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The 2004 Canadian Hypertension Education Program recommendations for the management of hypertension: Part I--Blood pressure measurement, diagnosis and assessment of risk.

https://arctichealth.org/en/permalink/ahliterature181499
Source
Can J Cardiol. 2004 Jan;20(1):31-40
Publication Type
Article
Date
Jan-2004
Author
Brenda R Hemmelgarn
Kelly B Zarnke
Norman R C Campbell
Ross D Feldman
Donald W McKay
Finlay A McAlister
Nadia Khan
Ernesto L Schiffrin
Martin G Myers
Peter Bolli
George Honos
Marcel Lebel
Mitchell Levine
Raj Padwal
Author Affiliation
Division of Nephrology, University of Calgary, Calgary, Canada.
Source
Can J Cardiol. 2004 Jan;20(1):31-40
Date
Jan-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - therapeutic use
Blood Pressure Determination - standards
Blood Pressure Monitoring, Ambulatory - standards
Canada - epidemiology
Cardiovascular Diseases - prevention & control
Diet
Evidence-Based Medicine - standards
Female
Health Education - organization & administration
Humans
Hypertension - diagnosis - epidemiology - therapy
Incidence
Life Style
Male
Middle Aged
Prognosis
Risk assessment
Societies, Medical
Abstract
To provide updated, evidence-based recommendations for the assessment of the diagnosis, cardiovascular risk and identifiable causes for adults with high blood pressure.
For persons in whom a high blood pressure value is recorded, the assignment of a diagnosis of hypertension is dependent on the appropriate measurement of blood pressure, the level of the blood pressure elevation and the duration of follow-up. In addition, the presence of concomitant vascular risk factors, target organ damage and established atherosclerotic diseases should be assessed to determine the urgency, intensity and type of treatment. For persons diagnosed as having hypertension, defining overall risk of adverse cardiovascular outcomes requires an assessment of concomitant vascular risk factors, including laboratory testing, a search for target organ damage and an assessment for modifiable causes of hypertension. Home and ambulatory blood pressure assessment and echocardiography are options for selected patients.
The identification of persons at increased risk of adverse cardiovascular outcomes; the quantification of overall cardiovascular risk; and the identification of persons with potentially modifiable causes of hypertension.
Medline searches were conducted from November 2001, one year before the period of the last revision of the Canadian recommendations for the management of hypertension, to October 2003. Reference lists were scanned, experts were polled, and the personal files of subgroup members and authors were used to identify other studies. Identified articles were reviewed and appraised using prespecified levels of evidence by content experts and methodological experts.
A high value was placed on the identification of persons at increased risk of cardiovascular morbidity and mortality, and persons with identifiable and potentially modifiable causes of hypertension.
The identification of persons at higher risk of cardiovascular disease will permit counselling for lifestyle maneuvers and introduction of antihypertensive drugs to reduce blood pressure for patients with sustained hypertension. The identification of specific causes of hypertension may permit the use of cause-specific interventions. For certain subgroups of patients and specific classes of drugs, blood pressure lowering has been associated with reduced cardiovascular morbidity and/or mortality.
The document contains recommendations for blood pressure measurement, diagnosis of hypertension and assessment of cardiovascular risk for adults with high blood pressure. These include the accurate measurement of blood pressure, criteria for diagnosis of hypertension, and recommendations for follow-up, assessment of overall cardiovascular risk, routine and optional laboratory testing, assessment for renovascular and endocrine causes, home and ambulatory blood pressure monitoring, and the role of echocardiography for those with hypertension.
All recommendations were graded according to strength of evidence and voted on by the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. Only the recommendations that achieved high levels of consensus are reported. These guidelines will be updated annually.
PubMed ID
14968141 View in PubMed
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The 2004 Canadian recommendations for the management of hypertension: Part III--Lifestyle modifications to prevent and control hypertension.

https://arctichealth.org/en/permalink/ahliterature181497
Source
Can J Cardiol. 2004 Jan;20(1):55-9
Publication Type
Article
Date
Jan-2004
Author
R M Touyz
N. Campbell
A. Logan
N. Gledhill
R. Petrella
R. Padwal
Author Affiliation
Clinical Research Institute of Montreal, University of Montreal, Montreal, Quebec, Canada. touyzr@icrm.qc.ca
Source
Can J Cardiol. 2004 Jan;20(1):55-9
Date
Jan-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antioxidants - administration & dosage
Blood Pressure Determination - standards
Canada
Diet
Dietary Supplements
Evidence-Based Medicine - standards
Female
Humans
Hypertension - prevention & control - therapy
Life Style
Male
Middle Aged
Primary prevention - methods
Prognosis
Risk assessment
Severity of Illness Index
Societies, Medical
Treatment Outcome
Abstract
To provide updated, evidence-based recommendations regarding the role of lifestyle modification in the treatment and prevention of hypertension.
Lifestyle modification interventions including exercise, weight reduction, alcohol consumption, dietary modification, intake of dietary cations and stress management are reviewed. Antioxidants and fish oil supplements are also reviewed, although specific recommendations cannot be made at present.
MEDLINE searches were conducted from January 2002 to September 2003 to update the 2001 recommendations for the management of hypertension. Supplemental searches in the Cochrane Collaboration databases were also performed. Reference lists were scanned, experts were contacted, and the personal files of the subgroup members and authors were used to identify additional published studies. All relevant articles were reviewed and appraised independently using prespecified levels of evidence by content and methodology experts.
Key recommendations include the following: lifestyle modification should be extended to nonhypertensive individuals who are at risk for developing high blood pressure; 30 min to 45 min of aerobic exercise should be performed on most days (four to five days) of the week; an ideal body weight (body mass index 18.5 kg/m2 to 24.9 kg/m2) should be maintained and weight loss strategies should use a multidisciplinary approach; alcohol consumption should be limited to two drinks or fewer per day, and weekly intake should not exceed 14 standard drinks for men and nine standard drinks for women; a reduced fat, low cholesterol diet that emphasizes fruits, vegetables and low fat dairy products, and maintains an adequate intake of potassium, magnesium and calcium, should be followed; salt intake should be restricted to 65 mmol/day to 100 mmol/day in hypertensive individuals and less than 100 mmol/day in normotensive individuals at high risk for developing hypertension; and stress management should be considered as an intervention in selected individuals.
All recommendations were graded according to the strength of the evidence and voted on by the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. Individuals with irreconcilable competing interests (declared by all members, compiled and circulated before the meeting) relative to any specific recommendation were excluded from voting on that recommendation. Only those recommendations achieving at least 70% consensus are reported here. These guidelines will continue to be updated annually.
PubMed ID
14968143 View in PubMed
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The 2004 Canadian recommendations for the management of hypertension: Part II--Therapy.

https://arctichealth.org/en/permalink/ahliterature181498
Source
Can J Cardiol. 2004 Jan;20(1):41-54
Publication Type
Article
Date
Jan-2004
Author
Nadia A Khan
Finlay A McAlister
Norman R C Campbell
Ross D Feldman
Simon Rabkin
Jeff Mahon
Richard Lewanczuk
Kelly B Zarnke
Brenda Hemmelgarn
Marcel Lebel
Mitchell Levine
Carol Herbert
Author Affiliation
Division of General Internal Medicine, University of British Columbia, Vancouver, Canada.
Source
Can J Cardiol. 2004 Jan;20(1):41-54
Date
Jan-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - administration & dosage
Blood Pressure Determination - standards
Canada - epidemiology
Cardiovascular Diseases - prevention & control
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Therapy, Combination
Evidence-Based Medicine - standards
Female
Humans
Hypertension - diagnosis - drug therapy - epidemiology
Male
Middle Aged
Prognosis
Risk assessment
Severity of Illness Index
Societies, Medical
Treatment Outcome
Abstract
To provide updated, evidence-based recommendations for the management of hypertension in adults.
For patients who require pharmacological therapy for hypertension, a number of antihypertensive agents may be used. Randomized trials evaluating first-line therapy with diuretics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers (CCBs), alpha-blockers, centrally acting agents or angiotensin receptor antagonists were reviewed. Also, randomized trials evaluating other agents, such as statins or acetylsalicylic acid, in patients with hypertension were reviewed. Changes in cardiovascular morbidity and mortality were the primary outcomes of interest. In addition, other relevant outcomes such as development of end-stage renal disease or changes in blood pressure were examined where appropriate.
MEDLINE searches were conducted from November 2001 to October 2003 to update the 2001 Recommendations for the management of hypertension. Reference lists were scanned, experts were contacted, and the personal files of the subgroup members and authors were used to identify additional published studies. All relevant articles were reviewed and appraised independently, using prespecified levels of evidence by content and methodology experts.
This document contains detailed recommendations and supporting evidence on treatment thresholds, target blood pressures and choice of agents for hypertensive patients with or without comorbidities. Lifestyle modifications are a key component of any antiatherosclerotic management strategy and detailed recommendations are contained in a separate document. Key recommendations for pharmacotherapy include the following: treatment thresholds and targets should take into account each individual's global atherosclerotic risk, target organ damage and comorbidities, with particular attention to systolic blood pressure; blood pressure should be lowered to 140/90 mmHg or less in all patients, and 130/80 mmHg or less in those with diabetes mellitus or renal disease (125/75 mmHg or less in those with nondiabetic renal disease and more than 1 g of proteinuria per day); most adults with hypertension require more than one agent to achieve target blood pressures; for adults without compelling indications for other agents, initial therapy should include thiazide diuretics; other agents appropriate for first-line therapy for diastolic hypertension with or without systolic hypertension include beta-blockers (in those younger than 60 years), ACE inhibitors (in non-Blacks), long-acting dihydropyridine CCBs or angiotensin receptor antagonists; other agents appropriate for first-line therapy for isolated systolic hypertension include long-acting dihydropyridine CCBs or angiotensin receptor antagonists; certain comorbidities provide compelling indications for first-line use of other agents: in patients with angina, recent myocardial infarction or heart failure, beta-blockers and ACE inhibitors are recommended as first-line therapy; in patients with diabetes mellitus, ACE inhibitors or angiotensin receptor antagonists (or thiazides in patients with diabetes mellitus without albuminuria) are appropriate first-line therapies; and in patients with mild to moderate nondiabetic renal disease, ACE inhibitors are recommended; all hypertensive patients should have their fasting lipids screened and those with dyslipidemia should be treated using the thresholds, targets and agents as per the Recommendations for the management of dyslipidemia and the prevention of cardiovascular disease; and selected patients with hypertension should also receive statin and/or acetylsalicylic acid therapy.
All recommendations were graded according to the strength of the evidence and voted on by the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. Individuals with irreconcilable competing interests (declared by all members, compiled and circulated before the meeting) relative to any specific recommendation were excluded from voting on that recommendation. Only recommendations achieving at least 70% consensus are reported here. These guidelines will continue to be updated annually.
PubMed ID
14968142 View in PubMed
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The 2012 Canadian hypertension education program recommendations for the management of hypertension: blood pressure measurement, diagnosis, assessment of risk, and therapy.

https://arctichealth.org/en/permalink/ahliterature124290
Source
Can J Cardiol. 2012 May;28(3):270-87
Publication Type
Article
Date
May-2012
Author
Stella S Daskalopoulou
Nadia A Khan
Robert R Quinn
Marcel Ruzicka
Donald W McKay
Daniel G Hackam
Simon W Rabkin
Doreen M Rabi
Richard E Gilbert
Raj S Padwal
Martin Dawes
Rhian M Touyz
Tavis S Campbell
Lyne Cloutier
Steven Grover
George Honos
Robert J Herman
Ernesto L Schiffrin
Peter Bolli
Thomas Wilson
Ross D Feldman
M Patrice Lindsay
Brenda R Hemmelgarn
Michael D Hill
Mark Gelfer
Kevin D Burns
Michel Vallée
G V Ramesh Prasad
Marcel Lebel
Donna McLean
J Malcolm O Arnold
Gordon W Moe
Jonathan G Howlett
Jean-Martin Boulanger
Pierre Larochelle
Lawrence A Leiter
Charlotte Jones
Richard I Ogilvie
Vincent Woo
Janusz Kaczorowski
Luc Trudeau
Simon L Bacon
Robert J Petrella
Alain Milot
James A Stone
Denis Drouin
Maxime Lamarre-Cliché
Marshall Godwin
Guy Tremblay
Pavel Hamet
George Fodor
S George Carruthers
George Pylypchuk
Ellen Burgess
Richard Lewanczuk
George K Dresser
Brian Penner
Robert A Hegele
Philip A McFarlane
Mukul Sharma
Norman R C Campbell
Debra Reid
Luc Poirier
Sheldon W Tobe
Author Affiliation
Division of General Internal Medicine, McGill University, Montreal, Québec, Canada. stella.daskalopoulou@mcgill.ca
Source
Can J Cardiol. 2012 May;28(3):270-87
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antihypertensive Agents - therapeutic use
Blood Pressure Determination - methods
Canada
Cardiovascular Diseases - etiology - prevention & control
Education, Medical, Continuing - standards
Evidence-Based Medicine - standards
Female
Health Education - standards
Humans
Hypertension - complications - diagnosis - therapy
Male
Middle Aged
Monitoring, Physiologic - methods
Practice Guidelines as Topic - standards
Prognosis
Risk assessment
Treatment Outcome
Abstract
We updated the evidence-based recommendations for the diagnosis, assessment, prevention, and treatment of hypertension in adults for 2012. The new recommendations are: (1) use of home blood pressure monitoring to confirm a diagnosis of white coat syndrome; (2) mineralocorticoid receptor antagonists may be used in selected patients with hypertension and systolic heart failure; (3) a history of atrial fibrillation in patients with hypertension should not be a factor in deciding to prescribe an angiotensin-receptor blocker for the treatment of hypertension; and (4) the blood pressure target for patients with nondiabetic chronic kidney disease has now been changed to
PubMed ID
22595447 View in PubMed
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Addiction medicine in Canada: challenges and prospects.

https://arctichealth.org/en/permalink/ahliterature134877
Source
Subst Abus. 2011 Apr;32(2):93-100
Publication Type
Article
Date
Apr-2011
Author
Nady el-Guebaly
David Crockford
Sharon Cirone
Meldon Kahan
Author Affiliation
Addiction Division, University of Calgary, Calgary, Alberta, Canada. nady.el-guebaly@albertahealthservices.ca
Source
Subst Abus. 2011 Apr;32(2):93-100
Date
Apr-2011
Language
English
Publication Type
Article
Keywords
Canada
Certification - methods - standards
Clinical Competence - standards
Clinical Medicine
Evidence-Based Medicine - standards
Humans
Physicians, Family - education
Psychiatry - education
Substance Abuse Treatment Centers - manpower
Substance-Related Disorders
Abstract
In Canada, the qualification of physicians is the jurisdiction of the College of Family Physicians and the Royal College of Physicians and Surgeons. The Colleges have promoted the training of "generalists" in family medicine and "sophisticated generalists" among the traditional specialties, and the development of subspecialties has not been encouraged. Nevertheless, due to the increasing number of family physicians and specialists practicing a range of new subspecialties, including addiction medicine, the College of Family Physicians has recognized special interest or focused practices, whereas the Royal College has recognized, in psychiatry, 3 subspecialties (child, geriatric, forensic) requiring an extra year of training and may offer others a diploma recognition. These new opportunities will shape the training requirements of addiction medicine leading to available certification through the International and American Medical Societies of Addiction Medicine.
PubMed ID
21534130 View in PubMed
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Assessing guidelines for use in family practice.

https://arctichealth.org/en/permalink/ahliterature192508
Source
J Fam Pract. 2001 Nov;50(11):969-73
Publication Type
Article
Date
Nov-2001
Author
W W Rosser
D. Davis
E. Gilbart
Author Affiliation
Continuing Education, University of Toronto, 500 University Avenue, Suite 650, Toronto, Ontario M5G 1V7. erin.gilbart@utoronto.ca
Source
J Fam Pract. 2001 Nov;50(11):969-73
Date
Nov-2001
Language
English
Publication Type
Article
Keywords
Cost of Illness
Education, Medical, Continuing
Evidence-Based Medicine - standards
Family Practice - education - standards - statistics & numerical data
Health Priorities
Humans
Information Services
Internet
Morbidity
Needs Assessment
Ontario - epidemiology
Outcome Assessment (Health Care)
Peer Review, Research
Physician's Practice Patterns - standards - statistics & numerical data
Practice Guidelines as Topic - standards
Total Quality Management
Abstract
With more than 1000 new guidelines produced annually over the past decade, it is impossible for the practicing family physician to determine which ones should be adapted into their clinical practice. The Ontario Ministry of Health and Long-Term Care and the Ontario Medical Association formed the Guideline Advisory Committee (GAC) in 1997 to assess and disseminate guidelines that would improve the quality and utilization of health care services in the province. Over the past 3 years the GAC has developed a strategy to identify important topics, to rank order guidelines published on these topics based on the quality of their development, and to reformat guidelines as necessary to make them user-friendly for implementation in clinical practice. The GAC is currently assessing a number of strategies to enhance the dissemination of selected guidelines to improve the quality of care delivered in the province.
Notes
Comment In: J Fam Pract. 2001 Nov;50(11):974-511711014
PubMed ID
11711013 View in PubMed
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Assessment of decision-making capacity: views and experiences of consultation psychiatrists.

https://arctichealth.org/en/permalink/ahliterature118544
Source
Psychosomatics. 2013 Mar-Apr;54(2):115-23
Publication Type
Article
Author
Lisa Seyfried
Kerry A Ryan
Scott Y H Kim
Author Affiliation
Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109-2800, USA.
Source
Psychosomatics. 2013 Mar-Apr;54(2):115-23
Language
English
Publication Type
Article
Keywords
Aged
Attitude of Health Personnel
Canada
Clinical Competence - standards
Data Collection
Decision Making
Evidence-Based Medicine - standards
Female
Humans
Informed Consent - psychology
Male
Mental Competency - psychology
Middle Aged
Psychosomatic Medicine - standards
Referral and Consultation - standards
Regression Analysis
Societies, Medical
United States
Abstract
Decision-making capacity (DMC) assessments can have profound consequences for patients. With an aging population, an increasing emphasis on shared decision-making, and a rising number of potential medical interventions, the need for such assessments will continue to grow.
To assess psychosomatic medicine clinicians' training, experiences, and views about DMC assessments.
Online survey of members of the Academy of Psychosomatic Medicine (APM). Of 780 eligible members, 288 responded to the survey (36.9% response rate).
Approximately 1 in 6 psychiatric consultations are DMC assessments. Ninety percent of respondents reported that at least half of their capacity assessments involve patients older than 60 years. DMC assessments were seen as more challenging and time-consuming than other types of consultations; yet training in capacity evaluations was seen as suboptimal and half of respondents felt the evidence-base guiding DMC assessment is somewhat or much weaker than for other types of psychiatric consultations. In addition, the practice of capacity assessment seems to vary widely with no consistent approach among respondents. Respondents strongly endorsed multiple areas and topics for potential future research, indicating a desire for a stronger evidence-base.
Members of the APM perceive capacity assessments as common and challenging. Yet they perceive having received subpar training with relatively weak evidence to guide their current practice. Future research should address these potential deficiencies, given the likelihood that DMC assessments will only become more common.
PubMed ID
23194935 View in PubMed
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Best practices in scleroderma: an analysis of practice variability in SSc centres within the Canadian Scleroderma Research Group (CSRG).

https://arctichealth.org/en/permalink/ahliterature122345
Source
Clin Exp Rheumatol. 2012 Mar-Apr;30(2 Suppl 71):S38-43
Publication Type
Article
Author
Sarah Harding
Sarit Khimdas
Ashley Bonner
Murray Baron
Janet Pope
Author Affiliation
University of Western Ontario, London, ON, Canada. sarahharding@rcsi.ie
Source
Clin Exp Rheumatol. 2012 Mar-Apr;30(2 Suppl 71):S38-43
Language
English
Publication Type
Article
Keywords
Benchmarking - standards
Canada
Consensus
Databases, Factual
Diagnostic Tests, Routine - standards
Evidence-Based Medicine - standards
Female
Guideline Adherence - standards
Humans
Male
Middle Aged
Outcome and Process Assessment (Health Care) - standards
Physician's Practice Patterns - standards
Practice Guidelines as Topic - standards
Predictive value of tests
Prospective Studies
Quality Indicators, Health Care - standards
Rheumatology - standards
Scleroderma, Systemic - complications - diagnosis - therapy
Severity of Illness Index
Time Factors
Treatment Outcome
Abstract
There is currently no consensus on best practice in systemic sclerosis (SSc). To determine if variability in treatment and investigations exists, practices among Canadian Sclerodermia Research Group (CSRG) centres were compared.
Prospective clinical and demographic data from adult SSc patients are collected annually from 15 CSRG treatment centres. Laboratory parameters, self-reported socio-demographic questionnaires, current and past medications and disease outcome measures are recorded. For centres with >50 patients enrolled, treatment practices were analysed to determine practice variability.
Data from 640 of 938 patients within the CSRG database met inclusion criteria, where 87.3% were female, the mean ± SEM age was 55.3±0.5, 48.9% had limited SSc and 47.8% had diffuse SSc (and 3.3% uncharacterised). Some investigation and treatment practices were inconsistent among 6 centres including proportion receiving: PDE5 (phosphodiesterase type 5) inhibitors for Raynaud's phenomenon (p=0.036); cyclophosphamide (p=0.037) and azathioprine (p=0.037) for treatment of ILD; and current use of D-penicillamine, although uncommon, varied among sites. Annual echocardiograms and PFTs were frequently done and did not vary among sites but the rate of pulmonary arterial hypertension (PAH) was directly related to site size and this was not the case for other organ involvement.
Despite routine tests within a database, site variation in SSc with respect to investigations and management among CSRG centres exists suggesting a need for a standardised approach to the investigation and treatment of SSc. One can speculate that larger centres are more export in detecting PAH.
PubMed ID
22691207 View in PubMed
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Bridging the gaps: getting evidence into practice.

https://arctichealth.org/en/permalink/ahliterature149218
Source
CMAJ. 2009 Oct 13;181(8):457-8
Publication Type
Article
Date
Oct-13-2009
Author
William McGuire
Peter W Fowlie
Author Affiliation
Centre for Reviews and Dissemination, Hull York Medical School, University of York, YO10 5DD, UK. william.mcguire@hyms.ac.uk
Source
CMAJ. 2009 Oct 13;181(8):457-8
Date
Oct-13-2009
Language
English
Publication Type
Article
Keywords
Bronchopulmonary Dysplasia - epidemiology - prevention & control
Canada - epidemiology
Cross Infection - epidemiology - prevention & control
Evidence-Based Medicine - standards
Female
Humans
Infant, Newborn
Infant, Premature
Pregnancy
Prenatal Care - methods
Prevalence
Quality Assurance, Health Care
Notes
Cites: Pediatrics. 2000 Nov;106(5):1070-911061777
Cites: Cochrane Database Syst Rev. 2001;(4):CD00107711687096
Cites: Qual Saf Health Care. 2003 Aug;12(4):298-30312897365
Cites: Semin Perinatol. 2003 Aug;27(4):281-714510318
Cites: Semin Perinatol. 2003 Aug;27(4):293-30114510320
Cites: Pediatrics. 2004 Jun;113(6):1593-60215173479
Cites: BMJ. 2004 Oct 30;329(7473):100415514344
Cites: CMAJ. 2009 Oct 13;181(8):469-7619667033
Cites: Pediatrics. 2007 May;119(5):876-9017473087
Cites: N Engl J Med. 2007 Nov 8;357(19):1893-90217989382
Cites: Arch Dis Child Fetal Neonatal Ed. 2008 May;93(3):F225-917893123
Cites: Pediatrics. 2009 Jun;123(6):1562-7319482769
Comment In: CMAJ. 2010 Feb 9;182(2):17620142390
Comment On: CMAJ. 2009 Oct 13;181(8):469-7619667033
PubMed ID
19667032 View in PubMed
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Canadian clinical practice guidelines for acute and chronic rhinosinusitis.

https://arctichealth.org/en/permalink/ahliterature133720
Source
J Otolaryngol Head Neck Surg. 2011 May;40 Suppl 2:S99-193
Publication Type
Article
Date
May-2011
Author
Martin Desrosiers
Gerald A Evans
Paul K Keith
Erin D Wright
Alan Kaplan
Jacques Bouchard
Anthony Ciavarella
Patrick W Doyle
Amin R Javer
Eric S Leith
Atreyi Mukherji
R. Robert Schellenberg
Peter Small
Ian J Witterick
Author Affiliation
Division of Otolaryngology-Head and Neck Surgery Centre Hospitalier de l'Université de Montréal, Université de Montréal Hotel-Dieu de Montreal, Montreal General Hospital, McGill University, Montreal, QC, Canada. desrosiers_martin@ hotmail.com
Source
J Otolaryngol Head Neck Surg. 2011 May;40 Suppl 2:S99-193
Date
May-2011
Language
English
French
Publication Type
Article
Keywords
Acute Disease
Anti-Bacterial Agents - therapeutic use
Canada
Chronic Disease
Dose-Response Relationship, Drug
Drug Administration Schedule
Drug Resistance, Bacterial
Drug Therapy, Combination
Evidence-Based Medicine - standards
Female
Humans
Male
Microbial Sensitivity Tests
Practice Guidelines as Topic
Prognosis
Quality Control
Rhinitis - diagnosis - drug therapy
Sinusitis - diagnosis - drug therapy
Treatment Outcome
Abstract
This document provides health care practitioners with information regarding the management of acute rhinosinusitis (ARS) and chronic rhinosinusitis (CRS) to enable them to better meet the needs of this patient population. These guidelines describe controversies in the management of acute bacterial rhinosinusitis (ABRS) and include recommendations that take into account changes in the bacteriologic landscape. Recent guidelines in ABRS have been released by American and European groups as recently as 2007, but these are either limited in their coverage of the subject of CRS, do not follow an evidence-based strategy, or omit relevant stakeholders in the development of guidelines and do not address the particulars of the Canadian health care environment.Advances in understanding the pathophysiology of CRS, along with the development of appropriate therapeutic strategies, have improved outcomes for patients with CRS. CRS now affects large numbers of patients globally, and primary care practitioners are confronted by this disease on a daily basis. Although initially considered a chronic bacterial infection, CRS is now recognized as having multiple distinct components (eg, infection, inflammation), which have led to changes in therapeutic approaches (eg, increased use of corticosteroids). The role of bacteria in the persistence of chronic infections and the roles of surgical and medical management are evolving. Although evidence is limited, guidance for managing patients with CRS would help practitioners less experienced in this area offer rational care. It is no longer reasonable to manage CRS as a prolonged version of ARS, but, rather, specific therapeutic strategies adapted to pathogenesis must be developed and diffused.Guidelines must take into account all available evidence and incorporate these in an unbiased fashion into management recommendations based on the quality of evidence, therapeutic benefit, and risks incurred. This document is focused on readability rather than completeness yet covers relevant information, offers summaries of areas where considerable evidence exists, and provides recommendations with an assessment of the strength of the evidence base and the degree of endorsement by the multidisciplinary expert group preparing the document.These guidelines have been copublished in both Allergy, Asthma, and Clinical Immunology and the Journal of Otolaryngology-Head and Neck Surgery.
PubMed ID
21658337 View in PubMed
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50 records – page 1 of 5.