cTAKES/YTEX Canonical Concepts

Canonical concepts created with the Apache cTAKES natural language processing system.
Document ID Recommendation Canonical Concepts
32470 A thorough history and physical examination should be obtained/ performed in patients presenting with HF to identify cardiac and noncardiac disorders or behaviors that might cause or accelerate the development or progression of HF. (I-C) [patient, noncardiac, cardiac, physical, progression, obtain, disorder, present, development, identify, accelerate, history, cause, behavior, thorough, perform, hf, examination]
32471 In patients with idiopathic dilated cardiomyopathy (DCM), a 3-generational family history should be obtained to aid in establishing the diagnosis of familial DCM. [diagnosi, history, patient, dilat, dcm, establish, family, generational, dcm, cardiomyopathy, familial, obtain, aid, idiopathic]
32472 Volume status and vital signs should be assessed at each patient encounter. This includes serial assessment of weight, as well as estimates of jugular venous pressure and the presence of peripheral edema or orthopnea. [orthopnea, encount, thi, assessment, asses, edema, serial, patient, sign, pressure, well, presence, estimate, each, peripheral, include, statu, venou, volume, weight, vital, jugular]
32473 Validated multivariable risk scores can be useful to estimate subsequent risk of mortality in ambulatory or hospitalized patients with HF. [ambulatory, useful, risk, estimate, subsequent, multivariable, validat, patient, risk, score, mortality, hf, hospitaliz]
32474 Initial laboratory evaluation of patients presenting with HF should include a complete blood cell count, urinalysis, measurement of serum electrolytes (including calcium and magnesium), blood urea nitrogen, serum creatinine, glucose, and thyroid-stimulating hormone, a fasting lipid profile, and liver function tests. [hormone, evaluation, electrolyte, urea, function, present, liv, patient, calcium, fast, thyroid, serum, nitrogen, blood, lipid, glucose, blood, initial, include, count, serum, profile, creatinine, complete, cell, stimulat, hf, includ, test, magnesium, laboratory, urinalysi, measurement]
32475 Serial monitoring, when indicated, should include serum electrolyte levels and renal function. [include, serial, electrolyte, serum, monitor, function, renal, level, indicat]
32476 A 12-lead electrocardiogram should be performed initially on all patients presenting with HF [initially, present, electrocardiogram, patient, lead, hf, perform]
32477 Screening for hemochromatosis or HIV is reasonable in selected patients who present with HF. [reasonable, hiv, patient, select, hemochromatosi, screen, present, hf]
32478 Diagnostic tests for rheumatological diseases, amyloidosis, or pheochromocytoma are reasonable in patients presenting with HF in whom there is a clinical suspicion of these diseases. [hf, diseas, patient, pheochromocytoma, test, suspicion, clinical, present, amyloidosi, diagnostic, rheumatological, reasonable, diseas]
32479 For patients at risk of developing HF, natriuretic peptide biomarker–based screening followed by team-based care, including a cardiovascular specialist optimizing GDMT, can be useful to prevent the development of left ventricular dysfunction (systolic or diastolic) or new-onset HF. [optimiz, patient, gdmt, specialist, hf, hf, useful, team, cardiovascular, screen, bas, new, ventricular, care, dysfunction, natriuretic, diastolic, prevent, develop, systolic, onset, bas, peptide, left, includ, follow, development, biomark, risk]
32480 In patients presenting with dyspnea, measurement of natriuretic peptide biomarkers is useful to support a diagnosis or exclusion of HF. [patient, dyspnea, present, support, biomarker, exclusion, natriuretic, measurement, useful, peptide, diagnosi, hf]
32481 Measurement of BNP or NT-proBNP is useful for establishing prognosis or disease severity in chronic HF. [chronic, nt, establish, disease, prognosi, probnp, useful, measurement, severity, hf, bnp]
32482 Measurement of baseline levels of natriuretic peptide biomarkers and/or cardiac troponin on admission to the hospital is useful to establish a prognosis in acutely decompensated HF. [measurement, useful, acutely, natriuretic, decompensat, peptide, biomarker, hf, prognosi, cardiac, level, hospital, troponin, admission, baseline, establish]
32483 During a HF hospitalization, a predischarge natriuretic peptide level can be useful to establish a postdischarge prognosis. [level, establish, useful, dur, natriuretic, peptide, postdischarge, hf, prognosi, predischarge, hospitalization]
32484 In patients with chronic HF, measurement of other clinically available tests, such as biomarkers of myocardial injury or fibrosis, may be considered for additive risk stratification. [consider, measurement, additive, myocardial, biomarker, fibrosi, risk, injury, stratification, clinically, hf, such, test, chronic, oth, patient, available]
32485 Patients with suspected or new-onset HF, or those presenting with acute decompensated HF, should undergo a chest x-ray to assess heart size and pulmonary congestion and to detect alternative cardiac, pulmonary, and other diseases that may cause or contribute to the patient’s symptoms. [present, suspect, alternative, new, congestion, cardiac, decompensat, undergo, hf, acute, patient, those, diseas, oth, hf, asses, detect, symptom, contribute, che, patient, pulmonary, heart, size, pulmonary, onset, cause]
32486 A 2-dimensional echocardiogram with Doppler should be performed during initial evaluation of patients presenting with HF to assess ventricular function, size, wall thickness, wall motion, and valve function. [hf, perform, function, doppl, dimensional, size, wall, function, echocardiogram, thicknes, wall, evaluation, motion, dur, valve, present, initial, ventricular, patient, asses]
32487 Repeat measurement of EF and measurement of the severity of structural remodeling are useful to provide information in patients with HF who have had a significant change in clinical status; who have experienced or recovered from a clinical event; or who have received treatment, including GDMT, that might have had a significant effect on cardiac function; or who may be candidates for device therapy. [clinical, change, significant, treatment, significant, includ, hf, statu, device, provide, information, measurement, effect, remodel, therapy, repeat, recover, ef, candidate, measurement, function, gdmt, cardiac, clinical, severity, useful, patient, experienc, receiv, structural, event]
32488 Noninvasive imaging to detect myocardial ischemia and viability is reasonable in patients presenting with de novo HF, who have known CAD and no angina, unless the patient is not eligible for revascularization of any kind. [noninvasive, myocardial, imag, patient, ischemia, viability, kind, known, novo, cad, angina, eligible, present, unles, reasonable, detect, hf, revascularization, de, patient]
32489 Viability assessment is reasonable in select situations when planning revascularization in HF patients with CAD. [viability, situation, patient, plan, hf, reasonable, cad, assessment, select, revascularization]
32490 Radionuclide ventriculography or magnetic resonance imaging can be useful to assess LVEF and volume when echocardiography is inadequate. [radionuclide, useful, volume, echocardiography, asses, inadequate, imag, magnetic, ventriculography, resonance, lvef]
32491 Magnetic resonance imaging is reasonable when assessing myocardial infiltrative processes or scar burden. [resonance, burden, imag, magnetic, myocardial, asses, infiltrative, process, reasonable, scar]
32492 Routine repeat measurement of LV function assessment in the absence of clinical status change or treatment interventions should NOT be performed. [measurement, repeat, treatment, routine, clinical, intervention, assessment, function, absence, change, lv, perform, statu]
32493 Invasive hemodynamic monitoring with a pulmonary artery catheter should be performed to guide therapy in patients who have respiratory distress or clinical evidence of impaired perfusion in whom the adequacy or excess of intracardiac filling pressures cannot be determined from clinical assessment. [evidence, adequacy, monitor, artery, fil, impair, distres, pulmonary, cathet, exces, therapy, invasive, patient, intracardiac, hemodynamic, perform, guide, determin, clinical, perfusion, assessment, pressure, respiratory, clinical]
32494 Invasive hemodynamic monitoring can be useful for carefully selected patients with acute HF who have persistent symptoms despite empiric adjustment of standard therapies, and: • Whose fluid status, perfusion, or systemic or pulmonary vascular resistance is uncertain; • Whose systolic pressure remains low, or is associated with symptoms, despite initial therapy; • Whose renal function is worsening with therapy; • Who require parenteral vasoactive agents; or • Who may need consideration for mechanical circulatory support (MCS) or transplantation. [despite, therapie, therapy, initial, select, whose, consideration, circulatory, empiric, invasive, mcs, statu, carefully, vascular, vasoactive, resistance, whose, therapy, support, useful, function, acute, pulmonary, symptom, pressure, uncertain, monitor, fluid, low, nee, associat, agent, symptom, hemodynamic, parenteral, systolic, whose, standard, mechanical, worsen, transplantation, persistent, perfusion, adjustment, hf, remain, despite, require, systemic, renal, patient]
32495 When ischemia may be contributing to HF, coronary arteriography is reasonable for patients eligible for revascularization. (IIa-C) [hf, ischemia, eligible, iia, patient, coronary, arteriography, contribut, reasonable, revascularization]
32496 Endomyocardial biopsy can be useful in patients presenting with HF when a specific diagnosis is suspected that would influence therapy. [diagnosi, patient, influence, endomyocardial, biopsy, specific, useful, suspect, hf, therapy, present]
32497 Routine use of invasive hemodynamic monitoring is NOT recommended in normotensive patients with acute decompensated HF and congestion with symptomatic response to diuretics and vasodilators. [acute, congestion, normotensive, vasodilator, hemodynamic, decompensat, recommend, diuretic, monitor, response, symptomatic, use, routine, hf, patient, invasive]
32498 Endomyocardial biopsy should NOT be performed in the routine evaluation of patients with HF. [perform, biopsy, endomyocardial, evaluation, patient, routine, hf]
32499 Hypertension and lipid disorders should be controlled in accordance with contemporary guidelines to lower the risk of HF. [disorder, hf, control, contemporary, risk, lipid, accordance, hypertension, guideline, low]
32500 Other conditions that may lead to or contribute to HF, such as obesity, diabetes mellitus, tobacco use, and known cardiotoxic agents, should be controlled or avoided. [avoid, contribute, cardiotoxic, known, condition, agent, use, mellitu, lead, control, such, obesity, diabete, tobacco, hf, oth]
32501 In all patients with a recent or remote history of MI or acute coronary syndrome and reduced EF, angiotensin-converting enzyme (ACE) inhibitors should be used to prevent symptomatic HF and reduce mortality. In patients intolerant of ACE inhibitors, angiotensin-receptor blockers are appropriate unless contraindicated. [receptor, intolerant, mortality, use, prevent, patient, convert, inhibitor, reduce, enzyme, acute, mi, blocker, contraindicat, remote, angiotensin, coronary, symptomatic, angiotensin, hf, recent, unles, history, ef, ace, appropriate, reduc, ace, inhibitor, syndrome, patient]
32503 In all patients with a recent or remote history of MI or acute coronary syndrome and reduced EF, evidence-based beta blockers should be used to reduce mortality. [coronary, reduce, bas, mi, reduc, ef, mortality, use, remote, beta, recent, syndrome, evidence, history, patient, acute, blocker]
32504 In all patients with a recent or remote history of MI or acute coronary syndrome, statins should be used to prevent symptomatic HF and cardiovascular events. [statin, cardiovascular, coronary, remote, use, recent, symptomatic, acute, event, syndrome, hf, prevent, history, mi, patient]
32505 In patients with structural cardiac abnormalities, including LV hypertrophy, in the absence of a history of MI or ACS, blood pressure should be controlled in accordance with clinical practice guidelines for hypertension to prevent symptomatic HF. [practice, patient, cardiac, symptomatic, absence, includ, control, clinical, history, hypertrophy, hypertension, acs, guideline, blood, mi, pressure, hf, prevent, structural, lv, abnormalitie, accordance]
32506 ACE inhibitors should be used in all patients with a reduced EF to prevent symptomatic HF, even if they do not have a history of MI. [reduc, patient, history, inhibitor, hf, even, symptomatic, ef, ace, mi, prevent, use]
32507 Beta blockers should be used in all patients with a reduced EF to prevent symptomatic HF, even if they do not have a history of MI. [hf, ef, prevent, blocker, patient, symptomatic, reduc, use, history, beta, even, mi]
32508 To prevent sudden death, placement of an implantable cardioverterdefibrillator (ICD) is reasonable in patients with asymptomatic ischemic cardiomyopathy who are ?40 days post-MI, have an LVEF of ?30%, are on appropriate medical therapy, and have a reasonable expectation of survival with a good functional status for >1 year. [statu, lvef, patient, implantable, death, reasonable, functional, placement, asymptomatic, survival, cardiomyopathy, therapy, reasonable, cardioverterdefibril, day, expectation, medical, ischemic, icd, prevent, appropriate, sudden, good, year]
32509 Nondihydropyridine calcium channel blockers with negative inotropic effects may be harmful in asymptomatic patients with low LVEF and no symptoms of HF after MI. [inotropic, blocker, lvef, symptom, hf, nondihydropyridine, calcium, negative, effect, patient, aft, mi, asymptomatic, low, channel, harmful]
32510 Patients with HF should receive specific education to facilitate HF self-care. [facilitate, hf, specific, patient, care, receive, self, hf, education]
32511 Sodium restriction is reasonable for patients with symptomatic HF to reduce congestive symptoms. [patient, hf, reduce, sodium, congestive, restriction, symptom, symptomatic, reasonable]
32512 Exercise training (or regular physical activity) is recommended as safe and effective for patients with HF who are able to participate to improve functional status. (I-A) [functional, train, physical, participate, activity, patient, recommend, improve, effective, exercise, safe, hf, statu, regular]
32513 Cardiac rehabilitation can be useful in clinically stable patients with HF to improve functional capacity, exercise duration, health-related quality of life (HRQOL), and mortality. [quality, functional, cardiac, duration, stable, health, hf, patient, rehabilitation, life, mortality, exercise, relat, useful, hrqol, capacity, clinically, improve]
32514 Measures listed as Class I recommendations for patients in stages A and B are recommended where appropriate for patients in stage C. (I-A, I-B, and I-C as appropriate) [list, recommend, clas, patient, appropriate, stage, stage, measure, patient, recommendation, appropriate]
32515 GDMT as depicted in Figure 1 should be the mainstay of pharmacological therapy for HFrEF. (I-A) <> [therapy, figure, figure2, hfref, pharmacological, depict, gdmt, mainstay]
32516 HFrEF NYHA class I–IV (Stage C) ACEI or ARB AND GDMT beta blocker; diuretics as needed (COR I) [diuretic, stage, clas, beta, hfref, cor, iv, block, need, acei, nyha, gdmt, arb]
32517 NYHA class II–IV, provided est. CrCl >30 mL/min & K+ <5.0 mEq/L implement Aldosterone antagonist (COR I) [antagonist, clas, min, ii, ml, implement, provid, iv, est, crcl, meq, aldosterone, cor, nyha]
32518 NYHA class II–III HF Adequate BP on ACEI or ARB; No C/I to ARB or sacubitril then Discontinue ACEI or ARB; initiate ARNI [discontinue, hf, initiate, arb, sacubitril, ii, arb, arni, nyha, acei, arb, bp, iii, clas, acei, adequate]
32519 NYHA class III–IV, in black patients implment Hydral-Nitrates [implment, patient, hydral, clas, iv, black, nitrate, iii, nyha]
32520 NYHA class II–III, LVEF ?35%; (caveat: >1 y survival, >40 d post MI) implement implantable cardioverter-defibrillator [nyha, mi, implement, caveat, clas, ii, post, survival, defibrillator, cardiovert, iii, lvef, implantable]
32521 NYHA class II–IV, LVEF ?35%, NSR & QRS ?150 ms with LBBB pattern [ii, clas, qrs, nsr, iv, lvef, pattern, lbbb, ms, nyha]
32522 NYHA class II–III, NSR, heart rate ?70 bpm on maximally tolerated dose beta blocker [iii, tolerat, heart, maximally, beta, block, ii, nyha, clas, nsr, bpm, dose, rate]
32523 patients are Stage D refractory NYHA class III-IV consider additional therapy of palliative care (COR I) or transplant (COR I) or left ventricular assist device (COR IIa) or Investigational studies [consid, stage, cor, transplant, therapy, patient, iia, cor, assist, cor, clas, nyha, additional, iii, left, ventricular, studie, palliative, investigational, care, refractory, iv, device]
32524 Diuretics are recommended in patients with HFrEF with fluid retention [diuretic, patient, fluid, hfref, recommend, retention]
32525 ACE inhibitors are recommended for all patients with HFrEF [ace, recommend, inhibitor, hfref, patient]
32526 ARBs are recommended in patients with HFrEF who are ACE inhibitor–intolerant [arb, patient, intolerant, recommend, inhibitor, ace, hfref]
32527 ARBs are reasonable as alternatives to ACE inhibitors as first-line therapy in HFrEF [hfref, line, arb, alternatif, reasonable, first, therapy, inhibitor, ace]
32528 Addition of an ARB may be considered in persistently symptomatic patients with HFrEF on GDMT [arb, consider, persistently, gdmt, symptomatic, hfref, patient, addition]
32529 Routine combined use of an ACE inhibitor, ARB, and aldosterone antagonist is potentially harmful for patients with HFrEF. [combin, arb, ace, use, harmful, inhibitor, aldosterone, hfref, patient, antagonist, routine, potentially]
32530 Use of 1 of the 3 beta blockers proven to reduce mortality is recommended for all stable patients [beta, patient, stable, proven, mortality, use, blocker, recommend, reduce]
32531 Aldosterone receptor antagonists are recommended in patients with NYHA class II–IV HF who have LVEF ?35% [nyha, antagonist, hf, lvef, recommend, ii, clas, patient, receptor, iv, aldosterone]
32532 Aldosterone receptor antagonists are recommended to reduce morbidity and mortality following an acute MI in patients who have LVEF of ?40% who develop symptoms of HF or who have a history of diabetes mellitus, unless contraindicated. [symptom, aldosterone, reduce, receptor, follow, develop, antagonist, acute, mellitu, recommend, diabete, mi, morbidity, contraindicat, patient, unles, hf, history, lvef, mortality]
32533 Inappropriate use of aldosterone receptor antagonists is potentially harmful because of life-threatening hyperkalemia or renal insufficiency when serum creatinine is >2.5 mg/dL in men or >2.0 mg/dL in women (or estimated glomerular filtration rate <30 mL/min/1.73 m2), and/or potassium >5.0 mEq/L. [serum, life, glomerular, creatinine, renal, estimat, min, antagonist, mg, potentially, man, woman, harmful, receptor, threaten, inappropriate, dl, meq, m2, hyperkalemia, mg, insufficiency, dl, filtration, aldosterone, ml, use, potassium, rate]
32534 The combination of hydralazine and isosorbide dinitrate is recommended for African Americans with NYHA class III–IV HFrEF on GDMT [african, dinitrate, gdmt, american, hydralazine, nyha, isosorbide, clas, iv, iii, recommend, hfref, combination]
32535 A combination of hydralazine and isosorbide dinitrate can be useful in patients with HFrEF who cannot be given ACE inhibitors or ARBs [combination, inhibitor, dinitrate, isosorbide, arb, hfref, ace, given, useful, hydralazine, patient]
32536 Digoxin can be beneficial in patients with HFrEF, unless contraindicated, to decrease hospitalizations for HF. [digoxin, contraindicat, hf, beneficial, hospitalization, patient, unles, hfref, decrease]
32537 Patients with chronic HF with permanent/persistent/paroxysmal AF and an additional risk factor for cardioembolic stroke (history of hypertension, diabetes mellitus, previous stroke or transient ischemic attack, or ?75 years of age) should receive chronic anticoagulant therapy (in the absence of contraindications to anticoagulation). [year, hf, absence, chronic, patient, permanent, stroke, diabete, persistent, therapy, transient, stroke, ischemic, hypertension, paroxysmal, factor, contraindication, anticoagulation, af, anticoagulant, history, receive, mellitu, age, cardioembolic, attack, additional, previou, chronic, risk]
32538 The selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal AF should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. ( [patient, warfarin, international, warfarin, individualiz, drug, apixaban, tak, persistent, basi, interaction, permanent, anticoagulant, clinical, selection, cost, tolerability, agent, patient, time, factor, therapeutic, normaliz, includ, af, potential, risk, rivaroxaban, oth, dabigatran, characteristic, range, preference, ratio, paroxysmal]
32539 Chronic anticoagulation is reasonable for patients with chronic HF who have permanent/persistent/paroxysmal AF but are without an additional risk factor for cardioembolic stroke (in the absence of contraindications to anticoagulation). ( [chronic, risk, cardioembolic, af, anticoagulation, paroxysmal, factor, anticoagulation, additional, reasonable, patient, absence, permanent, without, hf, chronic, stroke, contraindication, persistent]
32540 Anticoagulation is NOT recommended in patients with chronic HFrEF without AF, a prior thromboembolic event, or a cardioembolic source [patient, without, source, cardioembolic, hfref, af, event, chronic, recommend, anticoagulation, prior, thromboembolic]
32541 Statins are NOT beneficial as adjunctive therapy when prescribed solely for HF [beneficial, hf, statin, therapy, prescrib, adjunctive, solely]
32542 Omega-3 PUFA supplementation is reasonable to use as adjunctive therapy in HFrEF or HFpEF patients [hfref, patient, use, reasonable, adjunctive, therapy, supplementation, hfpef, omega, pufa]
32543 Nutritional supplements as treatment for HF are NOT recommended in patients with current or prior symptoms of HFrEF. ( [hf, supplement, prior, treatment, nutritional, recommend, patient, current, hfref, symptom]
32544 Hormonal therapies other than to correct deficiencies are NOT recommended in HFrEF [deficiencie, oth, therapie, hormonal, correct, recommend, hfref]
32545 Drugs known to adversely affect the clinical status of patients with current or prior symptoms of HFrEF are potentially harmful and should be avoided or withdrawn whenever possible (eg, most antiarrhythmic drugs, most calcium channel–blocking drugs [except amlodipine], nonsteroidal anti-inflammatory drugs, or thiazolidinediones). [drug, potentially, drug, drug, known, amlodipine, possible, calcium, symptom, affect, withdrawn, whenev, hfref, clinical, harmful, eg, thiazolidinedione, current, avoid, adversely, nonsteroidal, drug, prior, except, antiarrhythmic, channel, statu, patient, bloc]
32546 Long-term use of infused positive inotropic drugs is potentially harmful for patients with HFrEF, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment [term, harmful, inotropic, use, infus, end, drug, potentially, palliation, stage, positive, except, patient, long, stabiliz, treatment, hfref, patient, medical, standard, disease]
32547 Calcium channel–blocking drugs are NOT recommended as routine treatment in HFrEF [routine, drug, calcium, channel, treatment, recommend, bloc, hfref]
32548 The clinical strategy of inhibition of the renin-angiotensin system with ACE inhibitors OR ARBs in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic HFrEF to reduce morbidity and mortality. [antagonist, evidence, chronic, patient, clinical, angiotensin, patient, select, inhibition, strategy, renin, system, bas, morbidity, conjunction, mortality, blocker, aldosterone, arb, recommend, reduce, ace, inhibitor, hfref, beta]
32549 The clinical strategy of inhibition of the renin-angiotensin system with ARNI in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic HFrEF to reduce morbidity and mortality. [recommend, mortality, arni, system, angiotensin, chronic, evidence, beta, aldosterone, clinical, reduce, renin, conjunction, strategy, patient, inhibition, bas, morbidity, blocker, patient, hfref, select, antagonist]
32550 The use of ACE inhibitors is beneficial for patients with prior or current symptoms of chronic HFrEF to reduce morbidity and mortality. [morbidity, symptom, mortality, beneficial, hfref, patient, prior, use, inhibitor, chronic, ace, reduce, current]
32551 The use of ARBs to reduce morbidity and mortality is recommended in patients with prior or current symptoms of chronic HFrEF who are intolerant to ACE inhibitors because of cough or angioedema. [use, chronic, cough, angioedema, morbidity, mortality, ace, patient, intolerant, recommend, symptom, reduce, hfref, current, arb, inhibitor, prior]
32552 In patients with chronic symptomatic HFrEF NYHA class II or III who tolerate an ACE inhibitor or ARB, replacement by an ARNI is recommended to further reduce morbidity and mortality. [tolerate, replacement, inhibitor, recommend, chronic, clas, patient, hfref, symptomatic, nyha, arni, mortality, ace, reduce, iii, morbidity, furth, ii, arb]
32553 Angiotensin receptor-neprilysin inhibitor should not be administered concomitantly with ACE inhibitors or within 36 hours of the last dose of an ACE inhibitor. [within, administer, inhibitor, neprilysin, hour, ace, inhibitor, concomitantly, last, receptor, ace, angiotensin, inhibitor, dose]
32554 Angiotensin receptor-neprilysin inhibitor should not be administered to patients with a history of angioedema. [administer, receptor, angioedema, patient, inhibitor, neprilysin, angiotensin, history]
32555 Ivabradine can be beneficial to reduce HF hospitalization for patients with symptomatic (NYHA class II-III) stable chronic HFrEF (LVEF ?35%) who are receiving GDEM, including a beta blocker at maximum tolerated dose, and who are in sinus rhythm with a heart rate of ?70 bpm at rest. [gdem, hfref, maximum, dose, iii, tolerat, ivabradine, rhythm, rate, ii, chronic, hf, includ, receiv, sinu, block, clas, symptomatic, rest, beta, patient, heart, lvef, beneficial, bpm, nyha, stable, hospitalization, reduce]
32556 Diuretics are recommended in patients with HFrEF who have evidence of fluid retention, unless contraindicated, to improve symptoms. [diuretic, recommend, unles, fluid, improve, patient, symptom, evidence, contraindicat, hfref, retention]
32557 ACE inhibitors are recommended in patients with HFrEF and current or prior symptoms, unless contraindicated, to reduce morbidity and mortality. (I-A) [ace, unles, morbidity, patient, inhibitor, reduce, contraindicat, current, symptom, recommend, hfref, prior]
32558 ARBs are recommended in patients with HFrEF with current or prior symptoms who are ACE inhibitor–intolerant, unless contraindicated, to reduce morbidity and mortality. [current, reduce, recommend, unles, arb, prior, symptom, morbidity, patient, inhibitor, ace, intolerant, contraindicat, hfref, mortality]
32559 ARBs are reasonable to reduce morbidity and mortality as alternatives to ACE inhibitors as first-line therapy for patients with HFrEF, especially for patients already taking ARBs for other indications, unless contraindicated. [contraindicat, already, oth, unles, mortality, reasonable, ace, arb, arb, therapy, patient, tak, alternatif, reduce, line, morbidity, indication, especially, inhibitor, first, hfref, patient]
32560 Addition of an ARB may be considered in persistently symptomatic patients with HFrEF who are already being treated with an ACE inhibitor and a beta blocker in whom an aldosterone antagonist is not indicated or tolerated. [patient, indicat, beta, tolerat, aldosterone, persistently, symptomatic, consider, ace, addition, antagonist, arb, block, hfref, already, inhibitor, treat, bee]
32562 Use of 1 of the 3 beta blockers proven to reduce mortality (ie, bisoprolol, carvedilol, and sustained-release metoprolol succinate) is recommended for all patients with current or prior symptoms of HFrEF, unless contraindicated, to reduce morbidity and mortality. [carvedilol, beta, ie, symptom, recommend, bisoprolol, use, blocker, reduce, unles, morbidity, release, mortality, hfref, mortality, reduce, contraindicat, prior, succinate, patient, sustain, metoprolol, proven, current]
32563 Aldosterone receptor antagonists (or mineralocorticoid receptor antagonists) are recommended in patients with NYHA class II–IV and who have LVEF of ?35%, unless contraindicated, to reduce morbidity and mortality. Patients with NYHA class II should have a history of prior cardiovascular hospitalization or elevated plasma natriuretic peptide levels to be considered for aldosterone receptor antagonists. Creatinine levels should be ?2.5 mg/dL in men or ?2.0 mg/dL in women (or estimated glomerular filtration rate >30 mL/min/1.73 m2) 2) and potassium levels should be <5.0 mEq/L. Careful monitoring of potassium levels, renal function, and diuretic dosing should be performed at initiation and closely followed thereafter to minimize risk of hyperkalemia and renal insufficiency. [estimat, antagonist, mg, morbidity, minimize, elevat, lvef, thereaft, insufficiency, ii, ii, mineralocorticoid, receptor, closely, iv, nyha, min, meq, reduce, potassium, recommend, contraindicat, dl, unles, nyha, receptor, plasma, m2, woman, renal, renal, antagonist, function, mortality, ml, patient, dl, level, follow, history, glomerular, dos, peptide, level, initiation, mg, patient, monitor, potassium, aldosterone, man, antagonist, clas, diuretic, rate, level, hospitalization, filtration, prior, receptor, cardiovascular, natriuretic, consider, creatinine, perform, aldosterone, level, hyperkalemia, risk, clas, careful]
32566 The combination of hydralazine and isosorbide dinitrate is recommended to reduce morbidity and mortality for patients selfdescribed as African Americans with NYHA class III–IV HFrEF receiving optimal therapy with ACE inhibitors and beta blockers, unless contraindicated. [blocker, reduce, contraindicat, isosorbide, unles, hydralazine, african, nyha, receiv, selfdescrib, patient, iv, inhibitor, mortality, beta, therapy, dinitrate, combination, ace, morbidity, optimal, hfref, iii, clas, american, recommend]
32567 A combination of hydralazine and isosorbide dinitrate can be useful to reduce morbidity or mortality in patients with current or prior symptomatic HFrEF who cannot be given an ACE inhibitor or ARB because of drug intolerance, hypotension, or renal insufficiency, unless contraindicated. [drug, morbidity, isosorbide, unles, ace, reduce, useful, insufficiency, contraindicat, dinitrate, inhibitor, mortality, hydralazine, patient, intolerance, arb, symptomatic, current, renal, combination, given, hypotension, hfref, prior]
32570 The selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal AF should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. [patient, cost, international, permanent, clinical, warfarin, preference, time, tolerability, selection, rivaroxaban, anticoagulant, includ, tak, af, characteristic, paroxysmal, range, oth, basi, interaction, ratio, warfarin, drug, potential, agent, factor, risk, patient, dabigatran, therapeutic, apixaban, normaliz, persistent, individualiz]
32571 Chronic anticoagulation is reasonable for patients with chronic HF who have permanent/persistent/paroxysmal AF but are without an additional risk factor for cardioembolic stroke (in the absence of contraindications to anticoagulation). [factor, hf, anticoagulation, reasonable, additional, risk, contraindication, absence, without, chronic, chronic, cardioembolic, paroxysmal, anticoagulation, stroke, persistent, patient, permanent, af]
32572 Anticoagulation is NOT recommended in patients with chronic HFrEF without AF, a prior thromboembolic event, or a cardioembolic source. (III-B: No Benefit) [af, without, chronic, anticoagulation, prior, patient, benefit, recommend, event, thromboembolic, iii, cardioembolic, source, hfref]
32573 Statins are NOT beneficial as adjunctive therapy when prescribed solely for the diagnosis of HF in the absence of other indications for their use. [oth, diagnosi, statin, therapy, indication, adjunctive, absence, beneficial, solely, prescrib, use, hf]
32574 Omega-3 polyunsaturated fatty acid (PUFA) supplementation is reasonable to use as adjunctive therapy in patients with NYHA class II–IV symptoms and HFrEF or HFpEF, unless contraindicated, to reduce mortality and cardiovascular hospitalizations. [pufa, therapy, hfpef, fatty, cardiovascular, acid, hfref, nyha, omega, hospitalization, clas, adjunctive, patient, iv, mortality, use, unles, reasonable, reduce, contraindicat, ii, supplementation, symptom, polyunsaturat]
32575 Nutritional supplements as treatment for HF are NOT recommended in patients with current or prior symptoms of HFrEF. [current, prior, patient, hfref, symptom, treatment, supplement, recommend, nutritional, hf]
32576 Hormonal therapies other than to correct deficiencies are NOT recommended for patients with current or prior symptoms of HFrEF. [hormonal, hfref, prior, symptom, therapie, oth, patient, current, correct, deficiencie, recommend]
32578 Long-term use of infused positive inotropic drugs is potentially harmful for patients with HFrEF, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment (see recommendations for stage D starting on page 34). [inotropic, stage, positive, hfref, end, treatment, medical, recommendation, palliation, term, drug, potentially, harmful, infus, page, except, stage, see, start, standard, use, disease, patient, patient, long, stabiliz]
32579 Calcium channel–blocking drugs are NOT recommended as routine treatment for patients with HFrEF. [bloc, drug, hfref, patient, treatment, calcium, channel, routine, recommend]
32580 Systolic and diastolic blood pressure should be controlled in patients with HFpEF in accordance with published clinical practice guidelines to prevent morbidity. [guideline, patient, publish, hfpef, diastolic, accordance, morbidity, clinical, systolic, prevent, practice, control, blood, pressure]
32581 Diuretics should be used for relief of symptoms due to volume overload in patients with HFpEF. [use, patient, relief, hfpef, overload, volume, due, symptom, diuretic]
32582 Coronary revascularization is reasonable in patient with CAD in whom symptoms (angina) or demonstrable myocardial ischemia is judged to be having an adverse effect on symptomatic HFpEF despite GDMT. [demonstrable, despite, hfpef, gdmt, cad, patient, symptom, judg, ischemia, coronary, myocardial, symptomatic, effect, revascularization, adverse, hav, angina, reasonable]
32583 Management of AF according to published clinical practice guidelines in patients with HFpEF is reasonable to improve symptomatic HF. [practice, clinical, improve, publish, accord, patient, management, af, hfpef, symptomatic, guideline, hf, reasonable]
32584 The use of beta-blocking agents, ACE inhibitors, and ARBs in patients with hypertension is reasonable to control blood pressure in patients with HFpEF. [inhibitor, agent, arb, patient, pressure, beta, ace, bloc, hfpef, hypertension, patient, blood, use, control, reasonable]
32585 In appropriately selected patients with HFpEF (with EF ?45%, elevated BNP levels or HF admission within 1 year, estimated glomerular filtration rate >30 mL/min, creatinine <2.5 mg/dL, potassium <5.0 mEq/L), aldosterone receptor antagonists might be considered to decrease hospitalizations. [dl, admission, mg, bnp, potassium, appropriately, select, receptor, consider, estimat, elevat, level, rate, meq, glomerular, hospitalization, min, year, creatinine, antagonist, decrease, hfpef, hf, filtration, ml, ef, patient, aldosterone, within]
32586 The use of ARBs might be considered to decrease hospitalizations for patients with HFpEF. [hfpef, use, hospitalization, consider, patient, arb, decrease]
32587 Routine use of nitrates or phosphodiesterase-5 inhibitors to increase activity or QoL in patients with HFpEF is ineffective. [hfpef, inhibitor, patient, activity, ineffective, increase, nitrate, routine, phosphodiesterase, qol, use]
32588 Routine use of nutritional supplements is not recommended for patients with HFpEF. [nutritional, patient, use, supplement, routine, recommend, hfpef]
32589 ICD therapy is recommended for primary prevention of sudden cardiac death (SCD) to reduce total mortality in selected patients with nonischemic DCM or ischemic heart disease ?40 days post-MI with LVEF of ?35% and NYHA class II or III symptoms on chronic GDMT, who have a reasonable expectation of meaningful survival for >1 year.a .a (I-A) [primary, gdmt, lvef, meaningful, disease, reasonable, heart, year, death, survival, symptom, ii, iii, prevention, total, day, select, nonischemic, nyha, recommend, cardiac, clas, chronic, expectation, ischemic, sudden, mortality, reduce, patient, scd, therapy, dcm, icd]
32590 Cardiac resynchronization therapy is indicated for patients who have LVEF of 35% or less, sinus rhythm, left bundle-branch block (LBBB) with a QRS duration of 150 ms or greater, and NYHA class II, III, or ambulatory class IV symptoms on GDMT. [ms, indicat, symptom, lbbb, clas, nyha, block, qrs, rhythm, ii, left, therapy, iii, les, duration, ambulatory, great, gdmt, bundle, lvef, resynchronization, iv, sinu, clas, cardiac, branch, patient]
32591 ICD therapy is recommended for primary prevention of SCD to reduce total mortality in selected patients at least 40 days post-MI with LVEF of 30% or less and NYHA class I symptoms while receiving GDMT, who have a reasonable expectation of meaningful survival for more than 1 year. [receiv, symptom, gdmt, nyha, patient, therapy, prevention, year, select, recommend, survival, reasonable, scd, day, mortality, primary, more, icd, clas, expectation, meaningful, lvef, reduce, les, total]
32592 CRT can be useful for patients who have LVEF of ?35% , sinus rhythm, a non-LBBB pattern with a QRS duration of ?150 ms, and NYHA class III/ambulatory class IV symptoms on GDMT. [qrs, gdmt, duration, iii, patient, symptom, clas, ambulatory, nyha, useful, iv, ms, crt, sinu, clas, pattern, lvef, rhythm]
32593 CRT can be useful for patients who have LVEF of ?35%, sinus rhythm, LBBB with a QRS duration of 120–149 ms, and NYHA class II, III, or ambulatory class IV symptoms on GDMT. [qrs, patient, clas, iv, lvef, ms, gdmt, crt, ii, iii, useful, ambulatory, clas, sinu, rhythm, duration, nyha, lbbb, symptom]
32594 CRT can be useful in patients with AF and LVEF of ?35% on GDMT if a) the patient requires ventricular pacing or otherwise meets CRT criteria and b) atrioventricular nodal ablation or pharmacological rate control will allow near 100% ventricular pacing with CRT. [lvef, patient, crt, crt, crt, atrioventricular, rate, pac, patient, criteria, ventricular, gdmt, meet, otherwise, af, require, pac, ventricular, pharmacological, control, near, nodal, ablation, useful, allow]
32595 CRT can be useful for patients on GDMT who have LVEF of ?35% and are undergoing placement of a new or replacement device with anticipated requirement for significant (>40%) ventricular pacing. [new, ventricular, significant, anticipat, device, patient, pac, gdmt, undergo, useful, replacement, requirement, lvef, crt, placement]
32596 The usefulness of implantation of an ICD is of uncertain benefit to prolong meaningful survival in patients with a high risk of nonsudden death as predicted by frequent hospitalizations, advanced frailty, or comorbidities such as systemic malignancy or severe renal dysfunction. [frailty, benefit, predict, icd, nonsudden, hospitalization, advanc, implantation, high, usefulnes, survival, such, comorbiditie, risk, severe, uncertain, patient, malignancy, systemic, death, meaningful, dysfunction, prolong, renal, frequent]
32597 CRT may be considered for patients who have LVEF of ?35%, sinus rhythm, a non-LBBB pattern with a QRS duration of 120–149 ms, and NYHA class III/ambulatory class IV on GDMT. [iii, clas, gdmt, ambulatory, nyha, crt, ms, rhythm, sinu, clas, pattern, lvef, duration, consider, qrs, patient, iv]
32598 CRT may be considered for patients who have LVEF of ?35%, sinus rhythm, a non-LBBB pattern with a QRS duration of ?150 ms, and NYHA class II symptoms on GDMT. [rhythm, consider, qrs, patient, nyha, clas, crt, ms, ii, gdmt, sinu, pattern, lvef, duration, symptom]
32599 CRT may be considered for patients who have LVEF of ?30%, ischemic etiology of HF, sinus rhythm, LBBB with a QRS duration of ?150 ms, and NYHA class I symptoms on GDMT. [rhythm, lvef, symptom, nyha, lbbb, patient, crt, ms, etiology, ischemic, gdmt, sinu, duration, clas, consider, qrs, hf]
32600 CRT is NOT recommended for patients with NYHA class I or II symptoms and non-LBBB pattern with a QRS duration of <150 ms. [crt, recommend, ii, qrs, nyha, clas, ms, patient, pattern, symptom, duration]
32601 CRT is NOT indicated for patients whose comorbidities and/or frailty limit survival with good functional capacity to <1 year. [functional, patient, crt, limit, whose, capacity, year, frailty, indicat, comorbiditie, survival, good]
32602 Fluid restriction (1.5–2 L/d) is reasonable in stage D, especially in patients with hyponatremia, to reduce congestive symptoms. [reasonable, stage, restriction, symptom, especially, patient, hyponatremia, reduce, congestive, fluid]
32603 Until definitive therapy (eg, coronary revascularization, MCS, heart transplantation) or resolution of the acute precipitating problem, patients with cardiogenic shock should receive temporary intravenous inotropic support to maintain systemic perfusion and preserve endorgan performance. [shock, temporary, acute, support, endorgan, intravenou, precipitat, patient, problem, perfusion, preserve, receive, revascularization, heart, resolution, definitive, transplantation, eg, cardiogenic, until, inotropic, systemic, coronary, performance, therapy, maintain, mcs]
32604 Continuous intravenous inotropic support is reasonable as “bridge therapy” in patients with stage D HF refractory to GDMT and device therapy who are eligible for and awaiting MCS or cardiac transplantation. [bridge, therapy, therapy, intravenou, stage, eligible, support, device, patient, gdmt, transplantation, mcs, hf, await, refractory, continuou, cardiac, reasonable, inotropic]
32605 Short-term, continuous intravenous inotropic support may be reasonable in those hospitalized patients presenting with documented severe systolic dysfunction who present with low blood pressure and significantly depressed cardiac output to maintain systemic perfusion and preserve end-organ performance. [those, perfusion, maintain, low, hospitaliz, present, pressure, continuou, systolic, document, dysfunction, blood, reasonable, inotropic, performance, cardiac, intravenou, support, significantly, depres, term, output, severe, present, short, organ, end, patient, preserve, systemic]
32606 Long-term, continuous intravenous inotropic support may be considered as palliative therapy for symptom control in select patients with stage D HF despite optimal GDMT and device therapy who are not eligible for either MCS or cardiac transplantation. [control, cardiac, symptom, despite, continuou, palliative, eligible, therapy, optimal, long, eith, support, inotropic, select, stage, gdmt, transplantation, patient, therapy, consider, device, mcs, intravenou, term, hf]
32607 Long-term use of either continuous or intermittent, intravenous parenteral positive inotropic agents, in the absence of specific indications or for reasons other than palliative care, is potentially harmful in the patient with HF. [use, care, parenteral, continuou, oth, intravenou, inotropic, specific, positive, patient, hf, palliative, term, harmful, intermittent, long, eith, absence, potentially, reason, indication, agent]
32608 Use of parenteral inotropic agents in hospitalized patients without documented severe systolic dysfunction, low blood pressure, or impaired perfusion, and evidence of significantly depressed cardiac output, with or without congestion, is potentially harmful. [hospitaliz, severe, congestion, cardiac, document, perfusion, use, patient, inotropic, output, without, parenteral, dysfunction, significantly, harmful, low, evidence, depres, blood, agent, potentially, systolic, without, impair, pressure]
32609 MCS is beneficial in carefully selected patients with stage D HFrEF in whom definitive management (eg, cardiac transplantation) or cardiac recovery is anticipated or planned. [carefully, stage, transplantation, management, beneficial, mcs, patient, plan, definitive, select, anticipat, hfref, recovery, eg, cardiac, cardiac]
32610 Nondurable MCS, including the use of percutaneous and extracorporeal ventricular assist devices, is reasonable as a “bridge to recovery” or a “bridge to decision” for carefully selecteda HFrEF a H patients with acute, profound hemodynamic compromise. [use, devex, extracorporeal, carefully, compromise, hfref, bridge, patient, includ, acute, hemodynamic, ventricular, mcs, recovery, percutaneou, nondurable, bridge, profound, selecteda, assist, decision, reasonable]
32611 Durable MCS is reasonable to prolong survival for carefully selecteda a patients with stage D HFrEF. [carefully, stage, patient, hfref, prolong, durable, survival, mcs, reasonable, selecteda]
32612 Evaluation for cardiac transplantation is indicated for carefully selected patients with stage D HF despite GDMT, device, and surgical management. [management, transplantation, stage, evaluation, patient, select, gdmt, despite, device, cardiac, hf, surgical, indicat, carefully]
32613 ACS precipitating acute HF decompensation should be promptly identified by ECG and serum biomarkers, including cardiac troponin testing, and treated optimally as appropriate to the overall condition and prognosis of the patient. [biomarker, serum, treat, decompensation, ecg, appropriate, overall, test, prognosi, acs, cardiac, hf, condition, acute, promptly, troponin, patient, precipitat, identifi, includ, optimally]
32614 Common precipitating factors for acute HF should be considered during initial evaluation, as recognition of these conditions is critical to guide appropriate therapy. [condition, therapy, hf, acute, evaluation, recognition, critical, dur, appropriate, common, precipitat, initial, factor, guide, consider]
32615 In patients with HFrEF experiencing a symptomatic exacerbation of HF requiring hospitalization during chronic maintenance treatment with GDMT, it is recommended that GDMT be continued in the absence of hemodynamic instability or contraindications. [chronic, gdmt, gdmt, requir, symptomatic, exacerbation, experienc, continu, absence, instability, hf, treatment, recommend, hospitalization, patient, contraindication, dur, maintenance, hemodynamic, hfref]
32616 Initiation of beta-blocker therapy is recommended after optimization of volume status and successful discontinuation of intravenous diuretics, vasodilators, and inotropic agents. Beta-blocker therapy should be initiated at a low dose and only in stable patients. [block, agent, volume, vasodilator, block, beta, optimization, successful, patient, therapy, recommend, statu, aft, initiat, therapy, diuretic, dose, inotropic, beta, initiation, low, intravenou, discontinuation, stable]
32617 Caution should be used when initiating the use of beta blockers in patients who have required inotropes during their hospital course. [initiat, requir, blocker, dur, caution, use, beta, use, course, inotrope, hospital, patient]
32618 Patients with HF admitted with evidence of significant fluid overload should be promptly treated with intravenous loop diuretics to reduce morbidity. [admit, morbidity, evidence, patient, overload, fluid, treat, diuretic, significant, hf, intravenou, promptly, reduce, loop]
32619 If patients are already receiving loop diuretic therapy, the initial intravenous dose should equal or exceed their chronic oral daily dose [daily, patient, receiv, dose, initial, diuretic, intravenou, therapy, exce, equal, oral, already, chronic, loop, dose]
32620 The effect of HF treatment should be monitored with careful measurement of fluid intake and output, vital signs, body weight that is determined at the same time each day, and clinical signs and symptoms of systemic perfusion and congestion. Daily serum electrolytes, urea nitrogen, and creatinine concentrations should be measured during the use of intravenous diuretics or active titration of HF medications. [nitrogen, urea, output, intake, treatment, electrolyte, body, dur, determin, concentration, systemic, measur, weight, monitor, diuretic, careful, measurement, serum, perfusion, medication, day, sign, intravenou, use, creatinine, fluid, each, clinical, effect, daily, same, hf, time, active, hf, vital, titration, symptom, sign, congestion]
32621 When diuresis is inadequate to relieve symptoms, it is reasonable to intensify the diuretic regimen using either: a. Higher doses of intravenous loop diuretics (IIa-B), or b. Addition of a second (eg, thiazide) diuretic (IIa-B). [dos, diuresi, loop, inadequate, use, eg, diuretic, reasonable, diuretic, iia, iia, addition, intensify, diuretic, intravenou, symptom, high, regiman, eith, second, relieve, thiazide]
32622 Low-dose dopamine infusion may be considered in addition to loop diuretic therapy to improve diuresis and better preserve renal functio and renal blood flow. [low, bet, dose, blood, flow, diuretic, consider, diuresi, preserve, dopamine, improve, infusion, functio, therapy, renal, addition, loop, renal]
32623 Ultrafiltration may be considered for patients with obvious volume overload to alleviate congestive symptoms and fluid weight. [congestive, weight, symptom, consider, volume, overload, alleviate, fluid, patient, ultrafiltration, obviou]
32624 Ultrafiltration may be considered for patients with refractory congestion not responding to medical therapy. [consider, ultrafiltration, therapy, patient, congestion, respond, refractory, medical]
32625 If symptomatic hypotension is absent, intravenous nitroglycerin, nitroprusside, or nesiritide may be considered as an adjuvant to diuretic therapy for relief of dyspnea in patients admitted with acute decompensated HF. [relief, absent, adjuvant, consider, patient, dyspnea, therapy, diuretic, nitroglycerin, hypotension, admit, acute, hf, decompensat, symptomatic, intravenou, nitroprusside, nesiritide]
32626 A patient admitted to the hospital with decompensated HF should receive venous thromboembolism prophylaxis with an anticoagulant medication if the risk–benefit ratio is favorable. [receive, thromboembolism, favorable, prophylaxi, benefit, ratio, anticoagulant, hospital, patient, admit, decompensat, medication, venou, hf, risk]
32627 In patients hospitalized with volume overload, including HF, who have persistent severe hyponatremia and are at risk for or having active cognitive symptoms despite water restriction and maximization of GDMT, vasopressin antagonists may be considered in the short term to improve serum sodium concentration in hypervolemic, hyponatremic states with either a V2 receptor–selective or a nonselective vasopressin antagonist. [antagonist, state, active, hyponatremia, persistent, hf, volume, receptor, includ, symptom, serum, selective, hav, consider, antagonist, vasopressin, concentration, hospitaliz, sodium, severe, maximization, risk, eith, despite, hyponatremic, gdmt, hypervolemic, improve, restriction, overload, term, wat, short, patient, cognitive, v2, vasopressin, nonselective]
32628 The use of performance improvement systems and/or evidence-based systems of care is recommended in the hospital and early postdischarge outpatient setting to identify appropriate HF patients for GDMT, provide clinicians with useful reminders to advance GDMT, and assess the clinical response. [system, provide, clinical, outpatient, gdmt, performance, bas, evidence, gdmt, appropriate, response, asses, care, use, reminder, hospital, advance, system, recommend, patient, useful, postdischarge, improvement, clinician, set, early, identify, hf]
32629 Throughout the hospitalization as appropriate, before hospital discharge, at the first postdischarge visit, and in subsequent follow-up visits, the following should be addressed (I-B): a. Initiation of GDMT if not previously established and not contraindicated b. Precipitant causes of HF, barriers to optimal care transitions, and limitations in postdischarge support c. Assessment of volume status and supine/upright hypotension with adjustment of HF therapy, as appropriate d. Titration and optimization of chronic oral HF therapy e. Assessment of renal function and electrolytes, where appropriate f. Assessment and management of comorbid conditions g. Reinforcement of HF education, self-care, emergency plans, and need for adherence h. Consideration for palliative care or hospice care in selected patients [visit, assessment, up, support, emergency, initiation, limitation, hospital, hospice, care, nee, care, visit, transition, addres, postdischarge, assessment, palliative, caus, upright, appropriate, patient, precipitant, discharge, consideration, volume, care, appropriate, optimal, statu, throughout, optimization, supine, renal, therapy, before, adjustment, subsequent, follow, function, first, establish, follow, comorbid, hf, condition, plan, previously, care, hf, hospitalization, titration, appropriate, adherence, electrolyte, chronic, hypotension, select, self, assessment, education, contraindicat, hf, gdmt, management, therapy, reinforcement, hf, postdischarge, oral, barrier]
32630 Multidisciplinary HF disease-management programs are recommended for patients at high risk for hospital readmission, to facilitate the implementation of GDMT, to address different barriers to behavioral change, and to reduce the risk of subsequent rehospitalization for HF. [patient, change, barrier, behavioral, gdmt, high, addres, reduce, hf, readmission, facilitate, program, risk, subsequent, rehospitalization, multidisciplinary, recommend, risk, implementation, different, hospital, disease, management, hf]
32631 Scheduling an early follow-up visit (within 7–14 days) and early telephone follow-up (within 3 days) of hospital discharge is reasonable. [telephone, schedul, early, within, visit, day, discharge, within, follow, up, hospital, early, reasonable, up, day, follow]
32632 Use of clinical risk-prediction tools and/or biomarkers to identify patients at higher risk for postdischarge clinical events is reasonable. [patient, identify, use, risk, high, risk, clinical, postdischarge, clinical, prediction, event, reasonable, biomarker, tool]
32633 In patients with NYHA class II and III HF and iron deficiency (ferritin <100 ng/mL or 100–300 ng/mL if transferrin saturation is <20%), intravenous iron replacement might be reasonable to improve functional status and QoL. [transferrin, intravenou, iron, functional, statu, iii, saturation, ng, reasonable, ferritin, deficiency, patient, qol, ng, ml, clas, iron, improve, ii, hf, ml, nyha, replacement]
32634 In patients with HF and anemia, erythropoietin-stimulating agents should not be used to improve morbidity and mortality. [anemia, erythropoietin, stimulat, use, mortality, hf, patient, morbidity, agent, improve]
32635 In patients at increased risk, stage A HF, the optimal blood pressure in those with hypertension should be <130/80 mm Hg. [optimal, stage, increas, patient, hf, pressure, blood, hypertension, mm, risk, hg, those]
32636 Patients with HFrEF and hypertension should be prescribed GDMT titrated to attain systolic blood pressure <130 mm Hg. [hg, patient, gdmt, pressure, mm, prescrib, titrat, blood, systolic, attain, hfref, hypertension]
32637 Patients with HFpEF and persistent hypertension after management of volume overload should be prescribed GDMT titrated to attain systolic blood pressure <130 mm Hg [attain, mm, management, aft, patient, persistent, gdmt, overload, hg, pressure, blood, hfpef, volume, systolic, titrat, hypertension, prescrib]
32638 In patients with NYHA class II–IV HF and suspicion of sleep disordered breathing or excessive daytime sleepiness, a formal sleep assessment is reasonable [ii, formal, sleep, suspicion, clas, daytime, sleepines, iv, reasonable, sleep, breath, nyha, patient, assessment, disorder, excessive, hf]
32639 In patients with cardiovascular disease and obstructive sleep apnea, CPAP may be reasonable to improve sleep quality and daytime sleepiness [reasonable, apnea, cpap, obstructive, daytime, sleepines, sleep, sleep, disease, cardiovascular, patient, improve, quality]
32640 In patients with NYHA class II–IV HFrEF and central sleep apnea, adaptive servo-ventilation causes harm [hfref, clas, apnea, iv, sleep, ventilation, central, nyha, servo, harm, caus, patient, adaptive, ii]
32641 Coronary artery revascularization via coronary artery bypass graft (CABG) or percutaneous intervention is indicated for patients (HFpEF and HFrEF) on GDMT with angina and suitable coronary anatomy, especially for a left main stenosis (>50%) or left main–equivalent disease. (I-C) [suitable, hfref, bypas, percutaneou, hfpef, coronary, equivalent, coronary, especially, intervention, stenosi, via, indicat, angina, gdmt, artery, coronary, graft, left, left, main, artery, anatomy, disease, cabg, patient, revascularization, main]
32642 Coronary artery revascularization via coronary artery bypass graft to improve survival is reasonable in patients with mild to moderate LV systolic dysfunction (EF 35%–50%) and significant (?70% diameter stenosis) multivessel CAD or proximal left anterior descending (LAD) coronary artery stenosis when viable myocardium is present in the region of intended revascularization. (IIa-B) [intend, via, left, reasonable, survival, bypas, myocardium, region, viable, significant, artery, anterior, coronary, lad, coronary, lv, ef, stenosi, proximal, artery, multivessel, revascularization, moderate, cad, revascularization, dysfunction, patient, graft, present, stenosi, descend, improve, systolic, iia, diamet, mild, coronary, artery]
32643 CABG or medical therapy is reasonable to improve morbidity and cardiovascular mortality for patients with severe LV dysfunction (EF <35%), HF, and significant CAD. [therapy, cabg, significant, cardiovascular, severe, hf, ef, lv, patient, improve, mortality, medical, reasonable, dysfunction, cad, morbidity]
32644 Surgical aortic valve replacement is reasonable for patients with critical aortic stenosis and a predicted surgical mortality of <10%. (IIa-B) [surgical, patient, aortic, surgical, stenosi, aortic, reasonable, predict, mortality, replacement, valve, critical, iia]
32645 Transcatheter aortic valve replacement after careful candidate consideration is reasonable for patients with critical aortic stenosis who are deemed inoperable. (IIa-B) [reasonable, critical, iia, careful, patient, replacement, aortic, transcathet, aft, valve, candidate, aortic, stenosi, consideration, inoperable, deem]
32646 CABG may be considered with the intent of improving survival in patients with ischemic heart disease with severe LV systolic dysfunction (EF <35%) and operable coronary anatomy whether or not viable myocardium is present. (IIb-B) [disease, iib, coronary, consider, wheth, survival, ischemic, operable, viable, improv, anatomy, myocardium, severe, systolic, present, ef, dysfunction, intent, patient, lv, heart, cabg]
32647 Transcatheter mitral valve repair or mitral valve surgery for functional mitral insufficiency is of uncertain benefit and should only be considered after careful candidate selection and with a background of GDMT. [careful, surgery, selection, functional, valve, mitral, candidate, transcathet, gdmt, aft, consider, uncertain, background, valve, mitral, mitral, benefit, repair, insufficiency]
32648 Surgical reverse remodeling or LV aneurysmectomy may be considered in carefully selected patients with HFrEF for specific indications including intractable HF and ventricular arrhythmias. [reverse, aneurysmectomy, indication, remodel, lv, intractable, hf, carefully, hfref, patient, ventricular, surgical, arrhythmia, specific, includ, consider, select]
32649 Effective systems of care coordination with special attention to care transitions should be deployed for every patient with chronic HF that facilitate and ensure effective care that is designed to achieve GDMT and prevent hospitalization. [care, care, effective, effective, coordination, ensure, hospitalization, attention, transition, chronic, deploy, care, special, system, hf, facilitate, gdmt, prevent, design, patient, achieve]
32650 Every patient with HF should have a clear, detailed, and evidencebased plan of care that ensures the achievement of GDMT goals, effective management of comorbid conditions, timely follow-up with the healthcare team, appropriate dietary and physical activities, and compliance with secondary prevention guidelines for cardiovascular disease. This plan of care should be updated regularly and made readily available to all members of each patient’s healthcare team. (I-C) [guideline, patient, plan, prevention, up, updat, each, made, timely, readily, member, healthcare, detail, cardiovascular, physical, follow, available, disease, ensure, plan, effective, care, secondary, regularly, dietary, goal, patient, compliance, care, comorbid, evidencebas, team, achievement, healthcare, team, condition, activitie, thi, appropriate, hf, management, gdmt, clear]
32651 Palliative and supportive care is effective for patients with symptomatic advanced HF to improve quality of life. (I-B) [effective, hf, symptomatic, care, palliative, life, improve, advanc, supportive, quality, patient]
32652 Performance measures based on professionally developed clinical practice guidelines should be used with the goal of improving quality of care for HF. [clinical, performance, hf, measure, quality, professionally, practice, improv, goal, bas, use, guideline, develop, care]
32653 Participation in quality improvement programs and patient registries based on nationally endorsed, clinical practice guideline–based quality and performance measures can be beneficial in improving quality of HF care. [improvement, performance, hf, improv, nationally, care, patient, endors, guideline, quality, quality, beneficial, quality, practice, participation, measure, program, registrie, clinical, bas, bas]
32654 We suggest noninvasive sampling with semiquantitative cultures to diagnose VAP, rather than invasive sampling with quantitative cultures and rather than noninvasive sampling with quantitative cultures [culture, semiquantitative, noninvasive, invasive, sampl, rath, sampl, vap, quantitative, noninvasive, diagnose, culture, rath, quantitative, sampl, culture, sug]
32655 Noninvasive sampling with semiquantitative cultures is the preferred methodology to diagnose VAP (see section I); however, the panel recognizes that invasive quantitative cultures will occasionally be performed by some clinicians. For patients with suspected VAP whose invasive quantitative culture results are below the diagnostic threshold for VAP, we suggest that antibiotics be withheld rather than continued [below, panel, howev, diagnose, sug, vap, invasive, clinician, see, diagnostic, prefer, antibiotic, culture, culture, withheld, methodology, vap, rath, whose, quantitative, quantitative, invasive, culture, section, continu, vap, suspect, threshold, recogniz, result, occasionally, patient, semiquantitative, noninvasive, sampl, perform]
32656 We suggest that patients with suspected HAP (non-VAP) be treated according to the results of microbiologic studies performed on respiratory samples obtained noninvasively, rather than being treated empirically [suspect, microbiologic, rath, studie, treat, sample, sug, accord, treat, result, respiratory, obtain, perform, hap, bee, empirically, noninvasively, patient]
32657 For patients with suspected HAP/VAP, we recommend using clinical criteria alone, rather than using serum PCT plus clinical criteria, to decide whether or not to initiate antibiotic therapy [criteria, clinical, therapy, antibiotic, decide, use, plu, patient, clinical, vap, use, initiate, serum, recommend, suspect, rath, criteria, pct, alone, hap, wheth]
32658 For patients with suspected HAP/VAP, we recommend using clinical criteria alone, rather than using bronchoalveolar lavage fluid (BALF) sTREM-1 plus clinical criteria, to decide whether or not to initiate antibiotic therapy [initiate, clinical, fluid, therapy, lavage, recommend, plu, rath, criteria, balf, criteria, use, vap, suspect, patient, hap, wheth, strem, alone, antibiotic, clinical, decide, use, bronchoalveolar]
32659 For patients with suspected HAP/VAP, we recommend using clinical criteria alone rather than using CRP plus clinical criteria, to decide whether or not to initiate antibiotic therapy [crp, decide, suspect, antibiotic, rath, recommend, patient, therapy, alone, initiate, vap, plu, use, use, wheth, criteria, hap, clinical, clinical, criteria]
32660 For patients with suspected HAP/VAP, we suggest using clinical criteria alone, rather than using CPIS plus clinical criteria, to decide whether or not to initiate antibiotic therapy [therapy, antibiotic, clinical, vap, use, patient, criteria, alone, initiate, hap, clinical, rath, wheth, criteria, cpi, decide, suspect, use, sug, plu]
32661 In patients with VAT, we suggest not providing antibiotic therapy [therapy, antibiotic, provid, patient, vat, sug]
32662 In patients with suspected VAP, we recommend including coverage for S. aureus, Pseudomonas aeruginosa, and other gram-negative bacilli in all empiric regimens [aeruginosa, bacilli, regimen, coverage, recommend, empiric, includ, pseudomona, gram, patient, oth, aureu, suspect, negative, vap]
32663 We suggest including an agent active against MRSA for the empiric treatment of suspected VAP only in patients with any of the following: a risk factor for antimicrobial resistance (Table 2), patients being treated in units where >10%–20% of S. aureus isolates are methicillin resistant, and patients in units where the prevalence of MRSA is not known [aureu, methicillin, prevalence, follow, unit, suspect, table, empiric, antimicrobial, mrsa, active, risk, patient, known, patient, includ, resistant, treat, factor, sug, vap, patient, treatment, against, resistance, isolate, bee, agent, unit, mrsa]
32664 We suggest including an agent active against methicillinsensitive S. aureus (MSSA) (and not MRSA) for the empiric treatment of suspected VAP in patients without risk factors for antimicrobial resistance, who are being treated in ICUs where <10%–20% of S. aureus isolates are methicillin resistant (weak recommendation, very low-quality evidence). [evidence, resistant, aureu, resistance, treatment, factor, low, suspect, very, risk, empiric, mrsa, methicillin, methicillinsensitive, quality, vap, includ, isolate, agent, treat, sug, antimicrobial, without, icu, aureu, patient, against, recommendation, mssa, bee, weak, active]
32665 If empiric coverage for MRSA is indicated, we recommend either vancomycin or linezolid [coverage, linezolid, indicat, empiric, mrsa, vancomycin, eith, recommend]
32666 When empiric treatment that includes coverage for MSSA (and not MRSA) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem (weak recommendation, very low-quality evidence). Oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven MSSA, but are not necessary for the empiric treatment of VAP if one of the above agents is used. [empiric, above, mssa, oxacillin, very, vap, prefer, includ, indicat, imipenem, mssa, mrsa, weak, tazobactam, sug, cefazolin, regiman, treatment, use, agent, nafcillin, quality, coverage, piperacillin, recommendation, include, levofloxacin, treatment, evidence, proven, treatment, cefepime, low, one, necessary, agent, empiric, meropenem]
32667 Oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven MSSA, but are not necessary for the empiric treatment of VAP if one of the above agents is used [one, proven, treatment, agent, cefazolin, oxacillin, empiric, prefer, use, mssa, treatment, nafcillin, vap, above, necessary, agent]
32668 We suggest prescribing 2 antipseudomonal antibiotics from different classes for the empiric treatment of suspected VAP only in patients with any of the following: a risk factor for antimicrobial resistance (Table 2), patients in units where >10% of gram-negative isolates are resistant to an agent being considered for monotherapy, and patients in an ICU where local antimicrobial susceptibility rates are not available [different, icu, patient, empiric, class, rate, susceptibility, isolate, vap, sug, antibiotic, prescrib, antimicrobial, available, negative, antimicrobial, unit, patient, patient, resistant, bee, follow, suspect, monotherapy, risk, table, local, gram, consider, resistance, agent, treatment, antipseudomonal, factor]
32669 We suggest prescribing one antibiotic active against P. aeruginosa for the empiric treatment of suspected VAP in patients without risk factors for antimicrobial resistance who are being treated in ICUs where ?10% of gram-negative isolates are resistant to the agent being considered for monotherapy [icu, treatment, gram, negative, without, agent, risk, treat, against, vap, factor, resistance, consider, monotherapy, isolate, empiric, one, bee, prescrib, bee, suspect, aeruginosa, antimicrobial, patient, antibiotic, active, resistant, sug]
32670 In patients with suspected VAP, we suggest avoiding aminoglycosides if alternative agents with adequate gram-negative activity are available [patient, adequate, gram, negative, aminoglycoside, avoid, activity, alternative, vap, suspect, sug, available, agent]
32671 In patients with suspected VAP, we suggest avoiding colistin if alternative agents with adequate gram-negative activity are available [negative, vap, avoid, activity, alternative, agent, suspect, sug, available, adequate, colistin, patient, gram]
32672 For patients being treated empirically for HAP, we recommend prescribing an antibiotic with activity against S. aureus [recommend, bee, against, patient, aureu, antibiotic, empirically, treat, prescrib, hap, activity]
32673 For patients with HAP who are being treated empirically and have either a risk factor for MRSA infection (ie, prior intravenous antibiotic use within 90 days, hospitalization in a unit where >20% of S. aureus isolates are methicillin resistant, or the prevalence of MRSA is not known, or who are at high risk for mortality, we suggest prescribing an antibiotic with activity against MRSA [sug, prevalence, patient, factor, treat, infection, empirically, activity, intravenou, methicillin, day, mrsa, prescrib, unit, within, mrsa, hap, antibiotic, antibiotic, high, prior, hospitalization, risk, resistant, known, mortality, aureu, bee, mrsa, risk, use, ie, isolate, against, eith]
32674 For patients with HAP who require empiric coverage for MRSA, we recommend vancomycin or linezolid rather than an alternative antibiotic [recommend, alternative, antibiotic, rath, coverage, hap, patient, empiric, require, linezolid, mrsa, vancomycin]
32675 For patients with HAP who are being treated empirically and have no risk factors for MRSA infection and are not at high risk of mortality, we suggest prescribing an antibiotic with activity against MSSA. When empiric treatment that includes coverage for MSSA (and not MRSA) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. Oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven MSSA, but are not necessary for empiric coverage of HAP if one of the above agents is used [coverage, activity, against, piperacillin, meropenem, above, empiric, oxacillin, regiman, mrsa, cefepime, sug, necessary, prescrib, sug, use, one, bee, mssa, includ, treatment, antibiotic, risk, imipenem, treatment, cefazolin, coverage, agent, empiric, hap, hap, patient, tazobactam, mrsa, mssa, include, empirically, risk, factor, prefer, mssa, infection, treat, indicat, mortality, levofloxacin, nafcillin, high, proven]
32676 When empiric treatment that includes coverage for MSSA (and not MRSA) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. Oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven MSSA, but are not necessary for empiric coverage of HAP if one of the above agents is used [proven, tazobactam, mssa, meropenem, cefepime, sug, regiman, coverage, hap, agent, include, includ, mrsa, nafcillin, treatment, coverage, levofloxacin, one, treatment, imipenem, necessary, use, piperacillin, mssa, above, empiric, empiric, oxacillin, prefer, cefazolin, indicat]
32677 For patients with HAP who are being treated empirically, we recommend prescribing antibiotics with activity against P. aeruginosa and other gram-negative bacilli [against, empirically, activity, treat, negative, aeruginosa, hap, bee, antibiotic, gram, recommend, patient, bacilli, oth, prescrib]
32678 For patients with HAP who are being treated empirically and have factors increasing the likelihood for Pseudomonas or other gram-negative infection (ie, prior intravenous antibiotic use within 90 days; also see Remarks) or a high risk for mortality, we suggest prescribing antibiotics from 2 different classes with activity against P. aeruginosa [prescrib, risk, see, sug, patient, likelihood, increas, activity, ie, high, negative, class, prior, day, different, empirically, pseudomona, aeruginosa, use, antibiotic, intravenou, antibiotic, remark, factor, hap, mortality, treat, gram, within, bee, infection, oth, against]
32679 For patients with HAP who are being treated empirically, we recommend not using an aminoglycoside as the sole antipseudomonal agent [use, aminoglycoside, treat, empirically, recommend, antipseudomonal, hap, patient, bee, agent, sole]
32680 For patients with HAP/VAP, we suggest that antibiotic dosing be determined using PK/PD data, rather than the manufacturer’s prescribing information [hap, prescrib, rath, use, pd, antibiotic, information, dos, determin, sug, vap, data, patient, pk, manufactur]
32681 For patients with VAP due to gram-negative bacilli that are susceptible to only aminoglycosides or polymyxins (colistin or polymyxin B), we suggest both inhaled and systemic antibiotics, rather than systemic antibiotics alone [negative, patient, due, gram, both, systemic, systemic, vap, alone, sug, bacilli, antibiotic, colistin, antibiotic, rath, susceptible, polymyxin, aminoglycoside, inhal, polymyxin]
32682 We recommend that MRSA HAP/VAP be treated with either vancomycin or linezolid rather than other antibiotics or antibiotic combinations [mrsa, treat, hap, combination, eith, antibiotic, vancomycin, linezolid, recommend, antibiotic, vap, oth, rath]
32683 For patients with HAP/VAP due to P. aeruginosa, we recommend that the choice of an antibiotic for definitive (not empiric) therapy be based upon the results of antimicrobial susceptibility testing [aeruginosa, result, test, vap, therapy, antimicrobial, bas, definitive, hap, choice, empiric, due, antibiotic, recommend, upon, susceptibility, patient]
32684 For patients with HAP/VAP due to P. aeruginosa, we recommend against aminoglycoside monotherapy (strong recommendation, very low-quality evidence). [patient, monotherapy, aminoglycoside, quality, recommend, vap, recommendation, hap, aeruginosa, strong, against, low, very, due, evidence]
32685 For patients with HAP/VAP due to P. aeruginosa who are not in septic shock or at a high risk for death, and for whom the results of antibiotic susceptibility testing are known, we recommend monotherapy using an antibiotic to which the isolate is susceptible rather than combination therapy [risk, susceptible, result, patient, monotherapy, recommend, aeruginosa, susceptibility, use, vap, test, hap, rath, antibiotic, therapy, isolate, septic, known, due, antibiotic, shock, combination, high, death]
32686 For patients with HAP/VAP due to P. aeruginosa who remain in septic shock or at a high risk for death when the results of antibiotic susceptibility testing are known, we suggest combination therapy using 2 antibiotics to which the isolate is susceptible rather than monotherapy [patient, antibiotic, monotherapy, shock, therapy, due, isolate, use, vap, high, rath, risk, combination, remain, result, antibiotic, aeruginosa, susceptible, death, septic, known, hap, test, susceptibility, sug]
32687 For patients with HAP/VAP due to P. aeruginosa, we recommend against aminoglycoside monotherapy [against, due, recommend, monotherapy, hap, aminoglycoside, patient, aeruginosa, vap]
32688 For patients with HAP/VAP due to ESBL-producing gramnegative bacilli, we recommend that the choice of an antibiotic for definitive (not empiric) therapy be based upon the results of antimicrobial susceptibility testing and patient-specific factors [esbl, specific, patient, factor, choice, produc, definitive, bacilli, gramnegative, susceptibility, upon, antibiotic, due, antimicrobial, therapy, vap, empiric, result, test, bas, patient, recommend, hap]
32689 In patients with HAP/VAP caused by Acinetobacter species, we suggest treatment with either a carbapenem or ampicillin/sulbactam if the isolate is susceptible to these agents [susceptible, sulbactam, patient, acinetobact, ampicillin, eith, hap, caus, agent, vap, specie, carbapenem, treatment, isolate, sug]
32690 In patients with HAP/VAP caused by Acinetobacter species that is sensitive only to polymyxins, we recommend intravenous polymyxin (colistin or polymyxin B) [hap, sensitive, acinetobact, specie, vap, recommend, polymyxin, polymyxin, polymyxin, caus, colistin, patient, intravenou]
32691 In patients with HAP/VAP caused by Acinetobacter species that is sensitive only to polymyxins, we suggest adjunctive inhaled colistin [inhal, sensitive, vap, caus, hap, adjunctive, colistin, specie, sug, polymyxin, patient, acinetobact]
32692 In patients with HAP/VAP caused by Acinetobacter species that is sensitive only to colistin, we suggest not using adjunctive rifampicin [specie, rifampicin, vap, use, sensitive, colistin, sug, hap, adjunctive, caus, patient, acinetobact]
32693 In patients with HAP/VAP caused by Acinetobacter species, we recommend against the use of tigecycline [tigecycline, specie, against, recommend, use, acinetobact, patient, hap, vap, caus]
32694 In patients with HAP/VAP caused by a carbapenem-resistant pathogen that is sensitive only to polymyxins, we recommend intravenous polymyxins (colistin or polymyxin B) [patient, sensitive, recommend, polymyxin, carbapenem, resistant, caus, colistin, polymyxin, hap, polymyxin, vap, pathogen, intravenou]
32695 In patients with HAP/VAP caused by a carbapenem-resistant pathogen that is sensitive only to polymyxins, we suggest adjunctive inhaled colistin [polymyxin, adjunctive, resistant, carbapenem, inhal, colistin, patient, hap, caus, vap, sug, sensitive, pathogen]
32696 For patients with VAP, we recommend a 7-day course of antimicrobial therapy rather than a longer duration [rath, antimicrobial, therapy, recommend, patient, duration, day, long, course, vap]
32697 For patients with HAP, we recommend a 7-day course of antimicrobial therapy [day, antimicrobial, recommend, therapy, patient, course, hap]
32698 For patients with HAP/VAP, we suggest that antibiotic therapy be de-escalated rather than fixed [vap, fix, antibiotic, rath, therapy, hap, sug, patient]
32699 For patients with HAP/VAP, we suggest using PCT levels plus clinical criteria to guide the discontinuation of antibiotic therapy, rather than clinical criteria alone [clinical, alone, rath, guide, plu, clinical, therapy, criteria, criteria, sug, antibiotic, hap, pct, vap, use, discontinuation, patient, level]
32700 For patients with suspected HAP/VAP, we suggest not using the CPIS to guide the discontinuation of antibiotic therapy [patient, antibiotic, sug, suspect, guide, discontinuation, hap, cpi, vap, use, therapy]
32701 Gram stain and culture of the pus or exudates from skin lesions of impetigo and ecthyma are recommended to help identify whether Staphylococcus aureus and/or a ?-hemolytic streptococcus is the cause [culture, help, aureu, pus, impetigo, staphylococcu, identify, stain, ecthyma, cause, gram, skin, streptococcu, wheth, hemolytic, exudate, recommend, lesion]
32702 Treatment without gram stain and culture of the pus or exudates from skin lesions of impetigo and ecthyma is reasonable in typical cases [gram, without, cas, impetigo, exudate, ecthyma, pus, stain, typical, culture, reasonable, treatment, skin, lesion]
32703 Treatment of bullous and nonbullous impetigo should be with either mupirocin or retapamulin bid for 5 days [treatment, bullou, impetigo, eith, bid, nonbullou, day, mupirocin, retapamulin]
32704 Oral therapy for ecthyma or impetigo should be a 7-day regimen with an agent active against S. aureus unless cultures yield streptococci alone (when oral penicillin is the recommended agent) [aureu, unles, penicillin, agent, ecthyma, agent, recommend, oral, impetigo, active, culture, streptococci, against, day, therapy, alone, oral, yield, regiman]
32705 Because Staphylococcus aureus isolates from impetigo and ecthyma are usually methicillin-susceptible, dicloxacillin or cephalexin is recommended. [usually, ecthyma, recommend, aureu, cephalexin, methicillin, impetigo, staphylococcu, susceptible, dicloxacillin, isolate]
32706 When methicillin-resistant Staphylococcus aureus is suspected or confirmed, doxycycline, clindamycin, or sulfamethoxazole-trimethoprim is recommended [recommend, trimethoprim, sulfamethoxazole, resistant, confirm, suspect, aureu, methicillin, doxycycline, clindamycin, staphylococcu]
32707 Systemic antimicrobials should be used for infections during outbreaks of post-streptococcal glomerulonephritis to help eliminate nephritogenic strains of Streptococcus pyogenes from the community [community, pyogene, eliminate, antimicrobial, glomerulonephriti, streptococcu, help, dur, use, outbreak, infection, strain, systemic, nephritogenic]
32708 Gram stain and culture of pus from carbuncles and abscesses are recommended, but treatment without these studies is reasonable in typical cases [reasonable, cas, studie, treatment, recommend, typical, stain, pus, gram, carbuncle, abscess, without, culture]
32709 Gram stain and culture of pus from inflamed epidermoid cysts are NOT recommended [stain, inflam, recommend, culture, epidermoid, gram, cyst, pus]
32710 Incision and drainage is the recommended treatment for inflamed epidermoid cysts, carbuncles, abscesses and large furuncles [cyst, incision, furuncle, abscess, inflam, large, recommend, epidermoid, carbuncle, treatment, drainage]
32711 The decision to administer antibiotics directed against S. aureus as an adjunct to incision and drainage should be made based on the presence or absence of systemic inflammatory response syndrome (SIRS) such as temperature >38°C or <36°C, tachypnea >24 breaths/min, tachycardia >90 beats/min or white blood cell count (WBC) >12,000 or <4000 cells/mm3 [min, direct, min, beat, count, breath, mm3, white, inflammatory, decision, cell, aureu, cell, bas, syndrome, absence, adjunct, antibiotic, against, incision, sir, tachycardia, temperature, drainage, presence, systemic, made, such, tachypnea, blood, response, administ, wbc]
32712 An antibiotic active against MRSA is recommended for patients with carbuncles or abscesses who have failed initial antibiotic treatment, have markedly impaired host defenses, or in patients with SIRS and hypotension [mrsa, hypotension, impair, against, markedly, antibiotic, defens, abscess, initial, patient, carbuncle, patient, recommend, antibiotic, sir, treatment, host, active, fail]
32713 A recurrent abscess at a site of previous infection should prompt a search for local causes such as a pilonidal cyst, hidradenitis suppurativa or foreign material [cyst, such, suppurativa, foreign, search, material, site, hidradeniti, prompt, caus, infection, absces, recurrent, previou, local, pilonidal]
32714 Recurrent abscesses should be drained and cultured early in the course of infection [cultur, recurrent, drain, course, early, infection, abscess]
32715 After obtaining cultures of recurrent abscess, treat with a 5- to 10-day course of an antibiotic active against the pathogen isolated [recurrent, antibiotic, culture, course, treat, isolat, aft, against, pathogen, absces, active, day, obtain]
32716 Consider a 5-day decolonization regimen of intranasal mupirocin bid, daily chlorhexidine washes, and daily decontamination of personal items such as towels, sheets, and clothes for recurrent S. aureus infection ( [decontamination, aureu, consid, decolonization, chlorhexidine, daily, item, daily, such, intranasal, clothe, recurrent, day, mupirocin, personal, infection, sheet, wash, regiman, towel, bid]
32717 Adult patients should be evaluated for neutrophil disorders if recurrent abscesses began in early childhood [neutrophil, adult, abscess, childhood, began, early, patient, evaluat, recurrent, disorder]
32718 Cultures of blood or cutaneous aspirates, biopsies, or swabs are NOT routinely recommended [swab, aspirate, culture, cutaneou, recommend, blood, biopsie, routinely]
32719 Cultures of blood are recommended in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites [recommend, chemotherapy, injurie, neutropenia, blood, patient, cell, mediat, malignancy, immersion, animal, immunodeficiency, culture, severe, bite]
32720 cultures and microscopic examination of cutaneous aspirates, biopsies, or swabs should be considered in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites ( [examination, cutaneou, mediat, culture, bite, malignancy, swab, biopsie, consider, immunodeficiency, neutropenia, microscopic, severe, cell, injurie, aspirate, immersion, chemotherapy, patient, animal]
32721 Typical cases of cellulitis without systemic signs of infection should receive an antimicrobial agent that is active against streptococci [antimicrobial, active, against, celluliti, without, sign, streptococci, cas, agent, receive, systemic, typical, infection]
32722 For cellulitis with systemic signs of infection (See Fig. 1/Nonpurulent/MODERATE) systemic antibiotics are indicated. Many clinicians could include coverage against methicillin-susceptible S. aureus (MSSA) ( [moderate, systemic, fig, include, antibiotic, coverage, see, sign, many, systemic, against, aureu, infection, susceptible, nonpurulent, mssa, clinician, indicat, methicillin, celluliti]
32723 For patients whose cellulitis is associated with penetrating trauma, evidence of MRSA infection elsewhere, nasal colonization with MRSA, injection drug use, or SIRS vancomycin or another antimicrobial effective against both MRSA and streptococci is recommended [anoth, colonization, drug, celluliti, streptococci, sir, injection, associat, penetrat, against, both, mrsa, trauma, whose, mrsa, elsewhere, recommend, patient, nasal, infection, antimicrobial, mrsa, evidence, use, vancomycin, effective]
32724 In severely compromised patients (patients who have failed oral antibiotic treatment or those with systemic signs of infection (such as temperature >38°C, tachycardia (heart rate >90 beats per minute), tachypnea (respiratory rate >24 breaths per minute) or abnormal white blood cell count (<12 000 or <400 cells/?L), or those who are immunocompromised,or those with clinical signs of deeper infection such as bullae, skin sloughing, hypotension, or evidence of organ dysfunction) broad-spectrum antimicrobial coverage may be considered [fail, infection, infection, minute, blood, breath, coverage, antimicrobial, oral, those, severely, evidence, cell, systemic, such, such, consider, hypotension, broad, organ, tachypnea, heart, spectrum, beat, patient, tachycardia, temperature, per, per, skin, treatment, respiratory, slough, clinical, sign, bulla, those, sign, abnormal, cell, count, minute, deep, antibiotic, dysfunction, immunocompromis, those, compromis, patient, rate, rate, white]
32725 Vancomycin plus either piperacillin-tazobactam or imipenem/meropenem is recommended as a reasonable empiric regimen for severe infections [infection, tazobactam, recommend, meropenem, empiric, eith, imipenem, vancomycin, severe, reasonable, plu, piperacillin, regiman]
32726 The recommended duration of antimicrobial therapy is 5 days, but treatment should be extended if the infection has not improved within this time period [recommend, therapy, thi, time, period, improv, duration, treatment, day, within, antimicrobial, infection, extend]
32727 Elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are recommended [recommend, cutaneou, treatment, area, affect, underlie, factor, predispos, disorder, elevation, edema, such]
32728 In lower extremity cellulitis, clinicians should carefully examine the interdigital toe spaces because treating fissuring, scaling, or maceration may eradicate colonization with pathogens and reduce the incidence of recurrent infection [reduce, interdigital, fissur, clinician, examine, recurrent, pathogen, extremity, incidence, colonization, treat, carefully, low, infection, celluliti, space, toe, maceration, eradicate, scal]
32729 Outpatient therapy is recommended for patients who do not have SIRS, altered mental status, or hemodynamic instability [mental, outpatient, alter, patient, instability, statu, recommend, sir, hemodynamic, therapy]
32730 Hospitalization is recommended if there is concern for a deeper or necrotizing infection, for patients with poor adherence to therapy, for infection in a severely immunocompromised patient or if outpatient treatment is failing [deep, adherence, hospitalization, immunocompromis, infection, patient, recommend, infection, patient, necrotiz, poor, treatment, severely, outpatient, therapy, concern, fail]
32731 Systemic corticosteroids (eg, prednisone 40 mg daily for 7 days) could be considered in nondiabetic adult patients with cellulitis [day, consider, corticosteroid, eg, patient, nondiabetic, prednisone, daily, adult, mg, celluliti, systemic]
32732 Identify and treat predisposing conditions such as edema, obesity, eczema, venous insufficiency, and toe web abnormalities. These practices should be performed as part of routine patient care and certainly during the acute stage of cellulitis. [celluliti, toe, identify, practex, eczema, perform, patient, routine, predispos, venou, obesity, acute, care, such, abnormalitie, edema, part, dur, treat, insufficiency, condition, stage, web, certainly]
32733 Administration of prophylactic antibiotics, such as oral penicillin or erythromycin bid for 4-52 weeks, or intramuscular benzathine penicillin every 2-4 weeks should be considered in patients who have 3-4 episodes of cellulitis per year despite attempts to treat or control predisposing factors [year, episode, control, penicillin, week, celluliti, oral, erythromycin, intramuscular, bid, patient, consider, prophylactic, attempt, per, factor, week, penicillin, predispos, despite, administration, treat, antibiotic, benzathine, such]
32734 This program should be continued so long as the predisposing factors persist [long, continu, persist, thi, factor, predispos, program]
32735 Suture removal plus incision and drainage should be performed for surgical site infections [removal, incision, perform, site, suture, infection, plu, surgical, drainage]
32736 Adjunctive systemic antimicrobial therapy is NOT routinely indicated but in conjunction with incision and drainage may be beneficial for surgical site infections associated with a significant systemic response such as erythema and induration extending >5 cm from the wound edge, temperature >38.5ºC, heart rate >110/min, or WBC count >12,000/mm3 [heart, drainage, ºc, count, extend, antimicrobial, systemic, significant, wound, response, therapy, mm3, conjunction, routinely, beneficial, such, adjunctive, indicat, temperature, surgical, systemic, rate, induration, wbc, associat, erythema, site, min, cm, incision, edge, infection]
32737 A brief course of systemic antimicrobial therapy is indicated in patients with surgical site infections after clean operations on the trunk, head and neck, or extremities that also have systemic signs of infection [head, brief, aft, infection, indicat, surgical, site, extremitie, sign, systemic, course, infection, antimicrobial, clean, operation, systemic, neck, trunk, patient, therapy]
32738 A first-generation cephalosporin or an anti-staphylococcal penicillin for MSSA or vancomycin, linezolid, daptomycin, telavancin or ceftaroline where risk factors for MRSA are high (nasal colonization, prior MRSA infection, recent hospitalization, recent antibiotics) is recommended [first, risk, cephalosporin, infection, recent, recent, daptomycin, mrsa, recommend, penicillin, hospitalization, colonization, ceftaroline, linezolid, prior, factor, high, telavancin, mrsa, antibiotic, generation, nasal, vancomycin, mssa]
32739 Agents active against Gram-negative bacteria and anaerobes, such as a cephalosporin or fluoroquinolone in combination with metronidazole, are recommended for infections after operations on the axilla, gastrointestinal (GI) tract, perineum or female genital tract [operation, gastrointestinal, gram, agent, anaerobe, recommend, aft, such, cephalosporin, genital, combination, against, tract, tract, bacteria, infection, female, active, fluoroquinolone, axilla, negative, perineum, metronidazole, gi]
32740 Prompt surgical consultation is recommended for patients with aggressive infections associated with signs of systemic toxicity or suspicion of necrotizing fasciitis or gas gangrene [gangrene, gas, sign, systemic, necrotiz, consultation, aggressive, surgical, prompt, suspicion, associat, patient, toxicity, recommend, fasciiti, infection]
32741 Empiric antibiotic treatment should be broad (eg, vancomycin or linezolid plus piperacillin-tazobactam or plus a carbapenem; or plus ceftriaxone and metronidazole), since the etiology can be polymicrobial (mixed aerobic-anaerobic microbes) or monomicrobial (Group A streptococcus, community-acquired MRSA) [group, community, etiology, microbe, streptococcu, tazobactam, antibiotic, eg, vancomycin, ceftriaxone, piperacillin, anaerobic, treatment, linezolid, acquir, empiric, monomicrobial, plu, carbapenem, aerobic, plu, mrsa, broad, polymicrobial, mix, plu, metronidazole]
32742 Penicillin plus clindamycin is recommended for treatment of documented Group A streptococcal necrotizing fasciitis [necrotiz, treatment, group, streptococcal, penicillin, document, recommend, plu, fasciiti, clindamycin]
32743 Magnetic resonance imaging (MRI) is the recommended imaging modality for establishing the diagnosis of pyomyositis. Computed tomography (CT) scan and ultrasound studies are also useful. [magnetic, studie, tomography, ultrasound, resonance, mri, imag, ct, recommend, modality, diagnosi, comput, establish, pyomyositi, imag, scan, useful]
32744 Cultures of blood and abscess material should be obtained [blood, absces, obtain, culture, material]
32745 Vancomycin is recommended for initial empiric therapy. An agent active against enteric Gram-negative bacilli should be added for infection in immunocompromised patients or after open trauma to the muscles (SR-M). [muscle, trauma, agent, active, recommend, negative, vancomycin, gram, enteric, infection, therapy, add, open, empiric, immunocompromis, sr, initial, aft, patient, against, bacilli]
32746 Cefazolin or antistaphylococcal penicillin (eg, nafcillin or oxacillin) is recommended for treatment of pyomyositis caused by MSSA (SR-M). [treatment, sr, antistaphylococcal, recommend, oxacillin, penicillin, caus, pyomyositi, cefazolin, mssa, eg, nafcillin]
32747 Early drainage of purulent material should be performed [drainage, purulent, perform, material, early]
32748 Repeat imaging studies should be performed in patients with persistent bacteremia to identify undrained foci of infection [imag, perform, undrain, foci, studie, identify, persistent, patient, bacteremia, repeat, infection]
32749 Antibiotics should be administered intravenously initially, but once the patient is clinically improved oral antibiotics are appropriate for patients in whom bacteremia cleared promptly and there is no evidence of endocarditis or metastatic abscess. Two to three weeks of therapy is recommended. [oral, absces, appropriate, once, antibiotic, clear, intravenously, metastatic, endocarditi, recommend, therapy, antibiotic, improv, week, bacteremia, three, clinically, initially, patient, patient, promptly, administer, two, evidence]
32750 Urgent surgical exploration of the suspected gas gangrene site and surgical debridement of involved tissue should be performed [debridement, surgical, involv, urgent, site, gas, tissue, perform, suspect, surgical, exploration, gangrene]
32751 In the absence of a definitive etiologic diagnosis, broad-spectrum treatment with vancomycin plus either piperacillin/tazobactam, ampicillin/sulbactam or a carbapenem antimicrobial is recommended (SR-L). [broad, absence, spectrum, sr, tazobactam, carbapenem, sulbactam, definitive, plu, recommend, ampicillin, eith, diagnosi, piperacillin, etiologic, vancomycin, treatment, antimicrobial]
32752 Definitive antimicrobial therapy with penicillin and clindamycin is recommended for treatment of clostridial myonecrosis (SR-L). [sr, therapy, clindamycin, recommend, treatment, definitive, penicillin, clostridial, antimicrobial, myonecrosi]
32753 Hyperbaric oxygen therapy is NOT recommended because it has not been proven as a benefit to patients and may delay resuscitation and surgical debridement (SR-L). [delay, therapy, sr, oxygen, patient, benefit, hyperbaric, recommend, resuscitation, proven, surgical, debridement]
32754 Preemptive early antimicrobial therapy for 3-5 days is recommended for patients who: a) are immunocompromised; b) are asplenic; c) have advanced liver disease; d) have preexisting or resultant edema of the affected area; e) have moderate to severe injuries, especially to the hand or face; or f) have injuries that may have penetrated the periosteum or joint capsule (SR-L). [immunocompromis, edema, disease, injurie, asplenic, antimicrobial, especially, joint, severe, advanc, moderate, capsule, face, preexist, patient, recommend, penetrat, preemptive, liv, injurie, hand, sr, resultant, early, affect, periosteum, therapy, day, area]
32755 Postexposure prophylaxis for rabies may be indicated. Consultation with local health officials is recommended to determine if vaccination should be initiated (SR-L). [prophylaxi, recommend, consultation, indicat, vaccination, determine, rabie, initiat, postexposure, health, official, sr, local]
32756 An antimicrobial agent or agents active against both aerobic and anaerobic bacteria such as amoxicillin-clavulanate should be used [agent, anaerobic, both, amoxicillin, such, against, active, agent, aerobic, use, antimicrobial, bacteria, clavulanate]
32757 Tetanus toxoid should be administered to patients without toxoid vaccination within 10 years. Tdap is preferred over Td if the former has not been previously given (SR-L). [form, tdap, patient, tetanu, administer, toxoid, without, prefer, year, sr, given, td, ove, toxoid, within, previously, vaccination]
32758 Primary wound closure is NOT recommended for wounds, with the exception of those to the face, which should be managed with copious irrigation, cautious debridement and preemptive antibiotics. [recommend, wound, face, copiou, primary, preemptive, those, wound, debridement, exception, manag, irrigation, cautiou, antibiotic, closure]
32759 Other wounds may be approximated (WR-L). [oth, wound, wr, approximat]
32760 Oral penicillin V 500 mg qid for 7-10 days is the recommended treatment for naturally acquired cutaneous anthrax (SR-H). [cutaneou, anthrax, sr, recommend, day, mg, naturally, treatment, oral, penicillin, qid, acquir]
32761 Ciprofloxacin 500 mg PO bid or levofloxacin 500 mg IV/PO q24h for 60 days is recommended for bioterrorism cases because of presumed aerosol exposure. [cas, day, mg, recommend, iv, presum, bioterrorism, ciprofloxacin, mg, exposure, po, aerosol, q24h, bid, po, levofloxacin]
32762 Azithromycin is recommended for cat scratch disease. Patients >45 kg, 500 mg on day 1 followed by 250 mg for 4 additional days. Patients <45 kg, 10 mg/kg on day 1 and 5 mg/kg for 4 more days [patient, mg, kg, follow, kg, kg, recommend, patient, disease, kg, additional, mg, scratch, more, mg, azithromycin, cat, day, day, day, day, mg]
32763 Erythromycin 500 mg qid or doxycycline 100 mg bid for 2 weeks to 2 months is recommended for treatment of bacillary angiomatosis (SR-M). [sr, mg, recommend, week, doxycycline, month, treatment, qid, bid, mg, bacillary, angiomatosi, erythromycin]
32764 Penicillin 500 mg qid or amoxicillin 500 mg tid for 7-10 days is recommended for treatment of erysipeloid (SR-H). [qid, penicillin, mg, treatment, day, tid, amoxicillin, mg, sr, recommend, erysipeloid]
32765 Ceftazidime, gentamicin, imipenem, doxycycline or ciprofloxacin is recommended based on in vitro susceptibility (SR-L). [ciprofloxacin, gentamicin, vitro, susceptibility, bas, ceftazidime, doxycycline, recommend, imipenem, sr]
32766 Bubonic plague should be diagnosed by Gram stain and culture of aspirated material from a suppurative lymph node [diagnos, node, aspirat, plague, lymph, stain, culture, gram, material, suppurative, bubonic]
32767 Streptomycin 15 mg/kg IM q12h or doxycycline 100 mg bid PO is recommended for treatment of bubonic plague (SR-L). [sr, treatment, recommend, kg, mg, streptomycin, mg, po, plague, q12h, bid, bubonic, doxycycline, im]
32768 Gentamicin could be substituted for streptomycin [gentamicin, streptomycin, substitut]
32769 Serologic tests are the preferred method of diagnosing tularemia (WR-L). [tularemia, test, wr, method, diagnos, serologic, prefer]
32770 Streptomycin 15 mg/kg q12h IM or gentamicin 1.5 mg/kg q8h IV is recommended for treatment of severe cases of tularemia (SR-L). [tularemia, kg, mg, treatment, cas, q12h, streptomycin, im, mg, q8h, severe, recommend, sr, iv, kg, gentamicin]
32771 Tetracycline 500 mg qid or doxycycline 100 mg bid PO is recommended for treatment of mild cases of tularemia (SR-L). [qid, tetracycline, bid, po, recommend, sr, mg, tularemia, cas, treatment, mg, doxycycline, mild]
32772 Notify the microbiology laboratory if tularemia is suspected (SR-H). [microbiology, tularemia, laboratory, suspect, sr, notify]
32773 In addition to infection, differential diagnosis of skin lesions should include drug eruption, cutaneous infiltration with the underlying malignancy, chemotherapy- or radiation-induced reactions, Sweet’s syndrome, erythema multiforme, leukocytoclastic vasculitis and graftversus-host disease among allogeneic transplant recipients (SR-H). [diagnosi, addition, disease, reaction, sweet, include, erythema, sr, syndrome, chemotherapy, malignancy, drug, radiation, induc, cutaneou, graftversu, multiforme, recipient, differential, infiltration, underlie, leukocytoclastic, skin, eruption, vasculiti, allogeneic, transplant, host, lesion, infection]
32774 Differential diagnosis for infection of skin lesions should include bacterial, fungal, viral and parasitic agents (SR-H). [diagnosi, fungal, skin, sr, lesion, bacterial, include, infection, agent, differential, viral, parasitic]
32775 Biopsy or aspiration of the lesion to obtain material for histologic and microbiologic evaluation should always be implemented as an early diagnostic step (SR-H). [sr, obtain, histologic, aspiration, lesion, early, biopsy, step, alway, diagnostic, evaluation, implement, microbiologic, material]
32776 Determine whether the current presentation of fever and neutropenia is the patient’s initial episode of fever and neutropenia or a persistent unexplained fever from their initial episode (after 4-7 days), or a subsequent episode of fever and neutropenia (recurrent) [persistent, neutropenia, day, unexplain, episode, initial, subsequent, fev, current, fev, aft, initial, patient, determine, neutropenia, wheth, fev, episode, presentation, neutropenia, recurrent, fev, episode]
32777 Aggressively determine the etiology of the skin and soft tissue infection by aspiration and/or biopsy of skin and soft tissue lesions and submit these for thorough cytologic/histologic assessments, microbial staining and cultures [skin, cytologic, microbial, etiology, culture, infection, lesion, aspiration, assessment, determine, tissue, soft, submit, histologic, stain, tissue, soft, skin, thorough, aggressively, biopsy]
32778 Risk-stratify patients with fever and neutropenia according to susceptibility to infection: high-risk patients are those with anticipated prolonged (>7 days) and profound neutropenia (ANC <100 cells/?L) or with a Multinational Association for Supportive Care (MASCC) score of <21; low-risk patients are those with anticipated brief (<7 days) periods of neutropenia and few comorbidities or with a MASCC of ?21 [cell, anc, few, score, brief, day, neutropenia, mascc, fev, comorbiditie, risk, patient, those, risk, patient, association, stratify, those, accord, infection, prolong, susceptibility, risk, neutropenia, anticipat, high, supportive, anticipat, day, period, low, neutropenia, care, mascc, multinational, profound, patient]
32779 Determine the extent of infection through a thorough physical examination, blood cultures, chest radiograph and additional imaging (including chest CT) [includ, physical, thorough, additional, determine, imag, che, blood, infection, che, examination, through, extent, ct, radiograph, culture]
32780 Hospitalization and empiric antibacterial therapy with vancomycin plus antipseudomonal antibiotics such as cefepime, a carbapenem (imipenem-cilastatin or meropenem or doripenem) or piperacillintazobactam are recommended [vancomycin, cefepime, doripenem, meropenem, cilastatin, antipseudomonal, piperacillintazobact, hospitalization, such, imipenem, carbapenem, recommend, antibiotic, therapy, antibacterial, plu, empiric]
32781 Documented clinical and microbiologic skin and soft tissue infections should be treated based on antimicrobial susceptibilities of isolated organisms [bas, organism, microbiologic, soft, tissue, antimicrobial, clinical, susceptibilitie, infection, document, treat, isolat, skin]
32782 The treatment duration for most bacterial skin and soft tissue infections should be 7-14 days [day, skin, infection, bacterial, tissue, treatment, duration, soft]
32783 Surgical intervention is recommended for drainage of soft-tissue abscess after marrow recovery or for a progressive polymicrobial necrotizing fasciitis or myonecrosis [drainage, absces, progressive, surgical, polymicrobial, aft, tissue, necrotiz, intervention, recovery, fasciiti, recommend, soft, marrow, myonecrosi]
32784 Adjunct colony-stimulating factor therapy (G-CSF, GM-CSF) or granulocyte transfusions [csf, therapy, adjunct, granulocyte, stimulat, gm, csf, colony, transfusion, factor]
32785 Acyclovir should be administered to patients suspected or confirmed to have cutaneous or disseminated herpes simplex (HSV) or varicella zoster virus (VZV) infection (SR-M). [infection, cutaneou, hsv, sr, suspect, acyclovir, confirm, varicella, patient, herpe, simplex, viru, administer, zost, vzv, disseminat]
32786 Yeasts and molds remain the primary cause of infection-associated fever and neutropenia. Therefore, empiric antifungal therapy (Table 5) should be added to the antibacterial regimen (SR-H). [regiman, add, neutropenia, remain, infection, associat, empiric, primary, yeast, therapy, antifungal, antibacterial, table, therefore, cause, sr, fev, mold]
32787 Empiric administration of vancomycin or other agents with Gram-positive activity (linezolid, daptomycin or ceftaroline) should be added if not already being administered [already, administration, vancomycin, agent, daptomycin, add, gram, linezolid, ceftaroline, empiric, administer, positive, activity, bee, oth]
32788 Candida species skin and soft tissue infections should be treated with an echinocandin or, if Candida parapsilosis has been isolated, lipid formulation amphotericin-B (SR-H) [treat, candida, tissue, lipid, amphotericin, infection, soft, echinocandin, parapsilosi, skin, sr, isolat, formulation, candida, specie]
32789 if Candida parapsilosis has been isolated treat with fluconazole as an acceptable alternative to lipid formulation amphotericin-B [parapsilosi, amphotericin, alternative, candida, fluconazole, formulation, isolat, lipid, treat, acceptable]
32790 Treatment should be for 2 weeks after clearance of blood stream infection or resolution of skin lesions. [stream, clearance, week, aft, resolution, treatment, lesion, blood, skin, infection]
32791 Aspergillus skin and soft tissue infections should be treated with voriconazole [tissue, infection, treat, voriconazole, soft, aspergillu, skin]
32792 alternatively to voriconazole treat Aspergillus skin and soft tissue infections with lipid formulations of amphotericin B, posaconazole or echinocandin for 6-12 weeks [tissue, alternatively, amphotericin, week, aspergillu, skin, echinocandin, posaconazole, formulation, voriconazole, treat, soft, infection, lipid]
32793 Mucor/Rhizopus infections should be treated with lipid formulation amphotericin B [rhizopu, mucor, treat, formulation, infection, amphotericin, lipid]
32794 Mucor/Rhizopus infections should be treated with posaconazole [rhizopu, posaconazole, mucor, treat, infection]
32795 The addition of an echinocandin could be considered based on synergy in murine models of mucormycosis and observational clinical data (WR-L). [bas, clinical, murine, observational, addition, data, model, synergy, consider, mucormycosi, echinocandin, wr]
32796 Fusarium species infections should be treated with high-dose IV voriconazole or posaconazole [high, iv, infection, treat, voriconazole, specie, posaconazole, dose, fusarium]
32797 Begin treatment for antibiotic-resistant bacterial organisms (Table 6) in patients currently on antibiotics. [antibiotic, table, patient, treatment, currently, bacterial, organism, begin, antibiotic, resistant]
32798 Intravenous acyclovir should be added to the patient’s antimicrobial regimen for suspected or confirmed cutaneous or disseminated HSV or VZV infections (SR-M). [infection, intravenou, patient, hsv, acyclovir, sr, confirm, vzv, suspect, regiman, cutaneou, antimicrobial, disseminat, add]
32799 Blood cultures should be obtained, and skin lesions in this population of patients should be aggressively evaluated by culture aspiration, biopsy or surgical excision since they may be caused by resistant microbes, yeast or molds [lesion, yeast, excision, skin, resistant, mold, biopsy, blood, thi, population, evaluat, aggressively, culture, caus, culture, patient, surgical, microbe, obtain, aspiration]
32800 Polymerase chain reaction (PCR) in peripheral blood for HSV and VZV might be helpful in establishing a diagnosis of disseminated infection in patients with unexplained skin lesions (WR-M). [reaction, patient, disseminat, chain, polymerase, blood, peripheral, skin, pcr, hsv, establish, lesion, infection, vzv, unexplain, wr, diagnosi, helpful]
32801 Consider immediate consultation with a dermatologist familiar with cutaneous manifestations of infection in patients with cellular immune defects (eg, those with lymphoma, lymphocytic leukemia, recipients of organ transplants, or those receiving immunosuppressive drugs such as anti-tumor necrosis factors or certain monoclonal antibodies) [eg, antibodie, such, patient, factor, lymphoma, lymphocytic, consid, monoclonal, necrosi, drug, immunosuppressive, consultation, receiv, organ, immune, cutaneou, transplant, infection, familiar, certain, immediate, dermatologist, leukemia, cellular, recipient, those, manifestation, defect, those]
32802 Consider biopsy and surgical debridement early in the management of these patients [patient, early, consid, surgical, management, biopsy, debridement]
32803 Empiric antibiotics, antifungals and/or antivirals should be considered [consider, antifungal, antiviral, empiric, antibiotic]
32804 The use of specific agents should be decided with the input of the primary team, dermatology, infectious disease and other consulting teams [disease, agent, decid, oth, specific, primary, use, team, infectiou, dermatology, input, consult, team]
32805 In patients with a suspected or known abdominal aortic aneurysm (AAA), the SVS recommends performing physical examination that includes an assessment of femoral and popliteal arteries. [arterie, assessment, svs, femoral, include, examination, aortic, aneurysm, suspect, recommend, aaa, physical, popliteal, perform, known, abdominal, patient]
1 There is insufficient evidence to recommend use of TS, DPD, or TP for monitoring response to therapy. [evidence, tp, use, response, monitor, insufficient, dpd, therapy, recommend, ts]
424 Assaying for loss of heterozygosity (LOH) on the long arm of chromosome 18 (18q) or deleted in colon cancer (DCC) protein determination by IHC should not be used to determine the prognosis of operable colorectal cancer, nor to predict response to therapy. [operable, cancer, 18q, response, use, determination, loh, cancer, chromosome, predict, long, heterozygosity, colorectal, protein, therapy, ihc, los, assaie, prognosi, determine, delet, dcc, arm, colon]
847 None of the three markers TS, DPD, or TP are recommended for use to determine the prognosis of colorectal carcinoma. [prognosi, marker, ts, none, determine, use, carcinoma, tp, three, dpd, colorectal, recommend]
2 Surgeries performed with the intent to limit the venous outflow of the penis are not recommended. [peni, limit, outflow, recommend, surgerie, venou, intent, perform]
425 Only vacuum constriction devices containing a vacuum limiter should be used whether purchased over-the-counter or procured with a prescription . [limit, constriction, purchas, contain, wheth, count, vacuum, devex, procur, use, vacuum, prescription]
848 Arterial reconstructive surgery is a treatment option only in healthy individuals with recently acquired erectile dysfunction secondary to a focal arterial occlusion and in the absence of any evidence of generalized vascular disease . [healthy, arterial, dysfunction, recently, vascular, reconstructive, surgery, option, disease, individual, secondary, occlusion, acquir, focal, evidence, arterial, treatment, absence, generaliz, erectile]
3 The Task Force recommends the following endpoints be considered for safety and risk assessment in future studies: Appearance of or change in hirsutism, acne, male pattern balding, clitoromegaly, and deepening of the voice. Cardiovascular and metabolic evaluation, with and without estrogen replacement, should include fasting lipid profiles, vascular reactivity, markers of insulin sensitivity, and markers of inflammation. Effects on the breast, with or without estrogen replacement, should be measured. Breast biopsy studies with in vitro markers of cell proliferation and apoptosis should be considered. Alterations in the endometrium with and without estrogen coadministration Alterations in mood using validated instruments. [male, instrument, bald, evaluation, estrogen, follow, cardiovascular, marker, endometrium, without, profile, fast, estrogen, breast, change, validat, effect, without, hirsutism, include, voice, coadministration, insulin, biopsy, risk, replacement, consider, metabolic, assessment, task, acne, measur, proliferation, clitoromegaly, cell, consider, studie, deepen, vitro, reactivity, alteration, pattern, alteration, safety, without, recommend, estrogen, force, marker, use, apoptosi, inflammation, replacement, endpoint, vascular, studie, appearance, future, lipid, mood, marker, sensitivity, breast]
426 The Task Force recommends further study of physiologic targets of androgen action such as: Sexual dysfunction Cognition Mood Bone Cardiovascular function Body composition Muscle strength and function [cognition, target, composition, action, strength, androgen, bone, sexual, body, such, study, task, cardiovascular, function, function, mood, recommend, muscle, furth, dysfunction, force, physiologic]
849 The Task Force recommends additional research in the following human model systems to define the clinical syndrome of androgen deficiency and to study the benefits and risks of androgen therapy . Surgical menopause is a condition in which the ovarian, but not adrenal androgen precursors are removed abruptly independent of age. Hypopituitarism, although uncommon, can be used to study the physiological replacement of both ovarian androgens and adrenal androgen precursors. Anorexia nervosa may be used as a model of androgen deficiency secondary to dysfunction of the hypothalamic-pituitary and adrenal axes. Primary adrenal insufficiency allows for the investigation of the loss of adrenal androgen precursors in the presence of intact ovarian androgen function. Ablation-replacement models in normal women using GnRH analogs to eliminate ovarian androgens, with or without suppression of adrenal androgen precursors, offer another way to assess the effects of androgen withdrawal and replacement. Subjects with complete androgen insensitivity syndrome offer a way to investigate target tissue effects which are dependent on the androgen receptor but are independent of aromatization. There are studies in patients with low weight and HIV and with natural aging; however, these systems are too complex to recommend as initial models to understand the potential therapeutic role of androgens in women. [insufficiency, hypopituitarism, normal, withdrawal, secondary, system, adrenal, precursor, complex, human, androgen, androgen, benefit, precursor, tissue, androgen, anorexia, abruptly, risk, ovarian, syndrome, model, independent, androgen, study, suppression, recommend, adrenal, use, nervosa, additional, androgen, age, initial, ovarian, uncommon, independent, replacement, howev, precursor, way, deficiency, adrenal, although, investigate, recommend, complete, low, hiv, define, natural, dependent, receptor, system, research, primary, androgen, aromatization, use, ovarian, anoth, woman, adrenal, precursor, physiological, surgical, androgen, target, androgen, replacement, androgen, condition, model, ovarian, androgen, gnrh, therapeutic, ablation, pituitary, model, use, los, dysfunction, therapy, menopause, intact, androgen, model, woman, eliminate, without, age, function, way, subject, syndrome, androgen, analog, clinical, task, patient, adrenal, adrenal, effect, understand, potential, allow, investigation, androgen, androgen, force, presence, studie, effect, both, hypothalamic, replacement, insensitivity, deficiency, axe, remov, weight, follow, asses, study, role]
204 Combination oxaliplatin, short-term infusional 5-fluorouracil (5FU), and folinic acid (FA) (FOLFOX) is an important component of therapy and oxaliplatin should be made available for the treatment of advanced colorectal cancer. [treatment, folfox, folinic, fluorouracil, oxaliplatin, cancer, therapy, fa, component, short, colorectal, available, acid, made, advanc, combination, oxaliplatin, infusional, important, term, 5fu]
627 After progression on first-line anti-thymidylate synthase monotherapy (e.g., 5FU/FA; capecitabine), irinotecan is standard second-line therapy. FOLFOX is a reasonable alternative for patients with contraindications to the use of second-line irinotecan. [contraindication, first, use, folfox, irinotecan, standard, alternative, line, patient, reasonable, 5fu, aft, line, line, fa, monotherapy, synthase, therapy, progression, second, second, capecitabine, irinotecan]
1050 After progression on both irinotecan and an anti-thymidylate synthase agent, FOLFOX is the preferred therapy. [aft, agent, prefer, synthase, progression, irinotecan, both, folfox, therapy]
5 Surveillance colonoscopy with multiple biopsy specimens should be performed every 1 to 2 years beginning after 8 to 10 years of disease. [aft, year, year, disease, multiple, begin, specimen, colonoscopy, perform, surveillance, biopsy]
428 Genetic testing along with counseling is recommended for individuals with hereditary forms of CRC, including familial adenomatous polyposis (FAP) and hereditary nonpolyposis colon cancer (HNPCC) . [hereditary, crc, cancer, hnpcc, familial, individual, form, colon, along, nonpolyposi, includ, test, recommend, fap, genetic, polyposi, hereditary, adenomatou, counsel]
851 Alternative methods for CRC screening in average-risk patients include yearly fecal occult blood testing (A), flexible sigmoidoscopy every 5 years, combined yearly fecal occult blood testing (FOBT) and flexible sigmoidoscopy every 5 years . [include, test, flexible, screen, year, fobt, flexible, occult, yearly, test, yearly, combin, patient, risk, sigmoidoscopy, year, sigmoidoscopy, crc, alternative, average, fecal, occult, blood, fecal, method, blood]
341 Institutional policies should be developed for provision of patient- and family-centered care through environmental design, practice, and staffing in collaboration with patients and their families. [policie, provision, patient, patient, collaboration, center, through, design, practice, family, environmental, staf, institutional, develop, familie, care]
764 The option of family-member presence should be encouraged for all aspects of emergency department care. [option, department, family, memb, aspect, presence, emergency, encourag, care]
1187 Knowledge of the patient's experience and perspective is essential to practice culturally effective care that promotes patient dignity, comfort, and autonomy. [perspective, comfort, dignity, care, patient, patient, experience, promote, practice, essential, effective, autonomy, knowledge, culturally]
4 Caregivers should be trained to assess neonates for pain using multidimensional tools. [use, tool, pain, caregiver, asses, multidimensional, neonate, train]
427 Use of a combination of oral sucrose/glucose and other nonpharmacologic pain-reduction methods (nonnutritive sucking, kangaroo care, facilitated tuck, swaddling, developmental care) should be used for minor routine procedures. [use, kangaroo, oral, routine, oth, reduction, procedure, nonnutritive, sucrose, glucose, suc, developmental, method, use, pain, nonpharmacologic, tuck, care, combination, swaddl, care, minor, facilitat]
850 Sufficient anesthesia should be provided to prevent intraoperative pain and stress responses to decrease postoperative analgesic requirements. [pain, intraoperative, requirement, respons, prevent, decrease, postoperative, stres, anesthesia, provid, analgesic, sufficient]
6 It is recommended that patients with a severe head injury receive an early tracheostomy. [receive, patient, head, injury, recommend, early, tracheostomy, severe]
429 It is recommended that early tracheostomy be considered in all trauma patients anticipated to require mechanical ventilation for > 7 days. [recommend, ventilation, early, trauma, mechanical, require, patient, day, tracheostomy, consider, anticipat]
852 There is no mortality difference between patients receiving early tracheostomy (3 to 7 days) and late tracheostomy or extended endotracheal intubation. [endotracheal, receiv, extend, between, tracheostomy, day, early, late, tracheostomy, intubation, difference, patient, mortality]
416 Management:General Advice:Ideally, treatment should be effective (microbiological cure rate >95%), easy to take (not more than twice daily), with a low side effect profile, and cause minimal interference with daily lifestyle . [side, interference, rate, effect, take, more, twice, ideally, daily, minimal, management, easy, profile, effective, lifestyle, treatment, cause, general, microbiological, daily, advice, low, cure]
839 Rectal, Pharyngeal and Conjunctival Specimens, Men and Women:Due to the emergence of rectal Lymphogranuloma venereum (LGV) infection in men who have sex with men (French, Ison, & Macdonald, 2005), the current (2006) recommended method of detecting rectal LGV infection is to perform a rectal NAAT which, if positive, is sent to the Health Protection Authority for confirmation. [detect, man, protection, positive, confirmation, authority, conjunctival, man, lgv, naat, health, pharyngeal, lgv, lymphogranuloma, rectal, ison, method, infection, macdonald, perform, specimen, rectal, current, venereum, man, rectal, infection, recommend, emergence, sent, woman, sex, rectal, french, due]
1262 Sites to Be Sampled:If a speculum examination is not possible then urine samples can be utilized. [urine, possible, speculum, examination, sampl, sample, utiliz, site]
19 For patients with systolic dysfunction (ejection fraction [EF] <40%) who have no contraindications:Aldosterone antagonist (low dose) for patients with rest dyspnea or with a history of rest dyspnea or for symptomatic patients who have suffered a recent myocardial infarction . [ejection, patient, history, patient, patient, myocardial, dyspnea, dose, dyspnea, systolic, low, ef, symptomatic, suffer, antagonist, infarction, contraindication, dysfunction, fraction, aldosterone, recent, rest, rest]
442 Bi-ventricular pacemakers considered for patients requiring defibrillators who have symptomatic HF and QRS durations > 120 msec . [consider, patient, qrs, pacemaker, requir, defibrillator, msec, hf, symptomatic, duration]
865 Implantable defibrillators considered for prophylaxis against sudden cardiac death in patients with EF < 35% . [sudden, implantable, consider, defibrillator, cardiac, against, prophylaxi, patient, ef, death]
313 Lateral flexion and extension radiography is recommended as an adjunct to determine the presence of lumbar fusion postoperatively. The lack of motion between vertebrae, in the absence of rigid instrumentation, is highly suggestive of successful fusion. [suggestive, lateral, recommend, instrumentation, fusion, successful, between, rigid, determine, lack, extension, lumbar, highly, absence, presence, adjunct, vertebra, fusion, postoperatively, radiography, flexion, motion]
736 Static lumbar radiographs are not recommended as a stand-alone means to assess fusion status following lumbar arthrodesis surgery. [fusion, statu, mean, follow, static, alone, asses, radiograph, recommend, surgery, lumbar, arthrodesi, stand, lumbar]
1159 Technetium- 99 bone scanning is not recommended as a means to assess lumbar fusion. [mean, technetium, scan, fusion, lumbar, bone, recommend, asses]
7 It is recommended that patients in whom discography is positive but in whom MR imaging evidence of disc degeneration is absent not be considered candidates for operative intervention. [degeneration, candidate, evidence, recommend, patient, disc, intervention, positive, mr, absent, consider, imag, discography, operative]
430 It is recommended that discography be reserved for use in patients with equivocal MR imaging findings, especially at levels adjacent to clearly pathological levels. [equivocal, adjacent, reserv, pathological, patient, use, clearly, level, discography, mr, imag, especially, recommend, level, finding]
853 It is recommended that MR imaging-documented disc spaces that appear to be normal not be considered for treatment as a source of low-back pain. [low, imag, document, back, space, disc, normal, treatment, appear, recommend, consider, source, pain, mr]
311 In situ lumbar PLF is recommended as a treatment option in addition to decompression in patients with lumbar stenosis without deformity in whom there is evidence of spinal instability. [deformity, plf, stenosi, instability, without, patient, lumbar, treatment, option, recommend, evidence, decompression, lumbar, spinal, addition, situ]
734 In situ posterolateral lumbar fusion is not recommended as a treatment option in patients with lumbar stenosis in whom there is no evidence of preexisting spinal instability or likely iatrogenic instability due to facetectomy. [stenosi, recommend, evidence, fusion, lumbar, treatment, facetectomy, lumbar, preexist, instability, iatrogenic, situ, spinal, posterolateral, due, option, patient, instability]
1157 The addition of pedicle screw instrumentation is not recommended in conjunction with PLF following decompression for lumbar stenosis in patients without spinal deformity or instability. [follow, lumbar, stenosi, without, spinal, patient, instrumentation, decompression, conjunction, pedicle, plf, instability, addition, deformity, recommend, screw]
312 The use of lumbar brace therapy as a preoperative diagnostic tool to predict outcome following lumbar fusion surgery is not recommended. [use, fusion, tool, outcome, lumbar, therapy, surgery, lumbar, brace, preoperative, predict, diagnostic, recommend, follow]
735 The use of transpedicular external fixation as a tool to predict outcome following lumbar fusion surgery is not recommended. [outcome, tool, transpedicular, use, surgery, fixation, lumbar, external, recommend, follow, fusion, predict]
1158 Lumbar braces are recommended as a means of decreasing the number of sick days lost due to low-back pain among workers with a previous lumbar injury. They are not recommended as a means of decreasing low-back pain in the general working population. [low, mean, pain, injury, worker, numb, sick, low, back, work, back, mean, recommend, brace, pain, lost, lumbar, population, lumbar, day, decreas, recommend, due, previou, decreas, general]
343 In primary care and specialty medical settings, ACIP recommends implementation of standing orders to identify adults recommended for hepatitis B vaccination and administer vaccination as part of routine services. To ensure vaccination of adults at risk for HBV infection who have not completed the vaccine series, ACIP recommends the following implementation strategies: Provide information to all adults regarding the health benefits of hepatitis B vaccination, including risk factors for HBV infection and persons for whom vaccination is recommended. Help all adults assess their need for vaccination by obtaining a history that emphasizes risks for sexual transmission and percutaneous or mucosal exposure to blood. Vaccinate all adults who report risks for HBV infection. Vaccinate all adults requesting protection from HBV infection, without requiring them to acknowledge a specific risk factor. [recommend, person, adult, risk, obtain, strategie, benefit, vaccination, factor, risk, adult, protection, identify, adult, asses, specialty, ensure, adult, recommend, vaccine, vaccination, medical, report, order, vaccinate, vaccination, request, hbv, infection, adult, follow, acknowledge, regard, health, hbv, acip, specific, hbv, includ, vaccination, risk, hbv, blood, recommend, provide, emphasiz, help, acip, history, vaccination, risk, nee, vaccination, transmission, complet, infection, part, care, serie, sexual, vaccinate, risk, infection, requir, adult, recommend, routine, exposure, implementation, primary, percutaneou, mucosal, administ, hepatiti, infection, hepatiti, setting, servex, implementation, stand, factor, without, information]
766 Public health programs and primary care providers should adopt strategies appropriate for the practice setting to ensure that all adults at risk for HBV infection are offered hepatitis B vaccine. [practice, program, hepatiti, public, care, vaccine, primary, adopt, risk, infection, appropriate, provider, strategie, adult, health, offer, ensure, hbv, set]
1189 Hepatitis B vaccination is recommended for all unvaccinated adults at risk for HBV infection and for all adults requesting protection from HBV infection (see Box below titled "Adults Recommended to Receive Hepatitis B Vaccination"). Acknowledgment of a specific risk factor should not be a requirement for vaccination. [infection, recommend, titl, hepatiti, risk, see, hbv, vaccination, risk, below, protection, requirement, infection, adult, hepatiti, acknowledgment, adult, recommend, adult, receive, vaccination, unvaccinat, request, vaccination, hbv, specific, box, factor]
342 Patients currently treated in hospital who are potentially suitable for home haemodialysis on clinical grounds, but who have not previously been offered a choice, should be reassessed and informed about their dialysis options. [clinical, patient, potentially, suitable, hospital, treat, dialysi, choice, reasses, currently, option, home, ground, offer, inform, previously, haemodialysi]
765 t is recommended that all suitable patients should be offered the choice between home haemodialysis or haemodialysis in a hospital/satellite unit. [choice, unit, home, haemodialysi, between, patient, suitable, hospital, offer, haemodialysi, recommend, satellite]
1188 Patients performing haemodialysis at home and their carers will require initial training and an accessible and responsive support service. The support service should offer the possibility of respite hospital/satellite unit dialysis as required. [requir, responsive, satellite, require, accessible, hospital, possibility, support, train, patient, perform, service, support, home, haemodialysi, unit, service, carer, respite, dialysi, initial]
205 This guidance applies to the use of the aromatase inhibitors anastrozole, exemestane, and letrozole, within the marketing authorisations for each drug at the time of this appraisal, for the treatment of early oestrogen-receptor-positive breast cancer; that is: Anastrozole for primary adjuvant therapy Exemestane for adjuvant therapy following 2?3 years of adjuvant tamoxifen therapy Letrozole for primary adjuvant therapy and extended adjuvant therapy following standard tamoxifen therapy. [therapy, guidance, therapy, drug, extend, positive, use, letrozole, each, year, early, standard, therapy, exemestane, breast, adjuvant, tamoxifen, letrozole, market, aromatase, receptor, tamoxifen, oestrogen, adjuvant, cancer, therapy, therapy, treatment, within, exemestane, adjuvant, time, follow, thi, follow, adjuvant, anastrozole, applie, primary, therapy, appraisal, authorisation, anastrozole, thi, adjuvant, primary, inhibitor]
628 The aromatase inhibitors anastrozole, exemestane, and letrozole, within their licensed indications, are recommended as options for the adjuvant treatment of early oestrogen-receptor-positive invasive breast cancer in postmenopausal women. [adjuvant, early, recommend, positive, letrozole, aromatase, licens, receptor, option, oestrogen, anastrozole, cancer, within, woman, postmenopausal, treatment, invasive, breast, exemestane, inhibitor, indication]
1051 The choice of treatment should be made after discussion between the responsible clinician and the woman about the risks and benefits of each option. Factors to consider when making the choice include whether the woman has received tamoxifen before, the licensed indications and side-effect profiles of the individual drugs and, in particular, the assessed risk of recurrence. [factor, risk, drug, profile, choice, option, wheth, between, particular, choice, consid, tamoxifen, each, receiv, risk, discussion, effect, indication, benefit, include, recurrence, woman, made, aft, clinician, treatment, before, side, individual, woman, mak, asses, responsible, licens]
206 Laparoscopic (including laparoscopically assisted) resection is recommended as an alternative to open resection for individuals with colorectal cancer in whom both laparoscopic and open surgery are considered suitable. [resection, open, resection, suitable, individual, surgery, laparoscopic, laparoscopic, cancer, open, both, laparoscopically, consider, assist, includ, recommend, alternative, colorectal]
629 The decision about which of the procedures (open or laparoscopic) is undertaken should be made after informed discussion between the patient and the surgeon. In particular, they should consider: The suitability of the lesion for laparoscopic resection The risks and benefits of the two procedures The experience of the surgeon in both procedures [experience, laparoscopic, undertaken, aft, inform, open, discussion, procedure, surgeon, particular, surgeon, between, laparoscopic, consid, resection, suitability, risk, decision, two, benefit, patient, made, procedure, both, procedure, lesion]
1052 Laparoscopic colorectal surgery should be performed only by surgeons who have completed appropriate training in the technique and who perform this procedure often enough to maintain competence. The exact criteria to be used should be determined by the relevant national professional bodies. Cancer networks and constituent Trusts should ensure that any local laparoscopic colorectal surgical practice meets these criteria as part of their clinical governance arrangements. [criteria, governance, meet, thi, colorectal, perform, determin, complet, maintain, train, laparoscopic, procedure, bodie, national, perform, exact, relevant, use, constituent, clinical, technique, surgical, enough, network, criteria, laparoscopic, ensure, part, arrangement, appropriate, trust, surgery, local, practice, competence, professional, colorectal, surgeon, cancer]
82 Further treatment with efalizumab is not recommended in patients unless their psoriasis has responded adequately at 12 weeks . [psoriasi, adequately, furth, efalizumab, week, treatment, respond, recommend, unles, patient]
505 Etanercept treatment should be discontinued in patients whose psoriasis has not responded adequately at 12 weeks. Further treatment cycles are not recommended in these patients. [whose, treatment, respond, treatment, week, discontinu, psoriasi, adequately, cycle, patient, etanercept, patient, furth, recommend]
928 Patients who have begun a course of treatment with efalizumab at the date of publication of this guidance should have the option of continuing to receive treatment until the patients and their clinicians consider it is appropriate to stop. [continu, clinician, thi, course, patient, publication, efalizumab, receive, date, guidance, until, option, appropriate, treatment, begun, treatment, patient, stop, consid]
18 Programme providers should also ensure that support is available to enable the participation of parents who might otherwise find it difficult to access these programmes. [participation, find, programme, parent, available, acces, support, ensure, difficult, programme, otherwise, enable, provider]
441 Individual-based parent-training/education programmes are recommended in the management of children with conduct disorders only in situations where there are particular difficulties in engaging with the parents or a family's needs are too complex to be met by group-based parent-training/education programmes. [need, parent, management, difficultie, bas, train, train, conduct, education, parent, engag, parent, individual, group, family, disorder, recommend, education, situation, children, programme, particular, met, complex, bas, programme]
864 It is recommended that all parent-training/education programmes, whether group- or individual-based, should: Be structured and have a curriculum informed by principles of social-learning theory Include relationship-enhancing strategies Offer a sufficient number of sessions, with an optimum of 8 to 12, to maximise the possible benefits for participants Enable parents to identify their own parenting objectives Incorporate role-play during sessions, as well as homework to be undertaken between sessions, to achieve generalisation of newly rehearsed behaviours to the home situation Be delivered by appropriately trained and skilled facilitators who are supervised, have access to necessary ongoing professional development, and are able to engage in a productive therapeutic alliance with parents Adhere to the programme developer's manual and employ all of the necessary materials to ensure consistent implementation of the programme. [therapeutic, group, parent, homework, facilitator, bas, achieve, parent, parent, skil, train, parent, objectif, undertaken, inform, curriculum, development, identify, benefit, include, rehears, professional, train, ensure, well, deliver, principle, behaviour, home, relationship, necessary, session, acces, ongo, programme, session, develop, theory, incorporate, wheth, individual, enable, programme, programme, strategie, appropriately, manual, optimum, session, structur, engage, adhere, sufficient, play, education, possible, necessary, role, generalisation, supervis, newly, between, dur, learn, recommend, participant, numb, material, situation, alliance, productive, implementation, maximise, social, employ, enhanc, consistent]
348 Routine Tdap Vaccination:Recommendations for Use: Adults aged 19 to 64 years should receive a single dose of Tdap to replace a single dose of tetanus and diphtheria toxoids vaccine (Td) for active booster vaccination against tetanus, diphtheria, and pertussis if they received their last dose of Td >10 years earlier. Replacing 1 dose of Td with Tdap will reduce the morbidity associated with pertussis in adults and might reduce the risk for transmitting pertussis to persons at increased risk for pertussis and its complications. [tdap, vaccine, vaccination, age, pertussi, tdap, receive, diphtheria, single, tdap, td, recommendation, pertussi, diphtheria, receiv, dose, person, toxoid, replac, last, single, tetanu, complication, risk, tetanu, earli, routine, dose, reduce, dose, replace, boost, use, vaccination, reduce, against, year, year, dose, morbidity, transmit, increas, adult, pertussi, associat, risk, adult, active, pertussi, td, td]
771 Not Contraindications or Precautions for Tdap:The following conditions are not contraindications or precautions for Tdap, and adults with these conditions may receive a dose of Tdap if otherwise indicated. The conditions in italics are precautions for pediatric DTP/DTaP but are not contraindications or precautions for Tdap vaccination in adults ("Pertussis vaccination," 1997). Temperature >105 degrees F (>40.5 degrees C) within 48 hours after pediatric DTP/DTaP not attributable to another cause Collapse or shock-like state (hypotonic hyporesponsive episode) within 48 hours after pediatric DTP/DTaP Persistent crying lasting >3 hours, occurring within 48 hours after pediatric DTP/DTaP Convulsions with or without fever, occurring within 3 days after pediatric DTP/DTaP Stable neurologic disorder, including well-controlled seizures, a history of seizure disorder that has resolved, and cerebral palsy (See section, "Safety Considerations for Adult Vaccination with Tdap" in the original guideline document) Brachial neuritis Immunosuppression, including persons with human immunodeficiency virus (HIV). The immunogenicity of Tdap in persons with immunosuppression has not been studied and could be suboptimal. Breastfeeding Intercurrent minor illness Use of antimicrobials History of an extensive limb swelling (ELS) reaction following pediatric DTP/DTaP or Td that was not an Arthus hypersensitivity reaction (see "Safety Considerations for Adult Vaccination with Td" section in the original guideline document for descriptions of ELS and Arthus reactions). [precaution, dtp, hiv, antimicrobial, arthu, section, history, contraindication, reaction, precaution, minor, contraindication, aft, seizure, limb, neurologic, pediatric, viru, persistent, intercurrent, dtap, els, brachial, occur, neuriti, occur, indicat, vaccination, crie, vaccination, safety, reaction, safety, pediatric, aft, hypersensitivity, consideration, tdap, follow, tdap, dtap, tdap, arthu, section, receive, includ, illnes, convulsion, control, disord, contraindication, italic, guideline, episode, pediatric, hour, vaccination, attributable, dtap, see, anoth, collapse, dtap, studi, dtp, reaction, resolv, person, within, consideration, pediatric, immunosuppression, aft, within, original, degree, hypotonic, description, adult, condition, tdap, condition, tdap, includ, temperature, otherwise, td, dtp, shock, immunogenicity, vaccination, hour, history, fev, hour, day, see, palsy, adult, suboptimal, last, cerebral, dtp, pertussi, dtp, extensive, precaution, dtp, person, use, without, cause, pediatric, aft, els, stable, degree, original, follow, human, breastfeed, state, condition, well, guideline, document, precaution, document, dose, swel, td, hyporesponsive, disord, within, hour, within, seizure, immunosuppression, pediatric, immunodeficiency, tdap, dtap, adult, adult, dtap]
1194 Routine Tdap Vaccination: Recommendations for Use:Prevention of pertussis among infants aged <12 months by vaccinating their adult contacts: Adults who have or who anticipate having close contact with an infant aged <12 months (e.g., parents, grandparents aged <65 years, child-care providers, and health-care personnel [HCP]) should receive a single dose of Tdap at intervals <10 years since the last Td to protect against pertussis if they have not previously received Tdap. Ideally, these adults should receive Tdap at least 2 weeks before beginning close contact with the infant. An interval as short as 2 years from the last dose of Td is suggested to reduce the risk for local and systemic reactions after vaccination; shorter intervals may be used. Infants aged <12 months are at highest risk for pertussis-related complications and hospitalizations compared with older age groups. Young infants have the highest risk for death. Vaccinating adult contacts might reduce the risk for transmitting pertussis to these infants (see "Infant Pertussis and Transmission to Infants" in the original guideline document). Infants should be vaccinated on-time with pediatric diphtheria and tetanus toxoids, acellular pertussis antigens (DTaP) ("Pertussis vaccination," 1997; CDC, "Recommended childhood and adolescent immunization schedule," 2006). When possible, women should receive Tdap before becoming pregnant. Approximately half of all pregnancies in the United States are unplanned (Henshaw, 1998). Any woman of childbearing age who might become pregnant is encouraged to receive a single dose of Tdap if she has not previously received Tdap (see "Vaccination During Pregnancy" below). Women, including those who are breastfeeding, should receive a dose of Tdap in the immediate postpartum period if they have not previously received Tdap. The postpartum Tdap should be administered before discharge from the hospital or birthing center. If Tdap cannot be administered before discharge, it should be administered as soon as feasible. [infant, pertussi, age, vaccinat, relat, parent, tdap, aft, yoing, tdap, woman, pediatric, those, protect, receive, includ, suggest, unplan, before, receiv, schedule, month, infant, previously, tdap, hospital, contact, tdap, administer, administer, unit, immunization, pregnancy, close, pertussi, old, adolescent, risk, year, single, hcp, contact, age, before, vaccination, before, year, dtap, tdap, pregnant, receiv, child, risk, pertussi, discharge, cent, becom, pertussi, time, week, tdap, document, henshaw, adult, guideline, transmission, birth, see, tdap, short, reaction, infant, pertussi, compar, high, recommendation, tetanu, dose, local, breastfeed, see, single, age, anticipate, receiv, high, infant, last, administer, period, health, pregnant, recommend, reduce, adult, childbear, personnel, group, begin, become, woman, risk, td, care, receive, receive, short, interval, receive, interval, woman, vaccination, hav, dose, month, against, state, transmit, use, immediate, receive, vaccination, infant, previously, diphtheria, vaccinat, vaccinat, childhood, soon, last, adult, possible, dur, adult, half, approximately, previously, tdap, pregnancie, td, care, postpartum, prevention, discharge, pertussi, tdap, provider, contact, infant, dose, grandparent, vaccination, below, original, complication, antigen, tdap, toxoid, before, hospitalization, acellular, reduce, dose, month, infant, infant, death, age, encourag, contact, cdc, systemic, tdap, age, routine, interval, pertussi, age, risk, year, close, ideally, feasible, use, postpartum, infant]
8 The USPSTF recommends against routine screening for elevated blood lead levels in asymptomatic children aged 1 to 5 years who are at average risk . [routine, blood, recommend, level, year, screen, risk, elevat, against, asymptomatic, age, uspstf, lead, children, average]
431 The USPSTF recommends against routine screening for elevated blood lead levels in asymptomatic pregnant women. [asymptomatic, woman, elevat, routine, recommend, blood, pregnant, against, level, uspstf, screen, lead]
854 The USPSTF concludes that evidence is insufficient to recommend for or against routine screening for elevated blood lead levels in asymptomatic children aged 1 to 5 who are at increased risk. [screen, risk, evidence, children, conclude, routine, recommend, blood, uspstf, increas, level, age, insufficient, lead, elevat, against, asymptomatic]
344 Complete disability certification forms objectively, accurately and in a timely manner. [complete, timely, certification, disability, form, objectively, accurately, man]
767 Determine the presence or absence of a permanent impairment that substantially limits one or more major life activities. [limit, more, life, activitie, one, determine, impairment, substantially, absence, presence, major, permanent]
1190 Assess fitness for duty and employability by comparing the patient's work capacity to workplace demands. Obtain a functional capacity examination if needed. [fitnes, workplace, capacity, obtain, employability, duty, patient, need, functional, asses, capacity, demand, work, compar, examination]
299 Esophageal pH recording is possibly indicated to detect refractory reflux in patients with chest pain after cardiac evaluation using a symptom reflux association scheme, preferably the symptom association probability calculation (pH study done after a trial of proton pump inhibitor therapy for at least 4 weeks). [proton, evaluation, pain, ph, preferably, refractory, cardiac, esophageal, study, inhibitor, che, reflux, symptom, indicat, therapy, trial, scheme, association, done, detect, pump, patient, use, calculation, possibly, reflux, ph, symptom, aft, week, probability, association, aft, record]
722 Esophageal pH recording is possibly indicated to document concomitant gastroesophageal reflux disease in an adult onset, nonallergic asthmatic suspected of having reflux-induced asthma (pH study done after withholding antisecretory drugs for > 1 week). Note: a positive test does not prove causality. [ph, drug, week, note, aft, test, disease, positive, study, suspect, indicat, document, reflux, reflux, doe, gastroesophageal, hav, induc, asthmatic, ph, onset, prove, concomitant, causality, done, adult, record, possibly, antisecretory, withhold, esophageal, nonallergic, asthma]
1145 Esophageal pH recording is indicated to evaluate patients with either normal or equivocal endoscopic findings and reflux symptoms that are refractory to proton pump inhibitor therapy (pH study done after withholding antisecretory drug regimen for >= 1 week if the study is done to confirm excessive acid exposure or while taking the antisecretory drug regimen if symptom-reflux correlation is to be scored). [equivocal, reflux, done, excessive, proton, evaluate, ph, study, ph, normal, exposure, scor, reflux, done, tak, symptom, therapy, acid, record, antisecretory, inhibitor, regiman, withhold, correlation, pump, aft, indicat, drug, patient, symptom, eith, drug, finding, antisecretory, regiman, study, esophageal, confirm, refractory, week, endoscopic]
9 Provide or refer for psychotherapy . [provide, ref, psychotherapy]
432 Conduct a comprehensive assessment of the social factors specific to spinal cord injury. [spinal, social, specific, assessment, comprehensive, conduct, cord, injury, factor]
855 Use established diagnostic criteria to diagnose depression. [use, depression, establish, diagnostic, diagnose, criteria]
1270 Determine Magnification Required (task dependent) The magnification required for distance vision improvement is predicted by the ratio of the denominator of the present visual acuity to the denominator of the desired visual acuity. Example: If actual visual acuity is 10/60 and desired visual acuity is 10/20, then 60/20 = 3X magnification required. [determine, vision, requir, denominator, requir, acuity, visual, example, acuity, dependent, acuity, ratio, distance, present, magnification, improvement, acuity, predict, desir, task, actual, magnification, visual, visual, 3x, desir, denominator, requir, magnification, visual]
1271 A central visual field defect can significantly affect visual functioning, such as reading ability. Size, location, and density of the scotoma (relative, absolute, or both) will determine its effect on visual functioning and can influence the response to near magnification. In many cases, even with appropriate magnification, certain parameters of print reading ability (e.g., print size, reading speed, comprehension, and duration) may be compromised due to the central field disturbance and nature of the task, even though ability to navigate through the environment is relatively unaffected. In the eye with a macular scotoma, the stimulus to foveate the target may persist; however, with time or training, the patient may learn to view eccentrically. [read, central, influence, size, read, density, eccentrically, near, both, relatively, such, central, through, though, howev, significantly, response, function, view, persist, compromis, time, defect, comprehension, magnification, relative, stimulu, scotoma, target, field, cas, navigate, many, nature, scotoma, due, visual, even, size, ability, duration, even, disturbance, effect, field, affect, task, foveate, function, certain, print, macular, patient, visual, appropriate, determine, ability, read, eye, train, environment, unaffect, visual, spe, location, learn, parameter, absolute, magnification, ability, print]
1272 Consider Electronic/electro-optical Options Head-mounted video display systems provide variable autofocus magnification, variable brightness, and contrast enhancement and reverse polarity capability. [mount, magnification, variable, head, consid, electronic, provide, autofocu, enhancement, brightnes, contrast, variable, display, system, video, polarity, capability, option, reverse]
10 Physicians should fully explain diagnosis, prognosis, and all treatment options to each patient. [physician, option, fully, treatment, prognosi, explain, each, patient, diagnosi]
433 Discussions should occur with the patient or legal agent about life expectancy and quality of life. [discussion, patient, life, expectancy, legal, life, agent, quality, occur]
856 For patients requiring dialysis, but who have an uncertain prognosis or for whom a consensus cannot be reached about providing dialysis, nephrologists should consider offering a time-limited trial of dialysis. [offer, reach, trial, nephrologist, consid, dialysi, requir, uncertain, prognosi, dialysi, patient, consensu, provid, time, limit, dialysi]
11 Focus on providing opportunities for societal participation in meaningful roles. [opportunitie, societal, meaningful, role, focu, participation, provid]
434 Perform a comprehensive neurological examination according to International Standards for Neurological and Functional Classification between 3 and 7 days after injury. [injury, accord, perform, neurological, standard, neurological, classification, aft, international, comprehensive, functional, examination, day, between]
857 Facilitate opportunities for optimal quality of life within the full continuum of health-care and rehabilitation programs. [rehabilitation, program, life, care, continuum, full, within, optimal, opportunitie, quality, facilitate, health]
12 Brief cognitive assessment instruments that focus on limited aspects of cognitive function (i.e., Clock Drawing Test, Time and Change Test) may be considered when screening patients for dementia. [change, dementia, aspect, test, cognitive, screen, function, patient, clock, assessment, time, limit, focu, test, consider, brief, instrument, draw, cognitive]
435 General cognitive screening instruments (e.g., Mini-Mental State Examination) should be considered for the detection of dementia in individuals with suspected cognitive impairment. [impairment, cognitive, cognitive, instrument, detection, screen, general, state, examination, individual, consider, suspect, dementia]
858 Neuropsychologic batteries should be considered useful in identifying patients with dementia, particularly when administered to a population at increased risk of cognitive impairment. [identifie, increas, particularly, useful, neuropsychologic, impairment, cognitive, consider, batterie, risk, patient, population, dementia, administer]
207 Antipsychotics should be used to treat agitation or psychosis in patients with dementia where environmental manipulation fails (Standard). Atypical agents may be better tolerated compared with traditional agents . [manipulation, compar, traditional, environmental, agitation, agent, standard, antipsychotic, use, agent, atypical, fail, bet, psychosi, tolerat, patient, dementia, treat]
630 Graded assistance, practice, and positive reinforcement should be used to increase functional independence. [positive, increase, use, practice, reinforcement, assistance, functional, independence, grad]
1053 Low lighting levels, music, and simulated nature sounds may improve eating behaviors for persons with dementia, and intensive multimodality group training may improve activities of daily living, but these approaches lack conclusive supporting data. [simulat, improve, activitie, group, low, person, improve, approach, eat, support, lack, data, daily, nature, liv, level, multimodality, light, conclusive, intensive, behavior, sound, dementia, train, music]
208 Patients with asymptomatic microscopic hematuria who are at risk for urologic disease or primary renal disease should undergo an appropriate evaluation.In patients at low risk for disease, some components of the evaluation may be deferred . [disease, hematuria, low, disease, urologic, appropriate, microscopic, risk, evaluation, undergo, asymptomatic, component, patient, disease, primary, patient, defer, renal, evaluation, risk]
631 The initial determination of microscopic hematuria should be based on microscopic examination of the urinary sediment from a freshly voided, clean-catch, midstream urine specimen. [sediment, catch, urine, speciman, microscopic, midstream, hematuria, determination, microscopic, bas, void, initial, examination, clean, urinary, freshly]
1054 The prevalence of asymptomatic microscopic hematuria varies from 0.19 percent to as high as 21 percent. [varie, microscopic, hematuria, prevalence, asymptomatic, high, percent, percent]
65 Skin inspection should occur regularly; the frequency of inspections should be determined in response to changes in the individual's condition in relation to both deterioration or recovery. [change, regularly, skin, recovery, frequency, inspection, relation, both, inspection, determin, occur, response, deterioration, individual, condition]
488 Patients who are able and willing should be informed and educated about risk assessment and resulting prevention strategies. This strategy where appropriate should include carers . [risk, patient, prevention, educat, strategy, include, appropriate, strategie, inform, wil, result, assessment, carer, thi]
911 Assessing an individual's risk of developing pressure ulcers should involve both informal and formal assessment procedures. [ulcer, formal, involve, risk, develop, assessment, individual, pressure, procedure, both, informal, asses]
32 Prophylaxis Based on Patient Stratification for RiskThe duration of the prophylaxis for thromboembolism should be individualized, depending on the need, medical condition, functional status, support services, and risk of the patient. [condition, support, functional, medical, prophylaxi, individualiz, riskthe, risk, statu, stratification, prophylaxi, duration, nee, servex, thromboembolism, depend, patient, patient, bas]
455 Anticoagulants should be continued until discharge in patients with incomplete injuries, for 8 weeks in patients with uncomplicated complete motor injury, and for 12 weeks or until discharge from rehabilitation for those with complete motor injury and other risk factors (e.g., lower limb fractures, a history of thrombosis, cancer, heart failure, obesity, or age over 70). [discharge, those, risk, cancer, patient, motor, patient, complete, injurie, obesity, oth, thrombosi, failure, incomplete, week, discharge, week, injury, age, until, motor, low, fracture, uncomplicat, factor, heart, history, continu, ove, until, limb, injury, complete, anticoagulant, rehabilitation]
878 Health care professionals should be aware of the signs and symptoms of deep venous thrombosis and should perform physical assessment to detect this complication. [thrombosi, symptom, professional, detect, assessment, deep, physical, aware, perform, complication, thi, health, care, sign, venou]
371 Principles of Treatment Selection:Certain types of psychotherapy (as well as other psychosocial modalities) and certain psychotropic medications are effective in the treatment of borderline personality disorder. [selection, certain, personality, disord, modalitie, type, psychotropic, well, effective, psychotherapy, psychosocial, oth, treatment, principle, medication, certain, borderline, treatment]
794 Clinical experience suggests that partial efficacy of a selective serotonin reuptake inhibitor may be enhanced by adding lithium. [clinical, partial, suggest, add, serotonin, reuptake, lithium, efficacy, inhibitor, enhanc, experience, selective]
1217 Multiple- Versus Single-Clinician Treatment: Treatment by a single clinician and treatment by more than one clinician are both viable approaches. [single, more, clinician, treatment, both, one, viable, treatment, versu, treatment, single, multiple, clinician, approach, clinician]
417 Treatment is indicated for:Women undergoing some surgical procedures . [indicat, surgical, undergo, procedure, treatment, woman]
840 Allergy: Allergy to metronidazole is uncommon. Use 2% clindamycin cream for metronidazole allergic women. [uncommon, use, metronidazole, metronidazole, allergy, woman, clindamycin, allergic, allergy, cream]
1263 The results of further randomised controlled trials of screening and treating all pregnant women are awaited, but there are insufficient data to make such a recommendation at present. In conclusion, symptomatic pregnant women should be treated in the usual way . [treat, trial, await, result, woman, treat, data, conclusion, recommendation, pregnant, screen, furth, such, randomis, pregnant, present, usual, way, woman, control, make, insufficient, symptomatic]
13 Schools should be considered appropriate sites for the availability of condoms, because they contain large adolescent populations and may potentially provide a comprehensive array of related educational and health care resources. [adolescent, condom, educational, population, relat, appropriate, resource, array, school, health, care, large, potentially, consider, provide, site, availability, comprehensive, contain]
436 To be most effective, condom availability programs should be developed through a collaborative community process and accompanied by comprehensive sequential sexuality education, which is ideally part of a K-12 health education program, with parental involvement, counseling, and positive peer support. [part, health, education, involvement, sexuality, sequential, accompani, availability, education, effective, pee, ideally, community, comprehensive, positive, counsel, condom, program, parental, collaborative, develop, support, through, proces, program]
859 Research is encouraged to identify methods to increase correct and consistent condom use by sexually active adolescents and to evaluate effectiveness of strategies to promote condom use, including condom education and availability programs in schools. [evaluate, education, program, strategie, promote, method, condom, school, use, sexually, availability, condom, identify, increase, includ, active, research, correct, adolescent, encourag, effectivenes, consistent, condom, use]
209 For patients with Parkinson's disease in whom levodopa treatment is being instituted, either an immediate-release or sustained-release preparation may be considered. [patient, treatment, parkinson, eith, consider, bee, disease, immediate, institut, release, levodopa, release, preparation, sustain]
632 In patients with Parkinson's disease who require the initiation of dopaminergic treatment, either levodopa or a dopamine agonist may be used. [require, treatment, dopamine, patient, eith, use, levodopa, initiation, agonist, dopaminergic, parkinson, disease]
1055 Initial symptomatic treatment of patients with Parkinson's disease with selegiline in order to confer mild, symptomatic benefit prior to the institution of dopaminergic therapy may be considered. [consider, prior, mild, benefit, treatment, symptomatic, symptomatic, patient, conf, selegiline, dopaminergic, disease, ord, parkinson, initial, institution, therapy]
14 Nonsteroidal anti-inflammatory drugs (NSAIDs) or acetaminophen may be used as adjuncts to opioids in selected patients. [acetaminophen, patient, select, opioid, adjunct, nonsteroidal, use, nsaid, drug]
437 Propofol is the preferred sedative when rapid awakening (e.g., for neurologic assessment or extubation) is important. [sedative, extubation, awaken, rapid, neurologic, assessment, important, prefer, propofol]
860 Fentanyl is preferred for a rapid onset of analgesia in acutely distressed patients. [acutely, rapid, fentanyl, prefer, distres, analgesia, patient, onset]
38 Vision screening should be performed at the earliest possible age and at regular intervals during childhood as recommended by the American Academy of Pediatrics (AAP). The goal remains to eliminate preventable blindness and treatable visual disability. [academy, goal, earli, treatable, remain, eliminate, pediatric, visual, vision, disability, dur, recommend, screen, regular, preventable, possible, interval, childhood, aap, american, perform, age, blindnes]
461 Photoscreening is an innovative tool that can facilitate vision screening in children, especially in children who are difficult to screen (i.e., infants, toddlers, and children with developmental delays). Photoscreening systems are one option to increase the screening rate in preschool-aged children. [preschool, toddler, vision, screen, especially, system, delay, option, children, rate, one, children, age, innovative, infant, children, increase, developmental, screen, photoscreen, tool, difficult, screen, children, facilitate, photoscreen]
884 Regardless of the type of photoscreening system used, the evaluator must know how to properly apply the technology and understand the limitations of the test, such as the possible occurrence of false-positive and false-negative results as they apply to the population being tested. [type, possible, positive, population, apply, know, regardles, photoscreen, technology, negative, occurrence, test, result, understand, false, bee, false, properly, test, system, limitation, such, use, evaluator, apply]
15 Use of unattended APAP to either initially determine pressures for fixed CPAP or for self-adjusting APAP treatment in CPAP-naïve patients is not currently established. [cpap, cpap, use, initially, self, patient, determine, currently, fix, unattend, establish, adjust, apap, apap, pressure, eith, treatment, naïve]
438 Certain APAP devices may be used during attended titration to identify by polysomnography, a single pressure for use with standard continuous positive airway pressure (CPAP) for treatment of OSA. [identify, dur, use, treatment, single, apap, airway, attend, continuou, use, polysomnography, titration, osa, pressure, devex, pressure, certain, standard, positive, cpap]
861 APAP devices are not currently recommended for splitnight titration. [apap, recommend, devex, titration, splitnight, currently]
29 Surgical Management:The anterolateral approach is recommended for hemiarthroplasty. [management, surgical, anterolateral, hemiarthroplasty, recommend, approach]
452 Preoperative Care:Patients should be operated on as soon as possible (within 24 hours), during standard daytime working hours, including weekends, if their medical conditions allows. [daytime, within, operat, soon, care, hour, standard, condition, includ, medical, allow, preoperative, dur, hour, work, patient, possible, weekend]
875 Early Postoperative Management: Fluid and electrolyte management in elderly patients should be monitored regularly. [postoperative, management, electrolyte, elderly, fluid, regularly, management, early, patient, monitor]
373 Trauma patients with an injury severity score >9, who can receive anticoagulants, should receive low molecular weight heparin as their primary mode of venous thromboembolism prophylaxis. [primary, thromboembolism, weight, molecular, receive, heparin, venou, trauma, severity, anticoagulant, prophylaxi, low, patient, injury, receive, mode, score]
796 Older age is an increased factor for venous thromboembolism but it is not clear at which exact age the risk increases substantially. [venou, substantially, thromboembolism, exact, clear, risk, increas, age, age, increas, factor, old]
1219 Hand-held Doppler ultrasound may be used to assess symptomatic trauma patients with suspected deep vein thrombosis. Confirmatory venography may be needed in patients who screen positive for deep vein thrombosis with Doppler ultrasound. [deep, symptomatic, doppl, venography, hand, confirmatory, thrombosi, ultrasound, held, ultrasound, asses, doppl, trauma, thrombosi, screen, patient, patient, vein, vein, positive, use, suspect, deep, need]
372 Women with early stage (stages I and II) breast cancer who have undergone breast conservation surgery should be offered postoperative breast irradiation. [conservation, breast, breast, breast, postoperative, early, irradiation, offer, undergone, woman, surgery, stage, stage, cancer, ii]
795 The optimal fractionation schedule for breast irradiation has not been established and the role of boost irradiation is unclear. Outside of a clinical trial, two commonly used fractionation schedules are suggested: 50 Gy in 25 fractions to the whole breast, or 40 Gy in 16 fractions to the whole breast with a local boost to the primary site of 12.5 Gy in five fractions. Shorter schedules (e.g., 40 or 44 Gy in 16 fractions) have also been used routinely in some centres. The enrolment of patients in ongoing clinical trials is encouraged. [whole, enrolment, fraction, breast, gy, whole, schedule, primary, use, suggest, site, use, boost, short, unclear, gy, outside, fraction, irradiation, gy, gy, clinical, boost, ongo, fraction, patient, routinely, schedule, two, role, encourag, optimal, fraction, schedule, fractionation, irradiation, breast, establish, trial, clinical, breast, commonly, trial, five, fractionation, local, centre]
1218 Women who have undergone breast conservation surgery should receive local breast irradiation as soon as possible following wound healing. A safe interval between surgery and the start of radiotherapy is unknown, but it is reasonable to start breast irradiation within 12 weeks of definitive surgery. [safe, irradiation, wound, irradiation, breast, interval, unknown, local, breast, between, radiotherapy, woman, heal, surgery, follow, soon, breast, within, conservation, receive, definitive, start, undergone, reasonable, start, surgery, surgery, possible, week]
418 Colony-stimulating factors are not recommended for routine use to treat febrile or afebrile neutropenic patients. [stimulat, patient, colony, recommend, factor, treat, neutropenic, routine, use, afebrile, febrile]
841 Trimethoprim-sulfamethoxazole (TMP-SMZ) therapy is recommended at risk for Pneumocystis carinii pneumonitis, regardless of whether they have neutropenia . [carinii, wheth, neutropenia, trimethoprim, pneumoniti, risk, sulfamethoxazole, regardles, therapy, pneumocysti, recommend, smz, tmp]
1264 If the patient becomes afebrile but remains neutropenic, the proper antibiotic course is less well defined. Some specialists recommend continuation of antibiotics, given intravenously or orally, until neutropenia is resolved. [until, resolv, well, become, orally, recommend, les, intravenously, patient, prop, antibiotic, neutropenic, remain, course, given, specialist, continuation, afebrile, defin, neutropenia, antibiotic]
16 Orotracheal intubation guided by direct laryngoscopy is the emergency tracheal intubation procedure of choice for trauma patients. [orotracheal, emergency, choice, patient, trauma, procedure, tracheal, intubation, laryngoscopy, direct, intubation, guid]
439 The laryngeal mask airway and Combitube are alternatives to cricothyrostomy and may be selected when cricothyrostomy expertise is limited. [cricothyrostomy, mask, cricothyrostomy, alternatif, limit, airway, laryngeal, expertise, combitube, select]
862 Tracheal Intubation Immediately Following Traumatic Injury Emergency tracheal intubation is needed in trauma patients with the following traits: airway obstruction hypoventilation severe hypoxemia (hypoxemia despite supplemental oxygen) severe cognitive impairment (Glasgow Coma Score [GCS] <8) cardiac arrest severe hemorrhagic shock. [severe, hypoxemia, supplemental, emergency, hypoxemia, follow, intubation, despite, impairment, tracheal, need, score, patient, airway, oxygen, cognitive, shock, hypoventilation, intubation, hemorrhagic, injury, severe, trait, cardiac, obstruction, arr, severe, coma, traumatic, immediately, follow, gcs, glasgow, tracheal, trauma]
17 A focused exam of the hair and scalp should be performed. [exam, scalp, hair, perform, focus]
440 If the patient has been treated with one of these medications within the past 6 months (as would be the case if the initial treatment was unsuccessful), resistance to that agent should be suspected and a different agent should be chosen for treatment. [chosen, case, one, initial, resistance, month, within, different, treat, medication, unsuccessful, treatment, suspect, past, patient, treatment, agent, agent]
863 Items that have come in direct contact with the infected person's head should be washed in hot, soapy water and dried with heat in order to eliminate the lice and nits. Use of insecticides or extraordinary cleaning measures in the person's environment are not indicated. [clean, direct, head, person, use, nit, heat, soapy, come, wat, extraordinary, insecticide, eliminate, dri, item, indicat, hot, ord, contact, environment, measure, infect, wash, person, lice]
36 Educate caregivers to assist in their ability to care for the wanderer. [wander, caregiver, care, ability, educate, assist]
459 Assess for neurocognitive deficits and wandering patterns using the Algase Wandering Scale (AWS). [wander, pattern, algase, aws, use, wander, deficit, scale, neurocognitive, asses]
882 Provide stimulation clues such as pictures and signs . [such, clue, stimulation, provide, sign, picture]
422 Risk Assessment:Offer genetic testing for family members, as appropriate . [family, member, genetic, appropriate, assessment, test, risk]
845 Education/Health Promotion:Provide contact information for support groups as requested . [promotion, support, provide, group, request, education, information, contact, health]
1268 Prenatal Diagnosis:If the family mutation is known, preimplantation diagnosis is feasible. [diagnosi, mutation, prenatal, preimplantation, feasible, diagnosi, known, family]
39 Previously Treated Patients with Intermediate- or High-Risk Chronic Lymphocytic Leukemia Fludarabine is an acceptable treatment option after failure of first-line therapy. Choice of treatment should be influenced by previously used regimens and patient preference. [leukemia, previously, risk, line, preference, chronic, choice, treatment, intermediate, lymphocytic, influenc, therapy, patient, high, aft, fludarabine, regimen, patient, failure, use, treatment, treat, acceptable, option, previously, first]
462 It is recommended that patients who have been treated with fludarabine receive irradiated blood products because of the risk of transfusion related graft versus host disease. [versu, disease, relat, receive, fludarabine, blood, graft, product, recommend, treat, transfusion, risk, host, patient, irradiat]
885 As first line treatment in patients with intermediate- or high-risk chronic lymphocytic leukemia, fludarabine or conventional chemotherapy (chlorambucil) are acceptable treatment options. Fludarabine improves progression-free survival but has a greater risk of toxicity, including specific infections. [acceptable, conventional, great, risk, risk, treatment, includ, intermediate, fludarabine, toxicity, line, leukemia, lymphocytic, improf, first, chemotherapy, infection, option, chlorambucil, fludarabine, patient, specific, survival, free, treatment, chronic, high, progression]
66 Recommend patients with wounds and LEAD seek care guided by a clinical wound expert. [care, guid, wound, wound, recommend, expert, lead, seek, clinical, patient]
489 Relate wound treatments to adequacy of perfusion status. [wound, statu, treatment, relate, adequacy, perfusion]
912 Prior to treatment, assess causative and contributive factors and significant signs and symptoms to differentiate types of lower-extremity ulcers, which require varying treatment modalities. [treatment, type, causative, factor, differentiate, low, sign, contributive, modalitie, prior, significant, require, ulcer, asses, extremity, symptom, varie, treatment]
33 Pain response to therapy should not be used as the sole diagnostic indicator of the underlying etiology of an acute headache. [use, etiology, diagnostic, headache, underlie, sole, response, indicator, acute, therapy, pain]
456 Patients presenting to the emergency department with headache and abnormal findings in a neurologic examination (i.e., focal deficit, altered mental status, altered cognitive function) should undergo emergent* noncontrast head computed tomography (CT) scan. Patients presenting with acute sudden-onset headache should be considered for an emergent* head computed tomography scan. Human immunodeficiency virus (HIV)-positive patients with a new type of headache should be considered for an urgent* neuroimaging study.Patients who are older than 50 years presenting with new type of headache without abnormal findings in a neurologic examination should be considered for an urgent neuroimaging study. [alter, examination, head, alter, acute, consider, noncontrast, focal, consider, abnormal, present, examination, headache, emergent, patient, patient, patient, mental, finding, headache, emergent, neurologic, scan, headache, head, hiv, ct, function, neuroimag, tomography, finding, neurologic, study, onset, old, present, undergo, viru, cognitive, department, human, new, neuroimag, sudden, positive, emergency, comput, deficit, type, urgent, immunodeficiency, statu, headache, year, consider, type, comput, urgent, new, scan, tomography, study, without, abnormal, patient, present]
879 Adult patients with headache exhibiting signs of increased intracranial pressure including papilledema, absent venous pulsations on funduscopic examination, altered mental status, or focal neurologic deficits should undergo a neuroimaging study before having an LP. In the absence of findings suggestive of increased intracranial pressure, an LP can be performed without obtaining a neuroimaging study. [funduscopic, includ, increas, absence, suggestive, adult, exhibit, sign, neuroimag, papilledema, study, lp, before, study, focal, intracranial, headache, patient, pressure, increas, undergo, mental, absent, neuroimag, examination, finding, neurologic, pressure, intracranial, statu, deficit, perform, venou, pulsation, hav, alter, without, obtain, lp]
67 Evaluate the patient for the presence of risk factors for heart failure. [failure, risk, factor, heart, presence, evaluate, patient]
490 Monitor the patient's condition and response to treatment. [response, monitor, patient, treatment, condition]
913 Treat the chronic underlying cardiac condition. [underlie, treat, chronic, cardiac, condition]
421 Step 1: Is the patient dehydrated or does the patient have a fluid/electrolyte imbalance? Consider seriously the presence of a fluid/electrolyte imbalance whenever a patient experiences new symptoms or a decline of an existing condition that cannot be readily attributed to another cause. [seriously, new, presence, symptom, exist, consid, cause, dehydrat, attribut, imbalance, condition, readily, patient, whenev, anoth, doe, fluid, electrolyte, patient, decline, patient, step, fluid, electrolyte, imbalance, experience]
844 Step 6: Are the causes and consequences of the patient's dehydration or fluid/electrolyte imbalance to be treated? If it is decided to treat the causes of the patient's dehydration or fluid/electrolyte imbalance or to intervene to correct or prevent a fluid deficit or electrolyte imbalance, proceed to Step 7.If the cause of the patient's dehydration is not clear, continue to look for that cause while providing appropriate support and symptomatic management. If it is decided not to treat or intervene because the patient has a terminal or end-stage condition or because the patient or family has requested no intervention, or for any other valid clinical reason, document the reasons for this decision in the patient's medical record. [oth, imbalance, cause, terminal, deficit, family, document, patient, intervene, patient, continue, record, patient, decision, clear, fluid, symptomatic, caus, treat, request, fluid, intervention, imbalance, stage, appropriate, patient, dehydration, prevent, fluid, treat, dehydration, intervene, patient, proce, valid, electrolyte, electrolyte, cause, patient, dehydration, provid, caus, decid, step, correct, look, treat, consequence, imbalance, reason, reason, end, electrolyte, step, thi, management, support, condition, clinical, medical, decid]
1267 Step 2 Is the patient at risk for dehydration or fluid/electrolyte imbalance? If the patient is not currently dehydrated and has either no fluid/electrolyte imbalance or a mild fluid/electrolyte imbalance, it is important to identify the risk for development or progression of these conditions. Caregivers should pay close attention to clinical conditions and environmental factors that may increase risk for dehydration or fluid/electrolyte imbalance . [electrolyte, fluid, currently, important, development, imbalance, progression, imbalance, patient, dehydrat, close, dehydration, environmental, mild, attention, fluid, risk, condition, risk, condition, imbalance, fluid, identify, imbalance, pay, electrolyte, risk, eith, electrolyte, caregiver, electrolyte, fluid, dehydration, increase, step, clinical, factor, patient]
292 Antibiotic therapy can be deferred for many asymptomatic patients, and for most cases of OME . [ome, patient, many, cas, defer, antibiotic, therapy, asymptomatic]
715 Distinguish between acute otitis media (AOM) and otitis media with effusion (OME) in making therapeutic decisions. [otiti, effusion, distinguish, media, ome, decision, media, therapeutic, between, aom, otiti, acute, mak]
1138 For isolated symptomatic episodes of AOM, the antibiotic of choice is amoxicillin (at a dose of 60 to 90 mg/kg/day, divided dosing twice a day [div b.i.d.] for 5 to 10 days). Treat AOM that is clinically unresponsive to amoxicillin after 72 hours of therapy with high-dose amoxicillin/clavulanate . Patients with persistent symptoms on high-dose amoxicillin/clavulanate should receive 1 to 3 doses of intramuscular (IM) ceftriaxone . [hour, intramuscular, isolat, aom, div, symptomatic, ceftriaxone, clavulanate, antibiotic, twice, patient, dose, therapy, divid, choice, aom, kg, symptom, amoxicillin, day, unresponsive, amoxicillin, high, episode, dose, amoxicillin, dose, dos, day, treat, persistent, dos, aft, clavulanate, mg, receive, clinically, day, im, amoxicillin, high]
40 Expand the delineation of disease manifestations, noninvasive tests, and the role of the liver biopsy, so that the application of current treatment practices may be refined. [role, refin, delineation, application, manifestation, noninvasive, test, treatment, expand, liv, practex, current, biopsy, disease]
463 Organize randomized controlled trials (RCTs) to extend treatment to special populations not represented in current clinical trials and to determine the applicability of accepted antiviral drug combinations to populations such as children and adolescents, and patients with acute hepatitis. Effective approaches are needed for drug users receiving drug treatment, alcohol abusers, prisoners, patients with stabilized depression, those with co-infection with human immunodeficiency virus, patients with decompensated cirrhosis, and HCV infections in transplant recipients. Such efforts should lead to decreased morbidity and mortality from the disease, as well as a decrease in the reservoir of disease. [receiv, cirrhosi, organize, infection, reservoir, depression, rct, population, accept, patient, effective, acute, stabiliz, drug, decompensat, treatment, morbidity, prisoner, those, decreas, viru, mortality, combination, drug, treatment, adolescent, such, population, such, well, patient, applicability, trial, immunodeficiency, hepatiti, special, abuser, patient, children, trial, hcv, represent, disease, randomiz, control, drug, human, antiviral, extend, decrease, current, transplant, need, effort, disease, lead, clinical, determine, user, recipient, alcohol, approach]
886 Develop reliable, reproducible, and efficient culture systems for propagating HCV and expand basic research in the pathogenic mechanisms underlying hepatic fibrosis. [propagat, develop, mechanism, reproducible, pathogenic, basic, efficient, hcv, reliable, hepatic, culture, underlie, expand, system, research, fibrosi]
41 The U.S. Preventive Services Task Force concludes that the evidence is insufficient to recommend for or against routine clinical breast examination (CBE) alone to screen for breast cancer. [evidence, breast, screen, clinical, conclude, insufficient, examination, cbe, against, task, routine, force, alone, breast, preventive, servex, recommend, cancer]
464 The U.S. Preventive Services Task Force recommends screening mammography, with or without clinical breast examination, every 1-2 years for women aged 40 and older. [breast, without, examination, recommend, woman, age, force, year, mammography, task, old, screen, clinical, preventive, servex]
887 The U.S. Preventive Services Task Force concludes that the evidence is insufficient to recommend for or against teaching or performing routine breast self-examination (BSE). [force, self, recommend, conclude, evidence, teach, perform, breast, preventive, insufficient, servex, examination, bse, task, routine, against]
42 Use either a transparent dressing or sterile gauze to cover the cannula site. [cov, cannula, dres, sterile, eith, site, transparent, use, gauze]
465 Discard multi-dose vials, when suspected or visible contamination occurs or when the manufacturerâ??s stated expiration date is due. [date, stat, due, manufacturerâ, expiration, suspect, occur, vial, contamination, discard, visible]
888 Cleanse the rubber diaphragm of multi-dose vials with 70% alcohol before inserting a device into the vial. [cleanse, insert, device, rub, diaphragm, before, vial, alcohol, vial]
68 School personnel involved in detection of head lice infestation should be appropriately trained. The importance and difficulty of correctly diagnosing an active head lice infestation should be acknowledged. Schools should examine any lice related policies they may have with this in mind. [mind, thi, head, lice, examine, detection, lice, acknowledg, involv, difficulty, policie, infestation, active, school, personnel, infestation, appropriately, train, importance, diagnos, lice, correctly, relat, head, school]
491 Head lice screening programs have not been proven to have a significant effect on the incidence of head lice in the school setting over time and are not cost-effective. Parent education programs may be helpful in the management of head lice in the school setting. [ove, set, head, lice, set, incidence, effective, significant, cost, helpful, head, effect, lice, proven, program, parent, screen, time, program, head, school, school, management, education, lice]
914 None of the currently available pediculicides are 100% ovicidal and resistance has been reported with lindane, pyrethrins, and permethrin. Treatment failure does not equate with resistance, and most instances of such failure represent misdiagnosis/misidentification or noncompliance with the treatment regimen. [none, equate, report, treatment, represent, noncompliance, regiman, misdiagnosi, available, treatment, resistance, failure, misidentification, ovicidal, doe, resistance, permethrin, such, instance, currently, pyrethrin, lindane, pediculicide, failure]
28 Transabdominal ultrasound may be used as a complementary examination if the uterus is significantly enlarged or a wider view of the pelvis or abdomen is required. Transabdominal ultrasound may also be used in the small proportion of women in whom it proves technically impossible to perform a transvaginal ultrasound. [woman, use, technically, prof, transabdominal, pelvi, significantly, proportion, uteru, examination, use, enlarg, perform, ultrasound, ultrasound, impossible, small, complementary, wid, requir, transvaginal, ultrasound, view, transabdominal, abdoman]
451 Hysteroscopy with biopsy is preferable as the first line of investigation in women taking tamoxifen who experience post-menopausal bleeding. [line, hysteroscopy, first, bleed, investigation, tamoxifen, biopsy, tak, preferable, woman, experience]
874 Clinicians should be aware of the background incidence of endometrial cancer among users and non-users of HRT and in those who present with post-menopausal bleeding (PMB). [pmb, endometrial, bleed, present, background, incidence, clinician, user, hrt, aware, those, cancer]
374 Keep the head of the patient's bed at or below a 30-degree angle. [keep, below, bed, head, degree, angle, patient]
797 If potential for improving mobility and activity status exists for particular patients, begin rehabilitation (i.e., range of motion exercises, encourage ambulation). Consider a Physical Therapy referral. [motion, potential, range, particular, patient, ambulation, exist, consid, improv, rehabilitation, mobility, statu, physical, referral, therapy, exercis, activity, encourage, begin]
1220 Minimize skin injury due to friction and shearing. Do not drag skin across linens when positioning or lifting up the patient in bed. Use lifting devices such as a trapeze, lifting sheet, or Hoyer lift. [patient, lift, lift, up, hoy, linen, lift, use, trapeze, acros, devex, injury, drag, bed, friction, skin, shear, sheet, skin, such, due, position, minimize, lift]
69 Buteyko Breathing Techniques may be helpful in reducing reliever use and improving quality of life, but this will involve a considerable cost to the patient. [thi, involve, life, improv, patient, quality, breath, cost, use, helpful, reduc, reliev, technique, considerable, buteyko]
492 Metered dose inhalers (MDIs) plus spacers are at least as effective as wet nebulisers in mild to moderate acute asthmatic episodes. [meter, plu, wet, mild, dose, asthmatic, inhaler, effective, mdi, spacer, acute, episode, moderate, nebuliser]
915 Long-acting beta2-agonists should not be used for the treatment of acute (or chronic) symptoms of asthma in the absence of inhaled anti-inflammatory therapy. [beta2, symptom, treatment, inhal, long, absence, asthma, use, therapy, agonist, chronic, acute, act]
296 GECS may be combined with pharmacological prophylaxis or intermittent pneumatic compression (IPC) in surgical patients, to increase efficacy in reducing the incidence of DVT. [compression, incidence, ipc, dvt, surgical, patient, prophylaxi, pharmacological, combin, increase, gec, intermittent, reduc, efficacy, pneumatic]
719 Early mobilisation and leg exercises should be encouraged in patients recently immobilised. [exercis, patient, mobilisation, immobilis, early, encourag, recently, leg]
1142 In patients undergoing major cardiothoracic surgery who are at significant risk of VTE, subcutaneous low-dose UFH or LMWH are recommended. Mechanical prophylaxis (GECS ± IPC) is an alternative. [alternative, ipc, low, cardiothoracic, significant, subcutaneou, ufh, dose, surgery, mechanical, risk, major, prophylaxi, patient, lmwh, gec, vte, undergo, recommend]
70 Use the bed only for sleeping (or sex). [use, sleep, bed, sex]
493 Management of medical conditions, psychological disorders and/or symptoms that interfere with sleep such as: depression, pain, hot flashes, anemia, or uremia. [anemia, interfere, psychological, uremia, symptom, sleep, such, medical, disorder, depression, hot, condition, management, pain, flash]
916 For patients with a current diagnosis of a sleep disorder, documentation and continuation of ongoing treatments, such as continuous positive airway pressure (CPAP), should be maintained and reinforced by patient and family education. [maintain, disord, airway, family, reinforc, sleep, patient, diagnosi, positive, treatment, ongo, documentation, patient, cpap, such, education, current, continuation, pressure, continuou]
318 Document the presence/absence of an indwelling urinary catheter. Determine appropriate indwelling catheter use: severely ill patients, patient with Stage III to IV pressure ulcers of the trunk, urinary retention unresolved by other interventions. [absence, cathet, ill, urinary, unresolv, presence, stage, severely, retention, indwel, urinary, patient, iv, trunk, determine, indwel, oth, document, patient, appropriate, ulcer, iii, pressure, cathet, use, intervention]
741 Teach pelvic muscle exercises to be used in conjunction with the above strategy. [muscle, use, teach, above, strategy, conjunction, exercis, pelvic]
1164 Modify environment to be conducive to maintaining independence with continence. [maintain, continence, modify, conducive, environment, independence]
347 Parameters of Assessment: Use the three group risk assessment tool (White, Karam & Cowell, 1994) to assess for skin tear risk. Use the Payne-Martin Classification system to classify skin tear: Category I- a skin tear without tissue loss Category II- a skin tear with partial tissue loss Category III- a skin tear with complete tissue loss, where the epidermal flap is absent. [category, asses, tear, skin, skin, tear, group, karam, skin, white, payne, skin, classify, tissue, three, use, risk, tissue, iii, tear, los, risk, tear, tear, system, skin, without, cowell, los, assessment, use, assessment, los, partial, tissue, parameter, category, classification, absent, complete, flap, tool, epidermal, category, martin, ii]
770 Parameters of Assessment: Assess for intrinsic and extrinsic risk factors Braden Scale-cutscore (at risk) 18 or below for elderly and persons with darkly pigmented skin 16 or below for other adults. [below, braden, darkly, person, elderly, below, extrinsic, assessment, parameter, asses, risk, cutscore, risk, oth, adult, scale, factor, skin, intrinsic, pigment]
1193 Follow-up Monitoring of Condition: Monitor effectiveness of prevention interventions Monitor healing of any existing pressure ulcers. [pressure, heal, monitor, ulcer, up, effectivenes, follow, exist, prevention, monitor, condition, monitor, intervention]
322 Regular review of medications for prevention of iatrogenesis. [medication, review, iatrogenesi, prevention, regular]
745 Provide consistent and appropriate care and follow-up in presence of a medication-related problem. [follow, care, consistent, medication, up, relat, problem, presence, provide, appropriate]
1168 Assess the older person for cognitive capacity and social support. [social, person, support, capacity, old, cognitive, asses]
71 Develop a nursing plan tailored to the patient's presenting problem(s) and risk factors. [tailor, factor, problem, risk, patient, plan, present, develop, nurs]
494 Identify patient characteristics and care problems that continue to be refractory and involve consultants (e.g., geriatric specialists, psychiatric-liaison specialists) in devising an expanded range of alternative approaches. [psychiatric, care, devis, continue, involve, refractory, problem, range, consultant, specialist, expand, approach, specialist, patient, alternative, liaison, geriatric, identify, characteristic]
917 Identify risk factors for falls and disruption of therapy (e.g., for fall risk, assess memory, balance, orthostatic blood pressure, vision and hearing, use of sedative-hypnotic drugs or narcotic agents). [use, balance, drug, risk, fall, pressure, disruption, fall, hear, hypnotic, asses, orthostatic, narcotic, memory, blood, agent, factor, vision, identify, risk, therapy, sedative]
420 The Discharge Planning Process:Discuss symptom management. [discus, proces, symptom, discharge, management, plan]
843 The Discharge Planning Process:Clarify activity level and ability, with a focus on safety and mobility. [plan, activity, ability, mobility, safety, discharge, clarify, focu, proces, level]
1266 Surveillance interventions (potential areas to address):Ensure adequate functional status before discharge or refer for appropriate home care needs. [before, discharge, addres, adequate, potential, functional, intervention, ensure, need, ref, area, appropriate, statu, home, care, surveillance]
43 Patients should be instructed in the correct use of glucose meters, including quality control. Comparison between SMBG and concurrent laboratory glucose analysis should be performed at regular intervals to evaluate the accuracy of patient results. [between, meter, instruct, glucose, includ, accuracy, use, perform, evaluate, result, concurrent, control, analysi, quality, interval, glucose, comparison, correct, smbg, laboratory, patient, regular, patient]
466 Blood ketone determinations that rely on the nitroprusside reaction should be used only as an adjunct to diagnose DKA and should not be used to monitor treatment of DKA. [monitor, use, blood, treatment, adjunct, rely, reaction, dka, nitroprusside, ketone, determination, use, dka, diagnose]
889 At a minimum, the end-points should be glycated hemoglobin (GHb) and frequency of hypoglycemic episodes. Ideally, outcomes (e.g., long-term complications and hypoglycemia) should also be examined. [point, hypoglycemic, examin, end, ghb, minimum, long, term, episode, outcome, hemoglobin, hypoglycemia, frequency, ideally, complication, glycat]
44 It is recommended that a thorough history and physical examination including a detailed neurologic examination and developmental assessment be performed in children presenting with an apparent first, unprovoked seizures. [developmental, examination, apparent, neurologic, unprovok, present, history, includ, assessment, perform, thorough, first, examination, physical, recommend, seizure, detail, children]
467 Neuroimaging Routine neuroimaging (magnetic resonance imaging [MRI]/computed tomography [CT]) is not recommended in children with first unprovoked seizures unless the history, physical exam, or neurologic and developmental assessment suggest focality or deterioration/delay, in which case an MRI is the procedure of choice. [mri, neuroimag, focality, case, exam, routine, children, choice, resonance, deterioration, first, procedure, imag, comput, neurologic, ct, unles, delay, mri, magnetic, assessment, neuroimag, developmental, recommend, history, seizure, physical, sug, tomography, unprovok]
890 Electroencephalogram (EEG) It is recommended that patients with an apparent first unprovoked seizure be considered for neurologic evaluation after consultation between the parents and treating physician. Neurologic consultation may be more beneficial in situations where the diagnosis is equivocal after a thorough history and physical or in cases of persistent parental anxiety. [apparent, recommend, neurologic, equivocal, unprovok, aft, aft, more, beneficial, history, anxiety, seizure, cas, parental, neurologic, physical, electroencephalogram, between, parent, consultation, persistent, patient, treat, eeg, physician, consultation, situation, thorough, first, consider, diagnosi, evaluation]
45 Parental choice regarding management of the delivery and subsequent care of the infant should be respected within the limits of medical feasibility and appropriateness [parental, subsequent, medical, management, regard, feasibility, respect, choice, appropriatenes, limit, infant, within, delivery, care]
468 Parents should receive appropriate information about maternal risks associated with delivery options, potential for infant survival, and risks of adverse long-term outcomes. [option, maternal, associat, potential, long, outcome, infant, appropriate, adverse, parent, term, survival, risk, receive, risk, information, delivery]
891 Physicians should become knowledgeable about contemporaneous local, referral center, and national comparative data regarding survival and long-term outcomes associated with extremely preterm birth. [contemporaneou, associat, birth, term, become, regard, preterm, comparative, outcome, data, physician, long, national, referral, cent, extremely, knowledgeable, local, survival]
200 As an alternative to conventional cervical cytology smears, cervical screening may be performed every two years using liquid-based cytology; at or after age 30, women who have had three consecutive, technically satisfactory normal/negative cytology results may be screened every two to three years (unless they have a history of in utero DES exposure, are HIV+, or are immunocompromised). [exposure, conventional, history, screen, three, liquid, two, cervical, normal, smear, woman, negative, use, three, cytology, two, age, bas, cytology, utero, alternative, technically, cytology, consecutive, satisfactory, screen, immunocompromis, unles, hiv, des, year, cervical, perform, aft, year, result]
623 Cervical cancer screening should begin approximately three years after the onset of vaginal intercourse. Screening should begin no later than 21 years of age. [intercourse, age, begin, begin, year, approximately, lat, onset, screen, cancer, year, screen, three, cervical, aft, vaginal]
1046 Screening with vaginal cytology tests following total hysterectomy (with removal of the cervix) for benign gynecologic disease is not indicated. Efforts should be made to confirm and/or document via physical exam and review of the pathology report (when available) that the hysterectomy was performed for benign reasons (the presence of cervical intraepithelial neoplasia (CIN) 2/3 is not considered benign) and that the cervix was completely removed. [benign, gynecologic, remov, total, hysterectomy, follow, cervix, hysterectomy, test, removal, completely, effort, review, cytology, cervix, reason, exam, confirm, intraepithelial, indicat, neoplasia, vaginal, perform, consider, disease, available, physical, document, made, pathology, benign, benign, presence, report, via, screen, cin, cervical]
46 The USPSTF concludes that the evidence is insufficient to recommend for or against the routine use of human papillomavirus (HPV) testing as a primary screening test for cervical cancer. [human, routine, cancer, against, screen, test, hpv, insufficient, evidence, cervical, use, papillomaviru, uspstf, test, conclude, primary, recommend]
469 The USPSTF concludes that the evidence is insufficient to recommend for or against the routine use of new technologies to screen for cervical cancer. [cervical, conclude, screen, new, uspstf, cancer, evidence, insufficient, routine, recommend, use, technologie, against]
892 The U.S. Preventive Services Task Force (USPSTF) strongly recommends screening for cervical cancer in women who have been sexually active and have a cervix. [active, uspstf, force, cervix, woman, servex, screen, recommend, cancer, sexually, strongly, cervical, task, preventive]
47 For patients with declining hemoglobin levels but less severe anemia (those with hemoglobin concentration < 12 g/dL but who never have fallen below 10 g/dL), the decision of whether to use epoetin immediately or to wait until hemoglobin levels fall closer to 10 g/dL should be determined by clinical circumstances. Red blood cell transfusion is also a therapeutic option when warranted by severe clinical conditions. [fall, transfusion, severe, therapeutic, hemoglobin, use, circumstance, determin, dl, epoetin, les, dl, fallen, decision, option, until, severe, red, wheth, level, blood, those, declin, nev, wait, hemoglobin, immediately, clinical, warrant, clos, patient, hemoglobin, cell, concentration, dl, condition, clinical, below, level, anemia]
470 Continuing epoetin treatment beyond 6-8 weeks in the absence of response (e.g., < 1-2 g/dL rise in hemoglobin level), assuming appropriate dose increase has been attempted in nonresponders, does not appear to be beneficial. Patients who do not respond should be investigated for underlying tumor progression or iron deficiency. As with other failed individual therapeutic trials, consideration should be given to discontinuing the medication. [fail, treatment, therapeutic, consideration, continu, appear, trial, doe, week, deficiency, nonresponder, attempt, level, discontinu, beneficial, patient, given, response, medication, hemoglobin, epoetin, assum, dose, individual, dl, tumor, increase, iron, oth, appropriate, underlie, absence, investigat, progression, rise, respond, beyond]
893 Hemoglobin levels can be raised to (or near) a concentration of 12 g/dL, at which time the dosage of epoetin should be titrated to maintain that level or restarted when the level falls to near 10 g/dL. Insufficient evidence to date supports the "normalization" of hemoglobin levels to above 12 g/dL. [time, near, near, hemoglobin, dl, fall, dl, date, support, level, above, level, hemoglobin, titrat, level, restart, insufficient, epoetin, concentration, maintain, level, normalization, dl, evidence, dosage, rais]
48 Pediatricians can work locally, nationally, and internationally to help change cultural norms conducive to eating disorders and proactively to change media messages. [message, internationally, change, cultural, change, pediatrician, proactively, norm, work, eat, help, media, conducive, disorder, nationally, locally]
471 Pediatricians should be aware of the careful balance that needs to be in place to decrease the growing prevalence of eating disorders in children and adolescents. [disorder, pediatrician, need, adolescent, careful, aware, decrease, children, balance, eat, prevalence, place, grow]
894 Pediatricians should be familiar with the screening and counseling guidelines for disordered eating and other related behaviors. [behavior, screen, guideline, pediatrician, familiar, counsel, eat, relat, oth, disorder]
49 If a patient has GFR <30 mL/min/1.73 m2, low-density lipoprotein (LDL) should be targeted to <100 mg/dL; non-high-density lipoprotein (HDL) cholesterol should be targeted to <130 mg/dL; and fasting triglycerides >500 mg/dL should be treated. [triglyceride, fast, treat, dl, mg, mg, dl, cholesterol, patient, ldl, target, lipoprotein, density, mg, hdl, gfr, min, ml, m2, target, low, dl, density, lipoprotein]
472 If a patient has GFR <30 mL/min/1.73 m2 and it has been determined that s/he will receive hemodialysis, veins suitable for placement of vascular access should be preserved . [hemodialysi, vascular, vein, patient, preserv, suitable, receive, ml, acces, m2, min, placement, determin, gfr]
895 If a patient has GFR <30 mL/min/1.73 m2 then his/her chronic metabolic acidosis should be corrected to a serum bicarbonate of >22 mmol/L . [ml, m2, correct, mmol, chronic, patient, bicarbonate, metabolic, min, gfr, acidosi, serum]
352 There is evidence from one randomized controlled trial demonstrating that continuous hyperfractionated accelerated radiation therapy (CHART) improves survival over standard radiotherapy of 60 Gy in 30 fractions, in patients with locally advanced, unresectable stage III non-small cell lung cancer (NSCLC). Selected patients (with Eastern Cooperative Oncology Group [ECOG] performance status > 1 who do not fit the criteria for induction chemotherapy and radiotherapy or patients who prefer radiotherapy only) may be considered for continuous hyperfractionated accelerated radiation therapy. [radiotherapy, therapy, criteria, patient, demonstrat, continuou, induction, radiation, accelerat, nsclc, patient, locally, cooperative, radiotherapy, continuou, statu, fraction, chemotherapy, group, cell, consider, fit, gy, performance, ove, oncology, therapy, trial, select, pref, hyperfractionat, lung, patient, unresectable, control, improf, stage, eastern, chart, radiotherapy, cancer, radiation, survival, evidence, hyperfractionat, ecog, standard, iii, accelerat, one, advanc, randomiz]
775 Of those trials designed to improve therapeutic ratios in patients with locally advanced, unresectable stage III non-small cell lung cancer there is insufficient data of high quality to recommend hyperfractionation over standard radiotherapy of 60 Gy in 30 fractions. Further randomized controlled trials are necessary to confirm the benefits, if any, of hyperfractionation radiotherapy. [recommend, control, confirm, standard, therapeutic, locally, fraction, trial, gy, hyperfractionation, high, advanc, quality, furth, data, randomiz, patient, lung, design, ove, improve, necessary, those, ratio, iii, cancer, hyperfractionation, unresectable, radiotherapy, trial, insufficient, radiotherapy, cell, benefit, stage]
1198 Evidence from a comparative cohort study suggests that hyperfractionated accelerated radiation therapy (HART) also improves survival over standard radiotherapy. [study, accelerat, hyperfractionat, cohort, standard, suggest, therapy, radiation, ove, hart, improf, radiotherapy, survival, comparative, evidence]
50 At present there is insufficient evidence to recommend gemcitabine combined with a taxane as first-line therapy for non-small cell lung cancer. [first, therapy, present, insufficient, cancer, taxane, cell, lung, line, gemcitabine, recommend, evidence, combin]
473 Cisplatin-gemcitabine can be recommended as one of several first-line chemotherapy regimen options for patients with locally advanced or metastatic non-small cell lung cancer. [cancer, option, gemcitabine, advanc, cisplatin, several, regiman, metastatic, patient, line, chemotherapy, locally, first, one, lung, cell, recommend]
896 There is insufficient evidence to recommend adding a third drug to a gemcitabine-platinum combination. [recommend, evidence, platinum, insufficient, combination, gemcitabine, drug, third, add]
51 Coordinate signing and sending sympathy card. [sympathy, sign, send, coordinate, card]
474 Prior to the death of the resident, the Bereavement Leader should provide information about end-of-life care services, and assistance in contacting these services. [life, prior, servex, bereavement, care, death, end, resident, assistance, servex, information, lead, contact, provide]
897 Organize and participate in the Memorial Service . [participate, organize, memorial, service]
201 In choosing the components for a clinically relevant vaccine, the physician should be familiar with local and regional aerobiology and indoor and outdoor allergens, paying special attention to potential allergens in the patient's own environment. [component, allergen, allergen, outdoor, paie, choos, regional, environment, attention, vaccine, relevant, physician, indoor, patient, potential, clinically, local, familiar, aerobiology, special]
624 Summary Statement 55. In older adults, medications and co-morbid medical conditions may increase the risk from immunotherapy. Therefore, special consideration must be given to the benefits and risks of immunotherapy in older adults. [statement, special, adult, given, consideration, therefore, old, immunotherapy, old, medication, increase, adult, risk, medical, risk, summary, condition, benefit, immunotherapy]
1047 The maintenance concentrate and serial dilutions, whether a single vaccine or a mixture of vaccines, should be prepared and labeled for each patient. [mixture, maintenance, serial, single, concentrate, each, wheth, prepar, vaccine, patient, vaccine, label, dilution]
52 Nutrition Screening A procedure for periodic nutrition rescreening should be implemented. [nutrition, periodic, screen, rescreen, procedure, nutrition, implement]
475 In the absence of an outcomes validated approach to nutrition assessment, a combination of clinical (history and physical exam) and biochemical parameters should be used to assess the presence of malnutrition. [history, validat, malnutrition, outcome, clinical, approach, combination, absence, biochemical, parameter, exam, physical, presence, assessment, asses, use, nutrition]
898 A formal nutrition assessment should be carried out in any patient, independent of the care setting, who is identified by a nutrition screen as nutritionally at risk. [independent, nutrition, identifi, nutritionally, out, screen, care, nutrition, patient, carri, risk, assessment, formal, set]
20 Specialized nutrition support (SNS) should be used in patients who cannot meet their nutrient requirements by oral intake. [patient, oral, use, nutrient, intake, requirement, sns, support, meet, nutrition, specializ]
443 When SNS is indicated, PN should be used when the gastrointestinal tract is not functional or cannot be accessed and in patients who cannot be adequately nourished by oral diets or EN. [use, en, patient, diet, gastrointestinal, indicat, sns, nourish, tract, oral, adequately, acces, pn, functional]
866 When SNS is required, enteral nutrition (EN) should generally be used in preference to parenteral nutrition (PN). [requir, parenteral, nutrition, use, pn, nutrition, sns, en, generally, preference, enteral]
53 Protein Requirements Histidine is a conditionally essential amino acid for neonates and infants up to 6 months of age and should be specifically supplemented. [conditionally, supplement, essential, acid, specifically, up, month, infant, requirement, neonate, protein, amino, age, histidine]
476 Fluid and Electrolytes Water and electrolyte requirements should be adjusted in pediatric patients undergoing surgical procedures or who have on-going losses from stomas or other sites. [patient, fluid, requirement, oth, stoma, electrolyte, goe, wat, electrolyte, procedure, adjust, site, loss, undergo, pediatric, surgical]
899 Carbohydrates For the neonate, carbohydrate delivery in PN should begin at approximately 6 to 8 mg/kg per minute of dextrose and be advanced, as tolerated to a goal of 10 to 14 mg/kg per minute. [delivery, advanc, pn, kg, per, carbohydrate, minute, goal, neonate, dextrose, begin, approximately, kg, mg, per, tolerat, carbohydrate, minute, mg]
54 Each parenteral nutrition formulation compounded should be inspected for signs of gross particulate contamination, discoloration, particulate formation, and phase separation at the time of compounding and before administration. [time, particulate, formulation, sign, gros, before, each, compound, discoloration, particulate, parenteral, compound, phase, nutrition, separation, contamination, inspect, formation, administration]
477 EN patients who develop diarrhea should be evaluated for antibiotic-associated causes, including Clostridium difficile. [difficile, antibiotic, evaluat, en, patient, includ, caus, diarrhea, develop, associat, clostridium]
900 In the absence of reliable information concerning compatibility of a specific drug with an SNS formula, the medication should be administered separately from the SNS . [concern, absence, administer, separately, specific, drug, reliable, information, sns, compatibility, medication, formula, sns]
35 Critical Illness Patients with critical illnesses are at nutrition risk and should undergo nutrition screening to identify those who require formal nutrition assessment with development of a nutrition care plan. [nutrition, those, illnes, screen, undergo, identify, nutrition, critical, assessment, illness, critical, formal, risk, nutrition, patient, care, require, plan, development, nutrition]
458 Pancreatitis PN should be used in patients with pancreatitis if SNS is indicated and EN is not tolerated. [pancreatiti, pancreatiti, indicat, use, tolerat, pn, patient, sns, en]
881 Critical Care Burns There is no current role for the routine use of specific nutrients and anabolic agents (e.g., arginine, glutamine, omega-3 fatty acids, vitamins, trace minerals, antioxidants, growth hormone oxandrolone, etc) in burn patients. [mineral, anabolic, etc, agent, trace, role, omega, hormone, burn, current, antioxidant, care, arginine, vitamin, growth, use, specific, glutamine, burn, nutrient, patient, fatty, oxandrolone, routine, acid, critical]
72 Infants and children with eating disorders should receive an oromotor assessment by an occupational therapist, speech therapist, nurse, or physician with training in pediatric oromotor dysfunction. [physician, nurse, therapist, speech, assessment, occupational, receive, eat, therapist, pediatric, infant, oromotor, disorder, children, dysfunction, oromotor, train]
495 Infants and children requiring tube feedings for eating disorders should receive the minimum supplemental support necessary to maintain growth and development. [eat, infant, feeding, requir, disorder, development, necessary, growth, tube, children, supplemental, support, receive, maintain, minimum]
918 Weight loss should not be a goal for the acutely ill, hospitalized obese child. [weight, los, ill, hospitaliz, obese, acutely, child, goal]
55 For individuals without symptoms or a history of cancer, the guideline developers recommend against the use of serial chest x-rays (CXRs) to screen for the presence of lung cancer. [cxr, history, developer, cancer, use, symptom, guideline, recommend, individual, serial, without, lung, presence, screen, against, che, cancer]
478 For individuals without either symptoms or a history of cancer, the guideline developers recommend against the use of single or serial sputum cytologic evaluation to screen for the presence of lung cancer. [single, lung, use, without, screen, eith, evaluation, developer, cancer, serial, symptom, cancer, against, individual, presence, sputum, cytologic, guideline, history, recommend]
901 For individuals without symptoms or a history of cancer, the guideline developers recommend against the use of a single low-dose computed tomography scan (LDCT) or serial LDCTs to screen for the presence of lung cancer. At-risk individuals who express an interest in undergoing low-dose computed tomography scan screening should be made aware of several ongoing high quality clinical studies of this technology. [ongo, comput, serial, symptom, lung, tomography, high, cancer, use, screen, tomography, cancer, low, history, dose, single, technology, risk, quality, ldct, scan, several, individual, without, against, undergo, individual, inter, thi, comput, developer, expres, aware, low, made, presence, clinical, scan, guideline, screen, studie, ldct, dose, recommend]
56 Diagnosis of Primary TumorIn patients with a central lesion who present with or without hemoptysis, sputum cytology (at least three specimens) is a reasonable first step (in centers with a formal program directed at the acquisition, handling, and interpretation of sputum samples) in the diagnostic workup. [step, acquisition, interpretation, direct, handl, without, lesion, specimen, tumorin, central, diagnosi, workup, center, three, reasonable, cytology, diagnostic, hemoptysi, present, first, formal, sample, sputum, primary, patient, program, sputum]
479 General Approach to Diagnosis A patient with a solitary peripheral lesion that is even moderately suspicious for lung cancer, who appears to have early-stage disease (i.e., negative findings on a chest computed tomography [CT] of the mediastinum) and is a surgical candidate, should undergo excisional biopsy and subsequent lobectomy if a resectable lung cancer is confirmed. [undergo, finding, che, mediastinum, solitary, patient, confirm, lung, diagnosi, negative, tomography, appear, ct, comput, cancer, early, cancer, approach, suspiciou, biopsy, candidate, subsequent, even, surgical, excisional, stage, peripheral, resectable, lobectomy, moderately, lesion, disease, lung, general]
902 Diagnosis of Primary Tumor Therefore, a nonspecific result on bronchoscopy of a peripheral lesion that is suspicious for lung cancer requires further testing to definitively rule out cancer. [definitively, nonspecific, therefore, require, primary, rule, lesion, lung, test, out, diagnosi, furth, cancer, cancer, tumor, bronchoscopy, peripheral, result, suspiciou]
57 In patients with a positron-emission tomography (PET) scan that is positive in the mediastinum, confirmation should be obtained by an invasive test that allows sampling of the PET-positive nodes with a high sensitivity and a low FN rate. In general, mediastinoscopy is likely to be the best test. [fn, sampl, tomography, patient, best, obtain, general, positive, emission, mediastinoscopy, positron, pet, mediastinum, allow, high, node, scan, confirmation, invasive, test, positive, pet, rate, test, sensitivity, low]
480 In patients who have extensive mediastinal infiltration with tumor (T4 involvement or involvement to the point of not being able to see discrete lymph nodes), the primary goal of an invasive procedure is to provide confirmation of the diagnosis. (The radiographic staging of mediastinal node involvement is compelling.) For these patients, transthoracic needle aspiration (TTNA) and endoscopic ultrasound-guided needle aspiration (EUS-NA) are procedures of choice based on high sensitivity (approximately 90%) and low morbidity (outpatient procedure). [goal, na, patient, tumor, procedure, infiltration, node, endoscopic, needle, invasive, guid, aspiration, involvement, ttna, mediastinal, approximately, point, needle, extensive, ultrasound, choice, transthoracic, high, primary, morbidity, sensitivity, provide, see, procedure, stag, procedure, outpatient, discrete, compel, confirmation, involvement, lymph, radiographic, t4, bas, eus, mediastinal, low, aspiration, involvement, patient, node, bee]
903 In patients suspected of having non-small cell lung cancer, who have no evidence of distant metastases, and who have normal mediastinal nodes by CT, but in whom invasive staging of the mediastinum is recommended (because of a high FN rate of CT), mediastinoscopy is the invasive procedure of choice to rule out mediastinal node involvement. This recommendation is based on the ability of mediastinoscopy to stage most of the commonly involved mediastinal node stations with a low FN rate (approximately 10%) and low morbidity (2%; outpatient procedure). For these patients, TBNA, TTNA, and EUS-NA are not recommended because of a high FN rate(approximately 10%) and low morbidity (2%; outpatient procedure). For the subset of these patients who have a left upper lobe cancer, the Chamberlain procedure, extended cervical mediastinoscopy, or thoracoscopy should be additionally performed to evaluate the aortopulmonary window nodes. [station, invasive, fn, tbna, normal, evidence, high, mediastinoscopy, node, additionally, ttna, approximately, ct, perform, cancer, high, mediastinoscopy, distant, stag, procedure, chamberlain, thoracoscopy, na, choice, invasive, aortopulmonary, node, recommend, ct, extend, procedure, low, approximately, mediastinum, rate, fn, cancer, upp, involv, commonly, suspect, low, cell, hav, lobe, ability, patient, subset, patient, stage, node, procedure, metastas, cervical, thi, outpatient, outpatient, procedure, eus, morbidity, fn, window, morbidity, rule, mediastinoscopy, mediastinal, involvement, node, recommendation, recommend, low, patient, out, lung, left, bas, mediastinal, rate, rate, mediastinal, evaluate]
58 All patients undergoing resection for stage I NSCLC (IA and IB) should have intraoperative systematic surgical mediastinal lymph node evaluation for accurate pathologic staging. [surgical, accurate, lymph, ib, node, mediastinal, undergo, ia, evaluation, pathologic, systematic, resection, stag, stage, intraoperative, patient, nsclc]
481 Patients with stage I NSCLC deemed medically unable to tolerate operative intervention or refusing surgical resection and having no medical contraindication to radiation therapy should receive this modality as definitive treatment. [operative, modality, resection, patient, medically, definitive, tolerate, refus, medical, radiation, thi, intervention, treatment, contraindication, stage, surgical, unable, nsclc, therapy, receive, deem, hav]
904 11.Patients with positive resection margins should be evaluated for additional local treatment modalities (surgical re-resection or radiation therapy). [surgical, evaluat, resection, treatment, positive, modalitie, margin, therapy, radiation, local, additional, patient]
59 Patients with stage IIIA (N2) lung cancer identified preoperatively have a relatively poor prognosis when treated with surgery as a single modality. Several small trials of induction chemotherapy have yielded conflicting results about its effect on survival. The relative roles of surgery and radiation therapy as the local treatment modality are also not clearly defined. Definitive treatment recommendations are difficult to make in this setting. Therefore, patients in this subset should be referred for multidisciplinary evaluation before embarking on definitive treatment. [cancer, definitive, stage, radiation, refer, preoperatively, recommendation, several, subset, modality, survival, evaluation, yield, treatment, prognosi, patient, single, embark, difficult, definitive, modality, small, induction, before, thi, conflict, make, chemotherapy, lung, treatment, role, patient, clearly, defin, set, relative, surgery, therapy, iiia, multidisciplinary, result, surgery, treatment, identifi, treat, thi, effect, n2, poor, relatively, therefore, trial, local]
482 In the patient with fully resected stage IIIA lung cancer, adjuvant chemotherapy administered alone might offer a very modest survival advantage, but this modality should not be routinely utilized outside of a clinical trial. [alone, lung, clinical, modality, fully, advantage, cancer, thi, very, mod, adjuvant, stage, chemotherapy, outside, routinely, administer, patient, survival, utiliz, resect, iiia, trial]
905 Bimodality or trimodality therapy is better than surgery alone for locally advanced stage IIIA lung cancer. [stage, locally, bet, trimodality, therapy, surgery, lung, advanc, bimodality, alone, iiia, cancer]
73 Patients with good PS (i.e., ECOG level 0 or 1) should be considered for a platinum-based chemotherapy regimen based on the survival advantage provided over best supportive care (BSC). [bsc, regiman, ps, supportive, care, chemotherapy, ove, good, level, bas, provid, best, patient, survival, bas, platinum, consider, ecog, advantage]
496 Combination platinum-based chemotherapy can be administered safely and with acceptable and manageable toxicity profiles in patients with good PS who have stage IV NSCLC. [ps, platinum, acceptable, chemotherapy, manageable, safely, nsclc, administer, profile, combination, patient, iv, bas, good, toxicity, stage]
919 When selecting patients for systemic chemotherapy, performance status (PS) at the time of diagnosis should be used because it is a consistent prognostic factor for survival. Patients with a PS of Eastern Cooperative Oncology Group (ECOG) 0 or 1 should be offered chemotherapy. Data are not yet sufficient to routinely recommend chemotherapy to patients with a PS of ECOG level 2 . Patients with a PS of ECOG level 3 or 4 should not receive chemotherapy. [consistent, chemotherapy, diagnosi, offer, chemotherapy, sufficient, use, ps, ecog, patient, statu, data, factor, select, patient, patient, chemotherapy, group, ps, ecog, prognostic, patient, ps, systemic, routinely, performance, eastern, level, survival, cooperative, level, chemotherapy, time, receive, recommend, ecog, oncology, ps]
74 Treatment of Extensive-Stage SCL First-Line Treatment Patients achieving a complete remission (CR) should be offered prophylactic cranial irradiation (PCI). [treatment, patient, first, pci, offer, irradiation, scl, complete, prophylactic, extensive, treatment, line, achiev, cr, remission, stage, cranial]
497 Elderly patients with good performance status and with intact organ function should be treated with platinum-based chemotherapy. [statu, function, patient, platinum, good, elderly, treat, performance, organ, intact, chemotherapy, bas]
920 Staging of Small SCLC For the routine staging of patients with SCLC, positron emission tomography (PET) scanning is not recommended outside of a clinical trial. [small, stag, scan, outside, sclc, clinical, routine, emission, sclc, recommend, positron, stag, trial, pet, patient, tomography]
75 Patients with symptomatic brain metastases should be treated with dexamethasone, 16 mg/d, for 4 weeks during the course of whole-brain radiation therapy (WBRT); dexamethasone should then be rapidly tapered and discontinued. [taper, dexamethasone, discontinu, metastas, treat, patient, week, therapy, brain, wbrt, symptomatic, brain, radiation, course, dur, mg, whole, rapidly, dexamethasone]
498 In patients who do not respond to external beam radiation for the relief of pain caused by bony metastases, bisphosphonates can be administered alone or as an adjunct to external radiation therapy for bone metastases. [external, beam, radiation, bisphosphonate, adjunct, alone, radiation, patient, metastas, respond, caus, external, pain, relief, bony, therapy, metastas, bone, administer]
921 For patients with bone metastases, external radiation therapy is indicated to control localized pain. Higher fractionated doses of external radiation therapy provide the most predictable and longer-lasting pain relief for bone metastases. [predictable, external, patient, last, fractionat, bone, therapy, pain, radiation, provide, pain, therapy, relief, control, bone, radiation, long, high, dos, metastas, indicat, localiz, metastas, external]
76 Patients with lung cancer should have clear understandable information about their diagnosis, treatment, and possible outcomes. Patients and their families should be offered clear, full, prompt, and culturally appropriate information, preferably in both verbal and written form. [clear, outcome, patient, full, information, cancer, understandable, patient, information, form, treatment, familie, appropriate, offer, written, possible, clear, verbal, culturally, prompt, both, diagnosi, preferably, lung]
499 Ongoing Care For patients with lung cancer in whom death or a significant change in clinical status occurs, the primary care physician and all management team members should be advised. Likewise, the primary care physician should notify the management team and all interested parties if a change in clinical status of the patient should occur at home. [likewise, cancer, change, patient, primary, care, change, death, patient, physician, clinical, team, notify, statu, team, statu, partie, home, care, physician, management, primary, care, lung, occur, ongo, advis, occur, member, interest, management, significant, clinical]
922 All patients with known or suspected lung cancer should be referred to a multidisciplinary team of physicians or a physician with experience in the management of lung cancer. [physician, lung, refer, management, team, suspect, multidisciplinary, known, cancer, lung, experience, patient, physician, cancer]
21 Healthcare professionals should have an increased awareness of the possibility of the presence of otitis media with effusion in asymptomatic children. [presence, healthcare, children, otiti, effusion, media, possibility, increas, asymptomatic, awarenes, professional]
444 Parents of children with otitis media with effusion should be advised to refrain from smoking. [otiti, parent, refrain, children, smok, media, advis, effusion]
867 Children with otitis media with effusion should not be treated with antibiotics. [effusion, media, otiti, treat, antibiotic, children]
77 Offer screening with FOBT every year combined with flexible sigmoidoscopy every 5 years. When both tests are performed, the FOBT should be done first. [test, combin, flexible, fobt, year, both, perform, done, fobt, year, screen, first, sigmoidoscopy]
500 Screening People at Increased Risk People with a first-degree relative with colon cancer or adenomatous polyp diagnosed at age >60 years or 2 second-degree relatives with colorectal cancer should be advised to be screened as average risk persons, but beginning at age 40 years. [year, colon, age, diagnos, relative, risk, increas, advis, people, second, year, degree, polyp, screen, adenomatou, risk, cancer, people, screen, begin, first, degree, cancer, colorectal, person, age, average, relatif]
923 Surveillance with colonoscopy should be considered for patients who are at increased risk because they have been treated for colorectal cancer, have an adenomatous polyp diagnosed, or have a disease that predisposes them to colorectal cancer, such as inflammatory bowel disease. [cancer, diagnos, colonoscopy, colorectal, cancer, disease, treat, disease, bowel, inflammatory, adenomatou, risk, increas, such, surveillance, consider, predispos, colorectal, patient, polyp]
392 Fire hoses are sometimes found in hallways and stairwells of older facilities. Water from hoses is not sterile. The water can also create an electric shock hazard. In addition, the water stream itself can deliver sufficient force to cause injury or mechanical damage and can make the hose difficult to hold onto. The guideline developers do not recommend the uses of fire hoses to extinguish surgical fires. [sufficient, electric, itself, hazard, deliv, hos, mechanical, create, cause, developer, fire, stairwell, injury, wat, stream, hold, hos, make, wat, extinguish, damage, force, hallway, recommend, sterile, difficult, hos, fire, facilitie, sometime, old, guideline, wat, surgical, hose, found, onto, addition, use, shock, fire]
815 Fire Drills: Fire drills not only allow staff to practice for a fire but also help troubleshoot any difficulties that might occur. Some elements to consider in planning a fire drill are: The proper response of each surgical team member and the operating suite staff. How the patient can easily and safely be moved to another OR How the spread of smoke should be prevented (for example, through the use of smoke doors and air duct dampers). The location and operation of fire extinguishers, fire alarm pull stations, and exits. What the response of additional fire-fighting personnel (such as the fire response team and local fire department) should be. [staff, fire, department, local, prop, drill, response, station, memb, troubleshoot, element, through, operation, practice, damper, exit, such, help, fire, additional, fire, drill, easily, door, each, consid, team, fire, fight, fire, response, mov, drill, operat, alarm, pull, suite, safely, personnel, prevent, patient, fire, extinguisher, occur, allow, spread, air, plan, duct, staff, use, smoke, smoke, location, fire, team, difficultie, surgical, anoth, response, example, fire, fire]
1238 If Evacuation is Necessary: In some very rare cases, extreme smoke and fire conditions may force the evacuation of the OR where the fire occurs. In such cases, the acronym RACE defines the actions that should take place: rescue the patient if possible, alert staff in nearby ORs and activate fire alarm systems, confine the smoke and fire by shutting all doors and closing off gas, vacuum, and power systems, and evacuate the OR and, if necessary, the surgical suite. [alert, fire, rescue, fire, acronym, force, necessary, condition, suite, pow, vacuum, possible, race, alarm, action, cas, gas, cas, rare, very, patient, take, place, shut, evacuation, evacuate, define, smoke, nearby, surgical, fire, door, occur, fire, evacuation, necessary, staff, smoke, extreme, such, system, confine, clos, activate, ors, system]
78 Opioids should be used for patients with OA or RA when other medications and nonpharmacologic interventions produce inadequate pain relief and the patientâ??s quality of life is affected by the pain. Morphine, oxycodone, hydrocodone, or other mu agonist opioids, as a single agent or combined with an NSAID or with acetaminophen, should be used for moderate to severe OA or RA pain that has not responded to other treatments. The use of codeine and propoxyphene should be avoided because of their side effects and limited analgesic effectiveness. [use, pain, pain, limit, oth, quality, opioid, analgesic, opioid, hydrocodone, agent, effect, nsaid, oa, inadequate, agonist, affect, side, effectivenes, treatment, nonpharmacologic, ra, relief, severe, acetaminophen, patient, intervention, use, medication, propoxyphene, oa, patientâ, combin, ra, moderate, produce, single, morphine, pain, use, mu, oxycodone, codeine, life, respond, oth, avoid, oth]
501 For optimal functional results, people with disabling arthritis should be referred for surgical care prior to the onset of joint contracture, severe deformity, and advanced muscular wasting and deconditioning rather than as a last resort. [disabl, severe, arthriti, joint, last, muscular, people, surgical, resort, contracture, care, prior, rath, result, decondition, deformity, wast, refer, functional, onset, optimal, advanc]
924 Whenever conscious or deep sedation is required to perform any procedure, the guidelines developed by the American Academy of Pediatrics for patient monitoring and resuscitative equipment should be followed. [pediatric, guideline, academy, american, whenev, procedure, monitor, patient, equipment, perform, deep, resuscitative, consciou, follow, develop, requir, sedation]
387 Interpretation of Serum Human Chorionic Gonadotropin (hCG) Levels:Arrange follow-up for patients with a nondiagnostic transvaginal ultrasound and a serum hCG level above 2,000 mIU/mL because they have an increased likelihood of ectopic pregnancy. [ultrasound, ectopic, follow, nondiagnostic, miu, interpretation, pregnancy, increas, patient, up, level, ml, arrange, serum, transvaginal, above, human, hcg, gonadotropin, level, serum, hcg, likelihood, chorionic]
810 Methotrexate in Ectopic Pregnancy:Because the symptoms associated with gastrointestinal side effects of methotrexate therapy may mimic an acute ectopic rupture, rule out ectopic rupture resulting from treatment failure before attributing gastrointestinal symptoms to methotrexate toxicity. [ectopic, rupture, methotrexate, pregnancy, symptom, rupture, methotrexate, symptom, treatment, rule, failure, gastrointestinal, gastrointestinal, therapy, toxicity, effect, result, acute, ectopic, associat, out, attribut, mimic, methotrexate, before, side, ectopic]
1233 Interpretation of Serum Human Chorionic Gonadotropin (hCG) Levels:Consider transvaginal ultrasound because it may detect ectopic pregnancy when the serum hCG level is below 1,000 mIU/mL. [transvaginal, pregnancy, hcg, ml, human, miu, consid, serum, gonadotropin, ultrasound, below, chorionic, serum, hcg, detect, interpretation, ectopic, level, level]
137 Perform a renal ultrasound (or repeat the ultrasound if it was done prenatally). If the patient is found to have an abnormality of the urinary tract, continue monitoring for urinary tract infections and renal function. [patient, renal, abnormality, perform, urinary, urinary, found, repeat, ultrasound, prenatally, infection, done, renal, tract, tract, continue, monitor, ultrasound, function]
560 Continue to evaluate the child's renal status (urinalysis and culture, as indicated) if a renal anomaly is present. [present, continue, urinalysi, statu, renal, anomaly, culture, renal, child, indicat, evaluate]
983 Check the adolescent annually for scoliosis and kyphosis. [annually, check, adolescent, kyphosi, scoliosi]
79 All patients should receive education on the importance of lifestyle changes (e.g., engaging in regular weight-bearing exercise, quitting smoking, avoiding excessive alcohol intake), as well as vitamin D and calcium supplementation. [exercise, supplementation, patient, receive, alcohol, weight, regular, engag, excessive, bear, avoid, calcium, vitamin, smok, quitt, education, change, well, lifestyle, intake, importance]
502 A selective estrogen receptor modulator (SERM) has been approved by the FDA for the prevention and treatment of osteoporosis in menopausal women. A bone disease specialist should participate in the decision to choose a SERM in patients with GI diseases. [treatment, serm, osteoporosi, estrogen, participate, choose, gi, menopausal, patient, diseas, woman, receptor, prevention, fda, serm, bone, decision, selective, approv, modulator, specialist, disease]
925 Corticosteroid dosing in IBD should be kept to a minimum, and other immunomodulatory agents should be considered to help withdraw patients from corticosteroids once corticosteroid dependence becomes evident. [corticosteroid, patient, corticosteroid, oth, immunomodulatory, ibd, kept, once, help, dependence, minimum, become, dos, corticosteroid, agent, consider, evident, withdraw]
80 Practice settings need a policy with respect to providing and requesting advance notice when transferring or admitting clients between practice settings when special resources (e.g., surfaces) are required. [resource, requir, transfer, setting, between, special, nee, advance, respect, setting, policy, practice, surface, request, provid, practice, notice, admit, client]
503 Reassess ulcers at least weekly to determine the adequacy of the treatment plan. [ulcer, reasses, adequacy, treatment, determine, plan, weekly]
926 Medical management may include initiating a two-week trial of topical antibiotics for clean pressure ulcers that are not healing or are continuing to produce exudate after two to four weeks of optimal patient care. The antibiotic should be effective against gram-negative, gram-positive and anaerobic organisms. [trial, continu, week, patient, include, two, topical, management, pressure, ulcer, gram, anaerobic, antibiotic, gram, produce, exudate, organism, medical, negative, four, initiat, aft, optimal, heal, clean, effective, care, against, antibiotic, two, week, positive]
197 GH treatment is indicated in children with documented GHD for correction of hypoglycemia and for induction of normal statural growth. [indicat, document, children, ghd, gh, statural, induction, correction, hypoglycemia, growth, normal, treatment]
620 GH treatment is indicated for girls with Turner syndrome. [turn, syndrome, treatment, gh, indicat, girl]
1043 GH therapy is best accomplished under the direct supervision of a clinical endocrinologist. Short-term GH treatment is safe in both children and adults. Continued monitoring of side effects and long-term treatment results is needed. [long, therapy, side, need, adult, continu, short, both, supervision, direct, effect, monitor, term, result, gh, treatment, endocrinologist, children, best, clinical, term, treatment, und, gh, accomplish, safe]
81 Parents should be advised that home cardiorespiratory monitoring has not been proven to prevent sudden unexpected deaths in infants. [unexpect, cardiorespiratory, home, parent, infant, proven, advis, sudden, monitor, death, prevent]
504 Home cardiorespiratory monitoring may be warranted for premature infants who are at high risk of recurrent episodes of apnea, bradycardia, and hypoxemia after hospital discharge. The use of home cardiorespiratory monitoring in this population should be limited to approximately 43 weeks postmenstrual age or after the cessation of extreme episodes, whichever comes last. [recurrent, postmenstrual, cessation, aft, limit, use, hospital, high, monitor, come, infant, cardiorespiratory, population, approximately, bradycardia, last, hypoxemia, extreme, thi, home, episode, home, aft, risk, warrant, discharge, whichev, episode, week, apnea, premature, age, monitor, cardiorespiratory]
927 Home cardiorespiratory monitoring should not be prescribed to prevent sudden infant death syndrome (SIDS). [infant, cardiorespiratory, prescrib, home, monitor, sid, syndrome, prevent, death, sudden]
210 Treat or Prevent All Comorbid Conditions. [treat, condition, comorbid, prevent]
633 Provide Routine Education on Patient Self-Management. [management, self, education, patient, provide, routine]
1056 Assess for Referral to Specialty Care. [care, asses, referral, specialty]
390 Minimally invasive therapies: Transurethral microwave heat treatment:Be careful not to oversedate the patient. As patient perception of pain is an important safety mechanism to ensure that the heating of the tissue is not excessive. General or spinal anesthesia should not be used. [patient, ensure, heat, therapie, mechanism, excessive, microwave, treatment, tissue, important, spinal, anesthesia, careful, patient, heat, safety, oversedate, perception, use, general, invasive, transurethral, pain, minimally]
813 Surgery:The patient may appropriately select surgical treatment as his initial treatment if he has bothersome symptoms. [surgical, surgery, patient, select, treatment, treatment, appropriately, bothersome, symptom, initial]
1236 Surgery:The choices of surgical approach (open or endoscopic and energy source--electrocautery versus laser) are technical decisions based on the patient's prostate size, the individual surgeon's judgment, and the patient's comorbidities. [comorbiditie, surgical, individual, size, technical, judgment, decision, surgery, electrocautery, approach, las, prostate, surgeon, patient, bas, patient, endoscopic, energy, open, versu, source, choex]
380 Women at Average Risk:Begin mammography at age 40. [begin, average, age, risk, mammography, woman]
803 Women at Average Risk: For women in their 20s and 30s, it is recommended that clinical breast examination (CBE) be part of a periodic health examination, preferably at least every three years. Asymptomatic women aged 40 and over should continue to receive a clinical breast examination as part of a periodic health examination, preferably annually. [receive, annually, risk, examination, woman, 30s, health, preferably, part, health, breast, three, clinical, cbe, clinical, periodic, age, year, ove, recommend, examination, examination, examination, asymptomatic, continue, breast, part, woman, 20s, woman, periodic, average, preferably]
1226 Women at Average Risk:Beginning in their 20s, women should be told about the benefits and limitations of breast self-examination (BSE). [average, told, woman, risk, self, breast, limitation, bse, examination, woman, begin, 20s, benefit]
83 To reduce the incidence and mortality rate of cervix cancer, effective screening and preventive strategy must be actively pursued, in addition to early detection of disease and effective therapy . [reduce, detection, strategy, pursu, cancer, preventive, addition, rate, early, mortality, cervix, screen, disease, incidence, therapy, effective, actively, effective]
506 Ovarian conservation should be considered for young patients. [consider, ovarian, yoing, patient, conservation]
929 The addition of post-operative treatment using a combination of chemotherapy and radiotherapy has been shown to improve survival outcome for patients with tumour involvement of pelvic lymph nodes, resection margins, and/or parametrial tissue. [node, involvement, survival, chemotherapy, pelvic, addition, outcome, treatment, tissue, parametrial, lymph, improve, use, shown, radiotherapy, patient, margin, tumour, combination, resection]
84 Serological screening for hepatitis B surface (HBs) antigen and antibody (HBs Ag, anti-HBs IgG) should be done within 6 months pre-vaccination for all, except newborns. Hepatitis B vaccinations, except for newborns, should be given at months 0, 1, and 6, and anti-HBs IgG should be checked within 3 months after the booster dose at month 6. For newborns, vaccinations are given at months 0, 1, and 5. Newborns of hepatitis B virusâ??infected mothers who are hepatitis B e antigen (HBeAg) positive should also be given hepatitis B immunoglobulin at birth. [month, infect, screen, hbs, igg, boost, newborn, serological, given, aft, within, hepatiti, newborn, except, vaccination, surface, given, within, month, hbs, igg, done, month, hbeag, newborn, newborn, given, dose, antigen, birth, virusâ, vaccination, hepatiti, month, antibody, hepatiti, immunoglobulin, month, except, mother, positive, chec, antigen, ag, hepatiti, hepatiti]
507 Patients should be told of the risks of hepatocellular carcinoma (HCC) associated with chronic hepatitis B infection and offered the option of hepatocellular carcinoma surveillance. For patients who are agreeable to surveillance, ultrasonography and serum alpha-fetoprotein should be done at regular intervals. Ultrasonography should be done at 6- and 12-monthly intervals for cirrhotic and non-cirrhotic patients, respectively. Patients' blood should be sampled for alpha-fetoprotein every 3 to 6 months and 6 to 12 months for cirrhotic and non-cirrhotic patients, respectively. [cirrhotic, respectively, patient, told, interval, agreeable, alpha, hepatocellular, interval, hepatiti, month, respectively, patient, done, regular, ultrasonography, carcinoma, associat, option, patient, carcinoma, serum, alpha, fetoprotein, done, hepatocellular, month, chronic, patient, infection, surveillance, fetoprotein, cirrhotic, monthly, ultrasonography, risk, sampl, hcc, patient, blood, offer, surveillance]
930 Patients with normal serum alanine transaminase (ALT) levels should have 6-monthly outpatient follow-up visits with repeat serum ALT done at each visit. Patients with elevated serum ALT levels should have more frequent follow-up visits, with repeat liver function tests carried out based on the physician-in-charge's discretion. [repeat, serum, level, alt, transaminase, function, up, each, charge, serum, serum, physician, monthly, follow, elevat, out, patient, test, alanine, more, visit, follow, normal, done, level, frequent, visit, bas, alt, visit, repeat, outpatient, liv, patient, up, discretion, alt, carri]
24 All patients with acute stroke should undergo brain scanning (computed tomography [CT] or magnetic resonance imaging [MRI]) as soon as possible preferably within 24 hours (GPP). A local protocol for more urgent scans should be made available. [resonance, acute, possible, imag, scan, comput, undergo, made, protocol, tomography, gpp, urgent, magnetic, ct, more, local, within, mri, available, soon, preferably, stroke, scan, hour, patient, brain]