Patient Preference

U.S. Selected Practice Recommendations for Contraceptive Use (U.S. SPR), adapted by CDC from global guidance developed by the World Health Organization (WHO), provides evidence-based guidance on contraceptive use for U.S. health care providers (1). During January-February, 2021, CDC evaluated the 2019 WHO recommendation on self-administered subcutaneous depot medroxyprogesterone acetate (DMPA-SC) (2). CDC adopted the WHO recommendation on the basis of moderate-certainty evidence that self-administered DMPA-SC is safe and effective, and has higher continuation rates compared with provider-administered DMPA. The new U.S. SPR recommendation states that self-administered DMPA-SC should be made available as an additional approach to deliver injectable contraception. Provider-administered DMPA should remain available. Self-administered DMPA-SC is a user-controlled method that has the potential to improve contraceptive access and increase reproductive autonomy. Self-administered DMPA-SC should be offered in a noncoercive manner through a shared decision-making process between patients and their health care providers, with a focus on patient preferences and equitable access to the full range of contraceptive methods.

Author/s:

Curtis, K. M., Nguyen, A., Reeves, J. A., Clark, E. A., Folger, S. G., Whiteman, M. K.

Canadian guideline for Parkinson disease

Brian Desmarais — Mon, 03 Feb 2020 17:28:55 +0000

Date Added:

February 3, 2020

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

September 9, 2019

Issue:

Volume:

191

Pages:

E989-E1004

URL:

Canadian guideline for Parkinson disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.181504

MeSH

Hospice and Palliative Care Nursing

Parkinsonian Disorders

decision making

communication

Canada

Updated Canadian guidelines for management of Parkinson’s Disease. James W. Mold, MD, MPH

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KEY POINTS

This guideline update reflects substantial changes in the literature on diagnosis and treatment of Parkinson disease, and adds information on palliative care.
Impulse control disorders can develop in a person with Parkinson disease who is on any dopaminergic therapy at any stage in the disease course, especially for those taking dopamine agonists.
Advanced therapies like deep brain stimulation and intrajejunal levodopa-carbidopa gel infusion are now routinely used in Parkinson disease to manage motor symptoms and fluctuations.
Evidence exists to support early institution of exercise at the time of diagnosis of Parkinson disease, in addition to the clear benefit now shown in those with well-established disease.
Palliative care requirements of people with Parkinson disease should be considered throughout all phases of the disease, which includes an option of medical assistance in dying.

Author/s:

Grimes,D., Fitzpatrick, M., Gordon, J., Miyasaki, J., Fon, E.A., Schlossmacher, M., Suchowersky, O., Rajput, A., Lafontaine, A.L, Mestre, T., Appel-Cresswell, S., Kalia, S., Schoffer, K., Zurowski, M., Postuma, R.B., Udow, S., Fox, S., Barbeau, P., Hutton, B.

Testosterone Treatment in Adult Men With Age-Related Low Testosterone: A Clinical Guideline From the American College of Physicians

John Bayhi — Tue, 07 Jan 2020 19:22:41 +0000

Date Added:

January 7, 2020

Journal/Publication:

Annals of Internal Medicine

Publisher:

American College of Physicians

Publication Date:

January 7, 2020

URL:

Testosterone Treatment in Adult Men With Age-Related Low Testosterone: A Clinical Guideline From the American College of Physicians

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M19-0882

Keywords

testosterone

guidelines

age-related testosterone deficiency

PMID (1):

31905405

MeSH

depressive disorder, major

Sexual Dysfunction

Physiological

Cognition

cardiovascular diseases

It appears that testosterone replacement in men with documented age-related testosterone deficiency may have small benefits in terms of sexual function and quality of life with no effect on physical function and no increase in significant adverse events. James W. Mold, MD, MPH

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DESCRIPTION:

The American College of Physicians (ACP) developed this guideline to provide clinical recommendations based on the current evidence of the benefits and harms of testosterone treatment in adult men with age-related low testosterone. This guideline is endorsed by the American Academy of Family Physicians.

METHODS:

The ACP Clinical Guidelines Committee based these recommendations on a systematic review on the efficacy and safety of testosterone treatment in adult men with age-related low testosterone. Clinical outcomes were evaluated by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system and included sexual function, physical function, quality of life, energy and vitality, depression, cognition, serious adverse events, major adverse cardiovascular events, and other adverse events.

TARGET AUDIENCE AND PATIENT POPULATION:

The target audience includes all clinicians, and the target patient population includes adult men with age-related low testosterone.

RECOMMENDATION 1A:

ACP suggests that clinicians discuss whether to initiate testosterone treatment in men with age-related low testosterone with sexual dysfunction who want to improve sexual function (conditional recommendation; low-certainty evidence). The discussion should include the potential benefits, harms, costs, and patient's preferences.

RECOMMENDATION 1B:

ACP suggests that clinicians should reevaluate symptoms within 12 months and periodically thereafter. Clinicians should discontinue testosterone treatment in men with age-related low testosterone with sexual dysfunction in whom there is no improvement in sexual function (conditional recommendation; low-certainty evidence).

RECOMMENDATION 1C:

ACP suggests that clinicians consider intramuscular rather than transdermal formulations when initiating testosterone treatment to improve sexual function in men with age-related low testosterone, as costs are considerably lower for the intramuscular formulation and clinical effectiveness and harms are similar.

RECOMMENDATION 2:

ACP suggests that clinicians not initiate testosterone treatment in men with age-related low testosterone to improve energy, vitality, physical function, or cognition (conditional recommendation; low-certainty evidence).

Author/s:

Qaseem, A., Horwitch, CA, Vijan, S, Etxeandia-Ikobaltzeta, I, Kansagara, D, Clinical Guidelines Committee of the American College of Physicians

Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement From the American College of Physicians

Brian Desmarais — Thu, 07 Nov 2019 15:39:51 +0000

Date Added:

November 7, 2019

Journal/Publication:

Annals of Internal Medicine

Publication Date:

November 5, 2019

Issue:

Volume:

171

Pages:

643-654

URL:

Screening for Colorectal Cancer in Asymptomatic Average-Risk Adults: A Guidance Statement From the American College of Physicians

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M19-0642

Keywords

Colonoscopy

Early Detection of Cancer

MeSH

early detection of cancer

2019 CRC screening guideline for average risk adults. James W. Mold, MD, MPH

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DESCRIPTION:

The purpose of this guidance statement is to guide clinicians on colorectal cancer screening in average-risk adults.

METHODS:

This guidance statement is derived from a critical appraisal of guidelines on screening for colorectal cancer in average-risk adults and the evidence presented in these guidelines. National guidelines published in English between 1 June 2014 and 28 May 2018 in the National Guideline Clearinghouse or Guidelines International Network library were included. The authors also included 3 guidelines commonly used in clinical practice. Web sites were searched for guideline updates in December 2018. The AGREE II (Appraisal of Guidelines for Research and Evaluation II) instrument was used to evaluate the quality of guidelines.

TARGET AUDIENCE AND PATIENT POPULATION:

The target audience is all clinicians, and the target patient population is adults at average risk for colorectal cancer.

GUIDANCE STATEMENT 1:

Clinicians should screen for colorectal cancer in average-risk adults between the ages of 50 and 75 years.

GUIDANCE STATEMENT 2:

Clinicians should select the colorectal cancer screening test with the patient on the basis of a discussion of benefits, harms, costs, availability, frequency, and patient preferences. Suggested screening tests and intervals are fecal immunochemical testing or high-sensitivity guaiac-based fecal occult blood testing every 2 years, colonoscopy every 10 years, or flexible sigmoidoscopy every 10 years plus fecal immunochemical testing every 2 years.

GUIDANCE STATEMENT 3:

Clinicians should discontinue screening for colorectal cancer in average-risk adults older than 75 years or in adults with a life expectancy of 10 years or less.

Author/s:

Qaseem, A., Crandall, C.J., Mustafa, R.A., Hicks, L.A., Wilt, T.J., Clinical Guidelines Committee of the American College of Physicians