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ΠΦΥ -Εκπαίδευση => Συζητήσεις πάνω σε ιατρικά θέματα => Μήνυμα ξεκίνησε από: Gatekeeper στις 27 Φεβρουαρίου 2008, 08:45:17

Τίτλος: Practice Guidelines
Αποστολή από: Gatekeeper στις 27 Φεβρουαρίου 2008, 08:45:17
National Institute for Health and Clinical Excellence guidance

Prostate Cancer
Prostate cancer: diagnosis and treatment

Guidance type:  Clinical guideline 
Date issued:  February 2008 

Τίτλος: Απ: Practice Guidelines
Αποστολή από: Gatekeeper στις 27 Φεβρουαρίου 2008, 08:47:28

National Institute for Health and Clinical Excellence guidance


The care and management of osteoarthritis in adults

Guidance type:  Clinical guideline 
Date issued:  February 2008 
Τίτλος: GOLD recommendations for the diagnosis, management, and prevention of COPD
Αποστολή από: Gatekeeper στις 27 Φεβρουαρίου 2008, 08:50:36
Global Strategy for the Diagnosis, Management, and Prevention of COPD
Revised 2007. Peer-reviewed summary of GOLD recommendations for the diagnosis, management, and prevention of COPD, with citations from the scientific literature.
Τίτλος: Secondary prevention in primary and secondary care for patients following a myoc
Αποστολή από: Gatekeeper στις 27 Φεβρουαρίου 2008, 09:03:21
National Institute for Health and Clinical Excellence guidance

Secondary prevention in primary and secondary care for patients following a myocardial infarction

Guidance type:  Clinical guideline 
Date issued:  May 2007 
Τίτλος: Guidelines Irritable bowel syndrome in adults
Αποστολή από: Gatekeeper στις 27 Φεβρουαρίου 2008, 11:07:49
National Institute for Health and Clinical Excellence guidance

Irritable bowel syndrome in adults: diagnosis and management of irritable bowel syndrome in primary care

Guidance type:  Clinical guideline 
Date issued:  February 2008 

The advice in the NICE guideline covers the care of adults with irritable bowel syndrome, including:

the support, treatment and advice people should be offered by their GP in diagnosing and helping to manage their irritable bowel syndrome
circumstances when people need to be referred to a specialist for further tests.
It does not specifically look at:

iirritable bowel syndrome in children and young people under 18 years
people with other gastrointestinal disorders such as non-ulcer dyspepsia (indigestion with no obvious cause) or coeliac disease.



Τίτλος: Απ: Practice Guidelines
Αποστολή από: kvasilakos στις 28 Φεβρουαρίου 2008, 22:57:08
ΕΥΧΑΡΙΣΤΟΥΜΕ ΠΟΛΥ.ΕΙΝΑΙ ΠΡΑΓΜΑΤΙΚΑ ΠΟΛΥ ΧΡΗΣΙΜΑ.
Τίτλος: Απ: Practice Guidelines
Αποστολή από: eliastheod στις 28 Φεβρουαρίου 2008, 23:40:49
atrial fibrillation - the management
Τίτλος: Απ: Practice Guidelines
Αποστολή από: eliastheod στις 28 Φεβρουαρίου 2008, 23:42:53
American Cancer Society Updates Annual Guidelines for Early Cancer Detection
Τίτλος: Απ: Practice Guidelines
Αποστολή από: eliastheod στις 29 Φεβρουαρίου 2008, 00:08:13
breast cancer
Τίτλος: The European Resuscitation Council Guidelines
Αποστολή από: Gatekeeper στις 29 Φεβρουαρίου 2008, 08:04:26
The European Resuscitation Council Guidelines for Resuscitation 2005 Summary

Για την πληρη εκδοση   http://www.erc.edu/index.php/guidelines_download_2005/en/
Τίτλος: Management of Arterial Hypertension
Αποστολή από: Gatekeeper στις 29 Φεβρουαρίου 2008, 23:35:31
EUROPEAN SOCIETY OF CARDIOLOGY (ESC)

ESC Guidelines: Management of Arterial Hypertension
Τίτλος: Universal Definition of Myocardial Infarction
Αποστολή από: Gatekeeper στις 1 Μαρτίου 2008, 15:15:49
EUROPEAN SOCIETY OF CARDIOLOGY (ESC)


ESC Guidelines: Universal Definition of Myocardial Infarction
Τίτλος: Diabetes, Pre-diabetes, and Cardiovascular Diseases
Αποστολή από: Gatekeeper στις 1 Μαρτίου 2008, 15:22:46
EUROPEAN SOCIETY OF CARDIOLOGY (ESC)



ESC Guidelines: Diabetes, Pre-diabetes, and Cardiovascular Diseases

Τίτλος: Treatment of Malaria (Guidelines For Clinicians)
Αποστολή από: Gatekeeper στις 4 Μαρτίου 2008, 21:59:56
Centers for Disease Control (CDC )


CDC Guidelines:Treatment of Malaria (Guidelines For Clinicians) March 2007
Τίτλος: WHO Guidelines for the treatment of malaria
Αποστολή από: Gatekeeper στις 4 Μαρτίου 2008, 22:08:29
World Health Organization (WHO)

WHO Guidelines for the treatment of malaria 2006
Τίτλος: UK malaria treatment guidelines
Αποστολή από: Gatekeeper στις 4 Μαρτίου 2008, 22:14:58
British Infection Society

British Infection Society Guidelines: UK malaria treatment guidelines Journal of Infection 2007; 54(2):111-21
Τίτλος: Guidelines Issued for Management of Hip and Knee Osteoarthritis
Αποστολή από: Gatekeeper στις 7 Μαρτίου 2008, 15:39:52
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.
Τίτλος: Απ: Guidelines Issued for Acute Otitis Externa
Αποστολή από: eliastheod στις 8 Μαρτίου 2008, 10:59:16
Guidelines Issued for Acute Otitis Externa

Otolaryngol Head Neck Surg. 2006;134(suppl):24-48
Τίτλος: Απ: Guidelines for Lyme Disease Prevention
Αποστολή από: eliastheod στις 8 Μαρτίου 2008, 12:21:02
New Guidelines for Lyme Disease Prevention

Clin Infect Dis. 2006;43:000-000
Τίτλος: Υπάρχει η νόσος του Lyme ενδημικά στην Ελλάδα;
Αποστολή από: Argirios Argiriou στις 8 Μαρτίου 2008, 13:26:20
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;
Τίτλος: Απ: ν. LYME στην Ελλάδα
Αποστολή από: eliastheod στις 8 Μαρτίου 2008, 17:16:39
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
Τίτλος: Απ: Guidelines Issued for Acute Otitis Externa
Αποστολή από: ManolisGP στις 8 Μαρτίου 2008, 23:02:17
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.

http://www.aafp.org/afp/20061101/1510.pdf
Τίτλος: Απ: Guidelines Issued for Early Detection of Colorectal Cancer
Αποστολή από: eliastheod στις 20 Μαρτίου 2008, 10:04:18
Guidelines Issued for Early Detection of Colorectal Cancer
CA Cancer J Clin. Published online March 5, 2008
Τίτλος: Guidelines Updated for Influenza Immunization in Children
Αποστολή από: Gatekeeper στις 14 Απριλίου 2008, 22:19:33
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.
 
Τίτλος: Clinical guidelines: Potential benefits, limitations,and harms.
Αποστολή από: Gatekeeper στις 29 Απριλίου 2008, 00:21:45
Clinical guidelines: Potential benefits, limitations,and harms.

Απο το BMJ.
Τίτλος: Απ: Clinical guidelines: Potential benefits, limitations,and harms.
Αποστολή από: Argirios Argiriou στις 30 Απριλίου 2008, 07:29:18
Παρ όλα αυτά νομίζω ότι τα πλεονεκτήματα του να βγάζει μια χώρα guidelines ζυγίζουν περισσότερο από τα μειονεκτήματα.
Τίτλος: Guidelines for Ventricular Arrythmias
Αποστολή από: πρώτη & καλύτερη στις 3 Μαΐου 2008, 22:38:02
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.   
Τίτλος: Screening for Osteoporosis in Men: from the American College of Physicians
Αποστολή από: Gatekeeper στις 10 Μαΐου 2008, 19:13:01
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.



Τίτλος: Γιατρέ, να βάλω βηματοδότη /απινιδωτή ??
Αποστολή από: πρώτη & καλύτερη στις 12 Ιουνίου 2008, 15:07:48
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.

http://content.onlinejacc.org/cgi/content/full/51/21/2085?linkType=FULL&journalCode=jacc&resid=51/21/2085

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

http://cardiology.jwatch.org/cgi/content/full/2008/611/1
Τίτλος: Απ: Practice Guidelines
Αποστολή από: kapioskanis στις 15 Ιουλίου 2008, 08:29:43
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
Τίτλος: Management of suspected bacterial UTI in adults
Αποστολή από: Gatekeeper στις 28 Σεπτεμβρίου 2008, 20:57:08
Management of suspected bacterial UTI in adults

SIGN July 2006
Τίτλος: Influenza (prophylaxis) - amantadine, oseltamivir and zanamivir
Αποστολή από: Gatekeeper στις 1 Οκτωβρίου 2008, 20:48:43
Influenza (prophylaxis) - amantadine, oseltamivir and zanamivir

Summary
NICE has said that its recommendations about oseltamivir and zanamivir should not reduce efforts to give vaccination (also called the flu jab) to people for whom it is recommended in national guidelines.

The guidance does not cover widespread epidemics.

Oseltamivir and zanamivir are recommended to prevent flu if all of the following apply:

The amount of flu virus going around is enough that if someone has a flu-like illness it is likely that it has been caused by the flu virus
The person is in an at-risk group (see page 4).
The person has been in contact with someone with a flu-like illness and can start treatment within 36 hours (for zanamivir) or within 48 hours (for oseltamivir)
The person has not been effectively protected by vaccination
Τίτλος: Clinical Practice Guidelines Issued for Managing Earwax Impaction
Αποστολή από: Gatekeeper στις 8 Οκτωβρίου 2008, 18:22:33
Clinical Practice Guidelines Issued for Managing Earwax Impaction

September 5, 2008 The American Academy of Otolaryngology–Head and Neck Surgery Foundation has issued evidence-based, clinical practice guidelines for managing cerumen (earwax) impaction and has published them in the September issue of Otolaryngology–Head and Neck Surgery. The new guidelines, which are intended for all clinicians who are likely to diagnose and manage patients with cerumen impaction, discourage routinely cleaning out cerumen.

"Unfortunately, many people feel the need to manually remove earwax, called cerumen, which serves an important protective function for the ear," lead author Peter S. Roland, MD, chairman of Otolaryngology–Head and Neck Surgery at University of Texas Southwestern Medical Center in Dallas, said in a news release. "Cotton swabs and some other home remedies can push cerumen further into the canal, potentially foiling the natural removal process and instead cause build-up, known as impaction."

Cerumen impaction is defined as an accumulation of cerumen that causes symptoms, prevents ear examination, or both. Although the term impaction suggests complete obstruction of the ear canal with cerumen, this working definition of cerumen impaction does not require complete obstruction.

The water-soluble mixture of secretions in cerumen produced in the outer third of the ear canal, along with hair and dead skin, serves a critical protective function for the ear and should not be removed unless it causes symptoms or prevents evaluation.

The objectives of these guidelines are to improve diagnostic accuracy regarding cerumen impaction, facilitate appropriate management for patients with cerumen impaction, highlight the need for assessment and intervention in special populations, ensure the implementation of indicated therapies with outcomes assessment, and improve counseling and education for the prevention of cerumen impaction.

The American Academy of Otolaryngology–Head and Neck Surgery Foundation appointed an expert panel of specialists in audiology, family medicine, geriatrics, internal medicine, nursing, otolaryngology–head and neck surgery, and pediatrics to review the appropriate evidence and to formulate these guidelines.

The panel made a strong recommendation that the indications for treating cerumen impaction are symptoms reported by the patient, or build-up sufficient to prevent indicated clinical examination.

Recommendations made by the panel were as follows:

Cerumen impaction should be diagnosed when accumulated cerumen is symptomatic or when it prevents needed examination of the external auditory canal, tympanic membrane, or both.


History and physical examination of the patient with cerumen impaction should focus on factors that could affect management, including a tympanic membrane that is not intact, ear canal stenosis, exostoses, diabetes mellitus, immunocompromised state, or anticoagulant therapy.


Patients with hearing aids should be evaluated during a healthcare encounter for the presence of cerumen impaction because cerumen can cause feedback, reduced sound intensity, or damage to the hearing aid. However, it is not necessary to perform this examination more often than once every 3 months.


Appropriate interventions for cerumen impaction may include ceruminolytic agents, irrigation, and/or manual removal other than irrigation. Ceruminolytic agents are effective, but evidence is lacking regarding the superiority of any particular agent. Irrigation or ear syringing is most effective when a ceruminolytic agent is instilled 15 to 30 minutes before treatment.


When in-office treatment of cerumen impaction is completed, clinicians should evaluate the patient and document that the impaction has resolved. Additional treatment should be prescribed if the impaction has not resolved. Alternative diagnoses should be considered if full or partial symptoms persist despite resolution of the impaction.
Options, which carry less weight than the recommendations, offered by the panel were as follows:

Patients with cerumen that is not impacted, is asymptomatic, and does not prevent adequate examination when an evaluation is indicated may be observed without active intervention.


In a patient who may not be able to express symptoms but who has cerumen obstructing the ear canal, clinicians may promptly evaluate the need for intervention.


The patient with cerumen impaction may be treated with ceruminolytic agents, irrigation, or manual removal other than irrigation.


Clinicians may educate and counsel patients who have cerumen impaction and/or excessive cerumen regarding appropriate control measures.


To avoid damaging the ear or create more impaction, suction devices or other specialty instruments should be used only under supervised medical care. Removal with specialty instruments is preferred for patients with narrow ear canals, eardrum perforation or tube, or immune deficiency.
The guidelines warn against patients using cotton-tipped swabs and against home use of oral jet irrigators. Ear candling, an alternative to traditional methods of earwax removal, is ineffective and is potentially dangerous.

"The complications from cerumen impaction can be painful and include infections and hearing loss," Dr. Roland said. "It is hoped that these guidelines will give clinicians the tools they need to spot an issue early and avoid serious outcomes."

The authors note that this clinical practice guideline is not intended to be the only source of guidance in managing cerumen impaction, nor is it intended to replace clinical judgment or to establish a protocol for all individuals with this condition. Although it is designed to assist clinicians by providing an evidence-based framework for decision-making strategies, it may not provide the only appropriate approach to diagnosing and managing this problem.

Three of the guidelines authors have disclosed various financial relationships with Alcon Labs, MedEl Corporation, Advanced Bionics, Cochlear Corporation, GlaxoSmithKline, Acclarent, Sinexus, National Institutes of Health, Krames Communication, Schering-Plough, and/or sanofi-aventis.

Otolaryngol–Head Neck Surg. 2008;139:S1-S21.

Study Highlights
The prevalence of cerumen impaction varies and in the United States has been estimated as affecting 10% of children, 5% of healthy adults, up to 57% of older persons in nursing homes, and 36% of those with mental disabilities.
12 million people seek treatment annually for cerumen impaction, and 8 million procedures are performed by healthcare professionals.
Treatment of impaction has resulted in complications such as ear canal laceration, infection, hearing loss, otitis externa, pain, syncope, and dizziness at the rate of 1 in 1000 ear irrigations.
Recommendations
The diagnosis of impaction requires a targeted history, physical examination, otoscopy, binocular microscopic examination, and audiologic evaluation.
Clinicians should diagnose impaction when it is associated with symptoms, prevents assessment of the ear, or both.
Factors that modify management include a tympanic membrane that is not intact, ear canal stenosis, exostosis, diabetes mellitus, anticoagulant treatment, or immunocompromise.
Narrow ear canals may be found in those with Down's syndrome and other craniofacial disorders.
Those with hearing aids should be examined for an impacted cerumen every 6 to 12 months because impaction can cause poor fit of the hearing aid and reduced sound intensity or feedback.
Appropriate interventions for an impacted cerumen include ceruminolytic agents, irrigation, or manual removal other than irrigation.
Manual removal other than irrigation includes a curette, probe, forceps, suction, and hook.
Mechanical removal is the preferred technique when the eardrum is not intact.
In the presence of anatomic anomalies, safe and effective irrigation is not always possible, and the binocular microscope with microinstrumentation may be needed.
Patients receiving anticoagulants are at higher risk for hemorrhage.
Clinicians should examine patients at the end of an intervention and document resolution of the impaction.
Alternative treatment and alternative diagnoses should be considered if resolution of the impaction does not occur.
Ear candling is potentially unsafe and is not endorsed by the US Food and Drug Administration to treat impaction.
Options
Observation of impaction is reasonable in the absence of symptoms, and a needs assessment of the ear can be conducted.
Elderly patients, young children, and those with cognitive impairment are at high risk for impaction and may not be able to express symptoms.
The clinician should weigh potential benefits and harms of treating impaction in this population.
Clinicians may use ceruminolytic agents including water or saline to manage impaction or instruct patients in home use.
Ceruminolytic agents may be water based or oil based.
No specific ceruminolytic agent has been found to be superior to another in clinical trials.
The use of cerumenolytics up to 15 minutes or days before irrigation improves the success of irrigation.
Clinicians may use irrigation in the management of impaction.
Clinicians may use manual removal other than irrigation for impaction, especially in those with abnormal otologic findings, systemic illness, or compromised immunity.
Clinicians should ensure adequate training and use of appropriate equipment for procedures.
Clinicians may educate patients on control measures including use of prophylactic topical preparations, irrigation of the ear canal, or routine cleaning by a clinician.


Τίτλος: Απ: Practice Guidelines
Αποστολή από: OBELIX στις 22 Νοεμβρίου 2008, 23:44:47
Για ογκολογικά: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp
Πρόκειται για τα επίσημα Αμερικάνικα Guidelines του Νational Comprehensive Cancer Network κυρίως για θεραπεία
Τίτλος: Ασπιρίνη ή αντιπηκτικά στην κολπική μαρμαρυγή ? Guidelines AHA/ACC/ASC
Αποστολή από: πρώτη & καλύτερη στις 27 Δεκεμβρίου 2008, 18:46:40
Στον παρακάτω πίνακα κατατάσσονται οι ασθενείς με κολπική μαρμαρυγή ανάλογα με τον κίνδυνο εμφάνισης stroke και δίδονται οδηγίες για την πρόληψή του με ασπιρίνη ή αντιπηκτικά peros.
Τίτλος: Απ: Ασπιρίνη ή αντιπηκτικά στην κολπική μαρμαρυγή ? Guidelines AHA/ACC/ASC
Αποστολή από: Argirios Argiriou στις 27 Δεκεμβρίου 2008, 21:39:59
BMJ, 29.01.2005,

Recent developments in atrial fibrillation:

............
.............................

Determine thromboembolic risk. (see figure number 3)

.............................................

http://www.bmj.com/cgi/content/full/330/7485/238
Τίτλος: Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage
Αποστολή από: KERASIDISN στις 23 Ιανουαρίου 2009, 18:08:24
A Statement for Healthcare Professionals From a Special Writing Group of the Stroke Council, American Heart Association

Stroke published online Jan 22, 2009

http://stroke.ahajournals.org/cgi/reprint/STROKEAHA.108.191395

Τίτλος: Carotid endarterectomy—An evidence-based review
Αποστολή από: flone στις 6 Απριλίου 2009, 18:00:05
Carotid endarterectomy—An evidence-based review: Report of the Therapeutics and Technology Assessment Subcommittee  of the American Academy of Neurology

AHA Conference Proceedings: Controversies in Carotid Artery Revascularization
Τίτλος: American Geriatrics Society - Pain Management Guidelines
Αποστολή από: Μαρία Χόρτη στις 17 Μαΐου 2009, 20:07:20
Geriatrics Society Changes Its Pain Management Guidelines

Older patients with moderate-to-severe pain are candidates for opioid therapy and should only "rarely" receive nonselective NSAIDs and COX-2 selective inhibitors, according to a revision of the American Geriatrics Society's pain management guidelines.

In its first revision since 2002, the society makes several recommendations, among them:

-Acetaminophen should be the "initial and ongoing" drug treatment for persistent — "particularly musculoskeletal" — pain.
-Nonselective NSAIDs and COX-2 selective inhibitors may be considered "with extreme caution" for patients in whom "other (safer) therapies have failed."
-Patients with fibromyalgia or neuropathic pain are candidates for adjuvant analgesics.
-Breakthrough pain should be anticipated with opioid use, and it should be treated with short-acting, immediate-release opioids.

http://www.americangeriatrics.org/education/final_recommendations.pdf
Τίτλος: New AHA/ASA Guidelines on TIA Management
Αποστολή από: Raptor στις 25 Μαΐου 2009, 12:38:21
New AHA/ASA Guidelines on TIA Management and Telemedicine in Acute Stroke Released

May 15, 2009 — The American Heart Association (AHA)/American Stroke Association (ASA) has released 2 new guideline documents, 1 advocating urgent treatment for transient ischemic attacks (TIA) and changing the clinical definition and the other giving a green light to the use of telemedicine consults in acute stroke assessment.

Along with the 2 scientific statements, a policy statement has also been published to provide recommendations on how best to implement telemedicine in stroke care systems.

The TIA and telemedicine stroke documents are published online May 7 and will appear in the June and July issues of Stroke, respectively.

New Definition of TIA

In the scientific statement examining the definition and evaluation of TIAs, the writing group points out that large cohort and population-based studies reported in the past 5 years have shown that the risk for stroke after a TIA is higher than previously thought. "Ten percent to 15% of patients have a stroke within 3 months, with half occurring within 48 hours," the group, chaired by J. Donald Easton, MD, professor and chair of the department of clinical neurosciences at Alpert Medical School of Brown University and the Rhode Island Hospital, in Providence, writes.

Accordingly, the authors recommend that TIAs be subject to the same urgent assessment and care given to acute strokes and, to that end, have changed the clinical definition of TIA. "We think a TIA should be treated as an emergency, just like a major stroke," Dr. Easton said in a news release from the AHA/ASA. "Because we know the high risk for a future stroke, this is a golden opportunity to prevent a catastrophic event."

The traditional clinical definition, dating to the mid-1960s, is "a sudden neurological deficit of presumed vascular origin lasting less than 24 hours." The new statement changes this definition to "a transient episode of neurological dysfunction caused by focal brain, spinal-cord, or retinal ischemia, without acute infarction."

The presence of infarction has been the main distinction between stroke and TIA, but the advent of more sensitive imaging of tissue damage using magnetic resonance imaging (MRI) has suggested that infarction with presumed TIAs may occur often.

"Research around the globe has shown that the arbitrary threshold based on duration of symptoms was too broad, because up to half of TIAs defined this way actually caused sustained brain injury according to an MRI," Dr. Easton noted.

Long-Distance Stroke Assessment

In the scientific statement on telemedicine, the writing group, chaired by Lee Schwamm, MD, from Harvard Medical School and Massachusetts General Hospital, in Boston, provides an evidence-based review of the scientific evidence supporting the use of telemedicine for stroke care delivery and concludes that high-quality videoconferencing systems can be used by remote stroke specialists to carry out National Institutes of Health Stroke Scale (NIHSS)-telestroke examinations when a bedside assessment is not immediately available for patients who may be having an acute stroke and provide results comparable to the beside assessment.

It is recommended that these examinations be supported by the use of a Food and Drug Administration (FDA)–approved teleradiology system, where computed-tomography (CT) and MRI scans can also be viewed by the remote stroke specialist, the authors note. The specialist can then make recommendations to the on-site providers about whether tissue plasminogen activator should be used or not.

Similarly, these systems can be used to provide occupational and physical therapy remotely, the document notes.

"Telemedicine is an effective avenue to eliminate disparities in access to acute stroke care, erasing the inequities introduced by geography, income, or social circumstance," Dr. Schwamm said in news release from the AHA/ASA.

Changes in reimbursement for telemedicine activities, though, are required for implementation of a telestroke system and require consideration of a number of other issues, including cost recovery, liability, and training of provider. For that reason, a second document of policy recommendations accompanies the scientific statement.

The recommendations include:

Whenever local or on-site acute stroke expertise or resources are insufficient to provide around-the-clock coverage for a healthcare facility, telestroke systems should be deployed to supplement resources at participating sites.
New models and codes for reimbursement of telestroke services should be developed to reflect the increased up-front costs to providers and reduced long-term healthcare costs to insurers.
Organizations providing or requesting telemedicine services should operate by contractual agreements that explicitly deal with such issues as assignment of costs for developing and maintaining the telemedicine network; compliance with relevant federal, state, and local statute boundaries and any existing noncompete relationships; assessment of medicolegal risk and provision of adequate malpractice coverage; and administrative and credentialing requirements for all providers.
"Telestroke can enable the initiation of cost-effective interventions proven to reduce complications and stroke recurrence and can identify and facilitate transfer of patients in the community for specific tertiary-care interventions, such as neurointensive care, decompressive surgery for life-threatening, space-occupying cerebral infarction, and prompt surgical or endovascular repair of ruptured cerebral aneurysms," the authors conclude.

.

Stroke. Published online May 7, 2009.

Τίτλος: Recommendation From USPSTF: Aspirin for the Prevention of Cardiovascular Disease
Αποστολή από: Raptor στις 2 Ιουνίου 2009, 14:06:46
Recommendation Statement From USPSTF: Aspirin for the Prevention of Cardiovascular Disease

Summary of Recommendations

The USPSTF recommends the use of aspirin for men age 45 to 79 years when the potential benefit due to a reduction in myocardial infarctions outweighs the potential harm due to an increase in gastrointestinal hemorrhage. Go to the Clinical Considerations section for discussion of benefits and harms. Grade: A recommendation.


The USPSTF recommends the use of aspirin for women age 55 to 79 years when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage. Go to the Clinical Considerations section for discussion of benefits and harms. Grade: A recommendation.


The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of aspirin for cardiovascular disease prevention in men and women 80 years or older. Grade: I statement.


The USPSTF recommends against the use of aspirin for stroke prevention in women younger than 55 years and for myocardial infarction prevention in men younger than 45 years. Grade: D recommendation
Τίτλος: Low back pain: NICE guideline
Αποστολή από: Gatekeeper στις 18 Ιουνίου 2009, 22:56:52
Low back pain 
Early management of persistent non-specific low back pain

NICE guideline 27 May 2009
Τίτλος: Απ: Practice Guidelines
Αποστολή από: Μαρία Χόρτη στις 21 Ιουνίου 2009, 19:55:40
Global Strategy for the Diagnosis and Management of Asthma in Children 5 Years and Younger. (GINA) 2009

http://www.ginasthma.org/Guidelineitem.asp??l1=2&l2=1&intId=1689

Pocket Guide for Asthma Management and Prevention in Children 5 Years and Younger

http://www.ginasthma.org/Guidelineitem.asp??l1=2&l2=1&intId=1691

Τίτλος: Asthma Guideline update
Αποστολή από: Raptor στις 9 Ιουλίου 2009, 12:15:03
Asthma Guideline update

The Scottish Intercollegiate Guidelines Network (SIGN) / British Thoracic Society (BTS) Guideline on the Management of Asthma has been updated

The update includes a review of the sections on pharmacological management, acute asthma and the management of asthma in pregnancy and key messages include:


---  Oxygen levels in patients with acute asthma should be maintained at SpO2 94-98%
---  Oxygen saturation should be measured by pulse oximeters in adults and children. Pulse oximeters should therefore be available for use by all health professionals assessing acute asthma in both primary and secondary care settings
---The importance of action plans in controlling asthma and reducing future hospitalisation is reinforced
---  Reinforced advice on the safe use of treatment during pregnancy [/li][/list]

In addition, inhaled steroid doses are now referenced to CFC-free metered dose inhaler devices due to the phased withdrawal of CFC containing inhalers.

Τίτλος: Primary Care Guidelines Updated for Management of HIV
Αποστολή από: Μαρία Χόρτη στις 22 Αυγούστου 2009, 10:02:12
The new recommendations were developed by an expert panel from the HIV Medicine Association (HIVMA) of the Infectious Diseases Society of America (IDSA) to assist primary care providers who care for HIV-infected patients or patients who may be at risk for acquiring HIV infection.
Specific changes and/or additions to the updated guidelines (and their accompanying level of evidence rating) since the previous 2004 update are as follows:

• Regardless of whether antiretroviral therapy will be started, all HIV-infected patients should have a genotypic resistance test at baseline (A-III).

• As soon as possible (within 96 hours) after exposure to a person with chickenpox or shingles, patients who are seronegative for varicella zoster virus (VZV) or with no history of chickenpox or shingles should receive postexposure prophylaxis with VZV immune globulin (VariZIG; A-III).

• Clinicians may consider varicella primary vaccination for HIV-infected, VZV-seronegative persons older than 8 years who have CD4 cell counts higher than 200 cells/mm3 (C-III) and in HIV-infected children aged 1 to 8 years who have CD4 cell percentages at least 15% (B-II).

• Cerebrospinal analysis is recommended for persons with syphilis who have neurologic or ocular signs or symptoms, active tertiary syphilis, syphilis treatment failure, or late-latent syphilis, including those with syphilis of unknown duration (A-II).

• To decrease the risk for a hypersensitivity reaction, human leukocyte antigen (HLA)-B*5701 testing is recommended before starting treatment with abacavir (A-I). Abacavir therapy should not be given to patients who are positive for the HLA B*5701 haplotype (A-II).

• Baseline urinalysis and calculated creatinine clearance may be helpful, particularly in black patients, because of greater risk for HIV-associated nephropathy (B-II).

• Before starting treatment with potentially nephrotoxic drugs such as tenofovir or indinavir, urinalysis and calculated creatinine clearance are recommended (B-II).

• Before starting treatment with a chemokine receptor 5 (CCR5)-antagonist antiretroviral drug, tropism testing is recommended (A-II).

• Women aged 40 to 49 years should periodically undergo individualized evaluation of risk for breast cancer and be informed regarding the potential benefits and risks of screening mammography (B-II).

• Routine use of hormone replacement therapy is not currently recommended because of slightly increased risk for breast cancer, cardiovascular disease, and thromboembolic disease (A-I). If hormone replacement is considered in women who experience vasomotor symptoms, vaginal dryness, or other severe menopausal symptoms, it should generally be used only for a limited period and at the lowest effective doses (B-II).

• The importance of adherence to care should be emphasized, rather than just adherence to medications (B-II).

“As we seek to make each patient comfortable and promote his or her engagement in primary care, it is important to keep in mind that HIV/AIDS affects a diverse group of persons in terms of race/ethnicity, culture, gender, and lifestyle,” the study authors conclude. “Each patient should be treated as an individual, and HIV treatment sites should provide culturally competent and appropriate care to the community of patients being served. A broad range of components, from having staff of the same race, culture, or lifestyle to having art and reading material in the clinic that reflects the culture of the local community, may be useful in facilitating this goal.”

http://www.medscape.com/viewarticle/707477?src=mpnews&spon=18&uac=32150DN
Τίτλος: Using Nontraditional Risk Factors in CHD: USPSTF Recommendation Statement
Αποστολή από: Gatekeeper στις 27 Οκτωβρίου 2009, 08:54:53
Nontraditional Risk Factors May Not Help Assess Coronary Heart Disease Risk

Use of nontraditional risk factors may not help assess coronary heart disease (CHD) risk in asymptomatic men and women with no CHD history, according to a new US Preventive Services Task Force (USPSTF) recommendation statement and accompanying evidence review reported in the October 6 issue of the Annals of Internal Medicine.

The USPSTF found that there was not sufficient evidence to evaluate the balance of benefits vs harms of using any of the 9 nontraditional risk factors to screen asymptomatic men and women with no history of CHD to prevent CHD events.

The 9 nontraditional risk factors evaluated were high-sensitivity C-reactive protein (hs-CRP), ankle-brachial index (ABI), leukocyte count, fasting blood glucose level, periodontal disease, carotid intima-media thickness, coronary artery calcification score on electron-beam computed tomography, homocysteine level, and lipoprotein(a) level.

"...CHD is the most common cause of mortality of adults in the United States," write Ned Calonge, MD, MPH, and USPSTF colleagues from the Agency for Healthcare Research and Quality in Rockville, Maryland. "Treatment to prevent CHD events by modifying risk factors is currently based on the Framingham risk model, which sorts individuals into low-, intermediate-, or high-risk groups. If the risk model could be improved, treatment might be better targeted, thereby maximizing screening benefits and minimizing harms."

The statement authors note that the best opportunity for nontraditional, or novel, risk factors to improve risk classification would be to change those in the intermediate-risk Framingham group to either a low-risk or high-risk group. In the United States, approximately 23 million people with no history of cardiovascular disease are classified by the Framingham score as intermediate risk, but it is unknown how many of these individuals are actually at high risk and could benefit from more aggressive therapy aiming at risk-factor modification reduction.

The Framingham score, which classifies people based on their projected 10-year risk for a major coronary event, uses 7 traditional risk factors for CHD: age, sex, total blood cholesterol level, high-density lipoprotein cholesterol level, smoking status, systolic blood pressure, and use of antihypertensive medication.

Systematic Reviews Performed

The investigators performed systematic reviews of the literature since 1996 on the 9 proposed nontraditional markers of CHD risk. They used a hierarchic approach in hopes of identifying which of these factors could practically and definitively recategorize individuals determined by their Framingham score to be intermediate risk. If these individuals could be reclassified, using any of the novel risk factors, as either high risk or low risk, outcomes might be improved by aggressively targeting risk factors in those individuals newly classified as high risk.

For 7 of the 9 nontraditional risk factors, evidence was insufficient to estimate the percentage of Framingham intermediate-risk individuals who would be reclassified as low risk or high risk using these factors.

Based on hs-CRP screening, approximately 11% of men classified as Framingham intermediate risk would be reclassified as high risk, and approximately 12% would be reclassified as low risk. Small study samples precluded determination of the effect of hs-CRP screening on risk classification in women.

Based on ABI screening, approximately 10% of women classified as Framingham intermediate risk would be reclassified as high risk, but data are insufficient regarding the effect of ABI screening on risk classification in men. For either hs-CRP or ABI screening, however, there are no data to evaluate whether reclassified individuals would benefit from additional treatments targeting these risk factors.

There was limited evidence to assess the harms of screening with novel risk factors. However, potential harms could include risks inherent in lifelong use of medications without proven benefit and psychological and other harms from being misclassified in a higher-risk category.

"The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of using the nontraditional risk factors studied to screen asymptomatic men and women with no history of CHD to prevent CHD events (I statement)," the recommendation statement authors write. "Clinicians should use the Framingham model to assess CHD risk and to guide risk-based therapy until further evidence is obtained....Because adding nontraditional risk factors to CHD assessment requires additional patient and clinical staff time and effort, routinely screening with nontraditional risk factors could result in lost opportunities for provision of other important health services of proven benefit."

Accompanying Evidence Review

The accompanying evidence review was a summary of 9 systematic reviews of novel risk factors by Mark Helfand, MD, from the Oregon Evidence-Based Practice Center, Veterans Affairs Medical Center, and Oregon Health & Science University in Portland, and colleagues.

"Traditional risk factors do not explain all of the risk for incident...CHD events," the review authors write. "Various new or emerging risk factors have the potential to improve global risk assessment for CHD."

The reviewers searched MEDLINE for relevant English-language articles describing cohort studies of novel CHD risk factors published from 1966 to September 2008. Inclusion criteria were no baseline cardiovascular disease in the participants and adjustment for at least 6 Framingham risk factors.

USPSTF criteria were used to assess methodologic quality of individual studies. For each nontraditional risk factor, overall quality of evidence was examined with a modified version of the Grading of Recommendations, Assessment, Development, and Evaluation framework. The potential clinical usefulness of each factor was determined by use of a set of criteria highlighting the importance of the impact of that factor on restratifying individuals at intermediate risk based on the Framingham score.

There was considerable variability across the risk factors in aggregate quality, availability and validity of the evidence, consistency of the results, and applicability to individuals in the general population classified by the Framingham score as intermediate risk. For most of the novel risk factors, no studies have examined their usefulness for reclassifying individuals at intermediate risk.

Limitations of the review included lack of access to original data, precluding arriving at definite conclusions concerning differences in risk prediction among racial and ethnic groups. Furthermore, the review was not able to highlight within-cohort comparisons of multiple novel risk factors.

"...CRP was the best candidate for use in screening and the most rigorously studied, but evidence that changes in CRP level lead to primary prevention of CHD events is inconclusive," the review authors write. "The current evidence does not support the routine use of any of the 9 risk factors for further risk stratification of intermediate-risk persons."

Conclusions of the USPSTF are not to be construed as official positions of the US government or the Agency for Healthcare Research and Quality. The statement and review authors have disclosed no relevant financial relationships.

Ann Intern Med. 2009;151:474-482, 496-507. Abstract

Additional Resources

More information on heart disease and risk factors is available on the Framingham Heart Study Web site. The risk assessment tool based on the Framingham data to estimate one's 10-year risk of a myocardial infarction or coronary death is also accessible.

Study Highlights

Researchers focused on the usefulness of nontraditional variables in further quantifying the CHD risk for intermediate-risk patients. These patients may benefit most by reclassification into low-risk (no treatment of CHD risk) or high-risk (aggressive treatment) groups.
Nontraditional risk factors assessed included hs-CRP, ABI, leukocyte count, fasting blood glucose level, periodontal disease, carotid intima-media thickness, coronary artery calcification score on electron beam computed tomography, homocysteine level, and lipoprotein(a) level.
The collective research into these nontraditional risk factors was mainly limited by a failure to assess the incremental value of nontraditional risk factors vs more traditional risk assessments.
Furthermore, there was no evidence that risk stratification with any nontraditional risk factor was associated with reduced rates of myocardial infarction or cardiovascular mortality.
Several factors, including periodontal disease, coronary artery calcium scans, and increased carotid intima-media thickness, were independent predictors of CHD. However, these variables were not applied specifically to those patients at intermediate risk for CHD.
Although elevated levels of lipoprotein(a) and homocysteine were predictive of a higher risk for CHD events, no research has examined their predictive value beyond traditional risk calculators.
hs-CRP would help to reclassify approximately 11% of men with an intermediate CHD risk into the high-risk category, and 12% of these men would be reclassified as low risk with hs-CRP testing. However, it is unknown whether treating patients reclassified as high risk based on hs-CRP testing is effective in reducing the risk for CHD events. hs-CRP testing is less well researched among women.
ABI may move 10% of women from the intermediate-risk group for CHD into the high-risk group. However, any similar efficacy of ABI testing among men remains unclear.
No studies have directly measured the potential harms associated with CHD risk testing by use of nontraditional variables. However, long-term preventive treatments with statins and aspirin may be increased if more patients are considered moderate risk or high risk for CHD.
Overall, the USPSTF concludes that there is insufficient evidence to assess the balance of benefits and harms of using nontraditional risk factors to screen for CHD risk among asymptomatic adults.

Clinical Implications

The algorithm by ATP III of the National Cholesterol Education Program calculates patients' 10-year risk for a CHD event using their age, sex, systolic blood pressure, serum total cholesterol level, high-density lipoprotein cholesterol level, and smoking status.
There is insufficient evidence to recommend the routine use of nontraditional variables to screen for CHD risk among asymptomatic adults, according to the USPSTF.
Τίτλος: Harmonizing the Metabolic Syndrome: A Joint Interim Statement
Αποστολή από: Gatekeeper στις 27 Οκτωβρίου 2009, 09:10:06
A new joint statement from a number of professional organizations has identified specific criteria for the clinical diagnosis of the metabolic syndrome, tightening up the definition, which previously differed from one organization to the next [1].

The statement, published online October 5, 2009, in Circulation, includes the participation of the International Diabetes Federation (IDF), the National Heart, Lung, and Blood Institute (NHLBI), the World Heart Federation, the International Atherosclerosis Society, and the American Heart Association (AHA) and is an attempt to eliminate some of the confusion regarding how to identify patients with the syndrome.

"This paper represents an attempt to make the definition global," Dr Robert Eckel (University of Colorado, Denver), one of the authors of the new report, told heartwire . "The IDF definition and the [National Cholesterol Education Program Adult Treatment Panel] ATP III definition have been the two that have been utilized most frequently, and now the different organizations--the IDF, the International Atherosclerosis Society, the NHLBI, and the AHA--have all signed on to a single definition. I think that's a step forward in terms of not continuing to confuse people who are working in this field."

Specifically, the new metabolic-syndrome definition streamlines previous differences related to abdominal obesity as defined by measurements in waist circumference. Substantial disparities existed between the previous IDF and the ATP III definitions of what constituted an excessively large waist circumference, by as much as 8 cm between the two groups, but these have been amended. Now, the criteria for elevated waist circumference are based on population- and country-specific definitions, which, although streamlined, do leave some work to be done, said Eckel.

"The problem that still exists is that regional differences around the world may be substantial in terms of what waist circumference confers additional risk for heart disease and diabetes," he said. "The new definition relies on different geographic regions, or different countries, to drill down into their own databases in terms of relating waist circumference to risk." Eckel noted that the IDF previously considered elevations in waist circumference mandatory when defining metabolic syndrome, although the ATP III did not. Now, waist circumference is just one of five criteria that physicians can use when diagnosing the metabolic syndrome. Patients with three of the five criteria--including elevated waist circumference, elevated triglycerides, reduced high-density lipoprotein (HDL)-cholesterol levels, elevated blood pressure, and elevated fasting-glucose levels--are considered to have the syndrome.

Criteria for Clinical Diagnosis of the Metabolic Syndrome Measure  Categorical cut points 
Elevated waist circumference  Population- and country-specific definitions
Elevated triglycerides (drug treatment for elevated triglycerides is an alternate indicator)  >150 mg/dL
Reduced HDL cholesterol (drug treatment for reduced HDL cholesterol is an alternate indicator)  <40 mg/dL for males and <50 mg/dL for females
Elevated blood pressure (drug treatment for elevated blood pressure is an alternate indicator)  Systolic >130 mm Hg and/or diastolic >85 mm Hg
Elevated fasting glucose (drug treatment for elevated glucose is an alternate indicator)  >100 mg/dL


Notably absent from the joint statement is the American Diabetes Association. As reported by heartwire , there are unresolved scientific issues between the ADA and other associations, including the AHA, regarding the metabolic syndrome. Specifically, the ADA, as well as the European Association for the Study of Diabetes (EASD), objected to the manner in which the metabolic syndrome was characterized as a risk factor for heart disease or diabetes, arguing that there was no need to diagnose a patient with the syndrome because emphasis should be placed on aggressively treating the individual risk factors. In 2005, the ADA and EASD issued their own joint statement calling for a critical appraisal of the metabolic syndrome, its designation as a syndrome, and its clinical utility.

To heartwire , Eckel said the IDF, AHA, NHLBI, and others began working on the new metabolic syndrome definition in 2008 and that they simply went ahead without ADA participation. He stressed the metabolic syndrome is not a disease but simply a clustering of risk factors. The original intention of identifying the syndrome was simply to draw clinicians' and the public's attention to the importance of a high-quality lifestyle, and the metabolic syndrome is never meant to be used as a predictor of heart disease or diabetes risk.

References

Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome. A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120:1640-1645. Abstract

http://circ.ahajournals.org/cgi/reprint/120/16/1640?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=metabolic+syndrome&searchid=1&FIRSTINDEX=0&resourcetype=HWCIT
Τίτλος: IDF Releases New Guidelines on Diabetes Management
Αποστολή από: Raptor στις 27 Οκτωβρίου 2009, 13:42:11
 The International Diabetes Federation (IDF) announced the release of several new guidelines related to diabetes management here at the IDF 20th World Diabetes Congress. These include the first-ever international guidelines on the management of diabetes in pregnancy and guidelines on the use of self-monitoring of blood glucose (SMBG) among type 2 diabetic patients not being treated with insulin.

Pregnancy and Diabetes Guidelines Call for Universal Screening

Lois Jovanovič, MD, CEO and chief scientific officer of Sansum Diabetes Research Institute in Santa Barbara, California, and clinical professor of medicine at the University of Southern California-Los Angeles Medical Center, is one of the authors of the IDF Global Guideline on Pregnancy and Diabetes. "The guidelines were created with evidence-based medicine. Then we asked an international group [of experts] to give us their opinion," she told Medscape Diabetes & Endocrinology.

"There was no international standard [for the diagnosis and management of gestational diabetes], said Dr. Jovanovič. "There was no consensus, there was a lot of confusion, women were suffering, and their pregnancy outcome was affected by having no standard by which to judge whether their diabetes was worth treating or not. This is the first time there is a worldwide consensus."

A key message of the new guidelines, according to Dr. Jovanovič, is the importance of universal screening. "Look for hyperglycemia in pregnancy," she said. "Preconceptional counseling [also] has to be universal. . . . For a [primary care] physician who has a [patient] in child-bearing years, the first question should be: Are you interested in getting pregnant again?"

Self-Monitoring of Blood Glucose in Noninsulin-Treated Type 2 Diabetes

The IDF Guideline on Self-Monitoring of Blood Glucose in Non-Insulin Treated Type 2 Diabetes was developed in a manner similar to the IDF pregnancy guidelines. Their highlights include the following:

SMBG should be considered at the time of diagnosis but should only be used when patients, their caregivers, and/or their healthcare providers have the knowledge and willingness to incorporate findings into the diabetes management plan.
SMBG should be considered a part of ongoing diabetes self-management education.
SMBG protocols should be individualized.
Patients and their healthcare providers should agree on how to use SMBG data.
Tools used to measure SMBG must be easy to use and accurate.
Unique Features of Guidelines

Both sets of guidelines have key features that differentiate them from guidelines on the same topics put out by other diabetes associations, such as the American Diabetes Association (ADA), said Dr. Jovanovič.

"The ADA hopefully will change soon, but right now they don't subscribe to the philosophy of universal screening [in pregnancy]. They talk about selective screening. Our guidelines not only talk about universal screening but almost assume that every woman has diabetes [and] doing the testing is to reassure her that she doesn't. So, it's a paradigm shift. The second major difference is the [IDF] recommendation that it be a 1-step [oral glucose tolerance] test, not a 2-step test [as currently recommended by the ADA]. The ADA also have the criteria for diagnosis [of gestational diabetes] very high to minimize the number of women identified. The strategies in the [IDF] guidelines actually increase the number of women that would be identified and therefore offer treatment worldwide with 1 standard of care."

According to a coauthor of the SMBG guidelines, David Owens, MD, from the Cardiff University Diabetes Research Unit in the United Kingdom, a unique feature of the IDF SMBG guidelines is that they clarify the role of SMBG in diabetic patients who are not receiving insulin therapy. "For the noninsulin-treated individuals, [other guidelines] say that it's a good idea to incorporate SMBG, . . . but there is no real clarity as to what to do about it. That's where we've tried to extend the story more toward what the patient can do about it in their circumstances. . . . There are [other] guidelines that suggest that maybe there's no reason to monitor blood glucose in the noninsulin-treated, and they say that . . . you need to look at the current evidence and see its limitations. Many of those publications are really not designed to ask [that] question."

Τίτλος: NICE Guidance - prasugrel (Efient®)
Αποστολή από: Raptor στις 30 Οκτωβρίου 2009, 12:37:43
A technology appraisal recommends (QRG) that prasugrel (Efient®) is an option in combination with aspirin for patients who are treated by percutaneous coronary intervention following an acute coronary syndrome. This applies only when they have had a ST-segment-elevation myocardial infarction (STEMI), have had a blocked stent while on treatment with clopidogrel or have diabetes. The Summary of Product Characteristics recommends treatment continues for up to 12 months unless discontinuation is clinically indicated at an earlier time, perhaps due to side effects.
Τίτλος: Practice Guidelines: NSAIDs in Primary Care
Αποστολή από: πρώτη & καλύτερη στις 14 Ιανουαρίου 2010, 11:21:42
Από το Medscape


•   Taking drug holidays or using intermittent dosing may be strategies to reduce the risks associated with NSAID use.
•   Dyspepsia and GI discomfort occur in 10% to 20% of persons taking NSAIDs, but dyspeptic symptoms do not correlate well with clinically significant ulcers.
•   GI adverse effects are increased with age and comorbidity.
•   The 1-year risk of serious GI bleeding from long-term NSAID use ranges from 1 in 2100 adults younger than 45 years to 1 in 110 older than 75 years.
•   Risk for death for the 2 groups ranges from 1 in 12,353 to 1 in 647 adults, respectively.
•   Concomitant anticoagulant use increases the risk by 5 to 6 times.
•   In those with a history of bleeding ulcers, the risk is 5% in 6 months, even with the use of COX-2 inhibitors or nonselective NSAIDs with a PPI.
•   Eradication of Helicobacter pylori only minimally decreases the rate of peptic ulcer in persons taking NSAIDs.
•   Taking misoprostol with an NSAID reduces ulcer-related complications but is contraindicated in pregnancy (category X) and has undesirable GI effects.
•   Use of PPIs or double-dose antihistamines with NSAIDs decreases the rate of endoscopically diagnosed ulcers.
•   Although low-dose aspirin has been shown to reduce the risk for coronary artery and cerebrovascular disease, other NSAIDs are associated with an increased risk for worsening congestive heart failure, increased blood pressure, and adverse cardiovascular events.
•   Blood pressure increases by 5 mm Hg, whereas use of nonselective NSAIDs and some COX-2 inhibitors also increases blood pressure.
•   COX-2 inhibitors have been implicated in the risk for myocardial infarction, although celecoxib may be safer than the others.
•   COX-2 inhibitors should be avoided in persons at risk for cardiovascular events, who should consider a nonselective NSAID with misoprostol or a PPI for GI protection instead.
•   Sulindac and diclofenac are associated with a higher rate of hepatic dysfunction than other NSAIDs, but clinically significant events are rare.
•   Idiosyncratic liver toxicity may occur in those with hepatitis C or underlying liver impairment.
•   NSAIDs should be avoided in persons with preexisting renal disease, congestive heart failure, or cirrhosis to prevent renal failure.
•   It is unclear whether monitoring renal function in those with renal risk who are taking NSAIDs reduces morbidity or mortality rates.
•   In high-risk persons with recent myocardial infarction or stent placement, aspirin should be continued before and after surgery.
•   In those with bleeding risk, aspirin and other NSAIDs may be withheld before surgery for 5 elimination half-lives (eg, 7 - 10 days before surgery for aspirin and 2 days for ibuprofen).
•   Aspirin should be avoided in those for whom benefits do not outweigh risks.
•   In persons taking anticoagulants, INR monitoring is required when using NSAIDs, and GI prophylaxis should be prescribed.
•   Central nervous system effects are rare and occur mainly in elderly persons, including tinnitus, cognitive changes, confusion, and depression.
•   Indomethacin has been associated with psychosis, whereas aseptic meningitis has been seen with lupus in those taking ibuprofen or naproxen.
•   Bronchoconstriction has been associated with NSAID use, especially in those with underlying respiratory disease such as asthma.
•   NSAIDs are not teratogenic in humans, and the American Academy of Pediatrics considers ibuprofen, indomethacin, and naproxen safe in breast-feeding women.
•   NSAID use close to term in pregnant women is associated with prolonged labor or gestation, blood loss and anemia, and increased risk of neonatal bleeding.
•   Low-dose aspirin is considered safe during pregnancy and lactation.

   Clinical Implications
•   The risk of GI bleeding with NSAID use is increased with age, duration of use, comorbidities, anticoagulant use, and a history of bleeding ulcers.
•   Other systemic adverse effects associated with NSAID use include those affecting the cardiovascular, hepatic, renal, hematologic, nervous, hematologic, and respiratory systems.
Τίτλος: United Kingdom (NHS): Clinical Guidelines for Acute Stroke and TIA.
Αποστολή από: Argirios Argiriou στις 19 Ιανουαρίου 2010, 09:43:17

http://www.nice.org.uk/nicemedia/pdf/CG68FullGuideline.pdf
Τίτλος: Απ: United Kingdom (NHS): Clinical Guidelines for Acute Stroke and TIA.
Αποστολή από: Argirios Argiriou στις 22 Ιανουαρίου 2010, 07:49:44
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος

http://www.nice.org.uk/nicemedia/pdf/CG68FullGuideline.pdf

Στα παραπάνω guidelines στη σελίδα 43 γράφει :
…………
…………………………
Many clinicians have used CT because of lack of access to MR but availability of MR is now improving rapidly across the U.K. Brain scanning may be used to detect stroke mimic (e.g. tumour) but yields are low, unless there are suggestive clinical features. Although CT is very sensitive to haemorrhage early after the event, bleeds may be missed if scanning is delayed.  Brain imaging is of value in determining the presence of vascular lesions (which may be helpful if there is diagnostic doubt) and helping to establish vascular territory where this is not clear. MR scanning, especially with diffusion – weighted imaging / fluid – attenuated inversion recovery (DWI/FLAIR) performed early (ideally within 24 hours) has high sensitivity for the detection of small ischaemic lesions which may be missed on CT-scan.
The clinical question to be addressed is in those patients with TIA who require brain imaging whether MR or CT provides the most information to guide treatment.
……………………
………………………………….

Ποιες απεικονιστικές μεθόδους χρησιμοποιούμε στα Ελληνικά Νοσοκομεία σε περιπτώσεις εγκεφαλικών επεισοδίων;

Πώς λέγεται στα Ελληνικά τo MR scanning, with diffusion – weighted imaging / fluid – attenuated inversion recovery (DWI/FLAIR); Χρησιμοποιούμε απλώς τον Αγγλικό όρο;

Στα παραπάνω guidelines, στον αλγόριθμο της σελίδας 15, γίνεται λόγος σε ορισμένες περιπτώσεις και για θρομβόλυση σε περίπτωση ισχαιμικών εγκεφαλικών.
Εφαρμόζεται θρομβόλυση σε περιπτώσεις ισχαιμικών εγκεφαλικών πουθενά στην Ελλάδα;
Τίτλος: Practice Guidelines: Treatment of Burns
Αποστολή από: πρώτη & καλύτερη στις 22 Ιανουαρίου 2010, 17:00:48
περιμένοντας το flone να σχολιάσει.....

Πρακτικές οδηγίες θεραπείας ελαφρού και σοβαρού εγκαύματος, που αλλάζουν κάποιες "πρακτικές" γνώσεις, εδώ http://uuhsc.utah.edu/burncenter/treatment.html
Τίτλος: Practice Guidelines: FLAIR και DWI
Αποστολή από: flone στις 22 Ιανουαρίου 2010, 20:22:21
Το απόσπασμα που παραθέτει ο κ. Αργυρίου αναφέρεται στην απεικονιστική διερεύνηση παροδικών επεισοδίων εστιακού νευρολογικού ελλείμματος. Αν δεν υπάρχει άλλη εξήγηση, θεωρούνται ισχαιμικής αιτιολογίας, τα γνωστά σε όλους μας "παροδικά ισχαιμικά".

Η αντιμετώπιση των "εγκεφαλικών" στην Ελλάδα γενικότερα, και ειδικά στα "επαρχιακά" νοσοκομεία και ΚΥ βρίσκεται στην εποχή του λίθου.
Πείτε ότι ΔΕΝ σας έχει τύχει να διώξετε σπίτι άνθρωπο που σας έρχεται επειδή πριν μια ώρα και για πέντε λεπτά "μούδιασε" το χέρι του και τώρα δεν έχει τίποτα και σας βγάζω το καπέλο υποκλινόμενος. Για άλλη μια φορά δίνεται η ευκαιρία να φωνάξουμε ότι ΤΑ ΠΑΡΟΔΙΚΑ ΕΠΕΙΣΟΔΙΑ ΔΕΝ ΕΙΝΑΙ "ΕΛΑΦΡΙΑ" ΑΕΕ.

Αν είχατε ασθενή με παροδικό και του κάνατε αξονική (τεχνική νευροαπεικόνισης που ΔΕΝ χρησιμοποιείται διεθνώς παρά μόνο σε 1. κλειστοφοβία 2. βηματοδότη 3. κώμα/επείγουσα εξέταση 4. ψάχνοντας για επασβεστώσεις, είναι ωστόσο η κύρια μέθοδος για τα ελληνικά νοσοκομεία), δεν έδειξε τίποτα, και τον στείλατε σπίτι, τότε μπορείτε να ΜΗΝ κοιμάστε ήσυχοι.

Το είχαμε δει και σε κείνα τα περιστατικά, αν θυμάστε τα "Μαθήματα Νευρολογίας στο ΓΝΦ" (ο κ. Νικολάου και οι καρωτίδες του).
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος
2-C [Πρέπει να αποδειχθεί ότι το έμφρακτο είναι σε περιοχή κατανομής προσθίου (καρωτιδικού) συστήματος, (π.χ. δεν είναι στη γέφυρα) αλλιώς ό,τι και να (ξανα)βρούμε πώς θα μιλάμε για "συμπτωματική" καρωτίδα? Η πρώτη αξονική δεν έδειξε τίποτα και μπορεί να μη δείξει ούτε η δεύτερη. Επίσης (το πιστεύετε?) μπορεί να μη μας φωτίσει ούτε η MRI, αν δεν έχουμε (ζητήσουμε) ακολουθία DWI, που απεικονίζει μόνο τις πρόσφατες ισχαιμικές βλάβες. Ψάξτε το εγκεφαλικό στις εικόνες "MRI flair" και "MRI flair 2" που επισυνάπτονται. Βρήκατε πολλά? Ποιο είναι το πρόσφατο, που έδωσε την κλινική εικόνα? Για δείτε τώρα την "DWI". Νά το, νά το!!!]

Προσθέτω άλλο ένα παράδειγμα (flair im.jpg και dwi im.jpg, ίδιος ασθενής) καθώς και μια ακολουθία Τ2 από άλλον ασθενή (t2.jpg)

Η ακολουθία DWI (Diffusion Weighted Imaging) είναι "λειτουργική". Καταγράφονται οι κινήσεις Brown (θυμάστε λίγο φυσική των ρευστών?) των μορίων του νερού. Σε μια περιοχή πρόσφατης ισχαιμίας, λόγω διαταραχής των μεμβρανικών αντλιών εξαιτίας της ισχαιμίας, έχουμε είσοδο νερού στα νευρικά κύτταρα, οι κινήσεις Brown είναι περισσότερες, με αποτέλεσμα να παίρνουμε διαφορετικό σήμα από τα κύτταρα αυτά. Είναι ακριβώς ο μηχανισμός σχηματισμού του κυτταροτοξικού οιδήματος, για το οποίο δίνουμε στα μεγάλα ισχαιμικά έμφρακτα τη γνωστή σε όλους μας μαννιτόλη. Έτσι, η ακολουθία DWI είναι πολύτιμο εργαλείο για να απαντήσουμε δυο βασικές ερωτήσεις:
1. οφείλονται τα συμπτώματα του ασθενούς σε ισχαιμία? (ιδίως όταν δεν προλάβαμε να τον εξετάσουμε όσο τα είχε, και ακόμα, όταν αναφέρονται μόνο αισθητικά συμπτώματα)
2. Στην περιοχή κατανομής ποιου αγγείου βρίσκεται η πρόσφατη ισχαιμική βλάβη?

Η FLAIR είναι μεταγενέστερη της Τ2 (και υπήρχε πριν την DW) και εξασθενεί (attenuation) το υψηλό σήμα του ΕΝΥγρού (fluid) με την τεχνική inversion recovery (που τώρα δεν θυμάμαι να σας πω ακριβώς τι κάνει). Αν δείτε στην Τ2 που επισυνάπτεται, θα καταλάβετε. Αν αναζητάτε παθολογικό σήμα (που θα φαίνεται "άσπρο", δηλ. αυξημένης έντασης) κοντά στο φλοιό (όπως τα μικρά εμβολικά έμφρακτα) ή περικοιλιακά (νόσος λευκής ουσίας ή εν τω βάθει έμφρακτα, τότε δεν θα το βρείτε γιατί και το παρακείμενο ΕΝΥ είναι επίσης άσπρο. Στη FLAIR, που το ΕΝΥ είναι "μαύρο" και η παθολογία εξακολουθεί και φαίνεται "άσπρη" (έχετε δηλαδή καλό contrast), μπορείτε εύκολα να ενοπίσετε παθολογικό σήμα στις περιοχές αυτές και να το μελετήσετε καλύτερα.

Τη FLAIR στα Ελληνικά την λέτε "φλαιρ" :o και την DWI την λέτε..."DWI" :D ή "διάχυση" (αν και με αυστηρά κριτήρια φυσικής δεν είναι σωστή η μετάφραση, έτσι έχει επικρατήσει).
Το να την λέτε, είναι εύκολο. Πού θα την βρείτε;
Σε όλους τους μαγνήτες που αγοράστηκαν από τα τέλη της δεκαετίας του 90 και μετά. Επειδή η αναβάθμιση είναι ρουτίνα στον ιδιωτικό τομέα, δεν θα δυσκολευτείτε. Στο ΕΣΥ, πρέπει να ψάξετε.
Αν έχετε καλή επιχειρηματολογία για να την ζητήσετε, κανείς δεν θα την αρνηθεί.
Η FLAIR είναι πιο «ρουτίνα». Θα την έχετε μάλλον χωρίς να την ζητήσετε.

Διάλειμμα για διαφημίσεις και επανέρχομαι...
Τίτλος: Απ: Practice Guidelines: FLAIR και DWI.
Αποστολή από: Argirios Argiriou στις 23 Ιανουαρίου 2010, 00:30:33
Flone, να προλάβω να ρωτήσω πριν συνεχίσεις:

Τι σημαίνει T2;

Αν κατάλαβα καλά από το σχόλιό σου , η FLAIR και η DWI είναι δύο διαφορετικά είδη MRI. Πότε πρέπει να επιλέγουμε τη μια και πότε την άλλη μορφή;
Τίτλος: Απ: Practice Guidelines
Αποστολή από: Πατρωνάκης Μάνος στις 23 Ιανουαρίου 2010, 19:28:31
 
Παράθεση
Πείτε ότι ΔΕΝ σας έχει τύχει να διώξετε σπίτι άνθρωπο που σας έρχεται επειδή πριν μια ώρα και για πέντε λεπτά "μούδιασε" το χέρι του
 και τώρα δεν έχει τίποτα και σας βγάζω το καπέλο υποκλινόμενος.
Μπορεί να συμφωνούμε όπως μπορεί και να διαφωνούμε, μα πάμε παρακάτω.
Τίτλος: Απ: Practice Guidelines
Αποστολή από: flone στις 23 Ιανουαρίου 2010, 20:41:11
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος
Τι σημαίνει T2;

Αν κατάλαβα καλά από το σχόλιό σου , η FLAIR και η DWI είναι δύο διαφορετικά είδη MRI. Πότε πρέπει να επιλέγουμε τη μια και πότε την άλλη μορφή;

     Ο κλινικός γιατρός παραπέμπει έναν ασθενή για MRI με κάποιες κλινικές ενδείξεις και μια κλινική εικόνα και ένα ιστορικό. Με βάση αυτά, ο ακτινολόγος, που οφείλει να γνωρίζει στοιχειώδη νοσολογία του οργάνου που απεικονίζει, θα διαλέξει ποιες «ακολουθίες» (T1, T2, FLAIR κλπ) θα κάνει. Για παράδειγμα, αν ο ασθενής μας κάνει επιληπτικές κρίσεις, θα πάρει (εκτός από τη «ρουτίνα») και ειδικές στεφανιαίες τομές (FLAIR και Τ1 με «σκιαστικό») για να δει τις έσω κροταφικές δομές (ιππόκαμποι). Αν υποψιαζόμαστε σκλήρυνση, πρέπει να πάρει και οβελιαίες Τ2 και FLAIR για να ψάξει για εστίες στο μεσολόβιο. Αν πρόκειται για ασθενή με παροδικό επεισόδιο, πρέπει να κάνει DWI. Συνεπώς, δεν πρόκειται για διαφορετικά είδη MRI, αλλά για διαφορετικές τεχνικές που δεν γίνονται όλες σε όλες τις εξετάσεις. Η εξέταση είναι μία, μαγνητική τομογραφία.
   Επειδή όμως πολλές φορές τα εργαστήρια λειτουργούν μόνο με τεχνικούς κι έρχονται αργότερα οι γιατροί για να γνωματεύσουν τις εξετάσεις, είναι καλό να επικοινωνούμε από πριν με τους υπεύθυνους για να μας κάνουν αυτά που θέλουμε. Για το συγκεκριμένο που συζητάμε, να ζητήσουμε να μας κάνουν DWI (αν δεν την συμπεριλαμβάνουν στο πρωτόκολλό τους).

Στο θέμα των παροδικών και πάλι, αξίζει να ξαναδιαβάσουμε το “Transient Ischemic Attack: A Scientific Statement for Healthcare Professionals From the American Heart Association…” που επισυνάπτει ο Raptor στο http://www.pfy.gr/forum/index.php/topic,40.msg6074.html#msg6074, New AHA/ASA Guidelines on TIA Management ("We think a TIA should be treated as an emergency, just like a major stroke").

Διαλέγω 4 σημεία από το paper:
·   30% to 50% of classically defined TIAs show brain injury on diffusion-weighted magnetic resonance (MR) imaging
·   Large cohort and population-based studies reported in the last 5 years have demonstrated a higher risk of early stroke after TIA than generally suspected. Ten percent to 15% of patients have a stroke within 3 months, with half occurring within 48 hours.
·   Often, health professionals and the public consider TIAs benign but regard strokes as serious. These views are incorrect.
·   Ischemic stroke appears to carry a lower short-term risk of subsequent ischemic stroke than TIA, with reported 3-month risks generally ranging from 4% to 8%.


Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος
Although CT is very sensitive to haemorrhage early after the event, bleeds may be missed if scanning is delayed.  

Εδώ νομίζω ότι μπερδεύτηκα λίγο.
Η περίπτωση αιμορραγίας που κλασικά η αξονική «πάσχει» είναι η υπαραχνοειδής αιμορραγία (η ευαισθησία πέφτει λίγες ώρες μετά το επεισόδιο) αλλά αφενός αυτή δεν εκδηλώνεται με παροδικά επεισόδια νευρολογικού ελλείμματος (τουλάχιστο μόνο με αυτά), αφετέρου πιθανολογώ ότι το κείμενο αναφέρεται στην περίπτωση μικρής ενδοπαρεγχυματικής αιμορραγίας που όντως θα μπορούσε να εκδηλωθεί με έλλειμμα διάρκειας αρκετών ωρών. Έχω την εντύπωση ότι θα πρέπει να είναι πολύ “delayed” η εξέταση για να μην την δούμε (εκτός κι αν οι συγγραφείς έχουν υπόψη τους τις καθυστερήσεις στα ραντεβού του NHS!)

Από τα αρχικά ερωτήματα του κ. Αργυρίου (http://www.pfy.gr/forum/index.php/topic,40.msg9401.html#msg9401), μένει το θέμα θρομβόλυση:

http://www.pfy.gr/forum/index.php/topic,2125.0.html (Θρομβόλυση στα ισχαιμικά ΑΕΕ)

Τίτλος: Prostate Cancer Screening Guideline Updated by ACS
Αποστολή από: Μαρία Χόρτη στις 23 Μαρτίου 2010, 16:09:47
Παραθέτω τα κυριότερα σημεία:

The new guideline has a more pronounced emphasis on informed decision-making (IDM) than in the past.
Men should only be screened "after they receive information about the uncertainties, risks, and potential benefits associated with prostate cancer screening," states the document.

Asymptomatic men with at least a 10-year life expectancy should be offered informed decision making about prostate cancer screening.

The age to begin screening is linked to risk:

    * At age 50 years for average-risk men
    * At age 45 years for higher-risk men (African American ethnicity or first-degree relative with prostate cancer before age 65 years)
    * At age 40 years for appreciably higher-risk men (multiple family members diagnosed with prostate cancer before age 65 years)


The "core elements" of the information to be provided to men to assist with their prostate cancer screening decision include the following:

    * Screening with the PSA blood test detects cancer at an earlier stage than if no screening is performed.
    * Prostate cancer screening might be associated with a reduction in the risk of dying from prostate cancer; however, evidence is conflicting.
    * For men whose prostate cancer is detected by screening, it is not currently possible to predict which men are likely to benefit from treatment.
    * Treatment for prostate cancer can lead to urinary, bowel, sexual, and other health problems that can be significant or minimal, permanent or temporary.
    * The PSA and DRE can produce false-positive or false-negative results.
    * Abnormal results from screening with PSA and DRE require prostate biopsies, which can be painful and lead to complications like infection or bleeding.
    * Not all men whose prostate cancer is detected through screening require immediate treatment. Some require periodic blood tests and prostate biopsies to determine the need for future treatment.


# In men who choose to undergo screening, PSA with or without DRE is recommended.

# The recommendations for follow-up depend on PSA level.
# If PSA level is less than 2.5 ng/mL, screening is recommended every 2 years; for levels of 2.5 ng/mL or higher, screening is recommended every year.

# If PSA level is between 2.5 to 4.0 ng/mL, individualized decision making is recommended:
    * Biopsy is recommended for high-risk patients (African American, family history of prostate cancer, increasing age, and an abnormal DRE result).
    * Previous negative biopsy result confers lower risk.

# The traditional PSA threshold level of 4.0 ng/mL is considered reasonable for biopsy
, although a true cutoff level has not been determined.

http://cme.medscape.com/viewarticle/718140?src=cmenews&uac=32150DN
Τίτλος: Chronic heart failure: NICE guideline
Αποστολή από: Gatekeeper στις 9 Σεπτεμβρίου 2010, 22:21:36
National Institute for Health and Clinical Excellence guidance


Chronic heart failure: Αυγουστος 2010




Τίτλος: Hypertension in pregnancy: NICE guideline
Αποστολή από: Gatekeeper στις 9 Σεπτεμβρίου 2010, 22:25:35
NICE guideline

Hypertension in pregnancy : 25 August 2010
Τίτλος: Recommendations for Preventing Iron Deficiency in Young Children
Αποστολή από: Μαρία Χόρτη στις 6 Οκτωβρίου 2010, 16:10:40
H American Academy of Pediatrics εξέδωσε κατευθυντήριες οδηγίες για τη διάγνωση και πρόληψη της σιδηροπενικής αναιμίας σε παιδιά ηλικίας έως 3 ετών.

Συνιστούν έλεγχο για αναιμία σε όλα τα παιδιά στην ηλικία των 12 μηνών.

Ακόμη αναφέρει τη συνιστώμενη προσλαμβανόμενη ποσότητα σιδήρου για κάθε ηλικιακή ομάδα και αποτελεσματικούς τρόπους πρόσληψης σιδήρου (πχ σίδηρο από του στόματος, γάλα ενισχυμένο με σίδηρο, τροφές πλούσιες σε σίδηρο)

Στον παρακάτω σύνδεσμο θα βρείτε το άρθρο σε pdf από το περιοδικό Pediatrics
http://pediatrics.aappublications.org/cgi/reprint/peds.2010-2576v1

Τίτλος: Reducing the pain of childhood vaccination guidelines
Αποστολή από: Μαρία Χόρτη στις 26 Νοεμβρίου 2010, 19:52:15
Κατευθυντηριες οδηγίες από τον Καναδά.

Ανάμεσα σε αυτά που προτείνονται είναι η χορήγηση εμβολίου με το παιδί σε όρθια στάση, η ενδομυική χορήγηση χωρίς αναρρόφηση, η χορήγηση του πιο επώδυνου εμβολίου τελευταίου (σε χορήγηση πολλών εμβολίων) κ.ά.


http://www.cmaj.ca/cgi/rapidpdf/cmaj.092048v1
Τίτλος: Type 2 diabetes: full guideline
Αποστολή από: Gatekeeper στις 11 Δεκεμβρίου 2010, 13:41:13
NICE guideline

TYPE 2 DIABETES

National clinical guideline for management
in primary and secondary care (update)
 30 March 2010
Τίτλος: Απ: Type 2 diabetes: full guideline
Αποστολή από: kdiwavvou στις 19 Δεκεμβρίου 2010, 00:13:35


Παράθεση
TYPE 2 DIABETES


μια προσπάθεια να συγκεντρωθεί όλο μαζί ένα μέρος από το υλικό σε ένα αρχείο acrobat

http://d01.megashares.com/dl/uddkoh3/dIaBeTes.pdf

Τίτλος: Απ: Practice Guidelines
Αποστολή από: kdiwavvou στις 24 Δεκεμβρίου 2010, 16:11:00
[logged]
σχετικά με την
Παράθεση
υπέρταση
: πάνω κάτω όλοι οι εκδότες κατευθυντηρίων οδηγιών διατυπώνουν παρεμφερείς απόψεις

μια προσπάθεια να συγκεντρωθεί όλο μαζί ένα μέρος από το υλικό σε ένα αρχείο acrobat

σύνδεσμος :  http://d01.megashares.com/dl/ba2f761/hYpertensiOn gUidanCe.pdf

δεν επισυνάπτω το αρχείο για 2 λόγους : 1ον → το μέγεθος ξεφεύγει = ~ 10mb kai 2ov → αρχεία τα οποία έχουν επισυναφθεί από συναδέλφους και προσπάθησα να τα κατεβάσω, έχουν  σύνδεσμο στο φόρουμ ο οποίος δεν ανταποκρίνεται σε αρχείο

ο server : megashares είναι ασφαλής, ενδεχομένως θα πρέπει να κάμετε reload αρκετές φορές για να έχετε πρόσβαση στο link[/logged]
Τίτλος: pressure ulcer guidelines
Αποστολή από: Gatekeeper στις 22 Ιανουαρίου 2011, 14:03:48
http://www.pfy.gr/forum/index.php/topic,2388.msg15648.html#msg15648
Τίτλος: World Health Organization's guidelines for the treatment of malaria
Αποστολή από: Gatekeeper στις 19 Φεβρουαρίου 2011, 21:59:46
 The World Health Organization (WHO) is releasing new guidelines for the treatment of malaria,
Τίτλος: Απ: Practice Guidelines
Αποστολή από: kdiwavvou στις 11 Μαρτίου 2011, 21:34:57
προβληματισμός  σχετικά με τις κατευθυντήριες οδηγίες

http://www.kdiwavvou.comuv.com/1aboutGuidanCe.htm (http://www.kdiwavvou.comuv.com/1aboutGuidanCe.htm)
Τίτλος: Απ: Guidelines for Ventricular Arrythmias
Αποστολή από: kdiwavvou στις 21 Μαρτίου 2011, 13:55:33
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος
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.   

πολλές φορές προσπάθησα να κατεβάσω επισυναπτόμενο αρχείο σε παλαιό post και ο σύνδεσμος έχει καταργηθεί
παραθέτω σύνδεσμο για το ως άνω άρθρο

google search : http://www.google.co.uk/#sclient=psy&hl=en&site=&source=hp&q=ACC%2FAHA%2FESC+2006+Guidelines+for+Management+of+Patients+With+Ventricular+Arrhythmias+and+the+Prevention+of+Sudden+Cardiac+Death&aq=&aqi=&aql=&oq=&pbx=1&fp=d64255a5dc9e493e

και απ ευθείας :  http://circ.ahajournals.org/cgi/reprint/114/10/1088

ερώτημα πολλαπλών :

Ποιο απο τα παρακατω φαρμακα θα χρησιμοποιουσατε για την αντιμετωπιση νοσηλευομενου ασθενους που παρουσιασε κοιλιακη ταχυκαρδια    :
•   Δακτυλιτιδα
•   Προπρανολολη
•   Βεραπαμιλη
•   Διλτιαζεμη
•   λιδοκαινη  [= η σωστή απάντηση ]

στην acess medicine κάμει την εξής ταξινόμηση :


η ηλεκτροφυσιολογική μελέτη βοηθά στην αναγνώριση των υποψηφίων για καυτηριασμό των αρρυθμιογόνων εστιών και στην αναγνώριση των αρρώστων με υψηλό κίνδυνο για αιφνίδιο θάνατο

παραθέτω την πηγή :  http://www.kdiwavvou.comuv.com/_____aRxeia/43quickanswersventriculartachycardia.pdf

ερώτημα :  γοα τον συγκεκριμένο νοσηλευόμενο άρρωστο δεν γνωρίζουμε εάν έχει δομική μυοκαρδιακή βλάβη ούτε εάν η κοιλιακή ταχυκαρδία είχε διάρκεια λιγότερο ή περισσότερο από 30 δεύτερα οπότε γιατί σωστή απάντησ δεν είναι και η προπρανολόλη ;
Τίτλος: Preventing type 2 diabetes
Αποστολή από: Gatekeeper στις 22 Μαΐου 2011, 00:06:49
Preventing type 2 diabetes - population and community interventions

NICE  guidance :  10 May 2011
Τίτλος: Eating Disorder Guidelines
Αποστολή από: Μαρία Χόρτη στις 7 Ιουνίου 2011, 11:26:02
H Academy of Eating Disorders (AED) εξέδωσε πρόσφατα κατευθυντ'ηριες οδηγίες για τη διάγνωση και την αντιμετώπιση των διαταραχών της όρεξης στην ΠΦΥ.

Αναφέρονται αναλυτικά τα σημεία και τα συμπτώματα και παραθέτονται στρατηγικές για να βοηθήσουν τον ιατρό στην ΠΦΥ να θέσει έγκαιρα τη διάγνωση, να σταθεροποιήσει τους ασθενείς και να παρέχει evidence-based φροντίδα στους ασθενείς με διαταραχές όρεξης.

Οι οδηγίες αναφέρονται τόσο σε παιδιά κι εφήβους όσο και σε ενήλικες.

Δίνεται μεγάλη βαρύτητα στην έγκαιρη ανίχνευση των διαταραχών αυτών και την άμεση παρέμβαση απο το γενικό ιατρό πριν την παραπομπή στον ειδικό.

Αναφέρεται επίσης στην παρέμβαση μέσω ομάδας επαγγελματιών υγείας (ιατρός, ψυχολόγος, διατροφολόγος) - για τους περισσότερους βέβαια απο εμάς αυτό είναι κάτι αδύνατο - αλλά και μέσω της συμμετοχής της οικογένειας.

Οι οδηγίες σε user-friendly PDF:
http://www.aedweb.org/AM/Template.cfm?Section=Medical_Care_Standards&Template=/CM/ContentDisplay.cfm&ContentID=2413

 Στο site της Academy of Eating Disorders υπάρχει και άλλο υλικό.
http://www.aedweb.org


Τίτλος: ACCF/AHA 2011 Expert Consensus on Hypertension in the Elderly
Αποστολή από: Μαρία Χόρτη στις 11 Ιουνίου 2011, 15:41:31
ACCF/AHA 2011 Expert Consensus on Hypertension in the Elderly

http://content.onlinejacc.org/cgi/reprint/57/20/2037.pdf
Τίτλος: Urolithiasis
Αποστολή από: Gatekeeper στις 27 Ιουνίου 2011, 16:37:48
Urolithiasis 2011

The European Association of Urology (EAU)

Τίτλος: The management of hip fracture in adults
Αποστολή από: Gatekeeper στις 13 Ιουλίου 2011, 19:21:15
The management of hip fracture in adults

NICE guideline  2011
Τίτλος: Percutaneous tibial nerve stimulation for faecal incontinence
Αποστολή από: Gatekeeper στις 13 Ιουλίου 2011, 19:29:25
Percutaneous tibial nerve stimulation for faecal incontinence

NICE  guidance :   2011


Τίτλος: Απ: Practice Guidelines
Αποστολή από: Μαρία Χόρτη στις 23 Ιουλίου 2011, 16:28:49
Το American College of Obstetricians and Gynecologists (ACOG) συστηνει πλέον μαστογραφία σε ετήσια βάση για όλες τις γυναίκες άνω των 40 ετων

http://www.acog.org/from_home/publications/press_releases/nr07-20-11-2.cfm

ενω το U.S. Preventive Services Task Force (USPSTF) πιστεύει πως γυναίκες <50 ετών δε θα έπρεπε να κάνουν μαστογραφία ως ρουτίνα, αλλά η απόφαση για μαστογραφία θα πρέπει να εξατομικευθεί ανάλογα με την ασθενή.

http://womens-health.jwatch.org/cgi/content/full/2009/1116/1?q=pfw
Τίτλος: Απ: Practice Guidelines
Αποστολή από: kdiwavvou στις 9 Αυγούστου 2011, 15:11:43
Posttraumatic stress disorder

Διαταραχή μετατραυματικού στρες


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some notes of mine

https://docs.google.com/document/pub?id=1zxVt11OAy02wR56Keh-Hn8DXcWHB1TKbpdoNeD_7aZw


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Guidelines for Treatment of PTSD

Edna B. Foa, Terence M. Keane and Matthew J. Friedman


http://www.springerlink.com/content/g34738676507ml01/


έχει να προσφέρει κάτι επιλέον μια `συνδρομητική` αναφορά οδηγιών συγκριτικά με δωρεάν αναφορές λοιπών εκδοτών ;

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ΝΙCE

http://www.google.gr/url?sa=t&source=web&cd=3&ved=0CDQQFjAC&url=http%3A%2F%2Fwww.nice.org.uk%2Fnicemedia%2Fpdf%2FCG026publicinfo.pdf&ei=gBJBTsLbMcHt-gb-99irCQ&usg=AFQjCNGVbzLts2_SzoRQHrAP_k5NGGN4Gg&sig2=scnT153kvkqVaEc6xPhEuQ


my link

http://kdiwavvou.comuv.com/_____aRxeia/     967 Posttraumatic stress disorder guidance.pdf

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CREST

http://www.google.gr/url?sa=t&source=web&cd=4&ved=0CD4QFjAD&url=http%3A%2F%2Fwww.gain-ni.org%2FLibrary%2FGuidelines%2Fpost_traumatic_stress_disorder.pdf&ei=gBJBTsLbMcHt-gb-99irCQ&usg=AFQjCNHyVVRW91q7PT0_mww6kJmcOespLw&sig2=_izVKfse_L2iYxaGW3zDJg


my link  

http://kdiwavvou.comuv.com/_____aRxeia/      967 post_traumatic_stress_disorder.pdf


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επαρκούν τα συγκεκριμένα guidances ;

Τι προτείνει η εμπειρία των Ειδικών ;


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paroxetine [ = SSRI ]  Or mirtazapine [ TeCA ]  ή  οποιονδήποτε  SSRI ;

έχουν ρόλο οι SNRI ;

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[ τα ερωτήματα που τίθενται δεν είναι ρητορικά , δεν βρήκα απαντήσεις στο διαδίκτυο [ που είναι η εκπαίδευση στην ΓΙ ; ]


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jUst fOr fUn


Τίτλος: Απ: Practice Guidelines
Αποστολή από: Denominator στις 18 Αυγούστου 2011, 11:33:26
Kατευθυντήριες οδηγίες του Αmerican College of Physicians για τη ΧΑΠ - Από το τελευταίο τεύχος του Annals of Internal Medicine [2011;155(3):179-191].
Τίτλος: Απ: Practice Guidelines
Αποστολή από: carlita στις 10 Νοεμβρίου 2011, 10:01:29
Draft Guidelines Recommend Against PSA Screening: USPSTF Review

The USPSTF already recommends against routine PSA screening in men older than 75 years. In the new draft recommendation, it extends this to all men. It now recommends against routine screening in men younger than 75 years, giving this a "D" rating, which means "there is moderate or high certainty that the service has no benefit or that the harms outweigh the benefits."

............

PSA Test is Not Specific
"It cannot distinguish cancer that will never make a difference in a man's lifetime from cancers that will make a difference," so might prompt men to undergo aggressive treatment unnecessarily, Virginia Moyer, MD, MPH, chair of the USPTSF panel that made the recommendation, stated in an interview yesterday with Bloomberg News. "So you go from being a guy who feels fine and who is potentially one of the majority who would never have known they had this disease, to being a guy who wears adult diapers," she said. Dr. Moyer is a professor of pediatrics at Baylor College of Medicine in Houston, Texas.
.........


http://www.medscape.org/viewarticle/751461?src=cmemp
Τίτλος: Απ: Practice Guidelines
Αποστολή από: anasm στις 11 Νοεμβρίου 2011, 17:27:19
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος
Draft Guidelines Recommend Against PSA Screening: USPSTF Review

The USPSTF already recommends against routine PSA screening in men older than 75 years. In the new draft recommendation, it extends this to all men. It now recommends against routine screening in men younger than 75 years, giving this a "D" rating, which means "there is moderate or high certainty that the service has no benefit or that the harms outweigh the benefits."
............

PSA Test is Not Specific
"It cannot distinguish cancer that will never make a difference in a man's lifetime from cancers that will make a difference," so might prompt men to undergo aggressive treatment unnecessarily, Virginia Moyer, MD, MPH, chair of the USPTSF panel that made the recommendation, stated in an interview yesterday with Bloomberg News. "So you go from being a guy who feels fine and who is potentially one of the majority who would never have known they had this disease, to being a guy who wears adult diapers," she said. Dr. Moyer is a professor of pediatrics at Baylor College of Medicine in Houston, Texas.
.........

http://www.medscape.org/viewarticle/751461?src=cmemp

Γεια χαρά..!

Καταρχάς, έχει ενδιαφέρον, νομίζω, η ενδεχόμενη Διαδικασία που ακολουθείται, προκειμένου μια Έρευνα,
από επίπεδο Draft Guidelines να μεταβεί σε επίπεδο Official Guidelines...

Δεν νομίζω οτι, απλά και μόνο, ένα σχετικά υψηλό PSA, από μόνο του, να αποτελεί την καθοριστική ένδειξη για προστατεκτομή...
Επίσης,
ένας άνδρας, που έχει υποβληθεί σε προστατεκτομή, δεν νομίζω οτι φτάνει σε τέτοιο βαθμό αναπηρίας, ώστε να ζεί πια μόνιμα με μια πάνα ηλικιωμένων (adult diaper..).
Παρεμπιπτόντως,
μια βασική, και σίγουρα βαθιά "ακρωτηριαστική", σωματικά αλλά κυρίως ψυχολογικά, επιπλοκή της προστατεκτομής,
ήταν η ανικανότητα στύσης, λόγω "αναπόφευκτης" εκτομής των αντίστοιχων νεύρων...
Τώρα πια, νομίζω, με σύγχρονες τεχνικές, η επιπλοκή αυτή έχει περιοριστεί σε πολύ χαμηλά ποσοστά...

Επίσης, μου κάνει εντύπωση που, βασικός εκπρόσωπος της αντίστοιχης Έρευνας, είναι μια Καθηγήτρια Παιδιατρικής...
Νομίζω, θα είχε τεράστια σημασία η τοποθέτηση των Ουρολόγων,
και αντίστοιχα του American Association/ College of Urologists...

Τίτλος: Απ: Practice Guidelines
Αποστολή από: schumifer στις 11 Νοεμβρίου 2011, 18:53:06
Όταν οι Αμερικάνικες ιδιωτικές εταιρείες είδαν πόσα θα γλίτωναν προφανώς και πίεσαν. Αυτό είναι όλο
Τίτλος: Απ: Practice Guidelines
Αποστολή από: Argirios Argiriou στις 12 Νοεμβρίου 2011, 16:51:42
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος
Draft Guidelines Recommend Against PSA Screening: USPSTF Review

The USPSTF already recommends against routine PSA screening in men older than 75 years. In the new draft recommendation, it extends this to all men. It now recommends against routine screening in men younger than 75 years, giving this a "D" rating, which means "there is moderate or high certainty that the service has no benefit or that the harms outweigh the benefits."
............

PSA Test is Not Specific
"It cannot distinguish cancer that will never make a difference in a man's lifetime from cancers that will make a difference," so might prompt men to undergo aggressive treatment unnecessarily, Virginia Moyer, MD, MPH, chair of the USPTSF panel that made the recommendation, stated in an interview yesterday with Bloomberg News. "So you go from being a guy who feels fine and who is potentially one of the majority who would never have known they had this disease, to being a guy who wears adult diapers," she said. Dr. Moyer is a professor of pediatrics at Baylor College of Medicine in Houston, Texas.
.........

http://www.medscape.org/viewarticle/751461?src=cmemp

Γεια χαρά..!

Καταρχάς, έχει ενδιαφέρον, νομίζω, η ενδεχόμενη Διαδικασία που ακολουθείται, προκειμένου μια Έρευνα,
από επίπεδο Draft Guidelines να μεταβεί σε επίπεδο Official Guidelines...

Δεν νομίζω οτι, απλά και μόνο, ένα σχετικά υψηλό PSA, από μόνο του, να αποτελεί την καθοριστική ένδειξη για προστατεκτομή...
Επίσης,
ένας άνδρας, που έχει υποβληθεί σε προστατεκτομή, δεν νομίζω οτι φτάνει σε τέτοιο βαθμό αναπηρίας, ώστε να ζεί πια μόνιμα με μια πάνα ηλικιωμένων (adult diaper..).
Παρεμπιπτόντως,
μια βασική, και σίγουρα βαθιά "ακρωτηριαστική", σωματικά αλλά κυρίως ψυχολογικά, επιπλοκή της προστατεκτομής,
ήταν η ανικανότητα στύσης, λόγω "αναπόφευκτης" εκτομής των αντίστοιχων νεύρων...
Τώρα πια, νομίζω, με σύγχρονες τεχνικές, η επιπλοκή αυτή έχει περιοριστεί σε πολύ χαμηλά ποσοστά...

Επίσης, μου κάνει εντύπωση που, βασικός εκπρόσωπος της αντίστοιχης Έρευνας, είναι μια Καθηγήτρια Παιδιατρικής...
Νομίζω, θα είχε τεράστια σημασία η τοποθέτηση των Ουρολόγων,
και αντίστοιχα του American Association/ College of Urologists...



Ίσως μια καθηγήτρια Παιδιατρικής (η οποία δεν έχει οικονομικά συμφέροντα απο το να χειρουργεί τους ασθενείς) να είναι πιο αντικειμενική στην συγκεκριμένη περίπτωση.
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος
.............
............................
Τώρα πια, νομίζω, με σύγχρονες τεχνικές, η επιπλοκή αυτή έχει περιοριστεί σε πολύ χαμηλά ποσοστά...
;
Τίτλος: Απ: Practice Guidelines
Αποστολή από: noname στις 30 Νοεμβρίου 2011, 00:15:27
Και για πρωτη φορα ελληνικα πρωτοκολλα ιατρικών πράξεων και φαρμάκων .

http://www.eof.gr/web/guest/protocols
Τίτλος: Απ: Practice Guidelines
Αποστολή από: Μαρία Χόρτη στις 21 Μαρτίου 2012, 20:02:41
Αν και εφαρμόζοντας τα πρωτόκολλα του ΕΟΦ θα σταματήσουμε να κοιτάμε απο δω και απο εκεί για κατευθυντήριες οδηγίες,
ποστάρω οδηγίες για την αντιμετώπιση της οξείας παραρρινοκολπίτιδας απο το IDSA

http://cid.oxfordjournals.org/content/early/2012/03/20/cid.cir1043.full


Guideline Issued for Managing Acute Bacterial Rhinosinusitis

The Infectious Diseases Society of America has released a clinical practice guideline on the management of acute bacterial rhinosinusitis in children and adults.
The guideline, published in Clinical Infectious Diseases, first points out that a bacterial cause accounts for 2%–10% of acute rhinosinusitis cases. Among the recommendations:
    Bacterial rather than viral rhinosinusitis should be diagnosed when any of the following occurs:
        persistent symptoms lasting at least 10 days, without improvement;
        severe symptoms or high fever and purulent nasal discharge or facial pain for 3–4 days at illness onset;
        worsening symptoms after an initial respiratory infection, lasting 5–6 days, has started to improve.
    Empirical therapy should be started as soon as acute bacterial rhinosinusitis is diagnosed clinically; amoxicillin-clavulanate, instead of amoxicillin alone, is recommended for both children and adults.
    Macrolides and trimethoprim-sulfamethoxazole are not recommended as empirical therapy, because of high rates of antimicrobial resistance.

The guideline includes an algorithm for sinusitis management, with recommendations for treating patients who do not respond to initial empirical therapy.


Τίτλος: Απ: Practice Guidelines
Αποστολή από: carlita στις 23 Απριλίου 2012, 22:43:39
New Screening Guidelines for Cervical Cancer

The American Cancer Society today released new screening recommendations for the prevention and early detection of cervical cancer. Screenings are tests for women who have no symptoms of cervical cancer. Among the changes: the American Cancer Society no longer recommends that women get a Pap test every year.

During the past few decades, screening has reduced deaths from cervical cancer, as doctors have been able to find cancer early and treat it, or prevent it from ever developing. Researchers continue to find out more about what causes cervical cancer, and the best ways to screen for it.

There are 2 types of tests used for cervical cancer screening.

    The Pap test can find early cell changes and treat them before they become cancer. The Pap test can also find cervical cancer early, when it’s easier to treat.
     
    The HPV (human papilloma virus) test finds certain infections that can lead to cell changes and cancer. HPV infections are very common, and most go away by themselves and don’t cause these problems. The HPV test may be used along with a Pap test, or to help doctors decide how to treat women who have an abnormal Pap test.

The American Cancer Society regularly reviews the science and updates screening recommendations when new evidence suggests that a change may be needed. The latest recommendations are:

    All women should begin cervical cancer screening at age 21.
     
    Women between the ages of 21 and 29 should have a Pap test every 3 years. They should not be tested for HPV unless it is needed after an abnormal Pap test result.
     
    Women between the ages of 30 and 65 should have both a Pap test and an HPV test every 5 years. This is the preferred approach, but it is also OK to have a Pap test alone every 3 years.
     
    Women over age 65 who have had regular screenings with normal results should not be screened for cervical cancer. Women who have been diagnosed with cervical pre-cancer should continue to be screened.
     
    Women who have had their uterus and cervix removed in a hysterectomy and have no history of cervical cancer or pre-cancer should not be screened.
     
    Women who have had the HPV vaccine should still follow the screening recommendations for their age group.
     
    Women who are at high risk for cervical cancer may need to be screened more often. Women at high risk might include those with HIV infection, organ transplant, or exposure to the drug DES. They should talk with their doctor or nurse.

In short, the American Cancer Society no longer recommends that women get a Pap test every year, because it generally takes much longer than that, 10 to 20 years, for cervical cancer to develop and overly frequent screening could lead to procedures that are not needed.

http://www.cancer.org/Cancer/news/new-screening-guidelines-for-cervical-cancer
Τίτλος: Απ: Practice Guidelines
Αποστολή από: Argirios Argiriou στις 16 Σεπτεμβρίου 2012, 15:48:51
NICE guidelines change how high blood pressure is diagnosed and treated.

Statement from the British Hypertension Society
August 2011


http://www.bhsoc.org/latest-guidelines
Τίτλος: Απ: Practice Guidelines
Αποστολή από: Gatekeeper στις 1 Ιουλίου 2013, 18:56:41
Arterial Hypertension (Management of)
ESH/ESC Clinical Practice Guidelines 2013

http://www.escardio.org/guidelines-surveys/esc-guidelines/Pages/arterial-hypertension.aspx
Τίτλος: Απ: Universal Definition of Myocardial Infarction
Αποστολή από: Gatekeeper στις 1 Ιουλίου 2013, 18:57:45
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος
EUROPEAN SOCIETY OF CARDIOLOGY (ESC)


ESC Guidelines: Universal Definition of Myocardial Infarction

Third Universal Definition of Myocardial Infarction
ESC Clinical Practice Guidelines   2012

http://www.escardio.org/guidelines-surveys/esc-guidelines/GuidelinesDocuments/Guidelines_Univ_Def_Myocardial_Infarc_FT.pdf
Τίτλος: Απ: Practice Guidelines
Αποστολή από: Gatekeeper στις 1 Ιουλίου 2013, 19:03:08
Global update on HIV treatment 2013: Results, impact and opportunities
30 June 2013, WHO

http://apps.who.int/iris/bitstream/10665/85326/1/9789241505734_eng.pdf
Τίτλος: Απ: Practice Guidelines
Αποστολή από: kakalos στις 20 Νοεμβρίου 2013, 21:21:12
New Cholesterol Guidelines Abandon LDL Targets

http://www.medscape.com/viewarticle/814152 (http://www.medscape.com/viewarticle/814152)
Τίτλος: Απ: Practice Guidelines
Αποστολή από: carlita στις 13 Δεκεμβρίου 2013, 21:09:00
New IDF Guidelines Target Diabetes Care in the Elderly


http://www.idf.org/sites/default/files/IDF%20Guideline%20for%20Older%20People.pdf
Τίτλος: Απ: Practice Guidelines
Αποστολή από: drpetros στις 14 Δεκεμβρίου 2013, 20:54:41
A COMPUTER-INTERPRETABLE CLINICAL GUIDELINE FOR THE DIAGNOSIS AND MANAGEMENT OF THYROID NODULES

AACE 2013

http://aace.metapress.com/content/mj02m58754013656/fulltext.pdf (http://aace.metapress.com/content/mj02m58754013656/fulltext.pdf)

Τίτλος: Απ: Practice Guidelines
Αποστολή από: carlita στις 18 Δεκεμβρίου 2013, 20:03:54
JNC-8 Loosens BP Cuffs


http://www.medpagetoday.com/Cardiology/Hypertension/43489?isalert=1&uun=g686482d448R5852380u&utm_source=breaking-news&utm_medium=email&utm_campaign=breaking-news&xid=NL_breakingnews_2013-12-18
Τίτλος: Απ: Practice Guidelines
Αποστολή από: Argirios Argiriou στις 21 Δεκεμβρίου 2013, 19:18:02
Clinical Practice Guidelines for the Management of Hypertension in the Community.

A Statement by the American Society of Hypertension and the International Society of Hypertension


http://www.ash-us.org/documents/ASH_ISH-Guidelines_2013.pdf
Τίτλος: Απ: Practice Guidelines
Αποστολή από: schumifer στις 21 Δεκεμβρίου 2013, 20:05:38
Έχουν τρελαθεί εκεί στο αμέρικα. Πολύ οδηγία και πολύ γκρίνια επίσης
Τίτλος: Απ: Practice Guidelines
Αποστολή από: Argirios Argiriou στις 22 Δεκεμβρίου 2013, 11:51:26
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος
Έχουν τρελαθεί εκεί στο αμέρικα. Πολύ οδηγία και πολύ γκρίνια επίσης

Σχετικό σχόλειο του Φαρμακοποιού Διαμαντή Κλημεντίδη στο Facebook:

Πάρε κόσμε guidelines. Μια μέρα μετά την JNC 8, η American Society of Hypertension δημοσίευσε δικές της, ξεχωριστές οδηγίες (!). Σε ότι αφορά την επιλογή φαρμάκων, βλέπω ότι αποκλίνει από την JNC 8 και πλησιάζει στη λογική των BHS/NICE (ο αλγόριθμος είναι σχεδόν όμοιος, με εξαίρεση την ηλικία: το NICE χρησιμοποιεί τα 55 έτη ως σημείο αναφοράς για την επιλογή μεταξύ ACEI/ARB και CCB/Thiazide, ενώ η ASH τα 60 έτη).

http://www.ash-us.org/documents/ASH_ISH-Guidelines_2013.pdf
Τίτλος: Απ: Practice Guidelines
Αποστολή από: schumifer στις 22 Δεκεμβρίου 2013, 21:40:28
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος
Έχουν τρελαθεί εκεί στο αμέρικα. Πολύ οδηγία και πολύ γκρίνια επίσης

Σχετικό σχόλειο του Φαρμακοποιού Διαμαντή Κλημεντίδη στο Facebook:

Πάρε κόσμε guidelines. Μια μέρα μετά την JNC 8, η American Society of Hypertension δημοσίευσε δικές της, ξεχωριστές οδηγίες (!). Σε ότι αφορά την επιλογή φαρμάκων, βλέπω ότι αποκλίνει από την JNC 8 και πλησιάζει στη λογική των BHS/NICE (ο αλγόριθμος είναι σχεδόν όμοιος, με εξαίρεση την ηλικία: το NICE χρησιμοποιεί τα 55 έτη ως σημείο αναφοράς για την επιλογή μεταξύ ACEI/ARB και CCB/Thiazide, ενώ η ASH τα 60 έτη).

http://www.ash-us.org/documents/ASH_ISH-Guidelines_2013.pdf


Και κάπου διάβασα και γκρίνια από τους ενδοκρινολόγους. Δε συγκράτησα όμως πού είχαν αντιρρήσεις γιατί απλά το βρήκα βαρετό
Τίτλος: Απ: Practice Guidelines
Αποστολή από: klaudiapaula στις 12 Δεκεμβρίου 2016, 08:33:13
Καλημερα σε ολους!!
Εδω και μια βδομαδα περιπου νιωθω περιεργους πονους στο πισω μερος του κεφαλιου μου.. ξερετε τι μπορει να ειναι αυτο?
Τίτλος: Απ: Practice Guidelines
Αποστολή από: GirousisN στις 12 Δεκεμβρίου 2016, 09:17:53
Δεν είναι ορατοί οι σύνδεσμοι (links). Εγγραφή ή Είσοδος
Καλημερα σε ολους!!
Εδω και μια βδομαδα περιπου νιωθω περιεργους πονους στο πισω μερος του κεφαλιου μου.. ξερετε τι μπορει να ειναι αυτο?

Δεν νομίζετε ότι η ''τηλειατρική'' είναι κομματάκι επικίνδυνη συνάδελφε ? Aν σας απαντούσα ότι πιθανά το σύμπτωμά σας οφείλεται σε κεφαλαλγία τάσεως θα ήσασταν ικανοποιημένη/ος ? Συγγνώμη για την off-topic απάντηση.
Τίτλος: ΚΑΤΕΥΘΥΝΤΗΡΙΕΣ ΟΔΗΓΙΕΣ ΣΥΝΤΑΓΟΓΡΑΦΗΣΗΣ ΓΑΣΤΡΟΣΚΟΠΗΣΗΣ & ΚΟΛΟΝΟΣΚΟΠΗΣΗΣ
Αποστολή από: Gatekeeper στις 23 Σεπτεμβρίου 2021, 11:19:23
ΚΑΤΕΥΘΥΝΤΗΡΙΕΣ ΟΔΗΓΙΕΣ ΣΥΝΤΑΓΟΓΡΑΦΗΣΗΣ ΓΑΣΤΡΟΣΚΟΠΗΣΗΣ & ΚΟΛΟΝΟΣΚΟΠΗΣΗΣ - ΕΟΠΥΥ

https://www.eopyy.gov.gr/article/ebe4431e-defa-495e-9b31-d189a5777fcf