Persius/hicric huggingface dataset:
Guidelines: prevention and treatment of HIV and other sexually transmitted infections among men who have sex with men and transgender people: recommendations for a public health approach 2011.#
The mention of specific companies or of certain manufacturers' products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use.
Printed by the WHO Document Production Services, Geneva, Switzerland Declaration of interest forms were collected from every member of each guidelines working group. Two declarations of interest were made. Dr Jeffrey Klausner declared that he had received research support in the form of test kit donations, which ceased in 2008, from Becton, Dickinson and Company, GenProbe and Roche. This interest was assessed by the WHO Secretariat as not sufficient to preclude Dr Klausner' s participation in meetings. Dr Andrew Grulich declared that he had received research and travel funding from CSL Biotherapies. This interest was assessed by the WHO Secretariat as not sufficient to preclude Dr Grulich' s participation in the development of the guidelines.

# TABLE OF CONTENTS

# Acronyms and abbreviations
WHO guideline on school health services. Web Annex C. Systematic overview of systematic reviews of comprehensive school health services: methodology and select findings# Contents
Safety and Efficacy of a D-Dimer-Guided Strategy for Extension of Secondary Prophylaxis of Venous Thromboembolism - a Prospective and Randomized Management Trial

# Official Title
Safety and Efficacy of a D-Dimer-Guided Strategy for Extension of Secondary Prophylaxis of Venous Thromboembolism - a Prospective and Randomized Management Trial

# Objective
This clinical trial will investigate the hypothesis that D-Dimer testing can be successfully used to tailor the duration of OAT in patients after an unprovoked episode of deep venous thrombosis (DVT) using a prospective, randomized, and controlled design.

# Sponsor
University Hospital, Bonn

# Timeline
The previous information was derived from ClinicalTrials.gov on 09/20/2013 using the identification number NCT00895505.

# Study Description
The previous information was derived from ClinicalTrials.gov on 09/20/2013 using the identification number NCT00895505.

# Eligibility Criteria

## Inclusion Criteria
- To be enrolled in this study, patients must:
Have an objectively confirmed first episode of unprovoked VTE or of VTE during a minor transient risk factor. Minor transient risk factors include 6 weeks of : estrogen therapy, prolonged air travel (i.e., > 6 hours), pregnancy, less marked leg injuries or immobilization without injury or surgical intervention
Be scheduled to receive oral anticoagulant treatment for at least 3 months
Be willing to be randomized
Be willing to participate for the full duration of the study
- Have an objectively confirmed first episode of unprovoked VTE or of VTE during a minor transient risk factor. Minor transient risk factors include 6 weeks of : estrogen therapy, prolonged air travel (i.e., > 6 hours), pregnancy, less marked leg injuries or immobilization without injury or surgical intervention
- Be scheduled to receive oral anticoagulant treatment for at least 3 months
- Be willing to be randomized
- Be willing to participate for the full duration of the study

## Exclusion Criteria
- Pregnancy or breast feeding
- Contraindications against OAT (Oral Anticoagulant Therapy) (i.e., intracranial hemorrhage, subarachnoid hemorrhage, hemorrhagic stroke)
- Age < 18 years
- Presence of antiphospholipid antibodies or any other thrombophilic risk factor requiring long-term OAT (i.e., antithrombin deficiency, hereditary PC  deficiency)
- Poor patient compliance

# Outcomes

## Primary Outcomes
Incidence and severity of objectively documented deep vein  thrombosis (DVT) and/or pulmonary embolism (PE)  

## Secondary Outcomes
Incidence and severity of signs and symptoms associated with OAT-induced bleeding measured using the World Health Organization (WHO) bleeding scale.  

# Publications

## Results

## Conclusion
The Living Guidelines: Prevention of thromboembolism in patients with atrial fibrillation undergoing cardioversion: Suggest Revisions to the CLASS IIa Guidelines

# Class IIa Guidelines
1. During the first 48 h after onset of AF, the need for anticoagulation before and after cardioversion may be based on the patients risk of thromboembolism. (Level of Evidence: C) 
2. As an alternative to anticoagulation prior to cardioversion of AF, it is reasonable to perform TEE in search of thrombus in the LA or LAA. (Level of Evidence: B) 
3. For patients with atrial flutter undergoing cardioversion, anticoagulation can be beneficial according to the recommendations as for patients with AF. (Level of Evidence: C)
The Living Guidelines: Prevention of thromboembolism in patients with atrial fibrillation undergoing cardioversion: Suggest Revisions to the CLASS I Guidelines

# Class I Guidelines
- For patients with AF of 48-h duration or longer, or when the duration of AF is unknown, anticoagulation (INR 2.0 to 3.0) is recommended for at least 3 week prior to and 4 wk after cardioversion, regardless of the method (electrical or pharmacological) used to restore sinus rhythm. (Level of Evidence: B) 
- For patients with AF of more than 48-h duration requiring immediate cardioversion because of hemodynamic instability, heparin should be administered concurrently (unless contraindicated) by an initial intravenous bolus injection followed by a continuous infusion in a dose adjusted to prolong the activated partial thromboplastin time to 1.5 to 2 times the reference control value. Thereafter, oral anticoagulation (INR 2.0 to 3.0) should be provided for at least 4 wk, as for patients undergoing elective cardioversion. Limited data support subcutaneous administration of low molecular weight heparin in this indication. (Level of Evidence: C) 
- For patients with AF of less than 48-h duration associated with hemodynamic instability (angina pectoris, acute MI, cardiogenic shock, or pulmonary edema), cardioversion should be performed immediately without delay for prior initiation of anticoagulation. (Level of Evidence: C)
The Negative Predictive Value of D-dimer on the Risk of Recurrent Venous Thromboembolism in Patients With Multiple Previous Events: a Prospective Cohort Study

# Official Title
The Negative Predictive Value of D-dimer on the Risk of Recurrent Venous Thromboembolism in Patients With Multiple Previous Events: a Prospective Cohort Study

# Objective
Aim of this study is to assess the negative predictive value of D-dimer in patients with recurrent VTE and to evaluate the clinical utility of this approach in this patient setting.

# Sponsor
Universita degli Studi dell'Insubria

# Timeline
The previous information was derived from ClinicalTrials.gov on 09/25/2013 using the identification number NCT00428441.

# Study Description
The previous information was derived from ClinicalTrials.gov on 09/25/2013 using the identification number NCT00428441.

# Eligibility Criteria

## Inclusion Criteria
- Patients with at least two episodes of objectively documented venous thromboembolism (at least one proximal deep vein thrombosis or pulmonary embolism)
- Ongoing treatment with oral anticoagulants for at least a) 12 months in case idiopathic DVT was the last event; b) 6 months in all other cases
- Age > 18 years
- Informed consent provided

## Exclusion Criteria
- Pregnancy/puerperium
- One or more episodes of massive pulmonary embolism
- Last event isolated idiopathic pulmonary embolism
- Two or more idiopathic VTE events
- First degree relatives with recurrent VTE
- Right ventricular disfunction or pulmonary hypertension
- Active cancer
- Antiphospholipid antibodies syndrome
- Antithrombin deficiency
- Homozygous Factor V Leiden or G20210A prothrombin mutation
- Heterozygous Factor V Leiden and G20210A prothrombin mutation
- Concomitant congenital thrombophilic mutations
- Concomitant indications to long term oral anticoagulant treatment
- Severe cardiorespiratory insufficiency
- Severe liver or renal disease (creatinine clearance > 2 mg/dL)
- Limited life expectancy
- Geographic inaccessibility

# Outcomes

## Primary Outcomes
- Recurrent deep vein thrombosis or pulmonary embolism in patients with persistently negative D-dimer levels
- Rate of patients with altered D-dimer levels and temporal distribution of alterations

## Secondary Outcomes
- Recurrent deep vein thrombosis or pulmonary embolism in patients who resumed oral anticoagulant therapy
- Incidence of major bleeding in patients who resumed oral anticoagulant therapy
- Mortality

# Publications

## Results

## Conclusion
The Living Guidelines: Prevention of thromboembolism in patients with atrial fibrillation undergoing cardioversion: Polling Results for CLASS IIa Guidelines

# Class IIa Guidelines
1. During the first 48 h after onset of AF, the need for anticoagulation before and after cardioversion may be based on the patients risk of thromboembolism. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 1 for pharmacological cardioversion of atrial fibrillation should be:
2. As an alternative to anticoagulation prior to cardioversion of AF, it is reasonable to perform TEE in search of thrombus in the LA or LAA. (Level of Evidence: B) <
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 2 for pharmacological cardioversion of atrial fibrillation should be:
2a. For patients with no identifiable thrombus, cardioversion is reasonable immediately after anticoagulation with unfractionated heparin (e.g., initiate by intravenous bolus injection and an infusion continued at a dose adjusted to prolong the activated partial thromboplastin time to 1.5 to 2 times the control value until oral anticoagulation has been established with a vitamin K antagonist (e.g., warfarin), as evidenced by an INR equal to or greater than 2.0.). (Level of Evidence: B) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 2a for pharmacological cardioversion of atrial fibrillation should be:
2a 1. Thereafter, oral anticoagulation (INR 2.0 to 3.0) is reasonable for a total anticoagulation period of at least 4 wk, as for patients undergoing elective cardioversion. (Level of Evidence: B) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 2a-1 for pharmacological cardioversion of atrial fibrillation should be:
2a-2. Limited data are available to support the subcutaneous administration of a low molecular weight heparin in this indication. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 2a-2 for pharmacological cardioversion of atrial fibrillation should be:
2b. For patients in whom thrombus is identified by TEE, oral anticoagulation (INR 2.0 to 3.0) is reasonable for at least 3 week prior to and 4 week after restoration of sinus rhythm, and a longer period of anticoagulation may be appropriate even after apparently successful cardioversion, because the risk of thromboembolism often remains elevated in such cases. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 2b for pharmacological cardioversion of atrial fibrillation should be:
3. For patients with atrial flutter undergoing cardioversion, anticoagulation can be beneficial according to the recommendations as for patients with AF. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 3 for pharmacological cardioversion of atrial fibrillation should be:
A Single Ascending Dose Study Examining the Safety and Pharmacokinetic Profile of Reconstituted High Density Lipoprotein (CSL112) Administered to Patients

# Official Title
A phase 2a, multi-center, randomized, double-blind, placebo-controlled, single ascending dose study to investigate the safety, tolerability and pharmacokinetics of a single intravenous infusion of CSL112 in patients with stable atherothrombotic disease

# Objective
To determine the safety, tolerability and pharmacokinetics of a single ascending dose of intravenous infusion of CSL-112 in patients with stable atherothrombotic disease.

# Sponsor
CSL Limited

# Timeline
The previous information was derived from ClinicalTrials.gov on 09/19/2013 using the identification number NCT01499420.

# Study Description
The previous information was derived from ClinicalTrials.gov on 09/19/2013 using the identification number NCT01499420.

# Eligibility Criteria

## Inclusion Criteria
- Male or female aged 18 years to 80 years
- Subjects must have documented evidence of a history of atherosclerotic coronary artery disease/surgical revascularization
- Subjects on a stable medication regimen
- Body weight 50 kg or greater at screening

## Exclusion Criteria
- Moderate/severe heart failure or renal impairment
- Uncontrolled hyperglycemia in subjects with type 1 or type 2 diabetes
- Receipt of the combination of omeprazole and clopidogrel within 1 month of randomization
- Subjects whose medical history, condition or medication regimen may interfere with the evaluation of the safety and tolerability of CSL112 (for example      significantly altered electrocardiogram (ECG) waveform, hepatobiliary disease, malignancy, thrombocytopenia, etc.)
- Known hypersensitivity to the product components

# Outcomes

## Primary Outcomes
- Safety
Time Frame: 14 days
Designated as safety issue: Yes
- Time Frame: 14 days
- Designated as safety issue: Yes
- Clinically significant elevation of alanine aminotransferase (ALT) or aspartate aminotransferase (AST)
Time Frame: 14 days
Designated as safety issue: Yes
- Time Frame: 14 days
- Designated as safety issue: Yes

## Secondary Outcomes
- Pharmacokinetic profile of apolipoprotein A-I (apoA-I)
Time Frame: 9 days
Designated as safety issue: No
- Time Frame: 9 days
- Designated as safety issue: No
- Plasma apoA-I area under the curve (AUC)
Time Frame: 9 days
Designated as safety issue: No
- Time Frame: 9 days
- Designated as safety issue: No
- Plasma apoA-I Cmax
Time Frame: 9 days
Designated as safety issue: No
- Time Frame: 9 days
- Designated as safety issue: No
- Plasma apoA-I Tmax
Time Frame: 9 days
Designated as safety issue: No
- Time Frame: 9 days
- Designated as safety issue: No

# Publications

## Results
Pending

## Conclusion
Pending
The Living Guidelines: Prevention of thromboembolism in patients with atrial fibrillation undergoing cardioversion: Polling Results for CLASS I Guidelines

# Class I Guidelines
1. For patients with AF of 48-h duration or longer, or when the duration of AF is unknown, anticoagulation (INR 2.0 to 3.0) is recommended for at least 3 week prior to and 4 wk after cardioversion, regardless of the method (electrical or pharmacological) used to restore sinus rhythm. (Level of Evidence: B) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 1 for prevention of thromboembolism in patients with atrial fibrillation undergoing cardioversion should be:
2. For patients with AF of more than 48-h duration requiring immediate cardioversion because of hemodynamic instability, heparin should be administered concurrently (unless contraindicated) by an initial intravenous bolus injection followed by a continuous infusion in a dose adjusted to prolong the activated partial thromboplastin time to 1.5 to 2 times the reference control value. Thereafter, oral anticoagulation (INR 2.0 to 3.0) should be provided for at least 4 wk, as for patients undergoing elective cardioversion. Limited data support subcutaneous administration of low molecular weight heparin in this indication. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 2 for prevention of thromboembolism in patients with atrial fibrillation undergoing cardioversion should be:
3. For patients with AF of less than 48-h duration associated with hemodynamic instability (angina pectoris, acute MI, cardiogenic shock, or pulmonary edema), cardioversion should be performed immediately without delay for prior initiation of anticoagulation. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class I Recommendation 3 for prevention of thromboembolism in patients with atrial fibrillation undergoing cardioversion should be:
The Living Guidelines: Direct-current cardioversion of atrial fibrillation and atrial flutter: Suggest Revisions to the CLASS III Guidelines

# Class III Guidelines
- Frequent repetition of direct-current cardioversion is not recommended for patients who have relatively short periods of sinus rhythm between relapses of AF after multiple cardioversion procedures despite prophylactic antiarrhythmic drug therapy. (Level of Evidence: C) 
- Electrical cardioversion is contraindicated in patients with digitalis toxicity or hypokalemia. (Level of Evidence: C)
The Living Guidelines: Direct-current cardioversion of atrial fibrillation and atrial flutter: Suggest Revisions to the CLASS IIa Guidelines

# Class IIa Guidelines
- Direct-current cardioversion can be useful to restore sinus rhythm as part of a long-term management strategy for patients with AF. (Level of Evidence: B) 
- Patient preference is a reasonable consideration in the selection of infrequently repeated cardioversion for the management of symptomatic or recurrent AF. (Level of Evidence: C)
The Living Guidelines: Direct-current cardioversion of atrial fibrillation and atrial flutter: Suggest Revisions to the CLASS I Guidelines

# Class I Guidelines
- When a rapid ventricular response does not respond promptly to pharmacological measures for patients with AF with ongoing myocardial ischemia, symptomatic hypotension, angina, or HF, immediate R-wave synchronized direct-current cardioversion is recommended. (Level of Evidence: C) 
- Immediate direct-current cardioversion is recommended for patients with AF involving pre-excitation when very rapid tachycardia or hemodynamic instability occurs. (Level of Evidence: B) 
- Cardioversion is recommended in patients without hemodynamic instability when symptoms of AF are unacceptable to the patient. In case of early relapse of AF after cardioversion, repeated direct-current cardioversion attempts may be made following administration of antiarrhythmic medication. (Level of Evidence: C)
Thrombus Aspiration is Associated with Improved 1 Year Mortality Rates in STEMI Patients: the Results of the 1 Year TAPAS Follow-Up Study
June 6, 2008 by Scott P. Williams , Leah H. Biller 
Groningen, Netherlands: Investigators from University Medical Centre Groningen published a 1 year follow-up of The Thrombus Aspiration during Percutaneous coronary intervention in Acute myocardial infarction Study (TAPAS) in which they demonstrated that thrombus aspiration prior to stenting improved clinical outcomes when compared to conventional percutaneous coronary intervention (PCI). Thrombus aspiration is hypothesized to decrease thrombotic complications that arise during PCI by removing clots and atherosclerotic plaque, and thereby reducing the potential for distal embolization.  This 1-year follow-up study, published in the Lancet.
, builds upon the TAPAS investigators earlier finding that thrombus aspiration prior to stenting improved myocardial reperfusion for ST-segment elevation myocardial infarction (STEMI) patients.
TAPAS was a single center study of 1071 STEMI patients, randomized in a 1:1 ratio to thrombus aspiration or conventional PCI.  All randomized patients were pretreated with 500 mg aspirin, 5000 IU heparin and a 600 mg loading dose of clopidogrel.  Patients in the thrombus aspiration arm were treated using the Export Aspiration Catheter; patients in the conventional PCI arm were treated with standard balloon angioplasty and stent placement.  During the procedure, patients in both arms were administered weight-adjusted abciximab.  After treatment, all patients received standard therapies in accordance with current guidelines. One year follow-up data on clinical outcomes were obtained for 530 patients in each arm of the study.
The primary endpoint of this study was defined as cardiac death or non-fatal reinfarction during the 1 year follow-up period.  Fewer instances of cardiac death occurred among patients in the thrombus aspiration arm when compared to patients in the conventional PCI arm (3.6% vs. 6.7%; hazard ratio 1.93; 95% CI 1.11-3.37; p=0.020).   Similarly, instances of cardiac death or 1 year non-fatal reinfarction occurred less frequently among patients in the thrombus aspiration arm than in the conventional PCI arm (5.6% vs. 9.9%; HR 1.81; 95% CI 1.16-2.84; p=0.009).
Due to the original intent and design of TAPAS to evaluate myocardial reperfusion, the study had limited statistical power to assess the relationship between thrombus aspiration and overall clinical outcomes; nonetheless, the significant reduction in the occurrence of cardiac death and non-fatal reinfarction demonstrated in this 1 year follow-up TAPAS study suggests that thrombus aspiration prior to stenting may improve outcomes for STEMI patients.
The study was supported by Thorax Centre of the University Medical Centre Groningen and an unrestricted grant from Medtronic.
Class III recommendations in guidelines for cardiovascular medicine list of guidelines organization by level of evidence - Unclassified

# Overview

# Class III Recommendations with Unclassified Level of Evidence: Organized by Guideline Keywords

# Class III Recommendations with Unclassified Level of Evidence: Organized by Year of Guideline Publication
The Living Guidelines: Direct-current cardioversion of atrial fibrillation and atrial flutter: Polling Results for CLASS III Guidelines

# Class III Guidelines
1. Frequent repetition of direct-current cardioversion is not recommended for patients who have relatively short periods of sinus rhythm between relapses of AF after multiple cardioversion procedures despite prophylactic antiarrhythmic drug therapy. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class III Recommendation 1 for Direct-current cardioversion of atrial fibrillation and atrial flutter should be:
2. Electrical cardioversion is contraindicated in patients with digitalis toxicity or hypokalemia. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class III Recommendation 2 for Direct-current cardioversion of atrial fibrillation and atrial flutter should be:
The Living Guidelines: Direct-current cardioversion of atrial fibrillation and atrial flutter: Polling Results for CLASS IIa Guidelines

# Class IIa Guidelines
1. Direct-current cardioversion can be useful to restore sinus rhythm as part of a long-term management strategy for patients with AF. (Level of Evidence: B) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 1 for Direct-current cardioversion of atrial fibrillation and atrial flutter should be:
2. Patient preference is a reasonable consideration in the selection of infrequently repeated cardioversion for the management of symptomatic or recurrent AF. (Level of Evidence: C) 
ACC / AHA 2008 guidelines for diagnosis and management of atrial fibrillation: Class IIa Recommendation 2 for Direct-current cardioversion of atrial fibrillation and atrial flutter should be: