Evidence-Based Medicine Guidelines / Edition 1 available in Hardcover
Evidence-Based Medicine Guidelines / Edition 1
- ISBN-10:
- 047001184X
- ISBN-13:
- 9780470011843
- Pub. Date:
- 03/04/2005
- Publisher:
- Wiley
Evidence-Based Medicine Guidelines / Edition 1
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Overview
The title was first published in Finland by the Finnish Medical Society, where it is now considered to be the single most important support tool for the physicians' decision making in their daily work.
What sets EBM Guidelines apart from competing books?
- Provides physicians with fast and easy access to practice guidelines based on the best available research evidence
- Covers practically all medical conditions encountered in general practice
- Developed by over 300 experienced general practitioners and specialists worldwide
- Includes both diagnostic and therapeutic guidelines, and recommendations on diagnostic tests and drug dosage
- Presented in a user-friendly format with self contained chapters based on clinical subjects
- Clear and concise explanations of all available evidence results in the guideline for treatment
- The strength of evidence is graded from A-D making this title a quick and easy reference whenever and wherever you need it!
- Assumes no prior knowledge of EBM or statistics - all the work of searching and appraisal has been done for you!
- Seeks to include guidelines where clinical evidence is incomplete or unavailable
- Contains full-colour photographs and tables throughout
Easy-to-read and fast support at the point of care - EBM Guidelines:
- Summarises the best available evidence - Cochrane reviews - DARE abstracts - Clinical Evidence topics - original articles in medical journals - abstracts in the Health Technology Assessment Database - NHS Economic Evaluation
- Evaluates and grades the strength of all individual evidence from A (Strong research-based evidence) to D (No scientific evidence)
- Suggests guidelines based on clinical evidence. If clinical evidence is inadequate or missing, an expert panel evaluate all other available information and suggests the appropriate guideline
With over 1000 problem-orientated or disease-specific guidelines including reference to evidence summaries for all guidelines, this title is the most extensive collection of guidelines for primary care today.
Here are just a few examples of the raving reviews for Evidence-Based Medicine Guidelines:
"An excellent resource… quick to use, even during consultations…very helpful to check whether our preferred diagnostic and therapeutic methods are adequate…competent suggestions based on real evidence…" —Heinz Bhend, PRIMARY CARE
"clinically useful answers…easy-to-read …this resource is worth using…" —Carl Heneghan, Centre for Evidence-Based Medicine, Oxford, UK, EVIDENCE-BASED MEDICINE Journal
Product Details
| ISBN-13: | 9780470011843 |
|---|---|
| Publisher: | Wiley |
| Publication date: | 03/04/2005 |
| Pages: | 1384 |
| Sales rank: | 108,656 |
| Product dimensions: | 8.00(w) x 10.50(h) x 2.30(d) |
About the Author
Read an Excerpt
Evidence-Based Medicine Guidelines
By Ilkka Kunnamo
John Wiley & Sons
Copyright © 2005 John Wiley & Sons, LtdAll right reserved.
ISBN: 0-470-01184-X
Chapter One
1.10 Prolonged fever in the adultVille Valtonen
Principles
* Diagnose common diseases (pneumonia, sinusitis, urinary tract infection) before ordering a large number of tests.
* Decide on the urgency of tests according to the patient's general condition, risk factors (immunosuppression) and local signs.
* Repeat history and physical examination before repeating tests.
Diagnostic strategy
* Exclude the following common diseases before further investigations:
Pneumonia (chest x-ray and auscultation)
- Chest x-ray may also show tuberculosis, sarcoidosis, alveolitis, pulmonary infarction or lymphoma.
Urinary tract infection (urine test and culture)
- Urine test may even also suggest epidemic nephropathy or renal tumour.
Maxillary sinusitis (ultrasound or x-ray).
* Important questions on the history include
Occurrence (measuring!) and duration of fever
Travelling, place (country) of birth, living
Past diseases, particularly tuberculosis and valvular defects
Drug therapy, including over-the-counter drugs
Use of alcohol
Systematic review of organ systems for symptoms
* Diagnostic clues and possible aetiologies
See Table 1.10.1
* Tests
Primary investigations
- Urine test and culture
- CRP and ESR
- Haemoglobin, WBC count (WBC differential and platelet count)
- AST and ALT
- Option: serum sample to be frozen for eventual serology
- Chest x-ray
- Maxillary sinus ultrasound or x-ray
Secondary investigations
- Abdominal ultrasonography
- Bone marrow aspiration - Serology (Yersinia, tularaemia, HIV, Borrelia burgdorferi, viral antibodies, serum HBs-Ag, serum HCV-Ab, antinuclear antibodies)
- Blood bacterial culture
* Consider your tactics before continuing with investigations
See Table 1.10.2.
* Browse a list of causes for fever to see what may have escaped your notice.
Causes of prolonged fever
* Tuberculosis (any organ)
* Bacterial infections Sinusitis
Urinary tract infection
Intra-abdominal infections (cholecystitis, appendicitis, abscesses)
Perianal abscess
Abscesses of the chest cavity (lungs, mediastinum)
Bronchiectasis
Salmonellosis, Shigellosis
Osteomyelitis * Bacteraemia without focus (more often an acute disease rather than prolonged fever)
* Intravascular infections
Endocarditis
Infections of vascular prostheses
* Generalized viral or bacterial infections
Mononucleosis
Adeno-, Cytomegalo- or Coxsackie B viral infections
Hepatitis
HIV
Chlamydial infection (Psittacosis, Ornitosis)
Toxoplasmosis
Lyme disease
Tularaemia
Malaria
* Benign temperature elevation after an infectious disease
* Chronic fatigue syndrome
* Sarcoidosis
* Atrial myxoma
* Subacute thyreoiditis
* Thyreotoxicosis
* Hemolytic diseases
* Post-traumatic tissue damage and haematoma
* Vascular thrombosis, pulmonary embolism
* Kawasaki disease
* Erythema nodosum
* Drug fever
* Malignant neuroleptic syndrome
* Allergic alveolitis
Farmer's lung
* Connective tissue diseases
Polymyalgia rheumatica, temporal arteritis
Ankylosing spondylitis
Rheumatoid arthritis
Systemic lupus erythematosus (SLE)
Still's disease of the adult
Rheumatic fever
Vasculitides
Periarteritis nodosa
Wegener's granulomatosis
* Inflammatory bowel diseases
Regional enteritis (Crohn's disease)
Ulcerative colitis * Cirrhosis of the liver, alcoholic hepatitis * Malignant diseases
Leukaemia
Cancer of the pancreatic and biliary ducts
Renal carcinoma (hypernephroma)
Sarcomas
Hodgkin's disease, other lymphomas
Metastases (renal carcinoma, melanoma, sarcoma)
FUO
* The diagnosis Febris e causa ignota (fever of undetermined origin, FUO) is used when a fever above 38³C has lasted longer than 2-3 weeks.
* Usually the cause is a serious disease, which can often be treated. An aetiological diagnosis should be pursued intensively, preferably in the hospital.
* The final diagnosis is infection in about 35% of the patients, malignant disease in 20%, collagenosis in 15% and some other disease in 15%. In about 15% of the patients the cause remains unknown.
1.20 Yersiniosis
Rauli Leino
Basic rules
* Consider yersiniosis in patients with
acute abdominal pain
acute diarrhoea
fever of unknown origin
Reiter's disease
- arthritis
- urethritis
- iritis, conjunctivitis
erythema nodosum
abnormal results in urine test, liver function tests or tests for pancreatitis
hypersedimentation.
Causative agents
* Yersinia enterocolitica 3 and 9, Y. pseudotuberculosis IA and 3.
* The causative agent cannot be identified on the basis of the clinical symptoms.
Symptoms and clinical picture
Symptoms of acute infection
* Fever
* Diarrhoea: children often have blood and mucus in the stools.
* Abdominal pain: in children often in the right lower quadrant. If the patient is operated on, mesenteric lymphadenopathy, terminal ileitis, or true appendicitis may be detected.
Post-infectious symptoms
* Reactive arthritis
1-3 weeks after enteritis
The symptoms vary from mild arthralgia to severe polyarthritis, sometimes Reiter's syndrome.
A small proportion of the patients develop chronic arthritis.
The disease is strongly associated with HLA-B27.
* Ocular symptoms
Iritis
Conjunctivitis * Urinary symptoms
Urethritis
Balanitis
Glomerulonephritis
* Skin symptoms
Erythema nodosum is the most common skin manifestation (about 10% of cases are caused by Yersinia); it can be the only symptom of yersiniosis.
* Cardiac findings
Transient ECG abnormalities
Valvular disease is not associated with yersiniosis.
* Other symptoms
Hepatitis, pancreatitis or thyroiditis
Diagnosis
Faecal bacterial culture
* Useful in acute disease
* The sensitivity decreases rapidly after the symptoms of enteritis have disappeared.
Serology
* The primary diagnostic method in post-infectious symptoms (arthritis)
* The ELISA method is the most specific.
A recent infection can be diagnosed on the basis of one serum sample.
Class IgM antibodies appear in a few days and disappear after a few months.
Class IgG antibodies can be detected for years.
Class IgA antibodies are particularly associated with arthritis.
A cross-reaction occurs between Y. enterocolitica 9 and Brucella, but an ELISA inhibition test confirming the diagnosis is automatically performed in positive cases.
Treatment
* The disease is usually cured spontaneously.
* Chronic carriers have not been detected.
* There is little evidence on the effect of antibiotic treatment; its effect on the occurrence of post-infectious symptoms is not known.
Indications for antibiotics
* Septicaemia
* Fulminant disease or severe post-infective symptoms (such as arthritis) are relative indications for antibiotics.
Selection and dosage
* Quinolones, e.g. ciprofloxacin 500 mg x 2 x 7-10 days
* Tetracyclines are a good alternative.
* Trimethoprim-sulpha is the drug of choice for children.
Indications for specialist referral
* Acute appendicitis
* Severe post-infectious symptoms
1.21 Tularaemia
Janne Laine
Aims
* Suspect tularaemia in patients with fever, lymphadenopathy and an ulcerated skin lesion (Figure 1.21.1) at the site of a mosquito bite or a scratch.
* Begin treatment on the basis of the clinical picture if the symptoms are typical. Diagnosis can be confirmed with serology.
Transmission
* The most important reservoir host is the mole.
* The infection is transmitted by
mosquitoes (most important)
other blood-sucking arthropods (horse-flies, black flies, ticks)
bites or scratches of a sick animal
inhalation of infected aerosols
ingestion of contaminated water or food
ingestion of meat from an affected animal (even after freezing the meat)
* Incubation period is 1 to 14 days (mean 4 days)
Symptoms
* Varying clinical manifestations:
The ulceroglandular form (75-85% of the cases) causes fever, a small infected skin lesion as well as swelling and tenderness of regional lymph nodes.
The glandular form (5-10% of the cases) causes fever and lymphadenopathy but no skin lesions.
The typhoidal form (5-15% of the cases) causes severe systemic symptoms (fever, fatigue and weight loss) and possibly enlargement of the liver and spleen.
The oculoglandular form causes granulomatous conjunctivitis with regional lymphadenopathy.
The oropharyngeal form (2-4% of the cases) causes tonsillitis, pharyngitis and cervical lymphadenopathy.
* Symptomless infection is common (about 50% of the cases).
* Rash has been reported in up to 20% of the patients.
* Pneumonia is seen in 15% of the ulceroglandular cases and in nearly all patients with other forms of the disease.
* Elevated liver enzyme values, enlarged liver
* Peritonitis, meningitis and osteomyelitis are rare.
* CRP increases moderately, ESR to a lesser extent.
* Anaemia
Diagnosis
* Treatment is begun on the basis of the clinical picture.
* Diagnosis is confirmed by serology. The antibody titre rises first 10-14 days after onset of fever. The blood samples are taken 2-3 times, at 2 week intervals. A rise in the antibody titre is an indication of a recent infection. A 4-fold rise of the titre, or a single clearly elevated titre (1:160 with agglutination technique, 1:128 with microagglutination technique), is considered diagnostic.
* Bacterial culture of the secreting lesion can also be performed.
Treatment
* Fluoroquinolones are the recommended antibiotic therapy in mild and moderate cases (the dose of ciprofloxacin is 500 mg b.d. for adults). Alternatively, doxycycline (100 mg b.d. for 10 to 14 days, or 2-3 weeks after onset of symptoms), or streptomycin or aminoglycosides for 1-2 weeks can be used depending on the severity of the disease.
* If the patient has severe symptoms, an infectious disease physician should be consulted.
* Beta-lactam antibiotics are ineffective.
* Children are managed under the supervision of a paediatrician. Ciprofloxacin has been used for children in verified cases of tularaemia. The dose is 15-20 mg/kg daily divided into two doses.
Prevention
* A live attenuated vaccine has been developed, but is not currently available.
* Recommendations have been issued in the United States for measures to be taken in case tularaemia is used as a biological weapon. Doxycycline and ciprofloxacin are recommended for exposed individuals during an epidemic.
1.22 Erysipeloid
Petteri Carlson
Epidemiology
* The bacterium that causes erysipeloid (Erysipelothrix rhusiopathiae) can be found in many animals (pigs, fish, birds).
* Humans can be infected through skin erosions.
* Occurs as a rare occupational disease among animal farmers, butchers, fishermen, veterinarians etc.
Symptoms
* Swollen, bluish, well-demarcated skin lesions usually in the hands (Figure 1.22.1) . There is no suppuration.
* There is usually intense pain, and itching and a prickling sensations are also common.
* Local lymph nodes often swell, but otherwise systemic symptoms are rare. Septicaemia and endocarditis may sometimes occur.
* The disease is self-limiting within a few weeks. The skin remains brown and often scaly.
Diagnosis
* The diagnosis can be made on the basis of history and the typical clinical picture. Staining and culture from a biopsy sample or tissue fluid obtained by aspiration can be performed but is rarely indicated.
Treatment
* Penicillin 1.5 million units x 2 x 10 shortens the duration of the disease. Also cephalosporins, macrolides, and fluoroquinolones are probably effective D.
Prevention
* Good occupational practice, covering hand wounds and erosions
1.23 Listeriosis
Kirsi Skogberg
Epidemiology
* Listeria monocytogenes, a gram-positive rod, has been isolated from soil, animals and stools of asymptomatic individuals; food, dairy products in particular, has also been implicated as a source of infection.
* Pregnant women, foetuses and newborns as well as those with impaired cell-mediated immunity are more susceptible to the infection.
Symptoms
* Sepsis or meningitis are the most common clinical presentations, seen mostly in those with impaired immunity.
* In foetal infection the result is abortion, intrauterine death or sepsis of the newborn (early infection).
* Newborn may also be infected through genital tract or the infection can be hospital born. Meningitis may develop days of weeks after delivery (late infection).
* Listeriosis in individuals with no underlying risk factors may present as a flu like illness or gastroenteritis, rarely as meningitis or sepsis.
Diagnosis
* Bacterial staining and culture. Listeria is grown from normal blood and CSF samples. Special request is needed in order to inform the laboratory of the use of specific conditions for culture from other locations.
* Serology is of little use.
Treatment
* The first drug of choice is ampicillin or G penicillin intravenously in large doses. Synergism with aminoglycosides may prove clinically useful.
* In penicillin allergy, trimethoprim-sulphamethoxazole or in mild cases, erythromycin may be used.
* Cephalosporins are not effective against listeria.
* Antimicrobial therapy should continue for at least 2 weeks.
Prevention
* Measures for reducing the risk of listeriosis.
General recommendations
- Cook or roast all meat thoroughly.
- Wash raw vegetables carefully before eating them.
- Store uncooked meat away from vegetables, cooked food and convenience foods. - Avoid unpasteurized milk and products prepared from such milk.
- Wash your hands and all knives and chopping boards that you have used for preparing the above-mentioned uncooked foods.
Recommendations for persons at risk
- Avoid soft, (mould-)ripened cheeses.
- Avoid vacuum-packed raw-pickled or raw-smoked fish products.
- Before eating leftover foods and convenience foods warm the food until it is steaming hot.
1.24 Tetanus
Janne Mikkola Aims
* Prevention by vaccination and careful treatment of contaminated wounds
* Early identification of the disease in unvaccinated patients
Definition
* Tetanus is a severe systemic infection in the unvaccinated individual caused by Clostridium tetani, which can be found in high concentrations in the soil and in normal intestinal flora.
Symptoms
* First, a local wound infection in which the bacteria multiply and produce toxin.
* Within days or weeks, a generalized systemic infection with muscle spasms most often beginning at the mandibular joint (trismus)
* Localized tetanus consists of muscle rigidity and painful spasms close to the site of injury.
* In spite of intensive care, mortality is high.
Diagnosis
* Depends mostly on history and clinical features. The usefulness of aspirate gram-stain and culture is limited.
Treatment
* Making the airway secure, supportive care with anticonvulsive medications and sedation require intensive care in most cases.
* Human antitetanus immunoglobulin and debridement of the wound are the cornerstones of treatment.
* Metronidazole orally or i.v. is the drug of choice. The dose for adults is 500 mg × 3 and for children 30 mg/kg daily in three doses. G penicillin is an alternative. * Active immunization should be initiated during convalescence.
(Continues...)
Excerpted from Evidence-Based Medicine Guidelines by Ilkka Kunnamo Copyright © 2005 by John Wiley & Sons, Ltd. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.
Table of Contents
Foreword.Preface.
List of Abbreviations.
1. Infectious Diseases.
2. Travelling and Tropical Diseases.
3. Vaccinations.
4. Cardiovascular Diseases.
5. Vascular Diseases.
6. Pulmonary Diseases.
7. Oral Medicine.
8. Gastroenterology.
9. Hepatology and Pancreatic Diseases.
10. Nephrology.
11. Urology.
12. Sexually Transmitted Diseases.
13. Dermatology.
14. Allergology.
15. Haematology.
16. Oncology.
17. Anaesthesiology.
18. Traumatology and Plastic Surgery.
19. Sports Medicine.
20. Physical Medicine and Orthopaedics.
21. Rheumatology.
22. Geriatrics.
23. Diabetes.
24. Endocrinology.
25. Gynaecology.
26. Obstetrics.
27. Birth Control.
28. Child and School Health Services.
29. Paediatric Neurology.
30. Genetics
31. Paediatric Infectious Diseases.
32. Paediatrics.
33. Paediatric Psychiatry.
34. Adolescent Psychiatry.
35. Psychiatry.
36. Neurology.
37. Ophthalmology.
38. Otorhinolaryngology.
39. Clinical Pharmacology.
40. Alcohol and Drugs.
41. Forensic Medicine.
42. Radiology.
43. Administration.
44. Occupational Health Service.
45. Pollution and Health.
Index.
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