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Back to Top Date Sent: 3/24/2020 499 these criteria do not imply or guarantee approval knee pain treatment home remedy buy azulfidine once a day. Among these are unblinding laser pain treatment utah order azulfidine mastercard, including heterogeneous groups of population prescription pain medication for shingles purchase genuine azulfidine on-line, potential selection bias, insufficient power to detect significant differences between therapies, relatively high dropout rates, and/or analyses were not based on intention to treat. Additionally, the studies were funded by the manufacturer of the airway clearance systems used. Safety, tolerability, and efficacy of high-frequency chest wall oscillation in pediatric patients with cerebral palsy and neuromuscular diseases: an exploratory randomized controlled trial. Back to Top Date Sent: 3/24/2020 500 these criteria do not imply or guarantee approval. The Clinical Review Criteria only apply to Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc. Use of the Clinical Review Criteria or any Kaiser Permanente entity name, logo, trade name, trademark, or service mark for marketing or publicity purposes, including on any website, or in any press release or promotional material, is strictly prohibited. Kaiser Permanente Clinical Review Criteria are developed to assist in administering plan benefits. However, on an individual member basis, Kaiser Permanente can share a copy of the specific criteria document used to make a utilization management decision. It is provided for historical purposes and does not necessarily reflect the most current published literature. Background the criteria for admission to home health services are based on the federal regulations for the Medicare home health benefit. Back to Top Date Sent: 3/24/2020 501 these criteria do not imply or guarantee approval. Back to Top Date Sent: 3/24/2020 502 these criteria do not imply or guarantee approval. The Clinical Review Criteria only apply to Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc. Use of the Clinical Review Criteria or any Kaiser Permanente entity name, logo, trade name, trademark, or service mark for marketing or publicity purposes, including on any website, or in any press release or promotional material, is strictly prohibited. Kaiser Permanente Clinical Review Criteria are developed to assist in administering plan benefits. However, on an individual member basis, Kaiser Permanente can share a copy of the specific criteria document used to make a utilization management decision. If requesting this service, please send the following documentation to support medical necessity: • Last 6 months of clinical notes from requesting provider &/or specialist (oncologist, radiologist, primary care provider) • Most recent imaging the following information was used in the development of this document and is provided as background only. It is provided for historical purposes and does not necessarily reflect the most current published literature. Background Prostate cancer is the second most frequently diagnosed cancer across the globe (Wolff et al. A 20082010 data estimated that 15% of men in the United States will be diagnosed with prostate cancer at some point in their lives (Wolff et al. Back to Top Date Sent: 3/24/2020 503 these criteria do not imply or guarantee approval. Two mechanisms including hyperthermia and acoustic cavitation cause the destruction of the tissue (Kennedy, Ter Haar, & Cranston, 2014. First, high energy is produced and converted to heat as the ultrasound wave disseminates through the tissue. This high energy leads to extreme temperatures surpassing the threshold level of protein denaturation (>43-degree C) resulting in coagulative necrosis. In the surrounding areas of the target zone, temperatures decrease suddenly keeping the outside tissues unaffected. Second, the interaction between ultrasound and micro-bubbles of water in the sonicated tissue result in cavitation. Cavitation may lead to diffusion of energy reinforcing tissue destruction (Stride & Coussios, 2010. For this procedure, a transducer, covered by a condom through which cooled water is circulated to cool the rectal wall, is inserted into the rectum and several images are taken.

Advice • Advise patients with moderate to severe asthma to receive an influenza vaccination every year pain treatment for psoriatic arthritis purchase azulfidine without a prescription, or at least when vaccination of the general population is advised (Evidence C regional pain treatment center effective 500 mg azulfidine. Bronchial thermoplasty Bronchial thermoplasty is a potential treatment option at Step 5 in some countries for adult patients whose asthma remains uncontrolled despite optimized therapeutic regimens and referral to an asthma specialty center (Evidence B pain treatment center hartford ct purchase azulfidine 500 mg mastercard. Bronchial thermoplasty involves treatment of the airways during three separate bronchoscopies with a localized 113 113 radiofrequency pulse. Extended follow up of some treated patients reported a sustained reduction 276 in exacerbations compared with pre-treatment. However, longer-term follow up of larger cohorts comparing effectiveness and safety, including for lung function, in both active and sham-treated patients is needed. Advice • For adult patients whose asthma remains uncontrolled despite optimization of asthma therapy and referral to a severe asthma specialty center, bronchial thermoplasty is a potential treatment option at Step 5 in some countries (Evidence B. In a meta-analysis, benefit for asthma worsenings was seen in some studies, but to date, there is no good-quality evidence that Vitamin D supplementation leads to improvement in asthma control or reduction in 280-282 exacerbations. The advice and evidence level are summarized in Box 3-9, with brief text on the following pages. Non-pharmacological interventions summary Intervention Advice/recommendation (continued on next page) Evidence Cessation of • At every visit, strongly encourage people with asthma who smoke to quit. Initiate D treatment under close medical supervision by a specialist • If cardioselective beta-blockers are indicated for acute coronary events, asthma is not an absolute D contra-indication, but the relative risks/benefits should be considered Healthy diet • Encourage patients with asthma to consume a diet high in fruit and vegetables for its general A health benefits 60 3. In people with asthma (children and adults), exposure to passive smoke increases the risk of hospitalization and poor asthma control. After smoking cessation, lung function improves and airway 284 inflammation decreases. Reduction of passive smoke exposure improves asthma control and reduces hospital 285 admissions in adults and children. They should be provided with access to counseling and, if available, to smoking cessation programs (Evidence A. Physical activity For people with asthma, as in the general population, regular moderate physical activity has important health benefits including reduced cardiovascular risk and improved quality of life. Overall, physical activity has no benefit on lung 287 function or asthma symptoms, but improved cardiopulmonary fitness may reduce the risk of dyspnea unrelated to airflow limitation being mistakenly attributed to asthma. In one study of non-obese patients with asthma, high intensity interval training together with a diet with high protein and low glycemic index improved asthma symptom control, 288 although no benefit on lung function was seen. In young people with asthma, swimming training is well tolerated and 289 leads to increased lung function and cardio-pulmonary fitness; however, there are some concerns about chlorine exposure with indoor pools. Advice • Encourage people with asthma to engage in regular physical activity because of its general health benefits (Evidence A. However, regular physical activity confers no specific benefit on lung function or asthma symptoms per se, with the exception of swimming in young people with asthma (Evidence B. There is insufficient evidence to recommend one form of physical activity over another (Evidence D. Avoidance of occupational exposures Occupational exposures to allergens or sensitizers account for a substantial proportion of the incidence of adult 290 asthma. Once a patient has become sensitized to an occupational allergen, the level of exposure necessary to induce symptoms may be extremely low, and resulting exacerbations become increasingly severe. Attempts to reduce 36 occupational exposure have been successful, especially in industrial settings. Cost-effective minimization of latex 36 sensitization can be achieved by using non-powdered low-allergen gloves instead of powdered latex gloves. Treating to control symptoms and minimize future risk Advice • Ask all patients with adult-onset asthma about their work history and other exposures (Evidence A. Beta-blocker drugs administered orally or intra-ocularly 292 may cause bronchospasm and have been implicated in some asthma deaths. However, beta-blockers have a proven benefit in the management of cardiovascular disease. People with asthma who have had an acute coronary event and received cardio-selective beta blockers within 24 hours of hospital admission have been found to have lower in-hospital 293 mortality rates.

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However gallbladder pain treatment diet purchase azulfidine on line, all were unblinded; industry sponsored pain disorder treatment generic 500 mg azulfidine with visa, and according to the authors neuropathic pain treatment drugs buy azulfidine overnight delivery, had poor ascertainment of harm. The authors analyzed anterior and posterior fusion separately as well as cervical and lumbar fusion. The authors of the meta-analysis noted that early journal publications misrepresented the effectiveness and harms through selective reporting, under-reporting, and duplicate publications. They concluded that their technology had no proven advantage over bone graft and may be associated with important harms. The primary outcomes were patient centered pain and function, fusion and adverse events. The authors noted however; the difference may not be clinically significant as patients in both treatment groups experienced considerable reduction in pain. Back to Top Date Sent: 3/24/2020 556 these criteria do not imply or guarantee approval. The studies recruited patients with a variety of spinal disorders and different approaches were used for the fusion. The co-primary outcomes of the analysis were solid fusion rate, clinical outcomes, complications, and reoperation rate. There were statistically significant differences in the overall success of clinical outcomes, complication rate, blood loss, hospital stay, patient satisfaction, or work status. This was a high-quality meta-analysis as regards its methodology, analysis and grading the evidence for each outcome. However, the quality of the results of a meta-analysis relies heavily on the quality of the studies it includes. In addition, there were other limitations to the published studies regarding methods of randomization and allocation procedures. The authors explained that imaging was used to assess the status of spinal fusion, and that it provides less accurate data compared to direct operative exploration. In addition, the majority of the studies were industry sponsored and some of the authors reported conflict of interest. No significant differences were observed between the two procedures for overweight or obese patients. Back to Top Date Sent: 3/24/2020 557 these criteria do not imply or guarantee approval. Effectiveness and harms of recombinant human bone morphogenetic protein-2 in spine fusion: a systematic review and meta-analysis. Safety and effectiveness of recombinant human bone morphogenetic protein-2 for spinal fusion: a metaanalysis of individual-participant data. A meta-analysis of lumbar spinal fusion surgery using bone morphogenetic proteins and autologous iliac crest bone graft. Back to Top Date Sent: 3/24/2020 558 these criteria do not imply or guarantee approval. The Clinical Review Criteria only apply to Kaiser Foundation Health Plan of Washington and Kaiser Foundation Health Plan of Washington Options, Inc. Use of the Clinical Review Criteria or any Kaiser Permanente entity name, logo, trade name, trademark, or service mark for marketing or publicity purposes, including on any website, or in any press release or promotional material, is strictly prohibited. Kaiser Permanente Clinical Review Criteria are developed to assist in administering plan benefits. Conventional therapies such as administration of high concentrations of oxygen, hyperventilation, highfrequency ventilation, the induction of alkalosis, neuromuscular blockade, and sedation have failed or are expected to fail. Treatment of pulmonary hypertension in pre-term newborns (ff34 weeks) There is insufficient evidence in the published medical literature to show that this service/therapy is as safe as standard services/therapies and/or provides better long-term outcomes than current standard services/therapies. Treatment of Cyanotic Congenital Heart Disease with pulmonary hypertensive crisis (all pediatric patients) 1. The patient is being managed for acute pulmonary hypertension crisis and acute right heart failure with a predisposition to unrestricted over-circulation. The following information was used in the development of this document and is provided as background only. Back to Top Date Sent: 3/24/2020 559 these criteria do not imply or guarantee approval. Conventional therapies include supplemental oxygen with often requires intubation and mechanical ventilation, induction of alkalosis, paralysis, sedation, as well as maintenance of temperature, electrolytes, glucose, and intravascular volume.

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