‘Guidelines’ Tagged Posts

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HHS: Up to date Bodily Exercise Tips for Individuals Launched


November 12, 2018

Preschool-aged children (ages 3–5 years) should be physically active throughout the day

Preschool-aged children (ages 3–5 years) should be physically active throughout the day

The US Department of Health and Human Services (HHS) has released the second edition of the Physical Activity Guidelines for Americans at the American Heart Association’s Scientific Sessions meeting. This document complements the Dietary Guidelines for Americans, which was released by the HHS and the US Department of Agriculture (USDA). The new edition was developed by the 2018 Physical Activity Guidelines Advisory Committee who conducted systematic reviews of available scientific literature.

This guidance, updated for the first time since 2008, provides evidence-based recommendations for children (ages 3-17) and adults. Specifically, it includes new guidelines for children aged 3–5 years and updated recommendations for children and adolescents aged 6–17 years, adults, older adults, women during pregnancy and the postpartum period, and adults with chronic health conditions or disabilities. The second edition outlines the types and amounts of activity recommended for these various populations. For example, while the previous guidelines had suggested that for adults, bouts of at least 10 minutes of physical activity were necessary, the new guidelines state that some physical activity is better than none, even if it is less than 10 minutes.

For preschool-aged children, the Committee recommends:

  • Preschool-aged children (ages 3–5 years) should be physically active throughout the day to enhance growth and development 
  • Adult caregivers of preschool-aged children should encourage active play that includes a variety of activity types

“Probably the most important message from the 2018 guidelines is that the greatest health benefits accrue by moving from no, to even small amounts of, physical activity, especially if that activity is of moderate (eg, brisk walking) or vigorous (eg, jogging and running) intensity,” stated Paul D Thompson MD and Thijs MH Eijsvogels, PhD, in a recent JAMA Editorial. “The point for clinicians is that physical activity should be strongly considered as primary or adjunctive therapy for many common clinical conditions such as mild depression, anxiety, and sleep difficulties.”

The executive summary of the key guidelines can be found here. 

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For more information visit Health.gov.

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AGA: New Opioid-Induced Constipation Administration Tips Obtainable


October 18, 2018

The recommendations have been published in the AGA's official journal, Gastroenterology

The recommendations have been published in the AGA’s official journal, Gastroenterology

The American Gastroenterological Association (AGA) has issued new guidelines on the medical management of opioid-induced constipation (OIC). The recommendations have been published in the AGA’s official journal, Gastroenterology.

“These guidelines presume that patients have been appropriately diagnosed and that they have either a prolonged requirement or dependence on opioids,” write the authors. “Therefore, one of the first steps to managing patients with OIC is to ensure that the indication for opioid therapy is appropriate, that patients are participating in a pain management program (ideally in conjunction with a pain specialist), and that they are taking the minimum necessary opioid dose.”

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The recommendations were developed using GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology, with a strong recommendation indicating that most patients should receive the recommended course of action; a conditional recommendation would mean that different choices may apply depending on the patient, and a clinician may need to spend extra time to work toward a decision.

In the management of OIC, the new guidelines state the following:

  • In patients with OIC, the use of laxatives as first-line agents is recommended (Strong; moderate-quality evidence)
  • In patients with laxative refractory OIC, naldemedine is recommended over no treatment (Strong; high-quality evidence)
  • In patients with laxative refractory OIC, naloxegol is recommended over no treatment (Strong; moderate-quality evidence)
  • In patients with laxative refractory OIC, methylnaltrexone is suggested over no treatment (Conditional; low-quality evidence)
  • The AGA makes no recommendation for the use of lubiprostone in OIC (No recommendation; evidence gap)
  • The AGA makes no recommendation for the use of prucalopride in OIC (No recommendation; evidence gap)

Addressing their recommendations on newer agents (intestinal secretagogues, selective 5-HT agonists), the guideline panel writes that given the lack of published data on long-term use, additional studies are needed to establish the benefits of these drugs.

“Physicians have struggled with treating this condition due to previous lack of clinical guidance,” said Seth D. Crockett, MD, MPH, lead author of the guideline, University of North Carolina School of Medicine, Chapel Hill. “The new AGA guideline clarifies existing data and provides clear direction for physicians on how to best treat opioid-induced constipation.”

For more information visit gastrojournal.org.

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Tips for Managing Perimenopausal Melancholy Now Obtainable


September 05, 2018

The panel notes that estrogen is not approved by the Food and Drug Administration to treat mood disturbance

The panel notes that estrogen is not approved by the Food and Drug Administration to treat mood disturbance

The first-ever guidelines for the evaluation and treatment of perimenopausal depression have been published by The North American Menopause Society in collaboration with the National Network on Depression Centers for Women and Mood Disorders Task Group. The new guidelines have been endorsed by the International Menopause Society and are currently available for review in the journal Menopause and the Journal of Women’s Health.

The 5 topics addressed by the 11-member expert panel include epidemiology, clinical presentation, therapeutic effects of antidepressants, effects of hormone therapy, and the effectiveness of other therapies (eg, psychotherapy, exercise, natural health products). “The reason these guidelines are needed is because depression during the perimenopausal phase can occur along with menopausal symptoms, and these 2 sets of symptoms are hard to tease apart, which makes it difficult for clinicians to appropriately treat these women,” said Dr Pauline Maki, professor of psychology and psychiatry in the University of Illinois at Chicago College of Medicine and co-lead author of the new guidelines. “Many women experience a new onset of depressive symptoms. If there is underlying low-level depression to begin with, perimenopause can increase the intensity of depressive symptoms.”

Regarding treatment, the panel recommends proven therapeutic options such as antidepressants, cognitive-behavioral therapy, and other psychotherapies as first-line therapies for major depressive episodes. When selecting an antidepressant, clinicians should consider the patient’s prior experience with these agents, as well as the possibility of adverse events and safety issues such as drug-drug interactions.

At usual doses, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been shown to be effective and may also improve menopause-related issues such as vasomotor symptoms and pain. Desvenlafaxine, in particular, has proven efficacy based on large, placebo-controlled trials involving peri- and postmenopausal depressed women. In addition, sleep disturbance and night sweats should be factored into the treatment of menopause-related depression. 

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With regard to estrogen therapy, the guidelines state that the treatment is ineffective for depressive disorders in postmenopausal women, although there is some evidence to suggest that estrogen has antidepressant effects similar to that seen with antidepressant agents in depressed perimenopausal women. In women approaching menopause, hormonal contraceptives, used continuously, may improve depressive symptoms. The panel notes that estrogen is not approved by the Food and Drug Administration to treat mood disturbance and that most studies of hormone therapy as a treatment for depression examined the effects of unopposed estrogen; data on combined hormone therapy or for progestogens is inconclusive.

As for botanical and alternative approaches, there is insufficient evidence to recommend these treatments for depression related to perimenopause.

“There has been a need for expert consensus as well as clear clinical guidance regarding how to evaluate and treat depression in women during perimenopause,” said Dr Susan Kornstein, professor of psychiatry and obstetrics & gynecology at Virginia Commonwealth University and co-lead author of the guidelines. “These new clinical recommendations address this gap and offer much-needed information and guidance to healthcare practitioners so that they can provide optimal care and treatment for midlife women.”

For more information visit journals.lww.com.

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HCV Pointers Up to date to Embrace Suggestions for Key Populations

Universal screening for pregnant women is recommended, ideally at the start of prenatal care

Common screening for pregnant girls is really useful, ideally firstly of prenatal care

Pointers for the administration of hepatitis C virus (HCV) an infection have been up to date to incorporate testing and therapy suggestions for pregnant girls, males who’ve intercourse with males (MSM), people who inject medicine and people who find themselves incarcerated. The rules have been developed by the American Affiliation for the Examine of Liver Ailments and the Infectious Ailments Society of America.

“Immediately, hepatitis C is curable for over 95 % of people that bear therapy,” clarify HCV Steering Co-Chairs, Marc G. Ghany, MD, MHSc; Arthur Y. Kim, MD; Kristen M. Marks, MD; and Hugo E. Vargas, MD. “With the success of HCV therapies, the medical neighborhood should now shift our focus towards eliminating HCV as a public well being drawback. As a primary step, our Panel has made new suggestions to re-emphasize the significance of testing key populations and treating nearly all sufferers with the virus.”