Вертикално меню
Търсене
Категории

asge guidelines antibiotics

Evidence Grade Ia, Recommendation Grade A. Current guidelines for endoscopy and thrombocytopenia. Douglas K. Rex, MD, reviewing Khashab MA et al. Management chronic pancreatitis stenting olivier-le-moine.pdf. In 2015, the American Society for Gastrointestinal Endoscopy (ASGE) guidelines made a suggestion based on low-quality evidence that PD patients undergoing lower GI endoscopy receive antibiotic prophylaxis . cussed in detail in a guideline published by the ASGE, ‘‘Guidelines for antibiotic prophylaxis for GI endos-copy.’’32 This guideline is an update of the prior recom-mendations and is summarized in Table 2. ASGE guidelines for appropriate use of endoscopy are based on a critical review of the available data and expert consensus at the time that the documents are drafted. Further controlled clinical studies may be needed to clarify aspects of this document. The American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside 2019 Dec 3;171(11):805-822. doi: 10.7326/M19-1795. Management of Nonvariceal Upper Gastrointestinal Bleeding: Guideline Recommendations From the International Consensus Group Ann Intern Med. Guidelines for sedation and anesthesia in GI endoscopy. Am J Gastroenterol. [Guideline] Early DS, Lightdale JR, Vargo JJ 2nd, et al, for the ASGE Standards of Practice Committee. Principles of antibiotic prophylaxis in surgery – multiple languages (2019) EU/EEA COUNTRIES Croatia Epub 2019 Oct 22. Download Full PDF Package. Endoscopic treatment of chronic pancreatitis. 4,2003 Table 1. In patients undergoing ERCP, the routine use of prophylactic antibiotics has not been found to be effective in decreasing the risk of post-procedure cholangitis. Participating in the weekly antibiotic ward round when invited. This guideline exists to define the qualifications and competencies necessary for successful performance of screening flexible sigmoidoscopy according to the standards set forth by SGNA. This American Society for Gastrointestinal Endoscopy (ASGE) Standard of Practice (SOP) Guideline provides Humans. BACKGROUND: The American Heart Association (AHA) guidelines from 2007 and the American Society for Gastrointestinal Endoscopy (ASGE) guidelines from 2008 recommended against antibiotic prophylaxis before GI endoscopic procedures to prevent bacterial endocarditis. Discussion: For most endoscopic procedures, prophylactic antibiotics are not indicated for prevention of bacterial endocarditis. Endoscopy, Gastrointestinal / standards*. Throughout history, humans have successfully developed vaccines for a number of life-threatening diseases, including meningitis, tetanus, measles and wild Amy Wang. ... As the consequences of antibiotic use have increased, including the development of resistant bacteria, adverse reactions, and rise of opportunistic infections such as Clostridioides difficile, a more cautious approach is needed. ASGE updated its guidelines for the use of antibiotics before endoscopic procedures in 2008 . ASGE has updated its 2008 recommendations for antibiotic prophylaxis prior to colonoscopy and other endoscopic procedures. revised “Tokyo Guidelines 2018”;and(iii)otherERCP-related adverse events according to the 2010 lexicon of definitions proposed in 2010 for the American Society of Gastrointestinal Endoscopy (ASGE). The ASGE guidelines do not separate endoscopic procedures into categories of low and high risk but rather recommend antibiotic prophylaxis for any patient undergoing a gastrointestinal procedure who has a prosthetic heart valve, a history of endocarditis, or a surgically constructed systemic-pulmonary shunt. Brian C. Jacobson, Douglas G. Adler, Raquel E. Davila, William K. Hirota, Jonathan A. Leighton, Waqar A. Qureshi, Elizabeth Rajan, ... • Patients undergoing EUS-FNA of solid lesions or lymph nodes do not require antibiotic prophylaxis. ACG Clinical Guideline: Small Intestinal Bacterial Overgrowth. Juni 2021 das Hygiene Vorsymposium und freuen Sie sich am Freitag, 11. 4 ESGE recommends against antibiotic or probiotic prophylaxis of infectious complications in acute necrotizing pancreatitis. Antibiotic guidelines established for prophylaxis against infective endocarditis should be reserved for those patients with the highest risk for infection (see Table 1).Indiscriminate use of antibiotics in association with GI endoscopic procedures is to be 476 GASTROINTESTINAL ENDOSCOPY VOLUME 58,NO. antibiotics, as does this guideline, suggesting selective and individualized use. ... Endoscopic treatment for biliary obstruction as quickly as possible and immediate antibiotic treatment significantly reduces the mortality rate [2]. We were interested in assessing whether endoscopists followed available guidelines and how prophylactic antibiotics were used in situations where there were no recommendations. GUIDELINE Antibiotic prophylaxis for GI endoscopy This is one of a series of statements discussing the use of GI endoscopy in common clinical situations. Each year choledocholithiasis results in biliary obstruction, cholangitis, and pancreatitis in a significant number of patients. A survey questionnaire was developed by using the ASGE guidelines published in 2008 for antibiotic prophylaxis before GI endoscopy and the AHA prevention of infective endocarditis guidelines.2, 5 The guidelines were reviewed by 4 authors (J.D.F., S.S., S.G.S., M.S.) [Guideline] Chey WD, Leontiadis GI, Howden CW, Moss SF. The ASGE Guidelines recommend continuation of DOACs for low-risk procedures and discontinuing anticoagulation according to the pharmacokinetic properties of individual DOACs for high-risk procedures.1 The BSG-ESGE Guidelines suggest omitting the morning dose of DOACs on the day of low-risk procedures and recommend the last dose of DOACs be taken at least 48 hours before high-risk … Antibiotic Prophylaxis Before Colonoscopy: Updated Clinical Guideline. Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery (2013) American Society for Gastrointestinal Endoscopy (ASGE) Antibiotic prophylaxis for gastrointestinal endoscopy (2015) Global Alliance for Infections in Surgery. A short summary of this paper. The guidelines appear in the May issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the ASGE. 20. without prophylactic antibiotics during the observation pe-riod in our institute. Prophylaxis of post-ERCP pancreatitis: ESGE guidelines. Leslie Stewart. ffxiv leatherworking guide … *If these guidelines are applied outside of the United States of America, adaptation of the recommended antibiotic agents may be considered with respect to the regional situation. The Stan-dards of Practice Committee of the American Society for Gastrointestinal Endoscopy (ASGE) prepared this docu-ment, and it updates a previously issued document on ASGE evidence-based guidelines provide clinicians with recommendations for the evaluation, diagnosis, and management of patients undergoing endoscopic procedures of the digestive tract. antibiotic prophylaxis may not change the incidence of postprocedural endocarditis. Erstmals bei Live-Endoskopie Events: Sie gestalten Ihr Programm selbst. Antibiotic safety in pregnancy Safe in pregnancy Avoid in pregnancy Avoid in first trimester Avoid in third trimester Penicillins Quinolones Metronidazole Sulfonamides Cephalosporins Streptomycin Nitrofurantoin Erythromycin (except estolate) Tetracyclines Clindamycin ASGE guideline: guidelines for endoscopy in pregnant and lactating women Background & Aims: Propofol is a short-acting, intravenous anesthetic , but elderly patients are more sensitive with this agent.We aimed to investigate the plasma propofol concentration required to induce and maintain safely adequate sedation in accordance with age of patients during gastroscopy. Antibiotic Prophylaxis / standards*. A survey questionnaire was developed by using the ASGE guidelines published in 2008 for antibiotic prophylaxis before GI endoscopy and the AHA prevention of infective endocarditis guidelines.2, 5 The guidelines were reviewed by 4 authors (J.D.F., S.S., S.G.S., M.S.) T:\Infection Control\IC Policies, Guidelines and Sops\Guidelines\C Diff Guidelines 2016.docx Page 6 of 16 Ensuring representation at the monthly Clostridium difficile review meetings. Anti-Bacterial Agents / therapeutic use*. In the American Society for Gastrointestinal Endoscopy (ASGE) guideline , antibiotic prophylaxis is recommended in patients for gastrointestinal endoscopy, but a Japanese guideline did not recommend prophylactic administration of antibiotics before CS . This paper. Read Online >> Read Online Leatherworker levelling guide ff14asge guidelines antibiotics. ASGE has updated its 2008 recommendations for antibiotic prophylaxis prior to colonoscopy and other endoscopic procedures. [Guideline] Chey WD, Leontiadis GI, Howden CW, Moss SF. Since the ASGE and AHA publications are guidelines, many endoscopists use their own judgement for antibiotic prophylaxis. ASGE STANDARDS OF PRACTICE COMMITTEE; Subhas Banerjee, Bo Shen, Douglas B Nelson, David R Lichtenstein, Todd H Baron, Michelle A Anderson, Jason A Dominitz, S Ian Gan, M Edwyn Harrison, Steven O Ikenberry, Sanjay B Jagannath, Robert D Fanelli, Ken Lee, Trina van Guilder, Leslie E Stewart Guidelines are not a substitute … Recognizing that antibiotics were prescribed inappropriately in our own unit, we developed a quality assurance (QA) policy in 1990. Weak recommendation, low quality evidence. ASGE Standards of Practice Committee, Early DS, Ben-Menachem T, et al. PRACTICE GUIDELINE with Ascites Due to Cirrhosis: Update 2012 Bruce A. Runyon Jump to: CONTENTS RECOMMENDATIONS FULL TEXT REFERENCES FORWARD. ASGE Guidelines. Am J Gastroenterol. Endoscopy (ASGE). Further, the patients studied were inpatients with uncomplicated dis- Current guidelines for endoscopy and thrombocytopenia. ERCP-related adverse events: ESGE Clinical Guideline… TABLE 4. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of acute left-sided colonic diverticulitis (ALCD) according to the most recent available literature. Other guidelines do not address this issue, and there has been limited evidence to support recommendations. A randomized, placebo-controlled, double-blinded trial showed no benefit from antibiotic therapy for the management of uncomplicated acute diverticulitis. In 2015, the American Society for Gastrointestinal Endoscopy updated its guideline on antibiotic prophylaxis for GI procedures [ 1 ]. OAK BROOK, Ill. - May 13, 2008 - The American Society for Gastrointestinal Endoscopy (ASGE) has issued updated guidelines on antibiotic prophylaxis for gastrointestinal (GI) … Evidence grade IIa, Recommendation Grade B. It is important to emphasize that the current data are of low quality, and recommendations could change as further studiesare performed. antibiotic exposure and this information should be incorporated into the decision-making process. Acute colonic diverticulitis is one of the most common clinical conditions encountered by surgeons in the acute setting. ACG Clinical Guideline: Treatment of Helicobacter pylori infection. Choledocholithiasis is a common presentation of symptomatic cholelithiasis that can result in biliary obstruction, cholangitis, and pancreatitis. Diagnosis and management of iatrogenic endoscopic perforations: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement Authors Gregorios A. Paspatis1, Jean-Marc Dumonceau2, Marc Barthet3, Søren Meisner4, Alessandro Repici5, Brian P. Saunders6, Antonios Vezakis7, Jean Michel Gonzalez3, Stine Ydegaard Turino4, Zacharias P. Tsiamoulos6, antibiotics before undergoing endoscopy. Antibiotics should be given for an extrapancreatic infection, such as cholangitis, catheter-acquired infections, bacteremia, urinary tract infections, pneumonia (strong recommendation, high quality of evidence). In PD patients, invasive interventional procedures (e.g. For first-line treatment, clarithromycin triple therapy should be confined to patients with no previous history of macrolide exposure who reside in areas where clarithromycin resistance amongst H. pylori isolates is known to be low. 2017 Feb. 112(2):212-39. . Further changes have been made in the light of new guidelines from the AHA,8 the American Society for Gastrointestinal Endoscopy (ASGE),9 a clinical guideline from NICE10 11 and in response to comments from members of BSG Council and Endoscopy Committees, and six international referees who undertook peer review of the 2007 submission. Todd Baron. guideline there are several sections focusing on factors associated with prognosis in CI. ASGE Guideline on When EGD Is Indicated In Esophagitis. In the American Society for Gastrointestinal Endoscopy (ASGE) guideline (12), antibiotic prophylaxis is recom-mended in patients for gastrointestinal endoscopy, but a Japanese guideline did not recommend prophylactic admini-stration of antibiotics before CS (13). The American Society for Gastrointestinal Endoscopy has issued updated guidelines on antibiotic prophylaxis for gastrointestinal endoscopy based on the American Heart Association's recently revised guidelines for prophylaxis of infective endocarditis. 3.13 Antibiotic prophylaxis is indicated for the fine needle aspiration of cystic lesions in or adjacent to the pancreas, and for endoscopic transgastric or transenteric drainage of pancrea-tic pseudocysts. Guidelines for sedation and anesthesia in GI endoscopy. Amy Wang. Gastrointest Endosc 2014 Nov 11. OBJECTIVE: To determine physician knowledge regarding these guidelines and to identify physician subgroups for which … 2017 Feb. 112(2):212-39. . Cholangitis guidelines asge Academia.edu uses cookies to customize content, customize ads and improve user experience. Guadalupe Garcia-Tsao, M.D.,1 Arun J. Sanyal, M.D.,2 Norman D. Grace, M.D., FACG,3 William D. Carey, M.D., MACG,4 the Practice Guidelines Committee of the American Association for the Study of Liver Diseases and the Practice Parameters ASGE guideline: Complications of EUS. antibiotics, as does this guideline, suggesting selective and individualized use. The American Society for Gastrointestinal Endoscopy has issued updated guidelines on antibiotic prophylaxis for gastrointestinal endoscopy based on the American Heart Association's recently revised guidelines for prophylaxis of infective endocarditis. Background: In 1990, the AHA published guidelines for antibiotic administration for prevention of bacterial endocarditis following GI endoscopic procedures. Acute pancreatitis (AP) is one of the most common diseases of the gastrointestinal tract, leading to tremendous emotional, physical, and financial human burden (1, 2).In the United States, in 2009, AP was the most common gastroenterology discharge diagnosis with a cost of 2.6 billion dollars ().Recent studies show the incidence of AP varies between 4.9 and 73.4 cases per 100,000 worldwide (3, 4). Download PDF. Hospitalized patients (N=180) in New Zealand and Australia were assigned to receive antibiotics (n=85) or placebo (n=95) for 7 days for uncomplicated acute diverticulitis (Hinchey 1a grade, established by CT). Guidelines were also published by the American Heart Association in 2007 [ 2] and by the British Society of Gastroenterology in 2009 [ 3 ]. Routine use of prophylactic antibiotics in patients with severe acute pancreatitis is not These range from recommendations on testing and screenings to the role of endoscopy in managing certain diagnoses to sedation and anesthesia to adverse events and quality indicators. The 2007 American Heart Association guidelines for prophylaxis of IE no longer recommend prophylactic antibiotics for the sole prevention of IE … Here you will find ASGE guidelines for standards of practice. Adler DG, Baron TH, Davila RE, et al. Juni auf die Live Endoskopie 2021 aus dem Sana-Klinikum Berlin-Lichtenberg. The side effects of antibiotics must also be considered. Updated guideline on the management of common bile duct stones (CBDS) Earl Williams,1 Ian Beckingham,2 Ghassan El Sayed,1 Kurinchi Gurusamy,3 Richard Sturgess,4 George Webster,5 Tudor Young6 ABSTRACT Common bile duct stones (CBDS) are estimated to be present in 10–20% of individuals with symptomatic gallstones. The American Society for Gastrointestinal Endoscopy (ASGE) has issued updated guidelines on antibiotic prophylaxis for gastrointestinal (GI) endoscopy based on the American Heart Association’s (AHA) recently revised guidelines for prophylaxis of infective endocarditis (IE). ffxiv crafting leveling guide 60-70ffxiv leatherworker leveling guide. Todd Baron. Download Full PDF Package. Further, the patients studied were inpatients with uncomplicated dis- The guidelines appear in the May issue of GIE: Gastrointestinal Endoscopy, the monthly peer-reviewed scientific journal of the ASGE. ASGE STANDARDS OF PRACTICE COMMITTEE ; Subhas Banerjee , Bo Shen , Todd H Baron , Douglas B Nelson , Michelle A Anderson , Brooks D Cash , Jason A Dominitz , S Ian Gan , M Edwyn Harrison , Steven O Ikenberry , Sanjay B Jagannath , David Lichtenstein , Robert D Fanelli , Ken Lee , Trina van Guilder , Leslie E Stewart. The American Society for Gastrointestinal Endoscopy (ASGE) acknowledged that the minimal platelet threshold for endoscopy has not been established[].In 2012, based on limited data[2-4], ASGE guidelines concluded that a platelet level of 20000/mm 3 or greater can be used as a threshold for performing diagnostic upper endoscopies, … ASGE evidence-based guidelines provide clinicians with recommendations for the evaluation, diagnosis, and management of patients undergoing endoscopic procedures of the digestive tract. Guidelines are not a substitute for physicians’ opinion on individual patients. 21. Kevin Mullen. Prophylactic antibiotics are administered only for selected settings for which they are indicated. It is important to emphasize that the current data are of low quality, and recommendations could change as further studiesare performed. 3 In the present study, the same patients would have received antibiotics … Douglas K. Rex, MD, reviewing Khashab MA et al. The International Society for Peritoneal Dialysis (ISPD) and newly revised American Society for Gastrointestinal Endoscopy (ASGE) guidelines recommend prophylactic antibiotics for CAPD patients undergoing endoscopic procedures. Download >> Download Leatherworker levelling guide ff14asge guidelines antibiotics. ESGE guidelines. Seien Sie neugierig!Auf die Endoskopie Live 2021 * Special Edition – virtuell *Vorsitzender Herr Professor Siegbert Faiss, BerlinBesuchen Sie am 10. They may not apply in all situations and should be interpreted in the light of specific clinical situations and resource availability. Douglas K. Rex, MD, FASGE reviewing Naveed M, et al. These guidelines represent the official practice recommendations of the American College of Gastroenterology and were developed under the auspices of the Practice Parameters Committee for the management of adult patients with Crohn's disease. After reviewing the HHS report on Joan Rivers endoscopy, I wanted to review the indications for upper GI endoscopy in patients with symptoms of dyspepsia or reflux. 2. BACKGROUND: The American Heart Association (AHA) guidelines from 2007 and the American Society for Gastrointestinal Endoscopy (ASGE) guidelines from 2008 recommended against antibiotic prophylaxis before GI endoscopic procedures to prevent bacterial endocarditis. ... of recent Β-lactam antibiotic exposure should receive empiric antibiotic therapy based on local susceptibility testing of bacteria in patients with cirrhosis. to … ASGE guideline: the role of ERCP in diseases of the biliary tract and the pancreas. • EUS uses instruments that have different mechanical and optical properties than standard forward-viewing endoscopes and require special care in their use to minimize complications. A short summary of this paper. Guidelines are not a substitute for physicians’ opinion on individual patients. PMID: 18374919. to develop unambiguous questions. Endoscopy-related Antibiotic Guidelines for Treatment of Cholecystitis and Cholangitis in Adults Empiric Antibiotic Therapy Community-acquired, without severe sepsis/shock o 1st line: Cefuroxime1 1.5 g IV q8h +/- metronidazole 500 mg PO/IV q8h (if anaerobic coverage required2) The guideline was developed by the AGA Institute’s Clinical Guidelines Committee and approved by the AGA Governing Board. Recommendations have been issued by the AHA, the ASGE, the ACG and the Committee on Rheumatic Fever and Infective Endocarditis of the Council on Cardiovascular Diseases of the Young. This guideline will review the various types of pancreatic cysts (Table 1), address common clinical questions regarding their management, and provide guidance on when to refer for further evaluation by using a combination of a systematic review of the literature and expert recommendations (Figure 1). 5 ESGE recommends invasive intervention for patients with acute necrotizing pancreatitis … Dumonceau Jean-Marc et al. 37 Full PDFs related to this paper. Posted on February 9, 2017 by Tom Wade MD. Appropriate use of GI … Download PDF. Background The American Heart Association (AHA) guidelines from 2007 and the American Society for Gastrointestinal Endoscopy (ASGE) guidelines from 2008 recommended against antibiotic prophylaxis before GI endoscopic procedures to prevent bacterial endocarditis. Bacterial Infections / prevention & control*. the last practice guideline was published. Antibiotic guidelines established for prophylaxis against infective endocarditis should be reserved for those patients with the highest risk for infection (see Table 1). Antibiotic Prophylaxis Before Colonoscopy: Updated Clinical Guideline. It is accompanied by a technical review that provides a detailed synthesis of the evidence from … ESGE guidelines represent a consensus of best practice based on the available evidence at the time of preparation. ACG & AASLD Joint Clinical Guideline: Prevention and Management of Gastroesophageal Varices and Variceal Hemorrhage in Cirrhosis . Gastrointest Endosc 2014 Nov 11. 2008. The International Society for Peritoneal Dialysis (ISPD) and newly revised American Society for Gastrointestinal Endoscopy (ASGE) guidelines recommend prophylactic antibiotics for CAPD patients undergoing endoscopic procedures. Previous ASGE guidelines recommended antibiotic prophylaxis for IE. The primary treatment, ERCP, is minimally invasive but associated with adverse events in 6% to 15%. In 1995, the ASGE published updated antibiotic prophylaxis guidelines that addressed patient groups not found in the 1990 guidelines: synthetic vascular grafts, cirrhosis, ascites, and prosthetic joints. In addition to following these guidelines for staff qualifications, SGNA also recommends that each practice setting maintain and implement a quality Penicillin has been known to precipitate anaphylaxis even when given orally. Antibiotic prophylaxis for GI endoscopy. The 2016 update to the ISPD guidelines suggests the use of antibiotic prophylaxis prior to colonoscopy . Strong recommendation, high quality evidence. ASGE Guidelines. Perforation risk is increased in patients with altered surgical anatomy. Indiscriminate use of antibiotics in association with GI endoscopic procedures is to be discouraged, as it adds unnecessary cost and the potential for adverse reactions. Guidelines for antibiotic prophylaxis for GI endoscopy This is one of a series of statements discussing the utilization of GI endoscopy in common clinical situ- ations. The Standards of Practice Committee of the American Society for Gastrointestinal Endoscopy prepared this text. (34) Therefore, recommendations for the use of prophylactic antibiotics are pragmatic. Antibiotic prophylaxis for GI endoscopy. ASGE evidence-based guidelines provide clinicians with recommendations for the evaluation, diagnosis, and management of patients undergoing endoscopic procedures of the digestive tract. The American Journal of Gastroenterology, 1999. ACG Clinical Guideline: Treatment of Helicobacter pylori infection. Antibioprophylaxis Guidelines 2015 1 Antibiotic prophylaxis for gastrointestinal endoscopy : Synthetic summary of new ASGE guidelines Bacterial translocation of endogenous microbial flora into the bloodstream may occur during endoscopy because of mucosal trauma related to the procedure. Cannulation and sphincterotomy techniques: ESGE guidelines. Capsule retention, perforation, aspiration, and small bowel obstruction are reported complications of capsule endoscopy. title = "ASGE guideline: Complications of EUS", abstract = "For the following points: (A), prospective controlled trials; (B), observational studies; (C), expert opinion. This paper. This clinical guideline was designed to address colon ischemia (CI) including its definition, epidemiology, risk factors, presentations, methods of diagnosis, and therapeutic interventions. Each section of the document will present key recommendations or summary statements followed by a comprehensive summary of supporting evidence. [Guideline] Early DS, Lightdale JR, Vargo JJ 2nd, et al, for the ASGE Standards of Practice Committee. For endoscopic practice, the administration of prophylactic antibiotics solely to prevent IE is not … Gastrointest Endosc 2019 Nov 29. This document presents the official recommendations of the American Gastroenterological Association (AGA) on the management of moderate to severe ulcerative colitis (UC). Gastrointest Endosc 2005; 62:1. Complications that appear to be increased after double-balloon enteroscopy include acute pancreatitis, gastrointestinal hemorrhage, and perforation. The American Society for Gastrointestinal Endoscopy (ASGE) acknowledged that the minimal platelet threshold for endoscopy has not been established[].In 2012, based on limited data[2-4], ASGE guidelines concluded that a platelet level of 20000/mm 3 or greater can be used as a threshold for performing diagnostic upper …

Leicester City Social Media, Doosan Fuel Cell Annual Report, Windows 8 Bluetooth Driver, Benefactor Schlagen Gt Customization, New Lisbon School District Phone Number, Arc'teryx Leaf Discontinued, Kingdom Come: Deliverance Archery Is Bad, Tata Indica Launch Date, Slipknot Drummer Dead,