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18 Αυγούστου 2019, 00:14:13

Αποστολέας Θέμα: Practice Guidelines  (Αναγνώστηκε 92129 φορές)

0 μέλη και 1 επισκέπτης διαβάζουν αυτό το θέμα.

4 Μαρτίου 2008, 22:14:58
Απάντηση #15
Αποσυνδεδεμένος

Gatekeeper

Επώνυμοι
British Infection Society

British Infection Society Guidelines: UK malaria treatment guidelines Journal of Infection 2007; 54(2):111-21
“It’s a poor sort of memory that onlyworks backwards, the Queen remarked.”
Lewis Carroll, 1872,
Through the Looking Glass

7 Μαρτίου 2008, 15:39:52
Απάντηση #16
Αποσυνδεδεμένος

Gatekeeper

Επώνυμοι
Osteoarthritis Research Society International (OARSI)

New Guidelines Issued for Management of Hip and Knee Osteoarthritis

Study Highlights

The optimal management of OA of the hip and knee combines both nonpharmacologic and pharmacologic treatment modalities (SOR, 96%).
The initial treatment of OA should focus on patient empowerment and self-driven therapies. All patients should receive education on lifestyle changes, exercise, pacing of activities, and weight reduction (SOR, 97%).
Monthly telephone contact, even by lay personnel, can improve the clinical status of patients with OA (SOR, 66%).
A physical therapy consultation focusing on appropriate exercises may benefit patients with OA, although this recommendation is largely based on expert opinion. The physical therapy visit may also include advice regarding assistive devices for ambulation (SOR, 89%).
Weight loss is encouraged and can relieve pain and stiffness and improve function (SOR, 96%).
Assistive devices for ambulation can reduce pain associated with OA. Frames or wheeled walkers are preferable for patients with bilateral disease (SOR, 90%).
Among patients with knee OA and mild or moderate valgus or varus instability, a knee brace can reduce pain, improve stability, and reduce the risk of falling (SOR, 76%).
Insoles can also reduce pain among patients with knee OA (SOR, 77%).
Thermal modalities may improve knee OA, but there is less evidence that ice may be effective (SOR, 64%).
Transcutaneous electrical nerve stimulation can help with short-term pain control among patients with hip or knee OA (SOR, 58%).
Acupuncture can relieve symptoms of knee OA (SOR, 59%).
Acetaminophen is the first choice for pharmacologic treatment of OA. Doses up to 4 g/day may be initiated before the use of other medications (SOR, 92%).
NSAIDs may be used at their lowest effective dose, and long-term use should be avoided if possible. Among patients at an increased risk for gastrointestinal tract bleeding, clinicians should prescribe either a COX-2 selective agent or a nonselective NSAID with co-prescription of a proton pump inhibitor or misoprostol. NSAIDs should be used with caution among patients with cardiovascular risk factors (SOR, 93%).
Topical NSAIDs and capsaicin can be effective as monotherapy or adjunctive treatment for OA of the knee (SOR, 85%).
Patients with moderate to severe pain associated with knee OA that is not responding to oral therapy can be treated with intra-articular injections (SOR, 78%).
Intra-articular injections of hyaluronate are associated with delayed onset of analgesia but a prolonged duration of action vs injections of corticosteroids (SOR, 64%).
Treatment with glucosamine and chondroitin may relieve symptoms of OA, but treatment should be discontinued if there is no relief after 6 months of therapy (SOR, 63%).
Unicompartmental knee replacement is effective among patients with knee OA restricted to a single compartment (SOR, 76%).
Osteotomy may be considered for young adults with symptomatic hip OA, whereas high tibial osteotomy may reduce the need for joint replacement among young adults with knee OA (SOR, 75%).
Joint fusion of the knee can be performed to salvage a failed joint replacement (SOR, 69%).

Pearls for Practice

The current recommendations for nonpharmacologic treatment of OA of the hip and knee include regular telephone calls from the clinician's office; self-driven therapies; and education on lifestyle changes, exercise, and weight reduction. For patients with knee OA, a knee brace for varus or valgus instability, insoles for appropriate patients, acupuncture, and thermal therapy are recommended. However, the topical application of ice is less proved.
The current guidelines for pharmacologic treatment of OA of the hip and knee recommend acetaminophen as the first choice. Other treatments include NSAIDs and glucosamine and chondroitin, but long-term use of these medications should be avoided.
“It’s a poor sort of memory that onlyworks backwards, the Queen remarked.”
Lewis Carroll, 1872,
Through the Looking Glass

8 Μαρτίου 2008, 10:59:16
Απάντηση #17
Αποσυνδεδεμένος

eliastheod


Guidelines Issued for Acute Otitis Externa

Otolaryngol Head Neck Surg. 2006;134(suppl):24-48

8 Μαρτίου 2008, 12:21:02
Απάντηση #18
Αποσυνδεδεμένος

eliastheod


New Guidelines for Lyme Disease Prevention

Clin Infect Dis. 2006;43:000-000

8 Μαρτίου 2008, 13:26:20
Απάντηση #19
Αποσυνδεδεμένος

Argirios Argiriou

Moderator
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος
New Guidelines for Lyme Disease Prevention
Clin Infect Dis. 2006;43:000-000

Στην Σουηδία που δούλευα η νόσος Lyme ήταν ενδημική σε ορισμένες περιοχές.

Τί ισχύει στην Ελλάδα;  Εννοώ, γνωρίζει κανείς αν υπάρχει η νόσος του Lyme ενδημικά στην Ελλάδα;
« Τελευταία τροποποίηση: 8 Μαρτίου 2008, 13:39:53 από Argirios Argiriou »
Before ordering a test decide what you will do if it is (1) positive, or (2) negative. If both answers are the same, don't do the test. Archie Cochrane.

8 Μαρτίου 2008, 17:16:39
Απάντηση #20
Αποσυνδεδεμένος

eliastheod


δεν γνωρίζω αν υπάρχουν βιβλιογραφικές αναφορές για την ενδημικότητα της ν. Lyme στην Ελλάδα και θα είχε ενδιαφέρον αν κάποιος συνάδελφος γνώριζε κάτι για το θέμα αυτό.
Εργάζομαι στην περιοχή του β. Αιγαίου και αρκετά συχνά αντιμετωπίζω ασθενείς  με πρόσφατο δήγμα τσιμπουριού. Συνήθως προσέρχονται λίγες μέρες μετά το δήγμα και συχνά εμφανίζουν σύστοιχη λεμφαδενίτιδα στην περιοχή, που είναι και το σύμπτωμα που συνήθως τους οδηγεί στο γιατρό. Σε όλους συνηθίζω να δίνω χημειοπροφύλαξη για ν.Lyme όπως περιγράφεται στις οδηγίες που έχω επισυνάψει

8 Μαρτίου 2008, 23:02:17
Απάντηση #21
Αποσυνδεδεμένος

ManolisGP

Επώνυμοι
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος
Guidelines Issued for Acute Otitis Externa

Otolaryngol Head Neck Surg. 2006;134(suppl):24-48

Otitis Externa: Review and Clinical Update
Am Fam Physician 2006;74:1510-6.

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

20 Μαρτίου 2008, 10:04:18
Απάντηση #22
Αποσυνδεδεμένος

eliastheod


Guidelines Issued for Early Detection of Colorectal Cancer
CA Cancer J Clin. Published online March 5, 2008

14 Απριλίου 2008, 22:19:33
Απάντηση #23
Αποσυνδεδεμένος

Gatekeeper

Επώνυμοι
The American Academy of Pediatrics (AAP)


Guidelines Updated for Influenza Immunization in Children

The revised guidelines recommend influenza immunization for the following groups:

Healthy children aged 6 through 59 months (evidence grade B).

High-risk children and adolescents with underlying medical conditions, including:

Asthma, cystic fibrosis, or other chronic pulmonary diseases (evidence grade B);

Hemodynamically significant cardiac disease;

Immunosuppressive disorders or treatment;

HIV infection;

Sickle cell anemia and other hemoglobinopathies;

Diseases treated with long-term aspirin therapy, including juvenile idiopathic arthritis or Kawasaki's disease (trivalent inactivated influenza vaccine [TIV] only);

Chronic renal dysfunction;

Diabetes mellitus or other chronic metabolic disease; and

Any condition that can reduce respiratory function or handling of secretions or can increase risk for aspiration, including cognitive dysfunction, spinal cord injury, seizures, or other neuromuscular disorders.

Study Highlights

Community outbreaks of influenza can last 4 to 8 weeks or longer.
Rates of infection are highest among children, but serious infection and mortality rates are higher among people older than 65 years, children younger than 2 years, and patients with medical conditions.
The influenza attack rate among children is 10% to 40% annually, with a 1% hospitalization rate.
Rates of emergency department visits and hospitalizations are higher in children younger than 5 years and highest in those younger than 2 years.
Outpatient visit rates for influenza are 80 to 150 per 1000 children among those aged 23 to 59 months.
Associated morbidity rates increased during the influenza season include acute otitis media with a 10% to 30% increase in antimicrobial use.
Deaths attributable to influenza are less common among children vs elderly people, with a rate of 0.4 per 1000 reported in the 1990s vs 98.3 per 100 among adults 65 years or older.
The annual number of influenza-related deaths among children that were reported to the CDC in the past 3 seasons ranged from 44 to 68.
TIV is administered intramuscularly to children 6 months or older and is indicated for healthy children and for those with chronic medical conditions.
LAIV is live attenuated, administered intranasally, and approved by the US Food and Drug Administration for those aged 2 to 49 years.
Both vaccines are contraindicated in those with egg or egg protein allergy.
Efficacy depends on the age and immunocompetence of the recipient.
LAIV has shown greater efficacy and safety than TIV for children between 12 and 59 months without a history of wheezing or asthma and is better than TIV against both strains of influenza.
Children and adolescents with influenza should not receive aspirin or salicylate-containing products because of the risk for Reye's syndrome.
Influenza vaccine is recommended for healthy children 6 to 59 months of age, children at high risk, and adolescents with underlying medical conditions.
The underlying medical conditions include asthma, chronic pulmonary diseases such as cystic fibrosis, significant cardiac disease, immunosuppression, HIV infection, hemoglobinopathies, chronic renal dysfunction, metabolic disease, and diseases requiring long-term therapy such as rheumatoid arthritis.
Others requiring immunization include household contacts and caregivers of children younger than 5 years and children of all ages who are at risk, children who require regular hospital follow-up because of prior disease, any girl or woman who will become pregnant during the influenza season (TIV only), all individuals aged 5 years or older, healthy contacts at risk for development of complications from influenza infection, close contacts of immunosuppressed individuals, and healthcare workers.
Children who received only 1 dose of influenza vaccine in the previous season should receive 2 doses given 1 month apart in the following season.
Children younger than 9 years and at least 6 months old who were previously unimmunized should receive 2 doses 1 month apart beginning as soon as possible.
Influenza vaccine should be offered throughout the influenza season even after influenza activity has been documented in the community.
Healthcare clinicians should not prescribe amantadine or rimantadine for influenza treatment or chemoprophylaxis because of widespread resistance among influenza A strains.
Oseltamivir and zanamivir can be prescribed for treatment or chemoprophylaxis because both influenza A and B remain susceptible.


Pearls for Practice

Influenza has a high rate of attack among children, and morbidity rate is highest among children younger than 2 years.
Influenza vaccine should be offered throughout the influenza season according to current indications, and amantadine and rimantadine should be avoided for treatment or prophylaxis of influenza.
 
“It’s a poor sort of memory that onlyworks backwards, the Queen remarked.”
Lewis Carroll, 1872,
Through the Looking Glass

29 Απριλίου 2008, 00:21:45
Απάντηση #24
Αποσυνδεδεμένος

Gatekeeper

Επώνυμοι
Clinical guidelines: Potential benefits, limitations,and harms.

Απο το BMJ.
“It’s a poor sort of memory that onlyworks backwards, the Queen remarked.”
Lewis Carroll, 1872,
Through the Looking Glass

30 Απριλίου 2008, 07:29:18
Απάντηση #25
Αποσυνδεδεμένος

Argirios Argiriou

Moderator
Παρ όλα αυτά νομίζω ότι τα πλεονεκτήματα του να βγάζει μια χώρα guidelines ζυγίζουν περισσότερο από τα μειονεκτήματα.
« Τελευταία τροποποίηση: 30 Απριλίου 2008, 08:18:35 από Argirios Argiriou »
Before ordering a test decide what you will do if it is (1) positive, or (2) negative. If both answers are the same, don't do the test. Archie Cochrane.

3 Μαΐου 2008, 22:38:02
Απάντηση #26
Αποσυνδεδεμένος

πρώτη & καλύτερη

Ιατροί
Επισυνάπτω άρθρο από το Circulation με τίτλο ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. Το γεγονός ότι είναι οδηγίες που έχουν εξαχθεί από τρεις εταιρείες-οργανισμούς, σημαίνει ότι θα πρέπει να θεωρηθούν αρκετά σοβαρές οδηγίες. Το μεγαλύτερο μέρος των οδηγιών μάλλον δεν αφορά την ειδικότητά μας, αλλά τα σημεία των "ασταθών αρρυθμιών" περιέχουν κάποια σημαντικά νέα στοιχεία. Σταχυολόγησα κάποια σημεία που αξίζουν προσοχής:

1) Η χορήγηση β-blockers στην οξεία φάση του εμφράγματος του μυοκαρδίου, δεν παίζει το ρόλο "προστασίας" του μυοκαρδίου λόγω της μείωσης της καρδιακής συχνότητας, αλλά κυρίως γιατί έχει φανεί ότι μειώνουν την εμφάνιση ανακοπής-κοιλιακής μαρμαρυγής.

2) Μονόμορφη κοιλιακή ταχυκαρδία: Η προκαϊναμίδη επιστρέφει !! Θεωρείται πιο δόκιμη θεραπεία από την αμιοδαρόνη, που είναι κατάλληλη σε ασταθή μονόμορφη κοιλιακή ταχυκαρδία που δεν ανταποκρίνεται στην προκαϊναμίδη.
Η λιδοκαΐνη προτιμάται σε ταχυκαρδίες από οξέα στεφανιαία σύνδρομα.

3) Torsades de Pointes: Σε αυτό τον τύπο πολύμορφης κοιλιακής ταχυκαρδίας που οφείλεται σε παράταση QT, αντενδεικνύονται προκαϊναμίδη, αμιοδαρόνη και λιδοκαΐνη. Το μαγνήσιο είναι το φάρμακο εκλογής.   

10 Μαΐου 2008, 19:13:01
Απάντηση #27
Αποσυνδεδεμένος

Gatekeeper

Επώνυμοι
Screening for Osteoporosis in Men: A Clinical Practice Guideline from the American College of Physicians

 Amir Qaseem, MD, PhD, MHA; Vincenza Snow, MD; Paul Shekelle, MD, PhD; Robert Hopkins, Jr., MD; Mary Ann Forciea, MD; Douglas K. Owens, MD, MS, for the Clinical Efficacy Assessment Subcommittee of the American College of Physicians*

6 May 2008 | Volume 148 Issue 9 | Pages 680-684


Description: The American College of Physicians developed this guideline to present the available evidence on risk factors and screening tests for osteoporosis in men.

Methods: Published literature on this topic was identified by using MEDLINE (1990 to July 2007). Reference mining was done on the retrieved articles, references of previous reviews, and solicited articles from experts. The inclusion criteria for the studies were measuring risk factors for low bone mineral density or osteoporotic fracture in men or comparing 2 different methods of assessment for the presence of osteoporosis in men. This guideline grades the evidence and recommendations by using the American College of Physicians' clinical practice guidelines grading system.

Recommendation 1: The American College of Physicians recommends that clinicians periodically perform individualized assessment of risk factors for osteoporosis in older men (Grade: strong recommendation; moderate-quality evidence).

Recommendation 2: The American College of Physicians recommends that clinicians obtain dual-energy x-ray absorptiometry for men who are at increased risk for osteoporosis and are candidates for drug therapy (Grade: strong recommendation; moderate-quality evidence).

Recommendation 3: The American College of Physicians recommends further research to evaluate osteoporosis screening tests in men.



--------------------------------------------------------------------------------
Osteoporosis in men is an important public health problem. Osteoporosis in men is substantially underdiagnosed, undertreated, and underreported and inadequately researched (1, 2). Although osteoporosis is often viewed as a disease of women, studies show that osteoporotic fractures also result in substantial morbidity, mortality, and financial expenses in men (3–7). The prevalence of osteoporosis is estimated to be 7% in white men, 5% in black men, and 3% in Hispanic men. Data on prevalence in Asian-American men and other ethnic groups are lacking (2). With the aging of the population, rates of osteoporosis in men are expected to increase nearly 50% in the next 15 years, and hip fractures rates are projected to double or triple by 2040 (2).
This guideline presents the available evidence on risk factors and screening tests for osteoporosis in men. The target audience for this guideline is all clinicians, and the target patient population is all adult men older than age 50 years. These recommendations are based on the systematic evidence review by Liu and colleagues (8) in this issue and the Agency for Healthcare Research and Quality–sponsored Southern California Evidence-based Practice Center evidence report (9).


Methods 
 
 

The literature search was done by Liu and colleagues and included studies from MEDLINE from 1990 to July 2007. In addition, the authors did reference mining of retrieved articles, references of previous reviews, and solicited articles from experts. Four researchers (2 pairs of an endocrinologist and a general internist trained in health services research) reviewed the list of titles and selected articles for further review. This guideline is based on an evaluation of 389 articles, of which 176 addressed risk factors for osteoporosis and 27 addressed diagnostic tools for osteoporosis. All of the included studies measured risk factors for osteoporosis or fracture in men or compared a non–dual-energy x-ray absorptiometry (DXA) index screening test with a gold standard reference test (either DXA-defined osteoporosis [T-score threshold of –2.5] or the occurrence of an osteoporotic fracture). The background article in this issue (8) provides details about the methods used for the systematic evidence review.

This guideline grades the evidence and recommendations by using the American College of Physicians' clinical practice guidelines grading system adopted from the classification developed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) workgroup (Table). In addition, to assess the internal validity of diagnostic studies, Liu and colleagues (8) used the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) evaluation tool.





   Table. The American College of Physicians' Guideline Grading System
 
 

 

Our main interest is to determine the risk factors for osteoporotic fracture that are mediated through low bone mineral density (BMD) and thus define men who would be more likely to benefit from DXA. However, in the interest of brevity, for the remainder of the article we simplify this to "risk factors for osteoporosis." The objective of this guideline is to synthesize the evidence for the following questions:

1. What are the risk factors for osteoporosis in men?

2. Are there any validated tools (other than central BMD) to screen for osteoporosis in men?

3. What are the risk factors for low BMD–mediated fracture?


Clinical Diagnosis of Osteoporosis 
 

The clinical diagnosis of osteoporosis is made in 2 ways: occurrence of an osteoporotic fracture and the World Health Organization's (WHO) bone density criteria. Fragility fractures are an important characteristic of osteoporotic bone disease and typically occur after a prolonged decrease in BMD and quality. Fragility fracture is defined by the WHO as a fracture from low-level trauma, meaning a fall from a standing height or lower. The bones most commonly fractured are the distal radius, proximal humerus, hip, and vertebral body. In 1994, the WHO defined osteoporosis as a BMD greater than 2.5 SDs (T-score, –2.5) below that of a young, healthy population as measured by DXA.

The standard for measuring BMD and diagnosing osteoporosis in men (and women) is DXA (10, 11). However, DXA is not universally available, is not portable, and is an imperfect predictor of future fractures. In addition, screening with DXA may not be cost-effective in all groups (expenses per quality-adjusted life-year varied from $30 000 to $248 000, depending on age) (10–14). Therefore, it is important to evaluate non-DXA osteoporosis tests that are sensitive, inexpensive, and easily implemented.


Risk Factors for Osteoporosis  
 

A high-quality meta-analysis showed that the most important risk factors for osteoporosis in men are age (>70 years), low body weight (body mass index <20 to 25 kg/m2 or lower), weight loss (>10% [compared with the usual young or adult weight or weight loss in recent years]), physical inactivity (participates in no physical activity on a regular basis [walking, climbing stairs, carrying weights, housework, or gardening]), use of oral corticosteroids, and previous fragility fracture (15). Most of the studies in this systematic review included participants older than age 50 years from the United States or Europe; thus the findings are limited in their generalizability to other populations.

The authors also reviewed evidence for other potential risk factors. Alcohol use results in an increased probability of fracture but has not been associated with decreased BMD in the available studies (16–21). Androgen deprivation therapy (pharmacologic and orchiectomy) is a strong predictor of both osteoporosis and fracture (22–33). Cigarette smoking and low dietary intake of calcium are moderate predictors of an increased risk for low bone mass; they are probably also risk factors for fracture, but the supporting evidence is less clear. Spinal cord injury is a moderate predictor of both low BMD and osteoporotic fracture in men. Data are insufficient in men to determine whether the presence of respiratory disease (independent of steroid use), type 2 diabetes, dietary intake of vitamin D, thyroid disease and thyroid replacement therapy, gastrointestinal malabsorption, rheumatoid arthritis, and hyperparathyroidism increase the risk for low BMD–mediated fracture. All of these possible risk factors have plausible physiologic rationales, and some have data supporting an association with osteoporosis and fracture in women, but data in men are lacking.


Screening Tests for Osteoporosis  
 

The diagnosis of osteoporosis is based on reduced BMD as measured by DXA (10, 11). However, DXA is expensive, and it is not portable or available everywhere (10–14). Therefore, it is important to identify and evaluate the efficacy of non-DXA screening tests. When calcaneal ultrasonography was evaluated in women, it was not sufficiently sensitive or specific to serve as a screening test for diagnosis of osteoporosis (34).

The studies evaluating osteoporosis screening tests in this guideline can be broadly divided into 2 categories: those that assess a test against a BMD measurement (DXA) and those that assess a test against a fracture occurrence.

Calcaneal Ultrasonography versus DXA-Measured BMD

Calcaneal ultrasonography is a diagnostic tool in which an ultrasonography probe is placed on either heel to measure BMD. It has many advantages, including portability, low cost, and the absence of ionizing radiation. However, there is no accepted threshold for a positive T-score of the quantitative ultrasonography index, and the thresholds used in the evaluated studies varied from 0 to –2.5.

Evidence showed that a calcaneal ultrasonography T-score of –1.0 had a sensitivity of 75% and a specificity of 66% to diagnose BMD-determined osteoporosis (central DXA T-score <–2.5) (34–38). When the calcaneal ultrasonography T-score was decreased to –1.5, the specificity increased to 78% but sensitivity decreased to 47%.

Osteoporosis Self-assessment Screening Tool versus DXA-Measured BMD

The osteoporosis self-assessment screening tool (OST) is a simple test used to develop a risk score for osteoporosis by using a person's age and weight (risk score = [weight in kilograms – age in years] x 0.2). No accepted threshold for a positive OST risk score exists, and thresholds used have varied from –1 to 3 in various studies.

Evidence from 2 studies that evaluated Asian men showed that an OST risk score of –1 had a sensitivity of 70% to 90% and a specificity of 70% to diagnose BMD-determined osteoporosis (37, 39). In a study of U.S veterans, an OST threshold of 3 was associated with a sensitivity of 93% and specificity of 66% (40). However, when the OST threshold was decreased to 1, the sensitivity decreased to 75% and specificity increased to 80%.

Calcaneal Ultrasonography versus Fracture Occurrence

Evidence from 10 studies showed that calcaneal ultrasonography moderately predicts fragility fractures in men (41–48). Several studies showed that each additional SD reduction in a calcaneal ultrasonography measurement resulted in an increased risk for hip fracture and nonspinal fracture (46, 48), and ultrasonography stiffness parameters were strongly associated with previous fragility fracture (42).

Combination of Calcaneal Ultrasonography and DXA-Measured BMD

Some researchers have suggested the use of calcaneal ultrasonography to identify patients who should have a confirmatory DXA testing. The evidence is less clear on the benefit of combining calcaneal ultrasonography and DXA BMD measurements compared with either test alone to predict fractures. One study showed a strong association of fragility fractures with BMD at the hip (odds ratio, 3.4) and calcaneal ultrasonography (odds ratio, 3.2). When both tests were used, the odds ratio increased to 6.1 (42). However, analysis of receiver-operating characteristic curves from another study showed that the combination was not superior to either test alone in predicting hip fractures (area under the curve for ultrasonography alone, 0.84; for BMD alone, 0.85; and for the combination, 0.85) (48).


Summary  
 
 

High-quality evidence shows that age, low body weight, physical inactivity, and weight loss are strong predictors of an increased risk for osteoporosis in men. There is also moderate-quality evidence that previous fragility fracture, systemic corticosteroid therapy, androgen deprivation therapy, and spinal cord injury are predictors of an increased risk for osteoporosis in men. Cigarette smoking and low dietary intake of calcium predict low bone mass.

Some studies suggest that OST may have higher sensitivity and specificity than calcaneal ultrasonography does in diagnosing DXA-determined osteoporosis (37, 39, 40). However, the primary outcome in the studies was not fractures, so this result should be viewed with caution because the clinical outcome of fracture is of most interest to patients and clinicians. In addition, moderate-quality evidence showed that calcaneal ultrasonography is an independent predictor of fractures in men even though its ability to diagnose DXA-determined osteoporosis is limited. Whether the combination of DXA BMD measurements and calcaneal ultrasonography to assess for fractures is better than either test alone remains uncertain.


Recommendations 
 
 

Recommendation 1: The American College of Physicians recommends that clinicians periodically perform individualized assessment of risk factors for osteoporosis in older men (Grade: strong recommendation; moderate-quality evidence).

A careful assessment of risk for osteoporosis in men is important. The appropriate age to start risk assessment is uncertain. However, by age 65 years, at least 6% of men have DXA-determined osteoporosis (49), therefore, assessment of risk factors before this age is reasonable. Factors that increase the risk for osteoporosis in men include age (>70 years), low body weight (body mass index <20 to 25 kg/m2), weight loss (>10% [compared with the usual young or adult weight or weight loss in recent years]), physical inactivity (participates in no physical activities on a regular basis [walking, climbing stairs, carrying weights, housework, or gardening]), corticosteroid use, androgen deprivation therapy, and previous fragility fracture. Risk assessments should be updated periodically for men who choose not to be screened.

Recommendation 2: The American College of Physicians recommends that clinicians obtain DXA for men who are at increased risk for osteoporosis and are candidates for drug therapy (Grade: strong recommendation; moderate-quality evidence).

Bone density measurement with DXA is the accepted reference standard for diagnosing osteoporosis in men (10, 11). Men who are at increased risk for osteoporosis are candidates for DXA. Little evidence about alternatives to DXA exists. The 2 most studied methods are quantitative ultrasonography (usually of the calcaneus) and the OST. Available evidence indicates that neither alternative is sufficiently sensitive or specific at predicting DXA-determined bone mass to be recommended as a substitute for DXA. Although 1 study has demonstrated a strong relationship between calcaneal ultrasonography and subsequent fracture, until treatment trials establish the effectiveness of therapy for osteoporosis diagnosed by ultrasonography rather than DXA, the role of ultrasonography in initiating therapy remains uncertain. No studies have evaluated the optimal intervals for repeated screening by using BMD measurement with DXA.

The evidence review showed that calcaneal ultrasonography predicts DXA-determined osteoporosis only modestly well. However, more important, it was a strong predictor of fracture in men. This may be because ultrasonography identifies other bone properties, such as bone quality, which may not be identified on DXA. Because treatment trials have not measured the effectiveness of therapy for osteoporosis diagnosed by ultrasonography rather than DXA, the role of ultrasonography in diagnosis remains uncertain.

Recommendation 3: The American College of Physicians recommends further research to evaluate osteoporosis screening tests in men.

A major limitation of existing osteoporosis screening studies is the use of BMD measurement (DXA) as the primary outcome rather than fracture occurrence. Although there is a large body of evidence about risk factors for osteoporosis in women, more research is needed to understand whether these risk factors also apply to men. Therapy should be evaluated in terms of fracture occurrence because of the significant disability, morbidity, mortality, and expenses that are associated with osteoporotic fractures. Furthermore, the harms of screening in this age group, such as radiation exposure and false-positive results, should also be studied. In addition, more research is needed in evaluating other screening tests, such as quantitative computed tomography, other types of questionnaires, or peripheral BMD measurements, which might also be useful as screening tests in men. Further research should explore whether acceptable substitutes for DXA exist (in terms of establishing the need for pharmacologic therapy). Research that explores the age at which men should begin to consider screening for osteoporosis and effective prevention measures for osteoporosis in men is also needed.



“It’s a poor sort of memory that onlyworks backwards, the Queen remarked.”
Lewis Carroll, 1872,
Through the Looking Glass

12 Ιουνίου 2008, 15:07:48
Απάντηση #28
Αποσυνδεδεμένος

πρώτη & καλύτερη

Ιατροί
Το link που παραθέτω, οδηγεί σε άρθρο που δημοσιεύτηκε το Μάιο 2008 και αφορά οδηγίες της AHA (American Heart Association) και ACC (American College of Cardiology) για τους εμφυτεύσιμους βηματοδότες και απινιδωτές.

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

Μια σύντομη περίληψη, με τα σημαντικότερα σημεία ειδικά για τους εμφυτεύσιμους απινιδωτές εδώ:

Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος
« Τελευταία τροποποίηση: 12 Ιουνίου 2008, 15:18:19 από πρώτη & καλύτερη »

15 Ιουλίου 2008, 08:29:43
Απάντηση #29
Αποσυνδεδεμένος

kapioskanis


Καλημέρα σε όλους

Στην κεντρική σελίδα του

MD Consult

hxxp://www.mdconsult.com/das/guidelines/99569752-2/1/toc?tab=spec

θα βρείτε Guidelines κατηγοριοποιημένες ανά ειδικότητα, ανά θέμα ενδιαφέροντος, ανά οργανισμό εκδόσεως και μάλιστα με εμφάνιση ανά χρονική σειρά.

Και για τους βιαστικούς οι απ' ευθείας υπερσύνδεσμοι για :

Family Medicine : hxxp://www.mdconsult.com/das/guidelines/99569752-2/0/toc?tab=specd&selectedNode=17

Emergency Medicine : hxxp://www.mdconsult.com/das/guidelines/99569752-2/0/toc?tab=specd&selectedNode=15

Καλημέρα και καλό καλοκαίρι
« Τελευταία τροποποίηση: 15 Ιουλίου 2008, 08:33:21 από kapioskanis »
“Το πρώτο σου χρέος, εχτελώντας τη θητεία σου στη ράτσα, είναι να νιώσεις μέσα σου όλους τους προγόνους. Το δεύτερο, να φωτίσεις την ορμή τους και να συνεχίσεις το έργο τους. Το τρίτο σου χρέος, να παραδώσεις στο γιο τη μεγάλη εντολή να σε ξεπεράσει.” Ν.Καζαντζάκης

"Ο πολίτης ουδενί των άλλων ορίζεται μάλλον ή τω μετέχειν κρίσεως και αρχής" Αριστοτέλης

 

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