Head trauma (ie, head injury) is a significant public health concern and leading cause of morbidity mortality in children young adults. Neuroimaging plays an important role the management brain injury, which can be separated into acute (0–7 days), subacute (<3 months), then chronic (>3 months) phases. Over 75% classified as mild, over have normal Glasgow Coma Scale score 15, therefore clinical ...

Duchenne muscular dystrophy (DMD) is a severe, progressive disease that affects 1 in 3600-6000 live male births. Although guidelines are available for various aspects of DMD, comprehensive clinical care recommendations do not exist. The US Centers for Disease Control and Prevention selected 84 clinicians to develop care recommendations using the RAND Corporation-University of California Los Ang...

OBJECTIVES In women with endometrial carcinoma (EC), tumor recurrences tend to occur in the 2- to 3-year period following surgical staging. Management of disease recurrence in EC poses significant challenges. These patients represent a heterogenous group where histologic subtypes, previous adjuvant management, interval since completion of adjuvant therapy, and size and site(s) of disease recurr...

ABSTRACT Objective: To rationalize decision-making concerning the growing and costly off-label use of recombinant human factor VII (rFVIIa, NovoSeven®) therapy. Options: Using rFVIIa therapy for patients with bleeding or providing usual care (e.g., continued clotting factor replacement). Outcome: Morbidity and mortality related to continued bleeding or thrombosis. Evidence: A literature review ...

Interventions to reduce urinary catheter use involve lists of "appropriate" indications developed from limited evidence without substantial multidisciplinary input. Implementing these lists, however, is challenging given broad interpretation of indications, such as "critical illness." To refine criteria for appropriate catheter use-defined as use in which benefits outweigh risks-the RAND/UCLA A...

Journal of Clinical Sleep Medicine, Vol. 11, No. 6, 2015 Sleep is essential for optimal health. The American Academy of Sleep Medicine (AASM) and Sleep Research Society (SRS) developed a consensus recommendation for the amount of sleep needed to promote optimal health in adults, using a modifi ed RAND Appropriateness Method process. The recommendation is summarized here. A manuscript detailing ...

: Biological drug testing is a tool that provides information about an individual's recent substance use. Like any tool, its value depends on using it correctly; that is, on selecting the right test for the right person at the right time. This document is intended to clarify appropriate clinical use of drug testing in addiction medicine and aid providers in their decisions about drug testing fo...

Diverticulosis remains the commonest cause for acute lower gastrointestinal tract bleeding (GIB). Conservative management is initially sufficient most patients, followed by elective diagnostic tests. However, if GIB persists, it can be investigated with colonoscopy, CT angiography (CTA), or red blood cell (RBC) scan. Colonoscopy identify site and of provide effective treatment. CTA a noninvasiv...

OBJECTIVE The Appropriateness of Treating Glaucoma Suspects Study Group proposes to identify which patients suspected of glaucoma are suitable for treatment. Our objective is to analyse the concordance between our clinical decisions and this Study Group. METHODS Retrospective study of 77 patients (39 suspects, 38 ocular hypertensives). Variables such as age, family history, intraocular pressu...

OBJECTIVE To develop guidelines for performing initial skeletal survey (SS) in children <24 months old with fractures, based on available evidence and collective judgment of experts from diverse pediatric specialties. METHODS Following the Rand/UCLA Method, a multispecialty panel of 13 experts applied evidence from a literature review combined with their own expertise in rating the appropriat...