By V. Kelvin. Alliant International University.

Net sales and growth values denote company recognized revenue after discounts order generic lasix on line whats prehypertension mean, rebates and other price concessions generic 40 mg lasix fast delivery arrhythmia yawning. Existing Mechanism refers to subsequent products with existing mechanisms of action for an indication. All indications are for metastatic disease and second line or lower treatment sequence unless otherwise indicated. Chart notes: Averages are calculated among paid claims where a co-pay card is used as the secondary payer and normalized to 30 days. Chart notes: Cost exposure is calculated using paid and reversed claims where a coupon is the secondary payer and excludes instances in which a coupon is the primary payer, normalized to 30 days. Chart notes: Out-of-pocket costs include co-pay ofsets through coupons; patient categories are defned using longitudinal data to identify deductible spending patterns or mode payer, normalized to 30 days. Chart notes: The cohort of Facility-Other includes facilities for alternative medicine, elder care, labs, correctional programs, and workplace wellness. All facilities from the Healthcare Organization services ofering included except veterinarian facilities. Chart notes: The top states with a healthcare provider gap are defned by the percent of population in healthcare professional s gap areas as compared to the overall state population. Chart notes: Forecast growth reported on an invoice basis excluding of-invoice discounts and rebates. The prices do not refect of-invoice price concessions that reduce the net amount received by manufacturers. The approximately 640,000 facilities includes single ownership relationships and multiple purchasing, distribution, academic and alliance relationships. Formulary measures include tiered co-pay beneft designs, prior authorization restrictions, and often result in non- preferred prescriptions being rejected or switched at the pharmacy. It uses econometric modeling from the Economist Intelligence Unit to deliver in-depth analysis at a global, regional and country level about therapy class dynamics, distribution channel changes and brand vs. It includes information about product launches in each country, including the indication and price at the time of the initial launch, and covers more than 300, 000 launches. It includes information about the commercial, scientifc and clinical features of the products, analyst predictions of future performance, and reference information on their regulatory stage globally. Page 39 Appendix Top Therapeutic Classes by Prescriptions Dispensed Prescriptions Mn 2011 2012 2013 2014 2015 Total U. Includes prescription-bound products including insulins dispensed through chain and independent pharmacies, food store pharmacies, mail service pharmacies, and long-term care facilities. Prescriptions are not adjusted for length of therapy; 90-day and 30-day prescriptions are both counted as one prescription. Includes prescription and insulin products sold into chain and independent pharmacies, food store pharmacies, mail service pharmacies, long-term care facilities, hospitals, clinics, and other institutional settings. Table shows leading active-ingredients or fxed combinations of ingredients and includes both branded and generic products. Prescriptions for 90 days have been used to estimate 30 day prescriptions in all dispensing locations. Spending fgures also include sales into hospitals, clinics, and other institutional settings. Murray holds a Master of Commerce degree from the University of Auckland in New Zealand, and received an M. Lauren received her bachelor’s degree from James Madison University where she studied health communication. Its mission is to provide key policy setters and decision makers in the global health sector with unique and transformational insights into healthcare dynamics derived from granular analysis of information. Fulflling an essential need within healthcare, the Institute delivers objective, relevant insights and research that accelerate understanding and innovation critical to sound decision making and improved patient care. Timely, high-quality and relevant information is critical to sound healthcare decision making. Optimizing the performance of medical care through better understanding of disease causes, Insights gained from information and analysis treatment consequences and measures to should be made widely available to healthcare improve quality and cost of healthcare delivered stakeholders. Efective use of information is often complex, Understanding the future global role for requiring unique knowledge and expertise. Researching the role of innovation in health system products, processes and delivery Personal health information is confdential systems, and the business and policy systems and patient privacy must be protected. The private sector has a valuable role to play Informing and advancing the healthcare in collaborating with the public sector related agendas in developing nations through to the use of healthcare data. The logging and manufacturing processes are expected to conform to the environmental regulations of the country of origin. Whilst the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. In particular (but without limiting the generality of the preceding disclaimer) every effort has been made to check drug dosages; however it is still possible that errors have been missed. Furthermore, dosage schedules are constantly being revised and new adverse effects recognized. For these reasons the reader is strongly urged to consult the drug companies’ printed instructions before administering any of the drugs recommended in this book. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress. Sometimes, these treatment regimes involve potent and, at times, new and novel drugs. Many of these drugs are toxic or possibly fatal if administered incorrectly or in overdose. It is therefore very important to be able to carry out drug calculations correctly so as not to put the patient at risk. These calculations have to be performed competently and accurately, so as not to put not only the nurse but, more importantly, the patient at risk. This book aims to provide an aid to the basics of mathematics and drug calculations. It is intended to be of use to nurses of all grades and specialities, and to be a handy reference for use on the ward. The concept of this book arose from nurses themselves; a frequently asked question was: ‘Can you help me with drug calculations? This was very well received, and copies were being produced from original copies, indicating the need for such help and a book like this. The content of the book was determined by means of a questionnaire, sent to nurses asking them what they would like to see featured in a drug calculations book. As a result, this book was written and, hopefully, covers the topics that nurses would like to see. Although this book was primarily written with nurses in mind, others who use drug calculations in their work will also find it useful.

In addition cheap lasix 40 mg otc arteria zygomaticoorbitalis, lamotrigine is often combined with valproex sodium or valproic acid (Depakote® order lasix with mastercard blood pressure medication ringing in ears, Depakene®)—a combination that increases the risk for developing Stevens-Johnson syndrome. See page 32 for an expanded description of the symptoms of Stevens-Johnson syndrome. Stud- ies are not conclusive as to whether these medications will help to prevent future episodes of bipolar disorder. A recent study among children and adolescents aged 10 to 17 showed that this medication was effective in controlling the acute manic symptoms of bipolar disorder children and adolescents. A recent study among children and adolescents aged 10 to 17 years old showed that this drug was effective in controlling the acute symptoms of mania and mixed mania. This medica- tion was indicated in 2003 for the treatment of the depressive episodes of bipolar I disorder in adults. For example, in addition to being approved for children and adolescents aged 10 to 17 with bipolar mania or mixed mania, aripiprazole, risperidone, and olanzapine have been approved for treatment of schizophrenia in adolescents aged 13 to 17. Also, risperidone and apripiprazole are approved to treat the aggression and irritability associated with autistic disorder in children and adolescents aged 6 to 17. It appears that children and adolescents are more sensitive to the side effects of medications used for bipolar disorder than are adults. Caution also should be taken when giving a child or adolescent other medication while he or she is taking an atypical antipsychotic. Antihy- pertensive medications (such as Aldomet®, Procardia®, Vasotec®, and Lasix®) can cause a sudden drop in blood pressure. Over-the-counter cold and allergy medications may cause an increase in the sedative effects of atypical antipsy- chotic medication. In addition, caffeine and cigarettes can reduce the effective- ness of atypical antipsychotics. Ask your child’s doctor about potential drug interactions before taking any prescribed or over-the-counter medications. Mild to Moderate Side Effects Mild to moderate side effects common among atypical antipsychotics include: • Akathisia (restlessness) • Dizziness or fainting spell due to decrease in blood pressure when standing up (orthostasis) • Increased appetite • Weight gain • Tiredness • Drowsiness • Nausea • Heartburn • Night tremors • Decreased sexual interest Rapid weight gain is a well-recognized side effect from most atypical antipsy- chotics medications. If your child has gained weight while taking an atypical antipsychotic, consult with your child’s doctor and a dietician to create a plan that helps manage weight gain. More information about medication weight gain can be found on page 50 of this guide. In addition, many atypical antipsychotics medications increase the risk for seizures, especially at high doses. Patients with epilepsy should be closely monitored while taking these medications. It consists of marked muscle stiff- ness, high fever, racing heart beat, fainting spells, and a general sense of feeling very ill. This syndrome is more likely to occur when high doses of antipsychotic medication are prescribed, or when the dose is in- creased rapidly. If your child or adolescent is taking an atypical or typical antipsychotic and is active in sports or plays outside on very hot days, make sure he or she drinks plenty of liquids. Metabolic Syndrome Metabolic syndrome is a collection of risk factors that increase the likelihood of a person developing cardiovascular disease and/or diabetes. Many who take atypical antipsychotics have problems with metabolism, including weight gain, high blood sugar (causing diabetes), and high blood fat (lipids) are potential side effects that pose serious health risks. Children and adolescents are particu- larly sensitive to weight gain associated with atypical antipsychotics. Atypical antipsychotics differ in their short- and long-term effects on weight gain. Some research suggests that most of the weight gain occurs within the frst 6 months of taking an atypical antipsychotic. The information contained in this guide is not intended as, and is not a substitute for, professional medical ParentsMedGuide. Some common typical antipsychotics include haloperidol (Haldol®), chlorpromazine (Thorazine®), perphenazine (Trilafon®), and molindone (Moban®). These medications have been shown effective in adults for treatment of bipolar mania as well as bipolar psychosis. While some children and adoles- cents are still prescribed typical antipsychotics, most child and adolescents psychiatrists prefer to use atypical antipsychotics. Typical antipsychotics are associated with high rates of side effects, such as muscle stiffness, and tremor, restlessness of the legs (akathisia), involuntary muscle movements [tardive dyskinesia], and high levels of prolactin (a hor- mone that affects sexual development and function). This syndrome is more likely to occur when high doses of antipsychotic medication are prescribed, or when the dose is increased rapidly. If your child or adolescent is taking a typi- cal or atypical antipsychotic and is active in sports or plays outside on very hot days, make sure he or she drinks plenty of liquids. There are no large clinical trials that show that typical antipsychotics are safe and effective in children and adolescents with bipolar disorder. For this reason, typical antipsychotics are not commonly used to treat the symptoms of bipolar disorder. In most cases, these medications are taken along with an atypical antipsychotic or a mood stabilizer. Some of the medications that may be prescribed for the collateral symptoms of bipolar disorder in children and adolescents include: • Antidepressants in combination with a mood stabilizer: Sometimes anti- depressants are prescribed to treat the depressive phase of bipolar disorder or to treat a coexisting condition, such as anxiety. There is a risk of reemer- gence of manic symptoms if antidepressants are prescribed without a mood stabilizer. Research has not been conducted to determine how to best treat The information contained in this guide is not intended as, and is not a substitute for, professional medical ParentsMedGuide. However, in one large study of adults with bipolar disorder, data showed that antidepressants are not effective in treating the symptoms of bipolar disorder. For more information about the treatment of depres- sion, please see the Parent’s Medication Guide for depression at: http://www. Most of these medications are prescribed on a short-term basis because they can be habit forming. Over the years, doctors have found this medication helpful in managing impulsiv- ity, aggression, and agitation in children and adolescents with behavioral disorders. This medication also can be prescribed for insomnia and to relieve involuntary muscle movement. Ineffective Medications The following antiseizure medications have not been shown to effectively treat mania or depression associated with bipolar disorder include: gabapentin (Neurontin®), topiramate (Topamax®), levetiracetam (Keppra®), zonisamide (Zonegran®), pregabalin (Lyrica®), and tiagabin (Gabitril®). However, these medications can be prescribed to treat coexisting condition in children and Glossary of Terms Used to Describe Common Side Effects from Medication for Bipolar Disorder Akathisia is a syndrome characterized by inner restlessness that causes an inability to sit or stand still. Ataxia is a neurological disorder that causes a lack of coordination of muscle movements. Diabetes (also called diabetes mellitus) is a metabolic disorder that causes unusually high blood sugar levels.

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For example cheap lasix 40mg heart attack cover, one study found that only three percent of United States treatment programs used it for opioid use disorders cheap lasix 40 mg overnight delivery arrhythmia with normal heart rate. A recent study found that raising this limit further, rather than increasing the number of specialty addiction programs or waivered physicians, may be the most effective way to increase buprenorphine use. Major pediatric medical organizations, including the American Academy of Pediatrics, strongly recommend addressing these issues regularly at each well-adolescent visit and appropriate urgent care visits. The Affordable Care Act requires health plans to cover, at no out-of-pocket cost to families, the preventive care services outlined in this schedule. Bright Futures discusses how to incorporate screening into the preventive services visit for these age groups. The Joint Commission Requirements mandate that hospitals offer inpatients brief counseling for alcohol misuse and follow-up, and measure the provision of counseling as one of the core measures for hospital accreditation. The Health Care Workforce Is Limited in Key Ways Workforce Shortages Data on the substance use workforce are incomplete. Nevertheless, it is clear that the workforce is inadequate, as evidenced by its uneven geographic distribution (with rural areas underserved), access barriers for adolescents and children, and recruitment challenges across the treatment feld. A recent study documented stafng models in primary care practices and determined that, even among those designated as patient-centered medical homes, fewer than 23 percent employed health educators, pharmacists, social workers, nutritionists, or community service coordinators, and fewer than half employed care coordinators. In practice, the Block Grant is used broadly, and Medicaid less and only with a subset of providers. It is not yet clear whether the integration of substance use disorder treatments in general health care will help to address salary structure. Composition and Education An integrated health and substance use disorder treatment system requires a diverse workforce that includes substance use disorder specialists, physicians, nurses, mental health treatment providers, care managers, and recovery specialists. As substance use disorder treatment and general health care become more integrated, clinical staff in both systems will need to expand their scope of work, operate in an integrated manner with a variety of populations, and shift their treatment focus as needed. Health care professionals moving from the specialty workforce into integrated settings will require specifc training on treatment planning and care coordination and an ability and willingness to work under the leadership of medical staff. This transition to a highly collaborative team approach, offering individually tailored treatment plans, presents challenges to the traditional substance use disorder treatment workforce that is used to administering standard “programs” of services to all patients. Working in teams with the broad mandate of improved health is not currently commonplace and will require collaboration among professional and certifcation bodies. Incorporating peer workers, who bring specifc knowledge of patients’ experiences and needs and can encourage informed patient decision making, into teams will also require further adjustment. Improving the Quality of Health Care for Mental and Substance Use Conditions also discussed the shortage of skills both in specialty substance use disorder programs and in the general health care system. Workforce Development and Improvement The Annapolis Coalition on the Behavioral Health Workforce provided a framework for workforce development in response to the challenges described above,318 focusing on broadening the defnition of “workforce” to address needed changes to the health care system. Currently, 66 organizations license and credential addiction counselors,319,320 and although a consensus on national core competencies for these counselors exists,321 they have not been universally adopted. Credentialing for prevention specialists exists through the International Certifcation & Reciprocity Consortium,322,323 but core competencies for prevention professionals have not been developed. Without a comprehensive, coordinated, and focused effort, workforce expansion and training will continue to fall short of the challenge of meeting the needs of individuals across the continuum of service settings. Of particular note is the National Health Service Corps, where, as of September 2015, roughly 30 percent of its feld strength of 9,683 was composed of behavioral health providers, meeting service obligations by providing care in areas of high need. The development of the workforce qualifed to deliver these services and services to address co-occurring medical and mental disorders will have signifcant implications for the national workforce’s ability to reach the full potential of integration. Protecting Confdentiality When Exchanging Sensitive Information Effectively integrating substance use disorder treatment and general health care requires the timely exchange of patient health care information. In the early 1970s, the federal government enacted Confdentiality of Alcohol and Drug Abuse Patient Records (42 U. These privacy protections were motivated by the understanding that discrimination attached to a substance use disorder might dissuade people from seeking treatment, and were enacted in the context of patient methadone records being used in criminal cases. Given the long and continuing history of discrimination against people with substance use disorders, safeguards against inappropriate or inadvertent disclosures are important. Disclosures to insurers or to employers can render patients unable to obtain disability or life insurance and can cost patients their jobs. However, exchanging treatment records among health care providers has the potential to improve treatment and patient safety. For example, in the case of opioid prescribing, a study in health systems of long-term opioid users found those with a prior substance use disorder diagnosis received higher dosages and were co-prescribed sedative-hypnotic medications—which can increase the risk for overdose—more often. Because of privacy regulations, it is likely that physicians were not aware of their patients’ substance use disorders. Promising Innovations That Improve Access to Substance Use Disorder Treatment Clearly, integrating health care and substance use disorder treatment within health care systems, as well as integrating the substance use disorder treatment system with the overall health care system, are complex undertakings. In so doing, they are broadening the focus of interventions beyond just the treatment of severe substance use disorders to encompass the entire spectrum of prevention, treatment, and recovery. Medicaid Innovations Medicaid is not only an increasing source of fnancing for substance use disorder treatment services, it has become an important incubator for innovative substance use disorder fnancing and delivery models that can help integrate substance use disorder treatment and mainstream health care systems. Within the substance use disorder treatment beneft, and in addition to providing the federally required set of services, states also may offer a wide range of recovery-oriented services under Medicaid’s rehabilitative services option. These services include therapy, counseling, training in communication and independent living skills, recovery support and relapse prevention training, skills training to return to employment, and relationship skills. Nearly all states offer some rehabilitative mental health services, and most states offer the rehabilitation option for substance use disorder services. The agency is providing technical and program support to states to introduce policy, program, and payment reforms to identify individuals with substance use disorders, expand coverage for effective treatment, expand access to services, and develop data collection, measurement, and payment mechanisms that promote better outcomes. Health Homes Health homes are grounded in the principles of the primary care medical home, which focuses on primary care-based coordination of diverse health care services, and patient and provider engagement. The Affordable Care Act created an optional Medicaid State Plan beneft allowing states to establish health homes to coordinate care for participants who have chronic health conditions. Health homes operate under a “whole-person” philosophy that involves integrating and coordinating all primary, acute, behavioral health, and long-term care services to address all the individual’s health needs. Benefciaries with chronic conditions are eligible to enroll in health homes if they experience (or are at risk for) a second chronic condition, including substance use disorders, or are experiencing serious and persistent mental health conditions. These arrangements emphasize integration of care, targeting of health home services to high-risk populations with substance use and mental health concerns, and integration of social and community supports with general health services. As of January 2016, 19 states and the District of Columbia had established Medicaid health home programs – covering nearly one million individuals – and nearly a dozen additional states had plans for establishing them. The Oregon Health Authority publishes regular reports on quality, access, and progress toward benchmarks in both prevention and treatment. Federally Qualified Health Centers Increased insurance coverage and other provisions of the Affordable Care Act have sparked important changes that are facilitating comprehensive, high-quality care for people with substance use disorders. These community health centers emphasize coordinated primary and preventive services that promote reductions in health disparities for low-income individuals, racial and ethnic minorities, rural communities, and other underserved populations. Community health centers provide primary and preventive health services to medically underserved areas and populations and may offer behavioral and mental health and substance use services as appropriate to meet the health needs of the population served by the health center. Because they provide services regardless of ability to pay and are required to offer services on a sliding scale fee, they are well-positioned to serve low-income and economically vulnerable patients. These systems have the capacity to easily provide information in multiple languages and to put patients in touch with culturally appropriate providers through telehealth. These incentives have worked: The care coordination and population and National Electronic Health Record Survey found that as of 2014, public health; and maintain privacy and more than 80 percent of primary care physicians had adopted security of patient health information.

This scan easily be reasonable to recommend cystoscopy to assisin making a performed afr cystoscopy and can provide both relief to diagnosis before initiating therapy purchase 40 mg lasix overnight delivery heart attack signs, especially if there is any the patient buy lasix pills in toronto arteria technologies, as well as provide diagnostic information and indication on history, physical examination, urinalysis, or guide future therapy. A patienxperiencing relief from cytology suggesting thaother diseases need to be ruled out. Resolution of the pain by dysfunction (pelvic foor examination is easily added to a intravesical local anesthesia can be both diagnostic and cystoscopic examination) will directreatmenstragies. Sixty-eighpercenxperienced a reduc- diagnostic purposes may be appropria in certain situations. All non-responders were These may include: when a patienis unable to tolera subsequently diagnosed with non-bladder pathology causing cystoscopy under local anesthetic and is having a general their pelvic pain. Conservative therapies infammation are nospecifc, overlapping with other eti- ologies, and they correla poorly to cystoscopic fndings 1. Based on besvidence principles, initial managemenHowever, correlations have been found with specifc should focus on conservative stragies. Dundore eal found no signifcandifference in masUp to 90% of patients have exacerbations of their symp- cell counts in the lamina propria or detrusor on Giemsa- toms afr ingesting certain foods or drinks. The goal is to reduce voiding frequency, pontially treatmenshould be maximizing symptomatic control and increase bladder capacity, and reduce the need to void in quality of life while avoiding adverse events and treatmenresponse to urgency or pain. Timed voiding or scheduled complications, recognizing thathere is no curative treat- voiding involves urinating aregular seinrvals thadis- menfor this condition. Distraction (counting backwards) conditions with early referral to other specialists for multi- or relaxation (deep breathing) chniques may be used. The application of an algorithmic approach such behaviour modifcation program is suppord by pro- for the treatmenof all patients may lead to unsuccessful spective data showing symptom improvemenfor 45? Physical therapy chniques symptoms,68 stress-reduction stragies, such as exercising, bathing, reducing working hours, meditation, yoga, and 1. Amitriptyline 25�75 mg po qhs Various chniques have been described thainvolve skillful, Cimetidine 400 mg po bid hands-on maneuvers direcd toward relaxation, elongation, Hydroxyzine 10�50 mg po qhs stretching, and massaging of tighned muscles. Based on the including data on 448 patients has summarized the fndings inntion-to-treaanalysis, there was no signifcandiffer- of four of these trials. Of no, less was defned as a 50% or more improvemenin symptoms, than 50% of patients tolerad a dose of 50 mg and both including pain, urgency, frequency, and nocturia. Aa mean followup of 22 months, Guideline: Based on Level 1 and 2 evidence, amitriptyline Alzharani eal91 found tha54. They compared Two very small observational trials81,82 and one placebo- 300 mg vs. Thilagarajah repord a grear than 50% improvemenin symptoms, eal83 randomized 36 patients to cimetidine 400 mg orally respectively. Suprapubic pain and nocturia were found to effects included: diarrhea (25%); headache (18. No side effects were sea (15%); pelvic pain (13%); abdominal pain (13%); and repord. Twenty-two percenof patients discontinued Guideline: Based on scarce Level 1, 2, and 3 evidence, treatmendue to side effects. Treatments may be adminisred in the clinic setting or a80 mg gentamicin home in some cases. Several observational studies have device thaprolongs dwell time, have also been recently repord a wide range of response ras, from 30? However, ishould be kepin mind thathree nega- In a sysmatic review, Mourtzoukou eal concluded thative trials have been compled withoupublished results. Bade eal observed improvemenin symptoms had symptomatic relief following resection, which lasd for 40% of patients compared to placebo, with rare hematuria more than three years for 40% of patients. Multiple small observational studies have consisntly shown a signifcanimprovemenin pain, urinary symp- D. A secondary cysctomy was performed in 17% ria, elevad post-void residual, and possible need for m- to treapersisnsuprapubic pain. Repeainjections capacity,197,201 were more likely to have improvemenin pain are safe. Therapy is costly and may nobe widely available and lower urinary tracsymptoms postoperatively. Patients musbe counselled on pontial side Guideline: Based on Level 3 evidence, major surgery with effects, particularly the possibility of urinary rention and substitution cystoplasty or urinary diversion � cysctomy need to catherize. Improvements symptoms, painful stimulation, uncomfortable sensations, in pain, urgency, frequency, capacity, and symptom scores batry si pain, seroma, infection, mechanical malfunc- were maintained for up to 12 months (p<0. Eighof the 36 patients (22%) who did nohave a canimprovemenin symptoms in the treatmenvs. Guidelines and recommendations are innded to promo beneficial or desirable outcomes bucannoguarane any specific outcome. These recommendations cannoadequaly convey all uncertainties and nuances of patiencare. We employed a group consensus process to grade the strength of recommendations (either strong or conditional). The guideline includes 74 recommendations: 23% are strong and 77% are conditional. These recommendations are noprescrip- tive, and the treatmendecisions should be made by physicians and patients through a shared decision-making process taking into accounpatients� values, preferences, and comorbidities. This process royalties from UpToDa, and has received grant/research includes the Grading of Recommendations Assessment, supporfrom Biogen. Author disclosures are detailed in the footnos of for a lisof Panel and am members) conducd the lira- this article. The Voting Panel included rheu- inrvention, comparator, and outcomes) development. The Core Leadership am collaborad with the ConnPanel Disclosures and managemenof con? Cosis a consideration in these recommendations; however, explicicost-effectiveness analyses were noconducd. A treatmenrecommendation favoring one medication over another means thathe preferred medication would be the recommended? However, favoring one medication over the other does noimply thathe nonfavored medication is contraindicad for use in thasituation; imay still be a pontial option under certain conditions. Duplica er data from both randomized and observational trials were references were removed. Con- searched to include articles published from January 1, 2009 tinuous outcomes were repord as mean differences with through March 3, 2014. We updad initial lirature searches on Sepmber ables were analyzed using the Manl-Haenszel method in a 17, 2014. These variables were repord as risk in collaboration with the Lirature Review am and were ratios with 95% con? The overall evidence quality grade was the al studies as the highest-quality source of evidence.

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