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Short-term QT variability markers for the prediction of ventricular arrhythmias and sudden cardiac death: a systematic review

Sudden cardiac death (SCD) is a major health burden and is primarily caused by ventricular arrhythmias. Currently, the most well-known marker for the risk of ventricular arrhythmias is QT/QTc prolongation. Animal studies indicate that QT variability might be a better indicator. Our objective was to give an overview of the literature on QT variability in humans, therefore we performed a free-text search in PubMed and Embase from inception through February 2013. We identified nine QT variability markers in 109 studies reporting on QT variability markers, measured on the surface ECG. QT variability can be distinguished using two characteristics: heart rate normalisation and whether QT interval is measured on consecutive beats. Most study populations were small (median 48 subjects, range 1-805) and different methods, time intervals and leads for measurement were used. QT variability markers were determinants for the risk of ventricular arrhythmias, (sudden) cardiac death and total mortality. Few studies compared the predictive value of QT variability with that of QT/QTc prolongation. A study comparing all different QT variability markers is lacking. In conclusion, QT variability markers are potential determinants of ventricular arrhythmias and cardiac mortality. However, it is unclear which marker and methodology are clinically most useful as well as what reference values are reliable. More studies on larger datasets are needed to find the most accurate marker for the prediction of arrhythmias and SCD to assess its value in addition to QT/QTc duration and its role in drug-induced arrhythmia and sudden death.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Drug Class Review: Newer Antihistamines: Final Report Update 2 [Internet]

Antihistamines inhibit the effects of histamine at H1 receptors. They have a number of clinical indications including allergic conditions (e.g., rhinitis, dermatoses, atopic dermatitis, contact dermatitis, allergic conjunctivitis, hypersensitivity reactions to drugs, mild transfusion reactions, and urticaria), chronic idiopathic urticaria (CIU), motion sickness, vertigo, and insomnia.

Drug Class Reviews - Oregon Health & Science University.

Version: May 2010
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Off-Label Use of Atypical Antipsychotics: An Update [Internet]

Antipsychotic medications are approved by the U.S. Food and Drug Administration (FDA) for treatment of schizophrenia, bipolar disorder, and for some drugs, depression. We performed a systematic review on the efficacy and safety of atypical antipsychotic drugs for use in conditions lacking FDA approval.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: September 2011
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Transient Loss of Consciousness (‘Blackouts’) Management in Adults and Young People [Internet]

There are a number of existing guidelines, for epilepsy, falls and cardiac arrhythmias; which all relate to transient loss of consciousness (TLoC), but there is no guideline which addresses the initial assessment and management of patients who blackout. As such patients may come under the care of a range of clinicians, the lack of a clear pathway contributes to their misdiagnosis, and inappropriate treatment.

NICE Clinical Guidelines - National Clinical Guideline Centre for Acute and Chronic Conditions (UK).

Version: August 2010
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Psychosis and Schizophrenia in Adults: Treatment and Management: Updated Edition 2014

This guideline has been developed to advise on the treatment and management of psychosis and schizophrenia in adults. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, people with psychosis and schizophrenia, their carers and guideline methodologists after careful consideration of the best available evidence. It is intended that the guideline will be useful to clinicians and service commissioners in providing and planning highquality care for people with psychosis and schizophrenia while also emphasising the importance of the experience of care for people with psychosis and schizophrenia and their carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2014

Bipolar Disorder: The Management of Bipolar Disorder in Adults, Children and Adolescents, in Primary and Secondary Care

This guideline has been developed to advise on the treatment and management of bipolar disorder. The guideline recommendations have been developed by a multidisciplinary team of healthcare professionals, patients and guideline methodologists after careful consideration of the best available evidence. It is intended that the guidelines will be useful to clinicians and service commissioners in providing and planning high quality care for those with bipolar disorder while also emphasising the importance of the experience of care for patients and carers.

NICE Clinical Guidelines - National Collaborating Centre for Mental Health (UK).

Version: 2006

Treatment-Related Nausea and Vomiting (PDQ®): Health Professional Version

Expert-reviewed information summary about nausea and vomiting as complications of cancer or its treatment. Approaches to the management of nausea and vomiting are discussed.

PDQ Cancer Information Summaries [Internet] - National Cancer Institute (US).

Version: May 10, 2017

Psychosocial and Pharmacologic Interventions for Disruptive Behavior in Children and Adolescents [Internet]

We systematically reviewed evidence on psychosocial and/or pharmacologic treatment for children with disruptive behavior disorders.

Comparative Effectiveness Reviews - Agency for Healthcare Research and Quality (US).

Version: October 2015
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Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. 2nd edition

These guidelines provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care.

World Health Organization.

Version: 2016

mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings: Mental Health Gap Action Programme (mhGAP): Version 2.0

Mental, neurological and substance use (MNS) disorders are highly prevalent, accounting for a substantial burden of disease and disability globally. In order to bridge the gap between available resources and the significant need for services, the World Health Organization launched the Mental Health Gap Action Programme (mhGAP). The objective of mhGAP is to scale-up care and services using evidence-based interventions for prevention and management of priority MNS conditions. The mhGAP Intervention Guide version 1.0 for MNS disorders for non-specialist health settings was developed in 2010 as a simple technical tool to allow for integrated management of priority MNS conditions using protocols for clinical decision-making.

World Health Organization.

Version: 2016
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The Epilepsies: The Diagnosis and Management of the Epilepsies in Adults and Children in Primary and Secondary Care: Pharmacological Update of Clinical Guideline 20

This guideline is a partial update of ‘The epilepsies: the diagnosis and management of the epilepsies in adults and children in primary and secondary care’ (NICE clinical guideline 20, 2004). It updates the pharmacological management sections of the 2004 guideline and also includes the use of the ketogenic diet.

NICE Clinical Guidelines - National Clinical Guideline Centre (UK).

Version: January 2012
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Drug interactions and protease inhibitors used in the treatment of hepatitis C: how to manage?

PURPOSE: The first-generation protease inhibitors (PI) boceprevir and telaprevir combined with pegylated interferon have revolutionized the treatment of type-1 hepatitis C by increasing the rates of sustained virologic response. However, they induce drug interactions, and their clinical relevance is difficult to predict. This review compiles available data on drug-drug interactions (DDI) based on their pharmacokinetic and pharmacodynamic properties with the aim of assisting clinicians in managing DDI METHODS: PubMed, drug interaction databases and hepatology and infectious disease conference abstracts were systematically searched using the key search terms "interaction", "hepatitis C", "telaprevir" and "boceprevir". All known interactions were compiled and reclassified according to their pharmacokinetic and pharmacodynamic mechanisms. The state of knowledge of interaction mechanisms are reported and a therapeutic approach is proposed.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Systematic Reviews in PubMed

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