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Hypersensitivity pneumonitis, or HP, is a disease in which the lungs become inflamed from breathing in foreign substances, such as molds, dusts, and chemicals.

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Idiopathic pulmonary fibrosis (IPF) is a chronic, progressive fibrotic interstitial lung disease (ILD) of unknown origin. It is a difficult disease to diagnose and often requires the collaborative expertise of a chest physician, radiologist and histopathologist to reach a consensus diagnosis. Most people with idiopathic pulmonary fibrosis experience symptoms of breathlessness, which may initially be only on exertion. Cough, with or without sputum is a common symptom. Over time, these symptoms are associated with a decline in lung function, reduced quality of life and ultimately death. Specific pharmacological therapies for IPF are limited but the last decade has seen more trials of new drugs which have had a variable impact on clinical practice. A number of difficulties arise when undertaking clinical trials in IPF in terms of defining precise, diagnostic inclusion criteria and clinically meaningful end-points. However, such trials are the only way by which promising new treatments will come to benefit patients. Furthermore, it is only by performing rigorous clinical trials, we have learned that drugs once widely used to treat IPF may in fact have been harmful. The limitations of current pharmacological therapies for IPF highlight the importance of other forms of treatment including lung transplantation and best supportive care such as oxygen therapy, pulmonary rehabilitation and palliation of symptoms. These are interventions which justifiably require scrutiny in the context of healthcare delivery by the modern NHS. Despite the significant burden of disease caused by IPF, there is currently no established framework within the NHS for its diagnosis and management thus creating an environment in which significant variations in clinical care may occur. In recognition of this, the Department of Health commissioned the National Institute of Health and Care Excellence (NICE) to produce a guideline aimed at improving the care of people with IPF.

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

Version: June 2013

Study found that for the treatment of rheumatoid arthritis, biologic disease-modifying antirheumatic drugs had cost per quality-adjusted life-year values greater than the thresholds stated by the National Institute for Health and Care Excellence and could not be considered cost-effective.

Health Technology Assessment - NIHR Journals Library.

Version: April 2016

In the United States, coronary heart disease and cardiovascular disease account for nearly 40% of all deaths each year. Coronary heart disease continues to be the leading cause of mortality and a significant cause of morbidity among North Americans. In 2006, coronary heart disease claimed 607 000 lives, translating into about 1 out of every 5 deaths in the United States. High levels of cholesterol, or hypercholesterolemia, are an important risk factor for coronary heart disease. The 3-hydroxy-3-methylglutaryl-coenzyme (HMG-CoA) reductase inhibitors, also known as statins, are the most effective class of drugs for lowering serum low-density lipoprotein cholesterol concentrations. They are first-line agents for patients who require drug therapy to reduce serum low-density lipoprotein cholesterol concentrations. The purpose of this review is to compare the benefits and harms of different statins in adults and children with hypercholesterolemia.

Drug Class Reviews - Oregon Health & Science University.

Version: November 2009

In the past 30–50 years, the natural history of urinary tract infection (UTI) in children has changed as a result of the introduction of antibiotics and improvements in health care. This change has contributed to uncertainty about the most appropriate and effective way to diagnose and treat UTI in children and whether or not investigations and follow-up are justified.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2007

This clinical guideline concerns the management of hypertensive disorders in pregnancy and their complications from preconception to the postnatal period. For the purpose of this guideline, ‘pregnancy’ includes the antenatal, intrapartum and postpartum (6 weeks after birth) periods. The guideline has been developed with the aim of providing guidance in the following areas: information and advice for women who have chronic hypertension and are pregnant or planning to become pregnant; information and advice for women who are pregnant and at increased risk of developing hypertensive disorders of pregnancy; management of pregnancy with chronic hypertension; management of pregnancy in women with gestational hypertension; management of pregnancy for women with pre-eclampsia before admission to critical care level 2 setting; management of pre-eclampsia and its complications in a critical care setting; information, advice and support for women and healthcare professionals after discharge to primary care following a pregnancy complicated by hypertension; care of the fetus during pregnancy complicated by a hypertensive disorder.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2010

The renin-angiotensin system is a complex biologic system between the heart, brain, blood vessels, and kidneys that leads to the production of biologically active agents, including angiotensin I and II and aldosterone, which act together to impact a variety of bodily functions including blood vessel tone, sodium balance, and glomerular filtration pressure. The multiple and varied effects of these agents allows the renin-angiotensin system to play a wide role in the pathology of hypertension, cardiovascular health, and renal function. Our ability to begin to intervene upon the complex cycle of hormone and other biochemical agent production within the renin-angiotensin system began with the advent of the first orally active ACE-I (angiotensin converting enzyme inhibitor), captopril, in 1981. AIIRAs (angiotensin II receptor blockers) were developed as an alternative to ACE-I, and block the interaction between angiotensin II and the angiotensin receptor. Losartan, the first commercially available AIIRA, was approved for clinical use in 1995. The goal of this report is to compare the effectiveness and harms between aliskiren and placebo and between AIIRAs and ACEIs in the treatment of diagnosed coronary heart disease, hypertension, left ventricular dysfunction, heart failure, nondiabetic chronic kidney disease, or diabetic nephropathy.

Drug Class Reviews - Oregon Health & Science University.

Version: January 2010

The guideline covers men (18 and over) with a clinical working diagnosis of lower urinary tract symptoms (LUTS). Options for conservative, pharmacological, surgical, and complementary or alternative treatments are considered in terms of clinical and cost effectiveness.

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

Version: 2010

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

Heavy menstrual bleeding (HMB) has an adverse effect on the quality of life of many women. It is not a problem associated with significant mortality. Many women seek help from their general practitioners and it is a common reason for referral into secondary care.

NICE Clinical Guidelines - National Collaborating Centre for Women's and Children's Health (UK).

Version: January 2007

Food allergy is an adverse immune response to a food. It can be classified into IgE-mediated and non-IgE-mediated reactions. Many non-IgE reactions, which are poorly defined both clinically and scientifically, are believed to be T-cell-mediated. Some reactions involve a mixture of both IgE and non-IgE responses and are classified as mixed IgE and non-IgE allergic reactions. Food allergy may be confused with food intolerance, which is a non-immunological reaction that can be caused by enzyme deficiencies, pharmacological agents and naturally occurring substances. Food intolerance will not be covered in this guideline. The starting point for the guideline is a suspicion of food allergy, and the use of an allergy-focused clinical history will help to determine whether a food allergy is likely.

NICE Clinical Guidelines - National Institute for Health and Clinical Excellence (UK).

Version: February 2011

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

The study found that few interventions for idiopathic pulmonary fibrosis have any statistically significant effect, and identified a lack of studies on palliative care approaches. Few direct comparisons of treatments were identified; an indirect comparison was performed through network meta-analysis, but the results should be interpreted with caution.

Health Technology Assessment - NIHR Journals Library.

Version: March 2015

The objective of this report is to perform a systematic review of the beneficial and harmful effects of vedolizumab intravenous (IV) infusion in accordance with the Health Canada–approved indication for the treatment of Crohn’s disease. Vedolizumab has been previously reviewed through the CADTH Common Drug Review (CDR) for the treatment of ulcerative colitis.

Common Drug Review - Canadian Agency for Drugs and Technologies in Health.

Version: December 2016

This guideline offers best practice advice on the identification and care of patients with chronic obstructive pulmonary disease (COPD). It aims to define the symptoms, signs and investigations required to establish a diagnosis of COPD. It also aims to define the factors that are necessary to assess its severity, provide prognostic information and guide best management. It gives guidance on the pharmacological and non-pharmacological treatment of patients with stable COPD, and on the management of exacerbations. The interface with surgery and intensive therapy units (ITU) are also discussed.

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

Version: June 2010

Although hip fracture is predominantly a phenomenon of later life, it may occur at any age in people with osteoporosis or osteopenia, and this guidance is applicable to adults across the age spectrum. Skills in its management have, however been accrued, researched and reported especially by collaborative teams specialising in the care of older people (using the general designation ‘orthogeriatrics’). These skills are applicable in hip fracture irrespective of age, and the guidance includes recommendations that cover the needs of younger patients by drawing on such skills in an organised manner.

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

Version: 2011

Anaphylaxis is a severe, life-threatening, generalised or systemic hypersensitivity reaction. It is characterised by rapidly developing, life-threatening problems involving: the airway (pharyngeal or laryngeal oedema) and/or breathing (bronchospasm with tachypnoea) and/or circulation (hypotension and/or tachycardia). In most cases, there are associated skin and mucosal changes.

NICE Clinical Guidelines - National Institute for Health and Clinical Excellence (UK).

Version: December 2011

Malaria case management, which consists of prompt diagnosis and effective treatment, remains a vital component of malaria control and elimination strategies. This third edition of the WHO Guidelines for the treatment of malaria contains updated recommendations based on new evidence as well as a recommendation on the use of drugs to prevent malaria in high-risk groups.

World Health Organization.

Version: 2015

To systematically review evidence addressing the diagnosis and management of infantile hemangiomas (IH).

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

Version: January 2016

The study found that there is only limited evidence supporting a role for allopurinol in reducing chronic kidney disease progression or cardiovascular events. Adverse events, including serious adverse events, due to allopurinol were found to be rare. In order to determine the effect of allopurinol in reducing chronic kidney disease progression and cardiovascular events, a randomised control trial commparing allopurinal to standard care is required, in addition to supporting data obtained from observational studies of patients with chronic kidney disease and using allopurinol.

Health Technology Assessment - NIHR Journals Library.

Version: June 2014

There are over 400,000 people with rheumatoid arthritis (RA) in the UK. Although this makes it a common disorder, there are numerous other conditions ahead of it in terms of numbers, and indeed as causes of excess mortality. What this does not capture however, is the dreadful morbidity associated with the disease. The synovitis of RA affects multiple sites causing widespread pain, and the subsequent destruction of the joints can lead to severe disability affecting all aspects of motor function from walking to fine movements of the hand. Furthermore, RA is not simply a disease of the joints but can affect many other organs causing, for example, widespread vasculitis or severe lung fibrosis. More recently it has become apparent that RA is associated with an increased prevalence of coronary artery disease and significant increased risk of premature mortality.

NICE Clinical Guidelines - National Collaborating Centre for Chronic Conditions (UK).

Version: February 2009

Systematic Reviews in PubMed

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