Download or read book Evidence for the Reaffirmation of the U S Preventive Services Task Force Recommendation on Screening for High Blood Pressure written by Tracy A. Wolff and published by . This book was released on 2007 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: High blood pressure is common, and screening is a well-established evidence-based standard of current medical practice. PURPOSE: To perform a literature search for new, substantial evidence on screening for high blood pressure that would inform the reaffirmation of the U.S. Preventive Services Task Force recommendation on screening for high blood pressure. DATA SOURCES: The PubMed and Cochrane databases were searched. The searches were limited to English-language articles on studies of adult humans (age >18 years) that were published between 1 October 2001 and 31 March 2006 in core clinical journals. Study Selection: For the literature on benefits, meta-analyses; systematic reviews; and randomized, controlled trials were included. For harms, meta-analyses; systematic reviews; randomized, controlled trials; cohort studies; case--control studies; and case series of large, multisite databases were included. Two reviewers independently reviewed titles, abstracts, and full articles for inclusion. DATA EXTRACTION: No new evidence was found on benefits or harms of screening. Two reviewers extracted data from studies on the harms of early treatment, including adverse effects of drug therapy and adverse quality-of-life outcomes. DATA SYNTHESIS: No new evidence was found for the benefits of screening for high blood pressure. New evidence on the harms of treatment of early hypertension shows that pharmacologic therapy is associated with common side effects; serious adverse events are uncommon. LIMITATIONS: The nonsystematic search may have missed some smaller studies on the benefits and harms of screening and treatment for high blood pressure. CONCLUSIONS: No new evidence was found on the benefits of screening. Pharmacotherapy for early hypertension is associated with common side effects.

Download or read book Screening for High Blood Pressure in Adults written by Margaret Piper and published by . This book was released on 2014 with total page 296 pages. Available in PDF, EPUB and Kindle. Book excerpt: OBJECTIVE: We conducted this systematic review to support the U.S. Preventive Services Task Force (USPSTF) in updating its recommendation on screening for high blood pressure (BP) in nonpregnant adults. CONCLUSIONS: ABPM (24-hour, daytime, or nighttime) is a better predictor of long-term CV outcomes than OBPM (usually manual sphygmomanometry) and should be considered the reference standard for evaluating noninvasive BP measurements. A small body of evidence suggests, but does not confirm, that HBPM can serve as a similar predictor of outcomes. Initial screening by office-based methods (manual sphygmomanometry or automated oscillometric devices) variably predicts hypertension as defined by ABPM, resulting in a significant population with isolated clinic hypertension. Limited evidence suggests that patients with isolated clinic hypertension have outcomes that are more similar to normotensive than hypertensive persons. Failure to confirm initial elevated OBPM results may result in misdiagnosis and overtreatment. Limited evidence suggests that repeated measurements and improved procedural control (e.g., by automation) may improve the diagnostic accuracy of OBPM when used to screen for high BP or confirm a diagnosis of hypertension. Studies of rescreening intervals at up to 6 years found a higher incidence of hypertension overall and at shorter intervals for persons with BP in the high-normal range, older adults, persons with an above normal BMI, and African Americans. These studies showed much lower incidence at longer rescreening intervals up to 6 years in persons without these risk factors.

Download or read book Screening for Hypertension in Children and Adolescents to Prevent Cardiovascular written by Oregon Evidence-based Oregon Evidence-based Practice Center and published by . This book was released on 2014-02-18 with total page 64 pages. Available in PDF, EPUB and Kindle. Book excerpt: The purpose of this systematic evidence review is for the U.S. Preventive Services Task Force (USPSTF) to update its recommendation on screening for high blood pressure in children and adolescents to prevent cardiovascular disease. In 2003, the USPSTF found poor evidence that routine blood pressure measurement accurately identifies children and adolescents at increased risk for cardiovascular disease, and poor evidence to determine whether treatment of elevated blood pressure in children or adolescents decreases the incidence of cardiovascular disease. Recent data from the National Health and Nutrition Examination Survey suggest that mean blood pressure levels are rising steadily in children, as is the prevalence of childhood hypertension. This may be due to the increase in the prevalence of obesity and overweight among children, which is highly correlated with high blood pressure. Screening of asymptomatic children has the potential to detect hypertension at earlier stages, so that interventions can be initiated which, if effective, could reduce the adverse health effects of childhood hypertension in both childhood and adulthood, including cardiovascular disease and organ damage. This report summarizes recent and older evidence on screening and diagnostic accuracy of screening tests for high blood pressure in children, the effectiveness and harms of treatment for screen-detected, primary childhood hypertension, and the tracking of hypertension from childhood to adulthood.

Download or read book Screening for Hypertension in Children and Adolescents to Prevent Cardiovascular Disease Systematic Review for the U S Preventive Services Task Force written by U. S. Department Human Services and published by Createspace Independent Publishing Platform. This book was released on 2013-04-17 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: The purpose of this systematic evidence review is for the U.S. Preventive Services Task Force (USPSTF) to update its recommendation on screening for high blood pressure in children and adolescents to prevent cardiovascular disease. In 2003, the USPSTF found poor evidence that routine blood pressure measurement accurately identifies children and adolescents at increased risk for cardiovascular disease, and poor evidence to determine whether treatment of elevated blood pressure in children or adolescents decreases the incidence of cardiovascular disease. As a result, the USPSTF could not determine the balance of benefits and harms of routine screening for high blood pressure in children and adolescents, which resulted in an I recommendation. Recent data from the National Health and Nutrition Examination Survey suggest that mean blood pressure levels are rising steadily in children, as is the prevalence of childhood hypertension. This may be due to the increase in the prevalence of obesity and overweight among children, which is highly correlated with high blood pressure. Screening of asymptomatic children has the potential to detect hypertension at earlier stages, so that interventions can be initiated which, if effective, could reduce the adverse health effects of childhood hypertension in both childhood and adulthood, including cardiovascular disease and end-organ damage. This report summarizes recent and older evidence on screening and diagnostic accuracy of screening tests for high blood pressure in children, the effectiveness and harms of treatment for screen-detected, primary childhood hypertension, and the tracking of hypertension from childhood to adulthood. Using the methods of the USPSTF and with the input of members of the USPSTF, we developed an analytic framework and key questions to guide our literature search and review. Key Questions include: 1. Is screening for hypertension in children/adolescents effective in delaying the onset of or reducing adverse health outcomes related to hypertension? 2. What is the diagnostic accuracy of screening tests for elevated blood pressure in children/adolescents? 3. What is the association between hypertension in children/adolescents and hypertension and other intermediate outcomes in adults? 4. What are the adverse effects of screening for hypertension in children/adolescents, including labeling and anxiety? 5. What is the effectiveness of drug, nondrug, and combination interventions for treating primary hypertension in children/adolescents? 6. What is the effectiveness of drug, nondrug, and combination interventions initiated for the treatment of primary hypertension in children/adolescents for reducing blood pressure and other intermediate outcomes in adults? 7. What is the effectiveness of drug, nondrug, and combination interventions initiated for the treatment of primary hypertension in children/adolescents for reducing adverse health outcomes in adults related to primary hypertension? 8. What are the adverse effects of drug, nondrug, and combination interventions for treating primary hypertension in children/adolescents?

Download or read book Screening for Hypertension in Adults written by Janelle Guirguis-Blake and published by . This book was released on 2021 with total page 210 pages. Available in PDF, EPUB and Kindle. Book excerpt: OBJECTIVE: We conducted this systematic review to support the U.S. Preventive Services Task Force (USPSTF) in updating its recommendation on screening for hypertension in adults. This systematic review addresses the benefits and harms of screening for hypertension in adults, including the accuracy of initial office-based screening measurements during a single encounter and confirmatory blood pressure measurements using various modalities in those who initially screen positive. DATA SOURCES: We performed a search of MEDLINE, PubMed (publisher-supplied records only), the Cochrane Collaboration Registry of Controlled Trials, and the Cumulative Index of Nursing and Allied Health for relevant English-language studies published between February 2014, and August 2019. Additionally, we re-evaluated all studies included in the 2014 USPSTF review. We supplemented searches by examining bibliographies from retrieved articles and consulting outside experts. We searched clinical trial registries for ongoing and/or unpublished trials. We conducted ongoing surveillance for relevant literature through March 26, 2021. STUDY SELECTION: Two investigators independently reviewed 21,741 abstracts and 544 full-text articles against a set of a priori inclusion and quality criteria. Resolution of disagreements was achieved through discussion with a third reviewer. We included the following study designs: randomized controlled trials (RCTs) and clinical controlled trials (CCTs) for effectiveness of screening (KQ1); test accuracy studies for accuracy of initial office-based blood pressure screening (KQ2) and subsequent confirmatory blood pressure measurements (KQ3) using an ambulatory blood pressure measurement (ABPM) reference standard; and RCTs, CCTs, and cohort and cross-sectional studies for screening and confirmation harms (KQ4). DATA ANALYSIS: One investigator abstracted data into evidence tables and a second investigator checked accuracy. We qualitatively synthesized data separately for each key question. We meta-analyzed study results for Key Questions 2 and 3. Our quantitative analyses utilized a bivariate model for sensitivity and specificity outcomes. We used visual inspection of forest plots arranged by various study, population, and test characteristics to explore heterogeneity. RESULTS: For KQ1, one community-based cluster RCT (N=140,642) of a multicomponent CVD health promotion program that included hypertension screening as the primary intervention for older adults reported a 9 percent relative reduction in composite CVD-related hospital admissions (rate ratio 0.91 [95% CI, 0.86 to 0.97]). For KQ2, meta-analysis of 15 studies (N=11,309) of office-based blood pressure measurement (OBPM) for screening at a single visit demonstrated a pooled sensitivity of 0.54 (95% CI, 0.37 to 0.70) and a pooled specificity of 0.90 (95% CI, 0.84 to 0.95) with considerable clinical and statistical heterogeneity. For KQ3, 18 studies (N=57,128) of various confirmatory blood pressure measurement modalities reported data that allowed accuracy calculations; these studies used confirmation modalities of: OBPM, home blood pressure measurement (HBPM), self-OBPM (measurement performed by a patient in the office setting), and truncated ABPM. Meta-analysis of eight OBPM confirmation studies (N=53,183) showed a pooled sensitivity of 0.80 (95% CI, 0.68 to 0.88) and a pooled specificity of 0.55 (95% CI, 0.42 to 0.66) with considerable clinical and statistical heterogeneity. Meta-analysis of four HBPM confirmation studies (N=1,001) showed a pooled sensitivity of 0.84 (95% CI, 0.76 to 0.90) and a pooled specificity of 0.60 (95% CI, 0.48 to 0.71) with considerable statistical heterogeneity. Two studies of self-OBPM (N=698) and one study of truncated ABPM (N=263) provided a limited evidence base for determination of accuracy for these modalities. There was limited information about the accuracy of protocol variations, precluding conclusions about the optimal protocol characteristics for screening and confirmatory blood pressure measurement in the included studies. For KQ4, 13 studies (N=5,150) suggest that screening is associated with no decrements in quality of life or psychological distress and scant evidence on screening's effect on absenteeism is mixed. ABPM followup testing is associated with minor adverse events including temporary sleep disturbance and bruising. LIMITATIONS: The literature identified for blood pressure screening and confirmation accuracy represented a heterogeneous group of studies resulting in inconsistent and imprecise accuracy estimates. The included protocol characteristics for screening and confirmatory blood pressure measurements likely represent "research quality" measures not followed in current practice. CONCLUSIONS: Blood pressure screening at a single visit has a low sensitivity and adequate specificity for detection of hypertension, leading to a substantial number of potentially missed cases. Confirmatory office or home blood pressure measurement applied to a population with a previously elevated blood pressure has adequate sensitivity and low specificity suggesting that these modalities may not be appropriate replacements for ABPM for diagnostic confirmation. Scant literature is available to inform best practices in blood pressure measurement to optimize test accuracy. Limited available evidence on the direct harms of screening and confirmatory blood pressure measurements suggest that the harms are minimal, and the most notable harm of blood pressure screening is likely misdiagnosis with ensuant under or over-treatment. Future research is needed to identify optimal blood pressure measurement protocols and confirmation algorithms--including blood pressure threshold values--to inform clinical practice.

Download or read book Screening for Hypertension in Children and Adolescents written by Gerald Gartlehner and published by . This book was released on 2020 with total page 144 pages. Available in PDF, EPUB and Kindle. Book excerpt: PURPOSE: To review the evidence about screening for high blood pressure in children and adolescents to delay the onset of or reduce adverse health outcomes related to high blood pressure. DATA SOURCES: MEDLINE, Embase, International Pharmaceutical Abstracts, the Cochrane Library, and trial registries through September 3, 2019; bibliographies from retrieved articles, outside experts, and surveillance of the literature through October 6, 2020. STUDY SELECTION: Two investigators independently selected studies using a priori defined inclusion and exclusion criteria. For this update, we included studies of screening for primary and secondary hypertension in asymptomatic children and adolescents. For benefits and harms of treatments or the association between hypertension in children and adolescents and intermediate outcomes in adults, we included participants with primary or secondary hypertension or elevated blood pressure. We selected studies that evaluated the diagnostic accuracy of blood pressure measurements in children and adolescents within primary care settings. We also included epidemiological studies that assessed the association between high blood pressure in children and adolescents and hypertension and other intermediate outcomes in adults. We included intermediate outcomes only if they were closely related to hypertension (e.g., left ventricular hypertrophy, urinary albumin excretion, retinal vascular changes, and intima media thickness). For treatment of hypertension, we selected controlled trials of pharmacological agents, lifestyle interventions, or combination treatments. We excluded studies with poor methodological quality and studies conducted in developing countries. DATA EXTRACTION AND ANALYSIS: One investigator extracted data and a second checked accuracy. Two reviewers independently rated methodological quality for all included studies using predefined criteria. Because data were insufficient for meta-analyses, we qualitatively synthesized findings for each key question. DATA SYNTHESIS: We included 42 studies (43 publications). We did not identify any studies directly evaluating health benefits or harms of screening. We also did not find studies assessing whether effective treatment of abnormal blood pressure during childhood has an impact on hypertension and other intermediate outcomes during adulthood. Furthermore, we did not find any studies that addressed screening for secondary hypertension in asymptomatic children. One fair study (n=247) assessed the diagnostic test accuracy of six office-based blood pressure measurements, 1 to 2 weeks apart, compared with ambulatory blood pressure monitoring as the reference standard. Office-based blood pressure measurements used recommendations of the Fourth Report as thresholds. Using systolic blood pressure (SBP) at the 90th percentile as a cutoff for abnormal blood pressure, the sensitivity of office-based measurements was 81.6 percent (confidence interval [CI] not reported) with a specificity of 70.3 percent (CI not reported). Twenty studies on data from nine national and international cohorts evaluated the association between high blood pressure in childhood and hypertension or other intermediate outcomes during adulthood. Despite substantial heterogeneity, studies consistently reported associations between abnormal blood pressure in childhood and abnormal blood pressure in adulthood. The strength of associations varied across studies (odds ratios [ORs] ranged from 1.1 to 4.5, relative risk [RR] ranged from 1.45 to 3.60, hazard ratios [HRs] ranged from 2.8 to 3.2; duration of followup ranged from 10 to 33 years). Studies also reported associations between abnormal blood pressure during childhood and carotid intima-media thickness (OR: 1.24, 95% CI, 1.13 to 1.37 [mean duration of followup was 25 years]; HRs ranged from 2.03 to 3.07 [duration of followup ranged from 10 to 21 years]; correlation coefficients ranged from 0.04 to 0.16 [duration of followup ranged from 21 to 31 years]), left ventricular hypertrophy (ORs ranged from 1.30 to 1.59, mean duration of followup was 25 years; HRs ranged from 1.92 to 3.41; duration of followup ranged from 10 to 21 years), and microalbuminuria (regression coefficients ranged from 0.016 to 0.315; mean duration of followup was 16.1 years). Twenty randomized, controlled trials (RCTs) and a meta-analysis assessing treatments for hypertension in children and adolescents met inclusion criteria. The majority of studies excluded children with known secondary hypertension. Thirteen fair-quality placebo-controlled RCTs and one meta-analysis evaluated the efficacy of various pharmacological treatments. All studies reported greater reductions of SBP and diastolic blood pressure (DBP) measurements in participants who received pharmacological treatments compared with those treated with placebo. The magnitude of reductions, however, varied, and not all differences reached statistical significance. Pooled reductions of SBP were −4.38 mmHg (95% CI, −2.16 to −7.27) for angiotensin-converting enzyme (ACE) inhibitors, −3.07 mmHg (95% CI, −1.44 to −4.99) for angiotensin receptor blockers (ARBs), −3.20 mmHg (95% CI, +2.23 to −8.69) for beta blockers, −3.10 mmHg (95% CI, +0.45 to −6.52) for calcium channel blockers, and −0.12 mmHg (95% CI, +3.46 to −3.69) for mineralocorticoid receptor antagonists. Followup of studies was limited to 2 to 4 weeks. One fair-quality trial, conducted from 1979 to 1981 in the United States and using a combination of a pharmacological treatment (low-dose propranolol/chlorthalidone) and lifestyle interventions (dietary and exercise modifications for children and parents), reported a statistically significant reduction of SBP (−7.6 mmHg) and DBP (−6.9 mmHg) after 6 months. A DASH (Dietary Approaches to Stop Hypertension) −type diet (high in fruits, vegetables, and low-fat dairy foods) achieved statistically significant reductions in SBP (−2.2 mmHg) and DBP (−2.8 mmHg) in a completers-only analysis of one fair-quality RCT. The effect did not last beyond the intervention period. Two fair-quality RCTs assessing physical exercise reported statistically significant decreases in SBP after 3 and 8 months (−8.3 and −4.9 mmHg, respectively) compared with lifestyle as usual. Only the study lasting 8 months reported a significant decrease in DBP (−3.8 mmHg vs. not reported). Based on evidence from three fair-quality trials, a low-sodium diet and progressive muscle relaxation did not achieve any significant or clinically relevant changes in SBP or DBP. Regarding harms of treatments, six fair-quality RCTs reported similar risks of adverse events between various pharmacological treatments (beta blocker, calcium channel blockers, angiotensin-converting enzyme, inhibitors or angiotensin receptor blockers) and placebo. The duration of trials, however, was limited to 2 to 4 weeks. One fair-quality RCT reported similar risks for adverse events between a combination of pharmacotherapy and lifestyle interventions and a control group without treatment over 6 months. LIMITATIONS: Only English-language studies were included. No direct evidence for the benefits or harms of screening was identified. In addition, the indirect evidence pathway from screening to improvement of health outcomes is scarce, of limited applicability, or entirely missing for some steps of the pathway. The evidence on diagnostic accuracy was limited to one poor quality study. Epidemiological studies determining associations between high blood pressure in childhood and adulthood used various definitions and thresholds; the results were generally consistent in demonstrating an association, although the strength of association varied. Pharmacological treatment studies were limited to durations of 2 to 4 weeks of followup and excluded children with secondary hypertension; no evidence was available for long-term effectiveness. The mean age of children in these studies ranged between 12 and 14 years; the generalizability of results to younger children or children with secondary hypertension is unknown. Studies of treatment were generally too short and underpowered for harm outcomes. We did not assess the comparative effectiveness or harms of treatments. CONCLUSIONS: We identified no direct evidence that compared screening with no screening in asymptomatic children and adolescents. Epidemiological studies indicate an association between hypertension in childhood and adolescence and hypertension in adulthood. Large longitudinal cohort studies also provide evidence that hypertension in adolescents and young adults is associated with end-stage renal disease and mortality from cerebrovascular events during adulthood. The proportion of spontaneous resolution of hypertension in children and the long-term benefits and harms of treatment, however, remain unclear. The evidence is also inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care. Short-term pharmacological treatments appear effective and safe, but no evidence with a followup of more than 4 weeks is available. No evidence exists to determine whether screening for hypertension is effective in identifying children with secondary hypertension who are asymptomatic. Most treatment studies excluded children with secondary hypertension.

Download or read book Primary Care Medicine written by Allan H. Goroll and published by Lippincott Williams & Wilkins. This book was released on 2014-05-29 with total page 5495 pages. Available in PDF, EPUB and Kindle. Book excerpt: Clinicians and students at all levels and in all primary care disciplines will benefit from the clear, practical, evidence-based writing and recommendations that address the full spectrum of clinical problems encountered in the adult primary care practice. Whether it’s the answer to a screening, prevention, evaluation, or management question or a comprehensive approach to a complex condition, the reader will find a review of best evidence integrated with considerations of affordability, cost-effectiveness, convenience and patient preference. Chapters present actionable, scientifically validated guidance that allows physicians to go beyond standard consensus guidelines and provide highly personalized care. Special consideration is given to team-based approaches of primary care delivery, recognizing its increasing importance to achieving high levels of practice performance. Primary Care Medicine’s digital format and quarterly updates ensure current, point-of-care decision support. New, online resources include a recommended curriculum for trainees and faculty, emphasizing a core knowledge base needed for all members of the primary care team, and access to state-of-the-art, condition-specific decision grids to facilitate patient participation in shared decision-making.

Download or read book Screening and Prevention in Primary Care An Issue of Primary Care Clinics in Office Practice written by Mack T. Ruffin IV and published by Elsevier Health Sciences. This book was released on 2014-06-28 with total page 237 pages. Available in PDF, EPUB and Kindle. Book excerpt: This issue of Primary Care: Clinics in Office Practice, edited by Mack T. Ruffin IV, MD, MPH and Cameron G. Shultz PhD, MSW, is devoted to Preventive Medicine. Articles in this issue include Risk Assessment Approach Screening; Substance Use and Tobacco Screening; Sexually Transmitted Infections; Planned Pregnancy; Violence Screening; Breast Cancer Screening; Lung Cancer Screening; Colorectal Cancer Screening; Prostate Cancer Screening; Heart Disease Screening; Screening for Depression; and Use of Genetic Markers.

Download or read book Rethinking Aging written by Nortin M. Hadler, M.D. and published by Univ of North Carolina Press. This book was released on 2011-09-12 with total page 273 pages. Available in PDF, EPUB and Kindle. Book excerpt: For those fortunate enough to reside in the developed world, death before reaching a ripe old age is a tragedy, not a fact of life. Although aging and dying are not diseases, older Americans are subject to the most egregious marketing in the name of "successful aging" and "long life," as if both are commodities. In Rethinking Aging, Nortin M. Hadler examines health-care choices offered to aging Americans and argues that too often the choices serve to profit the provider rather than benefit the recipient, leading to the medicalization of everyday ailments and blatant overtreatment. Rethinking Aging forewarns and arms readers with evidence-based insights that facilitate health-promoting decision making. Over the past decades, Hadler has established himself as a leading voice among those who approach the menu of health-care choices with informed skepticism. Only the rigorous demonstration of efficacy is adequate reassurance of a treatment's value, he argues; if it cannot be shown that a particular treatment will benefit the patient, one should proceed with caution. In Rethinking Aging, Hadler offers a doctor's perspective on the medical literature as well as his long clinical experience to help readers assess their health-care options and make informed medical choices in the last decades of life. The challenges of aging and dying, he eloquently assures us, can be faced with sophistication, confidence, and grace.

Download or read book Preventive Medical Care in Psychiatry written by Robert M. McCarron and published by American Psychiatric Pub. This book was released on 2015-04-01 with total page 484 pages. Available in PDF, EPUB and Kindle. Book excerpt: Preventive Medical Care in Psychiatry: A Practical Guide for Clinicians was written for psychiatrists in training and in clinical practice, as well as other health care providers who wish to learn an evidence-based and user-friendly approach to prevent commonly encountered, treatable, and potentially deadly illnesses in their patients. The poor health and early mortality of people with serious mental illnesses has been well documented: People who have serious mental illness have increased general medical comorbid conditions, receive minimal preventive medical services, and have a reduced life span of as much as thirty years when compared to the general population. In addition, there is now extensive data showing bidirectional interactions between chronic medical illnesses and mental disorders. Clearly, treating the whole person, instead of the disorder in isolation, is critical to improving outcomes and reducing suffering. The book's logical structure makes it easy to use, with sections devoted to general principles of preventive psychiatry, cardiovascular and pulmonary disorders, endocrine and metabolic disorders, infections disorders, and oncologic disorders. In addition, the volume: Provides evidence-based approaches to care across the prevention spectrum, from primary prevention (how to keep people healthy), to secondary prevention (how to detect early signs of common illnesses), through tertiary prevention (how to prevent disability and adverse outcomes once patients develop medical problems). Informs clinicians about how to more effectively interface with general medical practitioners, and instructs them in providing screening for common medical problems, as well as ensuring that preventive measures, such as vaccinations, are performed. Covers, in a section addressing "special topics," child, adolescent, and geriatric populations, as well as strategies for assessing and managing chronic pain. Concludes with an appendix that features a health questionnaire, Preventive Medicine in Psychiatry (PMAP), for use in screening and follow-up, and a handy summary of age based preventive medicine recommendations, references to which clinicians will return repeatedly. The Affordable Care Act has provided mental health practitioners with new opportunities to develop integrated models of care that better serve patients and populations, furthering the existing trend of treating the whole patient. Preventive Medical Care in Psychiatry: A Practical Guide for Clinicians is a critical resource which will prove indispensable to clinicians dedicated to improving the quality of life and longevity for patients who suffer from serious mental illness. Twenty-five percent of royalties help support Resident-Fellow Members (RFM) within the California Psychiatric Association.

Download or read book Bates Guide to Physical Examination and History Taking written by Lynn Bickley and published by Lippincott Williams & Wilkins. This book was released on 2012-11-01 with total page 1023 pages. Available in PDF, EPUB and Kindle. Book excerpt: With the 11th edition, focus turns back to the student in nurse practitioner, physician's assistant, and medical programs. The text continues be a trusted reference for nursing and medical students as well as practitioners. The art program has been revised to bring greater consistency and currency to the illustrations. Many photographs, particularly those depicting skin conditions, are being replaced with newer photos of higher quality. The well-respected and highly useful layout and organization of the book are retained. Each chapter has been reviewed and revised to keep the text up-to-date. The following features, long admired among dedicated Bates' users are also retained: · Detailed, beautifully depicted Tables of Abnormalities · Extensive Pediatric chapter · Illustrated Anatomy and Physiology review begins each chapter · Important information on Interviewing Techniques and Patient Communication · Outstanding line art program · Two-column format as guide for physical assessment · Useful Clinical tips throughout The ancillary assets are also being updated to redirect the focus toward higher level nursing students and medical students.

Download or read book Screening for Hypertension in Children and Adolescents to Prevent Cardiovascular Disease written by Matthew Thompson (Clinical scientist) and published by . This book was released on 2013 with total page 143 pages. Available in PDF, EPUB and Kindle. Book excerpt: BACKGROUND: Hypertension in children can be associated with adverse health outcomes and may persist into adulthood, where it presents a significant personal and public health burden. Screening asymptomatic children has the potential to detect hypertension at earlier stages, so that interventions can be initiated which, if effective, could reduce the adverse health effects of childhood hypertension in children and adults. PURPOSE: To assess the effects of screening for hypertension in asymptomatic children and adolescents to prevent cardiovascular disease. METHODS: We searched the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews (through July 2012) and MEDLINE (1946-July 9, 2012) and manually reviewed reference lists of included studies. Citations were independently reviewed by two investigators, and data extraction performed by one investigator and checked by a second for accuracy. We included studies of screening for hypertension in asymptomatic children and studies of benefits and harms of treatments for children with hypertension. Diagnostic accuracy studies were included if they used a reference standard and allowed calculation of sensitivity and specificity. We excluded studies focusing on secondary hypertension. RESULTS: No studies evaluated the effect of screening asymptomatic children for hypertension on subsequent health outcomes, including onset of hypertension. Two studies that assessed accuracy of screening tests for elevated blood pressure found moderate sensitivities (0.65 and 0.72) and specificities (0.75 and 0.92) and low positive predictive values (0.37, 0.17). The association between elevated blood pressure or hypertension in childhood and hypertension in adulthood was assessed in 10 studies, with most studies finding a small but significant association. Seven fair-quality studies found drug interventions were effective at lowering blood pressure after 4 weeks, based on the proportion achieving normotensive status and/or mean reductions in blood pressure. One trial of a drug combined with lifestyle modifications found lower mean blood pressures at 30 months, and one trial of increased exercise found lower mean blood pressures at 8 months, whereas other lifestyle trials found no differences. Of 13 studies assessing harms of interventions, only one study found that adverse event rates were significantly lower for those in the intervention group; all other studies found no difference in adverse events. CONCLUSIONS: Studies are needed to assess whether screening for hypertension in children and adolescents reduces adverse health outcomes or delays the onset of hypertension. Blood pressure screening may be effective at identifying children with hypertension, though evidence is limited and false-positive rates were high. The presence of hypertension in childhood is associated with hypertension in adults, but with limited evidence available for its association with end-organ damage markers in adults. Drug interventions for hypertension may be effective at lowering blood pressure with few serious side effects; however, studies of longer duration are needed to confirm results from short-term studies. Evidence on the effectiveness of childhood combination drug and lifestyle interventions and lifestyle-only interventions is sparse and mixed, with most studies showing no sustained reduction in blood pressure in childhood. Studies are needed to assess whether treating hypertension in childhood affects subsequent intermediate or clinical outcomes in adulthood.

Download or read book The Washington Manual of Outpatient Internal Medicine written by Thomas M. De Fer and published by Lippincott Williams & Wilkins. This book was released on 2015-03-26 with total page 1375 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Washington Manual of Outpatient Internal Medicine is designed as a companion to the Manual of Medical Therapeutics, addressing the most common encounters in outpatient internal medicine - for example, hypertension and diabetes. Disorders treated in the ambulatory setting fall outside traditional internal medicine; therefore, chapters also cover dermatology, otolaryngology, neurology and psychiatry and ophthalmology. The 2nd edition includes a complete update of all chapters.

Download or read book Clinical Psychiatry Recent Advances and Future Directions An Issue of Psychiatric Clinics of North America written by David Baron and published by Elsevier Health Sciences. This book was released on 2015-09-07 with total page 249 pages. Available in PDF, EPUB and Kindle. Book excerpt: Recent advances in clinical psychiatry are presented by David Baron and Lawrence Gross in this issue of Psychiatric Clinics. Psychiatrists will find here disorders they deal with daily in patients and topics include Advances in: Addictive disorders; Geriatric and healthy aging; Trauma and violence; PTSD; Schizophrenia; Intellectual disabilities; Neuropsychiatry, Psychopharmacology; Integrated care - psychiatry and primary care; Global and cultural psychiatry; Mood disorders. Also presented are the Future role of psychotherapy in psychiatry; Public mental health in the Affordable Care Act era; Genetics; and Diagnostic classification (DSM criteria) how they are transitioning in future - DSM V and beyond.

Download or read book Advanced Practice Nursing in the Care of Older Adults written by Laurie Kennedy-Malone and published by F.A. Davis. This book was released on 2014-01-20 with total page 689 pages. Available in PDF, EPUB and Kindle. Book excerpt: Explore effective ways to enhance the wellness and independence of older adults across the wellness-illness continuum. From an overview of the theories of aging and assessment through the treatment of disorders, including complex illnesses, this evidence-based book provides the comprehensive gerontological coverage you need to prepare for your role as an Advanced Practice Nurse. Understand how to easily identify factors that may affect the wellness of your patients and their families. Plus, enhance your critical-thinking skills with real-world case studies that bring concepts to life.

Download or read book Integrated Primary and Behavioral Care written by William O'Donohue and published by Springer. This book was released on 2015-10-23 with total page 256 pages. Available in PDF, EPUB and Kindle. Book excerpt: This timely analysis spotlights the concepts and possibilities of the Patient-Centered Medical Home for bringing mental health and other specialties into primary care. Overview chapters present the Patient-Centered Medical Home model, emphasizing how such systems are organized to solve widespread problems with accessibility, affordability, efficiency, and safety. Practitioner roles, boundaries, and opportunities plus applications are clarified, as well as staffing, financial, and technological challenges. And the section on applications describe care models for special populations, such as comprehensive services to the seriously mentally ill and behavioral services to patients with chronic health conditions. Included in the coverage: Integrated care and specialty behavioral health care in the patient-centered medical home. Training the behavioral health workforce for the patient-centered medical home. The importance of stepped care protocols for the redesign of behavioral health care in patient-centered medical homes. Depression management in the medical home. Treating obesity in a primary care setting. Integrating behavioral health in the pediatric medical home. For health and clinical psychologists, primary care and family physicians, and public health professionals, Integrated Primary and Behavioral Care represents the potential for an exciting new frontier in primary care reform.

Download or read book Ebersole and Hess Gerontological Nursing Healthy Aging written by Theris A. Touhy, DNP, CNS, DPNAP and published by Elsevier Health Sciences. This book was released on 2013-03-11 with total page 451 pages. Available in PDF, EPUB and Kindle. Book excerpt: Ebersole & Hess' Gerontological Nursing and Healthy Aging is the only gerontological nursing text that follows a wellness-based, holistic approach to older adult care. Designed to facilitate healthy aging regardless of the situation or disease process, this text goes beyond simply tracking recommended treatments to address complications, alleviate discomfort, and help older adults lead healthy lives. Featuring evidence-based practice boxes, safety alerts, expanded tables, and careful attention to age, gender, and cultural differences, Ebersole & Hess' Gerontological Nursing and Healthy Aging is the most complete text on the market. Focus on health and wellness helps you gain an understanding of the patient's experience. AACN and the Hartford Institute for Geriatric Nursing core competencies integrated throughout. Consistent chapter organization and pedagogy, including Learning Objectives, Glossary, and Research and Study Questions/Activities. Evidence-Based Practice boxes summarize research findings that confirm effective practices or identify practices with unknown, ineffective, or harmful effects. Careful attention to age, cultural, and gender differences helps you understand these important considerations in caring for older adults Expanded tables, boxes, and forms, including the latest scales and guidelines for proper health assessment make information easy to find and use. Activities and discussion questions at the end of every chapter equip you with the information you need to assess the patient. UPDATED! Healthy People 2020 boxes integrate information about healthy aging. NEW! Safety Alerts highlight safe practices and quality of care QSEN competencies. NEW! Chapter on Neurologic Compromise expands content on stroke and Parkinson's disease.