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1681. Distal Symmetrical Polyneuropathy: Definition for Clinical Research

not undergo the separate review process of Muscle & Nerve. This article is a joint report of the American Association of Electrodiagnostic Medicine, the American Academy of Neurology, and the American Academy of Physical Medicine and Rehabilitation Abbreviations: EMG, electromyography; MDNS, Michigan diabetic neurop- athy score; MNSI, Michigan neuropathy screening instrument; NCS, nerve- conductions study/studies; NDS, neuropathy disability score; NIS-LL, neu- ropathyimpairmentscoreinthelowerlimbs;QST (...) numbness” Clinical exam score4 188 400 Ch B Y 1 18 91 26 91 28 93 8 Diabetic PN 2 of 3: symptoms, abn temp. sens, 2ankle DTRs Neurologist clinical evaluation 15 23 Ch B Y 1 87 91 10 Diabetic PN Symptom questionnaire, neurologic exam, vibration detection NCS 47 157 Ch N ND 2 87 60 94 92 64 9718 18 Chronic symmetric PN in elderly Neuropathy symptoms Bilateral impaired sensation, strength, or DTR 11 9 CC B Y 2 78 82 2 Diabetic neuropathy Symptom score, disability score, vibration detection, cold detection

2005 American Association of Neuromuscular & Electrodiagnostic Medicine

1682. Guidelines on Consent for Anaesthesia or Sedation

Professional Documents are progressively being coded as follows: TE Training and Educational EX Examinations PS Professional Standards T Technical POLICY – defined as ‘a course of action adopted and pursued by the College’. These are matters coming within the authority and control of the College. RECOMMENDATIONS – defined as ‘advisable courses of action’. GUIDELINES – defined as ‘a document offering advice’. These may be clinical (in which case they will eventually be evidence-based), or non-clinical (...) be of concern. GENERAL PRINCIPLES The standard for consent in Australia is established by the common law. In New Zealand it is embodied in the Code of Health and Disability Services Consumers’ Rights. Consent for treatment provided by an anaesthetist is different from a statement as to the necessity for anaesthesia (which may form part of the consent for an operative procedure). Although legal processes that test the validity of consent differ, both Australian and New Zealand law state that the provision

2005 Australian and New Zealand College of Anaesthetists

1683. Therapies for essential tremor

a postural or kinetic tremor. ET has been referred to as a benign condition because of the perception that it does not reduce life expectancy or cause symptoms besides tremor and impaired tandem walking. However, ET may cause substantial physical and psychosocial disability, and it is unclear whether ET is associated with additional comorbid symptoms. Tremor amplitude gradually increases over time, and patients frequently experience increasing difficulty with writing, drinking, eating, dressing, speaking (...) -rating of functional disability, and accelerometry) while 66% of patients had their tremor magnitude reduced by more than 20% of their baseline values after 12 months (class III). A third open-label study examined the acute and chronic effects of propranolol and primidone in 50 patients with ET who were randomly assigned to receive either long-acting propranolol (80 to 160 mg/day) or primidone (50 to 250 mg/day). Patients were evaluated at 1, 3, 6, 9, and 12 months of treatment, and tremor

2005 American Academy of Neurology

1684. Carotid endarterectomy

, there was a greater benefit from CE in men compared to women. For prevention of an ipsilateral stroke of any severity or for prevention of a disabling stroke, the NNT was 12 and 16 for men and 67 and 125 for women. In addition, there was no demonstrable benefit in patients with retinal stroke or retinal TIA. A combined analysis of the symptomatic trials, done by Rothwell et al., included 6,092 patients with 35,000 patient-years of follow-up. The combined analysis included individual patient data, reassessed (...) the angiograms, and standardized the outcomes. Due to differences in the three trials in terms of definition of stroke outcome events and disabling stroke, the combined analysis utilized the following NASCET definitions: 1) stroke was defined as any cerebral or retinal event with symptoms lasting longer than 24 hours; 2) disabling stroke was defined as a stroke that resulted in a Rankin score of 3 or more, or an equivalent rating, at a defined follow-up interval. For all these studies, the outcome

2005 American Academy of Neurology

1685. Distal symmetric polyneuropathy: a definition for clinical research

), the reference standard employed, whether the reference standard was measured without knowledge of the result of the diagnostic predictor, the proportion of patients with the target disorder who were positive for the diagnostic predictor (sensitivity), and the proportion of patients without the target disorder who were negative for the diagnostic predictor (specificity). Each reviewer graded the risk of bias in each article by using the diagnostic test classification-of-evidence scheme in . In this scheme (...) Study, the Neuropathy Disability Score (NDS), the Neuropathy Impairment Score in the Lower Limbs (NIS-LL), the Michigan Neuropathy Screening Instrument (MNSI), the Michigan Diabetic Neuropathy Score (MDNS), and two other well-described clinical examination scores. Notably, simple composite examination scores are as accurate as more complex examinations. The sensitivities and specificities of quantitative sensory testing (QST) varied widely among studies. These psychophysical tests have greater

2005 American Academy of Neurology

1686. Treatment and recommendations for homeless people with with Otitis Media

Carolina. ADAPTING YOUR PRACTICE: Treatment & Recommendations for Homeless Children with Otitis Media Health Care for the Homeless Clinicians’ Network v Table of Contents Summary of Recommended Practice Adaptations vi Introduction 1 Case Study: Homeless Child with Otitis Media with Effusion 3 DIAGNOSIS AND EVALUATION History 4 Physical examination 7 Diagnostic tests 8 Case Study: Homeless Child with Acute Otitis Media 9 PLAN AND MANAGEMENT Education, self-management 10 Medications 12 Associated (...) are unavailable to the provider. • Hearing screening – Perform routine audiometric screening at every visit. If hearing loss is suspected, refer to audiologist. Be aware that hearing screening is among the services to which children on Medicaid are entitled (most homeless children qualify for Medicaid). PLAN & MANAGEMENT Education, Self-Management • Incidence – Inform parent/caregiver that children 6-24 mos. old have highest risk of ear infections. Explain relationship of AOM in infants to previous URIs

2008 National Health Care for the Homeless Council

1687. Treatment and recommendations for homeless people with asthma

, compromising routine asthma management and making episodic, crisis care more likely. However, providers should not be discouraged by this, and should continue to educate homeless clients about asthma control. ? Functional impairments – Cognitive deficits secondary to substance abuse, mental illness, trauma, and/or developmental disability may limit understanding of the disease process and compromise adherence to treatment. These should be taken into account when treating asthma. Involving case managers (...) of Contents Summary of Recommendations v Introduction 1 ADULT ASTHMA Case Study: Homeless Adult with Asthma 3 Diagnosis and Evaluation History 4 Physical examination 5 Diagnostic tests 6 Plan and Management Education, self-management 7 Medications 8 Associated problems/complications 9 Follow-up 10 PEDIATRIC ASTHMA Case Study: Homeless Child with Asthma 11 Diagnosis and Evaluation History 12 Physical examination 13 Diagnostic tests 13 Plan and Management Education, self-management 14 Medications 15

2008 National Health Care for the Homeless Council

1688. Botulinum neurotoxin in the treatment of autonomic disorders and pain

autonomic disorders associated with localized cholinergic overactivity. Its mode of action in pain, however, is less well understood. This article evaluates the current knowledge and evidence of BoNT in selected disorders of autonomic function and pain. DESCRIPTION OF THE ANALYTICAL PROCESS The literature search strategy, panel formation, and literature analytic process are described in the companion article on BoNT in the treatment of spasticity. Since the different preparations of BoNT have different (...) therapy, iontophoresis, or surgical procedures. Drooling may be a disabling problem in parkinsonian syndromes, amyotrophic lateral sclerosis, and cerebral palsy. In these disorders, drooling is primarily due to decreased swallowing rather than increased salivary production and may be amenable to pharmacologic treatment or local radiation and surgery in severe cases. Axillary hyperhidrosis. Two Class I studies and several Class II studies were identified in axillary hyperhidrosis (table e-1

2008 American Academy of Neurology

1689. Botulinum neurotoxin for the treatment of movement disorders

as an effective treatment for numerous movement disorders associated with muscle overactivity. Two companion articles provide reviews of the pharmacology and immunology of BoNT, and an evidence-based review of its use in spasticity, autonomic disorders, and pain. This article evaluates the current knowledge and evidence of BoNT in selected movement disorders. DESCRIPTION OF THE ANALYTICAL PROCESS The literature search strategy, panel formation, and literature analytic process are described in the companion (...) treatment. BoNT-A was superior to trihexyphenidyl for TWSTRS disability (2 points), Tsui scale (5 points), and general health perception (6 points). Although there was greater improvement in TWSTRS pain score with BoNT (2 points), this did not reach statistical significance. The total TWSTRS and TWSTRS severity scores were not given for either group. The trihexyphenidyl group had more adverse events (76 events vs 31 for BoNT-A, p < 0.0001). Four Class I studies enrolled subjects with previous response

2008 American Academy of Neurology

1690. Use of epidural steroid injections to treat radicular lumbosacral pain

of epidural steroid injections to treat radicular cervical pain (Level U). Chronic back pain and its associated disabilities represent an important health problem. The rising prevalence of obesity may increase the impact of chronic back pain. The competitive nature of the modern workplace places individuals with less than perfect health and, in particular, those with painful conditions at a disadvantage. Workplace accommodation may not be an option for many occupations and, even where possible (...) (TTA) produces evidence-based statements that assess the safety, utility, and effectiveness of new, emerging, or established therapeutic agents or technologies in the field of neurology. These are developed through a rigorous process of defining the topic, evaluating and rating the quality of the evidence, and translating the conclusions of the evidence into practical recommendations that can help to guide the practice of Neurology. Disclaimer. This statement is provided as an educational service

2007 American Academy of Neurology

1691. Clinical Guideline on the Treatment of Carpal Tunnel Syndrome

Clinical Guideline on the Treatment of Carpal Tunnel Syndrome CLINICAL PRACTICE GUIDELINE ON THE TREATMENT OF CARPAL TUNNEL SYNDROME Adopted by the American Academy of Orthopaedic Surgeons Board of Directors September 2008 This clinical guideline was developed by an AAOS physician volunteer Work Group and is provided as an educational tool based on an assessment of the current scientific and clinical information and accepted approaches to treatment. It is not intended to be a fixed protocol (...) postoperatively after routine carpal tunnel surgery (Grade B, Level II). We make no recommendation for or against the use of postoperative rehabilitation. (Inconclusive, Level II). Recommendation 9 We suggest physicians use one or more of the following instruments when assessing patients’ responses to CTS treatment for research: • Boston Carpal Tunnel Questionnaire (disease-specific) • DASH – Disabilities of the arm, shoulder, and hand (region-specific; upper limb) • MHQ – Michigan Hand Outcomes Questionnaire

2008 Congress of Neurological Surgeons

1692. Evaluation and Management of Adult Patients Presenting to the Emergency Department With Acute Headache

for an emergent* neuroimaging study. Level C recommendations. Patients who are older than 50 years and presenting with new type of headache but with a normal neurologic examination should be considered for an urgent† neuroimaging study. *Emergent studies are those essential for a timely decision regarding potentially life-threatening or severely disabling entities. †Urgent studies are those that are arranged prior to discharge from the ED (scan appointment is included in the disposition) or performed prior

2008 Congress of Neurological Surgeons

1693. Neutralizing antibodies to interferon-beta: assessment of their clinical and radiographic impact

-titers to IFNβ-1a compared to IFNβ-1b. Are NAbs to IFNβ associated with an increase in the activity or the severity of MS (measured either clinically or radiographically) in IFNβ-treated patients? Persistently high NAb titers to IFNβ seem likely to have an impact on the clinical and radiographic efficacy of IFNβ, particularly as assessed by MRI ( ). The effect of NAbs on clinical measures (especially measures of disease severity such as confirmed Expanded Disability Status Scale progression) is less (...) therapeutic agents or technologies in the field of neurology. Technology assessments and therapeutic assessments are developed through a rigorous process of defining the topic, evaluating and rating the quality of the evidence, and translating the conclusions of the evidence into practical assessments that can be used to guide the use of technologies and therapeutic agents in the practice of neurology. Disclaimer. This statement is provided as an educational service of the American Academy of Neurology

2007 American Academy of Neurology

1694. Neuroprotective strategies and alternative therapies for parkinson disease

treatments for the management of Parkinson disease (PD). These recommendations are meant to address the needs of specialists and nonspecialists caring for people with PD. Background and justification. PD is a neurodegenerative disorder characterized by the classic symptoms of bradykinesia, rigidity, and rest tremor. Although symptomatic therapy can provide benefit for many years, the disorder slowly progresses, eventually resulting in significant disability. Strategies to delay onset or slow progression (...) –August 2004, followed by a secondary search using the bibliographies of retrieved articles and knowledge from the expert panel extending to January 2005. The majority of articles were reviewed by the full panel. If a panelist was an author of one of the articles, at least two other panelists reviewed that article. If a disagreement was identified, consensus was reached by discussion with the whole group. The risk of bias for each study was determined using the classification of evidence scheme

2006 American Academy of Neurology

1695. Prediction of outcome in comatose survivors after cardiopulmonary resuscitation

, G. B. Young , C. L. Bassetti , S. Wiebe Neurology Jul 2006, 67 (2) 203-210; DOI: 10.1212/01.wnl.0000227183.21314.cd Citation Manager Formats Make Comment See Comments Downloads 68584 Share Abstract Objective: To systematically review outcomes in comatose survivors after cardiac arrest and cardiopulmonary resuscitation (CPR). Methods: The authors analyzed studies (1966 to 2006) that explored predictors of death or unconsciousness after 1 month or unconsciousness or severe disability after 6 (...) . Awakening generally takes place within 3 days after CPR, and neurologic impairment is expected if a patient fails to do so. These patients are often left in a severely cognitively disabled and fully dependent state; some remain in a minimally conscious or vegetative state, and very few awaken neurologically intact. The financial implications of caring for patients in a vegetative state or prolonged impaired consciousness are substantial. Health systems and family members directly are burdened

2006 American Academy of Neurology

1696. Diagnosis and prognosis of new onset parkinson disease

being the UK PD Society Brain Bank criteria (see appendix E-1 on the Neurology Web site at ). However, it has been suggested that an accuracy of 90% is the best that can be achieved with clinical assessment and clinical diagnostic criteria. Although symptomatic therapy can provide benefit for many years, PD is a progressive disorder that will eventually result in significant morbidity. Knowledge of the features that predict the rate of progression would empower clinicians to better counsel patients (...) . A second MEDLINE search covered 1966 through August 2004, followed by another search using the bibliographies of retrieved articles and knowledge from the expert panel extending to January 2005. At least two panel members reviewed each article. If a panelist was an author of one of the articles, at least two other panelists reviewed that article. If a disagreement was identified, consensus was reached by discussion with the whole group. The risk of bias for each study was determined using

2006 American Academy of Neurology

1697. Consent for anaesthesia 2 revised edition 2006

and training 27 Section 11 References 30 1 Consent A5 10/1/06 15:49 Page 1Section 1 Recommendations • Information about anaesthesia, preferably in the form of a patient- friendly leaflet, should be provided to patients undergoing elective surgery before they meet their anaesthetist. • The anaesthetic room immediately before induction is not an acceptable place or time to provide elective patients with new information other than in exceptional circumstances. • The amount and the nature of information (...) Consent A5 10/1/06 15:49 Page 2• The MCA places a duty upon carers to treat incapable patients in their best interests, to use the minimum necessary intervention when doing so, and to make efforts to reverse or minimise temporary incapacity to enable patients to make autonomous decisions. • When planning to allow trainees or others to use an opportunity presented by a patient for training in practical procedures, the anaesthetist should make every effort to minimise risk and maximise benefits

2006 Association of Anaesthetists of GB and Ireland

1698. Controlled drugs in perioperative care

Section 3 The Consultant Contract -Practical application Section 4 Direct Clinical Care Section 5 Supporting Activities Section 6 Additional NHS responsibilities Section 7 External Duties Section 8 On-Call Section 9 Leave Section 10 Pay and pensions Section 11 Clinical Excellence Awards Section 12 Appraisal and Continuing Medical Education Section 13 Work Diaries Section 14 Part time working Section 15 Job Plan Review and Appeal Section 16 Private Practice Section 17 Academic and Honorary Contracts (...) circumstances a consultant may wish to contract for fewer than 2.5 SPAs - but beware of the effect on appraisal and revalidation and on quality of care given to patients. Examples of SPA • Training (e.g. of trainees, medical students) • Continuing professional development (i.e. all regular activity such as reading journals, attending regular professional or academic meetings etc.) • Formal teaching (e.g. giving lectures, seminars) • Audit • Job planning • Appraisal • Research • Clinical management • Local

2006 Association of Anaesthetists of GB and Ireland

1699. Guidelines on Consent for Anaesthesia or Sedation

Professional Documents are progressively being coded as follows: TE Training and Educational EX Examinations PS Professional Standards T Technical POLICY – defined as ‘a course of action adopted and pursued by the College’. These are matters coming within the authority and control of the College. RECOMMENDATIONS – defined as ‘advisable courses of action’. GUIDELINES – defined as ‘a document offering advice’. These may be clinical (in which case they will eventually be evidence-based), or non-clinical (...) be of concern. GENERAL PRINCIPLES The standard for consent in Australia is established by the common law. In New Zealand it is embodied in the Code of Health and Disability Services Consumers’ Rights. Consent for treatment provided by an anaesthetist is different from a statement as to the necessity for anaesthesia (which may form part of the consent for an operative procedure). Although legal processes that test the validity of consent differ, both Australian and New Zealand law state that the provision

2005 Australian and New Zealand College of Anaesthetists

1700. Recommendations for the Pre-Anaesthesia Consultation

: A Guide for Clinicians, and PS26 Guidelines on Consent for Anaesthesia or Sedation). These requirements are also reflected in the New Zealand Code of Health and Disability Consumers’ Rights 6 issued by the New Zealand Health and Disability Commissioner, and the Australian Charter of Healthcare Rights 7 (endorsed July 2008). 2. PURPOSE The purpose of this document is to assist practitioners to ensure that patients are adequately assessed, prepared, and have given consent for the recommended treatment (...) of the anaesthetist’s role in health advocacy, as well as in optimal preparation or surgery, the pre-anaesthesia consultation is a valuable opportunity to encourage and educate patients regarding modifiable health factors such as encouraging smokers to quit (see PS12 Guidelines on Smoking as Related to the Perioperative Period). 5.13 The pre-anaesthesia consultation should identify and take note of any advanced care directives. In their absence the consultation may represent an appropriate opportunity to recommend

2008 Australian and New Zealand College of Anaesthetists

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