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brain injury

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181. Integrated care for older people (?ICOPE)?: guidance for person-centred assessment and pathways in primary care

Martin (King’s College London, United Kingdom). Sarah Johnson and Ward Rinehart of Jura Editorial Services were responsible for writing the final text. Many other WHO staff from the regional offices and a range of departments contributed both to specific sections relevant to their areas of work and to the development of the care pathways: Shelly Chadha (WHO Department of Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention), Neerja Chowdhary (WHO Department of Mental (...) Health and Substance Abuse), Tarun Dua (WHO Department of Mental Health and Substance Abuse), Maria De Las Nieves Garcia Casal (WHO Department of Nutrition for Health and Development), Zee A Han (WHO Department of Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention), Dena Javadi (WHO Department of Alliance for Health Policy and Systems Research), Silvio Paolo Mariotti (WHO Department of Management of Noncommunicable Diseases, Disability, Violence and Injury Prevention

2019 World Health Organisation Guidelines

182. Stroke, Diagnosis and Initial Treatment of Ischemic Stroke

III: Harm; LOE C-EO) Agree 2. There remains insufficient evidence to identify a threshold of hypoattenuation severity or extent that affects treatment response to alteplase. However, administering IV alteplase to patients whose CT brain imaging exhibits extensive regions of clear hypoattenuation is not recommended. These patients have a poor prognosis despite IV alteplase, and severe hypoattenuation defined as obvious hypodensity represents irreversible injury. (Class III: No Benefit; LOE A) Agree (...) early care for persons with an onset of stroke symp- toms. The recommendations in this guideline are for early management of stroke due to ischemic brain ischemia/infarction. This guideline does not address stroke prevention, transient ischemic stroke (TIA) or management of hemorrhagic stroke. To increase access to appropriate early care for stroke, Minnesota passed legislation to authorize the Minnesota Department of Health (MDH) to designate hospitals as Acute Stroke-Ready Hospitals, Primary

2019 Institute for Clinical Systems Improvement

183. Vaccine-preventable Infections and Immunization in Multiple Sclerosis

cases for Physicians Review Organization of Michigan and serves as a blinded rater for multiclinic clinical drug trials for MS, Parkinson disease, dementia, and epilepsy. Her spouse reviews adult cases for the Physician Review Organization of Michigan and serves as a principal investigator. 5 Y. Holler-Managan receives funding for travel from the AAN and serves on the editorial advisory board for Brain & Life. N. Kachuck has served on speakers bureaus for Teva Pharmaceuticals and Acorda Therapeutics (...) , continuing medical education companies, the University of South Florida, and the University of Massachusetts; and has provided expert testimony as a defense expert witness. M. Beilman reports no disclosures. G. Gronseth serves as an associate editor of Neurology; serves on the editorial advisory board for Brain & Life; served as a paid evidence-based medicine methodologist for the AAN; and received honoraria for presentations given at the AAN Annual Meeting. D. Michelson receives publishing royalties

2019 American Academy of Neurology

184. Identifying Child Abuse Fatalities During Infancy

abuse fatalities, with approximately 3700 sudden unexpected infant deaths in 2015 in the United States. However, deaths reported as child maltreatment fatalities are believed to be underestimates, with more than triple the number officially reported being estimated to occur. , Closed head injury is considered the leading cause of fatal abuse, with a peak incidence at 1 to 2 months of age, a time period that overlaps with sudden unexpected infant deaths. Several findings, such as subdural hematoma (...) and computed tomography (CT) imaging performed before autopsy may reveal evidence of traumatic skeletal injury or skeletal abnormalities indicative of a naturally occurring illness. The presence of both old and new traumatic injuries as well as fractures specific for abuse may suggest inflicted injuries and may lend focus to the postmortem examination, investigation of the circumstances of death, and police investigation. Ideally, such imaging should only be performed at the direction of the medical

2019 American Academy of Pediatrics

185. Dementia

Alzheimer disease (AD), frontotemporal dementia (FTD), Lewy bodies disease, vascular dementia (VaD), and mixed dementias [2]. Although the causes of most dementias remain elusive, genetic research has opened many frontiers to understanding the pathophysiology of heretofore enigmas such as AD [1,3]. Additionally, infectious, autoimmune, and toxic etiologies have become increasingly more appreciated as causes of cognitive decline. Trauma with brain injury may also be associated with premature dementia (...) of the final document. Reprint requests to: ACR Appropriateness Criteria ® 5 Dementia The major AD biomarkers that have been widely investigated at this time [7] can be subdivided into two classes based on the biology that is measured. Biomarkers of brain amyloid-beta (Aß) protein deposition are low CSF Aß42 and positive PET amyloid imaging. The second category is that of biomarkers of downstream neuronal degeneration or injury. The three major biomarkers in this category are 1

2019 American College of Radiology

186. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents

. – Treatment discontinuation also places individuals with ADHD at higher risk for catastrophic outcomes, such as motor vehicle crashes , ; criminality, including drug-related crimes and violent reoffending ; depression ; interpersonal issues ; and other injuries. , To continue providing the best care, it is important for a treating pediatrician or other PCC to engage in bidirectional communication with teachers and other school personnel as well as mental health clinicians involved in the child

2019 American Academy of Pediatrics

187. Movement Disorder and Neurodegenerative Diseases.

contrast Usually Appropriate O CT head without IV contrast May Be Appropriate ??? FDG-PET/CT brain May Be Appropriate ???? Tc-99m HMPAO SPECT/CT brain May Be Appropriate ???? MR spectroscopy head without IV contrast Usually Not Appropriate O CT head with IV contrast Usually Not Appropriate ??? CT head without and with IV contrast Usually Not Appropriate ??? MRI functional (fMRI) head without IV contrast Usually Not Appropriate O Variant 2: Chorea; suspected Huntington disease. Initial imaging (...) . Procedure Appropriateness Category Relative Radiation Level MRI head without IV contrast Usually Appropriate O MRI head without and with IV contrast May Be Appropriate O CT head without IV contrast May Be Appropriate ??? CT head with IV contrast Usually Not Appropriate ??? CT head without and with IV contrast Usually Not Appropriate ??? FDG-PET/CT brain Usually Not Appropriate ???? MR spectroscopy head without IV contrast Usually Not Appropriate O MRI functional (fMRI) head without IV contrast Usually

2019 American College of Radiology

188. Intrapartum fetal surveillance

aim of intrapartum fetal surveillance is to prevent adverse perinatal outcomes arising from fetal metabolic acidosis related to labour. 2 As the fetal brain modulates the fetal heart rate (FHR) through an interplay of sympathetic and parasympathetic forces, fetal heart rate monitoring can be used as an indicator of whether or not a fetus is well oxygenated. 3 In the absence of risk factors FHR surveillance by continuous electronic fetal monitoring (CEFM) does not provide proven benefit and may (...) and Care Excellence. Interpretation of cardiotoograph traces. Clinical Guideline No. 190. 2014. 23. Stampalija T, Signaroldi M, Mastroianni C, Rosti E, Signorelli V, Casati D, et al. Fetal and maternal heart rate confusion during intra-partum monitoring: comparison of trans-abdominal fetal electrocardiogram and doppler telemetry. Journal of Maternal-Fetal and Neonatal Medicine 2012;25(8):1517-20. 24. Miyashiro M, Mintz-Hittner H. Penetrating ocular injury with a fetal scalp monitoring spiral electrode

2019 Queensland Health

190. Standardization of Spirometry

and recovery from exacerbations To monitor people for adverse effects of exposure to injurious agents To watch for adverse reactions to drugs with known pulmonary toxicity Disability/impairment evaluations To assess patients as part of a rehabilitation program To assess risks as part of an insurance evaluation To assess individuals for legal reasons Other Research and clinical trials Epidemiological surveys Derivation of reference equations Preemployment and lung health monitoring for at-risk occupations (...) for Spirometry Due to increases in myocardial demand or changes in blood pressure Acute myocardial infarction within 1 wk Systemic hypotension or severe hypertension Significant atrial/ventricular arrhythmia Noncompensated heart failure Uncontrolled pulmonary hypertension Acute cor pulmonale Clinically unstable pulmonary embolism History of syncope related to forced expiration/cough Due to increases in intracranial/intraocular pressure Cerebral aneurysm Brain surgery within 4 wk Recent concussion

2019 American Thoracic Society

192. Characteristics, Prevention, and Management of Cardiovascular Disease in People Living With HIV: A Scientific Statement From the American Heart Association

(eg, middle cerebral and perforator) arteries are distinct and differ in their degree of media and adventitia thickness and presence or absence of dura mater. The additional barrier from the blood-brain interface, which is relevant to intracranial arteries, prevents systemic infection and freely circulating antibodies in the brain. However, HIV infection manipulates this barrier and enters an immune-naïve brain early during primary infection. These characteristics influence how extracranial (...) strategies evolve for CVD prevention in HIV (ranging from statins with demonstrated stroke prevention benefit to newer anti-inflammatory drugs), consideration for those that cross the blood-brain barrier will be critical in addressing the burden of intracranial arterial disease in the future. HF Pathogenesis and Presentation in HIV Myocardial dysfunction and HF have been known complications of HIV since the first reports of AIDS cardiomyopathy in the 1980s. Cases of AIDS cardiomyopathy in the pre-ART era

2019 American Heart Association

193. Evaluation and Management of the Child and Adult With Fontan Circulation: A Scientific Statement From the American Heart Association

patients with Fontan circulation are surviving into adulthood in greater numbers, their management is affected by a relative scarcity of medical knowledge of the pathophysiological origin and optimal care for their unique condition. Potential complications involve not only the heart but also multiple organ systems, including the liver, lungs, brain, bones, and lymphatic system. The end-organ consequences of the Fontan circulation are ubiquitous and usually progressive. Appropriate medical care (...) a 6-fold increase in death or transplantation and 6-year mortality of >40%. Patients with Fontan circulation with atrial tachycardia are more likely to develop right atrial thrombus, heart failure, and ventricular dysfunction and to require hospitalization. Traditionally, sinus node dysfunction and atrial tachycardia have been attributed to injury to the sinus node or its arterial supply, atrial suture lines, atrial dilatation, and hypertrophy related to elevated atrial pressures. Important causes

2019 American Heart Association

194. The Utility and Practice of Electrodiagnostic Testing in the Pediatric Population: An AANEM Consensus Statement

with localizing the site of injury which can include: muscle (e.g., nemaline rod myopathy), peripheral nerve (e.g., obstetrical trauma) or brainstem nuclei (e.g., brain stem dysgenesis). Normal values for facial nerve motor NCSs are available for age ranges throughout childhood 77 . Blink reflex testing evaluates integrity of the trigeminal and facial nerves as well as the pathways between their cranial nuclei. A supramaximal shock is applied to the supraorbital branch of the trigeminal nerve resulting (...) for traumatic and other acquired injuries have increased 2 . Additionally, selected standard electrophysiologic measures such as compound muscle action potentials (CMAPs) are being used in pediatric clinical trials, This article is protected by copyright. All rights reserved.Pediatric EDX Statement, page along with specialized electrophysiologic measures such as motor unit number estimation (MUNE) 3 . Despite this stable and perhaps increasing demand for pediatric EDX testing, the availability

2019 American Association of Neuromuscular & Electrodiagnostic Medicine

196. Child Abuse, Elder Abuse, and Intimate Partner Violence

. 14,15 One study reported that implementation of a standardized guideline did not result in increased resource utilization, including decreased admissions and no change in use of CT scans. 16 10Best Practices Guidelines for Trauma Center Recognition: Child Abuse Table 1. Clinical Screening Tools for Child Abuse Clinical Tool Intended Population Exclusion Criteria Injuries/Findings Validation Study Results Pediatric Brain Injury Research Network (PediBIRN) 10 Children under 3 years of age admitted (...) to the pediatric ICU with an acute, closed, traumatic cranial or intracranial injury; tool now also validated in an ED setting 19 y Imaging reveals “pre- existing brain malformation, disease, infection, or hypoxia- ischemia” y Injuries resulting from a motor vehicular collision The 4 variables used were: y Clinically significant respiratory compromise any time prior to admission; y Bruising of the torso, ears, neck; y Subdural hematoma or fluid bilaterally and/or in the interhemispheric fissure; y Any skull

2019 American College of Surgeons

197. 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, I

in the available OHCA trials would have a larger beneficial effect also remains uncertain but is suggested by observational data. That stated, the ALS Task Force acknowledged the importance of considering the cost burden incurred with a potential increase in short-term survival with unfavorable neurological outcome. Conversely, an increase in ROSC may allow the development of other treatments to prevent or mitigate neurological injury. The opportunity for families to see patients before death

2019 American Heart Association

198. Interventional Therapies for Acute Pulmonary Embolism: Current Status and Principles for the Development of Novel Evidence: A Scientific Statement From the American Heart Association

strain without hypotension (see above) primarily identifies these patients. RV strain includes RV dysfunction on computed tomography pulmonary angiography or echocardiography (RV/left ventricular [LV] ratio >0.9) , or RV injury and pressure overload detected by an increase in cardiac biomarkers such as troponins or brain natriuretic hormone. There are differences in the patients that the AHA and ESC include in this risk category. The AHA criterion for submassive PE is RV strain without hypotension (...) of complications or because hemodynamic measurements or imaging via PA catheterization reveals unexpected findings. Table 2. Risk Factors for Bleeding With and Contraindications to Use of Thrombolytic Therapy (Both Systemic and Locally Administered) Major contraindications Structural intracranial disease Previous ICH Ischemic stroke within 3 mo Active bleeding Recent brain or spinal surgery Recent head trauma with fracture or brain injury Bleeding diathesis Relative contraindications Systolic blood pressure

2019 American Heart Association

199. Use of Human Induced Pluripotent Stem Cell–Derived Cardiomyocytes in Preclinical Cancer Drug Cardiotoxicity Testing: A Scientific Statement From the American Heart Association

upstream biomarkers such as transcriptional changes, cardiac troponins, brain natriuretic peptide, microRNAs, or vesicles. Such studies may provide insights into direct cardiotoxic mechanisms and novel biomarkers for in vitro or subsequent clinical applications. Studies comparing biomarkers of myocardial injury–structural cardiotoxicity with general cytotoxicity studies (eg, human stem cell–derived neuronal or hepatic preparations) would be useful for elucidating general cytotoxic effects versus (...) , MD, PhD, FAHA , MD, PhD, FAHA, Vice Chair Gary Gintant , Paul Burridge , Lior Gepstein , Sian Harding , Todd Herron , Charles Hong , José Jalife , Joseph C. Wu , Originally published 19 Sep 2019 Circulation Research. 2019;125:e75–e92 Abstract It is now well recognized that many lifesaving oncology drugs may adversely affect the heart and cardiovascular system, including causing irreversible cardiac injury that can result in reduced quality of life. These effects, which may manifest in the short

2019 American Heart Association

200. Standards for Studies of Neurological Prognostication in Comatose Survivors of Cardiac Arrest: A Scientific Statement From the American Heart Association

, but mortality remains high. Most of the poor outcomes and deaths of cardiac arrest survivors have been attributed to widespread brain injury. This brain injury, commonly manifested as a comatose state, is a marker of poor outcome and a major basis for unfavorable neurological prognostication. Accurate prognostication is important to avoid pursuing futile treatments when poor outcome is inevitable but also to avoid an inappropriate withdrawal of life-sustaining treatment in patients who may otherwise have (...) cardiac arrest (OHCA) and 209 000 cases of in-hospital cardiac arrest (IHCA) in the United States. The survival to hospital discharge was 12% for OHCA and 25% for IHCA. For OHCA, survival with good neurological outcome is 8%. The vast majority of patients successfully resuscitated from cardiac arrest present in coma or with an altered level of consciousness caused by the widespread nature of brain injury after cardiac arrest. Although most of the deaths in patients initially resuscitated from cardiac

2019 American Heart Association


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