DOCSLIB.ORG

Diagnosis and Treatment of Low Back Pain (2017 LBP CPG), Includes Objective, Evidence-Based Information on the Diagnosis and Management of Acute and Chronic LBP

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Diagnosis and Treatment of Low Back Pain (2017 LBP CPG), Includes Objective, Evidence-Based Information on the Diagnosis and Management of Acute and Chronic LBP VA/DoD CLINICAL PRACTICE GUIDELINE FOR DIAGNOSIS AND TREATMENT OF LOW BACK PAIN Department of Veterans Affairs Department of Defense QUALIFYING STATEMENTS The Department of Veterans Affairs and the Department of Defense guidelines are based upon the best information available at the time of publication. They are designed to provide information and assist decision making. They are not intended to define a standard of care and should not be construed as one. Neither should they be interpreted as prescribing an exclusive course of management. This Clinical Practice Guideline is based on a systematic review of both clinical and epidemiological evidence. Developed by a panel of multidisciplinary experts, it provides a clear explanation of the logical relationships between various care options and health outcomes while rating both the quality of the evidence and the strength of the recommendation. Variations in practice will inevitably and appropriately occur when clinicians take into account the needs of individual patients, available resources, and limitations unique to an institution or type of practice. Every healthcare professional making use of these guidelines is responsible for evaluating the appropriateness of applying them in the setting of any particular clinical situation. These guidelines are not intended to represent Department of Veterans Affairs or TRICARE policy. Further, inclusion of recommendations for specific testing and/or therapeutic interventions within these guidelines does not guarantee coverage of civilian sector care. Additional information on current TRICARE benefits may be found at www.tricare.mil or by contacting your regional TRICARE Managed Care Support Contractor. Version 2.0 – 2017 VA/DoD Clinical Practice Guideline for Diagnosis and Treatment of Low Back Pain Prepared by: The Diagnosis and Treatment of Low Back Pain Work Group With support from: The Office of Quality, Safety and Value, VA, Washington, DC & Office of Evidence Based Practice, U.S. Army Medical Command Version 2.0 – 2017 Based on evidence reviewed through October 21, 2016 September 2017 Page 2 of 110 VA/DoD Clinical Practice Guideline for Diagnosis and Treatment of Low Back Pain Table of Contents I. Introduction ..................................................................................................................................... 5 II. Recommendations ........................................................................................................................... 6 III. Background...................................................................................................................................... 9 A. Description of Low Back Pain .............................................................................................................. 9 B. Epidemiology and Impact .................................................................................................................. 10 a. General Population ................................................................................................................................... 10 b. Veterans Affairs Population ..................................................................................................................... 11 c. Department of Defense Population ......................................................................................................... 11 IV. About this Clinical Practice Guideline ............................................................................................. 12 A. Scope of this Clinical Practice Guideline ........................................................................................... 12 B. Methods ............................................................................................................................................. 13 a. Grading Recommendations ...................................................................................................................... 14 b. Reconciling 2007 Clinical Practice Guideline Recommendations ............................................................ 15 c. Peer Review Process ................................................................................................................................. 16 C. Summary of Patient Focus Group Methods and Findings ................................................................ 16 D. Conflict of Interest ............................................................................................................................. 17 E. Highlighted Features of this Clinical Practice Guideline ................................................................... 18 F. Patient-centered Care ....................................................................................................................... 18 G. Shared Decision Making .................................................................................................................... 18 H. Implementation ................................................................................................................................. 19 V. Guideline Work Group ................................................................................................................... 20 VI. Algorithm ...................................................................................................................................... 21 Module A: Initial Evaluation of Low Back Pain .......................................................................................... 22 Module B: Management of Low Back Pain ............................................................................................... 24 VII. Discussion of Recommendations .................................................................................................... 26 A. Diagnostic Approach .......................................................................................................................... 26 B. Education and Self-care ..................................................................................................................... 31 C. Non-pharmacologic and Non-invasive Therapy ............................................................................... 33 D. Pharmacologic Therapy ..................................................................................................................... 39 E. Dietary Supplements ......................................................................................................................... 46 F. Non-surgical Invasive Therapy .......................................................................................................... 48 G. Team Approach to Treatment of Chronic Low Back Pain ................................................................ 50 September 2017 Page 3 of 110 VA/DoD Clinical Practice Guideline for Diagnosis and Treatment of Low Back Pain VIII. Knowledge Gaps and Recommended Research .............................................................................. 51 Appendix A: Evidence Review Methodology ....................................................................................... 53 A. Developing the Scope and Key Questions ........................................................................................ 53 a. Population(s) ............................................................................................................................................. 53 b. Intervention(s) .......................................................................................................................................... 54 c. Comparator(s) .......................................................................................................................................... 56 d. Outcomes .................................................................................................................................................. 56 e. Timing ....................................................................................................................................................... 57 f. Setting ....................................................................................................................................................... 57 B. Conducting the Systematic Review ................................................................................................... 57 a. Criteria for Study Inclusion/Exclusion....................................................................................................... 59 b. Literature Search Strategy........................................................................................................................ 60 C. Convening the Face-to-face Meeting ................................................................................................ 61 D. Grading Recommendations ............................................................................................................... 62 E. Recommendation Categorization ..................................................................................................... 65 a. Categorizing Recommendations with an Updated Review of the Evidence ........................................... 65 b. Categorizing Recommendations without an Updated Review of the Evidence ..................................... 66 c. Recommendation Categories and Definitions ......................................................................................... 66 F. Drafting and Submitting the Final Clinical Practice
Load more

Recommended publications
  • Opioids): SOR/2018-77 Canada Gazette, Part II, Volume 152, Number 9
    Canada Gazette, Part 2, Volume 152, Number 9: Regulations Amendin... http://gazette.gc.ca/rp-pr/p2/2018/2018-05-02/html/sor-dors77-eng.html Home (http://www.canada.ca/en/index.html) How government works (http://www.canada.ca/en/government/system/index.html) Treaties, laws and regulations (https://www.canada.ca/en/government/system/laws.html) Canada Gazette (/accueil-home-eng.html) Publications (/rp-pr/publications-eng.html) Part II: Vol. 152 (2018) (/rp-pr/p2/2018/index-eng.html) May 2, 2018 (/rp-pr/p2/2018/2018-05-02/html/index-eng.html) Regulations Amending the Food and Drug Regulations (Opioids): SOR/2018-77 Canada Gazette, Part II, Volume 152, Number 9 Registration April 23, 2018 FOOD AND DRUGS ACT P.C. 2018-429 April 20, 2018 Her Excellency the Governor General in Council, on the recommendation of the Minister of Health, pursuant to section 30a of the Food and Drugs Act b, makes the annexed Regulations Amending the Food and Drug Regulations (Opioids). Regulations Amending the Food and Drug Regulations (Opioids) Amendments 1 Subsections C.01.005(2) and (3) of the Food and Drug Regulations 1 are replaced by the following: (2) Subsection (1) does not apply to (a) a drug in dosage form that is compounded by a pharmacist under a prescription or by a practitioner; or (b) a drug in dosage form that is sold under a prescription if the following information appears on the drug’s label: (i) the drug’s proper name, common name or brand name, (ii) the drug’s potency, and (iii) the name of the drug’s manufacturer.
    [Show full text]
  • Minnesota Statutes 1979 Supplement
    MINNESOTA STATUTES 1979 SUPPLEMENT 152.01 PROHIBITED DRUGS CHAPTER 152. PROHIBITED DRUGS Sec. 152.01 Definitions. 152.02 Schedules of controlled substances; admin­ istration of chapter. 152.01 Definitions. [For text of subds 1 to 8, see M.S.1978] Subd. 9. Marijuana. "Marijuana" means all parts of the plant of any species of the genus Cannabis, including all agronomical varieties, whether growing or not; the seeds thereof; the resin extracted from any part of such plant; and every compound, manufacture, salt, derivative, mixture, or preparation of such plant, its seeds or resin, but shall not include the mature stalks of such plant, fiber from such stalks, oil or cake made from the seeds of such plant, any other compound, manufacture, salt, derivative, mix­ ture, or preparation of such mature stalks, except the resin extracted therefrom, fiber, oil, or cake, or the sterilized seed of such plant which is incapable of germination. [For text of subds 10 to 17, see M.S.1978] [ 1979 c 157 s 1 ] 152.02 Schedules of controlled substances; administration of chapter. [For text of subd 1, see M.S.1978) Subd. 2. The following items are listed in Schedule I: (1) Any of the following substances, including their isomers, esters, ethers, salts, and salts of isomers, esters, and ethers, unless specifically excepted, whenever the exis­ tence of such isomers, esters, ethers and salts is possible within the specific chemical des­ ignation: Acetylmethadol; Allylprodine; Alphacetylmethadol; Alphameprodine; Alpham- ethadol; Benzethidine; Betacetylmethadol; Betameprodine; Betamethadol; Betaprodine; Clonitazene; Dextromoramide; Dextrorphan; Diampromide; Diethyliambutene; Dime- noxadol; Dimepheptanol; Dimethyliambutene; Dioxaphetyl butyrate; Dipipanone; Ethylmethylthiambutene; Etonitazene; Etoxeridine; Furethidine; Hydroxypethidine; Ke- tobemidone; Levomoramide; Levophenacylmorphan; Morpheridine; Noracymethadol; Norlevorphanol; Normethadone; Norpipanone; Phenadoxone; Phenampromide; Pheno- morphan; Phenoperidine; Piritramide; Proheptazine; Properidine; Racemoramide; Tri­ meperidine.
    [Show full text]
  • Oklahoma Drug Threat Assessment
    2018 Oklahoma Drug Threat Assessment Oklahoma Bureau of Narcotics and Dangerous Drugs i John Scully, Director MARY FALLIN JOHN SCULLY Governor Director September 12, 2018 The Oklahoma Bureau of Narcotics has served the citizens of Oklahoma in the quest for a drug- free state since 1975. Our agency remains committed to working with lawmakers, law enforcement, public health officials, and the citizens of Oklahoma to develop comprehensive strategies to address drug abuse in communities across the state. While we know many factors contribute to drug abuse, OBN is committed to reducing the availability of illegal drugs in Oklahoma. Our agency works to eradicate illegal drugs in Oklahoma by enforcing drug laws, administering statewide programs, and providing continual outreach to our stakeholders – lawmakers, law enforcement, public health officials, and the citizens of Oklahoma. OBN agents enforce drug laws by utilizing aggressive investigative methods and administering statewide drug diversion programs. The Prescription Drug Monitoring Program is a valuable tool for practitioners, pharmacists, and law enforcement in the prevention and detection of the diversion and abuse of pharmaceutical controlled substances. As a service to our communities, OBN also administers the Safe Trips for Scripts Drug Prevention Program. This program provides citizens a safe way to discard unwanted medications by disposing of them in one of our 177 take back boxes located around the state. This drug threat assessment was created to help provide officials and citizens with helpful information about drug threats across our state. We will continue to collaborate with other agencies and the citizens to work toward a safer and healthier Oklahoma.
    [Show full text]
  • ESTIMATED WORLD REQUIREMENTS of NARCOTIC DRUGS in GRAMS for 2019 (As of 10 January 2019 )
    ESTIMATED WORLD REQUIREMENTS OF NARCOTIC DRUGS IN GRAMS FOR 2019 (as of 10 January 2019 ) Afghanistan Cannabis 50 Codeine 50 000 Cannabis resin 1 Dextropropoxyphene 10 000 Coca leaf 1 Diphenoxylate 5 000 Cocaine 15 Fentanyl 1 Codeine 650 000 Methadone 20 000 Codeine -N-oxide 1 Morphine 8 000 Dextromoramide 1 Pethidine 90 000 Dextropropoxyphene 200 000 Pholcodine 40 000 Difenoxin 1 Albania Dihydrocodeine 1 Cocaine 1 Diphenoxylate 1 Codeine 1 189 000 Dipipanone 1 Fentanyl 300 Ecgonine 2 Heroin 1 Ethylmorphine 1 Methadone 7 000 Etorphine 1 Morphine 7 800 Fentanyl 17 000 Oxycodone 2 000 Heroin 1 Pethidine 2 700 Hydrocodone 10 000 Pholcodine 1 500 Hydromorphone 4 000 Remifentanil 9 Ketobemidone 1 Sufentanil 2 Levorphanol 1 Algeria Methadone 100 000 Alfentanil 350 Morphine 1 550 000 Codeine 2 500 000 Morphine -N-oxide 1 Etorphine 1 Nicomorphine 1 Fentanyl 500 Norcodeine 1 Methadone 4 000 Normethadone 1 Morphine 9 000 Normorphine 1 Oxycodone 4 000 Opium 10 Pethidine 3 000 Oripavine 1 Pholcodine 1 500 000 Oxycodone 60 000 Remifentanil 1 Oxymorphone 1 Sufentanil 30 Pethidine 50 000 Andorra Phenoperidine 1 Cannabis 2 000 Pholcodine 1 Fentanyl 100 Piritramide 1 Methadone 1 000 Remifentanil 20 000 Morphine 500 Sufentanil 10 Oxycodone 2 000 Thebacon 1 Pethidine 500 Thebaine 70 000 Remifentanil 4 Tilidine 1 Angola Armenia Alfentanil 20 Codeine 3 000 Codeine 21 600 Fentanyl 40 Dextromoramide 188 Methadone 13 500 Dextropropoxyphene 200 Morphine 7 500 Dihydrocodeine 500 Thebaine 15 Diphenoxylate 300 Trimeperidine 1 500 Fentanyl 63 Aruba* Methadone 2 000
    [Show full text]
  • Problems of Drug Dependence 1980 Proceedings of the 42Nd Annual Scientific Meeting the Committee on Problems of Drug Dependence
    National Institute on Drug Abuse MONOGRAPH SERIES Problems of Drug Dependence 1980 Proceedings of the 42nd Annual Scientific Meeting The Committee on Problems of Drug Dependence, Inc. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES • Public Health Service • Alcohol, Drug Abuse, and Mental Health Administration Problems of Drug Dependence, 1980 Proceedings of the 42nd Annual Scientific Meeting, The Committee on Problems of Drug Dependence, Inc. Editor: Louis S. Harris, Ph.D. NIDA Research Monograph 34 February 1981 DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration National Institute on Drug Abuse Division of Research 5600 Fishers Lane Rockville, Maryland 20857 For sale by the Superintendent of Documents, U.S. Government Printing Office Washington, D.C. 20402 The NIDA Research Monograph series is prepared by the Division of Research of the National Institute on Drug Abuse. Its primary objective is to provide critical reviews of research problem areas and techniques, the content of state-of-the-art conferences, integrative research reviews and significant original research. Its dual publication emphasis is rapid and targeted dissemination to the scientific and professional community. Editorial Advisory Board Avram Goldstein, M.D. Addiction Research Foundation Palo Alto, California Jerome Jaffe, M.D. College of Physicians and Surgeons Columbia University, New York Reese T. Jones, M.D. Langley Porter Neuropsychiatric Institute University of California San Francisco, California William McGlothlin, Ph.D. Deportment of Psychology, UCLA Los Angeles, California Jack Mendelson, M.D. Alcohol and Drug Abuse Research Center Harvard Medical School McLean Hospital Belmont, Massachusetts Helen Nowlis, Ph.D. Office of Drug Education, DHHS Washington, D.C Lee Robins, Ph.D.
    [Show full text]
  • Epidural Ketamine for Postoperative Analgesia
    16 Mohamed Naguib M~ SCH MSC, Epidural ketamine Yaw Adu-Gyamfi MB, CHS FVARCS, FWACS, Gamil H. Absood PHO, for postoperative Hesham Farag ras scH FFARCS, Henry K. Gyasi MB CHa FFARCSl analgesia Thirty-four patients of ASA physical status 1 or H Following the identification of opiate receptors in scheduled for gall bladder surgery were studied in a the spinal cord, 1 the epidural and intrathecal use comparative prospective trial to evaluate the efficacy of of opioids has increased. However, these methods epidural and intramuscular ketamine for postoperative of pain relief are not without side-effects, 2 the most pain relief. They were divided randomly into three serious of which is delayed respiratory depression.3 groups. Group I (11 patients) received 30rag intra- Ketamine [2-(O-Chlorophenyl)-2-(methylamino) muscular ketamine. Group 11 (10 patients) and Group 111 cyclohexanone HCI] is a potent analgesic. 4 Recent (13 patients) received 10 and 30rag ketamine in 1Oral studies indicate that analgesia produced by ketamine saline respectively, through epidural catheters. Pain was is mediated by opiate receptors, s'6 Since ketamine evaluated every two hours for the first 24 hours post. administered systemically is unlikely to produce operatively by using a linear analogue pain scale from respiratory depression, 7 it seemed to offer an 0-10. Ketamine was given on the patient's request and obvious advantage over the opiates. whenever the pain score exceeded three. Ketamine pro- The demonstration of the safety of intrathecal duced analgesia in all patients studied. The reduction of ketamine with preservatives in baboons by Brock- pain score after two andJbur hours in Group I and lll was Utne et al.
    [Show full text]
  • Recommended Methods for the Identification and Analysis of Fentanyl and Its Analogues in Biological Specimens
    Recommended methods for the Identification and Analysis of Fentanyl and its Analogues in Biological Specimens MANUAL FOR USE BY NATIONAL DRUG ANALYSIS LABORATORIES Laboratory and Scientific Section UNITED NATIONS OFFICE ON DRUGS AND CRIME Vienna Recommended Methods for the Identification and Analysis of Fentanyl and its Analogues in Biological Specimens MANUAL FOR USE BY NATIONAL DRUG ANALYSIS LABORATORIES UNITED NATIONS Vienna, 2017 Note Operating and experimental conditions are reproduced from the original reference materials, including unpublished methods, validated and used in selected national laboratories as per the list of references. A number of alternative conditions and substitution of named commercial products may provide comparable results in many cases. However, any modification has to be validated before it is integrated into laboratory routines. ST/NAR/53 Original language: English © United Nations, November 2017. All rights reserved. The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries. Mention of names of firms and commercial products does not imply the endorse- ment of the United Nations. This publication has not been formally edited. Publishing production: English, Publishing and Library Section, United Nations Office at Vienna. Acknowledgements The Laboratory and Scientific Section of the UNODC (LSS, headed by Dr. Justice Tettey) wishes to express its appreciation and thanks to Dr. Barry Logan, Center for Forensic Science Research and Education, at the Fredric Rieders Family Founda- tion and NMS Labs, United States; Amanda L.A.
    [Show full text]
  • 3.2.2 Opioids and Abuse, Misuse and Dependence
    Opioids and abuse, misuse and dependence CONFIDENTIAL Medicines Adverse Reactions Committee Meeting date 3/12/2020 Agenda item 3.2.2 Title Opioids and abuse, misuse and dependence Submitted by Medsafe Pharmacovigilance Paper type For advice Team Active ingredient Product name Sponsor Buprenorphine Codeine Dihydrocodeine Fentanyl See Annex 1 for the full list of opioids approved in New Zealand Methadone Morphine Oxycodone Pethidine Tramadol PHARMAC funding All opioids in Annex 1 have at least one product funded on the Hospital and Community Schedules. Previous MARC 169th meeting – held 9 March 2017: Concomitant use of opioids, benzodiazepines meetings and other CNS depressants and the risk of serious side effects International action • FDA - Risk Evaluation and Mitigation Strategy (REMS) required for all opioids; prescribing information updates • MHRA – warnings on package labelling, updates to prescribing information, safety leaflets for patients • TGA – smaller pack sizes, boxed warnings and class statements in prescribing information and consumer medicine information, indication review • Health Canada – Mandatory risk management plans for prescription opioids, Warning sticker and patient information handout Prescriber Update The following is a list of recent articles only. • Spotlight on tramadol including updated advice for use in children June 2020 • Spotlight on Codeine June 2018 • Medicines Interacting with Methadone June 2018 • Transdermal Opioid Patches - Stick to the Correct Application March 2020 Classification See Annex 1. Medicines
    [Show full text]
  • Patterns of Opioid Prescribing in Minnesota: 2012 and 2015
    ISSUE BRIEF | APRIL, 2018 Patterns of Opioid Prescribing in Minnesota: 2012 and 2015 Introduction Key Findings: Opioids are a class of drugs that include prescription • Overall rates of opioid prescribing declined in opioid medications for pain relief —such as oxycodone Minnesota from 2012 to 2015, but the morphine (OxyContin®), hydrocodone (Vicodin®), codeine, morphine, milligram equivalents (MME) per prescription and fentanyl—as well as illicitly produced drugs like heroin increased. and fentanyl-related substances (also called fentanyl analogs).1 While prescription opioids play a role in the • Medicare and Medicaid, where eligibility is determined management of some types of severe acute, cancer-related by age, disability status, and/or income, covered and end-of-life pain, increased opioid use since 1990, approximately one-third of Minnesotans with general including for chronic pain unrelated to cancer, has resulted health coverage and accounted for two-thirds of opioid in sharply rising opioid addiction and overdoses, as well as prescriptions filled in 2015. increased healthcare utilization and costs. Recent Centers • Nearly one in three Minnesotans with an opioid for Disease Control and Prevention (CDC) guidelines point prescription in 2015 had multiple prescribers. out the limitations of the evidence base in support of opioid therapy for pain, recommend non-opioid therapy • In both 2012 and 2015, 6 in 10 opioid prescriptions for chronic pain, and emphasize the risks associated with were filled within 15 days of the patient’s last medical opioid therapy.2 In Minnesota, opioids—both prescription visit; however, 1 in 10 opioid prescriptions were filled and illicit—were responsible for 336 overdose deaths without a medical visit in the past 90 days, suggesting in 2015, more than a six-fold increase since 2000.3 In closer patient-prescriber communication or opioid 2016, opioid use accounted for 395 overdose deaths in oversight may be needed in some cases.
    [Show full text]
  • LAAM in the Treatment of Opiate Addiction: Treatment Improvement Protocol (TIP) Series 22
    TIP 22: LAAM in the Treatment of Opiate Addiction: Treatment Improvement Protocol (TIP) Series 22 A43664 Ira J. Marion, M.A. Consensus Panel Chair U.S. Department of Health and Human Services Public Health Service Substance Abuse and Mental Health Services Administration Center for Substance Abuse Treatment Rockwall II, 5600 Fishers Lane Rockville, MD 20857 DHHS Publication No. (SMA) 95-3052 Printed 1995. Disclaimer This publication is part of the Substance Abuse Prevention and Treatment Block Grant technical assistance program. All material appearing in this volume except quoted passages from copyrighted sources is in the public domain and may be reproduced or copied without permission from the Center for Substance Abuse Treatment (CSAT) or the authors. Citation of the source is appreciated. This publication was written under contract number ADM 270-91-0007 from the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration (SAMHSA). Sandra Clunies, M.S., served as the CSAT Government project officer. Robert A. Lubran, M.S., M.P.A., was the Government content advisor. Carolyn Davis, Constance Gartner, Linda Harteker, Lise Markl, Barbara Shapiro, and Deborah Shuman served as writers. The opinions expressed herein are the views of the consensus panel members and do not reflect the official position of CSAT or any other part of the U. S. Department of Health and Human Services (DHHS). No official support or endorsement of CSAT or DHHS for these opinions or for particular instruments or software that may be described in this document is intended or should be inferred. The guidelines proffered in this document should not be considered as substitutes for individualized patient care and treatment decisions.
    [Show full text]
  • Quality Issues in Caring for Older People
    Doctoral Thesis - Tesis Doctoral Quality issues in caring for older people: • Appropriateness of transition from long-term care facilities to acute hospital care • Potentially inappropriate medication: development of a European list Anna Renom Guiteras Prof. Gabriele Meyer Prof. Ramón Miralles Basseda Martin Luther University Halle-Wittenberg Universitat Autònoma de Barcelona Halle (Saale) & Barcelona, Catalonia University of Witten/Herdecke Spain Witten Germany Programa de doctorat en Medicina Departament de Medicina, Facultat de Medicina Universitat Autònoma de Barcelona Barcelona, 2015 13 Contents 15 1. Introduction • Research context • Background of the research topics • Pesetaio of the ailes 23 2. Summary and discussion of the results 31 3. Conclusions 37 4. References 47 5. Articles • Article 1: Renom-Guiteras A, Uhrenfeldt L, Meyer G, Mann E. Assessment tools for determining appropriateness of admission to acute care of persons transferred from long-term care facilities: a systematic review. BMC Geriatr. 2014;14:80 • Article 2: Renom-Guiteras A, Meyer G, Thürmann PA. The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries. Eur J Clin Pharmacol. 2015;71(7):861-75 77 6. Annexes • Annex 1.1 (article 1) - Additional file 1: Studies dealing with assessment tools for determining appropriateness of hospital admissions among residents of LTC facilities. • Annex 1.2 (article 1) - Additional file 2: Characteristics of the assessment tools for determining appropriateness of hospital admissions among residents of LTC facilities. • Annex 2.1 (article 2) - Appendix 1: Complete EU(7)-PIM list • Annex 2.2 (article 2) - Appendix 2: Questionable Potentially Inappropriate Medications (Questionable PIM): results of the Delphi survey.
    [Show full text]
  • The Cardiovascular Actions of Mu and Kappa Opioid Agonists In
    THE CARDIOVASCULAR ACTIONS OF MU AND KAPPA OPIOID AGONISTS IN VIVO AND IN VITRO. By Abimbola T. Omoniyi, BSc (Hons) A thesis submitted in accordance with the requirements of the University of Surrey for the Degree of Doctor of Philosophy. Department of Pharmacology, September 1998. Cornell University Medical College, New York, NY 10021, ProQuest Number: 27733163 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a com plete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest ProQuest 27733163 Published by ProQuest LLC (2019). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States C ode Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106 - 1346 ACKNOWLEDGEMENTS I would like to thank God through whom all things are made possible. Many thanks to Dr. Hazel Szeto for funding this thesis. Heartfelt gratitude to Dr. Dunli Wu for his support, encouragement and for keeping me sane. I thoroughly enjoyed the funny stories, the relentless Viagra jokes and endless tales of the Chinese revolution! Thanks to Dr. Yi Soong for all her support and generous assistance and all that food! Thanks to Dr. Ian Kitchen and Dr. Susanna Hourani for making this a successful collaborative degree. Thanks to my family for all their support and belief in me.
    [Show full text]