ABSTRACT
Psoriasis is a chronic, inflammatory, multisystem disease that affects up to 3.2% of the United States population. This guideline addresses important clinical questions that arise in psoriasis management and care and provides recommendations based on the available evidence. The treatment of psoriasis with topical agents and with alternative medicine will be reviewed, emphasizing treatment recommendations and the role of dermatologists in monitoring and educating patients regarding benefits as well as risks that may be associated. This guideline will also address the severity assessment methods of psoriasis in adults.
Subject(s)
Complementary Therapies/methods , Dermatologic Agents/administration & dosage , Dermatology/methods , Psoriasis/therapy , Academies and Institutes/standards , Administration, Cutaneous , Combined Modality Therapy/methods , Combined Modality Therapy/standards , Complementary Therapies/standards , Dermatology/standards , Evidence-Based Medicine/methods , Evidence-Based Medicine/standards , Foundations/standards , Humans , Patient Education as Topic/standards , Psoriasis/diagnosis , Severity of Illness Index , Treatment Outcome , United StatesABSTRACT
OBJECTIVE: To develop an evidence-based guideline for the comprehensive management of osteoarthritis (OA) as a collaboration between the American College of Rheumatology (ACR) and the Arthritis Foundation, updating the 2012 ACR recommendations for the management of hand, hip, and knee OA. METHODS: We identified clinically relevant population, intervention, comparator, outcomes questions and critical outcomes in OA. A Literature Review Team performed a systematic literature review to summarize evidence supporting the benefits and harms of available educational, behavioral, psychosocial, physical, mind-body, and pharmacologic therapies for OA. Grading of Recommendations Assessment, Development and Evaluation methodology was used to rate the quality of the evidence. A Voting Panel, including rheumatologists, an internist, physical and occupational therapists, and patients, achieved consensus on the recommendations. RESULTS: Based on the available evidence, either strong or conditional recommendations were made for or against the approaches evaluated. Strong recommendations were made for exercise, weight loss in patients with knee and/or hip OA who are overweight or obese, self-efficacy and self-management programs, tai chi, cane use, hand orthoses for first carpometacarpal (CMC) joint OA, tibiofemoral bracing for tibiofemoral knee OA, topical nonsteroidal antiinflammatory drugs (NSAIDs) for knee OA, oral NSAIDs, and intraarticular glucocorticoid injections for knee OA. Conditional recommendations were made for balance exercises, yoga, cognitive behavioral therapy, kinesiotaping for first CMC OA, orthoses for hand joints other than the first CMC joint, patellofemoral bracing for patellofemoral knee OA, acupuncture, thermal modalities, radiofrequency ablation for knee OA, topical NSAIDs, intraarticular steroid injections and chondroitin sulfate for hand OA, topical capsaicin for knee OA, acetaminophen, duloxetine, and tramadol. CONCLUSION: This guideline provides direction for clinicians and patients making treatment decisions for the management of OA. Clinicians and patients should engage in shared decision-making that accounts for patients' values, preferences, and comorbidities. These recommendations should not be used to limit or deny access to therapies.
Subject(s)
Foundations/standards , Hand Joints , Osteoarthritis, Hip/therapy , Osteoarthritis, Knee/therapy , Practice Guidelines as Topic/standards , Rheumatology/standards , Analgesics/administration & dosage , Disease Management , Exercise Therapy/methods , Exercise Therapy/standards , Hand Joints/pathology , Humans , Osteoarthritis, Hip/diagnosis , Osteoarthritis, Hip/epidemiology , Osteoarthritis, Knee/diagnosis , Osteoarthritis, Knee/epidemiology , United States/epidemiologyABSTRACT
Psoriasis is a chronic inflammatory disease involving multiple organ systems and affecting approximately 3.2% of the world's population. In this section of the guidelines of care for psoriasis, we will focus the discussion on ultraviolet (UV) light-based therapies, which include narrowband and broadband UVB, UVA in conjunction with photosensitizing agents, targeted UVB treatments such as with an excimer laser, and several other modalities and variations of these core phototherapies, including newer applications of pulsed dye lasers, intense pulse light, and light-emitting electrodes. We will provide an in-depth, evidence-based discussion of efficacy and safety for each treatment modality and provide recommendations and guidance for the use of these therapies alone or in conjunction with other topical and/or systemic psoriasis treatments.
Subject(s)
Dermatology/standards , Phototherapy/standards , Practice Guidelines as Topic , Psoriasis/therapy , Academies and Institutes/standards , Foundations/standards , Humans , Meta-Analysis as Topic , Phototherapy/instrumentation , Phototherapy/methods , Systematic Reviews as Topic , Treatment Outcome , United StatesABSTRACT
Consistent with the growing national focus on healthcare quality, the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have taken a leadership role over the past decade in developing measures of the quality of cardiovascular care by convening a joint ACCF/AHA Task Force on Performance Measures. The Task Force is charged with identifying the clinical topics appropriate for the development of performance measures and with assembling writing committees composed of clinical and methodological experts in collaboration with appropriate subspecialty societies. The Task Force has also created methodology documents that offer guidance in the development of process, outcome, composite, and efficiency measures. Cardiovascular performance measures using existing ACCF/AHA methodology are based on Class I or Class III guidelines recommendations, usually with Level A evidence. These performance measures, based on evidence-based ACCF/AHA guidelines, remain the most rigorous quality measures for both internal quality improvement and public reporting. However, many of the tools for diagnosis and treatment of cardiovascular disease involve advanced technologies, such as cardiac imaging, for which there are often no underlying guideline documents. Because these technologies affect the quality of cardiovascular care and also have the potential to contribute to cardiovascular health expenditures, there is a need for more critical assessment of the use of technology, including the development of quality and performance measures in areas in which guideline recommendations are absent. The evaluation of quality in the use of cardiovascular technologies requires consideration of multiple parameters that differ from other healthcare processes. The present document describes methodology for development of 2 new classes of quality measures in these situations, appropriate use measures and structure/safety measures. Appropriate use measures are based on specific indications, processes, or parameters of care for which high level of evidence data and Class I or Class III guideline recommendations may be lacking but are addressed in ACCF appropriate use criteria documents. Structure/safety measures represent measures developed to address structural aspects of the use of healthcare technology (e.g., laboratory accreditation, personnel training, and credentialing) or quality issues related to patient safety when there are neither guidelines recommendations nor appropriate use criteria. Although the strength of evidence for appropriate use measures and structure/safety measures may not be as strong as that for formal performance measures, they are quality measures that are otherwise rigorously developed, reviewed, tested, and approved in the same manner as ACCF/AHA performance measures. The ultimate goal of the present document is to provide direction in defining and measuring the appropriate use-avoiding not only underuse but also overuse and misuse-and proper application of cardiovascular technology and to describe how such appropriate use measures and structure/safety measures might be developed for the purposes of quality improvement and public reporting. It is anticipated that this effort will help focus the national dialogue on the use of cardiovascular technology and away from the current concerns about volume and cost alone to a more holistic emphasis on value.
Subject(s)
Advisory Committees/standards , American Heart Association , Cardiology/standards , Cardiovascular Diseases/therapy , Evaluation Studies as Topic , Quality of Health Care/standards , Cardiology/methods , Cardiovascular Diseases/diagnosis , Foundations/standards , Humans , United StatesABSTRACT
El Libro Blanco de los Herbolarios y las Plantas Medicinales hace un diagnóstico del sector, en el que se señalan sus principales debilidades y fortalezas. Según el mismo, España sólo representa el 4% del mercado europeo de preparados a base de plantas medicinales, mientras que países como Alemania y Francia representan el 39% y el 29%, respectivamente. En España destaca la falta de regulación adecuada, que incorpore la experiencia europea y proporcione seguridad y confianza, tanto para el consumidor de plantas medicinales, productos dietéticos y alimentación ecológica, como para los profesionales de la herboristería y para los laboratorios y empresas. El estudio incide también en la necesidad de modernizar los establecimientos, aportando otros servicios y valor es añadidos como recomendaciones dietéticas o cosméticas bajo supervisión profesional, que los consumidores solicitan. Y asimismo refleja la importancia de aumentar la cooperación entre profesionales para hacer frente al futuro (AU)
The White Book on the herbalists shop and the medicinal plants does a diagnosis of the sector, in which his principal weaknesses and for tresses are elucidated. According to it, Spain only represents 4 % of the European market of medicinal plant derived products, whereas countries like Germany and France represent 39 % and 29 %, respectively. The study emphasizes the lack of suitable regulation in Spain, which should incorporate the European experience and should provide safety and confidence to the consumer of medicinal plants, dietetic products and ecological nourishment, as well as to the professionals who commercialize the products and for the manufacturing laboratories and companies. The study calls also the attention to the need of modernising the herbalists establishments, of fering additional services and added values that the consumers request, such as dietetic or cosmetic advice under professional supervision. Finally, the importance of increasing the cooperation between professionals to face to the future is also stressed in the study (AU)
Subject(s)
Humans , Male , Female , Plants, Medicinal , Foundations/organization & administration , Foundations/standards , Foundations , Biological Products/therapeutic use , Phytotherapy/instrumentation , Phytotherapy/methods , Natural Resources Exploitation/methodsABSTRACT
Convencidos que de nada sirve alimentar a un niño si lo devolvemos al ambiente de miseria extrema del que proviene, se crea entonces el Primer Centro Multidisciplinario de Prevención de la Desnutrición Infantil "María Alejandrina Rosa de Arenas", único en su género. Allí, a través de distintos programas, se abordan las principales causas que dan origen a la desnutrición, entre ellos podemos mencionar: Estimulación de la Lactancia Materna, Asistencia Alimentaria Complementaria, Educación Nutricional, Educación para la salud, Ropero Familiar, Alfabetización para Adultos, Jardín Maternal e Infantil, Estimulación Temprana, Talleres de Artes y Oficios para padres, Minoridad y Familia, Documentación y Legalización de la Familia, Planificación Familiar Natural y Escuela de Capacitación Agraria. Otros Centros de similares características funcionan en el Departamento de Rivadavia, Mendoza y en la República de Paraguay (fundado en 1995 desde Mendoza). Simultáneamente se fueron dando los primeros pasos para concretar la construcción del Primer Centro de Recuperación de Lactantes Desnutridos de la República Argentina. Otro pilar fundamental en la lucha contra la desnutrición es la investigación, por ello CONIN ha creado el "Centro de Investigaciones Médico-Sociales Prof. Dr. José Luis Minoprio".
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Breast Feeding , Infant Mortality , Infant Nutrition Disorders/complications , Infant Nutrition Disorders/etiology , Infant Nutrition Disorders/prevention & control , Nutrition Rehabilitation , Argentina , Foundations , Foundations/standards , Infant Nutrition Disorders/therapy , Paraguay , Preventive MedicineABSTRACT
Convencidos que de nada sirve alimentar a un niño si lo devolvemos al ambiente de miseria extrema del que proviene, se crea entonces el Primer Centro Multidisciplinario de Prevención de la Desnutrición Infantil "María Alejandrina Rosa de Arenas", único en su género. Allí, a través de distintos programas, se abordan las principales causas que dan origen a la desnutrición, entre ellos podemos mencionar: Estimulación de la Lactancia Materna, Asistencia Alimentaria Complementaria, Educación Nutricional, Educación para la salud, Ropero Familiar, Alfabetización para Adultos, Jardín Maternal e Infantil, Estimulación Temprana, Talleres de Artes y Oficios para padres, Minoridad y Familia, Documentación y Legalización de la Familia, Planificación Familiar Natural y Escuela de Capacitación Agraria. Otros Centros de similares características funcionan en el Departamento de Rivadavia, Mendoza y en la República de Paraguay (fundado en 1995 desde Mendoza). Simultáneamente se fueron dando los primeros pasos para concretar la construcción del Primer Centro de Recuperación de Lactantes Desnutridos de la República Argentina. Otro pilar fundamental en la lucha contra la desnutrición es la investigación, por ello CONIN ha creado el "Centro de Investigaciones Médico-Sociales Prof. Dr. José Luis Minoprio". (AU)