Sunday, November 8, 2009
There are simple ways of obtaining information as well, such as looking in Wikipedia, Google, medical news such as Medscape, WebMD, Heart.org, etc. or for more sofisticated and resourceful physicians, into UpToDate and MDConsult.
Being able to obtain immediate information from the direct source (not the intermediaries) is a privilege that technology brings to us. Many physicians chose to avoid the hassle and just limit themselves to use Google. This is not bad, as Google will likley direct them to the original source as well. However, knowing or having the links to direct sources of information makes the reader a more careful and selective researcher.
I made a list according to the different medical specialties, linking to the most important medical societies in the United States and Europe that provide Practice Statements and Guidelines. I hope you find it useful.
SUGGESTED GENERAL GUIDELINE SITES:
AGENCY FOR HEALTHCARE RESEARCH
NATIONAL GUIDELINE CLEARINGHOUSE
ALLERGY, IMMUNOLOGY AND ENT
AMERICAN ACADEMY OF ALLERGY, ASTHMA AND IMMUNOLOGY
AMERICAN ACADEMY OF OTOLARYNGOLOGY AND HEAD AND NECK SURGERY
AMERICAN SOCIETY OF ANESTHESIOLOGISTS
AMERICAN COLLEGE OF CARDIOLOGY
AMERICAN HEART ASSOCIATION
EUROPEAN SOCIETY OF CARDIOLOGY
EUROPEAN SOCIETY OF HYPERTENSION
AMERICAN SOCIETY OF HYPERTENSION
HEART FAILURE SOCIETY OF AMERICA
AMERICAN ACADEMY OF DERMATOLOGY
ENDOCRINOLOGY AND DIABETES
AMERICAN DIABETES ASSOCIATION – 2009 RECOMMENDATIONS
THE ENDOCRINE SOCIETY
AMERICAN THYROID ASSOCIATION
AMERICAN COLLEGE OF GASTROENTEROLOGY
AMERICAN GASTROENTEROLOGICAL ASSOCIATION
AMERICAN ASSOCIATION FOR THE STUDY OF LIVER DISEASES
AMERICAN SOCIETY FOR GASTROINTESTINAL ENDOSCOPY
HEMATOLOGY AND ONCOLOGY
AMERICAN SOCIETY OF CLINICAL ONCOLOGY
AMERICAN SOCIETY OF HEMATOLOGY
INFECTIOUS DISEASES SOCIETY OF AMERICA
AMERICAN COLLEGE OF PHYSICIANS
INTERNATIONAL SOCIETY OF NEPHROLOGY (KDOQI GUIDELINES)
AMERICAN ACADEMY OF NEUROLOGY
STROKE GUIDELINES AND RESOURCES
THE BRAIN ATTACK COALITION
AMERICAN ACADEMY OF OPHTHALMOLOGY
AMERICAN ACADEMY OF ORTHOPEDIC SURGEONS
AMERICAN ACADEMY OF PHYSICAL MEDICINE AND REHABILITATION
AMERICAN SPINAL INJURY ASSOCIATION
NORTH AMERICAN SPINE SOCIETY
AMERICAN ACADEMY OF PEDIATRICS
AMERICAN PSYCHIATRIC ASSOCIATION
PULMONARY AND CRITICAL CARE/SLEEP
AMERICAN COLLEGE OF CHEST PHYSICIANS
AMERICAN THORACIC SOCIETY
SOCIETY OF CRITICAL CARE MEDICINE
AMERICAN ACADEMY OF SLEEP MEDICINE
AMERICAN COLLEGE OF RHEUMATOLOGY
EUROPEAN VASCULITIS STUDY GROUP
EUROPEAN LEAGUE AGAINST RHEUMATISM (EULAR)
AMERICAN COLLEGE OF SURGEONS
AMERICAN UROLOGICAL ASSOCIATION
EUROPEAN ASSOCIATION OF UROLOGY
SOCIETY FOR VASCULAR SURGERY
Tuesday, November 3, 2009
The American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have just released their 2009 update on perioperative betablockers.
You can access the update in perioperative betablockers here.
The whole 2009 Perioperative Guidelines (2007 guidelines with the update in perioperative betablockers) is here.
I summarized for you the current indications, and strongly invite you to access the new publications.
Class I indication
- Beta blockers should be continued in patients undergoing surgery who are receiving beta blockers for treatment of conditions with ACCF/AHA Class I guideline indications for the drugs. (Level of Evidence: C)
Class IIa indication
- Beta blockers titrated to heart rate and blood pressure are probably recommended for patients undergoing vascular surgery who are at high cardiac risk owing to coronary artery disease or the finding of cardiac ischemia on preoperative testing. (Level of Evidence: B)
- Beta blockers titrated to heart rate and blood pressure are reasonable for patients in whom
preoperative assessment for vascular surgery identifies high cardiac risk, as defined by the
presence of more than 1 clinical risk factor. (Level of Evidence: C)
- Beta blockers titrated to heart rate and blood pressure are reasonable for patients in whom
preoperative assessment identifies coronary artery disease or high cardiac risk, as defined by
the presence of more than 1 clinical risk factor, who are undergoing intermediate-risk surgery.
(Level of Evidence: B)
- The usefulness of beta blockers is uncertain for patients who are undergoing either intermediate risk procedures or vascular surgery in whom preoperative assessment identifies a single clinical risk factor in the absence of coronary artery disease. (Level of Evidence: C)
- The usefulness of beta blockers is uncertain in patients undergoing vascular surgery with noclinical risk factors who are not currently taking beta blockers. (Level of Evidence: B)
- Beta blockers should not be given to patients undergoing surgery who have absolute
contraindications to beta blockade. (Level of Evidence: C)
- Routine administration of high-dose beta blockers in the absence of dose titration is not useful and may be harmful to patients not currently taking beta blockers who are undergoing noncardiac surgery.8 (Level of Evidence: B)
I hope you find this updates useful. At this point it doesn't change a lot of our current practice, but simply emphasize the cautious approach to avoiding elevated doses of betablockers and a well avoiding starting them without careful uptitration.
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