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The Practice Guideline for the Treatment of Patients with Panic Disorder was initially published in 1998 ((1)). A committee of the American Psychiatric Association (APA) performed a literature review and drafted a document, which was then revised by the members and other organizations, and approved by the APA assembly and Board of Trustees. The intent was to revise this guideline at 3- to 5-yr intervals, but as yet no revision is in process. The committee categorized the strength of its endorsement for each recommendation on a scale of I-III: I.Recommended with substantial clinical confidence.II.Recommended with moderate clinical confidence.III.May be recommended on the basis of individual circumstances. [ABSTRACT FROM AUTHOR]

In general, the treatment of delirium is broken down into three parts—psychiatric management, environmental and supportive interventions, and somatic interventions. In the broadest terms, the underlying cause of the delirium should be sought and treated if possible. Behavioral and environmental intervention should be optimized and instituted first. If necessary, to prevent patient distress or harm, pharmacological interventions should be instituted, the mainstay of which is haloperidol therapy. [ABSTRACT FROM AUTHOR]

Two guidelines issued by the subcommittee on attention deficit hyperactivity disorder (ADHD) of the Committee on Quality Improvement for the American Academy of Pediatrics provide guidance for primary care clinicians interested in diagnosing and treating ADHD in school aged children. The 11 recommendations in these two guidelines encompass the spectrum of care for children suspected of or diagnosed with ADHD in the primary care setting. [ABSTRACT FROM AUTHOR]

About 70% of the nearly 60 million women who undergo Papanicolaou (Pap) testing each year in the United States will be told they have abnormal results. In the past, deciding who gets a colposcopy, when to repeat the Pap test, and which patients should be treated has been both confusing and controversial. The publication of two sets of guidelines from the American Society for Colposcopy and Cervical Pathology (ASCCP) has greatly clarified these issues. These new evidence-supported consensus-based guidelines provide algorithms for managing cervical cytological abnormalities and histologically confirmed cervical intraepithelial neoplasia (CIN). They were developed out of a consensus workshop convened by ASCCP in 2001 and subsequently published in JAMA and the American Journal of Obstetrics and Gynecology. These new guidelines were preceded by revisions to the Bethesda System of nomenclature for cervical cytology. This updated terminology, as well as advances in the understanding of human papillomavirus (HPV) as a cervical cancer precursor and the increased use of advanced technologies like liquid-based cervical cytology and HPV-DNA typing, were key in developing these guidelines. [ABSTRACT FROM AUTHOR]

Major depression is a clinical syndrome lasting at least up to 2 wk, during which the patient experiences either depressed mood or anhedonia (a decrease in interest in things that used to give pleasure) with at least five of the following nine symptoms: Depressed mood.Anhedonia.Appetite disturbance.Sleep disturbance.Fatigue.Psychomotor retardation or agitation.Poor self-image or guilt.Concentration impairment.Suicidal ideation. [ABSTRACT FROM AUTHOR]

Restless legs syndrome (RLS) has been called "the most common disorder that is never heard of." Although most primary care physicians have developed at least a passing familiarity with RLS in recent years, it remains true that this condition is very much underdiagnosed and undertreated. In an effort to promote more widespread awareness of RLS in the medical community and to share up-to-date knowledge regarding management of this condition, several guidelines, updates, and management algorithms have been published. These are summarized next. [ABSTRACT FROM AUTHOR]

Sports, and specifically contact sports, have the potential for serious injury and it is vital to balance the risks of participation with the safety of the participants. It is the role of physicians and health care professionals, to be the objective and unbiased arbiter of decisions relating to the health of athletes under their care. It is the job of the medical staff to allow the participation and return to play of the athletes without compromising their health or safety. [ABSTRACT FROM AUTHOR]

Migraine headache is a common disorder affecting nearly 18% of women and 6% of men in the United States. The American Academy of Neurology, in conjunction with the seven participating specialty societies of the US Headache Consortium, performed an evidence-based review of available treatments for migraine headache in both acute and preventive settings, as well as assessing the role of diagnostic imaging in evaluation and treatment of headache (1,2). [ABSTRACT FROM AUTHOR]

Occupational exposure to potentially infectious agents has received great attention because of the advent of HIV and the growing awareness of the possible serious clinical ramifications of hepatitis C. However, there are more than 20 diseases that have been linked to needle-stick injury. The latter group of illnesses are beyond the scope of this chapter but should be considered when developing institutional policies or when providing care for exposed health care personnel (HCP). The following guidelines apply to any health care worker (HCW; e.g., employees, students, contractors, attending clinicians, public safety workers, volunteers). [ABSTRACT FROM AUTHOR]

Worldwide, there are more than 8 million new cases of Mycobacterium tuberculosis (TB) and 3 million deaths each year. In the United States, approx 15 million people are infected with TB. In 1965, shortly after isoniazid was found to be effective for the treatment of TB, the first recommendation for treating latent M. tuberculosis infection (LTBI) in the general population was given. The American Thoracic Society recommended that all persons with evidence of previously untreated TB, with recent tuberculin test conversions, and all children younger than 3 yr of age with a positive tuberculin skin test (TST) should be treated with isoniazid. Despite broadened recommendations in 1967 and a more widespread number of people being treated with an inexpensive drug that was thought to have few side effects, the morbidity from TB never dramatically fell as had been projected. When the hepatotoxicity of isoniazid began to be recognized in the early 1970s a controversy erupted over what would be the appropriate age cutoff in low-risk people that would ensure the benefits of therapy for LTBI and outweigh the risks of treatment. Rifampin (RIF) was introduced for the treatment of LTBI in the early 1980s because the real and perceived problems with isoniazid's hepatotoxicity and the long period of treatment required with isoniazid had impaired isoniazid's widespread usefulness. [ABSTRACT FROM AUTHOR]

In August 2006 the Centers for Disease Control (CDC) issued the Sexually Transmitted Diseases Treatment Guidelines, 2006. The guidelines contain and establish the standard of care for the treatment of sexually transmitted diseases (STDs) nationwide. This chapter summarizes the most important points and the treatment regimens recommended in the guidelines, and follows the organization of the guidelines. All treatment regimens, as well as selected text presented here, are taken verbatim from the guidelines. In addition to treatment, it is essential to understand that counseling patients routinely about prevention of STD acquisition is an important aspect of routine clinical care of adolescents and adults. [ABSTRACT FROM AUTHOR]

One to two times a year every person in the United States has an episodic increase in the water content of their normal bowel movement, which then leads to an increase in the volume, frequency, or liquidity of their stools. It has been estimated that in the United States people have these diarrheal episodes up to 375 million times each year, resulting in 73 million physician consultations, 1.8 million hospitalizations, and 3100 deaths. When the Centers for Disease Control and Prevention (CDC) surveyed a population about their diarrheal illness, an estimated 31% used an antidiarrheal medication, 12% telephoned the physician or provider's office, 8% visited a physician's or other provider's office, 5% used an antimicrobial agent, and 0.6% were hospitalized. In addition to the acute morbidity and mortality of diarrhea, some causes of infectious diarrhea result in serious long-term sequelae such as hemolytic uremic syndrome (HUS) with renal failure, Guillain-Barré syndrome, and malnutrition. [ABSTRACT FROM AUTHOR]

This chapter summarizes the Advisory Committee on Immunization Practices (ACIP) Adult Immunization Schedule for 2005 and 2006. Each vaccine is addressed in a similar manner—vaccine-preventable disease characteristics are briefly discussed, candidates for vaccination are discussed, followed by specifics of vaccination (dosage and administration, efficacy, side effects, and contraindications and cautions). Figure 1 and 2 are a copy of the Centers for Disease Control (CDC) Adult Immunization Schedules with footnotes. [ABSTRACT FROM AUTHOR]

Rabies is a viral infection transmitted through the saliva of infected mammals. The virus enters the central nervous system and causes encephalomyelitis, which is almost always fatal. Human cases of rabies are rare in the United States (average of two cases per year); however, international travelers to areas where canine rabies is still endemic have a greatly increased risk of exposure. Rabies among wildlife (raccoons, skunks, and bats) has been increasing in prevelance since the 1950s, accounting for 85% of all reported cases of animal rabies. Rabies among the wildlife occurs throughout the continental United States; Hawaii remains rabies free. Since 1980, 58% of the 36 human cases of rabies in the United States have been associated with bats. In most other countries, dogs remain the most common source of rabies transmission to humans. [ABSTRACT FROM AUTHOR]

Group A streptococcal pharyngitis is defined as an acute infection of the oropharynx and sometimes the nasopharynx by Streptococcus pyogenes. The purpose of this guideline is to provide recommendations for the accurate diagnosis and optimal treatment of Group A streptococcal pharyngitis in children and adults. Following these recommendations should result in fewer cases of acute rheumatic fever, fewer cases of suppurative complications (e.g., peritonsillar abcesses, cervical lymphadenitis, and mastoiditis), a more rapid return to usual activities, and a decrease in infectivity. This decrease in infectivity will result in a reduced transmission of Group A β-hemolytic streptococci among family members and close contacts of the patient. Another important benefit to the widespread use of this guideline will be the minimization of inappropriate antibiotic therapy use. [ABSTRACT FROM AUTHOR]

Acute sinusitis, bronchitis, pharyngitis, and nonspecific upper respiratory tract infections (URIs) account for the majority of antibiotics prescribed by primary care physicians in the United States. The emergence of antibiotic-resistant bacteria in the community setting is now an issue for individual patients as well as society at large, and it is the responsibility of all clinicians to limit antibiotic treatment to those patients who are most likely to benefit from it. The vast majority of acute respiratory infections are caused by viruses. Antibiotic treatment of patients with these infections selects for resistant nasopharyngeal bacteria, acutely increasing the spread of resistant pathogens through secretions and predisposing the treated patient to more serious bacterial infections in the future. The guidelines summarized in this chapter were designed by a panel of physicians representing family medicine, internal medicine, emergency medicine, and infectious diseases to provide a practical approach to the appropriate diagnosis and treatment of previously healthy adults with nonspecific URI, acute sinusitis, or acute bronchitis in the ambulatory care setting. Recommendations for the diagnosis and treatment of pharyngitis are provided in a separate chapter. [ABSTRACT FROM AUTHOR]

The 2002 Prevention of Perinatal Group B Streptococcal Disease guidelines from the Center for Disease Control (CDC) represents a revision of a prior set of guidelines represented by the CDC in 1996. Group B streptococcus (GBS) remains a leading cause of serious neonatal infection despite the significant efforts in the disease prevention through the 1990s, including recommendations presented by the CDC, the American College of Obstetricians and Gynecologists (ACOG), and by the American Academy of Pediatrics (AAP). The updated 2002 guidelines were based on clinical evidence and expert opinions gathered since the 1996 recommendations (1). Significant changes in the newer guidelines included a recommendation for universal prenatal screening for GBS; detailed instructions on specimen collection, processing and testing; updated prophylaxis regimens for penicillin-allergic women; recommendations against routine antipartum antibiotic prophylaxis for GBS-colonized women undergoing planned cesarean deliveries prior to the onset of labor or the rupture of membranes; a suggested algorithm for management of threatened preterm delivery; and an updated algorithm for the management of newborns exposed to intrapartum antibiotics. [ABSTRACT FROM AUTHOR]

Acute otitis media (AOM) is one of the most common reasons for sick child visits in the United States. Controversy over its diagnosis and appropriate management has led the American Academy of Pediatrics and American Academy of Family Physicians to author evidence-based clinical practice guidelines. These guidelines are used for the healthy children aged 2 mo to 12 yr. The guidelines do not apply to children with underlying conditions that alter the nature of middle ear disease. Underlying conditions include anatomic abnormalities such as cleft palate and genetic conditions such as Down syndrome, immunodeficiencies, and the presence of cochlear implants. [ABSTRACT FROM AUTHOR]

The Infectious Disease Society of America (IDSA) produced clinical guidelines on the care of community-acquired pneumonia (CAP) in immunocompetent adults in 2000 and 2003 (1,2). Throughout the guidelines, a grading system is used to categorize the strength of evidence behind various recommendations (3), as listed in Table 1. [ABSTRACT FROM AUTHOR]

This chapter will concisely summarize the following sections of the anticoagulation guidelines (for management of deep vein thrombosis [DVT]/pulmonary embolism [PE], see chapter on DVT/PE): 1.Prevention of venous thromboembolism (VTE).2.Antithrombotic therapy in atrial fibrillation (AF).3.Antithrombotic therapy in valvular heart disease—native and prosthetic.4.Management of elevated international normalized ratios (INRs) or bleeding in patients receiving vitamin K antagonists (VKA).5.Managing anticoagulation therapy in patients requiring invasive procedures (1). The recommendations from the American College of Chest Physicians (ACCP) employ a grading system originally described in 2001. If experts are very certain that benefits do, or do not, outweigh risks, burdens, and costs, they will make a strong recommendation (grade 1). If they are less certain of the magnitude of the benefits and the risks, burdens, and costs, and thus of their relative impact, they make a weaker grade 2 recommendation. Consistent results from randomized clinical trial (RCTs) generate grade A recommendations. Observational studies with very strong effects or secure generalizations from RCTs generate grade C+. Inconsistent results from RCTs generate grade B recommendations and observational studies generate grade C recommendations. [ABSTRACT FROM AUTHOR]

Asthma is a chronic inflammatory disorder of the airways with episodic airway constriction manifesting as chest tightness, wheezing, and cough, particularly at night and early in the morning. Approximately 14-15 million people in the United States suffer from asthma and it is the most common chronic disease of childhood, with an estimated 4.8 million affected children. Asthma accounts for close to 500,000 hospitalizations each year in the United States and approx 5000 deaths each year. [ABSTRACT FROM AUTHOR]

Antimicrobial prophylaxis for bacterial endocarditis in select patients has become the standard of medical care in the United States. This practice exists despite the fact that there are no randomized controlled human studies in patients with underlying structural heart disease that definitely establish that antibiotic prophylaxis provides protection against endocarditis during procedures that induce bacteremia. This chapter is based on the recommendations formulated and published by the American Heart Association (AHA) in 1997 (1). When the AHA published the recommendations, it was expressly stated that the document was meant as a guideline and is "not intended as the standard of care or as a substitute for clinical judgment." The 1997 guidelines represent an update from recommendations published by the AHA in 1990. [ABSTRACT FROM AUTHOR]

The following recommendations summarize the anticoagulation guidelines from the seventh American College of Chest Physicians (ACCP) conference on antithrombotic and thrombolytic therapy and employ an evidence grading scale (summarized in Table 5), at the end of the chapter (1). [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) is a common cardiac arrhythmia. The prevalence of AF increases progressively with age, ranging from about 1% for those under 60 yr of age and increases to more than 8% for those over 80 yr of age. AF is more common in males, with the age-adjusted incidence for women being about half that of men. AF can occur in both the normal heart and the structurally abnormal heart. The cardiac conditions most commonly associated with AF are rheumatic mitral valve disease, ischemic heart disease, congestive cardiomyopathy, and hypertension. Other causes include hyperthyroidism, hypoxic conditions, and alcohol intoxication. The most widely accepted theory in the pathogenesis of AF is believed to be multiple re-entry wavelet mechanism. Patients with AF may be asymptomatic or have symptoms such as palpitations, light-headedness, shortness of breath, and poor exercise tolerance. Some symptoms are related to reduction of cardiac output. Patients with AF are at increased risk for systemic thromboembolism. The absolute risk for stroke is dependent on comorbidities and can range from 1 to 15% per year. The goals in the treatment of AF are to reduce the risk of stroke or other systemic embolus, control the symptoms of palpitations, and improve exercise tolerance. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) is the leading cause of death in the industrialized world. It is present in approx 50 million Americans, but afflicts close to 1 billion persons worldwide. Increasingly, societies with lesser socioeconomic privilege suffer cardiovascular end points, accounting for as much as 80% of the worldwide CVD burden. The presence of hypertension increases the risk of disease in all atherosclerotic beds by several orders of magnitude. Data from the Framingham Heart Study revealed that among men and women who are normotensive at the age of 55 or 65, the lifetime risk of hypertension is 90%. As the population continues to grow, the number of patients with hypertension will also increase. Consequently, effective management of hypertension is of paramount importance for dampening the imminent growth of CVD during the next century. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) remains the leading cause of overall mortality in America for both men and women. A major risk factor for CVD is hyperlipidemia, a condition referring to elevated levels of at least one of five families of plasma lipoproteins-chylomicrons, very low-density lipoproteins, intermediate-density lipoproteins, low-density lipoproteins (LDL), and high-density lipoproteins (HDL). [ABSTRACT FROM AUTHOR]

Appropriate management of erectile dysfunction (ED) is the same for providers of all specialties. With the advent of oral agents as first-line therapy for the treatment of ED, the path to discussion of ED and its treatment often winds through the primary care clinician's office. (The term primary care clinician [PCC] is intended to include physicians, nurse practitioners, and physician's assistants who provide primary care services to patients.) Indeed, on a national basis, approximately two-thirds of prescriptions for PDE5 inhibitors are written by PCCs. Because of the issues particularly pertinent to primary care, such as time constraints, multiple competing problems, long-term relationship with the patient, potential inclusion of the partner as a patient as well, an efficient and yet thorough management plan is essential. [ABSTRACT FROM AUTHOR]

The US Preventive Services Task Force recommends screening all women age 65 and over for osteoporosis using dual-energy X-ray absorptiometry (DXA) of the femoral neck. Neither the frequency of screening nor the age at which screening may stop are specified. Women at high risk should begin screening at age 60; however, the criteria for determining which women are at high risk are controversial. There is insufficient evidence to recommend for or against screening women younger than 60 or low-risk women aged 60-64. In making their recommendation, the US Preventive Services Task Force reviewed evidence related to five key questions, each of which is summarized next (1). [ABSTRACT FROM AUTHOR]