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Hospitalized patients frequently have considerable volumes of blood drawn (phlebotomy) for diagnostic testing during short periods of time. Phlebotomy is highly associated with changes in hemoglobin and hematocrit levels for patients and can contribute to anemia. This anemia, in turn, may have significant consequences, especially for patients with cardiorespiratory diseases. Additionally, reducing the frequency of daily unnecessary phlebotomy can result in significant cost savings for hospitals. Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America Clin Infect Dis [Internet]. Practice standards for electrocardiographic monitoring in hospital settings: an American Heart Association scientific statement from the Councils on Cardiovascular Nursing, Clinical Cardiology, and Cardiovascular Disease in the Young: endorsed by the International Society of Computerized Electrocardiology and the American Association of Critical-Care Nurses. Is telemetry monitoring necessary in low-risk suspected acute chest pain syndromes Guidelines for the early management of adults with ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: the American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Diagnostic blood loss from phlebotomy and hospital-acquired anemia during Acute Myocardial Infarction. Surgical vampires and rising health care expenditure: reducing the cost of daily phlebotomy. National guidelines articulate a reliance on physical examination and patient history for diagnosis of asthma and bronchiolitis in the pediatric population. Multiple studies have established limited clinical utility of chest radiographs for patients with asthma or bronchiolitis. Omission of the use of chest radiography will reduce costs, but not compromise diagnostic accuracy and care. Comprehensive reviews of the literature have demonstrated that the use of bronchodilators in children admitted to the hospital with bronchiolitis has no effect on any important outcomes. There is limited demonstration of clear impact of bronchodilator therapy upon the course of disease. Additionally, providers should consider the potential impact of adverse events upon the patient. Published guidelines recommend that corticosteroid medications not be used routinely in the management of bronchiolitis. Furthermore, additional studies in patients with other viral lower respiratory tract infections have failed to demonstrate any benefits. The utility of continuous pulse oximetry in pediatric patients with acute respiratory illness is not well established. Use of continuous pulse oximetry has been previously associated with increased admission rates and increased length of stay. The collated comments along with the results of the evidence review were then presented to the members of the panel. Two rounds of Delphi voting took place via electronic submission of votes by the panel. Validity and feasibility of each item was assessed by the Delphi panel on a nine-point scale for each of the 11 items and the mean of each item was obtained. The aggregate score of the means of validity and feasibility decided the final five items. Sources American Academy of Pediatrics, Diagnosis and Management of Bronchiolitis, Subcommittee on Diagnosis and Management of Bronchiolitis, Pediatrics. Chest radiograph in the evaluation of first time wheezing episodes: review of current clinical efficacy. Dexamethasone in salbutamol-treated inpatients with acute bronchiolitis: A randomized, controlled trial. Respiratory syncytial virus bronchiolitis: a double-blind dexamethasone efficacy study. Efficacy of proton-pump inhibitors in children with gastroesophageal reflux disease: a systematic review. Diagnosis and Management of Bronchiolitis, Subcommittee on Diagnosis and Management of Bronchiolitis. Impact of pulse oximetry and oxygen therapy on length of stay in bronchiolitis hospitalizations.

Effect of Mindfulness-Based Stress Reduction vs Cognitive Behavioral Therapy or Usual Care on Back Pain and Functional Limitations in Adults With Chronic Low Back Pain: A Randomized Clinical Trial. Mindfulness-Based Stress Reduction for Treating Low Back Pain: A Systematic Review and Meta-analysis. Effects of mindfulness-based stress reduction on perceived stress and psychological health in patients with tension headache. Emotional awareness and expression therapy, cognitive behavioral therapy, and education for fibromyalgia: a clusterrandomized controlled trial. The effects of a novel psychological attribution and emotional awareness and expression therapy for chronic musculoskeletal pain: A preliminary, uncontrolled trial. Biofeedback assisted diaphragmatic breathing and systematic relaxation versus propranolol in long term prophylaxis of migraine. Mindfulness-based stress reduction and cognitive behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial. Best Practices for Addressing Prescription Opioid Overdoses, Misuse and Addiction. Pain Psychology and the Biopsychosocial Model of Pain Treatment: Ethical Imperatives and Social Responsibility. A different kind of co-morbidity: Understanding posttraumatic stress disorder and chronic pain. Psychological functioning of people living with chronic pain: a metaanalytic review. Chronic pain and comorbid mental health conditions: independent associations of posttraumatic stress disorder and depression with pain, disability, and quality of life. A Mixed-methods Evaluation of the Feasibility, Acceptability and Preliminary Efficacy of a Mobile Intervention for Methadone Maintenance Clients. American Society of Anesthesiologists, American Society of Regional Anesthesia and Pain Medicine. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care: the Consortium Pain Task Force White Paper. Complementary and alternative medicine use among adults and children: United States, 2007. The persistence of the effects of acupuncture after a course of treatment: a meta-analysis of patients with chronic pain. How current Clinical Practice Guidelines for low back pain reflect Traditional Medicine in East Asian Countries: a systematic review of Clinical Practice Guidelines and systematic reviews. Evidence-Based Evaluation of Complementary Health Approaches for Pain Management in the United States. The Effect of Patient Characteristics on Acupuncture Treatment Outcomes: An Individual Patient Data Meta-Analysis of 20,827 Chronic Pain Patients in Randomized Controlled Trials. American College of Rheumatology 2012 recommendations for the use of nonpharmacologic and pharmacologic therapies in osteoarthritis of the hand, hip, and knee. Effectiveness and Economic Evaluation of Chiropractic Care for the Treatment of Low Back Pain: A Systematic Review of Pragmatic Studies. Effectiveness of classic physical therapy proposals for chronic non-specific low back pain: a literature review. The Effects of Massage Therapy on Pain and Anxiety after Surgery: A Systematic Review and Meta-Analysis. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplashassociated disorders or neck pain and associated disorders Effects of mindfulness-based stress reduction vs cognitivebehavioral therapy and usual care on back pain and functional limitations among adults with chronic low back pain: a randomized clinical trial. Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain.

Enrolled patients had echocardiographic evidence of ostium secundum atrial septal defect (device group: defect size less than or equal to 38 mm) and clinical evidence of right ventricular volume overload or had clinical symptoms such as paradoxical embolism or atrial dysrhythmia in the presence of a minimal shunt. The size of the defect was determined by obtaining the "stretched" diameter of the defect with a compliant balloon catheter. If the size and position of the defect were determined to be feasible for transcatheter closure, device placement was attempted. Surgical Control Group Surgical repair of an atrial septal defect requires sternotomy, cardiopulmonary bypass, aortic cross clamp, and right atriotomy. If the defect is small, primary repair by suturing the defect is feasible, however, if the defect is large, patch closure is the preferred method. These include but are not limited to cerebral embolism, cardiac perforation with tamponade, endocarditis, pericardial effusion with tamponade, repeat surgery, death, cardiac arrhythmias requiring permanent pacemaker placement or long term anti-arrhythmic medication and device embolizations requiring immediate surgical removal. Co-Primary Endpoints: Safety - the incidence of device and delivery system-related adverse events by subject. Effectiveness - the percentage of subjects for whom closure success was achieved through two years. Study visits and length of follow-up the required length of follow-up for enrolled subjects was two years. Post-procedure follow-up visits occurred at pre-discharge, one month, one year, and two years. Total number of Enrolled Study Sites and Subjects A total of 1000 subjects were enrolled at fifty study sites Follow-up Rate the visit follow-up rate was calculated using the number of subjects available at the visit plus deaths that occurred prior to the visit in the numerator and the total number of study subjects in the denominator. Hemodynamic Compromise Related to the Device Event Atrial Fibrillation a b # of Events 1 n/N (%) of Subjects Average Days from Implant to Event 215 Events per 100 Subject Years 0. Hemodynamic Compromise Related to the Device Event c a b # of Events 3 1 1 1 7 n/N (%) of Subjects Average Days from Implant to Event 74 12 11 0 66 Events per 100 Subject Years 0. One event was originally reported as a pericardial effusion and was later determined to be caused by a cardiac erosion. Co-Primary Effectiveness Endpoint the co-primary effectiveness endpoint was defined as the percentage of subjects for whom closure success was achieved through two-years. Two criteria were required to meet this endpoint: Technical Success - Successful deployment of the device percutaneously Closure Success - Closure of the atrial septal defect. Co-Primary Safety Endpoint: the incidence of device and delivery system-related adverse events by subject was 61/930 (6. Device Sizing the hemodynamic compromise event rate for patients with appropriately sized devices was 1/518 (0. High/Low Implanting Physicians the hemodynamic compromise event rate was 1/307 (0. In addition no statistically significant difference in physician implant rate per year was demonstrated between subjects who did and did not have a device-related hemodynamic compromise event. Study Strengths and Weaknesses Strengths - the post-approval study involved 1000 patients; availability of patient follow-up data was very high and results are applicable to real world application of the technology. Refer to Device Specifications/Recommended Sheath Sizes (Table 13) for recommended delivery system sheath sizes.

General Systemic, Gender Dysphoria, add Gender Dysphoria Mental Health Status Report form. Heart, revise Hypertension Dispositions Table to clarify certification requirements. In Pharmaceuticals (Therapeutic Medications) Antihypertensives, revise to include table with examples of medications that are acceptable and not acceptable for treatment of hypertension. Medical Policy 497 Guide for Aviation Medical Examiners 2015 09/30/2015 1. G-U Systems, Neoplastic Disorders,Dispositions Table, revise information for Renal Cancer. G-U Systems, Urinary System, revise Disposition Table to include information on Hematuria, Proteinuria, and Glycosuria. Removed information on renal calculi, which is now captured in Kidney Stone (s) Disposition Table. G-U Systems, revised the list of conditions to appear in the following order: -General Disorders -Gender Identity Disorders -Inflamatory Conditions -Kidney Stone(s) -Neoplastic Disorders Bladder Cancer Prostate Cancer Renal Cancer Testicular Cancer Other G-U Cancers/Neoplastic Disorders -Nephritis -Pregnancy -Urinary System In Item 41. Medical Policy 498 Guide for Aviation Medical Examiners information for Prostate Cancer. G-U System, Neoplastic Disorders, Dispositions Table, revise information for Bladder Cancer. Abdomen and Viscera, Dispositions, revise to include criteria for Liver Transplant - Recipient, Liver Transplant - Donor, and Combined Transplants (Liver in combination with kidney, heart, or other organ. G-U System, Neoplastic Disorders, Dispositions Table, revise information for Testicular Cancer. In Pharmaceuticals (Therapeutic Medications), add guidance for use of Erectile Dysfunction and/or Benign Prostatic Hyperplasia Medications, including table of wait times. Medical Policy 502 Guide for Aviation Medical Examiners disposition table for Gout and Pseudogout. In Disease Protocols, Obstructive Sleep Apnea, create additional hyperlinks within the material. Administrative 2015 02/11/2015 1 Administrative 504 Guide for Aviation Medical Examiners all acceptable for air traffic controllers. In Pharmaceuticals, Antihypertensives, revise to state that the combination use of beta-blockers and insulin, meglitinides, or sulfonylurea is now allowed. Pharmaceutical Considerations regarding chart of Acceptable Combinations of Diabetes Medications. Medical Policy 505 Guide for Aviation Medical Examiners 2. Medical Policy In Pharmaceuticals, revise chart of Acceptable Combinations of Diabetes Medications regarding Bydureon and Beta-Blockers. In Pharmaceuticals, (Therapeutic Medications), Sleep Aids, revise to include warning on eszopiclone. Medical Policy 506 Guide for Aviation Medical Examiners 3. Neurologic, In the dispositions table, change "Dystonia musculorum deformans" to "Dystonia primary or secondary. In Decision Considerations, Disease Protocols - Graded Exercise Stress Test Requirements, revise to remove hyperventilation requirement from testing. In Pharmaceuticals (Therapeutic Medications) revise to include chart of Acceptable Combinations of Diabetes Medications.