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Practice Guidelines
Raptor:
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
Gatekeeper:
Low back pain
Early management of persistent non-specific low back pain
NICE guideline 27 May 2009
Μαρία Χόρτη:
Global Strategy for the Diagnosis and Management of Asthma in Children 5 Years and Younger. (GINA) 2009
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Εγγραφή ή Είσοδος
Pocket Guide for Asthma Management and Prevention in Children 5 Years and Younger
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Εγγραφή ή Είσοδος
Raptor:
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.
Μαρία Χόρτη:
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.”
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