Management of Acute and Recurrent Gout: A Clinical Practice Guideline From the American College of Physicians

Description: The American College of Physicians (ACP) developed this guideline to present the evidence and provide clinical recommendations on the management of gout. Methods: Using the ACP grading system, the committee based these recommendations on a systematic review of randomized, controlled trials; systematic reviews; and large observational studies published between January 2010 and March 2016. Clinical outcomes evaluated included pain, joint swelling and tenderness, activities of daily living, patient global assessment, recurrence, intermediate outcomes of serum urate levels, and harms. Target Audience and Patient Population: The target audience for this guideline includes all clinicians, and the target patient population includes adults with acute or recurrent gout. Recommendation 1: ACP recommends that clinicians choose corticosteroids, nonsteroidal anti-inflammatory drugs (NSAIDs), or colchicine to treat patients with acute gout. (Grade: strong recommendation, high-quality evidence). Recommendation 2: ACP recommends that clinicians use low-dose colchicine when using colchicine to treat acute gout. (Grade: strong recommendation, moderate-quality evidence). Recommendation 3: ACP recommends against initiating long-term urate-lowering therapy in most patients after a first gout attack or in patients with infrequent attacks. (Grade: strong recommendation, moderate-quality evidence). Recommendation 4: ACP recommends that clinicians discuss benefits, harms, costs, and individual preferences with patients before initiating urate-lowering therapy, including concomitant prophylaxis, in patients with recurrent gout attacks. (Grade: strong recommendation, moderate-quality evidence)

Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 1)

Remdesivir, a broad-spectrum antiviral agent administered intravenously, was developed and studied as a potential treatment for Ebola virus disease and Marburg virus infection. In vitro and in vivo preclinical studies found antiviral activity for remdesivir against corona-like viruses, including Middle East respiratory syndrome coronavirus, severe acute respiratory syndrome coronavirus (SARS-CoV-1), the circulating human coronaviruses HCoV-OC42 and HCoV-229E, and SARS-CoV-2. Currently, the effectiveness of remdesivir is being tested as a treatment for patients infected with SARS-CoV-2 (COVID-19) and has been authorized for emergency use for treating COVID-19, by the U.S. Food and Drug Administration in the United States, and in other countries. The American College of Physicians (ACP) Scientific Medical Policy Committee (SMPC) based these rapid and living practice points on a systematic evidence review conducted by the U.S. Department of Veterans Affairs (VA) Evidence Synthesis Program in Minneapolis, Minnesota. This version of the practice points, based on a search completed on 3 June 2020 and updated through 31 August 2020, was approved by the ACP\u27s Executive Committee of Board of Regents on behalf of the Board of Regents on 14 August 2020 and submitted to Annals of Internal Medicine on 13 August 2020. Because many studies are planned or under way, literature surveillance is ongoing, with updates currently planned for every 2 months through December 2021. The target audience for these practice points includes clinicians and the public. The target patient population includes all nonpregnant patients with COVID-19

What Is the Antibody Response and Role in Conferring Natural Immunity After SARS-CoV-2 Infection? Rapid, Living Practice Points From the American College of Physicians (Version 1)

Description: The widespread availability of SARS-CoV-2 antibody tests raises important questions for clinicians, patients, and public health professionals related to the appropriate use and interpretation of these tests. The Scientific Medical Policy Committee (SMPC) of the American College of Physicians developed these rapid, living practice points to summarize the current and best available evidence on the antibody response to SARS-CoV-2 infection, antibody durability after initial infection with SARS-CoV-2, and antibody protection against reinfection with SARS-CoV-2. Methods: The SMPC developed these rapid, living practice points based on a rapid and living systematic evidence review done by the Portland VA Research Foundation and funded by the Agency for Healthcare Research and Quality. Ongoing literature surveillance is planned through December 2021. When new studies are identified and a full update of the evidence review is published, the SMPC will assess the new evidence and any effect on the practice points. Practice Points: Practice Point 1: Do not use SARS-CoV-2 antibody tests for the diagnosis of SARS-CoV-2 infection. Practice Point 2: Antibody tests can be useful for the purpose of estimating community prevalence of SARS-CoV-2 infection. Practice Point 3: Current evidence is uncertain to predict presence, level, or durability of natural immunity conferred by SARS-CoV-2 antibodies against reinfection (after SARS-CoV-2 infection)

Update Alert: Should Remdesivir Be Used for the Treatment of Patients With COVID-19? Rapid, Living Practice Points From the American College of Physicians (Version 2)

This is an update of the American College of Physicians\u27 living, rapid practice points about using remdesivir for treatment of COVID-19, which is based on an updated systematic review done through 10 May 2021. The evidence update identified 1 new study that could inform Practice Point 1. No new studies were identified as supporting evidence for Practice Points 2 or 3. The new study did not have an effect on our prior conclusions and resulted in no changes to the practice points (see the next section and the Supplement). We have changed the term mechanical ventilation to invasive ventilation to better reflect most of the patient populations informing the practice points. We define invasive ventilation as administering supplemental oxygen with positive pressure to the lungs via an endotracheal or tracheostomy tube. The Supplement summarizes the evidence, evidence gaps, and clinical considerations

Use of N95, Surgical, and Cloth Masks to Prevent COVID-19 in Health Care and Community Settings: Living Practice Points From the American College of Physicians (Version 1)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreads among persons in close proximity through droplets, although evidence is still emerging regarding potential airborne transmission. Reducing transmission of SARS-CoV-2 infection in health care and community settings is a major priority, especially in the absence of an effective vaccine or treatment. The use of respiratory personal protective equipment (PPE) may decrease the risk for respiratory infection, although controversy exists around the appropriate types of masks and the situations in which they should be used in community and health care settings for the prevention of SARS-CoV-2 infection. The following practice points (Table 1) are intended for clinicians, patients, and the public. Data on SARS-CoV-2 are limited. These practice points are based on the best available evidence on the effectiveness of N95 respirators, surgical masks, and cloth masks in reducing transmission of infection with SARS-CoV-1, Middle East respiratory syndrome coronavirus (MERS-CoV), and influenza-like or other respiratory viruses in community and health care settings. Evidence about reuse or extended use of N95 respirators in health care settings was also considered

Should Clinicians Use Chloroquine or Hydroxychloroquine Alone or in Combination With Azithromycin for the Prophylaxis or Treatment of COVID-19

Using chloroquine or hydroxychloroquine, with or without azithromycin, to prevent coronavirus disease (COVID-19) after infection with novel coronavirus (SARS-CoV-2) or to treat COVID-19 began to receive attention following preliminary reports from in vitro and human studies. While multiple studies are planned or under way, it is imperative to continually synthesize the results from the best available evidence to inform point-of-care decisions about the use of chloroquine or hydroxychloroquine. These practice points are based on a rapid and living systematic evidence review conducted by the University of Connecticut Health Outcomes, Policy, and Evidence Synthesis Group and will be updated as new evidence becomes available. The practice points development and update methods are included in the Appendix. This version of the practice points, based on an evidence review conducted on 17 April 2020, was approved by the American College of Physicians Board of Regents on 4 May 2020 and submitted to Annals of Internal Medicine on 6 May 2020

Testosterone treatment in adult men with age-related low testosterone: A clinical guideline from the American college of physicians

© 2020 American College of Physicians. Description: The American College of Physicians (ACP) developed this guideline to provide clinical recommendations based on the current evidence of the benefits and harms of testosterone treatment in adult men with age-related low testosterone. This guideline is endorsed by the American Academy of Family Physicians. Methods: The ACP Clinical Guidelines Committee based these recommendations on a systematic review on the efficacy and safety of testosterone treatment in adult men with age-related low testosterone. Clinical outcomes were evaluated by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system and included sexual function, physical function, quality of life, energy and vitality, depression, cognition, serious adverse events, major adverse cardiovascular events, and other adverse events. Target Audience and Patient Population: The target audience includes all clinicians, and the target patient population includes adult men with age-related low testosterone. Recommendation 1a: ACP suggests that clinicians discuss whether to initiate testosterone treatment in men with age-related low testosterone with sexual dysfunction who want to improve sexual function (conditional recommendation; low-certainty evidence). The discussion should include the potential benefits, harms, costs, and patient\u27s preferences. Recommendation 1b: ACP suggests that clinicians should reevaluate symptoms within 12 months and periodically thereafter. Clinicians should discontinue testosterone treatment in men with age-related low testosterone with sexual dysfunction in whom there is no improvement in sexual function (conditional recommendation; low-certainty evidence). Recommendation 1c: ACP suggests that clinicians consider intramuscular rather than transdermal formulations when initiating testosterone treatment to improve sexual function in men with age-related low testosterone, as costs are considerably lower for the intramuscular formulation and clinical effectiveness and harms are similar. Recommendation 2: ACP suggests that clinicians not initiate testosterone treatment in men with age-related low testosterone to improve energy, vitality, physical function, or cognition (conditional recommendation; low-certainty evidence)