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76
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79
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80
.
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85
1. EBM-Guidelines, 14.9.2004, www. ebm-guidelines.com.

2. ACC/AHA 2002 Guideline update for the management of patients with chronic stable angina, 2002;
www.acc.org.
3. ICSI Guideline for Hypertension diagnosis and treatment-revizija januari 2002 godina, www.isci.org.
4. ACC/AHA Guidelines for Percutaneus Coronary Interventions, 2005, www.acc.org.
5. ATP III (Adult Treatment Panel III), www. nhlbi.nih.gov.
2 .
2013 .

1. EBM-Guidelines (Coronary heart disease CHD:symptoms, diagnosis and treatment); 20.03.2008; www.
Ebm-guidelines.com.
2. EBM-Guidelines (Diagnostic coronary angiography);30.04.2008; www. Ebm-guidelines.com.
3. EBM Guidelines (Exercise stress test); 26.2.2007; www. Ebm-guidelines.com.
4. Guidelines on the management of stable angina pectoris: The task Force on the management of Stable
Angina Pectoris of the European Society of Cardiology, 2006; www.esc.org
5. 2007 Chronic Angina Focused Update of the ACC/AHA 2002 Guidelines for the Management
of Patients With Chronic Stable Angina: A Report of the American College of Cardiology/American Heart
Association Task Force on Practice Guidelines Writing Group to Develop the Focused Update of the 2002
Guidelines for the Management of Patients With Chronic Stable Angina, 2007; www.acc.org
6. ACCF/SCAI/STS/AATS/AHA/ASNC 2009 Appropriateness Criteria for Coronary Revascularization: A
Report by the American College of Cardiology Foundation Appropriateness Criteria Task Force, Society
for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association
for Thoracic Surgery, American Heart Association, the American Society of Nuclear Cardiology Endorsed
by the American Society of Echocardiography, the Heart Failure Society of America, and the Society of
Cardiovascular Computed Tomography, 2009; www.acc.org
7. 2007 Guidelines for the management of Arterial Hypertension. The task force for the management
of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of
Cardiology (ESC), 2007; www.esc.org
8. 2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary
Intervention: A Report of the American College of Cardiology/American Heart Association Task Force
on Practice Guidelines, 2007; www.acc.org
9. ACCF/ASNC Appropriateness Criteria for Single Photon Emission Computed Tomography Myocardial
Perfusion Imaging (SPECT MPI): A Report of the American College of Cardiology, 2005; www.acc.org
86
87
88

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93
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99

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101
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102

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106
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107
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108
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CHARM.
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( 7)
.
(New York Heart Association - NYHA ). NYHA
.
, ( 7). ,
: Killip Forrester ( 8).
NYHA (New York Heart Association)
. New York Heart
Association III IV
.
():
25% (
NYHA III IV). ,
.
45% ,
.
109
7. (ACC/AHA),
(NYHA)
ACC/AHA
NYHA
:
.

, .
I:
.
,
.
B:
,
, .
II:
. ,

, , .
C:
.
III:
. ,

, .
D:

.
IV:
.
.
, .
ACC = American College of Cardiology; AHA = American Heart Association;
110
8. ()
Killip
Forrester
I: .
.
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(PCWP).
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, S3
.

.
2.
().
III: .

.
3.

( ).
IV: .
( < 90 mmHg)
:
, .
4.
( ).
.
: , , ,
( vs. ). .
9.
111
9.
NYHA
III-IV*
QRS*
VO2*

*
BNP/N
BNP*
*
*
*
6-
/

VE/VCO2
* ()
112

: ,
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,
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.

.
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.
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.
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.

, :
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/.
( 2)

, ,
( 10). ,
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,

113
.

.
2 .

.
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- (< 40-45%), .
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.
.
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.
-.
. .
.
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.
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.
- amlodipine felodipine
.
.

.
114
10.
1.
2.
3.

-
. ( I, -C):
.
,

.
.

.
.
, .
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. / . ( I, -C):
, ,
.
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115

. ( I, -C):
, .
>2 kg 3 ,

.
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1.5-2 L/ , . ( IIb, -C).
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10-20 g/ (1-2 /
) ( II, -C)

( I, -C).
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( >30
kg/m2) ,
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.
-
.

, , , , . . ( I, -C):
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,
.
.
116
- - .

.
. ( I, -C):
.
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,
.
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.

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).
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-
, (-) , . .
NYHA III-IV.
, , ,

.

.
117
Phosphodiesterase 5 (PDE5) ( sildenal) ,

.
( III, -B).
( I, -C).
-
,
, .
.
.

, .
- (>1500 m)
. . , .
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. :
, ( I, -C).
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-
20%
.
.
( II, -C):
,
. ,

.
118

()
()
( 40%),
NYHA ( I,
-).
,
(-A). ,
. 90
.
- (-).

, . . ,

.
:
.
, :
( +>5.0 mmol/L), (
>221 mol/L),
( <90 mmHg).
:
:
;
,
1-2 .
:
2-4 ( 11).
. 1-4
. .
,
( ),
(-).
119
1, 3
6 6 .
, (, ),
.
:
: (20%), ,
, .
,
5.5 mmol/L 220-250 mol/L. ;
.
(< 20%)
. 30% . ( )
, . , .
,
.
,
, , ,
.
. . 50% 265 mol/L(~ 3 g/dL) . 265 mol/L (~ 3.0 g/dL), 310
mol/L (~ 3.5 g/dL),
. 310 mol/L \
(~ 3.5 g/dL) ,
.
, spironolactone, . . 5.5 mol/L,

. 6.0 mmol/L,
.
.
120

.
,
. , / , (, - , /- /-).
(, ),
. ,
.
.
90 mmHg, . .
, , : 20 mg enalapril ( ).
,
.
,
().
, .
:
+ / , +.
, +.
:
,
, .

.
, : / , (
).

,
(+).
121
11.

Captropril
6.25 mg ( )
25-50 mg ( )
Enalapril
2.5 mg ( )
10-20 mg ( )
Lisinopril
2.5-5 mg ( )
20-35 mg ( )
Ramipril
2.5 mg ( )
5 mg ( )
Trandolapril
0.5 mg ( )
4 mg ( )
()
() ,
40%,
-, -.

( I, -A).

( II, -B).
() . ,
. ,
( I, -A).
(
).
40% .
(NYHA II-IV) .
(NYHA IIIV), -.
,
.
.
:
, .
-.
;
, .
122
( 12):
:
;
: candesartan7 4-8 mg valsartan
40 mg .
1 .
:
2-4 . . 1 4
.
,
(evidence based target dose) - candesartan 32 mg
valsartan 160 mg -
( 12).
1, 3
6 6 .
, (, ),
.
, .
:
+ / - +.
, +.
:
,
.

.
, : / .

,
(+).
7 .
123
12.

Candesartan
4 8 mg ( )
32 mg ( )
Valsartan
40 mg ( )
160 mg ( )

( I, -B).
,
,
. , (-B).
:
:
.
.
Henle (loop diuretic)
.
( 13).

.
180-200 mol/L
(GFR) 30 ml/min, furosemide. hydrochlortiazide 50 mg . , furosemide. ,
furosemide .
,
furosemide.
, , .
.
(, ).
. .
124
:
.
, . ,
, .
.
.
2 , 3 . , .
14.
/ -
()/- :

.
//-, .

, /. -
. -
/ .
125
13.
Henle-
*
Furosemide
Bumetanide8
Torasemide
(mg)
(mg)
20-40
0.5-1.0
5-10
40-240
1-5
10-20
2.5
25
2.5
2.5
2.5-10
12.5-100
2.5-10
2.5-5
**
Bendroumenthiaside9
Hydroclorthiazide
Metalozone
Indapamide

+***
Spirinolactone/
eplerenone10
Amiloride
Triamterene
+/
12.5-25
2.5
25
-/
50
5
50
+/
50
20
100
-/
100-200
40
200
* / ;
.
** (GFR) 30 ml/min,
Henle- .
***Aldosterone
.
8 .
9 .
10 .
126
14.
Henle-
/
-

Henle- ,
/ Henle-
,

/**
(
/ )

colchicine

furosemide bumetanide
toresamide
-
Henle-
/metolazone
Henle-

Henle-
/

, .: , trimethoprim
-

Henle- ,

/

* (130-135 mmol/L),
. ,
.
** ,
.
= .
127
-
- ,
,
35% ,
NYHA III IV,
. -

,
. , -
( I, -A).
Spironolactone 25 mg/ ,
Henle- (-A).
Spironolactone (12.5-25mg) -
(eplernone) . .
( )
35%.
(NYHA
III IV).
- ( ).
: >5.0 mmol/L,
>220 mol/L (~2.5 g/dL), ,
.
spironolactone ( eplernone) (
13):
spironolactone ( eplernone):
.
: spironolactone 25mg ( eplernone
25mg ).

1 4 .
:
4-8 .
.
1
4 .
, (evidence-based target dose) spironolactone 50 mg eplerenone 50 mg - ( 13).
128
1, 2,
3 6 6 .
, (, ),
.
:
- >5.5 mmol/L,
spironolactone ( eplernone), .: 25 mg
. >6.0 mmol/L,
spironolactone ( eplerenone) ;
.
- >220 mol/L
(>2.5 g/dL), spironolactone ( eplernone), .:
25 mg . >310 mol/L (>3.5 g/dL), spironolactone (
eplernone) ; .
/ - spironolactone
eplernone.
:
+ / - +.
, , ( , ).
, +.
:
,
, .

.
, : / .

,
(+).
,
spironolactone .
-
-,
, 40%. - , -
129

. , , -
( I, -).
- . -
(-A).
- -
( NYHA ) (-).
- , . .
-? ( .)
40%.
(NYHA II-IV);
.
/ ( , ).
( .
). , ,
,

24
-.
- : (
), ,
( pacemaker), - (<60 /), (<90 mmHg).
/ :
(NYHA IV) .
(<4 )
, .: .
- :
:
( 16) ;

.
:
, .
130
, ,
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(-A).
1. Pitt B, Zannad F, Remme WJ et al. The eect of spironolactone on morbidity and mortality in patients with
severe heart failure. N Engl J Med 1999;341:709-717
2. Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Eects of an angiotensin-converting-enzyme
inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention
Evaluation Study Investigators. N Engl J Med 2000;342(3):145-53
3. Eect of enalapril on mortality and the development of heart failure in asymptomatic patients with
reduced left ventricular ejection fractions. The SOLVD Investigattors. N Engl J Med 1992;327(10):685-91
4. Follath F, Cleland JG, Just H, Papp JG, Scholz H, Peuhkurinen K, Harjola VP, Mitrovic V, Abdalla M, Sandell
EP, Lehtonen L. Ecacy and safety of intravenous levosimendan compared with dobutamine in severe
low-output heart failure (the LIDO study): a randomised double-blind trial. Lancet 2002;360(9328):196202
5. Remme WJ, Swedberg K. Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J
2001;22(17):1527-60
6. Maisel AS et al. Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart
failure. N Engl J Med 2002;347:161-7
7. Thoughton RW, Frampton CM, Yandle TG, Espiner EA, Nicholls MG, Richards AM. Treatment of heart
failure guided by plasma aminoterminal brain natriuretic peptide (N-BNP) concentrations. Lancet
2000;355:11261130
147
8. Caryana L et al. Do patients with suspected heart failure and preserved left ventricular systolic function
suer from diastolic heart failure or from misdiagnosis. BMJ 2000;321:2159
9. Swedberg K, Kjekshus J, Snapinn S. Long-term survival in severe heart failure in patients treated with
enalapril. Ten year follow-up of CONSENSUS I. Eur Heart J 1999;20(2):136-9
10. Packer M, Poole-Wilson PA, Armstrong PW, Cleland JG, Horowitz JD, Massie BM, Rydn L, Thygesen
K, Uretsky BF. Comparative eects of low and high doses of the angiotensin-converting enzyme
inhibitor, lisinopril, on morbidity and mortality in chronic heart failure. ATLAS Study Group. Circulation
1999;100(23): 2312-8
11. Cox NL et al. Why deny ACE inhibitors to patients with aortic stenosis? Lancet 1998;352:1112
12. Marc A Pfeer, Karl Swedberg, Christopher B Granger, Peter Held, John J V McMurray, Eric L Michelson,
Bertil Olofsson, Jan stergren, Salim Yusuf, for the CHARM Investigators and Committees. Eects of
candesartan on mortality and morbidity in patients with chronic heart failure: the CHARM-Overall
programme. Lancet 2003 362: 759-66
13. John J V McMurray, Jan stergren, Karl Swedberg, Christopher B Granger, Peter Held, Eric L Michelson,
Bertil Olofsson, Salim Yusuf, Marc A Pfeer, for the CHARM Investigators and Committees. Eects of
candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking
angiotensin-converting-enzyme inhibitors: the CHARM-Added trial. Lancet 2003; 362: 767-71
14. The Digitalis investigating group. The eect of digoxin on mortality and morbidity in patients with heart
failure. N Engl J Med 1997;336:52533
15. Adams KF, Gheorghiade M, Uretsky BF, Patterson JH, Schwartz TA, Young JB. Clinical benets of low
serum digoxin concentrations in heart failure. J Am Coll Cardiol 2002;39(6):946-53
16. Packer et al. Eect of carvedilol on morbidity and mortality in chronic heart failure. N Engl J Med
1996;334:134955
17. Packer M et al. The eect of carvedilol on survival in severe chronic heart failure. N Engl J Med
2001;344:1651-8 (COPERNICUS-trial)
18. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redeld MM. Trends in prevalence and outcome
of heart failure with preserved ejection fraction. N Engl J Med 2006;355(3):251-9
19. McAlister FA, Stewart S, Ferrua S, McMurray JJ. Multidisciplinary strategies for the management of heart
failure patients at high risk for admission: a systematic review of randomized trials. J Am Coll Cardiol
2004;44(4):810-9
20. Sisk JE, Hebert PL, Horowitz CR, McLaughlin MA, Wang JJ, Chassin MR. Eects of nurse management
on the quality of heart failure care in minority communities: a randomized trial. Ann Intern Med
2006;145(4):273-83
21. Yao G, Freemantle N, Calvert MJ, Bryan S, Daubert JC, Cleland JG. The long-term cost-eectiveness of
cardiac resynchronization therapy with or without an implantable cardioverter-debrillator. Eur Heart J
2007;28(1):42-51
22. Lenzen MJ, Scholte op Reimer WJ, Boersma E, Vantrimpont PJ, Follath F, Swedberg K, Cleland J, Komajda
M. Dierences between patients with a preserved and a depressed left ventricular function: a report
from the EuroHeart Failure Survey. Eur Heart J 2004;25(14):1214-20
23. : Markku Ellonen. Article ID: ebm00088 (004.072) 2008 Duodecim Medical Publications Ltd
1. EBM-Guidelines, www.ebm-guidelines.com, 10.04.2009.
2. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008; www.escardio.
org, 10.04.2009.
3. 2009 Focused Update: ACCF/AHA Guidelines for the diagnosis and management of heart failure in the
adults, www. acc.org , 15.04.2009.
4. Management of chronic heart failure, www.sign.ac.uk/guidelines/index.html ,
15.04.2009.
5. ISCI- Health Care Guideline: Heart Failure in Adults, 2007; www. icsi.org, 10.04.2009.
1. 2 .
2. 2012 .
148
149
150

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1. Lewis EJ et al. The eect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl

J Med 1993;329:145662
2. Maschio G, Alberti D, Janin G ym. Eect of the angiotensin-converting enzyme inhibitor benazepril on
the progress of chronic renal insuciency. N Engl J Med 1996;334:93945
3. Editors Article ID: rel00108 (010.022). 2009 Kustannus Oy Duodecim
1. Phrommintikul A, Haas SJ, Elsik M, Krum H. Mortality and target haemoglobin concentrations in anaemic
patients with chronic kidney disease treated with erythropoietin: a meta-analysis. Lancet 2007;369:381388
2. Virpi Rauta. Article ID: ebm00226 (010.022). 2008 Duodecim Medical Publications Ltd
1. EBM guidelines, 2007, www,interscience.wiley.com
2. 4 .
3. 2011 .
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1995 Jul;48(1):188-98. PubMed DARE
2. Editors. Article ID: evd01775 (010.021). 2008 Duodecim Medical Publications Ltd

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1. Sandhu S, Wiebe N, Fried LF, Tonelli M. Statins for improving renal outcomes: a meta-analysis. J Am Soc
Nephrol. 2006;17(7):2006-16. (DARE-12006002842 1)
2. Article ID: evd06049. 2008 Duodecim Medical Publications Ltd

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2. Article ID: evd04602. 2007 Duodecim Medical Publications Ltd
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1 Bent et al. Does this woman have an acute uncomplicated urinary tract infection? JAMA 2002; 287:27012710
2 Loeb M, Brazil K, Lohfeld L, et al. Eect of a multifaceted intervention on number of antimicrobial
prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised
controlled trial. BMJ 2005;331:669
3 Kontiokari T, Sundqvist K, Nuutinen M, et al. Regular drinking of cranberry-lingonberry juice concentrate
reduced recurrent urinary tract infections in women. BMJ 2001;322:1571-3
4 Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent
urinary tract infections. N Engl J Med 1993;329:753-6
5 Cardozo L, Lose G, McClish D, Versi E, de Koning Gran H. A systematic review of estrogens for recurrent
urinary tract infections: third report of the hormones and urogenital therapy (HUT) committee. Int
Urogynecol J 2001;12:15-20
6 Raz R, Colodner R, Rohana Y, et al. Eectiveness of estriol-containing vaginal pessaries and nitrofurantoin
macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women.
Clin Infect Dis 2003; 36:1362-8
7 Stothers L. A randomized trial to evaluate eectiveness and cost eectiveness of nathuropathic
cranberry products as prophylaxis against urinary tract infection in women. Can J Urol 2002;9:1558-62
8 Maarit Wuorela. Article ID: ebm00232 (010.010). 2008 Duodecim Medical Publications Ltd
1 EBM Guidelines, 2008, www.interscience.wiley.com

2 2 .
3 2011.
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stroke or TIA: assessment, investigation, immediate management and secondary prevention, published
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4 Scottish Intercollegiate Guidelines Network: Management of patient with
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1.
2.
3.
4.
5.
6.
7.
Principles of examination and treatment of stroke. Stroke unit, Neurology clinic, Helsinki University
Central Hospital
Stroke Unit Realists Collaboration. Organised inpatient (stroke unit) care for stroke. The Cochrane
Database of Systematic Reviews, Cochrane Library number: CD000197. In: The Cochrane Library, Issue
2, 2002. Oxford: Update Software. Updated frequently.
Coastal P. Anticoagulants for preventing stroke in patients with no rheumatic atria brillation and a
history of stroke or transient ischemic attacks. The Cochrane Database of Systematic Reviews, Cochrane
Library number: CD000185. In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated
frequently.
EAFT Study Group. Secondary prevention in nonrheumatic atrial brillation after transient ischaemic
attack or minor stroke. Lancet 1993;342:1255-1262
Koudstaal P. Anticoagulants versus antiplatelet therapy for preventing stroke in patients with
nonrheumatic atrial brillation and a history of stroke or transient ischemic attacks. The Cochrane
Lyrer P, Engelter S. Antithrombotic drugs for carotid dissection. The Cochrane Database of Systematic
Reviews, Cochrane Library number: CD000255. In: The Cochrane Library, Issue 2, 2002. Oxford: Update
Software. Updated frequently
Gueyer F, Boissel JP, Boutitie F, Pocock S, Coope J, Cutler J, Ekbom T, Fagard R, Friedman L, Kerlikowske
K, Perry M, Prineas R, Schron E. Eect of antihypertensive treatment in patients having already suered
from stroke: gathering the evidence. Stroke 1997;28:2557-2562
193
8. The Database of Abstracts of Reviews of Eectiveness (University of York), Database no.: DARE-980047.
In: The Cochrane Library, Issue 1, 2000. Oxford: Update Software
9. Agency for Health Care Research and Quality (AHRQ). Diagnosis and treatment of swallowing disorders
(dysphagia) in acute-care stroke patients. Rockville, MD: Agency for Health Care Research and Quality
(AHQR). Agency for Health care Research and Quality (AHQR). Evidence Report/tech. 1999.
10. The Health Technology Assessment Database, Database no.: HTA-998426. In: The Cochrane Library,
Issue 1, 2001. Oxford: Update Software
11. Counsell C, Sandercock P. Low-molecular weight heparins versus standard unfractionated heparin
for acute ischaemic stroke. The Cochrane Database of Systematic Reviews, Cochrane Library number:
CD000119. In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated frequently.
12. Counsell C, Sandercock P. Antiplatelet therapy for acute ischaemic stroke. The Cochrane Database of
Systematic Reviews, Cochrane Library number: CD000029. In: The Cochrane Library, Issue 2, 2002.
Oxford: Update Software. Updated frequently.
13. Wardlaw JM, Yamaguchi T, del Zoppo G. Thrombolysis for acute ischaemic stroke. The Cochrane
14. Liu M, Councell C, Wardlaw J. Fibrinogen depleting agents for acute ischaemic stroke. The Cochrane
15. Horn J, Limburg M. Calcium antagonists for acute ischemic stroke. The Cochrane Database of Systematic
Reviews, Cochrane Library number: CD001928. In: The Cochrane Library, Issue 2, 2002. Oxford: Update
Software. Updated frequently
16. He J, Whelton PK, Vu B, Klag MJ. Aspirin and risk of hemorrhagic stroke: a meta-analysis of randomized
controlled trials. JAMA 1998;280:1930-1935
17. The Database of Abstracts of Reviews of Eectiveness (University of York), Database no.: DARE-989728.
In: The Cochrane Library, Issue 4, 2000. Oxford: Update Software
18. Jorgensen HS, Nakayama H, Kammersgaard LP, Raaschou HO, Olsen TS. Predicted impact of
intravenous thrombolysis on prognosis of general population of stroke patients: simulation model.
BMJ 1999;319:288-289
19. Mazzone C, Chiodo Grandi F, Sandercock P, Miccio M, Salvi R. Physical methods for preventing deep
vein thrombosis in stroke. The Cochrane Database of Systematic Reviews, Cochrane Library number:
CD001922. In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated frequently
20. Hacke W, Kaste M, Bluhmki E et al; the ECASS Investigators. Thrombolysis with alteplase 3 to 4.5 hours
after acute ischemic stroke. N Engl J Med 2008;359:1317-1329
21. Wahlgren N, Ahmed N, Dvalos A, Hacke W, Milln M, Muir K, Roine RO, Toni D, Lees KR for the SITS
investigators. Thrombolysis with alteplase 34.5 h after acute ischaemic stroke (SITS-ISTR): an
observational study. The Lancet Early Online Publication, 15 Sept 2008
22. Risto O. Roine, Article ID: ebm00759 (036.031) 2009 Duodecim Medical Publications Ltd
23. Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. Lancet 2008 May 10;371(9624):1612-23. PubMed
24. Hankey GJ. Clinical update: management of stroke. Lancet 2007 Apr 21;369(9570):1330-2. PubMed
25. van der Worp HB, van Gijn J. Clinical practice. Acute ischemic stroke. N Engl J Med 2007 Aug 9;357(6):5729. PubMed
26. Author: Editors Article ID: rel00382 (036.021) 2009 Kustannus Oy Duodecim
1. EBM Guidelines, 25.03.2004, 26.03.2009, www.ebm-guidelines.com

2. 3 .
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1. Muller-Oerlinghausen B, Berghfer A, Bauer M. Bipolar disorder. Lancet 2002;359:241-7.

2. Macritchie KA, Geddes JR, Scott J, Haslam DR, Goodwin GM. Valproic acid, valproate and divalproex in
the maintenance treatment of bipolar disorder. Cochrane Database Syst Rev. 2001;(3):CD003196.
3. Macritchie K, Geddes JR, Scott J, Haslam D, de Lima M, Goodwin G. Valproate for acute mood episodes
in bipolar disorder. Cochrane Database Syst Rev. 2003;(1):CD004052.
4. Emilien G, Maloteaux JM, Seghers A, Charled G. Lithium compared to valproic acid and carbamazepine
in the treatment of mania: a statistical meta-analysis. European Psychopharmacology 1996;6:245-252
(DARE-11997003144 1)
5. Rendell JM, Gijsman HJ, Bauer MS, Goodwin GM, Geddes JR. Risperidone alone or in combination for
acute mania. Cochrane Database Syst Rev. 2006;(1):CD004043.
6. Geddes J. What are the eects of treatments in bipolar depression? Clinical Evidence 2005;13:11701179.
7. Erkki Isomets. Article ID: ebm00717 (035.022). 2009 Duodecim Medical Publications Ltd
205
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1. Alberta Cancer Board. Colorectal Cancer Control in Alberta. 2008

2. Bonis PAL, Ahnen DJ, Axell L, La Mont JT, Go B. Screening and management strategies for patients and
families with colon cancer syndromes
3. Towler BP, Irwig L, Glasziou P, Weller D, Kewenter J. Screening for colorectal cancer using the faecal
occult blood test, Hemoccult. The Cochrane Database of Systematic Reviews, Cochrane Library number:
CD001216. In: The Cochrane Library, Issue 2, 2002. Oxford: Update Software. Updated frequently.
4. Levin B, Lieberman DA, McFarland B, Smith RA, Broox D, Andrews KS, Dash C, Giardiello FM, Glick S, Levin
TR, Pickhardt P, Rex DK, Thorson A, Winawer SJ. Screening and Surveillance for the Early Detection of
Colorectal Cancer and Adenomatous Polyps, 2008. CA Cancer J Clin 2008;58:130160
5. Vernon SW. Participation in colorectal cancer screening: a review. J Nat Canc Instit 1997;89:1406-1422
6. Fletcher RH, Schnipper L, La Mont JT, Sokol HN. Screening for colorectal cancer: Strategies in patients at
average risk Up to date , January 2009
7. Flatcher RH, Ramsey SD, La Mont JT, Sokol HN. Screening strategies in patients with family history of colon
cancer or colonic polyps, Up To Date, October 2008
8. Peppercorn MA, Odze RD, Rutgeerts P, Bonis PAL. Colorectal cancer surveillance in inammatory bowel
disease Up To Date 2009
9. Louise CW, Lindquist K, Nugent Sean, Schult T, Lee SJ, Casadei MA, Partin MR.Impact of age and
comorbidity on colorectal cancer screening among older veterans. Ann Inter Med. 2009;150:465-473
10. The Database of Abstracts of Reviews of Eectiveness (University of York), Database no.: DARE-971223. In:
The Cochrane Library, Issue 4, 1999. Oxford: Update Software
218
11. Brewer DA, Fung CL, Chapuis PH, Bokey EL. Should relatives of patients with colorectal cancer be
screened? A critical review of the literature. Diseases of Colon and Rectum 1994;37:1328-1338
12. The Database of Abstracts of Reviews of Eectiveness (University of York), Database no.: DARE-954069. In:
The Cochrane Library, Issue 1, 2001. Oxford: Update Software
13. Lieberman DA, Weiss DG, Bond JH, Ahnen DJ, Garewal H, Chejfec G for the Veterans Aairs Cooperative
Study Group. Use of colonoscopy to screen asymptomatic adults for colorectal cancer. N Engl J Med
2000;343:162-168
14. Imperiale T, Wagner DR, Lin CY, Larkin GN, Rogge JD, Ransoho DF. Risk of advanced proximal neoplasms
in asymptomatic adults according to the distal colorectal ndings. N Engl J Med 2000;343:169-174
15. Asano T, McLeod RS. Dietary bre for the prevention of colorectal adenomas and carcinomas.The
Cochrane Database of Systematic Reviews, Cochrane Library number: CD003430. In: The Cochrane
Library, Issue 2, 2002. Oxford: Update Software.
16. Editors Article ID: ebm00198 (008.071) 2005 Duodecim Medical Publications Ltd
1. EBM Guidelines, 23.02.2005, www.ebm-guidelines.com
2. .
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232
1. Dienstag JL. Hepatitis B virus infection. Drug therapy. N Engl J Med 2008;359:1486-1500
2. Maheshwari A, Ray S, Thuluvath PJ. Acute hepatitis C. Lancet 2008;372:321-332
3. Hadziyannis et al. Peginterferon alfa-2A and ribavirin combination in chronic hepatitis C: A randomized
study of duration of treatment and ribavirin dose. Ann Intern Med 2004; 140:346355
4. Dahlgard O, Bjoro K, Hellum K, ym. Treatment with pegylated interferon and ribavarin in HCV infection
with genotype 2 or 3 for 14 weeks: a pilot study. Hepatology. 2004 Dec;40(6):1260-5. Hepatology
2004;40:1260-5
5. von Wagner M, Huber M, Berg T, ym. Peginterferon-alfa-2a (40kD) and ribavirin for 16 or 24 weeks in
patients with genotype 2 or 3 chronic hepatitis. Gastroenterology 2005;129:522-7
6. Mangia A, Santoro R, Minerva N, ym. Peginterferon alfa-2b and ribavirin for 12 vs. 24 weeks in HCV
genotype 2 or 3. N Engl J Med. 2005; 23;352:2609-17
7. Zeuzem S, Buti M, Ferenci P, ym. Ecacy of 24 weeks treatment with peginterferon alfa-2b plus ribavirin
in patients with chronic hepatitis C infected with genotype 1 and low pretreatment viremia. J Hepatol.
2006;44:97-103
8. Jensen D M, Morgan T R, Marcellin P, ym. Early identication of HCV genotype 1 patients responding to
24weeks peginterferonalfa-2a (40kD)/ribavirin therapy. Hepatology 2006;46:954-60
9. Lok ASF, McMahon BJ. AASLD Practice Guidelines. Chronic hepatitis B. Hepatology 2007;45:507-39
10. Maija Lappalainen i Martti Frkkil. Article ID: ebm00216 (009.020), 2008 Duodecim Medical
Publications Ltd.
11. National Guideline Clearinghouse: Chronic hepatitis B guideline. www.guideline.gov
EBM Guidelines, 10.03.2008
www.ebm-guidelines.com
National Guideline Clearinghouse

2.
National Guideline Clearinghouse
I
II-1
II-2
II-3
III

case-
,

,
1. Mast EE, Margolis HS, Fiore AE, Brink EW, Goldstein ST, Wang SA, et al. A comprehensive immunization
strategy to eliminate transmission of hepatitis B virus infection in the United States: recommendations
of the Advisory Committee on Immunization Practices (ACIP) part 1: immunization of infants, children,
and adolescents. MMWR Recomm Rep 2005; 54: 1-31
2. Bodsworth N, Donovan B, Nightingale BN. The eect of concurrent human immunodeciency virus
infection on chronic hepatitis B: a study of 150 homosexual men. J Infect Dis 1989; 160: 577-582
3. Gunson RN, Shouval D, Roggendorf M, Zaaijer H, Nicholas H, Holzmann H, et al. Hepatitis B virus (HBV)
and hepatitis C virus (HCV) infections in health care workers (HCWs): guidelines for prevention of
transmission of HBV and HCV from HCW to patients. J Clin Virol 2003; 27: 213-230.
4. Buster EH, van der Eijk AA, Schalm SW. Doctor to patient transmission of hepatitis B virus: implications
of HBV DNA levels and potential new solutions. Antiviral Res 2003; 60: 79-85
5. Liaw YF, Chu CM, Su IJ, Huang MJ, Lin DY, Chang-Chien CS. Clinical and histological events preceding
hepatitis B e antigen seroconversion in chronic type B hepatitis. Gastroenterology 1983; 84: 216-219
6. Lok AS, Lai CL, Wu PC, Leung EK, Lam TS. Spontaneous hepatitis B e antigen to antibody seroconversion
and reversion in Chinese patients with chronic hepatitis B virus infection. Gastroenterology 1987; 92:
1839-1843
7. Lok AS, Lai CL. Acute exacerbations in Chinese patients with chronic hepatitis B virus (HBV) infection.
Incidence, predisposing factors and etiology. J Hepatol 1990; 10: 29-34
8. Liaw YF, Tai DI, Chu CM, Pao CC, Chen TJ. Acute exacerbation in chronic type B hepatitis: comparison
between HBeAg and antibody-positive patients. HEPATOLOGY 1987; 7: 20-23
9. Brunetto MR, Oliveri F, Coco B, Leandro G, Colombatto P, Gorin JM, et al. Outcome of anti-HBe positive
chronic hepatitis B in alpha-interferon treated and untreated patients: a long term cohort study. J
Hepatol 2002; 36: 263-270
10. Chu CJ, Hussain M, Lok AS. Quantitative serum HBV DNA levels during dierent stages of chronic
hepatitis B infection. HEPATOLOGY 2002; 36: 1408-1415
11. Wong DK, Cheung AM, O'Rourke K, Naylor CD, Detsky AS, Heathcote J. Eect of alpha-interferon
treatment in patients with hepatitis B e antigen-positive chronic hepatitis B. A meta-analysis. (see
comments). Ann Intern Med 1993; 119: 312-323
12. Brook MG, Karayiannis P, Thomas HC. Which patients with chronic hepatitis B virus infection will respond
to alpha-interferon therapy? A statistical analysis of predictive factors. (see comments). HEPATOLOGY
1989; 10: 761-763.
13. Lai CL, Lok AS, Lin HJ, Wu PC, Yeoh EK, Yeung CY. Placebo-controlled trial of recombinant alpha
2-interferon in Chinese HBsAg-carrier children. Lancet 1987; 2: 877-880.
14. Lai CL, Lin HJ, Lau JN, Flok AS, Wu PC, Chung HT, et al. Eect of recombinant alpha 2 interferon with or
without prednisone in Chinese HBsAg carrier children. Q J Med 1991; 78: 155-163 1992; 15: 584-589
15. Hadziyannis S, Bramou T, Makris A, Moussoulis G, Zignego L, Papaioannou C. Interferon alfa-2b
treatment of HBeAg negative/serum HBV DNA positive chronic active hepatitis type B. J Hepatol 1990;
11(Suppl 1): S133-S136.
16. Pastore G, Santantonio T, Milella M, Monno L, Mariano N, Moschetta R, et al. Anti-HBe-positive chronic
hepatitis B with HBV-DNA in the serum response to a 6-month course of lymphoblastoid interferon. J
Hepatol 1992; 14: 221-225.
17. Papatheodoridis GV, Manesis E, Hadziyannis SJ. The long-term outcome of interferon-alpha treated and
untreated patients with HBeAg-negative chronic hepatitis B. J Hepatol 2001; 34: 306-313.
18. Lampertico P, Del Ninno E, Vigano M, Romeo R, Donato MF, Sablon E, et al. Long-term suppression of
hepatitis B e antigen-negative chronic hepatitis B by 24-month interferon therapy. HEPATOLOGY 2003;
37: 756-763.
233
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1. EBM-Guidelines, 14.9.2004, www. ebm-guidelines.com.

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1. Muller-Oerlinghausen B, Berghfer A, Bauer M. Bipolar disorder. Lancet 2002;359:241-7.

1. Alberta Cancer Board. Colorectal Cancer Control in Alberta. 2008

National Guideline Clearinghouse

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