Guidelines tag:www.smjr.org,2009-10-15:/guidelines//11 2010-01-15T04:57:19Z We tend to treat our knowledge as personal property to be protected and defended. NNT. Movable Type Pro 4.26 NKF/KDOQI: Anemia in Chronic Kidney Disease tag:www.smjr.org,2010:/guidelines//11.188 2010-01-15T04:51:05Z 2010-01-15T04:57:19Z 2.1.2 In the opinion of the Work Group, in dialysis and nondialysis patients with CKD receiving ESA therapy, the selected Hb target should generally be in the range of 11.0 to 12.0 g/dL. (Clinical Practice RECOMMENDATION) 2.1.3 In dialysis and... Patrick 2.1.2 In the opinion of the Work Group, in dialysis and nondialysis patients with CKD receiving ESA therapy, the selected Hb target should generally be in the range of 11.0 to 12.0 g/dL. (Clinical Practice RECOMMENDATION)

2.1.3 In dialysis and nondialysis patients with CKD receiving ESA therapy, the Hb target should not be greater than 13.0 g/dL. (Clinical Practice GUIDELINE - MODERATELY STRONG EVIDENCE)

KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease: 2007 Update of Hemoglobin Target]]> Determining Brain Death in Adults tag:www.smjr.org,2009:/guidelines//11.178 2009-11-02T09:14:12Z 2009-11-02T09:21:32Z IV. Confirmatory laboratory tests (Options) Brain death is a clinical diagnosis. A repeat clinical evaluation 6 hours later is recommended, but this interval is arbitrary. A confirmatory test is not mandatory but is desirable in patients in whom specific... Patrick

IV. Confirmatory laboratory tests (Options)

Brain death is a clinical diagnosis. A repeat clinical evaluation 6 hours later is recommended, but this interval is arbitrary. A confirmatory test is not mandatory but is desirable in patients in whom specific components of clinical testing cannot be reliably performed or evaluated. It should be emphasized that any of the suggested confirmatory tests may produce similar results in patients with catastrophic brain damage who do not (yet) fulfill the clinical criteria of brain death. The following confirmatory test findings are listed in the order of the most sensitive test first. Consensus criteria are identified by individual tests.

    1. A. Conventional angiography. No intracerebral filling at the level of the carotid bifurcation or circle of Willis. The external carotid circulation is patent, and filling of the superior longitudinal sinus may be delayed.

    2. B. Electroencephalography. No electrical activity during at least 30 minutes of recording that adheres to the minimal technical criteria for EEG recording in suspected brain death as adopted by the American Electroencephalographic Society, including 16-channel EEG instruments.

    3. C. Transcranial Doppler ultrasonography

      1. 1. Ten percent of patients may not have temporal insonation windows. Therefore, the initial absence of Doppler signals cannot be interpreted as consistent with brain death.

      2. 2. Small systolic peaks in early systole without diastolic flow or reverberating flow, indicating very high vascular resistance associated with greatly increased intracranial pressure.

    4. D. Technetium-99m hexamethylpropyleneamineoxime brain scan. No uptake of isotope in brain parenchyma ("hollow skull phenomenon").

    5. E. Somatosensory evoked potentials. Bilateral absence of N20-P22 response with median nerve stimulation. The recordings should adhere to the minimal technical criteria for somatosensory evoked potential recording in suspected brain death as adopted by the American Electroencephalographic Society.

 

American Academy of Neurology. Determining Brain Death in Adults.

 

]]> USPSTF: Screening for Breast Cancer tag:www.smjr.org,2009:/guidelines//11.173 2009-10-27T07:59:07Z 2009-10-28T07:09:00Z The U.S. Preventive Services Task Force (USPSTF) recommends screening mammography, with or without clinical breast examination (CBE), every 1-2 years for women aged 40 and older.Grade: B (recommended, fair evidence)The USPSTF concludes that the evidence is insufficient to recommend for... Patrick The U.S. Preventive Services Task Force (USPSTF) recommends screening mammography, with or without clinical breast examination (CBE), every 1-2 years for women aged 40 and older.
Grade: B (recommended, fair evidence)

The USPSTF concludes that the evidence is insufficient to recommend for or against routine CBE alone to screen for breast cancer.
Grade: I (insufficient evidence)

The USPSTF concludes that the evidence is insufficient to recommend for or against teaching or performing routine breast self-examination (BSE).
Grade: I (insufficient evidence)


Screening for Breast Cancer, Topic Page. November 2003. U.S. Preventive Services Task Force. Agency for Healthcare Research and Quality, Rockville, MD.
]]> NKF/KDOQI: Erythropoietin & Hemoglobin Target tag:www.smjr.org,2009:/guidelines//11.168 2009-10-21T06:49:56Z 2009-10-21T06:55:48Z Patrick 2.1.3 In dialysis and nondialysis patients with CKD receiving ESA therapy, the Hb target should not be greater than 13.0 g/dL. (Clinical Practice GUIDELINE - MODERATELY STRONG EVIDENCE)

 

KDOQI Clinical Practice Guideline and Clinical Practice Recommendations for Anemia in Chronic Kidney Disease: 2007 Update of Hemoglobin Target

]]> ACC/AHA: 2009 Heart Failure Dx & Mgmt tag:www.smjr.org,2009:/guidelines//11.162 2009-10-20T05:25:13Z 2009-10-20T05:41:32Z Patrick 3. Recommendations for the Initial Clinical Assessment of Patients Presenting With Heart Failure

Class IIa, number 9.

Measurement of natriuretic peptides (BNP and NT-proBNP) can be useful in the evaluation of patients presenting in the urgent care setting in whom the clinical diagnosis of HF is uncertain. Measurement of natriuretic peptides can be useful in risk stratification (Level of Evidence: A) 

3. Recommendations for Serial Clinical Assessment of Patients Presenting With Heart Failure

Class IIb, number 1.

The value of serial measurements of BNP to guide therapy for patients with HF is not well established (Level of Evidence: C)

 

2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults. J Am Coll Cardiol 2009; 53: 1343.

]]> Serum BNP levels have been shown to parallel the clinical severity of HF as assessed by NYHA class in broad populations. Levels are higher in hospitalized patients and tend to decrease during aggressive therapy for decompensation. Indeed, there is an increasing body of evidence demonstrating the power of the addition of BNP (or NT-proBNP) levels in the assessment of prognosis in a variety of cardiovascular disorders. However, it cannot be assumed that BNP levels can be used effectively as targets for adjustment of therapy in individual patients. Many patients taking optimal doses of medications continue to show markedly elevated levels of BNP, and some patients demonstrate BNP levels within the normal range despite advanced HF. The use of BNP measurements to guide the titration of drug doses has not been shown conclusively to improve outcomes more effectively than achievement of the target doses of drugs shown in clinical trials to prolong life. Ongoing trials will help to determine the role of serial BNP (or other natriuretic peptides) measurements in both diagnosis and management of HF.

]]> IDSA: Asymptomatic Bacteriuria in Adults tag:www.smjr.org,2009:/guidelines//11.154 2009-10-16T05:51:52Z 2009-10-20T05:42:06Z UNKWN http://www.themostbeautifullest.com 2. Pyuria accompanying asymptomatic bacteriuria is not an indication for antimicrobial treatment (A-II).

 

IDSA Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults

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Pyuria is present with asymptomatic bacteriuria in*:

32% of young women

90% of elderly institutionalized patients

90% of hemodialysis patients

30-75% of bacteriuric patients with short-term catheters in place

50-100% of individuals with long-term indwelling catheters in place

*see above link for appropriate references

 

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