| quadgram | freq | conditional |
|---|---|---|
| account individual'advocate carer should | 2 | 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. 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. |
| acinetobacter species sensitive only | 3 | in patients with hap/vap caused by acinetobacter species that is sensitive only to polymyxins, we recommend intravenous polymyxin (colistin or polymyxin b) in patients with hap/vap caused by acinetobacter species that is sensitive only to polymyxins, we suggest adjunctive inhaled colistin in patients with hap/vap caused by acinetobacter species that is sensitive only to colistin, we suggest not using adjunctive rifampicin |
| 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. |
| acute coronary syndrome reduced | 2 | in all patients with a recent or remote history of mi or acute coronary syndrome and reduced ef, angiotensin-converting enzyme (ace) inhibitors should be used to prevent symptomatic hf and reduce mortality. in patients intolerant of ace inhibitors, angiotensin-receptor blockers are appropriate unless contraindicated. in all patients with a recent or remote history of mi or acute coronary syndrome and reduced ef, evidence-based beta blockers should be used to reduce mortality. |
| 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. |
| addition considered persistently symptomatic | 2 | addition of an arb may be considered in persistently symptomatic patients with hfref on gdmt addition of an arb may be considered in persistently symptomatic patients with hfref who are already being treated with an ace inhibitor and a beta blocker in whom an aldosterone antagonist is not indicated or tolerated. |
| additional risk factor cardioembolic | 3 | patients with chronic hf with permanent/persistent/paroxysmal af and an additional risk factor for cardioembolic stroke (history of hypertension, diabetes mellitus, previous stroke or transient ischemic attack, or ?75 years of age) should receive chronic anticoagulant therapy (in the absence of contraindications to anticoagulation). chronic anticoagulation is reasonable for patients with chronic hf who have permanent/persistent/paroxysmal af but are without an additional risk factor for cardioembolic stroke (in the absence of contraindications to anticoagulation). ( chronic anticoagulation is reasonable for patients with chronic hf who have permanent/persistent/paroxysmal af but are without an additional risk factor for cardioembolic stroke (in the absence of contraindications to anticoagulation). |
| adequate gramnegative activity available | 2 | in patients with suspected vap, we suggest avoiding aminoglycosides if alternative agents with adequate gram-negative activity are available in patients with suspected vap, we suggest avoiding colistin if alternative agents with adequate gram-negative activity are available |
| adjunctive therapy when prescribed | 2 | statins are not beneficial as adjunctive therapy when prescribed solely for hf statins are not beneficial as adjunctive therapy when prescribed solely for the diagnosis of hf in the absence of other indications for their use. |
| 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. |
| adrenal mass ultrasonography scan | 2 | 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. 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. |
| adults requesting protection infection | 2 | in primary care and specialty medical settings, acip recommends implementation of standing orders to identify adults recommended for hepatitis b vaccination and administer vaccination as part of routine services. to ensure vaccination of adults at risk for hbv infection who have not completed the vaccine series, acip recommends the following implementation strategies: provide information to all adults regarding the health benefits of hepatitis b vaccination, including risk factors for hbv infection and persons for whom vaccination is recommended. help all adults assess their need for vaccination by obtaining a history that emphasizes risks for sexual transmission and percutaneous or mucosal exposure to blood. vaccinate all adults who report risks for hbv infection. vaccinate all adults requesting protection from hbv infection, without requiring them to acknowledge a specific risk factor. hepatitis b vaccination is recommended for all unvaccinated adults at risk for hbv infection and for all adults requesting protection from hbv infection (see box below titled "adults recommended to receive hepatitis b vaccination"). acknowledgment of a specific risk factor should not be a requirement for vaccination. |
| advance directives should taken | 2 | 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. 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. |
| 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. |
| advanced lung cancer staging | 2 | 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. 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| aeruginosa other gramnegative bacilli | 2 | in patients with suspected vap, we recommend including coverage for s. aureus, pseudomonas aeruginosa, and other gram-negative bacilli in all empiric regimens for patients with hap who are being treated empirically, we recommend prescribing antibiotics with activity against p. aeruginosa and other gram-negative bacilli |
| aeruginosa recommend against aminoglycoside | 2 | for patients with hap/vap due to p. aeruginosa, we recommend against aminoglycoside monotherapy (strong recommendation, very low-quality evidence). for patients with hap/vap due to p. aeruginosa, we recommend against aminoglycoside monotherapy |
| african americans nyha class | 2 | the combination of hydralazine and isosorbide dinitrate is recommended for african americans with nyha class iii–iv hfref on gdmt the combination of hydralazine and isosorbide dinitrate is recommended to reduce morbidity and mortality for patients selfdescribed as african americans with nyha class iii–iv hfref receiving optimal therapy with ace inhibitors and beta blockers, unless contraindicated. |
| 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. |
| 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. |
| 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. |
| against routine screening elevated | 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 | 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. children 7 through 9 years of age who never received any pediatric dtp/dtap/dt or td dose generally should receive 3 doses of td: dose 2 is administered 4 weeks or more after dose 1, and dose 3 is administered 6 to 12 months or longer after dose 2. a 10-year-old child could receive boostrix for 1 of these doses. a single dose of tdap is recommended for adolescents 11 to 18 years of age who have completed a 3-dose td series if the series did not include boostrix during the 10th year; an interval of at least 5 years between the most recent td dose and tdap is suggested . children 7 to 10 years of age who received other incomplete immunization schedules against tetanus, diphtheria, and pertussis should be immunized against tetanus and diphtheria according to catch-up recommendations (aap, 2003) using an all-td schedule (except children in their 10th year, who could receive a single dose of boostrix substituted for 1 dose of td).children with no history or an incomplete history of pediatric dtp/dtap/dt or td immunization could have received doses. health care professionals can obtain serologic testing for antibodies against tetanus and diphtheria. toxoids in these children. if tetanus and diphtheria toxoid antibody concentrations are each protective at >0.1 iu/ml, then the child can be presumed to have been immunized against tetanus, diphtheria, and possibly pertussis, and td immunization may be deferred until the child is 11 to 12 years of age, when tdap vaccine should be given. 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. |
| agent being considered monotherapy | 2 | we suggest prescribing 2 antipseudomonal antibiotics from different classes for the empiric treatment of suspected vap only in patients with any of the following: a risk factor for antimicrobial resistance (table 2), patients in units where >10% of gram-negative isolates are resistant to an agent being considered for monotherapy, and patients in an icu where local antimicrobial susceptibility rates are not available we suggest prescribing one antibiotic active against p. aeruginosa for the empiric treatment of suspected vap in patients without risk factors for antimicrobial resistance who are being treated in icus where ?10% of gram-negative isolates are resistant to the agent being considered for monotherapy |
| agents adequate gramnegative activity | 2 | in patients with suspected vap, we suggest avoiding aminoglycosides if alternative agents with adequate gram-negative activity are available in patients with suspected vap, we suggest avoiding colistin if alternative agents with adequate gram-negative activity are available |
| agents treatment proven mssa | 2 | when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem (weak recommendation, very low-quality evidence). oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven mssa, but are not necessary for the empiric treatment of vap if one of the above agents is used. oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven mssa, but are not necessary for the empiric treatment of vap if one of the above agents is used |
| aldosterone antagonists selected patients | 2 | the clinical strategy of inhibition of the renin-angiotensin system with ace inhibitors or arbs in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. the clinical strategy of inhibition of the renin-angiotensin system with arni in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. |
| aldosterone receptor antagonists recommended | 2 | aldosterone receptor antagonists are recommended in patients with nyha class ii–iv hf who have lvef ?35% aldosterone receptor antagonists are recommended to reduce morbidity and mortality following an acute mi in patients who have lvef of ?40% who develop symptoms of hf or who have a history of diabetes mellitus, unless contraindicated. |
| alone rather than using | 4 | for patients with suspected hap/vap, we recommend using clinical criteria alone, rather than using serum pct plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we recommend using clinical criteria alone, rather than using bronchoalveolar lavage fluid (balf) strem-1 plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we recommend using clinical criteria alone rather than using crp plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we suggest using clinical criteria alone, rather than using cpis plus clinical criteria, to decide whether or not to initiate antibiotic therapy |
| also option secondline therapy | 2 | erlotinib at a dose of 150 mg/day is recommended as third-line therapy for patients with advanced recurrent or progressive non-small cell lung cancer who maintain a good performance status following previous platinum-based and docetaxel (or pemetrexed) chemotherapy. erlotinib is also an option for second-line therapy, particularly in patients who are not candidates for chemotherapy or for those with progression after first-line docetaxel-platinum chemotherapy. single-agent pemetrexed (alimta®) at a dose of 500 mg/m2 every three weeks is also an option for second-line therapy of recurrent or progressive disease, if available. this chemotherapy should be administered with vitamin supplements: oral folic acid 350-1,000 micrograms daily and intramuscular vitamin b12 1,000 micrograms every nine weeks, beginning between one to two weeks before, and continuing until three weeks after chemotherapy. |
| alternative agents adequate gramnegative | 2 | in patients with suspected vap, we suggest avoiding aminoglycosides if alternative agents with adequate gram-negative activity are available in patients with suspected vap, we suggest avoiding colistin if alternative agents with adequate gram-negative activity are available |
| alternatives inhibitors firstline therapy | 2 | arbs are reasonable as alternatives to ace inhibitors as first-line therapy in hfref arbs are reasonable to reduce morbidity and mortality as alternatives to ace inhibitors as first-line therapy for patients with hfref, especially for patients already taking arbs for other indications, unless contraindicated. |
| ambulatory class symptoms gdmt | 3 | cardiac resynchronization therapy is indicated for patients who have lvef of 35% or less, sinus rhythm, left bundle-branch block (lbbb) with a qrs duration of 150 ms or greater, and nyha class ii, iii, or ambulatory class iv symptoms on gdmt. crt can be useful for patients who have lvef of ?35% , sinus rhythm, a non-lbbb pattern with a qrs duration of ?150 ms, and nyha class iii/ambulatory class iv symptoms on gdmt. crt can be useful for patients who have lvef of ?35%, sinus rhythm, lbbb with a qrs duration of 120–149 ms, and nyha class ii, iii, or ambulatory class iv symptoms on gdmt. |
| 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. |
| 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. |
| 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. |
| angiotensin receptorneprilysin inhibitor should | 2 | angiotensin receptor-neprilysin inhibitor should not be administered concomitantly with ace inhibitors or within 36 hours of the last dose of an ace inhibitor. angiotensin receptor-neprilysin inhibitor should not be administered to patients with a history of angioedema. |
| antagonists selected patients recommended | 2 | the clinical strategy of inhibition of the renin-angiotensin system with ace inhibitors or arbs in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. the clinical strategy of inhibition of the renin-angiotensin system with arni in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. |
| 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. |
| 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. |
| antibiotic susceptibility testing known | 2 | for patients with hap/vap due to p. aeruginosa who are not in septic shock or at a high risk for death, and for whom the results of antibiotic susceptibility testing are known, we recommend monotherapy using an antibiotic to which the isolate is susceptible rather than combination therapy for patients with hap/vap due to p. aeruginosa who remain in septic shock or at a high risk for death when the results of antibiotic susceptibility testing are known, we suggest combination therapy using 2 antibiotics to which the isolate is susceptible rather than monotherapy |
| anticoagulation oral such warfarin | 2 | for patients with af and prosthetic heart valves, the guideline developers recommend anticoagulation with an oral vka, such as warfarin. for af occurring shortly after open-heart surgery and lasting >48 hours, the guideline developers suggest anticoagulation with an oral vka, such as warfarin, if bleeding risks are acceptable (grade 2c). the target inr is 2.5 (range, 2.0 to 3.0). the guideline developers suggest continuing anticoagulation for several weeks following reversion to normal sinus rhythm (nsr), particularly if patients have risk factors for thromboembolism. |
| anticoagulation reasonable patients chronic | 2 | chronic anticoagulation is reasonable for patients with chronic hf who have permanent/persistent/paroxysmal af but are without an additional risk factor for cardioembolic stroke (in the absence of contraindications to anticoagulation). ( chronic anticoagulation is reasonable for patients with chronic hf who have permanent/persistent/paroxysmal af but are without an additional risk factor for cardioembolic stroke (in the absence of contraindications to anticoagulation). |
| anticoagulation recommended patients chronic | 2 | anticoagulation is not recommended in patients with chronic hfref without af, a prior thromboembolic event, or a cardioembolic source anticoagulation is not recommended in patients with chronic hfref without af, a prior thromboembolic event, or a cardioembolic source. (iii-b: no benefit) |
| antimicrobial resistance being treated | 2 | we suggest including an agent active against methicillinsensitive s. aureus (mssa) (and not mrsa) for the empiric treatment of suspected vap in patients without risk factors for antimicrobial resistance, who are being treated in icus where <10%–20% of s. aureus isolates are methicillin resistant (weak recommendation, very low-quality evidence). we suggest prescribing one antibiotic active against p. aeruginosa for the empiric treatment of suspected vap in patients without risk factors for antimicrobial resistance who are being treated in icus where ?10% of gram-negative isolates are resistant to the agent being considered for monotherapy |
| appropriate initial subsequent treatment | 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 | 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. |
| arbs recommended patients hfref | 2 | arbs are recommended in patients with hfref who are ace inhibitor–intolerant arbs are recommended in patients with hfref with current or prior symptoms who are ace inhibitor–intolerant, unless contraindicated, to reduce morbidity and mortality. |
| aromatase inhibitors anastrozole exemestane | 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. |
| artery revascularization coronary artery | 2 | coronary artery revascularization via coronary artery bypass graft (cabg) or percutaneous intervention is indicated for patients (hfpef and hfref) on gdmt with angina and suitable coronary anatomy, especially for a left main stenosis (>50%) or left main–equivalent disease. (i-c) coronary artery revascularization via coronary artery bypass graft to improve survival is reasonable in patients with mild to moderate lv systolic dysfunction (ef 35%–50%) and significant (?70% diameter stenosis) multivessel cad or proximal left anterior descending (lad) coronary artery stenosis when viable myocardium is present in the region of intended revascularization. (iia-b) |
| aspergillus skin soft tissue | 2 | aspergillus skin and soft tissue infections should be treated with voriconazole alternatively to voriconazole treat aspergillus skin and soft tissue infections with lipid formulations of amphotericin b, posaconazole or echinocandin for 6-12 weeks |
| 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. |
| assessment organizational readiness barriers | 2 | 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 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. |
| associated related macular degeneration | 2 | the use of pdt in occult cnv associated with wet age-related macular degeneration was not considered because the photosensitising agent (verteporfin) was not licensed for this indication when this appraisal began. no recommendation is made with regard to the use of this technology in people with this form of the condition. pdt is not recommended for the treatment of people with predominantly classic subfoveal cnv (that is, 50% or more of the entire area of the lesion is classic cnv but some occult cnv is present) associated with wet age-related macular degeneration, except as part of ongoing or new clinical studies that are designed to generate robust and relevant outcome data, including data on optimum treatment regimens, long-term outcomes, quality of life, and costs. |
| attain systolic blood pressure | 2 | patients with hfref and hypertension should be prescribed gdmt titrated to attain systolic blood pressure <130 mm hg. patients with hfpef and persistent hypertension after management of volume overload should be prescribed gdmt titrated to attain systolic blood pressure <130 mm hg |
| 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. |
| aureus isolates methicillin resistant | 3 | we suggest including an agent active against mrsa for the empiric treatment of suspected vap only in patients with any of the following: a risk factor for antimicrobial resistance (table 2), patients being treated in units where >10%–20% of s. aureus isolates are methicillin resistant, and patients in units where the prevalence of mrsa is not known we suggest including an agent active against methicillinsensitive s. aureus (mssa) (and not mrsa) for the empiric treatment of suspected vap in patients without risk factors for antimicrobial resistance, who are being treated in icus where <10%–20% of s. aureus isolates are methicillin resistant (weak recommendation, very low-quality evidence). for patients with hap who are being treated empirically and have either a risk factor for mrsa infection (ie, prior intravenous antibiotic use within 90 days, hospitalization in a unit where >20% of s. aureus isolates are methicillin resistant, or the prevalence of mrsa is not known, or who are at high risk for mortality, we suggest prescribing an antibiotic with activity against mrsa |
| axis positive scanning negative | 2 | 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. 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. |
| barriers education involvement members | 2 | 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 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. |
| 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. |
| based upon results antimicrobial | 2 | for patients with hap/vap due to p. aeruginosa, we recommend that the choice of an antibiotic for definitive (not empiric) therapy be based upon the results of antimicrobial susceptibility testing for patients with hap/vap due to esbl-producing gramnegative bacilli, we recommend that the choice of an antibiotic for definitive (not empiric) therapy be based upon the results of antimicrobial susceptibility testing and patient-specific factors |
| basic life support training | 2 | pediatricians and pediatric subspecialty providers should lead by example by taking and teaching basic life support training courses. basic life support training for the aforementioned groups should be advocated in policy advisory discussions at all governmental levels with a goal of making the training readily available and affordable. |
| basis risk factors cost | 2 | the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. ( the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. |
| 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. |
| behavioral interventions promote sustained | 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. |
| being treated empirically recommend | 3 | for patients being treated empirically for hap, we recommend prescribing an antibiotic with activity against s. aureus for patients with hap who are being treated empirically, we recommend prescribing antibiotics with activity against p. aeruginosa and other gram-negative bacilli for patients with hap who are being treated empirically, we recommend not using an aminoglycoside as the sole antipseudomonal agent |
| beneficial adjunctive therapy when | 2 | statins are not beneficial as adjunctive therapy when prescribed solely for hf statins are not beneficial as adjunctive therapy when prescribed solely for the diagnosis of hf in the absence of other indications for their use. |
| beta blockers aldosterone antagonists | 2 | the clinical strategy of inhibition of the renin-angiotensin system with ace inhibitors or arbs in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. the clinical strategy of inhibition of the renin-angiotensin system with arni in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. |
| beta blockers proven reduce | 2 | use of 1 of the 3 beta blockers proven to reduce mortality is recommended for all stable patients use of 1 of the 3 beta blockers proven to reduce mortality (ie, bisoprolol, carvedilol, and sustained-release metoprolol succinate) is recommended for all patients with current or prior symptoms of hfref, unless contraindicated, to reduce morbidity and mortality. |
| beta blockers should used | 2 | in all patients with a recent or remote history of mi or acute coronary syndrome and reduced ef, evidence-based beta blockers should be used to reduce mortality. beta blockers should be used in all patients with a reduced ef to prevent symptomatic hf, even if they do not have a history of mi. |
| 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. |
| 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. |
| biopsy radiographically enlarged mediastinal | 2 | 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. 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. |
| biopsy recommended mediastinal lymph | 2 | 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. 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. |
| biopsy rule metastatic disease | 2 | 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. 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. |
| blockers aldosterone antagonists selected | 2 | the clinical strategy of inhibition of the renin-angiotensin system with ace inhibitors or arbs in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. the clinical strategy of inhibition of the renin-angiotensin system with arni in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. |
| blockers proven reduce mortality | 2 | use of 1 of the 3 beta blockers proven to reduce mortality is recommended for all stable patients use of 1 of the 3 beta blockers proven to reduce mortality (ie, bisoprolol, carvedilol, and sustained-release metoprolol succinate) is recommended for all patients with current or prior symptoms of hfref, unless contraindicated, to reduce morbidity and mortality. |
| blocking drugs recommended routine | 2 | calcium channel–blocking drugs are not recommended as routine treatment in hfref calcium channel–blocking drugs are not recommended as routine treatment for patients with hfref. |
| 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. |
| blood pressure should controlled | 2 | in patients with structural cardiac abnormalities, including lv hypertrophy, in the absence of a history of mi or acs, blood pressure should be controlled in accordance with clinical practice guidelines for hypertension to prevent symptomatic hf. systolic and diastolic blood pressure should be controlled in patients with hfpef in accordance with published clinical practice guidelines to prevent morbidity. |
| 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 . |
| bone scanning liver ultrasonography | 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. |
| 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. |
| 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. |
| 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. |
| cancer adenomatous polyp diagnosed | 2 | screening people at increased risk people with a first-degree relative with colon cancer or adenomatous polyp diagnosed at age >60 years or 2 second-degree relatives with colorectal cancer should be advised to be screened as average risk persons, but beginning at age 40 years. surveillance with colonoscopy should be considered for patients who are at increased risk because they have been treated for colorectal cancer, have an adenomatous polyp diagnosed, or have a disease that predisposes them to colorectal cancer, such as inflammatory bowel disease. |
| cancer 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. |
| 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. |
| 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. |
| candida parapsilosis been isolated | 2 | candida species skin and soft tissue infections should be treated with an echinocandin or, if candida parapsilosis has been isolated, lipid formulation amphotericin-b (sr-h) if candida parapsilosis has been isolated treat with fluconazole as an acceptable alternative to lipid formulation amphotericin-b |
| candidates chemotherapy m erlotinib | 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. |
| cannot stabilized standard medical | 2 | long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment (see recommendations for stage d starting on page 34). |
| carbapenemresistant pathogen sensitive only | 2 | in patients with hap/vap caused by a carbapenem-resistant pathogen that is sensitive only to polymyxins, we recommend intravenous polymyxins (colistin or polymyxin b) in patients with hap/vap caused by a carbapenem-resistant pathogen that is sensitive only to polymyxins, we suggest adjunctive inhaled colistin |
| carefully selected patients stage | 2 | mcs is beneficial in carefully selected patients with stage d hfref in whom definitive management (eg, cardiac transplantation) or cardiac recovery is anticipated or planned. evaluation for cardiac transplantation is indicated for carefully selected patients with stage d hf despite gdmt, device, and surgical management. |
| caused acinetobacter species sensitive | 3 | in patients with hap/vap caused by acinetobacter species that is sensitive only to polymyxins, we recommend intravenous polymyxin (colistin or polymyxin b) in patients with hap/vap caused by acinetobacter species that is sensitive only to polymyxins, we suggest adjunctive inhaled colistin in patients with hap/vap caused by acinetobacter species that is sensitive only to colistin, we suggest not using adjunctive rifampicin |
| caused carbapenemresistant pathogen sensitive | 2 | in patients with hap/vap caused by a carbapenem-resistant pathogen that is sensitive only to polymyxins, we recommend intravenous polymyxins (colistin or polymyxin b) in patients with hap/vap caused by a carbapenem-resistant pathogen that is sensitive only to polymyxins, we suggest adjunctive inhaled colistin |
| 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. |
| cefazolin preferred agents treatment | 2 | when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem (weak recommendation, very low-quality evidence). oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven mssa, but are not necessary for the empiric treatment of vap if one of the above agents is used. oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven mssa, but are not necessary for the empiric treatment of vap if one of the above agents is used |
| cefazolin preferred treatment proven | 2 | for patients with hap who are being treated empirically and have no risk factors for mrsa infection and are not at high risk of mortality, we suggest prescribing an antibiotic with activity against mssa. when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used |
| cefepime levofloxacin imipenem meropenem | 3 | when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem (weak recommendation, very low-quality evidence). oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven mssa, but are not necessary for the empiric treatment of vap if one of the above agents is used. for patients with hap who are being treated empirically and have no risk factors for mrsa infection and are not at high risk of mortality, we suggest prescribing an antibiotic with activity against mssa. when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used |
| 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. |
| cellmediated immunodeficiency immersion injuries | 2 | cultures of blood are recommended in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites cultures and microscopic examination of cutaneous aspirates, biopsies, or swabs should be considered in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites ( |
| 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). |
| characteristics including time international | 2 | the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. ( the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. |
| 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. |
| 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. |
| chemotherapy neutropenia severe cellmediated | 2 | cultures of blood are recommended in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites cultures and microscopic examination of cutaneous aspirates, biopsies, or swabs should be considered in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites ( |
| chest radiograph findings normal | 2 | in patients with chronic cough with normal chest radiograph findings, normal spirometry findings, and no evidence of variable airflow obstruction or airway hyperresponsiveness, the diagnosis of nonasthmatic eosinophilic bronchitis as the cause of the chronic cough is confirmed by the presence of an airway eosinophilia, either by sputum induction or bronchial wash fluid obtained by bronchoscopy, and an improvement in the cough following corticosteroid therapy. in patients with a suspicion of airway involvement by a malignancy (e.g., smokers with hemoptysis), even when the chest radiograph findings are normal, bronchoscopy is indicated. |
| chest scan greater than | 2 | 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. 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. |
| 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. |
| children otitis media effusion | 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. |
| 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. |
| chronic anticoagulation reasonable patients | 2 | chronic anticoagulation is reasonable for patients with chronic hf who have permanent/persistent/paroxysmal af but are without an additional risk factor for cardioembolic stroke (in the absence of contraindications to anticoagulation). ( chronic anticoagulation is reasonable for patients with chronic hf who have permanent/persistent/paroxysmal af but are without an additional risk factor for cardioembolic stroke (in the absence of contraindications to anticoagulation). |
| chronic 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. |
| chronic hfref out prior | 2 | anticoagulation is not recommended in patients with chronic hfref without af, a prior thromboembolic event, or a cardioembolic source anticoagulation is not recommended in patients with chronic hfref without af, a prior thromboembolic event, or a cardioembolic source. (iii-b: no benefit) |
| chronic hfref reduce morbidity | 3 | the clinical strategy of inhibition of the renin-angiotensin system with ace inhibitors or arbs in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. the clinical strategy of inhibition of the renin-angiotensin system with arni in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. the use of ace inhibitors is beneficial for patients with prior or current symptoms of chronic hfref to reduce morbidity and mortality. |
| 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. |
| chronic obstructive pulmonary disease | 3 | in a patient with an acute respiratory infection manifested predominantly by cough, with or without sputum production, lasting no more than 3 weeks, a diagnosis of acute bronchitis should not be made unless there is no clinical or radiographic evidence of pneumonia and the common cold, acute asthma, or an exacerbation of chronic obstructive pulmonary disease (copd) have been ruled out as the cause of cough. at-risk adults and children are defined for the purpose of this guidance as those who are in at least one of the following groups. people who: have chronic respiratory disease (including asthma and chronic obstructive pulmonary disease). have significant cardiovascular disease (excluding people with hypertension only). have chronic renal disease. are immunocompromised. have diabetes mellitus. are aged 65 years or older. preoperative spirometry and chest radiography should not be used routinely for predicting risk for postoperative pulmonary complications. preoperative pulmonary function testing or chest radiography may be appropriate in patients with a previous diagnosis of chronic obstructive pulmonary disease or asthma. |
| chronic permanent persistent paroxysmal | 3 | patients with chronic hf with permanent/persistent/paroxysmal af and an additional risk factor for cardioembolic stroke (history of hypertension, diabetes mellitus, previous stroke or transient ischemic attack, or ?75 years of age) should receive chronic anticoagulant therapy (in the absence of contraindications to anticoagulation). chronic anticoagulation is reasonable for patients with chronic hf who have permanent/persistent/paroxysmal af but are without an additional risk factor for cardioembolic stroke (in the absence of contraindications to anticoagulation). ( chronic anticoagulation is reasonable for patients with chronic hf who have permanent/persistent/paroxysmal af but are without an additional risk factor for cardioembolic stroke (in the absence of contraindications to anticoagulation). |
| class ambulatory class symptoms | 3 | cardiac resynchronization therapy is indicated for patients who have lvef of 35% or less, sinus rhythm, left bundle-branch block (lbbb) with a qrs duration of 150 ms or greater, and nyha class ii, iii, or ambulatory class iv symptoms on gdmt. crt can be useful for patients who have lvef of ?35% , sinus rhythm, a non-lbbb pattern with a qrs duration of ?150 ms, and nyha class iii/ambulatory class iv symptoms on gdmt. crt can be useful for patients who have lvef of ?35%, sinus rhythm, lbbb with a qrs duration of 120–149 ms, and nyha class ii, iii, or ambulatory class iv symptoms on gdmt. |
| 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. |
| clinical characteristics including time | 2 | the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. ( the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. |
| clinical criteria alone rather | 4 | for patients with suspected hap/vap, we recommend using clinical criteria alone, rather than using serum pct plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we recommend using clinical criteria alone, rather than using bronchoalveolar lavage fluid (balf) strem-1 plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we recommend using clinical criteria alone rather than using crp plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we suggest using clinical criteria alone, rather than using cpis plus clinical criteria, to decide whether or not to initiate antibiotic therapy |
| clinical criteria decide whether | 4 | for patients with suspected hap/vap, we recommend using clinical criteria alone, rather than using serum pct plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we recommend using clinical criteria alone, rather than using bronchoalveolar lavage fluid (balf) strem-1 plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we recommend using clinical criteria alone rather than using crp plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we suggest using clinical criteria alone, rather than using cpis plus clinical criteria, to decide whether or not to initiate antibiotic therapy |
| clinical grounds out prior | 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. |
| 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. |
| clinical strategy inhibition reninangiotensin | 2 | the clinical strategy of inhibition of the renin-angiotensin system with ace inhibitors or arbs in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. the clinical strategy of inhibition of the renin-angiotensin system with arni in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. |
| clinically operable nsclc biopsy | 2 | 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. 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. |
| clinicians considering laboratory blood | 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 . |
| clinicians should refer patients | 2 | clinicians should refer patients who require treatment with multiple psychotropic medications and/or are using illicit substances for psychiatric consultation because of the risk of drug-drug interactions and toxicity. clinicians should refer patients with had who present with accompanying depression, mania, psychosis, behavioral disturbance, or substance use for psychiatric consultation to assist in psychopharmacologic treatment and management. |
| combination hydralazine isosorbide dinitrate | 4 | the combination of hydralazine and isosorbide dinitrate is recommended for african americans with nyha class iii–iv hfref on gdmt a combination of hydralazine and isosorbide dinitrate can be useful in patients with hfref who cannot be given ace inhibitors or arbs the combination of hydralazine and isosorbide dinitrate is recommended to reduce morbidity and mortality for patients selfdescribed as african americans with nyha class iii–iv hfref receiving optimal therapy with ace inhibitors and beta blockers, unless contraindicated. a combination of hydralazine and isosorbide dinitrate can be useful to reduce morbidity or mortality in patients with current or prior symptomatic hfref who cannot be given an ace inhibitor or arb because of drug intolerance, hypotension, or renal insufficiency, unless contraindicated. |
| 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. |
| commonly used fractionation schedules | 2 | the optimal fractionation schedule for breast irradiation has not been established and the role of boost irradiation is unclear. outside of a clinical trial, two commonly used fractionation schedules are suggested: 50 gy in 25 fractions to the whole breast, or 40 gy in 16 fractions to the whole breast with a local boost to the primary site of 12.5 gy in five fractions. shorter schedules (e.g., 40 or 44 gy in 16 fractions) have also been used routinely in some centres. the enrolment of patients in ongoing clinical trials is encouraged. altered dose fractionation whole brain radiotherapy schedules have not demonstrated any advantages in terms of overall survival or neurologic function relative to more commonly used fractionation schedules. |
| 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. |
| concludes evidence insufficient recommend | 7 | 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 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). 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 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 | 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. |
| conjunction evidencebased beta blockers | 2 | the clinical strategy of inhibition of the renin-angiotensin system with ace inhibitors or arbs in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. the clinical strategy of inhibition of the renin-angiotensin system with arni in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. |
| 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. |
| considered patients lvef sinus | 2 | crt may be considered for patients who have lvef of ?35%, sinus rhythm, a non-lbbb pattern with a qrs duration of 120–149 ms, and nyha class iii/ambulatory class iv on gdmt. crt may be considered for patients who have lvef of ?35%, sinus rhythm, a non-lbbb pattern with a qrs duration of ?150 ms, and nyha class ii symptoms on gdmt. |
| considered persistently symptomatic patients | 2 | addition of an arb may be considered in persistently symptomatic patients with hfref on gdmt addition of an arb may be considered in persistently symptomatic patients with hfref who are already being treated with an ace inhibitor and a beta blocker in whom an aldosterone antagonist is not indicated or tolerated. |
| 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 . |
| 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. |
| 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. |
| 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. |
| 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. |
| continuous intravenous inotropic support | 3 | continuous intravenous inotropic support is reasonable as “bridge therapy” in patients with stage d hf refractory to gdmt and device therapy who are eligible for and awaiting mcs or cardiac transplantation. short-term, continuous intravenous inotropic support may be reasonable in those hospitalized patients presenting with documented severe systolic dysfunction who present with low blood pressure and significantly depressed cardiac output to maintain systemic perfusion and preserve end-organ performance. long-term, continuous intravenous inotropic support may be considered as palliative therapy for symptom control in select patients with stage d hf despite optimal gdmt and device therapy who are not eligible for either mcs or cardiac transplantation. |
| continuous positive airway pressure | 2 | certain apap devices may be used during attended titration to identify by polysomnography, a single pressure for use with standard continuous positive airway pressure (cpap) for treatment of osa. for patients with a current diagnosis of a sleep disorder, documentation and continuation of ongoing treatments, such as continuous positive airway pressure (cpap), should be maintained and reinforced by patient and family education. |
| contraindicated reduce morbidity mortality | 4 | ace inhibitors are recommended in patients with hfref and current or prior symptoms, unless contraindicated, to reduce morbidity and mortality. (i-a) arbs are recommended in patients with hfref with current or prior symptoms who are ace inhibitor–intolerant, unless contraindicated, to reduce morbidity and mortality. use of 1 of the 3 beta blockers proven to reduce mortality (ie, bisoprolol, carvedilol, and sustained-release metoprolol succinate) is recommended for all patients with current or prior symptoms of hfref, unless contraindicated, to reduce morbidity and mortality. aldosterone receptor antagonists (or mineralocorticoid receptor antagonists) are recommended in patients with nyha class ii–iv and who have lvef of ?35%, unless contraindicated, to reduce morbidity and mortality. patients with nyha class ii should have a history of prior cardiovascular hospitalization or elevated plasma natriuretic peptide levels to be considered for aldosterone receptor antagonists. creatinine levels should be ?2.5 mg/dl in men or ?2.0 mg/dl in women (or estimated glomerular filtration rate >30 ml/min/1.73 m2) 2) and potassium levels should be <5.0 meq/l. careful monitoring of potassium levels, renal function, and diuretic dosing should be performed at initiation and closely followed thereafter to minimize risk of hyperkalemia and renal insufficiency. |
| 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. |
| coronary artery bypass graft | 2 | coronary artery revascularization via coronary artery bypass graft (cabg) or percutaneous intervention is indicated for patients (hfpef and hfref) on gdmt with angina and suitable coronary anatomy, especially for a left main stenosis (>50%) or left main–equivalent disease. (i-c) coronary artery revascularization via coronary artery bypass graft to improve survival is reasonable in patients with mild to moderate lv systolic dysfunction (ef 35%–50%) and significant (?70% diameter stenosis) multivessel cad or proximal left anterior descending (lad) coronary artery stenosis when viable myocardium is present in the region of intended revascularization. (iia-b) |
| coronary artery revascularization coronary | 2 | coronary artery revascularization via coronary artery bypass graft (cabg) or percutaneous intervention is indicated for patients (hfpef and hfref) on gdmt with angina and suitable coronary anatomy, especially for a left main stenosis (>50%) or left main–equivalent disease. (i-c) coronary artery revascularization via coronary artery bypass graft to improve survival is reasonable in patients with mild to moderate lv systolic dysfunction (ef 35%–50%) and significant (?70% diameter stenosis) multivessel cad or proximal left anterior descending (lad) coronary artery stenosis when viable myocardium is present in the region of intended revascularization. (iia-b) |
| corticosteroids followed inhaled corticosteroids | 2 | patients with severe and/or refractory cough due to asthma should receive a short course (1 to 2 weeks) of systemic (oral) corticosteroids followed by inhaled corticosteroids. in patients with cough secondary to sarcoidosis, therapy with oral corticosteroids followed by inhaled corticosteroids may improve symptoms. |
| cost tolerability patient preference | 2 | the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. ( the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. |
| 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. |
| coverage above agents used | 2 | for patients with hap who are being treated empirically and have no risk factors for mrsa infection and are not at high risk of mortality, we suggest prescribing an antibiotic with activity against mssa. when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used |
| criteria alone rather than | 4 | for patients with suspected hap/vap, we recommend using clinical criteria alone, rather than using serum pct plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we recommend using clinical criteria alone, rather than using bronchoalveolar lavage fluid (balf) strem-1 plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we recommend using clinical criteria alone rather than using crp plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we suggest using clinical criteria alone, rather than using cpis plus clinical criteria, to decide whether or not to initiate antibiotic therapy |
| criteria decide whether initiate | 4 | for patients with suspected hap/vap, we recommend using clinical criteria alone, rather than using serum pct plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we recommend using clinical criteria alone, rather than using bronchoalveolar lavage fluid (balf) strem-1 plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we recommend using clinical criteria alone rather than using crp plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we suggest using clinical criteria alone, rather than using cpis plus clinical criteria, to decide whether or not to initiate antibiotic therapy |
| culture exudates skin lesions | 2 | gram stain and culture of the pus or exudates from skin lesions of impetigo and ecthyma are recommended to help identify whether staphylococcus aureus and/or a ?-hemolytic streptococcus is the cause treatment without gram stain and culture of the pus or exudates from skin lesions of impetigo and ecthyma is reasonable in typical cases |
| current prior symptoms hfref | 5 | nutritional supplements as treatment for hf are not recommended in patients with current or prior symptoms of hfref. ( drugs known to adversely affect the clinical status of patients with current or prior symptoms of hfref are potentially harmful and should be avoided or withdrawn whenever possible (eg, most antiarrhythmic drugs, most calcium channel–blocking drugs [except amlodipine], nonsteroidal anti-inflammatory drugs, or thiazolidinediones). use of 1 of the 3 beta blockers proven to reduce mortality (ie, bisoprolol, carvedilol, and sustained-release metoprolol succinate) is recommended for all patients with current or prior symptoms of hfref, unless contraindicated, to reduce morbidity and mortality. nutritional supplements as treatment for hf are not recommended in patients with current or prior symptoms of hfref. hormonal therapies other than to correct deficiencies are not recommended for patients with current or prior symptoms of hfref. |
| current symptoms chronic hfref | 2 | the use of ace inhibitors is beneficial for patients with prior or current symptoms of chronic hfref to reduce morbidity and mortality. the use of arbs to reduce morbidity and mortality is recommended in patients with prior or current symptoms of chronic hfref who are intolerant to ace inhibitors because of cough or angioedema. |
| cutaneous aspirates biopsies swabs | 2 | cultures of blood or cutaneous aspirates, biopsies, or swabs are not routinely recommended cultures and microscopic examination of cutaneous aspirates, biopsies, or swabs should be considered in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites ( |
| cyclophosphamide doxorubicin vincristine prednisone | 2 | combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (chop) is recommended for patients with no apparent cardiac disease or significant comorbidity. dose and schedule should be the same as that used in younger patients. previously untreated patients with diffuse large b-cell lymphoma (dlbcl), or a variant of dlbcl (such as mediastinal sclerosing b-cell lymphoma, t-cell-rich b-cell lymphoma, burkitt-like lymphoma, or intravascular lymphoma), who are candidates for treatment with curative intent and will receive cyclophosphamide, doxorubicin, vincristine, and prednisone (chop), should receive this therapy in combination with rituximab. |
| 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. |
| decide whether initiate antibiotic | 4 | for patients with suspected hap/vap, we recommend using clinical criteria alone, rather than using serum pct plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we recommend using clinical criteria alone, rather than using bronchoalveolar lavage fluid (balf) strem-1 plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we recommend using clinical criteria alone rather than using crp plus clinical criteria, to decide whether or not to initiate antibiotic therapy for patients with suspected hap/vap, we suggest using clinical criteria alone, rather than using cpis plus clinical criteria, to decide whether or not to initiate antibiotic therapy |
| dedication qualified individual provide | 2 | 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 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. |
| dehydration fluid electrolyte imbalance | 2 | step 6: are the causes and consequences of the patient's dehydration or fluid/electrolyte imbalance to be treated? if it is decided to treat the causes of the patient's dehydration or fluid/electrolyte imbalance or to intervene to correct or prevent a fluid deficit or electrolyte imbalance, proceed to step 7.if the cause of the patient's dehydration is not clear, continue to look for that cause while providing appropriate support and symptomatic management. if it is decided not to treat or intervene because the patient has a terminal or end-stage condition or because the patient or family has requested no intervention, or for any other valid clinical reason, document the reasons for this decision in the patient's medical record. step 2 is the patient at risk for dehydration or fluid/electrolyte imbalance? if the patient is not currently dehydrated and has either no fluid/electrolyte imbalance or a mild fluid/electrolyte imbalance, it is important to identify the risk for development or progression of these conditions. caregivers should pay close attention to clinical conditions and environmental factors that may increase risk for dehydration or fluid/electrolyte imbalance . |
| 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). |
| density lipoprotein cholesterol highdensity | 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 | 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 | 2 | 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 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. |
| 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. |
| 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. |
| 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. |
| diagnostic evaluation patients advanced | 2 | 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. 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. |
| diphtheria tetanus toxoids acellular | 2 | 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. 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. |
| direct indirect supportive function | 2 | 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 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. |
| directives should taken fully | 2 | 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. 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. |
| discussion education reinforce importance | 2 | 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 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. |
| disease cannot stabilized standard | 2 | long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment (see recommendations for stage d starting on page 34). |
| disease patient otherwise considered | 2 | 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. 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. |
| distantsite palliative effects externalbeam | 2 | treatment:radiotherapy:local- and distant-site palliative effects of external-beam radiation treatment:radiotherapy:2003 recommendations:local- and distant-site palliative effects of external-beam radiation no change. |
| diuretics recommended patients hfref | 2 | diuretics are recommended in patients with hfref with fluid retention diuretics are recommended in patients with hfref who have evidence of fluid retention, unless contraindicated, to improve symptoms. |
| docetaxel m2 over hour | 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. |
| documented severe systolic dysfunction | 2 | short-term, continuous intravenous inotropic support may be reasonable in those hospitalized patients presenting with documented severe systolic dysfunction who present with low blood pressure and significantly depressed cardiac output to maintain systemic perfusion and preserve end-organ performance. use of parenteral inotropic agents in hospitalized patients without documented severe systolic dysfunction, low blood pressure, or impaired perfusion, and evidence of significantly depressed cardiac output, with or without congestion, is potentially harmful. |
| does preclude biopsy radiographically | 2 | 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. 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. |
| 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). |
| drug interactions other clinical | 2 | the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. ( the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. |
| drugs potentially harmful patients | 2 | long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment (see recommendations for stage d starting on page 34). |
| drugs recommended routine treatment | 2 | calcium channel–blocking drugs are not recommended as routine treatment in hfref calcium channel–blocking drugs are not recommended as routine treatment for patients with hfref. |
| duration nyha class ambulatory | 3 | crt can be useful for patients who have lvef of ?35% , sinus rhythm, a non-lbbb pattern with a qrs duration of ?150 ms, and nyha class iii/ambulatory class iv symptoms on gdmt. crt can be useful for patients who have lvef of ?35%, sinus rhythm, lbbb with a qrs duration of 120–149 ms, and nyha class ii, iii, or ambulatory class iv symptoms on gdmt. crt may be considered for patients who have lvef of ?35%, sinus rhythm, a non-lbbb pattern with a qrs duration of 120–149 ms, and nyha class iii/ambulatory class iv on gdmt. |
| duration nyha class symptoms | 2 | crt may be considered for patients who have lvef of ?35%, sinus rhythm, a non-lbbb pattern with a qrs duration of ?150 ms, and nyha class ii symptoms on gdmt. crt may be considered for patients who have lvef of ?30%, ischemic etiology of hf, sinus rhythm, lbbb with a qrs duration of ?150 ms, and nyha class i symptoms on gdmt. |
| 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. |
| 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. |
| eating disorders should receive | 2 | infants and children with eating disorders should receive an oromotor assessment by an occupational therapist, speech therapist, nurse, or physician with training in pediatric oromotor dysfunction. infants and children requiring tube feedings for eating disorders should receive the minimum supplemental support necessary to maintain growth and development. |
| education reinforce importance best | 2 | 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 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. |
| effective shortterm treatment infantile | 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 | 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 | 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 | 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 | 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 | 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. |
| emission tomography scanning recommended | 2 | staging of small sclc for the routine staging of patients with sclc, positron emission tomography (pet) scanning is not recommended outside of a clinical trial. [18f]fluorodeoxyglucose?positron emission tomography scanning:recommendation: [18f]fluorodeoxyglucose-positron emission tomography (fdg-pet) scanning is not recommended for routine breast cancer surveillance. |
| empiric coverage above agents | 2 | for patients with hap who are being treated empirically and have no risk factors for mrsa infection and are not at high risk of mortality, we suggest prescribing an antibiotic with activity against mssa. when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used |
| empiric treatment above agents | 2 | when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem (weak recommendation, very low-quality evidence). oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven mssa, but are not necessary for the empiric treatment of vap if one of the above agents is used. oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven mssa, but are not necessary for the empiric treatment of vap if one of the above agents is used |
| empiric treatment includes coverage | 3 | when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem (weak recommendation, very low-quality evidence). oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven mssa, but are not necessary for the empiric treatment of vap if one of the above agents is used. for patients with hap who are being treated empirically and have no risk factors for mrsa infection and are not at high risk of mortality, we suggest prescribing an antibiotic with activity against mssa. when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used |
| empiric treatment suspected only | 2 | we suggest including an agent active against mrsa for the empiric treatment of suspected vap only in patients with any of the following: a risk factor for antimicrobial resistance (table 2), patients being treated in units where >10%–20% of s. aureus isolates are methicillin resistant, and patients in units where the prevalence of mrsa is not known we suggest prescribing 2 antipseudomonal antibiotics from different classes for the empiric treatment of suspected vap only in patients with any of the following: a risk factor for antimicrobial resistance (table 2), patients in units where >10% of gram-negative isolates are resistant to an agent being considered for monotherapy, and patients in an icu where local antimicrobial susceptibility rates are not available |
| empiric treatment suspected patients | 2 | we suggest including an agent active against methicillinsensitive s. aureus (mssa) (and not mrsa) for the empiric treatment of suspected vap in patients without risk factors for antimicrobial resistance, who are being treated in icus where <10%–20% of s. aureus isolates are methicillin resistant (weak recommendation, very low-quality evidence). we suggest prescribing one antibiotic active against p. aeruginosa for the empiric treatment of suspected vap in patients without risk factors for antimicrobial resistance who are being treated in icus where ?10% of gram-negative isolates are resistant to the agent being considered for monotherapy |
| endoscopic general surgeon should | 2 | intraoperatively, the endoscopic general surgeon should participate in positioning the patient and selecting the proper locations of the trocars. the endoscopic general surgeon is not only responsible for safe entry into either the peritoneum or the retroperitoneum but also must participate in safe dissection to expose the proper spinal anatomy. he/she should be immediately available throughout the entire operative procedure. at the conclusion of the procedure, the endoscopic surgeon is responsible for safely exiting the peritoneum or retroperitoneum and for closure of trocar sites. the endoscopic surgeon must be capable of recognizing and managing intraoperative laparoscopic complications. the endoscopic general surgeon should arrange to interview and examine the patient preoperatively and should participate with the spine surgeon in development of an operative plan. special attention should be directed towards suitability of the patient for anesthesia and for the proposed endoscopic procedure. the endoscopic surgeon should not feel obligated to participate in any procedure that he/she does not feel is in the best interest of the patient. risks and complications unique to the endoscopic access portion of the procedure should be identified and communicated to the patient at this time, as well as the specific roles and responsibilities of the endoscopic general surgeon. the endoscopic general surgeon and spine surgeon should each communicate their individual experience in this procedure to the patient. this results in a true informed consent. both co-surgeons must be named on the patient consent form. |
| enlarged mediastinal lymph nodes | 2 | 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. 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. |
| enoxaparin 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. |
| 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. |
| 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. |
| esophageal recording possibly indicated | 2 | esophageal ph recording is possibly indicated to detect refractory reflux in patients with chest pain after cardiac evaluation using a symptom reflux association scheme, preferably the symptom association probability calculation (ph study done after a trial of proton pump inhibitor therapy for at least 4 weeks). 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. |
| estimated glomerular filtration rate | 3 | inappropriate use of aldosterone receptor antagonists is potentially harmful because of life-threatening hyperkalemia or renal insufficiency when serum creatinine is >2.5 mg/dl in men or >2.0 mg/dl in women (or estimated glomerular filtration rate <30 ml/min/1.73 m2), and/or potassium >5.0 meq/l. aldosterone receptor antagonists (or mineralocorticoid receptor antagonists) are recommended in patients with nyha class ii–iv and who have lvef of ?35%, unless contraindicated, to reduce morbidity and mortality. patients with nyha class ii should have a history of prior cardiovascular hospitalization or elevated plasma natriuretic peptide levels to be considered for aldosterone receptor antagonists. creatinine levels should be ?2.5 mg/dl in men or ?2.0 mg/dl in women (or estimated glomerular filtration rate >30 ml/min/1.73 m2) 2) and potassium levels should be <5.0 meq/l. careful monitoring of potassium levels, renal function, and diuretic dosing should be performed at initiation and closely followed thereafter to minimize risk of hyperkalemia and renal insufficiency. in appropriately selected patients with hfpef (with ef ?45%, elevated bnp levels or hf admission within 1 year, estimated glomerular filtration rate >30 ml/min, creatinine <2.5 mg/dl, potassium <5.0 meq/l), aldosterone receptor antagonists might be considered to decrease hospitalizations. |
| 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. |
| evaluation patients advanced lung | 2 | 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. 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. |
| 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. |
| evidence insufficient recommend against | 7 | 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 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). 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 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. |
| evidence supports dexrazoxane protect | 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. |
| evidencebased beta blockers aldosterone | 2 | the clinical strategy of inhibition of the renin-angiotensin system with ace inhibitors or arbs in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. the clinical strategy of inhibition of the renin-angiotensin system with arni in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. |
| except palliation patients stage | 2 | long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment (see recommendations for stage d starting on page 34). |
| experienced adverse event after | 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. |
| exudates skin lesions impetigo | 2 | gram stain and culture of the pus or exudates from skin lesions of impetigo and ecthyma are recommended to help identify whether staphylococcus aureus and/or a ?-hemolytic streptococcus is the cause treatment without gram stain and culture of the pus or exudates from skin lesions of impetigo and ecthyma is reasonable in typical cases |
| factors antimicrobial resistance being | 2 | we suggest including an agent active against methicillinsensitive s. aureus (mssa) (and not mrsa) for the empiric treatment of suspected vap in patients without risk factors for antimicrobial resistance, who are being treated in icus where <10%–20% of s. aureus isolates are methicillin resistant (weak recommendation, very low-quality evidence). we suggest prescribing one antibiotic active against p. aeruginosa for the empiric treatment of suspected vap in patients without risk factors for antimicrobial resistance who are being treated in icus where ?10% of gram-negative isolates are resistant to the agent being considered for monotherapy |
| factors cost tolerability patient | 2 | the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. ( the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. |
| 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. |
| 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. |
| fibrinolytic therapy patients symptoms | 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. |
| filtration rate m potassium | 2 | inappropriate use of aldosterone receptor antagonists is potentially harmful because of life-threatening hyperkalemia or renal insufficiency when serum creatinine is >2.5 mg/dl in men or >2.0 mg/dl in women (or estimated glomerular filtration rate <30 ml/min/1.73 m2), and/or potassium >5.0 meq/l. aldosterone receptor antagonists (or mineralocorticoid receptor antagonists) are recommended in patients with nyha class ii–iv and who have lvef of ?35%, unless contraindicated, to reduce morbidity and mortality. patients with nyha class ii should have a history of prior cardiovascular hospitalization or elevated plasma natriuretic peptide levels to be considered for aldosterone receptor antagonists. creatinine levels should be ?2.5 mg/dl in men or ?2.0 mg/dl in women (or estimated glomerular filtration rate >30 ml/min/1.73 m2) 2) and potassium levels should be <5.0 meq/l. careful monitoring of potassium levels, renal function, and diuretic dosing should be performed at initiation and closely followed thereafter to minimize risk of hyperkalemia and renal insufficiency. |
| finding isolated adrenal mass | 2 | 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. 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. |
| flexible sigmoidoscopy every years | 2 | alternative methods for crc screening in average-risk patients include yearly fecal occult blood testing (a), flexible sigmoidoscopy every 5 years, combined yearly fecal occult blood testing (fobt) and flexible sigmoidoscopy every 5 years . offer screening with fobt every year combined with flexible sigmoidoscopy every 5 years. when both tests are performed, the fobt should be done first. |
| 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. |
| following recommendations based primarily | 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. |
| following risk factor antimicrobial | 2 | we suggest including an agent active against mrsa for the empiric treatment of suspected vap only in patients with any of the following: a risk factor for antimicrobial resistance (table 2), patients being treated in units where >10%–20% of s. aureus isolates are methicillin resistant, and patients in units where the prevalence of mrsa is not known we suggest prescribing 2 antipseudomonal antibiotics from different classes for the empiric treatment of suspected vap only in patients with any of the following: a risk factor for antimicrobial resistance (table 2), patients in units where >10% of gram-negative isolates are resistant to an agent being considered for monotherapy, and patients in an icu where local antimicrobial susceptibility rates are not available |
| 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). |
| found chest scan greater | 2 | 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. 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. |
| 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. |
| fully into account individual'advocate | 2 | 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. 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. |
| gdmt device therapy eligible | 2 | continuous intravenous inotropic support is reasonable as “bridge therapy” in patients with stage d hf refractory to gdmt and device therapy who are eligible for and awaiting mcs or cardiac transplantation. long-term, continuous intravenous inotropic support may be considered as palliative therapy for symptom control in select patients with stage d hf despite optimal gdmt and device therapy who are not eligible for either mcs or cardiac transplantation. |
| gdmt reasonable expectation meaningful | 2 | icd therapy is recommended for primary prevention of sudden cardiac death (scd) to reduce total mortality in selected patients with nonischemic dcm or ischemic heart disease ?40 days post-mi with lvef of ?35% and nyha class ii or iii symptoms on chronic gdmt, who have a reasonable expectation of meaningful survival for >1 year.a .a (i-a) icd therapy is recommended for primary prevention of scd to reduce total mortality in selected patients at least 40 days post-mi with lvef of 30% or less and nyha class i symptoms while receiving gdmt, who have a reasonable expectation of meaningful survival for more than 1 year. |
| gdmt titrated attain systolic | 2 | patients with hfref and hypertension should be prescribed gdmt titrated to attain systolic blood pressure <130 mm hg. patients with hfpef and persistent hypertension after management of volume overload should be prescribed gdmt titrated to attain systolic blood pressure <130 mm hg |
| glomerular filtration rate m | 2 | inappropriate use of aldosterone receptor antagonists is potentially harmful because of life-threatening hyperkalemia or renal insufficiency when serum creatinine is >2.5 mg/dl in men or >2.0 mg/dl in women (or estimated glomerular filtration rate <30 ml/min/1.73 m2), and/or potassium >5.0 meq/l. aldosterone receptor antagonists (or mineralocorticoid receptor antagonists) are recommended in patients with nyha class ii–iv and who have lvef of ?35%, unless contraindicated, to reduce morbidity and mortality. patients with nyha class ii should have a history of prior cardiovascular hospitalization or elevated plasma natriuretic peptide levels to be considered for aldosterone receptor antagonists. creatinine levels should be ?2.5 mg/dl in men or ?2.0 mg/dl in women (or estimated glomerular filtration rate >30 ml/min/1.73 m2) 2) and potassium levels should be <5.0 meq/l. careful monitoring of potassium levels, renal function, and diuretic dosing should be performed at initiation and closely followed thereafter to minimize risk of hyperkalemia and renal insufficiency. |
| gram stain culture exudates | 2 | gram stain and culture of the pus or exudates from skin lesions of impetigo and ecthyma are recommended to help identify whether staphylococcus aureus and/or a ?-hemolytic streptococcus is the cause treatment without gram stain and culture of the pus or exudates from skin lesions of impetigo and ecthyma is reasonable in typical cases |
| gramnegative isolates resistant agent | 2 | we suggest prescribing 2 antipseudomonal antibiotics from different classes for the empiric treatment of suspected vap only in patients with any of the following: a risk factor for antimicrobial resistance (table 2), patients in units where >10% of gram-negative isolates are resistant to an agent being considered for monotherapy, and patients in an icu where local antimicrobial susceptibility rates are not available we suggest prescribing one antibiotic active against p. aeruginosa for the empiric treatment of suspected vap in patients without risk factors for antimicrobial resistance who are being treated in icus where ?10% of gram-negative isolates are resistant to the agent being considered for monotherapy |
| 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. |
| 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. |
| greater than shortest transverse | 2 | 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. 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. |
| 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. |
| guide discontinuation antibiotic therapy | 2 | for patients with hap/vap, we suggest using pct levels plus clinical criteria to guide the discontinuation of antibiotic therapy, rather than clinical criteria alone for patients with suspected hap/vap, we suggest not using the cpis to guide the discontinuation of antibiotic therapy |
| 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. |
| guideline developers suggest clinicians | 3 | for patients with recurrent acute mi, the guideline developers suggest clinicians do not use repeat administration of streptokinase. for patients undergoing cabg who have no other indication for vitamin k antagonists (vkas), the guideline developers suggest clinicians not administer vkas . for all patients undergoing ima bypass grafting who have no other indication for vkas, the guideline developers suggest clinicians not use vkas . |
| harmful patients hfref except | 2 | long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment (see recommendations for stage d starting on page 34). |
| 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. |
| 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. |
| hfref current prior symptoms | 2 | ace inhibitors are recommended in patients with hfref and current or prior symptoms, unless contraindicated, to reduce morbidity and mortality. (i-a) arbs are recommended in patients with hfref with current or prior symptoms who are ace inhibitor–intolerant, unless contraindicated, to reduce morbidity and mortality. |
| hfref except palliation patients | 2 | long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment (see recommendations for stage d starting on page 34). |
| hfref out prior thromboembolic | 2 | anticoagulation is not recommended in patients with chronic hfref without af, a prior thromboembolic event, or a cardioembolic source anticoagulation is not recommended in patients with chronic hfref without af, a prior thromboembolic event, or a cardioembolic source. (iii-b: no benefit) |
| hfref reduce morbidity mortality | 3 | the clinical strategy of inhibition of the renin-angiotensin system with ace inhibitors or arbs in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. the clinical strategy of inhibition of the renin-angiotensin system with arni in conjunction with evidence-based beta blockers, and aldosterone antagonists in selected patients, is recommended for patients with chronic hfref to reduce morbidity and mortality. the use of ace inhibitors is beneficial for patients with prior or current symptoms of chronic hfref to reduce morbidity and mortality. |
| high risk mortality suggest | 3 | for patients with hap who are being treated empirically and have either a risk factor for mrsa infection (ie, prior intravenous antibiotic use within 90 days, hospitalization in a unit where >20% of s. aureus isolates are methicillin resistant, or the prevalence of mrsa is not known, or who are at high risk for mortality, we suggest prescribing an antibiotic with activity against mrsa for patients with hap who are being treated empirically and have no risk factors for mrsa infection and are not at high risk of mortality, we suggest prescribing an antibiotic with activity against mssa. when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used for patients with hap who are being treated empirically and have factors increasing the likelihood for pseudomonas or other gram-negative infection (ie, prior intravenous antibiotic use within 90 days; also see remarks) or a high risk for mortality, we suggest prescribing antibiotics from 2 different classes with activity against p. aeruginosa |
| 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. |
| history acute coronary syndrome | 3 | in all patients with a recent or remote history of mi or acute coronary syndrome and reduced ef, angiotensin-converting enzyme (ace) inhibitors should be used to prevent symptomatic hf and reduce mortality. in patients intolerant of ace inhibitors, angiotensin-receptor blockers are appropriate unless contraindicated. in all patients with a recent or remote history of mi or acute coronary syndrome and reduced ef, evidence-based beta blockers should be used to reduce mortality. in all patients with a recent or remote history of mi or acute coronary syndrome, statins should be used to prevent symptomatic hf and cardiovascular events. |
| 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. |
| hormonal therapies other than | 2 | hormonal therapies other than to correct deficiencies are not recommended in hfref hormonal therapies other than to correct deficiencies are not recommended for patients with current or prior symptoms of hfref. |
| hospitals clinics officebased practices | 2 | pediatricians should create a variety of ways for children and families to serve as advisorsâ??as members of child or family advisory councils, committees, and task forces dealing with operational issues in hospitals, clinics, and office-based practices; as participants in quality improvement initiatives; as educators of staff and professionals in training; and as leaders or coleaders of peer support programs. health care institutions should design their facilities to promote the philosophy of family-centered care. pediatricians should advocate for opportunities for children and families to participate in design planning for renovation or construction of hospitals, clinics, and office-based practices. |
| 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. |
| 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. |
| 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. |
| human immunodeficiency virus infected | 2 | clinicians should monitor human immunodeficiency virus (hiv)-infected substance users receiving concurrent methadone and arv therapy for symptoms of withdrawal and/or excess sedation when arv therapy is initiated or changed. the task force suggests that clinicians consider short-term testosterone therapy as an adjunctive therapy in human immunodeficiency virus (hiv)-infected men with low testosterone levels and weight loss to promote weight maintenance and gains in lean body mass (lbm) and muscle strength. |
| hydralazine isosorbide dinitrate recommended | 2 | the combination of hydralazine and isosorbide dinitrate is recommended for african americans with nyha class iii–iv hfref on gdmt the combination of hydralazine and isosorbide dinitrate is recommended to reduce morbidity and mortality for patients selfdescribed as african americans with nyha class iii–iv hfref receiving optimal therapy with ace inhibitors and beta blockers, unless contraindicated. |
| hydralazine isosorbide dinitrate useful | 2 | a combination of hydralazine and isosorbide dinitrate can be useful in patients with hfref who cannot be given ace inhibitors or arbs a combination of hydralazine and isosorbide dinitrate can be useful to reduce morbidity or mortality in patients with current or prior symptomatic hfref who cannot be given an ace inhibitor or arb because of drug intolerance, hypotension, or renal insufficiency, unless contraindicated. |
| hyperfractionated accelerated radiation therapy | 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. |
| 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. |
| identified clients should referred | 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. |
| imipenem meropenem oxacillin nafcillin | 2 | for patients with hap who are being treated empirically and have no risk factors for mrsa infection and are not at high risk of mortality, we suggest prescribing an antibiotic with activity against mssa. when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used |
| immersion injuries animal bites | 2 | cultures of blood are recommended in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites cultures and microscopic examination of cutaneous aspirates, biopsies, or swabs should be considered in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites ( |
| immunodeficiency immersion injuries animal | 2 | cultures of blood are recommended in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites cultures and microscopic examination of cutaneous aspirates, biopsies, or swabs should be considered in patients with malignancy on chemotherapy, neutropenia, severe cell-mediated immunodeficiency, immersion injuries, and animal bites ( |
| implementation includes assessment organizational | 2 | 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 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. |
| implementation process ongoing opportunities | 2 | 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 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. |
| improve live birth rate | 2 | prepregnancy suppression of high luteinising hormone (lh) concentration among ovulatory women with recurrent miscarriage and polycystic ovaries who hypersecrete lh does not improve the live birth rate. currently there is no reliable evidence to show that steroids improve the live birth rate of women with recurrent miscarriage associated with antiphospholipid antibodies (apl) when compared with other treatment modalities; their use may provoke significant maternal and fetal morbidity. |
| improves survival over standard | 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 | 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 | 3 | 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. where drug treatment is considered appropriate, methylphenidate, atomoxetine and dexamfetamine are recommended, within their licensed indications, as options for the management of attention deficit hyperactivity disorder (adhd) in children and adolescents. 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. |
| includes assessment organizational readiness | 2 | 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 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. |
| including agent active against | 2 | we suggest including an agent active against mrsa for the empiric treatment of suspected vap only in patients with any of the following: a risk factor for antimicrobial resistance (table 2), patients being treated in units where >10%–20% of s. aureus isolates are methicillin resistant, and patients in units where the prevalence of mrsa is not known we suggest including an agent active against methicillinsensitive s. aureus (mssa) (and not mrsa) for the empiric treatment of suspected vap in patients without risk factors for antimicrobial resistance, who are being treated in icus where <10%–20% of s. aureus isolates are methicillin resistant (weak recommendation, very low-quality evidence). |
| including piperacillintazobactam cefepime levofloxacin | 3 | when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem (weak recommendation, very low-quality evidence). oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven mssa, but are not necessary for the empiric treatment of vap if one of the above agents is used. for patients with hap who are being treated empirically and have no risk factors for mrsa infection and are not at high risk of mortality, we suggest prescribing an antibiotic with activity against mssa. when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used |
| including time international normalized | 2 | the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. ( the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. |
| 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. |
| 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. |
| 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. |
| indicated suggest regimen including | 3 | when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem (weak recommendation, very low-quality evidence). oxacillin, nafcillin, or cefazolin are preferred agents for treatment of proven mssa, but are not necessary for the empiric treatment of vap if one of the above agents is used. for patients with hap who are being treated empirically and have no risk factors for mrsa infection and are not at high risk of mortality, we suggest prescribing an antibiotic with activity against mssa. when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used |
| 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. 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. 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. |
| individual provide support needed | 2 | 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 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. |
| individual'advocate carer should consulted | 2 | 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. 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. |
| individualized basis risk factors | 2 | the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. ( the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. |
| individuals out symptoms history | 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 | 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 | 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 | 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. |
| infection prior intravenous antibiotic | 2 | for patients with hap who are being treated empirically and have either a risk factor for mrsa infection (ie, prior intravenous antibiotic use within 90 days, hospitalization in a unit where >20% of s. aureus isolates are methicillin resistant, or the prevalence of mrsa is not known, or who are at high risk for mortality, we suggest prescribing an antibiotic with activity against mrsa for patients with hap who are being treated empirically and have factors increasing the likelihood for pseudomonas or other gram-negative infection (ie, prior intravenous antibiotic use within 90 days; also see remarks) or a high risk for mortality, we suggest prescribing antibiotics from 2 different classes with activity against p. aeruginosa |
| infection sufficient impair quality | 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. |
| infused positive inotropic drugs | 2 | long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment (see recommendations for stage d starting on page 34). |
| 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. |
| inhibitors recommended patients hfref | 2 | ace inhibitors are recommended for all patients with hfref ace inhibitors are recommended in patients with hfref and current or prior symptoms, unless contraindicated, to reduce morbidity and mortality. (i-a) |
| 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. |
| inotropic drugs potentially harmful | 2 | long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment (see recommendations for stage d starting on page 34). |
| 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 . |
| insufficient evidence time make | 2 | 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. there is insufficient evidence at this time to make a recommendation regarding the use of continuous epidural infusion vs. intermittent injection in trauma patients. |
| insufficient recommend against routine | 4 | 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 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. |
| interactions other clinical characteristics | 2 | the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. ( the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. |
| 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. |
| international normalized ratio therapeutic | 2 | the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. ( the selection of an anticoagulant agent (warfarin, dabigatran, apixaban, or rivaroxaban) for permanent/persistent/paroxysmal af should be individualized on the basis of risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the international normalized ratio therapeutic range if the patient has been taking warfarin. |
| interpretation serum human chorionic | 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 | 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 | 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 | 2 | 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. 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. |
| 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. |
| intravenous antibiotic in days | 2 | for patients with hap who are being treated empirically and have either a risk factor for mrsa infection (ie, prior intravenous antibiotic use within 90 days, hospitalization in a unit where >20% of s. aureus isolates are methicillin resistant, or the prevalence of mrsa is not known, or who are at high risk for mortality, we suggest prescribing an antibiotic with activity against mrsa for patients with hap who are being treated empirically and have factors increasing the likelihood for pseudomonas or other gram-negative infection (ie, prior intravenous antibiotic use within 90 days; also see remarks) or a high risk for mortality, we suggest prescribing antibiotics from 2 different classes with activity against p. aeruginosa |
| intravenous inotropic support reasonable | 2 | continuous intravenous inotropic support is reasonable as “bridge therapy” in patients with stage d hf refractory to gdmt and device therapy who are eligible for and awaiting mcs or cardiac transplantation. short-term, continuous intravenous inotropic support may be reasonable in those hospitalized patients presenting with documented severe systolic dysfunction who present with low blood pressure and significantly depressed cardiac output to maintain systemic perfusion and preserve end-organ performance. |
| isolate susceptible rather than | 2 | for patients with hap/vap due to p. aeruginosa who are not in septic shock or at a high risk for death, and for whom the results of antibiotic susceptibility testing are known, we recommend monotherapy using an antibiotic to which the isolate is susceptible rather than combination therapy for patients with hap/vap due to p. aeruginosa who remain in septic shock or at a high risk for death when the results of antibiotic susceptibility testing are known, we suggest combination therapy using 2 antibiotics to which the isolate is susceptible rather than monotherapy |
| isolated adrenal mass ultrasonography | 2 | 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. 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. |
| isolates resistant agent being | 2 | we suggest prescribing 2 antipseudomonal antibiotics from different classes for the empiric treatment of suspected vap only in patients with any of the following: a risk factor for antimicrobial resistance (table 2), patients in units where >10% of gram-negative isolates are resistant to an agent being considered for monotherapy, and patients in an icu where local antimicrobial susceptibility rates are not available we suggest prescribing one antibiotic active against p. aeruginosa for the empiric treatment of suspected vap in patients without risk factors for antimicrobial resistance who are being treated in icus where ?10% of gram-negative isolates are resistant to the agent being considered for monotherapy |
| 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. 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. 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. |
| 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 . |
| 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. |
| lbbb duration nyha class | 2 | crt can be useful for patients who have lvef of ?35%, sinus rhythm, lbbb with a qrs duration of 120–149 ms, and nyha class ii, iii, or ambulatory class iv symptoms on gdmt. crt may be considered for patients who have lvef of ?30%, ischemic etiology of hf, sinus rhythm, lbbb with a qrs duration of ?150 ms, and nyha class i symptoms on gdmt. |
| lbbb pattern duration nyha | 3 | crt can be useful for patients who have lvef of ?35% , sinus rhythm, a non-lbbb pattern with a qrs duration of ?150 ms, and nyha class iii/ambulatory class iv symptoms on gdmt. crt may be considered for patients who have lvef of ?35%, sinus rhythm, a non-lbbb pattern with a qrs duration of 120–149 ms, and nyha class iii/ambulatory class iv on gdmt. crt may be considered for patients who have lvef of ?35%, sinus rhythm, a non-lbbb pattern with a qrs duration of ?150 ms, and nyha class ii symptoms on gdmt. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| less than laar active | 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. |
| 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. |
| levofloxacin imipenem meropenem oxacillin | 2 | for patients with hap who are being treated empirically and have no risk factors for mrsa infection and are not at high risk of mortality, we suggest prescribing an antibiotic with activity against mssa. when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used when empiric treatment that includes coverage for mssa (and not mrsa) is indicated, we suggest a regimen including piperacillin-tazobactam, cefepime, levofloxacin, imipenem, or meropenem. oxacillin, nafcillin, or cefazolin are preferred for the treatment of proven mssa, but are not necessary for empiric coverage of hap if one of the above agents is used |
| licensed indications recommended options | 2 | 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. 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. |
| 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. |
| limitedstage small cell lung | 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 | 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 | 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 | 3 | 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. 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 | 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 | 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. |
| longterm infused positive inotropic | 2 | long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment long-term use of infused positive inotropic drugs is potentially harmful for patients with hfref, except as palliation for patients with end-stage disease who cannot be stabilized with standard medical treatment (see recommendations for stage d starting on page 34). |
| 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. |
| 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. |
| lung cancer staging locoregional | 2 | 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. 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. |
| lvef sinus rhythm lbbb | 4 | crt can be useful for patients who have lvef of ?35% , sinus rhythm, a non-lbbb pattern with a qrs duration of ?150 ms, and nyha class iii/ambulatory class iv symptoms on gdmt. crt can be useful for patients who have lvef of ?35%, sinus rhythm, lbbb with a qrs duration of 120–149 ms, and nyha class ii, iii, or ambulatory class iv symptoms on gdmt. crt may be considered for patients who have lvef of ?35%, sinus rhythm, a non-lbbb pattern with a qrs duration of 120–149 ms, and nyha class iii/ambulatory class iv on gdmt. crt may be considered for patients who have lvef of ?35%, sinus rhythm, a non-lbbb pattern with a qrs duration of ?150 ms, and nyha class ii symptoms on gdmt. |
| lymph nodes found chest | 2 | 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. 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. |
| 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. |
| m liver biopsy poses | 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 | 3 |