability were employed as compared to 64.6 percent for persons without a disability. Across all educational attainment groups, unemployment rates were higher for persons with a disability

2015 American Psychological Association

184. Back Pain

with Chronic Conditions workshops X X Physical therapy X X Yoga X X Tai chi X X Relaxation therapy (meditation, progressive muscle relaxation, biofeedback, guided visualization) X X Acupuncture X X Spinal manipulation (chiropractic) X X Massage X X NSAIDs X X Duloxetine X X Physical Medicine & Rehabilitation/Spine Care Clinic (where available) X Psychotherapy (cognitive behavioral therapy for pain, mindfulness- based stress reduction) Note: Self-referral for physical therapy, acupuncture, or spinal (...) ; advise patients to check with Member Services to determine their individual coverage and benefits. • Massage: There is some evidence of moderate improvement in both pain and function with massage. • Physical Medicine & Rehabilitation (PMR): Consider referral to PMR, which develops detailed treatment plans to enable individual patients to carry out their rehabilitation, including exercise and self-care. PMR can also provide a second opinion for patients with suboptimal response to a conservative

2017 Kaiser Permanente Clinical Guidelines

185. Neck pain: revision 2017.

, and when reported were minor, transient, and of short duration. For manual therapy or exercise, the only consistently reported problem was a mild transient exacerbation of symptoms. For manipulation, rare but serious adverse events such as stroke or serious neurological deficits were not reported in any of the trials. Serious but rare adverse events for manipulation are known to occur. One study reported mild adverse events equal in treatment and placebo groups, including tiredness, nausea, headache (...) need more intensive rehabilitation and an early pain education program. ( Grade of Recommendation: F ) Chronic For patients with chronic neck pain with movement coordination impairments (including WAD): Clinicians may provide the following: Patient education and advice focusing on assurance, encouragement, prognosis, and pain management Mobilization combined with an individualized, progressive submaximal exercise program including cervicothoracic strengthening, endurance, flexibility

2017 National Guideline Clearinghouse (partial archive)

186. Final recommendation statement: adolescent idiopathic scoliosis: screening.

less television). The USPSTF again acknowledges the subjective nature and the difficulty of assessing potential harms: for example, how bad is a "mild" stroke? The third domain is cost—not just monetary cost, but opportunity cost, in particular the amount of time a provider spends to provide the service, the amount of time the patient spends to partake of it, and the benefits that might derive from alternative uses of the time or money for patients, clinicians, or systems. Consideration (...) on Scoliosis Orthopaedic and Rehabilitation Treatment. The type of evidence supporting the recommendations is not specifically stated. Benefits of Early Detection and Intervention or Treatment The U.S. Preventive Services Task Force (USPSTF) found no direct evidence regarding the effect of screening for adolescent idiopathic scoliosis on patient-centered health outcomes. The USPSTF found inadequate evidence on the treatment of idiopathic scoliosis (Cobb angle <50° at diagnosis) in adolescents with exercise

2018 National Guideline Clearinghouse (partial archive)

187. Guideline for the management of knee and hip osteoarthritis

controlled trial RR relative risk SES socioeconomic status SMD standardised mean difference SNRI serotonin and norepinephrine reuptake inhibitor TEAE treatment-emergent adverse event TENS transcutaneous electrical nerve stimulation TGA Therapeutic Goods Administration TNF-alpha tumour necrosis factor alpha TrkA tyrosine kinase receptor TRPV1 Transient Receptor Potential Vanilloid 1 VAS Visual Analog Scale WHO World Health Organization WOMAC Western Ontario and McMaster Universities Osteoarthritis Indexv (...) Director, Medibank Private Ltd Associate Professor Marie Pirotta, general practitioner; Department of General Practice, University of Melbourne, Victoria Dr Michael Ponsford, rehabilitation medicine specialist, Epworth Hospital, Victoria Associate Professor Morton Rawlin, general practitioner, Macedon Medical Centre, Victoria Dr Xia Wang, epidemiologist, University of Sydney, New South Wales Dr Samuel Whittle, Senior consultant rheumatologist, Queen Elizabeth Hospital, Woodville South, South Australia

2018 Clinical Practice Guidelines Portal

188. Prostate Cancer

and 3D vascular sonography as a method for diagnosis and staging of prostate cancer. Eur Urol, 2003. 44: 21. 267. de Rooij, M., et al. Accuracy of Magnetic Resonance Imaging for Local Staging of Prostate Cancer: A Diagnostic Meta-analysis. Eur Urol, 2016. 70: 233. 268. Jager, G.J., et al. Local staging of prostate cancer with endorectal MR imaging: correlation with histopathology. AJR Am J Roentgenol, 1996. 166: 845. 269. Cornud, F., et al. Extraprostatic spread of clinically localized prostate

2018 European Association of Urology

189. ESC/ESH Management of Arterial Hypertension Full Text available with Trip Pro

–creatinine ratio (30–300 mg/g; 3.4–34 mg/mmol) (preferentially on morning spot urine) Moderate CKD with eGFR >30–59 mL/min/1.73 m 2 (BSA) or severe CKD eGFR <30 mL/min/1.73 m 2 b Ankle−brachial index <0.9 Advanced retinopathy: haemorrhages or exudates, papilloedema Established CV or renal disease Cerebrovascular disease: ischaemic stroke, cerebral haemorrhage, TIA CAD: myocardial infarction, angina, myocardial revascularization Presence of atheromatous plaque on imaging Heart failure, including HFpEF (...) (30–300 mg/g; 3.4–34 mg/mmol) (preferentially on morning spot urine) Moderate CKD with eGFR >30–59 mL/min/1.73 m 2 (BSA) or severe CKD eGFR <30 mL/min/1.73 m 2 b Ankle−brachial index <0.9 Advanced retinopathy: haemorrhages or exudates, papilloedema Established CV or renal disease Cerebrovascular disease: ischaemic stroke, cerebral haemorrhage, TIA CAD: myocardial infarction, angina, myocardial revascularization Presence of atheromatous plaque on imaging Heart failure, including HFpEF Peripheral

2018 European Society of Cardiology

190. Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU Full Text available with Trip Pro

, Delirium , Immobility ( mobilization /rehabilitation), and Sleep (disruption). Each section created Population, Intervention, Comparison, and Outcome, and nonactionable, descriptive questions based on perceived clinical relevance. The guideline group then voted their ranking, and patients prioritized their importance. For each Population, Intervention, Comparison, and Outcome question, sections searched the best available evidence, determined its quality, and formulated recommendations as “strong (...) ,” “conditional,” or “good” practice statements based on Grading of Recommendations Assessment, Development and Evaluation principles. In addition, evidence gaps and clinical caveats were explicitly identified. Results: The Pain , Agitation/ Sedation , Delirium , Immobility ( mobilization /rehabilitation), and Sleep (disruption) panel issued 37 recommendations (three strong and 34 conditional), two good practice statements, and 32 ungraded, nonactionable statements. Three questions from the patient-centered

2018 Society of Critical Care Medicine

191. Flu vaccination: increasing uptake

to organisations to increase uptake – there are a number of incentives in primary and secondary care to increase flu vaccination, including Quality and Outcomes Framework, or QOF (secondary prevention of coronary heart disease [CHD007]; diabetes mellitus [DM018]; chronic obstructive pulmonary disease [COPD007]; and stroke and transient ischaemic attack [STIA009]) and Commissioning for Quality and Flu vaccination: increasing uptake (NG103) © NICE 2019. All rights reserved. Subject to Notice of rights (https (...) , if the carer had flu. 1.6.2 Providers of flu vaccination, including primary care staff and nurses working in the community (such as district nurses, specialist nurses and those working in rehabilitation) could consider: Identifying and offering eligible carers a flu vaccination as the opportunity arises. For example, this could be offered during a home visit when the person they look after is being vaccinated. Informing the carer about other local vaccination services if a patient group direction

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

192. Adults With Congenital Heart Disease

( 5 min) rather than immediately after effort (e.g., walking into a clinic examination room). • Meticulous intravenous care to avoid air or particulate matter, which may include use of air/particulate filters on all intravenous access lines, when feasible, and careful de-airing of all lines. • Cerebral imaging for any new headache or neurologic sign to assess for possible cerebral abscess, hemorrhage, or stroke. • Measurement of serum uric acid and treatment with allopurinol in a patient (...) , medical therapy, myocardial infarction, noncardiac surgery, patent ductus arteriosus, perioperative care, physical activity, postoperative complications, pregnancy, preoperative assessment, psychosocial, pulmonary arterial hypertension, hypoplastic left heart syndrome, pulmonary regurgitation, pulmonary stenosis, pulmonary valve replacement, right heart obstruction, right ventricle to pulmonary artery conduit, single ventricle, supravalvular pulmonary stenosis, surgical therapy, tachyarrhythmia

2018 American College of Cardiology

193. Chronic obstructive pulmonary disease.

. Anticholinergics . Anticholinergic drugs may worsen symptoms and signs associated with narrow-angle glaucoma, prostatic hyperplasia, or bladder-neck obstruction and should be used with caution in patients with any of these conditions. Concerns about cardiovascular effects have diminished. Initially a meta-analysis suggested that inhaled anticholinergics (ipratropium and tiotropium) were associated with significantly increased risk of cardiovascular death, myocardial infarction (MI), or stroke among patients (...) guideline document). Empiric antibiotics are recommended for patients with increased sputum purulence plus either increased dyspnea or increased sputum volume [I-A] . Sputum culture is not routinely recommended [III-D] . Pulmonary rehabilitation should be considered for all patients with functional impairment [I-A] . Surgical and minimally invasive options include bullectomy, lung volume reduction procedures, and lung transplantation [II-B] . Life expectancy should be incorporated into shared decision

2017 National Guideline Clearinghouse (partial archive)

194. Chronic Kidney Disease - Medical management of coronary artery disease (excluding lipid-lowering therapy)

(a pentasaccharide inhibitor of factor Xa) in a RCT for the management of ACS (NSTE-ACS), examined the primary outcome of death, myocardial infarction or refractory ischaemia according to the GRACE risk score which is stratified for serum creatinine [23]. Of the 20,078 patients randomised, 6% had a serum creatinine > 140 µmol/L, 17% had a serum creatinine between 106-140 µmol/L and 77% had a serum creatinine 90mL/min OR 0.1.49 95% CI 0.89, 2.48) with a significant increase in the next 2 strata (CrCl >60-90 (...) compared with intravenous thrombolytic therapy for acute myocardial infarction: six-month follow up and analysis of individual patient data from randomized trials. American Heart Journal, 2003. 145(1): p. 47-57. 14. Keltai, M., et al., Renal function and outcomes in acute coronary syndrome: impact of clopidogrel. European Journal of Cardiovascular Prevention & Rehabilitation, 2007. 14(2): p. 312-8. 15. Best, P.J.M., et al., The efficacy and safety of short- and long-term dual antiplatelet therapy

2013 KHA-CARI Guidelines

195. Management of Acute Myocardial Infarction in patients presenting with ST-segment elevation Full Text available with Trip Pro

in Acute Myocardial Infarction CCNAP Council on Cardiovascular Nursing and Allied Professions CCP Council for Cardiology Practice CCU coronary care unit CHA 2 DS 2 -VASc Cardiac failure, Hypertension, Age ≥75 (Doubled), Diabetes, Stroke (Doubled) – VAScular disease, Age 65–74 and Sex category (Female) CI confidence interval CKD chronic kidney disease CMR cardiac magnetic resonance CPG Committee for Practice Guidelines CRISP AMI Counterpulsation to Reduce Infarct Size Pre-PCI-Acute Myocardial Infarction (...) In Myocardial Infarction 51 ATOLL Acute myocardial infarction Treated with primary angioplasty and inTravenous enOxaparin or unfractionated heparin to Lower ischaemic and bleeding events at short- and Long-term follow-up AV atrioventricular b.i.d. bis in die (twice a day) BMI body mass index BMS bare-metal stent BNP B-type natriuretic peptide CABG coronary artery bypass graft surgery CAD coronary artery disease CAPITAL AMI Combined Angioplasty and Pharmacological Intervention versus Thrombolytics ALone

2017 European Society of Cardiology

196. Early-Stage and Locally Advanced (non-metastatic) Non-Small-Cell Lung Cancer: ESMO Clinical Practice Guidelines

Pneumonectomy planned 1.5 Classgroupings A0 B 1–1.5 C 2–2.5 D >2.5 Ischaemic heart disease: history of myocardial infarction, history of posi- tive exercise test, current complaint of chest pain (myocardial ischae- mia), nitrate therapy, ECG with pathological Q waves. Cerebrovascular disease: transient ischaemic attack, stroke. ECG, electrocardiogram. Annals of Oncology Clinical Practice Guidelines Volume 28 | Supplement 4 | August 2017 doi:10.1093/annonc/mdx222 | iv9Systemictherapy In a period of about two (...) with ongoing cardiac care Institute any needed new medical interventions (i.e. beta-blockers, anticoagulants or statins) Cardiac consulation with non-invasive cardiac testing treatments as per AHA/ACC guidelines No History Physical examination Baseline ECG Calculate RCRI *RCRI weighted factors [138]: ? High risk surgery (including lobectomy or pneumonectomy) ? Ischaemic heart disease (prior myocardial infarction, angina pectoris) ? Heart failure ? Insulin-dependent diabetes ? Previous stroke or TIA

2017 European Society for Medical Oncology

197. Intermediate care including reablement

). Page 3 of 28This guideline is the basis of QS173. Ov Overview erview This guideline covers referral and assessment for intermediate care and how to deliver the service. Intermediate care is a multidisciplinary service that helps people to be as independent as possible. It provides support and rehabilitation to people at risk of hospital admission or who have been in hospital. It aims to ensure people transfer from hospital to the community in a timely way and to prevent unnecessary admissions (...) intermediate care teams. These might include: regular team meetings to share feedback and review progress shared notes opportunities for team members to express their views and concerns. 1.2.6 Ensure that the intermediate care team has a clear route of referral to and engagement with commonly used services, for example: general practice podiatry pharmacy mental health and dementia services specialist and longer-term rehabilitation services housing services voluntary, community and faith services specialist

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

198. Management of Valvular Heart Disease Full Text available with Trip Pro

navigation 21 September 2017 Article Contents Article Navigation 2017 ESC/EACTS Guidelines for the management of valvular heart disease Helmut Baumgartner Corresponding authors: Helmut Baumgartner, Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Albert Schweitzer Campus 1, Building A1, 48149 Muenster, Germany. Tel: +49 251 834 6110, Fax: +49 251 834 6109, E-mail: . Volkmar Falk, Department of Cardiothoracic and Vascular Surgery (...) , Germany. Tel: +49 251 834 6110, Fax: +49 251 834 6109, E-mail: . Volkmar Falk, Department of Cardiothoracic and Vascular Surgery, German Heart Center, Augustenburger Platz 1, D-133353 Berlin, Germany and Department of Cardiovascular Surgery, Charite Berlin, Charite platz 1, D-10117 Berlin, Germany. Tel: +49 30 4593 2000, Fax: +49 30 4593 2100, E-mail: . Search for other works by this author on: Jeroen J Bax Search for other works by this author on: Michele De Bonis Search for other works

2017 European Society of Cardiology

199. Diagnosis and Treatment of Peripheral Arterial Diseases Full Text available with Trip Pro

, demonstrated that DAPT vs. aspirin reduced silent cerebral micro-emboli by 37% after 7 days. No life-threatening intracranial or major bleeding was observed, but the sample size was small. For these reasons, DAPT may be considered within 24 h of a minor ischaemic stroke or transient ischaemic attack (TIA) and may be continued for 1 month in patients treated conservatively. DAPT is recommended in patients undergoing CAS. Two small RCTs comparing aspirin alone with DAPT for CAS were terminated prematurely (...) for Endarterectomy SAPT Single antiplatelet therapy SBP Systolic blood pressure SFA Superficial femoral artery SPACE Stent Protected Angioplasty versus Carotid Endarterectomy STAR Stent Placement in Patients With Atherosclerotic Renal Artery Stenosis and Impaired Renal Function TAMARIS Efficacy and Safety of XRP0038/NV1FGF in Critical Limb Ischaemia Patients With Skin Lesions TAVI Transcatheter aortic valve implantation TBI Toe-brachial index TcPO 2 Transcutaneous oxygen pressure TIA Transient ischaemic attack

2017 European Society of Cardiology

200. BSR guideline Management of Adults with Primary Sjögren's Syndrome Full Text available with Trip Pro

to replace tear film oil layer Punctal plugging—punctal or intracanalicular plugs (ophthalmology only) Nutritional tear substitutes Secretagogues Autologous or allogeneic serum eye drops (available via specialist commissioned centres only) Oral pilocarpine max 5 mg 4× per day (start with 2.5 mg od and build up) Permanent punctal occlusion via cautery of all four puncta Pilocarpine 4% (3 drops = 5 mg) for those who are unable to swallow (palliative care pathway [ ]) Periorbital botulinum toxin (...) commissioned centres only) Oral pilocarpine max 5 mg 4× per day (start with 2.5 mg od and build up) Permanent punctal occlusion via cautery of all four puncta Pilocarpine 4% (3 drops = 5 mg) for those who are unable to swallow (palliative care pathway [ ]) Periorbital botulinum toxin for significant blepharospasm Bandage contact lenses Amniotic membrane overlay or corneal grafting for significant corneal ulceration and corneal melt or perforation Based upon the DEWS workshop and the Meibomian Gland

2017 British Society for Rheumatology

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