| quintgram | freq | conditional |
|---|---|---|
| account individual'advocate carer should consulted | 2 | in all situations where informed discussion and consent is not possible advance directives should be taken fully into account and the individual's advocate and/or carer should be consulted. in all situations where informed discussion is not possible advance directives should be taken fully into account and the individual's advocate and/or carer should be consulted when appropriate. |
| activity part properly designed controlled | 2 | recommendation :practitioners, policy makers, and commissioners should only endorse exercise referral schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness .individuals should only be referred to schemes that are part of such a study. recommendation: practitioners, policy makers, and commissioners should only endorse pedometers and walking and cycling schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness . measures should include intermediate outcomes such as knowledge, attitude, and skills, as well as measures of physical activity levels. |
| acute myocardial infarction presenting in | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| administered hours before surgery continued | 2 | alternatives for thromboprophylaxis for moderate-risk* patients undergoing gynecologic surgery include the following: thigh-high graduated compression stockings placed intraoperatively and continued until the patient is fully ambulatory pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 2 hours before surgery and continued postoperatively every 8 hours until discharge. low-molecular-weight heparin (dalteparin, 2,500 antifactor-xa u, or enoxaparin, 40 mg) administered 12 hours before surgery and once a day postoperatively until discharge. alternatives for prophylaxis for high-risk* patients undergoing gynecologic surgery, especially for malignancy, include: pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 8 hours before surgery and continued postoperatively until discharge. dalteparin (5,000 antifactor-xa u) administered 12 hours before surgery and then once a day thereafter. enoxaparin (40 mg) administered 12 hours before surgery and then once a day thereafter. |
| adrenal mass ultrasonography scan scan | 2 | staging distant metastatic disease:2003 recommendations:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. staging distant metastatic disease:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. |
| advance directives should taken fully | 2 | in all situations where informed discussion and consent is not possible advance directives should be taken fully into account and the individual's advocate and/or carer should be consulted. in all situations where informed discussion is not possible advance directives should be taken fully into account and the individual's advocate and/or carer should be consulted when appropriate. |
| advanced anthracyclinesensitive cancer m continued | 2 | the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose epirubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician. there are no data indicating the optimal cumulative dose of epirubicin at which dexrazoxane should be instituted. for doxorubicin, use of dexrazoxane is recommended after the cumulative dose reaches 300 mg/m2 (i.e., 55% of the recommended maximum). a similar formula could be used for epirubicin; that is, institution of dexrazoxane when the cumulative dose of epirubicin reaches 550 mg/m2, as the recommended maximum cumulative dose in canada is 1,000 mg/m2. the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose doxorubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician, and who have received 300 mg/m2 or more of doxorubicin. |
| advanced lung cancer staging locoregional | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| advanced small cell lung cancer | 2 | the combination of paclitaxel (taxol®) or docetaxel (taxotere®) with cisplatin can be recommended as one of a number of chemotherapy options in the first-line therapy of patients with advanced non-small cell lung cancer and a good performance status. gefitinib monotherapy, if available, may be considered as a second-line and subsequent treatment option for selected symptomatic patients with advanced non-small cell lung cancer who are not candidates for chemotherapy and for whom erlotinib is not available. |
| advanced unresectable stage small cell | 2 | 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. 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. |
| adverse event after undergoing previous | 2 | people for whom liver biopsy poses a substantial risk (such as those with haemophilia, or those who have experienced an adverse event after undergoing a previous liver biopsy), and people with symptoms of extra-hepatic hcv infection sufficient to impair quality of life, may be treated on clinical grounds without prior histological classification. peope for whom liver biopsy poses a substantial risk(such as those with haemophilia,or those who have experienced an adverse event after undergoing a previous liver biopsy) and people with symptoms of extra hepatic hcv infection sufficient to impair quality of life,may be treated on clinical grounds without prior histological classification. |
| after undergoing previous liver biopsy | 2 | people for whom liver biopsy poses a substantial risk (such as those with haemophilia, or those who have experienced an adverse event after undergoing a previous liver biopsy), and people with symptoms of extra-hepatic hcv infection sufficient to impair quality of life, may be treated on clinical grounds without prior histological classification. peope for whom liver biopsy poses a substantial risk(such as those with haemophilia,or those who have experienced an adverse event after undergoing a previous liver biopsy) and people with symptoms of extra hepatic hcv infection sufficient to impair quality of life,may be treated on clinical grounds without prior histological classification. |
| against routine screening elevated blood | 3 | the uspstf recommends against routine screening for elevated blood lead levels in asymptomatic children aged 1 to 5 years who are at average risk . the uspstf recommends against routine screening for elevated blood lead levels in asymptomatic pregnant women. 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. |
| against tetanus diphtheria pertussis they | 2 | 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. adolescents 11 to 18 years of age should receive a single dose of tdap instead of tetanus and diphtheria toxoids (td) vaccine for booster immunization against tetanus, diphtheria, and pertussis if they have completed the recommended childhood diphtheria, tetanus, and pertussis (dtp)/diphtheria and tetanus toxoids and acellular pertussis (dtap) immunization series* and have not received td; the preferred age for tdap immunization is 11 to 12 years. |
| ambulatory unfractionated heparin administered hours | 2 | alternatives for thromboprophylaxis for moderate-risk* patients undergoing gynecologic surgery include the following: thigh-high graduated compression stockings placed intraoperatively and continued until the patient is fully ambulatory pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 2 hours before surgery and continued postoperatively every 8 hours until discharge. low-molecular-weight heparin (dalteparin, 2,500 antifactor-xa u, or enoxaparin, 40 mg) administered 12 hours before surgery and once a day postoperatively until discharge. alternatives for prophylaxis for high-risk* patients undergoing gynecologic surgery, especially for malignancy, include: pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 8 hours before surgery and continued postoperatively until discharge. dalteparin (5,000 antifactor-xa u) administered 12 hours before surgery and then once a day thereafter. enoxaparin (40 mg) administered 12 hours before surgery and then once a day thereafter. |
| analysis patients clinical presentation strongly | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| anthracyclinecontaining chemotherapy indicated opinion treating | 2 | the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose epirubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician. there are no data indicating the optimal cumulative dose of epirubicin at which dexrazoxane should be instituted. for doxorubicin, use of dexrazoxane is recommended after the cumulative dose reaches 300 mg/m2 (i.e., 55% of the recommended maximum). a similar formula could be used for epirubicin; that is, institution of dexrazoxane when the cumulative dose of epirubicin reaches 550 mg/m2, as the recommended maximum cumulative dose in canada is 1,000 mg/m2. the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose doxorubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician, and who have received 300 mg/m2 or more of doxorubicin. |
| anthracyclinesensitive cancer m continued anthracyclinecontaining | 2 | the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose epirubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician. there are no data indicating the optimal cumulative dose of epirubicin at which dexrazoxane should be instituted. for doxorubicin, use of dexrazoxane is recommended after the cumulative dose reaches 300 mg/m2 (i.e., 55% of the recommended maximum). a similar formula could be used for epirubicin; that is, institution of dexrazoxane when the cumulative dose of epirubicin reaches 550 mg/m2, as the recommended maximum cumulative dose in canada is 1,000 mg/m2. the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose doxorubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician, and who have received 300 mg/m2 or more of doxorubicin. |
| appropriate initial subsequent treatment waldenstrom'macroglobulinaemia | 2 | alkylating-agent based therapy is appropriate for the initial and subsequent treatment of waldenstrom's macroglobulinaemia. purine analogues are appropriate for the initial and subsequent treatment of waldenstrom's macroglobulinaemia. there is no consensus on the duration of treatment with cladribine or fludarabine, or on which purine analogue is superior. fludarabine is more active than cyclophosphamide, doxorubicin and prednisolone (cap) as salvage therapy. |
| appropriately qualified healthcare professional expertise | 2 | drug treatment should only be initiated by an appropriately qualified healthcare professional with expertise in adhd and should be based on a comprehensive assessment and diagnosis. continued prescribing and monitoring of drug therapy may be performed by general practitioners, under shared care arrangements. drug treatment with peginterferon alfa-2a or adefovir dipivoxil should be initiated only by an appropriately qualified healthcare professional with expertise in the management of viral hepatitis. continuation of therapy under shared-care arrangements with a general practitioner is appropriate. |
| aromatase inhibitors anastrozole exemestane letrozole | 2 | 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. 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. |
| assess fibrinolytic therapy patients symptoms | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| assessment organizational readiness barriers education | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| assessmentoffer genetic testing family members | 2 | risk assessment:offer genetic testing for family members, as appropriate . risk assessment:offer genetic testing for family members, as appropriate . |
| atypical thought obscuring segment analysis | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| axis positive scanning negative scanning | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| behavioral interventions promote sustained weight | 3 | the uspstf recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. the uspstf concludes that the evidence is insufficient to recommend for or against the use of counseling of any intensity and behavioral interventions to promote sustained weight loss in overweight adults. the uspstf concludes that the evidence is insufficient to recommend for or against the use of moderate- or low-intensity counseling together with behavioral interventions to promote sustained weight loss in obese adults. |
| biopsy radiographically enlarged mediastinal lymph | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| biopsy recommended mediastinal lymph nodes | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| biopsy rule metastatic disease patient | 2 | staging distant metastatic disease:2003 recommendations:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. staging distant metastatic disease:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. |
| blood lead levels asymptomatic children | 2 | the uspstf recommends against routine screening for elevated blood lead levels in asymptomatic children aged 1 to 5 years who are at average risk . 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. |
| blood test diagnose epileptic seizures | 3 | for clinicians considering a laboratory blood test to diagnose epileptic seizures (es)the utility of serum prl assay has not been established in the evaluation of status epilepticus, repetitive seizures, or neonatal seizures. for clinicians considering a laboratory blood test to diagnose epileptic seizures (es)elevated serum prolactin (prl), when measured in appropriate clinical setting at 10 to 20 minutes after a suspected event, should be considered a useful adjunct to differentiate generalized tonic-clonic seizures or complex partial seizures from psychogenic nonepileptic seizures among adults and older children. for clinicians considering a laboratory blood test to diagnose epileptic seizures (es)serum prl assay is not of utility to distinguish seizure from syncope . |
| bone scanning liver ultrasonography chest | 2 | in women with pathological stage iii tumours, bone scanning, liver ultrasonography, and chest radiography are recommended postoperatively as part of baseline staging. in women for whom treatment options are restricted to tamoxifen or hormone therapy, or for whom no further treatment is indicated because of age or other factors, routine bone scanning, liver ultrasonography, and chest radiography are not indicated as part of baseline staging. |
| cancer guideline developers recommend against | 3 | 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. 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. 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. |
| cancer m continued anthracyclinecontaining chemotherapy | 2 | the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose epirubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician. there are no data indicating the optimal cumulative dose of epirubicin at which dexrazoxane should be instituted. for doxorubicin, use of dexrazoxane is recommended after the cumulative dose reaches 300 mg/m2 (i.e., 55% of the recommended maximum). a similar formula could be used for epirubicin; that is, institution of dexrazoxane when the cumulative dose of epirubicin reaches 550 mg/m2, as the recommended maximum cumulative dose in canada is 1,000 mg/m2. the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose doxorubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician, and who have received 300 mg/m2 or more of doxorubicin. |
| candidates chemotherapy m erlotinib available | 2 | gefitinib at a dose of 250 mg/day may be considered for second-line and subsequent therapy only for selected symptomatic patients who are not candidates for chemotherapy and for whom erlotinib is not available. gefitinib monotherapy, if available, may be considered as a second-line and subsequent treatment option for selected symptomatic patients with advanced non-small cell lung cancer who are not candidates for chemotherapy and for whom erlotinib is not available. |
| causes segment elevation early repolarization | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| cell lung cancer good performance | 2 | the combination of paclitaxel (taxol®) or docetaxel (taxotere®) with cisplatin can be recommended as one of a number of chemotherapy options in the first-line therapy of patients with advanced non-small cell lung cancer and a good performance status. strong evidence including meta-analyses indicates that there is a small survival benefit of cisplatin-based chemotherapy over best supportive care in patients with non-small cell lung cancer and good performance status. |
| cesarean delivery transverse incision candidates | 2 | most women with one previous cesarean delivery with a low-transverse incision are candidates for vaginal birth after cesarean delivery (vbac) and should be counseled about vbac and offered a trial of labor. women with one previous cesarean delivery with a low transverse incision are candidates for and should be offered a trial of labor (tol). |
| chemotherapy indicated opinion treating physician | 2 | the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose epirubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician. there are no data indicating the optimal cumulative dose of epirubicin at which dexrazoxane should be instituted. for doxorubicin, use of dexrazoxane is recommended after the cumulative dose reaches 300 mg/m2 (i.e., 55% of the recommended maximum). a similar formula could be used for epirubicin; that is, institution of dexrazoxane when the cumulative dose of epirubicin reaches 550 mg/m2, as the recommended maximum cumulative dose in canada is 1,000 mg/m2. the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose doxorubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician, and who have received 300 mg/m2 or more of doxorubicin. |
| chest scan greater than shortest | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| children otitis media effusion should | 2 | parents of children with otitis media with effusion should be advised to refrain from smoking. children with otitis media with effusion should not be treated with antibiotics. |
| chronic cough nonasthmatic eosinophilic bronchitis | 2 | in patients with chronic cough due to nonasthmatic eosinophilic bronchitis, the possibility of an occupation-related cause needs to be considered. for patients with chronic cough due to nonasthmatic eosinophilic bronchitis, the first-line treatment is inhaled corticosteroids (except when a causal allergen or sensitizer is identified. |
| clients should referred trained healthcare | 2 | nurses in all practice settings should screen clients for evidence of depression, using a validated tool (such as the stroke aphasia depression questionnaire, geriatric depression scale, hospital anxiety and depression scale or the cornell scale for depression in dementia) prior to discharge throughout the continuum of care. in situations where evidence of depression is identified, clients should be referred to a trained healthcare professional for further assessment and management. nurses in all practice settings should assess/screen caregiver burden, using a validated tool (such as the caregiver strain index or the self related burden index). in situations where concerns are identified, clients should be referred to a trained healthcare professional for further assessment and management. |
| clinical grounds out prior histological | 2 | people for whom liver biopsy poses a substantial risk (such as those with haemophilia, or those who have experienced an adverse event after undergoing a previous liver biopsy), and people with symptoms of extra-hepatic hcv infection sufficient to impair quality of life, may be treated on clinical grounds without prior histological classification. peope for whom liver biopsy poses a substantial risk(such as those with haemophilia,or those who have experienced an adverse event after undergoing a previous liver biopsy) and people with symptoms of extra hepatic hcv infection sufficient to impair quality of life,may be treated on clinical grounds without prior histological classification. |
| clinically operable nsclc biopsy recommended | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| clinicians considering laboratory blood test | 3 | for clinicians considering a laboratory blood test to diagnose epileptic seizures (es)the utility of serum prl assay has not been established in the evaluation of status epilepticus, repetitive seizures, or neonatal seizures. for clinicians considering a laboratory blood test to diagnose epileptic seizures (es)elevated serum prolactin (prl), when measured in appropriate clinical setting at 10 to 20 minutes after a suspected event, should be considered a useful adjunct to differentiate generalized tonic-clonic seizures or complex partial seizures from psychogenic nonepileptic seizures among adults and older children. for clinicians considering a laboratory blood test to diagnose epileptic seizures (es)serum prl assay is not of utility to distinguish seizure from syncope . |
| compression placed intraoperatively continued until | 2 | alternatives for thromboprophylaxis for moderate-risk* patients undergoing gynecologic surgery include the following: thigh-high graduated compression stockings placed intraoperatively and continued until the patient is fully ambulatory pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 2 hours before surgery and continued postoperatively every 8 hours until discharge. low-molecular-weight heparin (dalteparin, 2,500 antifactor-xa u, or enoxaparin, 40 mg) administered 12 hours before surgery and once a day postoperatively until discharge. alternatives for prophylaxis for high-risk* patients undergoing gynecologic surgery, especially for malignancy, include: pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 8 hours before surgery and continued postoperatively until discharge. dalteparin (5,000 antifactor-xa u) administered 12 hours before surgery and then once a day thereafter. enoxaparin (40 mg) administered 12 hours before surgery and then once a day thereafter. |
| concludes evidence insufficient recommend against | 7 | 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. 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. the uspstf concludes that the evidence is insufficient to recommend for or against the routine use of new technologies to screen for cervical cancer. the uspstf concludes that the evidence is insufficient to recommend for or against the use of counseling of any intensity and behavioral interventions to promote sustained weight loss in overweight adults. 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. 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). the uspstf concludes that the evidence is insufficient to recommend for or against the use of moderate- or low-intensity counseling together with behavioral interventions to promote sustained weight loss in obese adults. |
| concomitant estrogen therapy cannot recommended | 2 | testosterone therapy without concomitant estrogen therapy cannot be recommended, because there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. testosterone therapy without concomitant estrogen therapy cannot be recommended becasue there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. |
| considering laboratory blood test diagnose | 3 | for clinicians considering a laboratory blood test to diagnose epileptic seizures (es)the utility of serum prl assay has not been established in the evaluation of status epilepticus, repetitive seizures, or neonatal seizures. for clinicians considering a laboratory blood test to diagnose epileptic seizures (es)elevated serum prolactin (prl), when measured in appropriate clinical setting at 10 to 20 minutes after a suspected event, should be considered a useful adjunct to differentiate generalized tonic-clonic seizures or complex partial seizures from psychogenic nonepileptic seizures among adults and older children. for clinicians considering a laboratory blood test to diagnose epileptic seizures (es)serum prl assay is not of utility to distinguish seizure from syncope . |
| contact information support groups requested | 2 | education/health promotion:provide contact information for support groups as requested . education/health promotion:provide contact information for support groups as requested . |
| contiguous limb leads greater than | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| contiguous precordial leads lacking features | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| continued anthracyclinecontaining chemotherapy indicated opinion | 2 | the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose epirubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician. there are no data indicating the optimal cumulative dose of epirubicin at which dexrazoxane should be instituted. for doxorubicin, use of dexrazoxane is recommended after the cumulative dose reaches 300 mg/m2 (i.e., 55% of the recommended maximum). a similar formula could be used for epirubicin; that is, institution of dexrazoxane when the cumulative dose of epirubicin reaches 550 mg/m2, as the recommended maximum cumulative dose in canada is 1,000 mg/m2. the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose doxorubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician, and who have received 300 mg/m2 or more of doxorubicin. |
| continued until patient fully ambulatory | 2 | alternatives for thromboprophylaxis for moderate-risk* patients undergoing gynecologic surgery include the following: thigh-high graduated compression stockings placed intraoperatively and continued until the patient is fully ambulatory pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 2 hours before surgery and continued postoperatively every 8 hours until discharge. low-molecular-weight heparin (dalteparin, 2,500 antifactor-xa u, or enoxaparin, 40 mg) administered 12 hours before surgery and once a day postoperatively until discharge. alternatives for prophylaxis for high-risk* patients undergoing gynecologic surgery, especially for malignancy, include: pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 8 hours before surgery and continued postoperatively until discharge. dalteparin (5,000 antifactor-xa u) administered 12 hours before surgery and then once a day thereafter. enoxaparin (40 mg) administered 12 hours before surgery and then once a day thereafter. |
| controlled research study determine effectiveness | 2 | recommendation :practitioners, policy makers, and commissioners should only endorse exercise referral schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness .individuals should only be referred to schemes that are part of such a study. recommendation: practitioners, policy makers, and commissioners should only endorse pedometers and walking and cycling schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness . measures should include intermediate outcomes such as knowledge, attitude, and skills, as well as measures of physical activity levels. |
| data safety efficacy testosterone therapy | 2 | testosterone therapy without concomitant estrogen therapy cannot be recommended, because there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. testosterone therapy without concomitant estrogen therapy cannot be recommended becasue there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. |
| dedication qualified individual provide support | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| density lipoprotein cholesterol highdensity lipoprotein | 2 | all women with pcos should be screened for dyslipidemia with a fasting lipoprotein profile, including total cholesterol, low-density lipoprotein (ldl) cholesterol, high-density lipoprotein (hdl) cholesterol, and triglyceride determinations. it is recommended that the following laboratory tests be obtained routinely in patients being evaluated for hf: serum electrolytes, blood urea nitrogen, creatinine, glucose, calcium, magnesium, lipid profile (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides), complete blood count, serum albumin, liver function tests, urinalysis, and thyroid function. |
| designed controlled research study determine | 2 | recommendation :practitioners, policy makers, and commissioners should only endorse exercise referral schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness .individuals should only be referred to schemes that are part of such a study. recommendation: practitioners, policy makers, and commissioners should only endorse pedometers and walking and cycling schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness . measures should include intermediate outcomes such as knowledge, attitude, and skills, as well as measures of physical activity levels. |
| develop plan implementation includes assessment | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| dexrazoxane protect against cardiotoxicity associated | 2 | the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose epirubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician. there are no data indicating the optimal cumulative dose of epirubicin at which dexrazoxane should be instituted. for doxorubicin, use of dexrazoxane is recommended after the cumulative dose reaches 300 mg/m2 (i.e., 55% of the recommended maximum). a similar formula could be used for epirubicin; that is, institution of dexrazoxane when the cumulative dose of epirubicin reaches 550 mg/m2, as the recommended maximum cumulative dose in canada is 1,000 mg/m2. the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose doxorubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician, and who have received 300 mg/m2 or more of doxorubicin. |
| diagnosisfamily mutation known preimplantation diagnosis | 2 | prenatal diagnosis:if the family mutation is known, preimplantation diagnosis is feasible. prenatal diagnosis:if the family mutation is known, preimplantation diagnosis is feasible. |
| diagnostic evaluation patients advanced lung | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| diphtheria tetanus toxoids acellular pertussis | 2 | adolescents 11 to 18 years of age should receive a single dose of tdap instead of tetanus and diphtheria toxoids (td) vaccine for booster immunization against tetanus, diphtheria, and pertussis if they have completed the recommended childhood diphtheria, tetanus, and pertussis (dtp)/diphtheria and tetanus toxoids and acellular pertussis (dtap) immunization series* and have not received td; the preferred age for tdap immunization is 11 to 12 years. 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. |
| directives should taken fully into | 2 | in all situations where informed discussion and consent is not possible advance directives should be taken fully into account and the individual's advocate and/or carer should be consulted. in all situations where informed discussion is not possible advance directives should be taken fully into account and the individual's advocate and/or carer should be consulted when appropriate. |
| discussion education reinforce importance best | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| disease patient otherwise considered potentially | 2 | staging distant metastatic disease:2003 recommendations:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. staging distant metastatic disease:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. |
| distantsite palliative effects externalbeam radiation | 2 | treatment:radiotherapy:2003 recommendations:local- and distant-site palliative effects of external-beam radiation no change. treatment:radiotherapy:local- and distant-site palliative effects of external-beam radiation |
| docetaxel m2 over hour every | 3 | in anthracycline-naive patients, who would ordinarily be offered treatment with a single-agent anthracycline (doxorubicin or epirubicin) or an anthracycline in a standard combination, the following options are also reasonable:treatment with single-agent docetaxel 100 mg/m2 over one hour every three weeks.docetaxel or paclitaxel in combination with doxorubicin. in anthracycline-naive patients for whom anthracyclines are contraindicated: treatment with single-agent docetaxel 100 mg/m2 over one hour every three weeks is recommended. in anthracycline-resistant patients or patients who have previously received an anthracycline as adjuvant therapy: either docetaxel (100 mg/m2 over one hour every three weeks) or paclitaxel (175 mg/m2 over three hours every three weeks) may be considered as a treatment option after failure of prior anthracycline treatment or in women whose disease is resistant to anthracyclines. the evidence supporting the use of single-agent docetaxel is more consistent and is based on a larger number of trials and patients than the evidence for paclitaxel. in selected patients, the combination of docetaxel and capecitabine is a therapeutic option. due to the toxicity of the combination, patient selection for good performance status or younger age is recommended. it is recommended that capecitabine in the docetaxel/capecitabine combination be given at 75% of full dose. |
| does preclude biopsy radiographically enlarged | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| early repolarization pericarditis left ventricular | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| education health promotionprovide contact information | 2 | education/health promotion:provide contact information for support groups as requested . education/health promotion:provide contact information for support groups as requested . |
| education reinforce importance best practices | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| effective shortterm treatment infantile spasms | 2 | vigabatrin is also possibly effective for the short-term treatment of infantile spasms in the majority of children with tuberous sclerosis. acth is probably effective for the short-term treatment of infantile spasms and in resolution of hypsarrhythmia . |
| effective should considered acute treatment | 2 | sumatriptan nasal spray is effective and should be considered for the acute treatment of migraine in adolescents. ibuprofen is effective and should be considered for the acute treatment of migraine in children. |
| efficacy testosterone therapy women using | 2 | testosterone therapy without concomitant estrogen therapy cannot be recommended, because there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. testosterone therapy without concomitant estrogen therapy cannot be recommended becasue there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. |
| elevated blood lead levels asymptomatic | 3 | the uspstf recommends against routine screening for elevated blood lead levels in asymptomatic children aged 1 to 5 years who are at average risk . the uspstf recommends against routine screening for elevated blood lead levels in asymptomatic pregnant women. 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. |
| elevation early repolarization pericarditis left | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| elevations greater than equal millivolts | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| enoxaparin administered hours before surgery | 2 | alternatives for thromboprophylaxis for moderate-risk* patients undergoing gynecologic surgery include the following: thigh-high graduated compression stockings placed intraoperatively and continued until the patient is fully ambulatory pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 2 hours before surgery and continued postoperatively every 8 hours until discharge. low-molecular-weight heparin (dalteparin, 2,500 antifactor-xa u, or enoxaparin, 40 mg) administered 12 hours before surgery and once a day postoperatively until discharge. alternatives for prophylaxis for high-risk* patients undergoing gynecologic surgery, especially for malignancy, include: pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 8 hours before surgery and continued postoperatively until discharge. dalteparin (5,000 antifactor-xa u) administered 12 hours before surgery and then once a day thereafter. enoxaparin (40 mg) administered 12 hours before surgery and then once a day thereafter. |
| equal millivolts more contiguous limb | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| equal more contiguous precordial leads | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| evaluation patients advanced lung cancer | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| event after undergoing previous liver | 2 | people for whom liver biopsy poses a substantial risk (such as those with haemophilia, or those who have experienced an adverse event after undergoing a previous liver biopsy), and people with symptoms of extra-hepatic hcv infection sufficient to impair quality of life, may be treated on clinical grounds without prior histological classification. peope for whom liver biopsy poses a substantial risk(such as those with haemophilia,or those who have experienced an adverse event after undergoing a previous liver biopsy) and people with symptoms of extra hepatic hcv infection sufficient to impair quality of life,may be treated on clinical grounds without prior histological classification. |
| evidence insufficient recommend against routine | 4 | 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. 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. the uspstf concludes that the evidence is insufficient to recommend for or against the routine use of new technologies to screen for cervical cancer. 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. |
| evidence supports dexrazoxane protect against | 2 | the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose epirubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician. there are no data indicating the optimal cumulative dose of epirubicin at which dexrazoxane should be instituted. for doxorubicin, use of dexrazoxane is recommended after the cumulative dose reaches 300 mg/m2 (i.e., 55% of the recommended maximum). a similar formula could be used for epirubicin; that is, institution of dexrazoxane when the cumulative dose of epirubicin reaches 550 mg/m2, as the recommended maximum cumulative dose in canada is 1,000 mg/m2. the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose doxorubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician, and who have received 300 mg/m2 or more of doxorubicin. |
| experienced adverse event after undergoing | 2 | people for whom liver biopsy poses a substantial risk (such as those with haemophilia, or those who have experienced an adverse event after undergoing a previous liver biopsy), and people with symptoms of extra-hepatic hcv infection sufficient to impair quality of life, may be treated on clinical grounds without prior histological classification. peope for whom liver biopsy poses a substantial risk(such as those with haemophilia,or those who have experienced an adverse event after undergoing a previous liver biopsy) and people with symptoms of extra hepatic hcv infection sufficient to impair quality of life,may be treated on clinical grounds without prior histological classification. |
| features infarction causes segment elevation | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| fibrinolytic therapy patients symptoms suggestive | 3 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations:assess for fibrinolytic therapy in patients with symptoms suggestive of ami and presenting within 12 hours of symptom onset if ecg reveals: 1.new or presumably new right bundle branch block (rbbb). 2.rbbb, atypical bbb, or ventricular paced and concordant st-segment deviations greater than or equal to 0.1 mv (1 mm) towards the major qrs deflection or discordant st-segment deviations greater than or equal to 0.5 mv (5 mm) away from the major qrs deflection in 2 or more contiguous leads. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| finding isolated adrenal mass ultrasonography | 2 | staging distant metastatic disease:2003 recommendations:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. staging distant metastatic disease:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. |
| following lumbar fusion surgery recommended | 2 | the use of lumbar brace therapy as a preoperative diagnostic tool to predict outcome following lumbar fusion surgery is not recommended. the use of transpedicular external fixation as a tool to predict outcome following lumbar fusion surgery is not recommended. |
| following recommendations based primarily consensus | 2 | the following recommendations are based primarily on consensus and expert opinion:in addition to health risks and benefits, patient counseling should include consideration of how oophorectomy may relate to the individual patient's body image, perceptions concerning sexuality, and personal feelings. the following recommendations are based primarily on consensus and expert opinion (level c): epidural anesthesia appears to be safe in women taking unfractionated low-dose heparin if the aptt is normal. |
| force concludes evidence insufficient recommend | 2 | 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. 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). |
| found chest scan greater than | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| fully ambulatory unfractionated heparin administered | 2 | alternatives for thromboprophylaxis for moderate-risk* patients undergoing gynecologic surgery include the following: thigh-high graduated compression stockings placed intraoperatively and continued until the patient is fully ambulatory pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 2 hours before surgery and continued postoperatively every 8 hours until discharge. low-molecular-weight heparin (dalteparin, 2,500 antifactor-xa u, or enoxaparin, 40 mg) administered 12 hours before surgery and once a day postoperatively until discharge. alternatives for prophylaxis for high-risk* patients undergoing gynecologic surgery, especially for malignancy, include: pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 8 hours before surgery and continued postoperatively until discharge. dalteparin (5,000 antifactor-xa u) administered 12 hours before surgery and then once a day thereafter. enoxaparin (40 mg) administered 12 hours before surgery and then once a day thereafter. |
| fully into account individual'advocate carer | 2 | in all situations where informed discussion and consent is not possible advance directives should be taken fully into account and the individual's advocate and/or carer should be consulted. in all situations where informed discussion is not possible advance directives should be taken fully into account and the individual's advocate and/or carer should be consulted when appropriate. |
| genetic testing family members appropriate | 2 | risk assessment:offer genetic testing for family members, as appropriate . risk assessment:offer genetic testing for family members, as appropriate . |
| greater than equal millivolts more | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| greater than equal more contiguous | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| greater than shortest transverse axis | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| grounds out prior histological classification | 2 | people for whom liver biopsy poses a substantial risk (such as those with haemophilia, or those who have experienced an adverse event after undergoing a previous liver biopsy), and people with symptoms of extra-hepatic hcv infection sufficient to impair quality of life, may be treated on clinical grounds without prior histological classification. peope for whom liver biopsy poses a substantial risk(such as those with haemophilia,or those who have experienced an adverse event after undergoing a previous liver biopsy) and people with symptoms of extra hepatic hcv infection sufficient to impair quality of life,may be treated on clinical grounds without prior histological classification. |
| guideline developers recommend against single | 2 | 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. 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. |
| health promotionprovide contact information support | 2 | education/health promotion:provide contact information for support groups as requested . education/health promotion:provide contact information for support groups as requested . |
| healthcare professional further assessment management | 2 | nurses in all practice settings should screen clients for evidence of depression, using a validated tool (such as the stroke aphasia depression questionnaire, geriatric depression scale, hospital anxiety and depression scale or the cornell scale for depression in dementia) prior to discharge throughout the continuum of care. in situations where evidence of depression is identified, clients should be referred to a trained healthcare professional for further assessment and management. nurses in all practice settings should assess/screen caregiver burden, using a validated tool (such as the caregiver strain index or the self related burden index). in situations where concerns are identified, clients should be referred to a trained healthcare professional for further assessment and management. |
| heparin administered hours before surgery | 2 | alternatives for thromboprophylaxis for moderate-risk* patients undergoing gynecologic surgery include the following: thigh-high graduated compression stockings placed intraoperatively and continued until the patient is fully ambulatory pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 2 hours before surgery and continued postoperatively every 8 hours until discharge. low-molecular-weight heparin (dalteparin, 2,500 antifactor-xa u, or enoxaparin, 40 mg) administered 12 hours before surgery and once a day postoperatively until discharge. alternatives for prophylaxis for high-risk* patients undergoing gynecologic surgery, especially for malignancy, include: pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 8 hours before surgery and continued postoperatively until discharge. dalteparin (5,000 antifactor-xa u) administered 12 hours before surgery and then once a day thereafter. enoxaparin (40 mg) administered 12 hours before surgery and then once a day thereafter. |
| highrisk chronic lymphocytic leukemia fludarabine | 2 | 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. 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. |
| history cancer guideline developers recommend | 3 | 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. 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. 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. |
| hours before surgery continued postoperatively | 2 | alternatives for thromboprophylaxis for moderate-risk* patients undergoing gynecologic surgery include the following: thigh-high graduated compression stockings placed intraoperatively and continued until the patient is fully ambulatory pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 2 hours before surgery and continued postoperatively every 8 hours until discharge. low-molecular-weight heparin (dalteparin, 2,500 antifactor-xa u, or enoxaparin, 40 mg) administered 12 hours before surgery and once a day postoperatively until discharge. alternatives for prophylaxis for high-risk* patients undergoing gynecologic surgery, especially for malignancy, include: pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 8 hours before surgery and continued postoperatively until discharge. dalteparin (5,000 antifactor-xa u) administered 12 hours before surgery and then once a day thereafter. enoxaparin (40 mg) administered 12 hours before surgery and then once a day thereafter. |
| hours symptom onset reveals elevations | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| hypertrophy incomplete bundle branch block | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| identified clients should referred trained | 2 | nurses in all practice settings should screen clients for evidence of depression, using a validated tool (such as the stroke aphasia depression questionnaire, geriatric depression scale, hospital anxiety and depression scale or the cornell scale for depression in dementia) prior to discharge throughout the continuum of care. in situations where evidence of depression is identified, clients should be referred to a trained healthcare professional for further assessment and management. nurses in all practice settings should assess/screen caregiver burden, using a validated tool (such as the caregiver strain index or the self related burden index). in situations where concerns are identified, clients should be referred to a trained healthcare professional for further assessment and management. |
| implementation includes assessment organizational readiness | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| implementation process ongoing opportunities discussion | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| improves survival over standard radiotherapy | 2 | 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. evidence from a comparative cohort study suggests that hyperfractionated accelerated radiation therapy (hart) also improves survival over standard radiotherapy. |
| in hours symptom onset reveals | 3 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations:assess for fibrinolytic therapy in patients with symptoms suggestive of ami and presenting within 12 hours of symptom onset if ecg reveals: 1.new or presumably new right bundle branch block (rbbb). 2.rbbb, atypical bbb, or ventricular paced and concordant st-segment deviations greater than or equal to 0.1 mv (1 mm) towards the major qrs deflection or discordant st-segment deviations greater than or equal to 0.5 mv (5 mm) away from the major qrs deflection in 2 or more contiguous leads. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| in their licensed indications recommended | 2 | olanzapine and valproate semisodium, within their licensed indications, are recommended as options for control of the acute symptoms associated with the manic phase of bipolar i disorder. 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. |
| includes assessment organizational readiness barriers | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| incomplete bundle branch block type | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| individual provide support needed education | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| individuals out symptoms history cancer | 2 | 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. 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. |
| infarction causes segment elevation early | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| infarction presenting in hours symptom | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| infected patients cd lymphocyte counts | 2 | hiv-infected patients with cd4+ lymphocyte counts of <200 cells/microl or those patients with counts of >200 cells/microl with unexplained fever, weight loss, or thrush who have unexplained cough should be suspected of having pneumocystis pneumonia, tuberculosis, and other opportunistic infections, and should be evaluated accordingly. in human immunodeficiency (hiv)-infected patients, cd4+ lymphocyte counts should be used in constructing the list of differential diagnostic possibilities potentially causing cough. |
| inhibitors anastrozole exemestane letrozole in | 2 | 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. 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. |
| intermediate highrisk chronic lymphocytic leukemia | 2 | 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. 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. |
| interpretation serum human chorionic gonadotropin | 2 | 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. 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. |
| interval between oral health reviews | 2 | the recommended interval between oral health reviews should be determined specifically for each patient and tailored to meet his or her needs, on the basis of an assessment of disease levels and risk of or from dental disease. he longest interval between oral health reviews for patients younger than 18 years should be 12 months. |
| interventions promote sustained weight loss | 3 | the uspstf recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. the uspstf concludes that the evidence is insufficient to recommend for or against the use of counseling of any intensity and behavioral interventions to promote sustained weight loss in overweight adults. the uspstf concludes that the evidence is insufficient to recommend for or against the use of moderate- or low-intensity counseling together with behavioral interventions to promote sustained weight loss in obese adults. |
| into account individual'advocate carer should | 2 | in all situations where informed discussion and consent is not possible advance directives should be taken fully into account and the individual's advocate and/or carer should be consulted. in all situations where informed discussion is not possible advance directives should be taken fully into account and the individual's advocate and/or carer should be consulted when appropriate. |
| intraoperatively continued until patient fully | 2 | alternatives for thromboprophylaxis for moderate-risk* patients undergoing gynecologic surgery include the following: thigh-high graduated compression stockings placed intraoperatively and continued until the patient is fully ambulatory pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 2 hours before surgery and continued postoperatively every 8 hours until discharge. low-molecular-weight heparin (dalteparin, 2,500 antifactor-xa u, or enoxaparin, 40 mg) administered 12 hours before surgery and once a day postoperatively until discharge. alternatives for prophylaxis for high-risk* patients undergoing gynecologic surgery, especially for malignancy, include: pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 8 hours before surgery and continued postoperatively until discharge. dalteparin (5,000 antifactor-xa u) administered 12 hours before surgery and then once a day thereafter. enoxaparin (40 mg) administered 12 hours before surgery and then once a day thereafter. |
| isolated adrenal mass ultrasonography scan | 2 | staging distant metastatic disease:2003 recommendations:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. staging distant metastatic disease:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. |
| jointly individual clinician responsible treatment | 3 | of the drugs available for the treatment of acute mania, the choice of which to prescribe should be made jointly by the individual and the clinician(s) responsible for treatment. the choice should be based on an informed discussion of the relative benefits and side-effect profiles of each drug, and should take into account the needs of the individual and the particular clinical situation. valid consent should be obtained in all cases where the individual has the ability to grant or refuse consent. the decision to use ect should be made jointly by the individual and the clinician(s) responsible for treatment, on the basis of an informed discussion. this discussion should be enabled by the provision of full and appropriate information about the general risks associated with ect and about the risks and potential benefits specific to that individual. consent should be obtained without pressure or coercion, which may occur as a result of the circumstances and clinical setting, and the individual should be reminded of their right to withdraw consent at any point. there should be strict adherence to recognised guidelines about consent and the involvement of patient advocates and/or carers to facilitate informed discussion is strongly encouraged. the decision regarding treatment should be made jointly by the individual and the clinician(s) responsible for treatment. the decision should be made after an informed discussion between the clinician(s) and the patient; this discussion should take into account contraindications and the side-effect profile of the agents, alternative treatments for locally advanced or metastatic breast cancer, and the clinical condition and preferences of the individual. |
| laboratory blood test diagnose epileptic | 3 | for clinicians considering a laboratory blood test to diagnose epileptic seizures (es)the utility of serum prl assay has not been established in the evaluation of status epilepticus, repetitive seizures, or neonatal seizures. for clinicians considering a laboratory blood test to diagnose epileptic seizures (es)elevated serum prolactin (prl), when measured in appropriate clinical setting at 10 to 20 minutes after a suspected event, should be considered a useful adjunct to differentiate generalized tonic-clonic seizures or complex partial seizures from psychogenic nonepileptic seizures among adults and older children. for clinicians considering a laboratory blood test to diagnose epileptic seizures (es)serum prl assay is not of utility to distinguish seizure from syncope . |
| lacking features infarction causes segment | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| lead levels asymptomatic children aged | 2 | the uspstf recommends against routine screening for elevated blood lead levels in asymptomatic children aged 1 to 5 years who are at average risk . 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. |
| leads greater than equal more | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| leads lacking features infarction causes | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| left atypical thought obscuring segment | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| left ventricular hypertrophy incomplete bundle | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| less than laar active ingredient | 2 | pregnant patients with unintentional exposure to less than 1 mg of laar active ingredient should be evaluated by their obstetrician or primary care provider as an outpatient. immediate referral to an emergency department or clinic is not required. patients with unintentional ingestion of less than 1 mg of laar active ingredient can be safely observed at home without laboratory monitoring. this includes practically all unintentional ingestions in children less than 6 years of age. |
| limb leads greater than equal | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| limitedstage small cell lung cancer | 2 | in patients with limited-stage small cell lung cancer, the addition of thoracic radiotherapy to standard combination chemotherapy improves both local control and overall survival and should be incorporated into a comprehensive treatment plan of combined modality therapy for limited-stage small cell lung cancer. based on currently available data, hyperfractionated thoracic radiotherapy is not recommended for limited-stage small cell lung cancer outside of a clinical trial. |
| lipoprotein cholesterol highdensity lipoprotein cholesterol | 2 | all women with pcos should be screened for dyslipidemia with a fasting lipoprotein profile, including total cholesterol, low-density lipoprotein (ldl) cholesterol, high-density lipoprotein (hdl) cholesterol, and triglyceride determinations. it is recommended that the following laboratory tests be obtained routinely in patients being evaluated for hf: serum electrolytes, blood urea nitrogen, creatinine, glucose, calcium, magnesium, lipid profile (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides), complete blood count, serum albumin, liver function tests, urinalysis, and thyroid function. |
| liver biopsy poses substantial risk | 2 | people for whom liver biopsy poses a substantial risk (such as those with haemophilia, or those who have experienced an adverse event after undergoing a previous liver biopsy), and people with symptoms of extra-hepatic hcv infection sufficient to impair quality of life, may be treated on clinical grounds without prior histological classification. peope for whom liver biopsy poses a substantial risk(such as those with haemophilia,or those who have experienced an adverse event after undergoing a previous liver biopsy) and people with symptoms of extra hepatic hcv infection sufficient to impair quality of life,may be treated on clinical grounds without prior histological classification. |
| liver ultrasonography chest radiography indicated | 2 | in women for whom treatment options are restricted to tamoxifen or hormone therapy, or for whom no further treatment is indicated because of age or other factors, routine bone scanning, liver ultrasonography, and chest radiography are not indicated as part of baseline staging. in women who have pathological stage ii tumours, a postoperative bone scan is recommended as part of baseline staging. routine liver ultrasonography and chest radiography are not indicated in this group but could be considered for patients with four or more positive lymph nodes. |
| locally advanced metastatic breast cancer | 3 | capecitabine monotherapy is recommended as an option for people with locally advanced or metastatic breast cancer who have not previously received capecitabine in combination therapy and for whom anthracycline and taxane-containing regimens have failed or further anthracycline therapy is contraindicated. in the treatment of locally advanced or metastatic breast cancer, capecitabine in combination with docetaxel is recommended in preference to single-agent docetaxel in people for whom anthracycline-containing regimens are unsuitable or have failed. the decision regarding treatment should be made jointly by the individual and the clinician(s) responsible for treatment. the decision should be made after an informed discussion between the clinician(s) and the patient; this discussion should take into account contraindications and the side-effect profile of the agents, alternative treatments for locally advanced or metastatic breast cancer, and the clinical condition and preferences of the individual. |
| locally advanced unresectable stage small | 2 | 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. 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. |
| lung cancer good performance status | 2 | the combination of paclitaxel (taxol®) or docetaxel (taxotere®) with cisplatin can be recommended as one of a number of chemotherapy options in the first-line therapy of patients with advanced non-small cell lung cancer and a good performance status. strong evidence including meta-analyses indicates that there is a small survival benefit of cisplatin-based chemotherapy over best supportive care in patients with non-small cell lung cancer and good performance status. |
| lymph nodes found chest scan | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| m continued anthracyclinecontaining chemotherapy indicated | 2 | the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose epirubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician. there are no data indicating the optimal cumulative dose of epirubicin at which dexrazoxane should be instituted. for doxorubicin, use of dexrazoxane is recommended after the cumulative dose reaches 300 mg/m2 (i.e., 55% of the recommended maximum). a similar formula could be used for epirubicin; that is, institution of dexrazoxane when the cumulative dose of epirubicin reaches 550 mg/m2, as the recommended maximum cumulative dose in canada is 1,000 mg/m2. the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose doxorubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician, and who have received 300 mg/m2 or more of doxorubicin. |
| m liver biopsy poses substantial | 2 | people for whom liver biopsy poses a substantial risk (such as those with haemophilia, or those who have experienced an adverse event after undergoing a previous liver biopsy), and people with symptoms of extra-hepatic hcv infection sufficient to impair quality of life, may be treated on clinical grounds without prior histological classification. peope for whom liver biopsy poses a substantial risk(such as those with haemophilia,or those who have experienced an adverse event after undergoing a previous liver biopsy) and people with symptoms of extra hepatic hcv infection sufficient to impair quality of life,may be treated on clinical grounds without prior histological classification. |
| m2 over hour every three | 3 | in anthracycline-naive patients, who would ordinarily be offered treatment with a single-agent anthracycline (doxorubicin or epirubicin) or an anthracycline in a standard combination, the following options are also reasonable:treatment with single-agent docetaxel 100 mg/m2 over one hour every three weeks.docetaxel or paclitaxel in combination with doxorubicin. in anthracycline-naive patients for whom anthracyclines are contraindicated: treatment with single-agent docetaxel 100 mg/m2 over one hour every three weeks is recommended. in anthracycline-resistant patients or patients who have previously received an anthracycline as adjuvant therapy: either docetaxel (100 mg/m2 over one hour every three weeks) or paclitaxel (175 mg/m2 over three hours every three weeks) may be considered as a treatment option after failure of prior anthracycline treatment or in women whose disease is resistant to anthracyclines. the evidence supporting the use of single-agent docetaxel is more consistent and is based on a larger number of trials and patients than the evidence for paclitaxel. in selected patients, the combination of docetaxel and capecitabine is a therapeutic option. due to the toxicity of the combination, patient selection for good performance status or younger age is recommended. it is recommended that capecitabine in the docetaxel/capecitabine combination be given at 75% of full dose. |
| made after informed discussion between | 2 | 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 the decision regarding treatment should be made jointly by the individual and the clinician(s) responsible for treatment. the decision should be made after an informed discussion between the clinician(s) and the patient; this discussion should take into account contraindications and the side-effect profile of the agents, alternative treatments for locally advanced or metastatic breast cancer, and the clinical condition and preferences of the individual. |
| made jointly individual clinician responsible | 3 | of the drugs available for the treatment of acute mania, the choice of which to prescribe should be made jointly by the individual and the clinician(s) responsible for treatment. the choice should be based on an informed discussion of the relative benefits and side-effect profiles of each drug, and should take into account the needs of the individual and the particular clinical situation. valid consent should be obtained in all cases where the individual has the ability to grant or refuse consent. the decision to use ect should be made jointly by the individual and the clinician(s) responsible for treatment, on the basis of an informed discussion. this discussion should be enabled by the provision of full and appropriate information about the general risks associated with ect and about the risks and potential benefits specific to that individual. consent should be obtained without pressure or coercion, which may occur as a result of the circumstances and clinical setting, and the individual should be reminded of their right to withdraw consent at any point. there should be strict adherence to recognised guidelines about consent and the involvement of patient advocates and/or carers to facilitate informed discussion is strongly encouraged. the decision regarding treatment should be made jointly by the individual and the clinician(s) responsible for treatment. the decision should be made after an informed discussion between the clinician(s) and the patient; this discussion should take into account contraindications and the side-effect profile of the agents, alternative treatments for locally advanced or metastatic breast cancer, and the clinical condition and preferences of the individual. |
| makers commissioners should only endorse | 2 | recommendation :practitioners, policy makers, and commissioners should only endorse exercise referral schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness .individuals should only be referred to schemes that are part of such a study. recommendation: practitioners, policy makers, and commissioners should only endorse pedometers and walking and cycling schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness . measures should include intermediate outcomes such as knowledge, attitude, and skills, as well as measures of physical activity levels. |
| management recommendations assess fibrinolytic therapy | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| mass ultrasonography scan scan requires | 2 | staging distant metastatic disease:2003 recommendations:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. staging distant metastatic disease:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. |
| mediastinal lymph nodes found chest | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| metastatic breast cancer being considered | 2 | single-agent gemcitabine is not recommended for women with metastatic breast cancer who are being considered for first-line single-agent anthracycline chemotherapy. the combination of gemcitabine, epirubicin, and paclitaxel (get) is not recommended as first-line chemotherapy for women with metastatic breast cancer who are being considered for anthracycline-based combination chemotherapy. |
| metastatic disease patient otherwise considered | 2 | staging distant metastatic disease:2003 recommendations:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. staging distant metastatic disease:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. |
| might reduce risk transmitting pertussis | 2 | 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. 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. |
| millivolts more contiguous limb leads | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| more contiguous limb leads greater | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| more contiguous precordial leads lacking | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| most women previous cesarean delivery | 2 | most women with one previous cesarean delivery with a low-transverse incision are candidates for vaginal birth after cesarean delivery (vbac) and should be counseled about vbac and offered a trial of labor. the use of prostaglandins for cervical ripening or induction of labor in most women with a previous cesarean delivery should be discouraged. |
| mutation known preimplantation diagnosis feasible | 2 | prenatal diagnosis:if the family mutation is known, preimplantation diagnosis is feasible. prenatal diagnosis:if the family mutation is known, preimplantation diagnosis is feasible. |
| myocardial infarction presenting in hours | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| negative scanning does preclude biopsy | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| nodes found chest scan greater | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| nsclc biopsy recommended mediastinal lymph | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| obscuring segment analysis patients clinical | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| ongoing opportunities discussion education reinforce | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| onset reveals elevations greater than | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| operable nsclc biopsy recommended mediastinal | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| opportunities discussion education reinforce importance | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| organizational readiness barriers education involvement | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| out concomitant estrogen therapy cannot | 2 | testosterone therapy without concomitant estrogen therapy cannot be recommended, because there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. testosterone therapy without concomitant estrogen therapy cannot be recommended becasue there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. |
| out symptoms history cancer guideline | 2 | 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. 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. |
| outcome following lumbar fusion surgery | 2 | the use of lumbar brace therapy as a preoperative diagnostic tool to predict outcome following lumbar fusion surgery is not recommended. the use of transpedicular external fixation as a tool to predict outcome following lumbar fusion surgery is not recommended. |
| over hour every three weeks | 2 | in anthracycline-naive patients for whom anthracyclines are contraindicated: treatment with single-agent docetaxel 100 mg/m2 over one hour every three weeks is recommended. in anthracycline-resistant patients or patients who have previously received an anthracycline as adjuvant therapy: either docetaxel (100 mg/m2 over one hour every three weeks) or paclitaxel (175 mg/m2 over three hours every three weeks) may be considered as a treatment option after failure of prior anthracycline treatment or in women whose disease is resistant to anthracyclines. the evidence supporting the use of single-agent docetaxel is more consistent and is based on a larger number of trials and patients than the evidence for paclitaxel. in selected patients, the combination of docetaxel and capecitabine is a therapeutic option. due to the toxicity of the combination, patient selection for good performance status or younger age is recommended. it is recommended that capecitabine in the docetaxel/capecitabine combination be given at 75% of full dose. |
| part properly designed controlled research | 2 | recommendation :practitioners, policy makers, and commissioners should only endorse exercise referral schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness .individuals should only be referred to schemes that are part of such a study. recommendation: practitioners, policy makers, and commissioners should only endorse pedometers and walking and cycling schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness . measures should include intermediate outcomes such as knowledge, attitude, and skills, as well as measures of physical activity levels. |
| patient fully ambulatory unfractionated heparin | 2 | alternatives for thromboprophylaxis for moderate-risk* patients undergoing gynecologic surgery include the following: thigh-high graduated compression stockings placed intraoperatively and continued until the patient is fully ambulatory pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 2 hours before surgery and continued postoperatively every 8 hours until discharge. low-molecular-weight heparin (dalteparin, 2,500 antifactor-xa u, or enoxaparin, 40 mg) administered 12 hours before surgery and once a day postoperatively until discharge. alternatives for prophylaxis for high-risk* patients undergoing gynecologic surgery, especially for malignancy, include: pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 8 hours before surgery and continued postoperatively until discharge. dalteparin (5,000 antifactor-xa u) administered 12 hours before surgery and then once a day thereafter. enoxaparin (40 mg) administered 12 hours before surgery and then once a day thereafter. |
| patient management recommendations assess fibrinolytic | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| patient otherwise considered potentially resectable | 2 | staging distant metastatic disease:2003 recommendations:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. staging distant metastatic disease:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. |
| patients advanced anthracyclinesensitive cancer m | 2 | the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose epirubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician. there are no data indicating the optimal cumulative dose of epirubicin at which dexrazoxane should be instituted. for doxorubicin, use of dexrazoxane is recommended after the cumulative dose reaches 300 mg/m2 (i.e., 55% of the recommended maximum). a similar formula could be used for epirubicin; that is, institution of dexrazoxane when the cumulative dose of epirubicin reaches 550 mg/m2, as the recommended maximum cumulative dose in canada is 1,000 mg/m2. the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose doxorubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician, and who have received 300 mg/m2 or more of doxorubicin. |
| patients advanced lung cancer staging | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| patients advanced small cell lung | 2 | the combination of paclitaxel (taxol®) or docetaxel (taxotere®) with cisplatin can be recommended as one of a number of chemotherapy options in the first-line therapy of patients with advanced non-small cell lung cancer and a good performance status. gefitinib monotherapy, if available, may be considered as a second-line and subsequent treatment option for selected symptomatic patients with advanced non-small cell lung cancer who are not candidates for chemotherapy and for whom erlotinib is not available. |
| patients chronic cough nonasthmatic eosinophilic | 2 | in patients with chronic cough due to nonasthmatic eosinophilic bronchitis, the possibility of an occupation-related cause needs to be considered. for patients with chronic cough due to nonasthmatic eosinophilic bronchitis, the first-line treatment is inhaled corticosteroids (except when a causal allergen or sensitizer is identified. |
| patients clinical presentation strongly suggestive | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| patients diabetes admitted hospital should | 2 | all patients with diabetes admitted to the hospital should be identified in the medical record as having diabetes. all patients with diabetes admitted to the hospital should have an a1c obtained for discharge planning if the result of testing in the previous 2 to 3 months is not available. |
| patients eastern cooperative oncology group | 2 | 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. 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. |
| patients intermediate highrisk chronic lymphocytic | 2 | 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. 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. |
| patients locally advanced unresectable stage | 2 | 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. 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. |
| patients symptoms suggestive acute myocardial | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| pericarditis left ventricular hypertrophy incomplete | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| persons increased risk syphilis infection | 2 | the uspstf recommends against routine screening of asymptomatic persons who are not at increased risk for syphilis infection. the uspstf strongly recommends that clinicians screen persons at increased risk for syphilis infection. |
| physical activity part properly designed | 2 | recommendation :practitioners, policy makers, and commissioners should only endorse exercise referral schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness .individuals should only be referred to schemes that are part of such a study. recommendation: practitioners, policy makers, and commissioners should only endorse pedometers and walking and cycling schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness . measures should include intermediate outcomes such as knowledge, attitude, and skills, as well as measures of physical activity levels. |
| placed intraoperatively continued until patient | 2 | alternatives for thromboprophylaxis for moderate-risk* patients undergoing gynecologic surgery include the following: thigh-high graduated compression stockings placed intraoperatively and continued until the patient is fully ambulatory pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 2 hours before surgery and continued postoperatively every 8 hours until discharge. low-molecular-weight heparin (dalteparin, 2,500 antifactor-xa u, or enoxaparin, 40 mg) administered 12 hours before surgery and once a day postoperatively until discharge. alternatives for prophylaxis for high-risk* patients undergoing gynecologic surgery, especially for malignancy, include: pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 8 hours before surgery and continued postoperatively until discharge. dalteparin (5,000 antifactor-xa u) administered 12 hours before surgery and then once a day thereafter. enoxaparin (40 mg) administered 12 hours before surgery and then once a day thereafter. |
| plan implementation includes assessment organizational | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| pneumatic compression placed intraoperatively continued | 2 | alternatives for thromboprophylaxis for moderate-risk* patients undergoing gynecologic surgery include the following: thigh-high graduated compression stockings placed intraoperatively and continued until the patient is fully ambulatory pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 2 hours before surgery and continued postoperatively every 8 hours until discharge. low-molecular-weight heparin (dalteparin, 2,500 antifactor-xa u, or enoxaparin, 40 mg) administered 12 hours before surgery and once a day postoperatively until discharge. alternatives for prophylaxis for high-risk* patients undergoing gynecologic surgery, especially for malignancy, include: pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 8 hours before surgery and continued postoperatively until discharge. dalteparin (5,000 antifactor-xa u) administered 12 hours before surgery and then once a day thereafter. enoxaparin (40 mg) administered 12 hours before surgery and then once a day thereafter. |
| policy makers commissioners should only | 2 | recommendation :practitioners, policy makers, and commissioners should only endorse exercise referral schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness .individuals should only be referred to schemes that are part of such a study. recommendation: practitioners, policy makers, and commissioners should only endorse pedometers and walking and cycling schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness . measures should include intermediate outcomes such as knowledge, attitude, and skills, as well as measures of physical activity levels. |
| positive scanning negative scanning does | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| possible advance directives should taken | 2 | in all situations where informed discussion and consent is not possible advance directives should be taken fully into account and the individual's advocate and/or carer should be consulted. in all situations where informed discussion is not possible advance directives should be taken fully into account and the individual's advocate and/or carer should be consulted when appropriate. |
| practitioners policy makers commissioners should | 2 | recommendation :practitioners, policy makers, and commissioners should only endorse exercise referral schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness .individuals should only be referred to schemes that are part of such a study. recommendation: practitioners, policy makers, and commissioners should only endorse pedometers and walking and cycling schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness . measures should include intermediate outcomes such as knowledge, attitude, and skills, as well as measures of physical activity levels. |
| preclude biopsy radiographically enlarged mediastinal | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| precordial leads lacking features infarction | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| predict outcome following lumbar fusion | 2 | the use of lumbar brace therapy as a preoperative diagnostic tool to predict outcome following lumbar fusion surgery is not recommended. the use of transpedicular external fixation as a tool to predict outcome following lumbar fusion surgery is not recommended. |
| prenatal diagnosisfamily mutation known preimplantation | 2 | prenatal diagnosis:if the family mutation is known, preimplantation diagnosis is feasible. prenatal diagnosis:if the family mutation is known, preimplantation diagnosis is feasible. |
| presenting in hours symptom onset | 3 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations:assess for fibrinolytic therapy in patients with symptoms suggestive of ami and presenting within 12 hours of symptom onset if ecg reveals: 1.new or presumably new right bundle branch block (rbbb). 2.rbbb, atypical bbb, or ventricular paced and concordant st-segment deviations greater than or equal to 0.1 mv (1 mm) towards the major qrs deflection or discordant st-segment deviations greater than or equal to 0.5 mv (5 mm) away from the major qrs deflection in 2 or more contiguous leads. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| preventive services task force concludes | 2 | 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. 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). |
| previous cesarean delivery transverse incision | 2 | most women with one previous cesarean delivery with a low-transverse incision are candidates for vaginal birth after cesarean delivery (vbac) and should be counseled about vbac and offered a trial of labor. women with one previous cesarean delivery with a low transverse incision are candidates for and should be offered a trial of labor (tol). |
| previously received anthracycline adjuvant therapy | 2 | in selected patients (e.g., those with good performance status, less than 70 years of age, and with no other major comorbidities) who are anthracycline-resistant or who have previously received an anthracycline as adjuvant therapy, the combination of docetaxel and capecitabine is an appropriate therapeutic option. in anthracycline-resistant patients or patients who have previously received an anthracycline as adjuvant therapy: either docetaxel (100 mg/m2 over one hour every three weeks) or paclitaxel (175 mg/m2 over three hours every three weeks) may be considered as a treatment option after failure of prior anthracycline treatment or in women whose disease is resistant to anthracyclines. the evidence supporting the use of single-agent docetaxel is more consistent and is based on a larger number of trials and patients than the evidence for paclitaxel. in selected patients, the combination of docetaxel and capecitabine is a therapeutic option. due to the toxicity of the combination, patient selection for good performance status or younger age is recommended. it is recommended that capecitabine in the docetaxel/capecitabine combination be given at 75% of full dose. |
| process ongoing opportunities discussion education | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| promote physical activity part properly | 2 | recommendation :practitioners, policy makers, and commissioners should only endorse exercise referral schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness .individuals should only be referred to schemes that are part of such a study. recommendation: practitioners, policy makers, and commissioners should only endorse pedometers and walking and cycling schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness . measures should include intermediate outcomes such as knowledge, attitude, and skills, as well as measures of physical activity levels. |
| promote sustained weight loss obese | 2 | the uspstf recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. the uspstf concludes that the evidence is insufficient to recommend for or against the use of moderate- or low-intensity counseling together with behavioral interventions to promote sustained weight loss in obese adults. |
| promotionprovide contact information support groups | 2 | education/health promotion:provide contact information for support groups as requested . education/health promotion:provide contact information for support groups as requested . |
| properly designed controlled research study | 2 | recommendation :practitioners, policy makers, and commissioners should only endorse exercise referral schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness .individuals should only be referred to schemes that are part of such a study. recommendation: practitioners, policy makers, and commissioners should only endorse pedometers and walking and cycling schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness . measures should include intermediate outcomes such as knowledge, attitude, and skills, as well as measures of physical activity levels. |
| protect against cardiotoxicity associated conventionaldose | 2 | the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose epirubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician. there are no data indicating the optimal cumulative dose of epirubicin at which dexrazoxane should be instituted. for doxorubicin, use of dexrazoxane is recommended after the cumulative dose reaches 300 mg/m2 (i.e., 55% of the recommended maximum). a similar formula could be used for epirubicin; that is, institution of dexrazoxane when the cumulative dose of epirubicin reaches 550 mg/m2, as the recommended maximum cumulative dose in canada is 1,000 mg/m2. the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose doxorubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician, and who have received 300 mg/m2 or more of doxorubicin. |
| provide support needed education implementation | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| qualified individual provide support needed | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| radiographically enlarged mediastinal lymph nodes | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| readiness barriers education involvement members | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| recommendation practitioners policy makers commissioners | 2 | recommendation :practitioners, policy makers, and commissioners should only endorse exercise referral schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness .individuals should only be referred to schemes that are part of such a study. recommendation: practitioners, policy makers, and commissioners should only endorse pedometers and walking and cycling schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness . measures should include intermediate outcomes such as knowledge, attitude, and skills, as well as measures of physical activity levels. |
| recommendations assess fibrinolytic therapy patients | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| recommendations based primarily consensus expert | 2 | the following recommendations are based primarily on consensus and expert opinion:in addition to health risks and benefits, patient counseling should include consideration of how oophorectomy may relate to the individual patient's body image, perceptions concerning sexuality, and personal feelings. the following recommendations are based primarily on consensus and expert opinion (level c): epidural anesthesia appears to be safe in women taking unfractionated low-dose heparin if the aptt is normal. |
| recommendationsthere insufficient evidence support refute | 3 | recommendations:there is insufficient evidence to support or refute the use of amantadine. recommendations:there is insufficient evidence to support or refute manual therapy, biofeedback, or alexander technique in the treatment of pd. recommendations:there is insufficient evidence to support or refute the use of mucuna pruriens for the treatment of motor symptoms of pd . |
| recommended child risk developmental difficulties | 2 | it is recommended that the child with ome who is at risk for developmental difficulties be aggressively managed as appropriate to his/her condition. it is recommended that the child with ome who is at risk for developmental difficulties be identified early. |
| recommended mediastinal lymph nodes found | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| recommended routine breast cancer surveillance | 2 | [18f]fluorodeoxyglucose?positron emission tomography scanning:recommendation: [18f]fluorodeoxyglucose-positron emission tomography (fdg-pet) scanning is not recommended for routine breast cancer surveillance. computed tomography (ct):recommendation: ct is not recommended for routine breast cancer surveillance. |
| recommends against routine screening elevated | 2 | the uspstf recommends against routine screening for elevated blood lead levels in asymptomatic children aged 1 to 5 years who are at average risk . the uspstf recommends against routine screening for elevated blood lead levels in asymptomatic pregnant women. |
| referred trained healthcare professional further | 2 | nurses in all practice settings should screen clients for evidence of depression, using a validated tool (such as the stroke aphasia depression questionnaire, geriatric depression scale, hospital anxiety and depression scale or the cornell scale for depression in dementia) prior to discharge throughout the continuum of care. in situations where evidence of depression is identified, clients should be referred to a trained healthcare professional for further assessment and management. nurses in all practice settings should assess/screen caregiver burden, using a validated tool (such as the caregiver strain index or the self related burden index). in situations where concerns are identified, clients should be referred to a trained healthcare professional for further assessment and management. |
| repolarization pericarditis left ventricular hypertrophy | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| requires biopsy rule metastatic disease | 2 | staging distant metastatic disease:2003 recommendations:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. staging distant metastatic disease:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. |
| reveals elevations greater than equal | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| right left atypical thought obscuring | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| risk assessmentoffer genetic testing family | 2 | risk assessment:offer genetic testing for family members, as appropriate . risk assessment:offer genetic testing for family members, as appropriate . |
| risk factors guideline developers recommend | 2 | for patients undergoing laparoscopic procedures and who have additional thromboembolic risk factors, the guideline developers recommend the use of thromboprophylaxis with one or more of the following: lduh, lmwh, ipc, or gcs. in patients with persistent af or paf, age 65 to 75 years, in the absence of other risk factors, the guideline developers recommend antithrombotic therapy . either an oral vka, such as warfarin (target inr, 2.5; range 2.0 to 3.0), or aspirin, 325 mg/d, are acceptable alternatives in this group of patients who are at intermediate risk of stroke. |
| risk postoperative pulmonary complications should | 2 | patients undergoing the following procedures are at higher risk for postoperative pulmonary complications and should be evaluated for other concomitant risk factors and receive pre- and postoperative interventions to reduce pulmonary complications: prolonged surgery (>3 hours), abdominal surgery, thoracic surgery, neurosurgery, head and neck surgery, vascular surgery, aortic aneurysm repair, emergency surgery, and general anesthesia. a low serum albumin level (<35 g/l) is a powerful marker of increased risk for postoperative pulmonary complications and should be measured in all patients who are clinically suspected of having hypoalbuminemia; measurement should be considered in patients with 1 or more risk factors for perioperative pulmonary complications. |
| routine screening elevated blood lead | 3 | the uspstf recommends against routine screening for elevated blood lead levels in asymptomatic children aged 1 to 5 years who are at average risk . the uspstf recommends against routine screening for elevated blood lead levels in asymptomatic pregnant women. 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. |
| rule metastatic disease patient otherwise | 2 | staging distant metastatic disease:2003 recommendations:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. staging distant metastatic disease:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. |
| safety efficacy testosterone therapy women | 2 | testosterone therapy without concomitant estrogen therapy cannot be recommended, because there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. testosterone therapy without concomitant estrogen therapy cannot be recommended becasue there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. |
| scan greater than shortest transverse | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| scan requires biopsy rule metastatic | 2 | staging distant metastatic disease:2003 recommendations:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. staging distant metastatic disease:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. |
| scan scan requires biopsy rule | 2 | staging distant metastatic disease:2003 recommendations:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. staging distant metastatic disease:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. |
| scanning does preclude biopsy radiographically | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| scanning liver ultrasonography chest radiography | 2 | in women with pathological stage iii tumours, bone scanning, liver ultrasonography, and chest radiography are recommended postoperatively as part of baseline staging. in women for whom treatment options are restricted to tamoxifen or hormone therapy, or for whom no further treatment is indicated because of age or other factors, routine bone scanning, liver ultrasonography, and chest radiography are not indicated as part of baseline staging. |
| scanning negative scanning does preclude | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| schemes promote physical activity part | 2 | recommendation :practitioners, policy makers, and commissioners should only endorse exercise referral schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness .individuals should only be referred to schemes that are part of such a study. recommendation: practitioners, policy makers, and commissioners should only endorse pedometers and walking and cycling schemes to promote physical activity that are part of a properly designed and controlled research study to determine effectiveness . measures should include intermediate outcomes such as knowledge, attitude, and skills, as well as measures of physical activity levels. |
| screening elevated blood lead levels | 3 | the uspstf recommends against routine screening for elevated blood lead levels in asymptomatic children aged 1 to 5 years who are at average risk . the uspstf recommends against routine screening for elevated blood lead levels in asymptomatic pregnant women. 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. |
| segment analysis patients clinical presentation | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| segment elevation early repolarization pericarditis | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| services task force concludes evidence | 2 | 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. 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). |
| shortest transverse axis positive scanning | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| should considered acute treatment migraine | 2 | sumatriptan nasal spray is effective and should be considered for the acute treatment of migraine in adolescents. ibuprofen is effective and should be considered for the acute treatment of migraine in children. |
| should made after informed discussion | 2 | 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 the decision regarding treatment should be made jointly by the individual and the clinician(s) responsible for treatment. the decision should be made after an informed discussion between the clinician(s) and the patient; this discussion should take into account contraindications and the side-effect profile of the agents, alternative treatments for locally advanced or metastatic breast cancer, and the clinical condition and preferences of the individual. |
| should made jointly individual clinician | 3 | of the drugs available for the treatment of acute mania, the choice of which to prescribe should be made jointly by the individual and the clinician(s) responsible for treatment. the choice should be based on an informed discussion of the relative benefits and side-effect profiles of each drug, and should take into account the needs of the individual and the particular clinical situation. valid consent should be obtained in all cases where the individual has the ability to grant or refuse consent. the decision to use ect should be made jointly by the individual and the clinician(s) responsible for treatment, on the basis of an informed discussion. this discussion should be enabled by the provision of full and appropriate information about the general risks associated with ect and about the risks and potential benefits specific to that individual. consent should be obtained without pressure or coercion, which may occur as a result of the circumstances and clinical setting, and the individual should be reminded of their right to withdraw consent at any point. there should be strict adherence to recognised guidelines about consent and the involvement of patient advocates and/or carers to facilitate informed discussion is strongly encouraged. the decision regarding treatment should be made jointly by the individual and the clinician(s) responsible for treatment. the decision should be made after an informed discussion between the clinician(s) and the patient; this discussion should take into account contraindications and the side-effect profile of the agents, alternative treatments for locally advanced or metastatic breast cancer, and the clinical condition and preferences of the individual. |
| should occur between patient practitioner | 2 | is combined androgen blockade better than castration alone? recommendation: a discussion should occur between the patient and his practitioner. the patient needs to appreciate that there is a small potential gain in overall survival (os) with the addition of a nonsteroidal antiandrogen to medical or surgical castration and that increased side effects may occur as a result. does early adt improve outcomes over deferred therapy? recommendation: until data from studies using modern medical diagnostic and biochemical tests and standardized follow-up schedules become available, no specific recommendations can be issued by the panel regarding the question of early versus deferred adt using lhrh agonists or orchiectomy. a discussion about the pros and cons of early versus deferred therapy should occur between patient and practitioner. antiandrogen monotherapy is not recommended. patients should be followed clinically and started on adt once symptoms of locally progressive or metastatic disease present. |
| should receive single dose tdap | 3 | 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. adolescents 11 to 18 years of age should receive a single dose of tdap instead of tetanus and diphtheria toxoids (td) vaccine for booster immunization against tetanus, diphtheria, and pertussis if they have completed the recommended childhood diphtheria, tetanus, and pertussis (dtp)/diphtheria and tetanus toxoids and acellular pertussis (dtap) immunization series* and have not received td; the preferred age for tdap immunization is 11 to 12 years. 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. |
| should referred emergency department immediately | 3 | patients with exposure due to suspected self-harm, abuse, misuse, or potentially malicious administration should be referred to an emergency department immediately regardless of the doses reported . patients with stated or suspected self-harm or who are the victims of a potentially malicious administration of beta-blocker should be referred to an emergency department immediately. this referral should be guided by local poison center procedures. in general, this should occur regardless of the dose reported patients with suspected self-harm or who are the victims of malicious administration of a tricyclic antidepressant (tca) should be referred to an emergency department immediately. |
| should referred trained healthcare professional | 2 | nurses in all practice settings should screen clients for evidence of depression, using a validated tool (such as the stroke aphasia depression questionnaire, geriatric depression scale, hospital anxiety and depression scale or the cornell scale for depression in dementia) prior to discharge throughout the continuum of care. in situations where evidence of depression is identified, clients should be referred to a trained healthcare professional for further assessment and management. nurses in all practice settings should assess/screen caregiver burden, using a validated tool (such as the caregiver strain index or the self related burden index). in situations where concerns are identified, clients should be referred to a trained healthcare professional for further assessment and management. |
| should taken fully into account | 2 | in all situations where informed discussion and consent is not possible advance directives should be taken fully into account and the individual's advocate and/or carer should be consulted. in all situations where informed discussion is not possible advance directives should be taken fully into account and the individual's advocate and/or carer should be consulted when appropriate. |
| singleagent docetaxel m2 over hour | 2 | in anthracycline-naive patients, who would ordinarily be offered treatment with a single-agent anthracycline (doxorubicin or epirubicin) or an anthracycline in a standard combination, the following options are also reasonable:treatment with single-agent docetaxel 100 mg/m2 over one hour every three weeks.docetaxel or paclitaxel in combination with doxorubicin. in anthracycline-naive patients for whom anthracyclines are contraindicated: treatment with single-agent docetaxel 100 mg/m2 over one hour every three weeks is recommended. |
| small cell lung cancer good | 2 | the combination of paclitaxel (taxol®) or docetaxel (taxotere®) with cisplatin can be recommended as one of a number of chemotherapy options in the first-line therapy of patients with advanced non-small cell lung cancer and a good performance status. strong evidence including meta-analyses indicates that there is a small survival benefit of cisplatin-based chemotherapy over best supportive care in patients with non-small cell lung cancer and good performance status. |
| stage small cell lung cancer | 3 | 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. staging: t stage in non-small cell lung cancer (nsclc):the presence of malignant cells is required to categorise the lesion as t4. 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. |
| study done after holding antisecretory | 2 | 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. 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). |
| suggestive acute myocardial infarction presenting | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| support needed education implementation process | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| supports dexrazoxane protect against cardiotoxicity | 2 | the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose epirubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician. there are no data indicating the optimal cumulative dose of epirubicin at which dexrazoxane should be instituted. for doxorubicin, use of dexrazoxane is recommended after the cumulative dose reaches 300 mg/m2 (i.e., 55% of the recommended maximum). a similar formula could be used for epirubicin; that is, institution of dexrazoxane when the cumulative dose of epirubicin reaches 550 mg/m2, as the recommended maximum cumulative dose in canada is 1,000 mg/m2. the evidence supports the use of dexrazoxane to protect against the cardiotoxicity associated with conventional-dose doxorubicin in patients with advanced but anthracycline-sensitive cancer, in whom the continued use of anthracycline-containing chemotherapy is indicated in the opinion of the treating physician, and who have received 300 mg/m2 or more of doxorubicin. |
| sustained weight loss obese adults | 2 | the uspstf recommends that clinicians screen all adult patients for obesity and offer intensive counseling and behavioral interventions to promote sustained weight loss for obese adults. the uspstf concludes that the evidence is insufficient to recommend for or against the use of moderate- or low-intensity counseling together with behavioral interventions to promote sustained weight loss in obese adults. |
| symptom onset reveals elevations greater | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| symptoms history cancer guideline developers | 3 | 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. 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. 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. |
| symptoms suggestive acute myocardial infarction | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| taken fully into account individual'advocate | 2 | in all situations where informed discussion and consent is not possible advance directives should be taken fully into account and the individual's advocate and/or carer should be consulted. in all situations where informed discussion is not possible advance directives should be taken fully into account and the individual's advocate and/or carer should be consulted when appropriate. |
| task force concludes evidence insufficient | 2 | 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. 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). |
| testosterone therapy out concomitant estrogen | 2 | testosterone therapy without concomitant estrogen therapy cannot be recommended, because there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. testosterone therapy without concomitant estrogen therapy cannot be recommended becasue there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. |
| testosterone therapy women using concomitant | 2 | testosterone therapy without concomitant estrogen therapy cannot be recommended, because there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. testosterone therapy without concomitant estrogen therapy cannot be recommended becasue there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. |
| than equal millivolts more contiguous | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| than equal more contiguous precordial | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| than shortest transverse axis positive | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| their licensed indications recommended options | 2 | olanzapine and valproate semisodium, within their licensed indications, are recommended as options for control of the acute symptoms associated with the manic phase of bipolar i disorder. 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. |
| therapy out concomitant estrogen therapy | 2 | testosterone therapy without concomitant estrogen therapy cannot be recommended, because there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. testosterone therapy without concomitant estrogen therapy cannot be recommended becasue there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. |
| therapy patients symptoms suggestive acute | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| therapy women using concomitant estrogen | 2 | testosterone therapy without concomitant estrogen therapy cannot be recommended, because there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. testosterone therapy without concomitant estrogen therapy cannot be recommended becasue there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. |
| there data safety efficacy testosterone | 2 | testosterone therapy without concomitant estrogen therapy cannot be recommended, because there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. testosterone therapy without concomitant estrogen therapy cannot be recommended becasue there are no data on the safety and efficacy of testosterone therapy in women not using concomitant estrogen. |
| there insufficient evidence time make | 2 | there is insufficient evidence at this time to make a recommendation regarding the use of continuous epidural infusion vs. intermittent injection in trauma patients. there is insufficient evidence at this time to make a definitive recommendation as to whether patients with a localized neocortical epileptogenic region will benefit or not benefit from surgical resection. |
| thought obscuring segment analysis patients | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| tool predict outcome following lumbar | 2 | the use of lumbar brace therapy as a preoperative diagnostic tool to predict outcome following lumbar fusion surgery is not recommended. the use of transpedicular external fixation as a tool to predict outcome following lumbar fusion surgery is not recommended. |
| trained healthcare professional further assessment | 2 | nurses in all practice settings should screen clients for evidence of depression, using a validated tool (such as the stroke aphasia depression questionnaire, geriatric depression scale, hospital anxiety and depression scale or the cornell scale for depression in dementia) prior to discharge throughout the continuum of care. in situations where evidence of depression is identified, clients should be referred to a trained healthcare professional for further assessment and management. nurses in all practice settings should assess/screen caregiver burden, using a validated tool (such as the caregiver strain index or the self related burden index). in situations where concerns are identified, clients should be referred to a trained healthcare professional for further assessment and management. |
| transverse axis positive scanning negative | 2 | diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:2003 recommendations:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. diagnostic evaluation of patients with advanced lung cancer: staging locoregional disease:for patients with clinically operable nsclc, biopsy is recommended of mediastinal lymph nodes found on chest ct scan to be greater than 1.0 cm in shortest transverse axis, or positive on fdg-pet scanning. negative fdg-pet scanning does not preclude biopsy of radiographically enlarged mediastinal lymph nodes. |
| ultrasonography scan scan requires biopsy | 2 | staging distant metastatic disease:2003 recommendations:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. staging distant metastatic disease:adrenal: the finding of an isolated adrenal mass on ultrasonography, ct scan, or fdg-pet scan requires biopsy to rule out metastatic disease if the patient is otherwise considered to be potentially resectable. |
| undergone breast conservation surgery should | 2 | women with early stage (stages i and ii) breast cancer who have undergone breast conservation surgery should be offered postoperative breast irradiation. 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. |
| unfractionated heparin administered hours before | 2 | alternatives for thromboprophylaxis for moderate-risk* patients undergoing gynecologic surgery include the following: thigh-high graduated compression stockings placed intraoperatively and continued until the patient is fully ambulatory pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 2 hours before surgery and continued postoperatively every 8 hours until discharge. low-molecular-weight heparin (dalteparin, 2,500 antifactor-xa u, or enoxaparin, 40 mg) administered 12 hours before surgery and once a day postoperatively until discharge. alternatives for prophylaxis for high-risk* patients undergoing gynecologic surgery, especially for malignancy, include: pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 8 hours before surgery and continued postoperatively until discharge. dalteparin (5,000 antifactor-xa u) administered 12 hours before surgery and then once a day thereafter. enoxaparin (40 mg) administered 12 hours before surgery and then once a day thereafter. |
| unresectable stage small cell lung | 2 | 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. 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. |
| until patient fully ambulatory unfractionated | 2 | alternatives for thromboprophylaxis for moderate-risk* patients undergoing gynecologic surgery include the following: thigh-high graduated compression stockings placed intraoperatively and continued until the patient is fully ambulatory pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 2 hours before surgery and continued postoperatively every 8 hours until discharge. low-molecular-weight heparin (dalteparin, 2,500 antifactor-xa u, or enoxaparin, 40 mg) administered 12 hours before surgery and once a day postoperatively until discharge. alternatives for prophylaxis for high-risk* patients undergoing gynecologic surgery, especially for malignancy, include: pneumatic compression placed intraoperatively and continued until the patient is fully ambulatory. unfractionated heparin (5,000 u) administered 8 hours before surgery and continued postoperatively until discharge. dalteparin (5,000 antifactor-xa u) administered 12 hours before surgery and then once a day thereafter. enoxaparin (40 mg) administered 12 hours before surgery and then once a day thereafter. |
| uspstf concludes evidence insufficient recommend | 5 | 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. the uspstf concludes that the evidence is insufficient to recommend for or against the routine use of new technologies to screen for cervical cancer. the uspstf concludes that the evidence is insufficient to recommend for or against the use of counseling of any intensity and behavioral interventions to promote sustained weight loss in overweight adults. 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. the uspstf concludes that the evidence is insufficient to recommend for or against the use of moderate- or low-intensity counseling together with behavioral interventions to promote sustained weight loss in obese adults. |
| uspstf recommends against routine screening | 4 | the uspstf recommends against routine screening for elevated blood lead levels in asymptomatic children aged 1 to 5 years who are at average risk . the uspstf recommends against routine screening of asymptomatic persons who are not at increased risk for syphilis infection. the uspstf recommends against routine screening for elevated blood lead levels in asymptomatic pregnant women. the uspstf recommends against routine screening for aaa in women. |
| uspstf strongly recommends clinicians screen | 2 | the uspstf strongly recommends that clinicians screen all pregnant women for syphilis infection. the uspstf strongly recommends that clinicians screen persons at increased risk for syphilis infection. |
| ventricular hypertrophy incomplete bundle branch | 2 | patient management recommendations. assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. patient management recommendations: assess for fibrinolytic therapy in patients with symptoms suggestive of acute myocardial infarction (ami) and presenting within 12 hours of symptom onset if ecg reveals: 1.st elevations greater than or equal to 0.1 millivolts (mv) (1 mm) in 2 or more contiguous limb leads or greater than or equal to 0.2 mv (2 mm) in 2 or more contiguous precordial leads lacking features of non-infarction causes of st-segment elevation (e.g., early repolarization, pericarditis, left ventricular hypertrophy [lvh], incomplete bundle branch block [bbb]). 2.any type of bbb (right, left, and atypical ? new or old) thought to be obscuring st-segment analysis in patients with clinical presentation strongly suggestive of ami. |
| whether direct indirect supportive function | 2 | organizations should develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education. involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process. ongoing opportunities for discussion and education to reinforce the importance of best practices. dedication of a qualified individual to provide the support needed for the education and implementation process. nursing best practice guidelines can be successfully implemented only where there are adequate planning, resources, organizational and administrative support, as well as appropriate facilitation. organizations may wish to develop a plan for implementation that includes: an assessment of organizational readiness and barriers to education involvement of all members (whether in a direct or indirect supportive function) who will contribute to the implementation process dedication of a qualified individual to provide the support needed for the education and implementation process ongoing opportunities for discussion and education to reinforce the importance of best practices opportunities for reflection on personal and organizational experience in implementing guidelines |
| women metastatic breast cancer being | 2 | single-agent gemcitabine is not recommended for women with metastatic breast cancer who are being considered for first-line single-agent anthracycline chemotherapy. the combination of gemcitabine, epirubicin, and paclitaxel (get) is not recommended as first-line chemotherapy for women with metastatic breast cancer who are being considered for anthracycline-based combination chemotherapy. |
| women previous cesarean delivery transverse | 2 | most women with one previous cesarean delivery with a low-transverse incision are candidates for vaginal birth after cesarean delivery (vbac) and should be counseled about vbac and offered a trial of labor. women with one previous cesarean delivery with a low transverse incision are candidates for and should be offered a trial of labor (tol). |
| years should receive single dose | 2 | 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. adolescents 11 to 18 years of age should receive a single dose of tdap instead of tetanus and diphtheria toxoids (td) vaccine for booster immunization against tetanus, diphtheria, and pertussis if they have completed the recommended childhood diphtheria, tetanus, and pertussis (dtp)/diphtheria and tetanus toxoids and acellular pertussis (dtap) immunization series* and have not received td; the preferred age for tdap immunization is 11 to 12 years. |