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102. Enhanced Recovery

. Several meta- analyses of RCTs have shown that goal-directed fluid ther - apy (GDFT) reduces postoperative morbidity and length of hospital stay, especially in high-risk patients undergo- ing major surgery. 213–216 High-risk patients have been vari- ably defined but have been noted to include patients with a history of severe cardiorespiratory illness (acute myo- cardial infarction, chronic obstructive pulmonary disease, stroke, etc), planned extensive surgery (>8 h), age >70 years with evidence (...) However, inherent biases in the study design, lack of control group or randomization of participants, small sample sizes, wide variances in com- pliance with protocols, and limited generalizability limited these studies. When looking at postoperative quality out- comes, small, single-center studies report no differences in postoperative complication rates and hospital length of stay with prehabilitation compared with control subjects or postoperative rehabilitation 103,106,109 or results have been

2017 American Society of Colon and Rectal Surgeons

103. Clinical Practice Guideline on the Management of Osteoarthritis of the Hip

must be published in or after 1990 for surgical treatment, rehabilitation, bracing, prevention and MRI Study must be published in or after 1990 for x-rays and non-operative treatment Study must be published in or after 1990 for all others non specified Study should have 10 or more patients per group (Work group may further define sample size) Study must have at least 90% OA Patients 20 Standard Criteria for all CPGs Article must be a full peer-reviewed published article report of a clinical study

2017 American Academy of Orthopaedic Surgeons

104. Managing Chronic Non-Terminal Pain in Adults Including Prescribing Controlled Substances

if ineffective. Extreme caution needed for older adults; use PPI with NSAID or with COX-2/aspirin . NSAID use in patients with heart disease or its risk factors increases overall risk of heart attack or stroke. Naproxen Aleve Initial: 225 – 550 mg BID Typical: 375 mg BID Max: 500 mg BID $13 / $13 NSAID use in patients with heart disease or its risk factors increases overall risk of heart attack or stroke. Opioids (listed in order of increasing potency) 1 Tramadol [Schedule 4] Ultram Initial: 25 or 50 mg QID (...) Managing Chronic Non-Terminal Pain in Adults Including Prescribing Controlled Substances 1 Quality Department Guidelines for Clinical Care Ambulatory Chronic Pain Management Guideline Team Team Leads Daniel W Berland, MD General Medicine / Anesthesiology Phillip E Rodgers, MD Family Medicine Team Members Carmen R Green, MD Anesthesiology R Van Harrison, PhD Medical Education Randy S Roth, PhD Physical Medicine & Rehabilitation Consultants Daniel J. Clauw, MD Rheumatology Jennifer A. Meddings

2017 University of Michigan Health System

105. Updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension Full Text available with Trip Pro

; CXR, chest X-ray; ECG, electrocardiogram; FC, functional class; HIV, human immunodeficiency virus; HPAH, heritable pulmonary arterial hypertension; HR, high resolution; IPAH, idiopathic pulmonary arterial hypertension; LFT, liver function test; MRI, magnetic resonance imaging; PCH, pulmonary capillary hemangiomatosis; PH, pulmonary hypertension; PHVD, pulmonary hypertensive vascular disease; PVOD, pulmonary veno-occlusive disease; VQ, ventilation/perfusion; WHO, World Health Organization. Modified (...) , computed tomography; CTEPH, chronic thromboembolic pulmonary hypertension; CXR, chest X-ray; ECG, electrocardiogram; FC, functional class; HIV, human immunodeficiency virus; HPAH, heritable pulmonary arterial hypertension; HR, high resolution; IPAH, idiopathic pulmonary arterial hypertension; LFT, liver function test; MRI, magnetic resonance imaging; PCH, pulmonary capillary hemangiomatosis; PH, pulmonary hypertension; PHVD, pulmonary hypertensive vascular disease; PVOD, pulmonary veno-occlusive

2019 International Society for Heart and Lung Transplantation

106. Impact of Affordable Care Act on Trauma and Emergency General Surgery

) Schoenfeld etal., 2015 Retrospectivepre-/post-MHRstudy,Massachusetts femoralneck fracturepatientsfrom the State InpatientDatabase Complications, AdjustedOdds Ratio OverallAOR1.56 (95%CI,1.46–1.67) Undurraga Perl etal.,2017 Retrospectivepre-/post-MEstudy,Traumapatients fromasingleLevelItraumacenterinOregon Complications, % Infection 32.4%to32.3%,p=0.98 VenousThromboembolism33.7%to23.4%, p<0.001 Pneumonia 15.9%to12.5%.p=0.18 Complicationswere definedasmyocardialinfarction,stroke orcerebrovascular accident (...) — importantoutcome Holzmacher etal.,2017 Retrospectivecohortstudy,Trauma patients from Maryland,WashingtonDC, andVirginiaseenata single LevelItrauma center inWashington, DC Discharge home,% Washington DC89.8%,Virginia 87.5%,Maryland 93.2% Discharge to SAR, SNF, oracute rehabilitation, % Washington DC7.9%,Virginia 12.5%, Maryland6.8% Virginiavs.DC,p=0.75 Marylandvs. DC, p=0.68 Leeetal.,2014 Retrospectivepre-/post-MHRstudy,Trauma patients admitted totheICUfromasingleLevelI trauma centerinMassachusetts

2019 Eastern Association for the Surgery of Trauma

107. Scleroderma Morphea

, radiation, or drugs, might cause microvascular injuries and induce T cell activation that subsequently result in a release of various adhesion molecules. 3 Up-regulation of some of these adhesion molecules (e.g. vascular cell adhesion molecule-1 and intercellular adhesion molecule-1) might induce T cell activation, which, in turn, activates 9 the release of key player pro-fibrotic cytokines, such as transforming growth factor-beta (TGF ß) and its signal transducers called SMAD proteins, platelet-derived (...) in clinical trials on LS, for example, ultrasound scanning, cutometer, durometer, thermography, laser Doppler flowmetry, and a computerized skin score. In most of the studies, these procedures were used as secondary outcome measures. Differential diagnoses A variety of differential diagnoses should be considered in LS. 48 In daily routine, the physicians’ pivotal challenge is to differentiate LS from SSc. 3 Typical facial (e.g. telangiectasia, beak-shaped nose, and microstomia) and vascular (e.g

2018 European Dermatology Forum

108. Transcatheter or surgical aortic valve replacement for patients with severe, symptomatic, aortic stenosis at low to intermediate surgical risk. Full Text available with Trip Pro

). It pools data on 3128 patients with symptomatic severe aortic stenosis at low or moderate risk of perioperative death, typically followed for two years. Fig 2 Patient and trial characteristics in the four trials of the linked meta-analysis Compared with SAVR, transfemoral TAVI reduced mortality and stroke, life threatening bleeds, atrial fibrillation, and acute kidney injury at two years, but increased heart failure, major vascular complications, pacemaker insertion, and need for aortic valve (...) heart failure Strokes Life-threatening bleeds New onset atrial fibrillation Median days in hospital Pacemaker insertions Aortic valve reinterventions Aortic valve reinterventions 197 45 fewer 20 fewer 252 fewer 178 fewer 79 10 226 161 134 87 8 242 Events per 1000 people – within 10 years 226 99 3 92 413 312 69 12 7 fewer 134 fewer 18 fewer 4 fewer 92 134 fewer Moderate Moderate quality evidence We are moderately confident in the evidence supporting the recommendation. Further research could have

2016 BMJ Rapid Recommendations

109. Acute Coronary Syndromes Guidelines

on the National Health and Medical Research Council (NHMRC) guideline development methodology, including grades of evidence, and Appendix 5 for details on the GRADE methodology. 900 D.P. Chew et al.1. Preamble 1.1. Incidence Acute coronary syndromes (ACS) – myocardial infarction (MI) and unstable angina (UA) – are the result of unstable atheromatous plaques or endothelial disruption with asso- ciated transient or permanent thrombotic occlusion of the coronary vascular tree leading to myocardial ischaemia (...) [EF] 40%) unless contraindicated. Strong IIA Initiate and continue angiotensin converting enzyme (ACE) inhibitors (or angiotensin receptor blockers [ARBs]) in patients with evidence of heart failure, LV systolic dysfunction, diabetes, anterior myocardial infarction or co-existent hypertension. Strong IA Attendance at cardiac rehabilitation or undertaking a structured secondary prevention service is recommended for all patients hospitalised with ACS. Strong IA Note: Refer to Appendix 4 for details

2016 Cardiac Society of Australia and New Zealand

110. Familial Hypercholesterolaemia

on Friday, 25 th November 2016. Diagnosis and Management of Familial Hypercholesterolaemia – CSANZ Position Statement Page 2 • FH should be suspected when there is a family history of premature ASCVD, and when LDL-C levels are greater than 4.9 mmol/L in adults or 4.0 mmol/L in children. • Family screening of patients is important to detect FH in near relatives at the earliest opportunity; all patients with premature CHD should be screened for FH, with coronary care and rehabilitation units having (...) from atherosclerotic disease prior to menopause, so the natural history of premature vascular disease is delayed by about one decade in women. However, the onset of CHD is accelerated by about 2 decades in both males and females (1). Additional metabolic and clinical features of FH are listed below. Table 1: Additional metabolic and clinical features of FH Metabolic Features Increased LDL-C Increased remnants including LDL’s precursor, IDL Clinical Features Premature CHD Premature CVD Aortic

2016 Cardiac Society of Australia and New Zealand

111. Guidelines for Perioperative Care for Liver Surgery: Enhanced Recovery After Surgery (ERAS) Society Recommendations Full Text available with Trip Pro

recovery after major surgery. The ERAS strategy has been validated in colorectal surgery and is applied in other specialties including urology, thoracic, vascular and orthopedic surgery [ , , ]. In colorectal surgery, ERAS pathways allow significant reduction in postoperative complications, faster functional recovery, shorter hospital stays and reduced costs, even in elderly patients [ , , ]. Patients within ERAS pathways mainly benefit from reduced medical complications, while surgical morbidity (...) . The expert panel agreed in the first round of the Delphi process to focus the systematic review on non-obstructive jaundiced patients without cirrhosis. All types of hepatectomy according to the Brisbane classification were included [ ]. Major hepatectomy was defined as resection of 3 or more Couinaud’s segments. Patients with choledocho-jejunostomy or vascular reconstruction were also included. All series including liver transplantation and patients with additional non-liver surgery (e.g., hepato

2016 ERAS Society

112. Management of adults with diabetes undergoing surgery

? Inappropriate use of intravenous insulin infusion ? Management errors when converting from the intravenous insulin infusion to usual medication ? Peri-operative infection. The high-risk surgical patient and the impact of diabetes The high-risk surgical population is made up of elderly patients with co-existing medical conditions undergoing complex or major surgery, often as an emergency. The most important co-morbid diseases include ischaemic heart disease, heart failure, respiratory disease, impaired renal (...) avoidable, still occurs on surgical wards and can result in post-operative death 13 . Complications of diabetes Diabetes is associated with a two to four fold increase in cardiovascular disease including hypertension, coronary artery disease and stroke 14 . The majority of people with diabetes booked for surgery are likely to have one or more of these cardiovascular diseases and a significant number will have microvascular disease (nephropathy or neuropathy). Those with impaired cardiac function

2016 Association of British Clinical Diabetologists

113. Heart Failure Full Text available with Trip Pro

a , b , c , d , , x John J. Atherton Affiliations Department of Cardiology, Royal Brisbane and Women’s Hospital, Brisbane, Australia Faculty of Medicine, University of Queensland, Brisbane, Australia Faculty of Science, Health, Education and Engineering, University of Sunshine Coast, Australia Faculty of Health, Queensland University of Technology, Brisbane, Australia Correspondence Corresponding author. , x Andrew Sindone Affiliations Heart Failure Unit and Department of Cardiac Rehabilitation (...) in patients with either a suspected diagnosis or new diagnosis of heart failure, to assess cardiac rhythm, QRS duration, and the presence of underlying conditions such as myocardial ischaemia or LV hypertrophy. Strong FOR Low A chest X-ray is recommended in patients with either a suspected diagnosis or new diagnosis of heart failure, to detect signs of pulmonary congestion and to identify alternative cardiac or non-cardiac causes for the patient’s symptoms. Strong FOR Very low Plasma B-type natriuretic

2018 Cardiac Society of Australia and New Zealand

114. The management of diabetes in adults and children with psychiatric disorders in inpatient settings

Glycaemic management during the inpatient enteral feeding of stroke patients with diabetes June 2012 JBDS 05 Self-Management of Diabetes in Hospital March 2012 JBDS 04 Management of adults with diabetes undergoing surgery and elective procedures: improving standards Revised March 2016 JBDS 03 The Management of Diabetic Ketoacidosis in Adults Revised September 2013 JBDS 02 The Hospital Management of Hypoglycaemia in Adults with Diabetes Mellitus Revised September 2013 JBDS 01 These documents (...) and cerebrovascular events, increased hospital admissions and death. 23,28–30 Screening for diabetes and a clinical review is always indicated in any older adult admitted to any inpatient setting. 9.2 Overview of models of care 9.2.1 Diabetes and Dementia 1. While there are no NICE guidelines for comorbid diabetes and dementia, in each condition, there is guidance that reinforces the need for early diagnosis, improved access to diagnostic and specialist clinics, access to the right information systems

2017 Association of British Clinical Diabetologists

115. Diagnosis and Treatment of Non-Neurogenic Overactive Bladder (OAB) in Adults

(the production of greater than 20 to 33% of total 24 hour urine output during the period of sleep, which is age-dependent with 20% for younger individuals and 33% for elderly individuals), 28 low nocturnal bladder capacity or both. In nocturnal polyuria, nocturnal voids are frequently normal or large volume as opposed to the small volume voids commonly observed in nocturia associated with OAB. Sleep disturbances, vascular and/or cardiac disease and other medical conditions are often associated with nocturnal (...) ., stroke, multiple sclerosis, spinal cord injury), mobility deficits, medically complicated/uncontrolled diabetes, fecal motility disorders (fecal incontinence/constipation), chronic pelvic pain, history of recurrent urinary tract infections (UTIs), gross hematuria, prior pelvic/vaginal surgeries (incontinence/prolapse surgeries), pelvic cancer (bladder, colon, cervix, uterus, prostate) and pelvic radiation. The female patient with significant prolapse (i.e., prolapse beyond the introitus) also may

2019 American Urological Association

116. Incontinence after Prostate Treatment: AUA/SUFU Guideline (2019)

. Absorbent Products – Liners, Guards, Briefs, Underwear. Most patients will start with absorbent pads and make adjustments in type based on the severity of leakage. 91 In general, milder incontinence is managed satisfactorily with shields or lower density guards, while severe incontinence requires briefs or underwear with or without inserts to prevent accidents. From a cost perspective, briefs and underwear systems have been demonstrated to be more effective than pads. 92 Thus, the patient should (...) than several pads or garments per day, financial considerations may influence the ability to change pads in a timely fashion. Therefore, it is important to ensure that the patient is utilizing the most effective product based on their degree of incontinence. Occlusive Devices (Clamps) . Occlusive devices may function as a stand-alone therapy for incontinence or as an adjunct to absorbent products. Combination therapy between the two types of devices, such as pads and clamps together, decreases

2019 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction

118. Management of Glaucoma

(Second Edition) 35 ischaemia. Initially fibrovascular membrane covers the angle, causing secondary open angle glaucoma. This can progress to angle closure glaucoma. The common conditions associated with NVG are proliferative diabetic retinopathy, central retinal vein occlusion and other conditions such as ocular ischaemic syndrome and tumours. Management of NVG involves optimising treatment of the underlying disease and control of high IOP. The treatment for NVG includes: 15 • medical treatment (...) ) 8. REHABILITATION 29 9. REFERRAL 30 10. SPECIAL CONDITIONS 31 10.1 Ocular Hypertension 31 10.2 Primary Open Angle Glaucoma Suspect 33 10.3 Steroid-Induced Glaucoma 34 10.4 Neovascular Glaucoma 34 10.5 Intraocular Pressure Monitoring in 35 Post-Refractive Surgery Cases 11. IMPLEMENTING THE GUIDELINES 37 11.1 Facilitating and Limiting Factors 37 11.2 Potential Resource Implications 37 REFERENCES 39 Appendix 1 Example of Search Strategy 45 Appendix 2 Clinical Questions 46 Appendix 3 Van Herick Test

2017 Ministry of Health, Malaysia

119. Clinical Practice Guidelines on Hypertension

, the results from a 2011 meta-analysis of RCTs of BP targets in subjects with type 2 diabetes and impaired fasting glucose 91 suggest that most of the beneficial reduction in all-cause mortality in the intensive treatment group (systolic BP 220 mmHg or diastolic BP > 120 mmHg, before specific treatment begins. 121 The rate of BP reduction would depend on the specific comorbidities. 9.4.2 Lowering of the BP after transient ischemic attack and after acute phase of stroke D After the acute phase of stroke (...) , begin antihypertensive treatment in hypertensive patients if the systolic BP is more than 140 mmHg and diastolic BP is more than 90 mmHg. 122,123 Grade D, Level 4 KEY RECOMMENDATION KEY RECOMMENDATION 53 A Use any of the five major pharmacological classes of antihypertensive drugs for stroke prevention in patients after the acute phase of stroke, provided that the BP is effectively lowered. 21,75 Grade A, Level 1 ++ GPP The target BP level in patients after transient ischemic attack and after acute

2017 Ministry of Health, Singapore

120. Global Vascular Guidelines for patients with chronic limb-threatening ischemia Full Text available with Trip Pro

Global Vascular Guidelines for patients with chronic limb-threatening ischemia Global vascular guidelines on the management of chronic limb-threatening ischemia - Journal of Vascular Surgery Email/Username: Password: Remember me Search JVS Journals Search Terms Search within Search Access provided by Volume 69, Issue 6, Supplement, Pages 3S–125S.e40 Global vascular guidelines on the management of chronic limb-threatening ischemia x Michael S. Conte Affiliations Division of Vascular (...) grade is 3 (chronic total occlusion of target artery origin). ---- | ---- Fig 5.7 Flow chart illustrating application of Global Limb Anatomic Staging System ( GLASS ) to stage infrainguinal disease pattern in chronic limb-threatening ischemia ( CLTI ). FP, Femoropopliteal; IP, infrapopliteal; PLAN, patient risk estimation, limb staging, anatomic pattern of disease; TAP, target arterial path; WIfI, Wound, Ischemia, and foot Infection. ---- | ---- Fig 6.1 Paradigm for evidence-based revascularization

2019 Society for Vascular Surgery


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