Magnesium

Guidelines for Perioperative Care in Elective Rectal/Pelvic Surgery: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations

J. Nygren, J. Thacker, F. Carli +6 more · World Journal of Surgery · 2012 · 2,174 citations

This meta-analysis and expert consensus found that a bundle of ~20 perioperative interventions—including preoperative counselling, carbohydrate loading, avoiding bowel prep, early feeding, and early mobilisation—reduces hospital stay by 2–3 days and complication rates by 30–50% in elective rectal/pelvic surgery, but many elements need modification for pelvic (vs. colonic) procedures due to higher complication rates and unique risks like nerve injury and urinary retention.

ESPEN guidelines on chronic intestinal failure in adults

Loris Pironi, Jann Arends, Federico Bozzetti +11 more · Clinical Nutrition · 2016 · 698 citations

BACKGROUND & AIMS: Chronic Intestinal Failure (CIF) is the long-lasting reduction of gut function, below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth. CIF is the rarest organ failure. Home parenteral nutrition (HPN) is the primary treatment for CIF. No guidelines (GLs) have been developed that address the global management of CIF. These GLs have been devised to generate comprehensive recommendations for safe and effective management of adult patients with CIF. METHODS: The GLs were developed by the Home Artificial Nutrition & Chronic Intestinal Failure Special Interest Group of ESPEN. The GRADE system was used for assigning strength of evidence. Recommendations were discussed, submitted to Delphi rounds, and accepted in an online survey of ESPEN members. RESULTS: The following topics were addressed: management of HPN; parenteral nutrition formulation; intestinal rehabilitation, medical therapies, and non-transplant surgery, for short bowel syndrome, chronic intestinal pseudo-obstruction, and radiation enteritis; intestinal transplantation; prevention/treatment of CVC-related infection, CVC-related occlusion/thrombosis; intestinal failure-associated liver disease, gallbladder sludge and stones, renal failure and metabolic bone disease. Literature search provided 623 full papers. Only 12% were controlled studies or meta-analyses. A total of 112 recommendations are given: grade of evidence, very low for 51%, low for 39%, moderate for 8%, and high for 2%; strength of recommendation: strong for 63%, weak for 37%. CONCLUSIONS: CIF management requires complex technologies, multidisciplinary and multiprofessional activity, and expertise to care for both the underlying gastrointestinal disease and to provide HPN support. The rarity of the condition impairs the development of RCTs. As a consequence, most of the recommendations have a low or very low grade of evidence. However, two-thirds of the recommendations are considered strong. Specialized management and organization underpin these recommendations.

Pediatric Gastroesophageal Reflux Clinical Practice Guidelines

Rachel Rosen, Yvan Vandenplas, Maartje Singendonk +9 more · Journal of Pediatric Gastroenterology and Nutrition · 2018 · 1,519 citations

This systematic review of pediatric GERD guidelines found that most infants with reflux symptoms do not need medication—only about 5–10% have true GERD—and that non-pharmacologic approaches (thickened feeds, positioning, avoiding overfeeding) should be tried first, with proton pump inhibitors reserved for confirmed cases, because PPIs show only modest benefit (number needed to treat ~4–14) and carry risks of infection and bone health issues.

CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016

Deborah Dowell, Tamara M. Haegerich, Roger Chou · MMWR Recommendations and Reports · 2016 · 2,682 citations

This guideline synthesizes evidence to help clinicians safely and effectively prescribe opioids for chronic non-cancer pain, emphasizing that non-opioid therapies are preferred, and if opioids are used, they should be at the lowest effective dose for the shortest possible duration, with careful monitoring for risks like overdose and opioid use disorder.

Part 1: Executive Summary

Robert W. Neumar, Michael Shuster, Clifton W. Callaway +21 more · Circulation · 2015 · 710 citations

The process used to generate the 2015 AHA Guidelines Update for CPR and ECC was significantly different from the process used in prior releases of the Guidelines, and marks the planned transition from a 5-year cycle of evidence review to a continuous evidence evaluation process. The AHA continues to partner with the International Liaison Committee on Resuscitation (ILCOR) in the evidence review process. However, for 2015, ILCOR prioritized topics for systematic review based on clinical significance and availability of new

The efficacy and safety of nutrient supplements in the treatment of mental disorders: a meta‐review of meta‐analyses of randomized controlled trials

Joseph Firth, Scott Teasdale, Kelly Allott +12 more · World Psychiatry · 2019 · 205 citations

The role of nutrition in mental health is becoming increasingly acknowledged. Along with dietary intake, nutrition can also be obtained from "nutrient supplements", such as polyunsaturated fatty acids (PUFAs), vitamins, minerals, antioxidants, amino acids and pre/probiotic supplements. Recently, a large number of meta-analyses have emerged examining nutrient supplements in the treatment of mental disorders. To produce a meta-review of this top-tier evidence, we identified, synthesized and appraised all meta-analyses of randomized controlled trials (RCTs) reporting on the efficacy and safety of nutrient supplements in common and severe mental disorders. Our systematic search identified 33 meta-analyses of placebo-controlled RCTs, with primary analyses including outcome data from 10,951 individuals. The strongest evidence was found for PUFAs (particularly as eicosapentaenoic acid) as an adjunctive treatment for depression. More nascent evidence suggested that PUFAs may also be beneficial for attention-deficit/hyperactivity disorder, whereas there was no evidence for schizophrenia. Folate-based supplements were widely researched as adjunctive treatments for depression and schizophrenia, with positive effects from RCTs of high-dose methylfolate in major depressive disorder. There was emergent evidence for N-acetylcysteine as a useful adjunctive treatment in mood disorders and schizophrenia. All nutrient supplements had good safety profiles, with no evidence of serious adverse effects or contraindications with psychiatric medications. In conclusion, clinicians should be informed of the nutrient supplements with established efficacy for certain conditions (such as eicosapentaenoic acid in depression), but also made aware of those currently lacking evidentiary support. Future research should aim to determine which individuals may benefit most from evidence-based supplements, to further elucidate the underlying mechanisms.

Optimal clinical management of children receiving dietary therapies for epilepsy: Updated recommendations of the International Ketogenic Diet Study Group

Eric H. Kossoff, Beth Zupec‐Kania, Stéphane Auvin +29 more · Epilepsia Open · 2018 · 724 citations

Ketogenic dietary therapies (KDTs) are established, effective nonpharmacologic treatments for intractable childhood epilepsy. For many years KDTs were implemented differently throughout the world due to lack of consistent protocols. In 2009, an expert consensus guideline for the management of children on KDT was published, focusing on topics of patient selection, pre-KDT counseling and evaluation, diet choice and attributes, implementation, supplementation, follow-up, side events, and KDT discontinuation. It has been helpful in outlining a state-of-the-art protocol, standardizing KDT for multicenter clinical trials, and identifying areas of controversy and uncertainty for future research. Now one decade later, the organizers and authors of this guideline present a revised version with additional authors, in order to include recent research, especially regarding other dietary treatments, clarifying indications for use, side effects during initiation and ongoing use, value of supplements, and methods of KDT discontinuation. In addition, authors completed a survey of their institution's practices, which was compared to responses from the original consensus survey, to show trends in management over the last 10 years.

Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report

EXPERT PANEL ON INTEGRATED GUIDELINES FOR CARDIOVASCULAR HEALTH AND RISK REDUCTION IN CHILDREN AND ADOLESCENTS · PEDIATRICS · 2011 · 2,570 citations

This expert panel report synthesised evidence from multiple large-scale studies (including the NHLBI-funded RCTs and the PDAY autopsy study) to create the first integrated paediatric cardiovascular health guidelines, finding that atherosclerosis begins in childhood and that specific lipid, blood pressure, and lifestyle targets can meaningfully reduce adult cardiovascular risk — but the evidence base for many recommendations remains surprisingly thin.

Optimizing Adequacy of Bowel Cleansing for Colonoscopy: Recommendations From the US Multi-Society Task Force on Colorectal Cancer

David A. Johnson, Alan Barkun, Larry Cohen +9 more · The American Journal of Gastroenterology · 2014 · 241 citations

Up to 25% of colonoscopies have inadequate bowel preparation, which dramatically reduces the detection of precancerous polyps; this meta-analysis found that split-dose bowel preparation (half the laxative the day before, half the morning of the procedure) significantly improves cleansing quality and should be the standard approach for anyone undergoing colonoscopy.

Wearables in Medicine

Ali K. Yetisen, J. L. Martínez-Hurtado, Barış Ünal +2 more · Advanced Materials · 2018 · 542 citations

This 2018 review article surveys the landscape of wearable medical devices—from smartwatches to electronic tattoos—and finds that while the technology for continuous physiological monitoring (heart rate, glucose, temperature, electrophysiological signals) exists and is rapidly improving, very few devices have been validated in randomized controlled trials, meaning their real-world clinical impact remains largely unproven for self-experimenters.

Management of acute myocardial infarction in patients presenting with ST-segment elevation

F VandeWerf · European Heart Journal · 2003 · 1,449 citations

The management of acute myocardial infarction continues to undergo major changes. Good practice should be based on sound evidence derived from well-conducted clinical trials. Because of the great number of trials on new treatments performed in recent years and because of new diagnostic tests, the European Society of Cardiology decided that it was opportune to upgrade the 1996 guidelines and appointed a Task …

Clinical, gut microbial and neural effects of a probiotic add-on therapy in depressed patients: a randomized controlled trial

Anna-Chiara Schaub, Else Schneider, Jorge F. Vázquez‐Castellanos +11 more · Translational Psychiatry · 2022 · 225 citations

A 31-day course of a high-dose multi-strain probiotic (900 billion CFU/day) added to standard treatment reduced depressive symptoms more than placebo in hospitalized depressed patients, with the effect persisting four weeks after stopping, and was linked to increased Lactobacillus in the gut and reduced putamen brain activation to neutral faces.

Psychological, Behavioral, and Immune Changes After a Psychological Intervention: A Clinical Trial

Barbara L. Andersen, William B. Farrar, Deanna M. Golden‐Kreutz +5 more · Journal of Clinical Oncology · 2004 · 415 citations

PURPOSE: This randomized clinical trial tests the hypothesis that a psychological intervention can reduce emotional distress, improve health behaviors and dose-intensity, and enhance immune responses. PATIENTS AND METHODS: We studied 227 women who were surgically treated for regional breast cancer. Before adjuvant therapy, women completed interviews and questionnaires assessing emotional distress, social adjustment, and health behaviors. A 60-mL blood sample was drawn for immune assays. Patients were randomly assigned to either the intervention group or assessment only group. The intervention was conducted in small patient groups, with one session per week for 4 months. The sessions included strategies to reduce stress, improve mood, alter health behaviors, and maintain adherence to cancer treatment and care. Reassessment occurred after completion of the intervention. RESULTS: As predicted, patients receiving the intervention showed significant lowering of anxiety, improvements in perceived social support, improved dietary habits, and reduction in smoking (all P <.05). Analyses of adjuvant chemotherapy dose-intensity revealed significantly more variability (ie, more dispersion in the dose-intensity values) for the assessment arm (P <.05). Immune responses for the intervention patients paralleled their psychological and behavioral improvements. T-cell proliferation in response to phytohemagglutinin and concanavalin A remained stable or increased for the Intervention patients, whereas both responses declined for Assessment patients; this effect was replicated across three concentrations for each assay (all P <.01). CONCLUSION: These data show a convergence of significant psychological, health behavior, and biologic effects after a psychological intervention for cancer patients.

Takotsubo Syndrome: Pathophysiology, Emerging Concepts, and Clinical Implications

Trisha Singh, Hilal Khan, David T. Gamble +3 more · Circulation · 2022 · 344 citations

Takotsubo syndrome is a condition characterized by acute transient left ventricular systolic dysfunction, which at presentation can be challenging to distinguish from acute myocardial infarction. Although previously thought to be a benign, self-limiting condition, recent studies have confirmed that patients with takotsubo syndrome have persistent subtle ongoing cardiac dysfunction, and many continue to have limiting symptoms despite restoration of left ventricular ejection fraction. Moreover, these patients have a substantial burden of morbidity and mortality, as well, with high rates of subsequent major adverse cardiovascular events that approach those of patients with acute coronary syndrome. The mechanisms behind this condition remain elusive. Despite substantial research, the medical community continues to have an incomplete understanding of its underlying pathogenesis and pathophysiology. Catecholamine-induced myocardial injury is the most established and well-known theory, but this does not explain all the clinical features and presentations of the condition, and numerous other pathways and abnormalities are emerging. Because of the poor understanding of its underlying pathophysiology, there is a lack of evidence-based interventions to treat the acute episode, to avoid recurrences, and to prevent major adverse cardiovascular events. This highlights the need for further research to gain a better understanding of the underlying pathophysiology to inform appropriate randomized controlled trials of interventions targeting the causative pathways. Only then can evidence-based management strategies be established to improve clinical outcomes of this potentially lethal condition.

Palliative Care

Michael H Levy, Anthony L. Back, Costantino Benedetti +16 more · Journal of the National Comprehensive Cancer Network · 2009 · 301 citations

Category 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus. Category 2A: The recommendation is based on lowerlevel evidence and there is uniform NCCN consensus. Category 2B: The recommendation is based on lowerlevel evidence and there is nonuniform NCCN consensus (but no major disagreement). Category 3: The recommendation is based on any level of evidence but reflects major disagreement. All recommendations are category 2A unless otherwise noted. Clinical trials: The NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.

Understanding nutrition, depression and mental illnesses

TS Sathyanarayana Rao, M. R. Asha, Balenahalli Narasingappa Ramesh +1 more · Indian Journal of Psychiatry · 2008 · 401 citations

This comprehensive review synthesizes evidence showing that nutritional deficiencies (especially omega-3s, B vitamins, magnesium, and amino acids) are strongly linked to the onset, severity, and duration of depression and other mental illnesses, suggesting that targeted dietary interventions and supplements can be effective complementary treatments.

Cancer-Related Fatigue

Ann M. Berger, Amy Pickar Abernethy, Ashley Atkinson +17 more · Journal of the National Comprehensive Cancer Network · 2010 · 275 citations

Category 1: The recommendation is based on high-level evidence (e.g., randomized controlled trials) and there is uniform NCCN consensus. Category 2A: The recommendation is based on lowerlevel evidence and there is uniform NCCN consensus. Category 2B: The recommendation is based on lowerlevel evidence and there is nonuniform NCCN consensus (but no major disagreement). Category 3: The recommendation is based on any level of evidence but reflects major disagreement. All recommendations are category 2A unless otherwise noted. Clinical trials: NCCN believes that the best management for any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged.

German S3‐Guideline on the treatment of Psoriasis vulgaris, adapted from EuroGuiDerm – Part 2: Treatment monitoring and specific clinical or comorbid situations

Alexander Nast, Andreas Altenburg, Matthias Augustin +15 more · JDDG Journal der Deutschen Dermatologischen Gesellschaft · 2021 · 48 citations

This clinical practice guideline synthesises evidence from randomised controlled trials and expert consensus to recommend specific systemic treatments for psoriasis patients who also have psoriatic arthritis, inflammatory bowel disease, diabetes, heart conditions, or other comorbidities — and it provides clear decision grids showing which drugs are safe or dangerous in each situation.

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

José A. Joglar, Mina K. Chung, Anastasia L. Armbruster +31 more · Circulation · 2023 · 2,198 citations

This clinical practice guideline synthesises decades of evidence to provide updated, evidence-based recommendations for diagnosing and managing atrial fibrillation (AF), including new guidance on risk factor modification (weight loss, exercise, alcohol reduction) that directly applies to personal health experiments.

The Generation R Study: design and cohort update 2010

Vincent W. V. Jaddoe, Cock M. van Duijn, Albert J. van der Heijden +7 more · European Journal of Epidemiology · 2010 · 1,044 citations

This is a large, ongoing observational study tracking nearly 10,000 children from before birth into adulthood to identify which environmental, genetic, and lifestyle factors during pregnancy and early childhood predict later health outcomes — but because it's observational, it can suggest associations, not prove causation.

Cohort Profile: The Study of Health in Pomerania

Henry Völzke, Dietrich Alte, Carsten Oliver Schmidt +62 more · International Journal of Epidemiology · 2010 · 1,004 citations

Although in the past century mortality in West Germany decreased similarly as in other Western nations, these changes were less pronounced in East Germany. After German reunification in 1990, there was a lack of scientifically valid data from East Germany to explain the regional differences in life expectancy and, consequently, a need for population-based research in northeast Germany.

Objectives, design and main findings until 2020 from the Rotterdam Study

M. Arfan Ikram, Guy Brusselle, Mohsen Ghanbari +14 more · European Journal of Epidemiology · 2020 · 472 citations

The Rotterdam Study is an ongoing prospective cohort study that started in 1990 in the city of Rotterdam, The Netherlands. The study aims to unravel etiology, preclinical course, natural history and potential targets for intervention for chronic diseases in mid-life and late-life. The study focuses on cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1700 research articles and reports. This article provides an update on the rationale and design of the study. It also presents a summary of the major findings from the preceding 3 years and outlines developments for the coming period.

2022 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death

Katja Zeppenfeld, Jacob Tfelt‐Hansen, Marta Riva +97 more · European Heart Journal · 2022 · 2,725 citations

This is not a single experiment but a comprehensive clinical guideline document—a systematic review and expert consensus on how to diagnose, risk-stratify, and treat ventricular arrhythmias (VAs) and prevent sudden cardiac death (SCD), synthesising hundreds of studies; for someone running a personal experiment, the key takeaway is that most VAs in otherwise healthy people are benign, but specific symptoms (syncope, family history of SCD, certain ECG patterns) warrant medical evaluation, and lifestyle factors like exercise intensity, electrolyte balance, and sleep deprivation are modifiable triggers that you can track.

2018 ESC/ESH Guidelines for the management of arterial hypertension

Bryan Williams, Giuseppe Mancia, Wilko Spiering +97 more · European Heart Journal · 2018 · 10,332 citations

These clinical practice guidelines from the European Society of Cardiology and European Society of Hypertension synthesise decades of trial evidence to recommend that most adults with high blood pressure should aim for a systolic target of 120–129 mmHg (not the older 140 mmHg target), using a combination of lifestyle changes and first-line medications from five drug classes, with treatment decisions based on repeated out-of-office measurements rather than single clinic readings.

Salt intakes around the world: implications for public health

Ian Brown, Ioanna Tzoulaki, Vanessa Candeias +1 more · International Journal of Epidemiology · 2009 · 1,192 citations

BACKGROUND: High levels of dietary sodium (consumed as common salt, sodium chloride) are associated with raised blood pressure and adverse cardiovascular health. Despite this, public health efforts to reduce sodium consumption remain limited to a few countries. Comprehensive, contemporaneous sodium intake data from around the world are needed to inform national/international public health initiatives to reduce sodium consumption. METHODS: Use of standardized 24-h sodium excretion estimates for adults from the international INTERSALT (1985-87) and INTERMAP (1996-99) studies, and recent dietary and urinary sodium data from observational or interventional studies--identified by a comprehensive search of peer-reviewed and 'grey' literature--presented separately for adults and children. Review of methods for the estimation of sodium intake/excretion. Main food sources of sodium are presented for several Asian, European and Northern American countries, including previously unpublished INTERMAP data. RESULTS: Sodium intakes around the world are well in excess of physiological need (i.e. 10-20 mmol/day). Most adult populations have mean sodium intakes >100 mmol/day, and for many (particularly the Asian countries) mean intakes are >200 mmol/day. Possible exceptions include estimates from Cameroon, Ghana, Samoa, Spain, Taiwan, Tanzania, Uganda and Venezuela, though methodologies were sub-optimal and samples were not nationally representative. Sodium intakes were commonly >100 mmol/day in children over 5 years old, and increased with age. In European and Northern American countries, sodium intake is dominated by sodium added in manufactured foods ( approximately 75% of intake). Cereals and baked goods were the single largest contributor to dietary sodium intake in UK and US adults. In Japan and China, salt added at home (in cooking and at the table) and soy sauce were the largest sources. CONCLUSIONS: Unfavourably high sodium intakes remain prevalent around the world. Sources of dietary sodium vary largely worldwide. If policies for salt reduction at the population level are to be effective, policy development and implementation needs to target the main source of dietary sodium in the various populations.

2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC)

Josép Brugada, Demosthenes G. Katritsis, Elena Arbelo +97 more · European Heart Journal · 2019 · 1,156 citations

This document is a clinical practice guideline, not a single experiment — it synthesises decades of evidence to recommend how to diagnose and treat supraventricular tachycardia (SVT), but for a self-experimenter, the key takeaway is that most SVTs are benign, can be terminated with simple vagal manoeuvres (like bearing down as if having a bowel movement), and that caffeine, alcohol, and stress are common but poorly quantified triggers that you can test systematically on yourself.

Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage

E. Sander Connolly, Alejandro A. Rabinstein, J. Ricardo Carhuapoma +10 more · Stroke · 2012 · 3,494 citations

This is a clinical practice guideline for doctors treating aneurysmal subarachnoid hemorrhage (aSAH)—a type of stroke caused by a ruptured brain aneurysm—and it does not contain experimental data suitable for a personal n=1 experiment, but it provides critical context for understanding why self-experimentation on brain blood vessel health, blood pressure control, and aneurysm screening is not advisable without medical supervision.

2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation

José A. Joglar, Mina K. Chung, Anastasia L. Armbruster +50 more · Journal of the American College of Cardiology · 2023 · 703 citations

Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations

Kristoffer Lassen, Mariëlle M.E. Coolsen, K. Slim +10 more · World Journal of Surgery · 2012 · 470 citations

Abstract Background Protocols for enhanced recovery provide comprehensive and evidence‐based guidelines for best perioperative care. Protocol implementation may reduce complication rates and enhance functional recovery and, as a result of this, also reduce length‐of‐stay in hospital. There is no comprehensive framework available for pancreaticoduodenectomy. Methods An international working group constructed within the Enhanced Recovery After Surgery (ERAS ® ) Society constructed a comprehensive and evidence‐based framework for best perioperative care for pancreaticoduodenectomy patients. Data were retrieved from standard databases and personal archives. Evidence and recommendations were classified according to the GRADE system and reached through consensus in the group. The quality of evidence was rated “high”, “moderate”, “low” or “very low”. Recommendations were graded as “strong” or “weak”. Results Comprehensive guidelines are presented. Available evidence is summarised and recommendations given for 27 care items. The quality of evidence varies substantially and further research is needed for many issues to improve the strength of evidence and grade of recommendations. Conclusions The present evidence‐based guidelines provide the necessary platform upon which to base a unified protocol for perioperative care for pancreaticoduodenectomy. A unified protocol allows for comparison between centres and across national borders. It facilitates multi‐institutional prospective cohort registries and adequately powered randomised trials.

The Rotterdam Study: 2018 update on objectives, design and main results

M. Arfan Ikram, Guy Brusselle, Sarwa Darwish Murad +11 more · European Journal of Epidemiology · 2017 · 451 citations

The Rotterdam Study is a prospective cohort study ongoing since 1990 in the city of Rotterdam in The Netherlands. The study targets cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1500 research articles and reports (see www.erasmus-epidemiology.nl/rotterdamstudy ). This article gives the rationale of the study and its design. It also presents a summary of the major findings and an update of the objectives and methods.

High-dimensional characterization of post-acute sequelae of COVID-19

Ziyad Al‐Aly, Yan Xie, Benjamin Bowe · Nature · 2021 · 1,596 citations

Nurturing care: promoting early childhood development

Pia R Britto, Stephen J Lye, Kerrie Proulx +15 more · The Lancet · 2016 · 1,511 citations

European Resuscitation Council and European Society of Intensive Care Medicine Guidelines for Post-resuscitation Care 2015

Jerry P. Nolan, Jasmeet Soar, Alain Cariou +7 more · Resuscitation · 2015 · 1,122 citations

Nutrition Therapy Recommendations for the Management of Adults With Diabetes

Alison B. Evert, Jackie L. Boucher, Marjorie Cypress +8 more · Diabetes Care · 2013 · 1,119 citations

There is no standard meal plan or eating pattern that works universally for all people with diabetes. In order to be effective, nutrition therapy should be individualized for each patient/client based on his or her individual health goals; personal and cultural preferences; health literacy and numeracy; access to healthful choices; and readiness, willingness, and ability to change. Nutrition interventions should emphasize a variety of minimally processed nutrient dense foods in appropriate portion sizes as part of a healthful eating pattern and provide the individual with diabetes with practical tools for day-to-day food plan and behavior change that can be maintained over the long term.

Age-related changes in behavior in C57BL/6J mice from young adulthood to middle age

Hirotaka Shoji, Keizo Takao, Satoko Hattori +1 more · Molecular Brain · 2016 · 466 citations

BACKGROUND: Aging is considered to be associated with progressive changes in the brain and its associated sensory, motor, and cognitive functions. A large number of studies comparing young and aged animals have reported differences in various behaviors between age-cohorts, indicating behavioral dysfunctions related to aging. However, relatively little is known about behavioral changes from young adulthood to middle age, and the effect of age on behavior during the early stages of life remains to be understood. In order to investigate age-related changes in the behaviors of mice from young adulthood to middle age, we performed a large-scale analysis of the behavioral data obtained from our behavioral test battery involving 1739 C57BL/6J wild-type mice at 2-12 months of age. RESULTS: Significant behavioral differences between age groups (2-3-, 4-5-, 6-7-, and 8-12-month-old groups) were found in all the behavioral tests, including the light/dark transition, open field, elevated plus maze, rotarod, social interaction, prepulse inhibition, Porsolt forced swim, tail suspension, Barnes maze, and fear conditioning tests, except for the hot plate test. Compared with the 2-3-month-old group, the 4-5- and 6-7-month-old groups exhibited decreased locomotor activity to novel environments, motor function, acoustic startle response, social behavior, and depression-related behavior, increased prepulse inhibition, and deficits in spatial and cued fear memory. For most behaviors, the 8-12-month-old group showed similar but more pronounced changes in most of these behaviors compared with the younger age groups. Older groups exhibited increased anxiety-like behavior in the light/dark transition test whereas those groups showed seemingly decreased anxiety-like behavior measured by the elevated plus maze test. CONCLUSIONS: The large-scale analysis of behavioral data from our battery of behavioral tests indicated age-related changes in a wide range of behaviors from young adulthood to middle age in C57BL/6J mice, though these results might have been influenced by possible confounding factors such as the time of day at testing and prior test experience. Our results also indicate that relatively narrow age differences can produce significant behavioral differences during adulthood in mice. These findings provide an insight into our understanding of the neurobiological processes underlying brain function and behavior that are subject to age-related changes in early to middle life. The findings also indicate that age is one of the critical factors to be carefully considered when designing behavioral tests and interpreting behavioral differences that might be induced by experimental manipulations.

The evidence underpinning sports performance products: a systematic assessment

Carl Heneghan, Jeremy Howick, Braden O’Neill +8 more · BMJ Open · 2012 · 45 citations

BACKGROUND: To assess the extent and nature of claims regarding improved sports performance made by advertisers for a broad range of sports-related products, and the quality of the evidence on which these claims are based. METHODS: The authors analysed magazine adverts and associated websites of a broad range of sports products. The authors searched for references supporting the performance and/or recovery claims of these products. The authors critically appraised the methods in the retrieved references by assessing the level of evidence and the risk of bias. The authors also collected information on the included participants, adverse events, study limitations, the primary outcome of interest and whether the intervention had been retested. RESULTS: The authors viewed 1035 web pages and identified 431 performance-enhancing claims for 104 different products. The authors found 146 references that underpinned these claims. More than half (52.8%) of the websites that made performance claims did not provide any references, and the authors were unable to perform critical appraisal for approximately half (72/146) of the identified references. None of the references referred to systematic reviews (level 1 evidence). Of the critically appraised studies, 84% were judged to be at high risk of bias. Randomisation was used in just over half of the studies (58.1%), allocation concealment was only clear in five (6.8%) studies; and blinding of the investigators, outcome assessors or participants was only clearly reported as used in 20 (27.0%) studies. Only three of the 74 (2.7%) studies were judged to be of high quality and at low risk of bias. CONCLUSIONS: The current evidence is not of sufficient quality to inform the public about the benefits and harms of sports products. There is a need to improve the quality and reporting of research, a move towards using systematic review evidence to inform decisions.

The International Classification of Headache Disorders, 3rd edition (beta version)

Ettlin, Dominik A · Cephalalgia · 2013 · 8,191 citations

eISSN 1468-2982.

Global strategy for asthma management and prevention: GINA executive summary

Eric D. Bateman, Suzanne S. Hurd, Peter J. Barnes +11 more · European Respiratory Journal · 2007 · 3,227 citations

Asthma is a serious health problem throughout the world. During the past two decades, many scientific advances have improved our understanding of asthma and ability to manage and control it effectively. However, recommendations for asthma care need to be adapted to local conditions, resources and services. Since it was formed in 1993, the Global Initiative for Asthma, a network of individuals, organisations and public health officials, has played a leading role in disseminating information about the care of patients with asthma based on a process of continuous review of published scientific investigations. A comprehensive workshop report entitled "A Global Strategy for Asthma Management and Prevention", first published in 1995, has been widely adopted, translated and reproduced, and forms the basis for many national guidelines. The 2006 report contains important new themes. First, it asserts that "it is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained," and recommends a change in approach to asthma management, with asthma control, rather than asthma severity, being the focus of treatment decisions. The importance of the patient-care giver partnership and guided self-management, along with setting goals for treatment, are also emphasised.

Opioid-free and opioid-sparing anesthesia

Eric Y. Siu, Tiffany S. Moon · International Anesthesiology Clinics · 2020 · 33 citations

This meta-analysis and narrative review found that opioid-free and opioid-sparing anesthesia techniques—using combinations of NSAIDs, acetaminophen, ketamine, lidocaine, and other non-opioid agents—can reduce postoperative opioid consumption by 19–40% and lower pain scores by 14–19%, without increasing complications, making them especially valuable for patients at high risk of opioid-related respiratory depression.

2003 European society of hypertension - European Society of Cardiology guidelines for the management of arterial hypertension

Giuseppe Mancia, E. Agabiti Rosei, Renata Cífková +24 more · Lirias (KU Leuven) · 2003 · 2,605 citations

status: Published

Adult Cancer Pain, Version 3.2019, NCCN Clinical Practice Guidelines in Oncology

Robert A. Swarm, Judith A. Paice, Doralina L. Anghelescu +27 more · Journal of the National Comprehensive Cancer Network · 2019 · 597 citations

In recent years, the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Adult Cancer Pain have undergone substantial revisions focusing on the appropriate and safe prescription of opioid analgesics, optimization of nonopioid analgesics and adjuvant medications, and integration of nonpharmacologic methods of cancer pain management. This selection highlights some of these changes, covering topics on management of adult cancer pain including pharmacologic interventions, nonpharmacologic interventions, and treatment of specific cancer pain syndromes. The complete version of the NCCN Guidelines for Adult Cancer Pain addresses additional aspects of this topic, including pathophysiologic classification of cancer pain syndromes, comprehensive pain assessment, management of pain crisis, ongoing care for cancer pain, pain in cancer survivors, and specialty consultations.

ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult

Sharon A. Hunt, William T. Abraham, Marshall H. Chin +26 more · Circulation · 2005 · 2,258 citations

It is important that the medical profession play a significant role in critically evaluating the use of diagnostic procedures and therapies as they are introduced and tested in the detection, management, or prevention of disease states. Rigorous and expert analysis of the available data documenting relative benefits and risks of those procedures and therapies can produce helpful guidelines that improve the effectiveness of care, optimize patient outcomes, and favorably affect the overall cost of care by focusing resources on the most effective strategies.

AHA Dietary Guidelines

Ronald M. Krauss, Robert H. Eckel, Barbara V. Howard +16 more · Circulation · 2000 · 1,459 citations

The Kenyan Luo migration study: observations on the initiation of a rise in blood pressure.

Neil R Poulter, Kay‐Tee Khaw, Bill Hopwood +4 more · BMJ · 1990 · 378 citations

OBJECTIVE: To demonstrate the magnitude, timing, and cause of changes in blood pressure that occur in migrants from a low blood pressure population on moving to an urban area. DESIGN: A controlled longitudinal observational study of migrants as soon after migration as possible and follow up at three, six, 12, 18, and 24 months after migration. A cohort of controls living in a rural area who were matched for age, sex, and locality were also observed at the same periods. SETTING: 35 Villages on the northern shores of Lake Victoria in western Kenya and Nairobi. PARTICIPANTS: 325 Members of the Luo tribe aged 15 to 34 years who had migrated to Nairobi and 267 controls living in villages. The numbers of both groups reduced during follow up such that only 63 migrants and 143 controls were followed up for two years. MAIN OUTCOME MEASURES: A medical questionnaire and three 24 hour diet histories were completed by migrants and controls. Height, weight, pulse, and blood pressure were measured. Three 12 hour overnight urine samples were collected from all participants and analysed for sodium, potassium, and creatinine concentrations. RESULTS: The mean systolic blood pressure of migrants was significantly higher than that of controls throughout the study, and the distribution of blood pressure was shifted to the right compared with controls. The mean diastolic blood pressure of the two groups diverged over time. Blood pressure differences were not due to selective migration. The migrants' mean urinary sodium:potassium ratio was higher than that of controls (p less than 0.001) throughout, and weight and pulse rate were also higher among migrants, although differences diminished with time. CONCLUSIONS: Urinary sodium:potassium ratio, pulse rate, and weight are important predictors of increased blood pressure among migrants from a low blood pressure community and may also be implicated in the initiation of essential hypertension.

ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

Douglas P. Zipes, A. John Camm, Martin Borggrefe +12 more · Circulation · 2006 · 1,076 citations

ACCF/AHA 2011 Expert Consensus Document on Hypertension in the Elderly

Wilbert S. Aronow, Jerome L. Fleg, Carl J. Pepine +16 more · Circulation · 2011 · 614 citations

Research should include both fundamental and clinical investigation defining pathogenesis of increased vascular and LV stiffness; RCTs to define appropriate treatment thresholds and goals; comparative effectiveness trials testing various treatment strategies (ie, different regimens and different intensities of lifestyle modification); and assessing the relative safety and efficacy of these approaches in the prevention of mortality and morbidity.

Guidelines for perioperative care for pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society recommendations

Kristoffer Lassen, Mariëlle M.E. Coolsen, K. Slim +10 more · Clinical Nutrition · 2012 · 541 citations

Guidelines for the management of inflammatory bowel disease in adults

M J Carter, A J Lobo, S P L Travis · Gut · 2004 · 1,084 citations

Ulcerative colitis (UC) and Crohn’s disease (CD) (collectively termed inflammatory bowel disease (IBD)) are complex disorders reflected by wide variation in clinical practice. These guidelines, commissioned by the Clinical Services’ Committee of the British Society of Gastroenterology (BSG) for clinicians and allied professionals caring for patients with IBD in the United Kingdom, provide an evidence based document describing good clinical practice for investigation and treatment. The guidelines are intended to bring consistency, but should not necessarily be regarded as the standard of care for all patients. Individual cases must be managed on the basis of all clinical data available for that case. Patient preferences should be sought and decisions jointly made between patient and health professional. ### 1.1 Development of guidelines A comprehensive literature search was performed using electronic databases (Medline, PubMed, and Ovid; keywords: “inflammatory bowel disease”, “ulcerative colitis”, and “Crohn’s disease”) by Dr Carter. A preliminary document was drafted by Dr Carter, Dr Lobo, and contributing authors. This was summarised by Dr Travis and revised after circulation first to the committee and then to members of the IBD section of the BSG, before submission to the Clinical Services’ Committee. ### 1.2 Grading of recommendations1 The guidelines conform to the North of England evidence based guidelines development project. The grading of each recommendation is dependent on the category of evidence supporting it: ### 1.3 Scheduled review of guidelines The content and evidence base …

Bifidobacterium longum 1714 as a translational psychobiotic: modulation of stress, electrophysiology and neurocognition in healthy volunteers

Andrew P. Allen, William Hutch, Yuliya Borre +7 more · Translational Psychiatry · 2016 · 497 citations

The emerging concept of psychobiotics-live microorganisms with a potential mental health benefit-represents a novel approach for the management of stress-related conditions. The majority of studies have focused on animal models. Recent preclinical studies have identified the B. longum 1714 strain as a putative psychobiotic with an impact on stress-related behaviors, physiology and cognitive performance. Whether such preclinical effects could be translated to healthy human volunteers remains unknown. We tested whether psychobiotic consumption could affect the stress response, cognition and brain activity patterns. In a within-participants design, healthy volunteers (N=22) completed cognitive assessments, resting electroencephalography and were exposed to a socially evaluated cold pressor test at baseline, post-placebo and post-psychobiotic. Increases in cortisol output and subjective anxiety in response to the socially evaluated cold pressor test were attenuated. Furthermore, daily reported stress was reduced by psychobiotic consumption. We also observed subtle improvements in hippocampus-dependent visuospatial memory performance, as well as enhanced frontal midline electroencephalographic mobility following psychobiotic consumption. These subtle but clear benefits are in line with the predicted impact from preclinical screening platforms. Our results indicate that consumption of B. longum 1714 is associated with reduced stress and improved memory. Further studies are warranted to evaluate the benefits of this putative psychobiotic in relevant stress-related conditions and to unravel the mechanisms underlying such effects.

Part 1: Executive summary

Jerry P. Nolan, Mary Fran Hazinski, John E. Billi +27 more · Resuscitation · 2010 · 697 citations