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982. Approaches to Enhancing Radiation Safety in Cardiovascular Imaging (Full text)

of care because of the invasive nature of these procedures. In addition to the above-mentioned potential radiogenic cancer risk, discussion of the potential for exceeding the thresholds for deterministic effects of radiation exposure with these procedures, including hair loss and skin injury, should be part of the informed consent for these procedures. In a recent survey of US practice, ≈7% to 10% of patients undergoing percutaneous coronary intervention or combined diagnostic and percutaneous (...) descriptor of radiation dose. Table 4. Fluoroscopic Radiation Dose Metrics Dose metric Unit Clinical utility of the dose metric Substantial radiation dose level Total air kerma at the reference point ( K a,r ) Gy Predictor of the risk of a skin injury; K a,r is not a direct measure of maximum skin dose 5 Gy Air kerma-area product. ( P KA ) (also known as dose-area product) Gy-cm 2 Integrated value of air kerma delivered to the patient, used to calculate relative stochastic risk; not an absolute risk

2014 American Heart Association PubMed abstract

983. Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12?25 Years of Age) (Full text)

cardiovascular disease include bronchial asthma, ruptured cerebral aneurysm, use of performance-enhancing or other drugs and substances, heat stroke, and pulmonary embolus. The mechanism of death in the vast majority of these events is a ventricular tachyarrhythmia, with the major exception being Marfan syndrome and related disorders associated with aortic dilatation, in which SD usually occurs because of aortic dissection/rupture. SDs occur in a wide variety of sports, most commonly football and basketball (...) . By convention, participation in such sports has been the prerogative and responsibility of the adult athlete, who accepts the inherent risks of serious injury or death during athletic competition. SD/cardiac arrest event rates are reported to be ≈0.5 per 100 000 marathon competitors, with fatalities in recent events less common because of the greater availability of automated external defibrillators on the race course. In triathlon competition (which includes distance running up to the marathon distance), 1

2014 American Heart Association PubMed abstract

984. Type 1 Diabetes Mellitus and Cardiovascular Disease: A Scientific Statement From the American Heart Association and American Diabetes Association (Full text)

, interleukin-6, and markers of platelet aggregation. These studies suggest that acute hypoglycemia in T1DM produces complex vascular effects involved in the activation of proinflammatory, prothrombotic, and proatherogenic mechanisms. Excess adiposity, in general a proinflammatory state, is associated with both microvascular and macrovascular complications in T1DM. , Levels of the adipokine leptin and its associated leptin receptor, which are involved in signaling satiety in the brain, are also increased

2014 American Heart Association PubMed abstract

986. Cervical Arterial Dissections and Association With Cervical Manipulative Therapy (Full text)

in a considerable number of CDs. Traumatic CDs can occur as the result of major blunt or penetrating trauma. In patients with blunt cervical trauma, the prevalence of CD is ≈1% to 2%, and this risk increases as the intensity of the external force increases such as that seen with concomitant major thoracic injuries, severe facial fractures, skull base fractures, and traumatic brain injury. CDs also can occur with minor trauma characterized by hyperextension, rotation, or lateroversion of the neck; various (...) horizontally in a groove on the superior aspect of the posterior arch of the atlas, adjacent to the atlanto-axial junction (C1-C2) where most rotation occurs, is most susceptible to injury. The V4 segment is the intracranial portion, after it has pierced the dura mater to enter the foramen magnum to join the opposite VA at the medullopontine level. During high-velocity, low-amplitude manipulation, a controlled force is applied to a joint in a specified direction, , causing movement of that joint

2014 American Heart Association PubMed abstract

987. Practice Guidelines for the Perioperative Management of Patients with Obstructive Sleep Apnea

studies report other pertinent patient characteristics associated with OSA that may be available in medical records, such as hypertension, history of stroke, , history of myocardial infarction, diabetes mellitus, or abnormal cephalometric measurements. ( Category B1-H evidence ). Noncomparative observational studies and case reports indicate that certain congenital conditions ( e.g. , Down syndrome, acromegaly) and disease states ( e.g. , neuromuscular disease, cerebral palsy) may also be associated

2014 American Society of Anesthesiologists

988. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes (Full text)

for a diagnosis of NSTEMI. Abnormalities on the ECG and elevated troponins in isolation are insufficient to make the diagnosis of ACS but must be interpreted in the appropriate clinical context. Thus, UA and NSTEMI are closely related conditions whose pathogenesis and clinical presentations are similar but vary in severity. The conditions differ primarily by whether the ischemia is severe enough to cause myocardial damage leading to detectable quantities of myocardial injury biomarkers. The term “possible ACS (...) ” is often assigned during initial evaluation if the ECG is unrevealing and troponin data are not yet available. UA can present without any objective data of myocardial ischemic injury (normal ECG and normal troponin), in which case the initial diagnosis depends solely on the patient’s clinical history and the clinician’s interpretation and judgment. However, with the increasing sensitivity of troponin assays, biomarker-negative ACS (ie, UA) is becoming rarer. The pathogenesis of ACS is considered

2014 American Heart Association PubMed abstract

989. Tinnitus

. Nonauditory sys- tem disorders that can cause tinnitus include vascular anomalies, myoclonus, and intracranial hypertension. Management of secondary tinnitus is targeted toward identification and treatment of the specific underly- ing condition and is not the focus of this guideline. Despite the high prevalence of tinnitus and its potential signifi- cant effect on QOL, there are no evidence-based, multidisci- plinary CPGs to assist clinicians with management. This guideline attempts to fill this void (...) of 3753 adults, there was an 8.2% baseline prevalence of tinnitus, with a new incidence of 5.7% after 5 years, rising to a 12.7% cumulative incidence at the 10-year follow-up. 24 Another study of 1292 adults found that the incidence of new tinnitus after 5 years was 18.0%. 25 Risk fac- tors were not consistent among studies but included male sex, history of arthritis or head injury, preexisting hearing loss, and any history of tobacco use. Tinnitus may improve spontaneously. In 1 cohort study, nearly

2014 American Academy of Otolaryngology - Head and Neck Surgery

990. Management of Benign Anorectal Disorders

with DD 65 Balloon defecation training Biofeedback superior DD, defecatory disorder; PEG, polyethylene glycol. © 2014 by the American College of Gastroenterology The American Journal of GASTROENTEROLOGY 7 ACG Guidelines Fecal Incontinence mass index, diarrhea, rectal urgency, cholecystectomy, anal fi stula, non-childbirth anal injury, urinary incontinence, chronic illnesses (e.g., diabetes mellitus or stroke), and psychoactive medications are associated with FI ( 64 – 70 ). Among women (...) with no underlying systemic disease, diarrhea and rectal urgency are the strongest independent risk factors for FI. Although obstetric anal sphincter injury can cause immediate FI, it more typically b e gin s 2 – 3 decades a ft er vaginal delivery among unselected w omen ( 62 ). Th ese observations suggest that similar to urinary incontinence, obstetric pelvic fl oor injury is an important risk factor for early-onset FI (e.g., postpartum FI) but much less so for late-onset FI. Recommendations for diagnostic

2014 American College of Gastroenterology

991. 2014 ACC/AHA Key Data Elements and Definitions for Cardiovascular Endpoint Events in Clinical Trials (Full text)

for the development of this vocabulary. The Writing Committee’s task was to review, refine, and advance as a clinical standard the cardiovascular endpoint terminology set developed by the SCTI. This terminology set largely reflects endpoints related to the symptoms, manifestations, treatment, and consequences of coronary artery disease in both cardiovascular and noncardiovascular drug and device trials. Endpoint concepts related to carotid/cerebral revascularization, peripheral surgical revascularization (...) categories but with a specific known cause, such as a pulmonary embolism or peripheral arterial disease. In addition, “death due to cardiovascular hemorrhage” refers to a death related to hemorrhage such as a nonstroke intracranial hemorrhage, nonprocedural or nontraumatic vascular rupture (eg, aortic aneurysm), or pulmonary hemorrhage from a pulmonary embolism. In contrast, if a pulmonary hemorrhage were a result of a contusion from a motor vehicle accident, the cause of death would be noncardiovascular

2014 American Heart Association PubMed abstract

992. AIUM Practice Parameter for the Performance of Neurosonography in Neonates and Infants

brain imaging. In: Slovis TL, Coley BD, Bulas DI, et al (eds). Caffey’s Pediatric Diagnostic Imaging. Vol 1. Philadelphia, PA: Elsevier; 2008:398–429. 6. Kersbergen KJ, Groenendaal F, Benders MJ, de Vries LS. Neonatal cerebral sinovenous thrombosis: neuroimaging and long-term follow-up. J Child Neurol 2011; 26:1111–1120. 7. Vizcaino-Diaz C, Sanchez-Zaplana H, Ruiz JC, Jimenez-Cobo B. Rupture of intracranial arterial aneurysms in neonates: case report and review of the literature. J Child Neurol 2009 (...) space, including only peripheral brain structures (superior sagittal sinus at the level of the frontal horns; measure the sinocortical distance, craniocortical distance, and width of the interhemispheric fissure). 17 The transducer may be tilted from side to side to image as much of the superficial peripheral surfaces of the cerebral hemispheres as possible. The appropriate frequency of the transducer should be selected to ensure that the superficial and deep structures are well depicted. In some

2014 American Institute of Ultrasound in Medicine

994. Perioperative Beta Blockade in Noncardiac Surgery: A Systematic Review for the 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery

million individuals who undergo surgery worldwide every year (1). After surgery, 2% of these patients suffer major cardiac complications (2), and 8% show evidence of significant myocardial injury (3). Perioperative beta blockade showed early promise as a means of preventing these complications, with enthusiasm driven by promising results in 2 RCTs (4, 5). Consequently, perioperative beta blockade was recommended for a fairly broad spectrum of surgical patients in initial versions of the American

2014 Society for Cardiovascular Angiography and Interventions

996. Management of Acute ST Segment Elevation Myocardial Infarction (STEMI) ? (3rd Edition)

• Risk of intracranial haemorrhage o History of intracranial bleed. o History of ischaemic stroke within 3 months. o Known structural cerebral vascular lesion (e.g. arteriovenous malformation). o Known intracranial neoplasm. • Risk of bleeding o Active bleeding or bleeding diathesis (excluding menses). o Significant head trauma within 3 months. o Suspected aortic dissection. Relative contraindications • Risk of intracranial haemorrhage o Severe uncontrolled hypertension on presentation (blood

2014 Ministry of Health, Malaysia

997. Clinical Practice guideline on the diagnosis and treatment of hyponatraemia

of water-loading tests. In addition, during group discussions, a fear of water-loading tests in patients with hypotonic hyponatraemia was ex- pressed, as they may aggravate hypotonicity. Ultimately, it was decided to issue a warning against using it as a diag- nostictestinSIAD. Cerebral salt wasting is a rare condition that has been observed in patients with intracranial disorders such as subarachnoid bleeding [41]. It can reduce extracellular ?uidvolumeduetoprofoundnatriuresis.Averyhighurine sodium (...) . This is seen in patients with anorexia (nervosa), beer potomania and so-called ‘tea andtoast’hyponatraemia[53]. 5.9.Hypotonichyponatraemiawithincreased extracellular?uidvolume 5.9.1. Kidney disease. When glomerular ?ltration rate deteriorates, or when there is tubular injury or scarring, the ability to dilute urine and excrete free water decreases. In ad- vanced kidney disease, urine osmolality is usually close to serum osmolality (isosthenuria). Free water removal is no longer regulated by vasopressin

2014 European Renal Best Practice

998. Diagnosis and Treatment of Overactive Bladder (Non-Neurogenic) in Adults: AUA/SUFU Guideline

complicated OAB patients. These co-morbid conditions include neurologic diseases (i.e., stroke, multiple sclerosis, spinal cord injury), mobility deficits, medically complicated/uncontrolled diabetes, fecal motility disorders (fecal incontinence/ constipation), chronic pelvic pain, history of recurrent urinary tract infections (UTIs), gross hematuria, prior pelvic/vaginal surgeries (incontinence/prolapse surgeries), pelvic cancer (bladder, colon, cervix, uterus, prostate) and pelvic radiation. The female

2014 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction

999. Child abuse: identification and action to be taken

or more risk factors should not eliminate a diagnosis of abuse. Case history The following should be suggestive of abuse: ? with infants: cases where parents report the baby is crying inconsolably and say that they are suffering from nervous exhaustion; ? at any age if: ? the abuse of a child or adolescent is disclosed by the victim, by a parent or by a third party, ? there is an injury for which: - there is a discrepancy between the injury observed, the age, level of development of the child (...) injury, regardless of their location. Burns The following are suggestive of abuse: ? burns with a sharp edge that could be the result of immersion (shaped like gloves or socks); ? contact burns with the shape of the causative agent (domestic appliance, cigarette); ? burns extending into the body creases; ? burns located on regions normally protected by clothes (buttocks, perineum); ? abrasions (can mimic burns) of the wrists and ankles (restraint by means of bonds). Guidance Leaflet – Child abuse

2014 HAS Guidelines

1000. Diagnosis and Treatment of Non-Neurogenic Overactive Bladder (OAB) in Adults: AUA/SUFU Guideline

. Patients may avoid certain activities (e.g., travel, situations that do not allow easy access to a toilet) because of their bladder symptoms. Co-morbid conditions should be completely elicited as these conditions may directly impact bladder function. Patients with co-morbid conditions and OAB symptoms would be considered complicated OAB patients. These co-morbid conditions include neurologic diseases (i.e., stroke, multiple sclerosis, spinal cord injury), mobility deficits, medically complicated

2014 American Urological Association

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