Articles related to GUIDELINES/RECOMMENDATIONS

Dive into the essence of AANA’s updated guidelines for obstetric anesthesia and analgesia as we spotlight its focus on health equity and safety in maternal care. Commencing with the unveiling of the revised practice guidelines for obstetric anesthesia and analgesia, the American Association of Nurse Anesthesiology (AANA) has emphasized enhancing patient care and safety. Interestingly, these updates also strive to tackle the critical issue of enduring health disparities in the United States. The AANA firmly believes in the power of certified registered nurse anesthetists (CRNAs) to help curb maternal mortality rates. The primary strategy focuses on mitigating racial and ethnic imbalances in pregnancy-related deaths. Beth Ann Clayton, DNP, CRNA, FAANA, FAAN, the key subject matter expert behind the revisions, underscores these inequalities as significant barriers to optimal maternal care. Using an evidence-based process, the AANA revised the guidelines, paying careful attention to current research. They’ve prioritized enhancing the readability of the content, updating the quality of references, and broadening their scope to encompass the most recent recommendations on obstetric analgesia and anesthesia care. The notable alterations include the broadening of analgesia and anesthesia considerations for labor and delivery. This expansion encompasses inhalation analgesia, neuraxial analgesia, general anesthesia, and an updated […]

Dive into this CME program to grasp the latest C. difficile guidelines and implement treatment strategies effectively. This interactive CME program focuses on Clostridioides difficile, or C. difficile. As you know, this bacterium causes severe GI disturbances. Alarmingly, it impacts half a million Americans annually and burdens the healthcare system. Who is this for? Infectious disease physicians, gastroenterologists, hospitalists, intensivists, and all HCPs managing patients with C. difficile infection (CDI) will benefit greatly. Initially, the program offers a comprehensive review of CDI. It presents the epidemiology and pinpoints key risk factors. Moreover, it explains the underlying pathophysiology and outlines clinical features. Significantly, it emphasizes the disease’s burden and unveils diagnostic tools, including NAAT, GDH assay, and toxin tests. Following this, the program shifts to treatment strategies for CDI. It details procedures for various severity levels – mild, severe, fulminant, and recurrent. Concurrently, it underlines the common challenges in therapy decision-making. Importantly, it stresses the necessity of adhering to CDI guidelines and presents preventative measures. In the concluding section, participants receive practical patient cases. This allows the application of newfound knowledge directly. Afterward, it wraps up with a summary and a best practice recap. Upon completion, participants will grasp the burden […]

Delve into the changes in the updated Beers criteria and their implications for medication use in older patients. The American Geriatrics Society (AGS) has recently revised the Beers criteria. Significantly, these guidelines advise physicians to be cautious when prescribing medications like warfarin and sodium-glucose cotransporter-2 (SGLT2) inhibitors for patients over 65. Importantly, warfarin is now a drug to avoid in initial therapy for venous thromboembolism or nonvalvular atrial fibrillation unless alternatives are contraindicated or face significant usage barriers. The Beers criteria are organized into five distinct categories. These include potentially inappropriate medications, ones that might be inappropriate for patients with certain conditions, medications requiring careful usage, potential drug-drug interactions, and medications needing renal function-based dosage adjustments. An expert panel sifted through evidence from June 1, 2017, to May 31, 2022, to create these updates. These guidelines apply to patients aged 65 years and older in most care settings in the US, excluding hospice and end-of-life care situations. Among the notable changes since 2019 is the inclusion of warfarin. For older patients using warfarin long-term, continuation might be reasonable if they show well-controlled international normalized ratios and no adverse effects. Additional drugs introduced since 2019 include ticagrelor and SGLT2 inhibitors (use […]

This case study applies the newly revised CDC Clinical Practice Guideline for Prescribing Opioids for Pain to a patient with chronic neck pain. The patient, Joanna, is a 78-year-old woman who has undergone two neck surgeries and experiences worsening pain. Her pain ranges from 6 to 7 on average and can increase up to 8. She has tried various non-pharmacologic modalities, such as heat, ice, TENS, physical therapy, and massage therapy, but insurance limitations and cost have hindered her access to these treatments. Considering Joanna’s medical history, physical therapy and topical analgesics are identified as potential options. However, due to limitations and contraindications with other medications, the only feasible options for her are low-dose acetaminophen and topical analgesics. As a result, initiating a low-dose opioid therapy is considered appropriate, in addition to low-dose acetaminophen, OTC menthol and methyl salicylate cream, and a referral to physical medicine and rehabilitation. Before initiating opioids, the patient’s risk of side effects, including overdose, addiction, constipation, and hypogonadal axis suppression, should be discussed. Joanna’s Risk Index for Overdose or Serious Opioid-Induced Respiratory Depression (RIOSORD) score indicates a risk class of 4 out of 7, with a 15% estimated probability of an opioid-induced respiratory depression event […]

A 29-member specialist interest group (SIG) was formed, comprising representation from neurology, neuroradiology, anesthesia, neurosurgery, and patient advocacy. The SIG unanimously agreed on the scope and purpose of the guideline. Using a modified Delphi method, the SIG then created guideline statements for a number of question themes. A rigorous literature study, surveys of patients and healthcare professionals, and a review by numerous international experts on SIH all contributed to this process. Any patient presenting with orthostatic headache should be evaluated for spontaneous intracranial hypotension (SIH) and its possible diagnosis. MRI of the brain with contrast and the whole spine should be used as first-line imaging. The non-targeted epidural blood patch (EBP) is the first-line treatment and should be performed as soon as possible. The authors discuss treatment ideas and present criteria for doing myelography based on the spine MRI result and response to EBP. There are also recommendations for conservative care, symptomatic headache treatment, and management of SIH consequences.

Recent draft guidelines from the United States Preventive Services Task Force (USPSTF) propose a change in routine screening mammography recommendations. The new guidelines suggest that women should begin undergoing regular mammograms 10 years earlier than previously advised, starting at the age of 40. This recommendation applies to all individuals assigned female at birth. Simultaneously, FDA has made updates to federal mammography regulations, with a particular focus on reporting requirements related to breast density. These regulatory changes are motivated by studies indicating that approximately half of women over the age of 40 have dense breast tissue in concordance with the high prevalence of breast cancer in the population.