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Mireille Duhon
NASS develops clinical practice guidelines regarding the diagnosis and treatment of spinal disorders. Guidelines are intended as educational tools for a multidisciplinary audience to improve patient care by outlining reasonable information-gathering and decision-making processes used in the management of back pain in adults.
The NASS Clinical Practice Guideline Committee is trained in evidence analysis and uses an evidence-based guideline development methodology. Questions? Contact guide...@spine.org.
Interested in proposing a topic for future NASS Clinical Practice Guidelines?
The NASS Clinical Practice Guideline (CPG) Committee accepts future CPG topic proposals from NASS members, nonmembers, societies, and all members of the public.
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NASS encourages widespread circulation and implementation of the evidence-based recommendations made in NASS guidelines. To this end, NASS supports responsible translation of its clinical practice guidelines into other languages. NASS strongly encourages use of appropriately trained translators with an excellent knowledge of the English language, an excellent knowledge of the target language, significant experience in both languages, cultures and medicine, and ideally some content knowledge.
It is also strongly recommended that translators implement a rigorous procedure for verifying the accuracy of translations via a multiple forward translation process or a back-translation process with careful comparisons between documents. Individuals interested in translating guidelines are granted permission to do so, provided the resulting publication follows these requirements:
Reprinted and translated with the permission of NASS. NASS does not verify, certify and is not responsible for the accuracy of any translations, and has advised any parties translating the NASS clinical practice guidelines to carefully verify the accuracy of their translations prior to publication and dissemination.
This clinical guideline should not be construed as including all proper methods of care or excluding other acceptable methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding any specific procedure or treatment is to be made by the physician and patient in light of all circumstances presented by the patient and the needs and resources particular to the locality or institution.
The treatment guidelines are written from a clinical perspective, to guide clinical care. Providers should consult the Medical Aid Rules and Fee Schedule (MARFS) for documentation and coding requirements.
The Treatment Guidelines (also called Medical Treatment Guidelines, Medical Practice Guidelines or Review Criteria) are evidence based and were developed by the Office of the Medical Director in collaboration with practicing physicians and advisors.
Some guidelines are intended to be educational tools for medical providers. Some guidelines and the review criteria are used by L&I in the Utilization Review program and claim management process to promote best practices and improve the health of injured workers. They are published by L&I, which is solely responsible for coverage decisions that may result from their use.
The Washington Legislature passed a new law in 2009 (ESHB 2105/ Chapter 258, Laws of 2009) that directed the State to convene an Advanced Imaging Management Work Group. The Work Group was directed to identify evidence-based best practice guidelines for advanced imaging; State agencies were directed to implement the Work Group recommendations. Work Group recommendations include:
L&I offers self-directed online learning, in-person seminars, and occasional conferences. Topics range from billing for staff to evidence based clinical topics for providers. Some allow you to meet our program requirements, some describe our processes, and some offer FREE education certificates.
These conservative care resources target specific occupational conditions/regions and were developed by the Industrial Insurance Chiropractic Advisory Committee in conjunction with L&I. The best evidence has been collected and organized to provide you with easy strategies to manage these conditions. Recommendations for provocation tests, diagnostic strategies, outcomes assessments and treatment interventions are included.
The AAOS provides evidence-based programs for current orthopaedic diagnostic, treatment, and postoperative procedures. Find Clinical Practice Guidelines, Appropriate Use Criteria, Performance Measures, and other derivative materials, along with published articles on the programs below.
Additionally, all AAOS Clinical Practice Guidelines (CPG), Appropriate Use Criteria, as well as CPG impactful statements and plain language summaries can be accessed through AAOS' OrthoGuidelines app, an online resource that provides up-to-date treatment guidelines to orthopaedic surgeons and professionals. This free mobile app is available via desktop browsers or as a native app from iOS or Google Play.
Lindsay E. Nicolle, Kalpana Gupta, Suzanne F. Bradley, Richard Colgan, Gregory P. DeMuri, Dimitri Drekonja, Linda O. Eckert, Suzanne E. Geerlings, Bla Kves, Thomas M. Hooton, Manisha Juthani-Mehta, Shandra L. Knight, Sanjay Saint, Anthony J. Schaeffer, Barbara Trautner, Bjorn Wullt, Reed Siemieniuk
Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.
Keywords: asymptomatic bacteriuria, bacteriuria, urinary tract infection, pyelonephritis, cystitis, diabetes, pregnancy, renal transplant, endourologic surgery, urologic devices, urinary catheter, older adults, nursing home, long-term care, spinal cord injury, neurogenic bladder
Summarized below are the 2019 revised recommendations for the management of ASB in adults and children. The guidelines are not intended to replace clinical judgment in the management of individual patients. A detailed description of the methods, background, and evidence summaries that support each recommendation can be found in the full text of the guideline.
Subsequent observational and intervention studies evaluating long-term screening and treatment in schoolchildren, pregnant women, and healthy women suggested that ASB was benign in children and in women who were not pregnant [6]. In addition, efforts to maintain sterile urine were often futile. Prospective, randomized studies of antimicrobials or no antimicrobials for bacteriuria in children, healthy women, older populations, patients with chronic indwelling or intermittent catheters, and patients with diabetes suggested that antimicrobial treatment did not confer any benefits. At the same time, antimicrobials increased the risk of outcomes such as antimicrobial resistance and Clostridioides difficile infection (CDI) and, in some cases, increased the risk of urinary tract infection (UTI) shortly after therapy [21, 22]. For some populations with a high prevalence of ASB, such as patients with chronic indwelling catheters [23], older institutionalized populations [24, 25], patients with spinal cord injury (SCI) [15, 26], and some persons with diabetes [22], a sterile urine cannot be maintained, despite intense antimicrobial use. The Infectious Diseases Society of America (IDSA) guidelines published in 2005 summarized this evidence for adults, and made recommendations for treatment or nontreatment of ASB in relevant populations [6].
The purpose of this document is to provide evidence-based guidance on the screening and treatment of ASB in populations where ASB has been identified as common or potentially detrimental. The target audience for this guideline includes all healthcare professionals who care for patients who may have ASB. These include general internists, internal medicine subspecialists (infectious diseases, nephrology, endocrinology, and others), surgeons, urologists, pediatricians, obstetricians and gynecologists, geriatricians, physical medicine specialists, family practitioners, hospitalists, pharmacists, nurse practitioners, and physician assistants. To determine the scope of the current guidelines, the panel considered whether there were any new data that might change the recommendations from the last IDSA guideline for ASB [6]. The panel also reviewed guidelines from other organizations relevant to the management of ASB.
Values and preferences were considered from the viewpoint of the patient and from the societal perspective. We believe that most patients would wish to receive antimicrobial therapy for ASB if the potential benefits of treatment outweigh possible harms. Where treatment of ASB is unlikely to confer a benefit, the risks of antimicrobial therapy, including adverse drug effects, CDI [38, 39], and the potential for inducing antimicrobial resistance, suggest that most individuals would not wish to receive antimicrobial treatment. From the societal perspective, avoidance of antimicrobial use where there is no benefit of therapy is preferred to minimize antimicrobial adverse effects and limit emergence of antimicrobial resistance, which may restrict future therapeutic efficacy for treatment of urinary tract or other infections. When the quality of evidence is low, and there is no suggestion of potential harm, we generally recommend against the treatment of ASB because of the high-quality evidence that antimicrobial therapy contributes to antimicrobial resistance. From a payer perspective, the cost of urine screening for ASB and of antimicrobial therapy in patients with ASB is more important than the very uncertain possibility of a small reduction in symptomatic UTI or other outcomes for populations where there is no evidence of benefit with treatment of ASB.
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