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181. Guidelines for adult stroke rehabilitation and recovery

). Apathy is mani- fested in >50% of survivors at 1 year after stroke 5 ; fatigue is a common and debilitating symptom in chronic stroke 6 ; daily physical activity of community-living stroke survivors is low 7 ; and depressive symptomology is high. 8 By 4 years after onset, >30% of stroke survivors report persistent participation restrictions (eg, difficulty with autonomy, engagement, or ful- filling societal roles). 9 The Rehabilitation Program Organization of Poststroke Rehabilitation Care (Levels (...) review therapy, motivational interviewing, nursing support programs, and physical exercise. Rehabilitation, Exercise, and Recovery A study with 49 depressed patients (24 treated for depres- sion and 25 not treated as determined by physician prefer- ence) was conducted to evaluate the effects of poststroke depression and antidepressant therapy on the improvement of motor scores and disability. 229 Poststroke depression was found to have negative effects on functional recovery, and the pharmacological

2016 American Academy of Neurology

182. Youth Sport Programs that Address Substance Use ? An Environmental Scan

found that participation in sports in school and sports where a coach was present was associated with less substance use, while out-of-school sport participation was associated with increased marijuana use (Sztainert, 2015). These inconsistent findings might be due in part to the complexity of measuring sport’s effect on substance use. The National Institute on Drug Abuse has stated that there are significant knowledge gaps when attempting to understand the relationship between physical activity (...) for the participant to change his or her behaviour. ? Programs that provided access to sport made sport available to youth to divert them from drug-related behaviours (e.g., the First Choice Physical Fitness Program). There is a lack of evaluation of these program types in terms of reducing substance use, but they might increase physical activity for participants. ? Multilevel programs used many of the above components in their program delivery, (e.g., the Athletic Prevention, Programming and Leadership Education

2016 Canadian Centre on Substance Abuse

183. Establishing breastfeeding

Refer to Table 6. Skin to skin contact and Table 7. Baby feeding patterns • Offer anticipatory guidance for managing minor concerns 2 • Offer information about breastfeeding support in the community o Peer counselling promotes the initiation and maintenance of breastfeeding 37 • Offer information about optimal maternal nutrition and physical activity 40 • Recommend an iodine supplement 150 micrograms oral daily 41 o Women with pre-existing thyroid conditions should seek advice from their general (...) Breastfeeding away from home o Maximising breastmilk if infant formula has been introduced o Continuing to breastfeed upon return to work o Contraception o Normal changes over time o Appropriate nutrition for babies o Smoking and alcohol consumption • Encourage review of baby by a health care professional at five to seven days of age o Refer to Queensland Clinical Guideline: Routine newborn assessment 73 Nutrition and physical activity • Provide advice about nutrition as per the Australian dietary

2016 Clinical Practice Guidelines Portal

184. Impact of Hypertension on Cognitive Function: A Scientific Statement From the American Heart Association

of experts examines the impact of hypertension on cognition to assess the state of the knowledge, to identify gaps, and to provide future directions. Methods— Authors with relevant expertise were selected to contribute to this statement in accordance with the American Heart Association conflict-of-interest management policy. Panel members were assigned topics relevant to their areas of expertise, reviewed the literature, and summarized the available data. Results— Hypertension disrupts the structure (...) cognition is not conclusive. Conclusions— After carefully reviewing the literature, the group concluded that there were insufficient data to make evidence-based recommendations. However, judicious treatment of hypertension, taking into account goals of care and individual characteristics (eg, age and comorbidities), seems justified to safeguard vascular health and, as a consequence, brain health. Introduction Dementia is a progressive and typically irreversible deterioration of cognitive function

2016 American Heart Association

185. AHA/ASA Guidelines for Adult Stroke Rehabilitation and Recovery

reintegration, health-related quality of life, maintenance of activity, and self-efficacy (ie, belief in one’s capability to carry out a behavior). Apathy is manifested in >50% of survivors at 1 year after stroke ; fatigue is a common and debilitating symptom in chronic stroke ; daily physical activity of community-living stroke survivors is low ; and depressive symptomology is high. By 4 years after onset, >30% of stroke survivors report persistent participation restrictions (eg, difficulty with autonomy (...) resting position of the scapula in lateral rotation. , Compared with those without voluntary movement, patients with some movement in the painful hemiparetic shoulder have a higher rate of shoulder joint tissue injury on magnetic resonance imaging, suggesting that more physical activity promotes injury. However, the relationship between altered kinematics and pain in the hemiparetic shoulder has not been established. For example, shoulder joint kinematics are altered with spasticity, yet

2016 American Heart Association

186. Delirium, Dementia, and Depression in Older Adults: Assessment and Care, Second Edition

expert panel was interprofessional in composition, comprising individuals holding clinical, administrative, and academic positions in a range of health- care organizations, practice areas, and sectors. These experts work with older adults receiving care and services in different types of health-care settings (acute care, long-term care G , home health care, mental health, and in the community in primary care and family health teams), as well as in other types of organizations such as associations (...) family/care partners, and the interprofessional team . V Recommendation 1 .3: Refer older adults suspected of delirium, dementia, and/or depression to the appropriate clinicians, teams, or services for further assessment, diagnosis, and/or follow-up care . Ia Recommendation 1 .4a: Assess the person’s ability to understand and appreciate information relevant to making decisions and, if concerns arise regarding the person’s mental capacity, collaborate with other members of the health-care team

2016 Registered Nurses' Association of Ontario

187. Clinical Practice Guidelines on Obesity

by the patient, and the diagnostic and treatment options available. Statement of IntentContents Key Guideline Recommendations 1 1 Introduction 19 2 Epidemiology, public health aspects and definition 21 3 Clinical significance of obesity 26 4 Diagnosis and Classification 30 5 Assessment 36 6 Treatment: Introduction 41 7 Treatment: Diet 43 8 Treatment: Physical activity 53 9 Treatment: Behavioural modifications and related therapy 58 10 Treatment: Information and communication technology (ICT) and tools (...) , obesity is preventable, thus making it a public health priority to address. As part of the obesity control efforts, Singapore continually empowers health professionals to better manage obesity in the community. With the updating of the Obesity Clinical Practice Guidelines, the revised guidelines aim to equip health professionals with the evidence-base for a holistic multi-disciplinary approach to manage obesity ranging from diet, physical activity, medication, surgery and more. With an all-rounded

2016 Ministry of Health, Singapore

188. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

of lifestyle therapy are associated with efficacy? 91 Q6.1. Meal plan and macronutrient composition 92 Q6.2. Physical activity 93 Q6.3. Behavior interventions 96 Q7. Is pharmacotherapy effective to treat overweight and obesity? 102 Q7.1. Should pharmacotherapy be used as an adjunct to lifestyle therapy? 102 Q7.2. Does the addition of pharmacotherapy produce greater weight loss and weight-loss maintenance than lifestyle therapy alone? 102 Q7.3. Should pharmacotherapy only be used in the short term to help (...) and meta-analyses of these trials [EL 1]), in the interest of conciseness, derivative EL 4 review publica- tions that include many primary evidence citations (EL 1, EL 2, and EL 3) are also included. In addition, rigorously reviewed guidelines by other organizations have been adopted for specific issues, such as physical activity guide- lines by the American Academy of Sports Medicine (28 [EL 4; NE]), physical activity guidelines by the American Heart Association and the American College of Cardiology

2016 American Association of Clinical Endocrinologists

189. Dementia

is associated with a 50–80% increased risk of dementia [ ]. Diabetes in middle or later life increases the risk of vascular and Alzheimer’s dementias by about 50% [ ]. Physical activity — an analysis of population-based data estimated that in the UK, the largest influence on dementia by modifiable risk factors is physical activity. Even a low intensity activity, such as walking, may reduce dementia risk by about 40% [ ; ; ]. Multiple risk factors — dementia risk increases incrementally if multiple (...) that does not fulfil the diagnostic criteria for dementia — for example, only one cognitive domain is affected, or ADLs are not significantly affected. The most common subtypes of dementia include: Alzheimer's disease (50–75%) which often co-exists with vascular dementia. Vascular dementia (up to 20%). Dementia with Lewy bodies (10–15%). Frontotemporal dementia (2%). Modification of specific risk factors (in particular, cardiovascular risk factors such as smoking, diabetes and lack of physical activity

2019 NICE Clinical Knowledge Summaries

190. Psoriasis: assessment and management

) Alcohol-use disorders: prevention (NICE public health guidance 24) Stop smoking services (NICE public health guidance 10) Physical activity: brief advice for adults in primary care (NICE public health guidance 44) Physical activity in the workplace (NICE public health guidance 13) Physical activity for children and young people (NICE public health guidance 17). T T opical ther opical therap apy: gener y: general recommendations al recommendations Offer practical support and advice about the use (...) activity: brief advice for adults in primary care (NICE public health guidance 44) Physical activity in the workplace (NICE public health guidance 13) Physical activity for children and young people (NICE public health guidance 17). 1.2.3.3 For people with multiple comorbidities and/or multimorbidities and any type of psoriasis needing second- or third-line therapy, ensure multidisciplinary working and communication between specialties and, if needed, interdisciplinary team working (for example when

2012 National Institute for Health and Clinical Excellence - Clinical Guidelines

191. Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders

/ Association Canadienne des troubles anxieux and McGill University Abstract Background: Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated. Methods: These guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained (...) intervention was then made, based on global impression of efficacy in clinical trials, effectiveness in clinical practice, and side effects, using a modified version of the periodic health examination guide- lines (Table 2). The guidelines were initiated prior to the introduction of the American Psychiatric Association’s (APA) fifth edi- tion of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the committee was sensitive to potential changes to the nosology of anxiety and related

2014 CPG Infobase

192. Guideline on the management of premature ovarian insufficiency

for the cardiovascular system? Women with POI are at increased risk of cardiovascular disease and should be advised of risk factors that they can modify through behavioural change (e.g. stopping smoking, taking regular weight-bearing exercise, healthy weight). B All women diagnosed with Turner Syndrome should be evaluated by a cardiologist with expertise in congenital heart disease. C Is estrogen replacement cardio-protective? Despite lack of longitudinal outcome data, hormone replacement therapy with early (...) to compliance. GPP No routine monitoring tests are required but may be prompted by specific symptoms or concerns. GPP Treatment with androgens Women should be informed that androgen treatment is only supported by limited data, and that long-term health effects are not clear yet. C If androgen therapy is commenced, treatment effect should be evaluated after 3-6 months and should possibly be limited to 24 months. GPP 18 HRT in women with POI and special issues Turner Syndrome Girls and women with POI due

2015 European Society of Human Reproduction and Embryology

193. Cortical Auditory Evoked Potential (CAEP) Testing

- organic component than previously recorded. After giving the test instructions, remove any hearing aids, headwear or ear-rings that may obstruct the correct placement of the transducers, cause discomfort or affect sound transmission. Wherever possible, hair, scarves etc., should not be allowed to sit between the ear and the transducer. Unlike conventional PTA in which any spectacles should be removed, CAEP testing requires that the patient be alert yet not physically active and in adult testing (...) Potential Testing BSA 2016 @BSA 2016 Page4 Contents 1. Introduction 6 1.1. Historical Setting 6 1.2. Characteristics and uses of the CAEP 6 2. Scope 9 3. Equipment & Test Environment 9 3.1. Equipment 9 3.2. Test Environment 10 4. Staff Training 10 5. Preparation for testing 11 5.1. Preparation of test patients 11 5.2. Patient Instructions 12 5.3. Electrodes 13 6. Stimuli 14 6.1. Calibration 14 6.2. Stimulus type 14 7. Masking 15 8. Data Collection 16 8.1. Stimulus repetition rate 16 8.2. Number

2016 British Society of Audiology

194. The Role of Bariatric Surgery in Improving Reproductive Health

by understanding how different surgical approaches impinge on or alter reproductive outcomes.Scientific Impact Paper No. 17 © Royal College of Obstetricians and Gynaecologists 8 of 10 References 1. Health and Social Care Information Centre (HSCIC). Statistics on Obesity, Physical Activity and Diet: England 2015. Leeds: HSCIC; 2015 [http://www.hscic.gov.uk/ catalogue/PUB16988/obes-phys-acti-diet-eng-2015.pdf]. Accessed 2015 Jul 27. 2. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al (...) data from women with gastric bypass (n = 286) alone, the risk of SGA was even higher (aOR 2.78). With respect to other outcomes, in contrast to smaller studies, no statistically significant differences were found between the groups regarding the risk of gestational diabetes mellitus, pre-eclampsia, labour induction, caesarean section, postpartum haemorrhage, Apgar score less than 7, admission to neonatal intensive care unit or perinatal death. The discrepancy between gestational diabetes and pre

2015 Royal College of Obstetricians and Gynaecologists

195. Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

to derive a recommendation from the evidence obtained from existing screening programmes illustrates the need for further work to collect quantitative data on the cost–benefit profile of performing ECG screening in different populations and in different healthcare systems and settings. Conversely, in consideration of the higher risk of arrhythmias and the worsening of structural or genetic diseases in individuals exposed to intense physical exercise, 81,82 we do support the existing recommendations (...) in life. The availability of novel technologies that allow faster and cheaper genotyping may soon provide data on very large populations and deliver the statistical power required for these investigations. 3.3.2 Patients with ischaemic heart disease For more than two decades investigators throughout the world have envisioned a broad range of ‘indicators’ for SCD occurring in the setting of ischaemic heart disease. Several non-invasive markers of risk of SCD have been proposed for patients

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2015 European Society of Cardiology

196. Late Effects of Treatment for Childhood Cancer (PDQ®): Health Professional Version

. A variety of approaches have been used to advance knowledge about the very long-term morbidity associated with childhood cancer and its contribution to early mortality. These initiatives have utilized a spectrum of resources including investigation of data from the following: Population-based registries.[ - ] Self-reported outcomes (provided through large-scale cohort studies).[ , ] Medical assessments.[ , ] Studies reporting outcomes in survivors who have been well characterized regarding clinical (...) status and treatment exposures, and comprehensively ascertained for specific effects through medical assessments, typically provide the highest quality data to establish the occurrence and risk profiles for late cancer treatment–related toxicity. Regardless of study methodology, it is important to consider selection and participation bias of the cohort studies in the context of the findings reported. Prevalence of Late Effects in Childhood Cancer Survivors Late effects are commonly experienced

2018 PDQ - NCI's Comprehensive Cancer Database

197. Bariatric Surgery in Improving Reproductive Health, The Role of

by understanding how different surgical approaches impinge on or alter reproductive outcomes.Scientific Impact Paper No. 17 © Royal College of Obstetricians and Gynaecologists 8 of 10 References 1. Health and Social Care Information Centre (HSCIC). Statistics on Obesity, Physical Activity and Diet: England 2015. Leeds: HSCIC; 2015 [http://www.hscic.gov.uk/ catalogue/PUB16988/obes-phys-acti-diet-eng-2015.pdf]. Accessed 2015 Jul 27. 2. Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al (...) data from women with gastric bypass (n = 286) alone, the risk of SGA was even higher (aOR 2.78). With respect to other outcomes, in contrast to smaller studies, no statistically significant differences were found between the groups regarding the risk of gestational diabetes mellitus, pre-eclampsia, labour induction, caesarean section, postpartum haemorrhage, Apgar score less than 7, admission to neonatal intensive care unit or perinatal death. The discrepancy between gestational diabetes and pre

2015 Royal College of Obstetricians and Gynaecologists

198. Evidence to inform the commissioning of social prescribing

review examining the effect of exercise referral schemes in primary care on physical activity and improving health outcomes. 5 The review included eight trials (5190 participants), six conducted in the UK. Participants were mainly sedentary, aged 54 to 71, with evidence of cardiovascular risk factor(s). The main referrer was the GP; follow-up ranged from two to 12 months. There were no significant differences in physical activity, physical fitness, or clinical outcomes between exercise referral (...) . 13 The review found no clear agreement about the definition of social prescribing but some evidence that some specific social prescription interventions can have a positive impact on people’s lives. These included exercise programmes such as: gym-based activity; guided/health walks; green activity; cycling; swimming and aqua-therapy; team sports; and exercise and dance classes. Robust evidence was found to support the mental health benefits of physical activity for clinical and non-clinical

2015 Evidence briefings

199. Hand Pain and Sensory Deficits: Carpal Tunnel Syndrome

physical therapy | volume 49 | number 5 | may 2019 | cpg9 Carpal Tunnel Syndrome: Clinical Practice Guidelines III Gelberman et al 103 compared carpal tunnel pressure between those with and without CTS. They report- ed a statistically significant higher carpal tunnel pressure in the patient group when compared to the controls with the wrist in a neutral position (P .05) using data from the middle finger. Static 2PD I II Results from 1 level I and 1 level II study showed that 2PD (using less than 4 (...) fingers from SWMT increased sen - sitivity from 16% to 82%, with specificity equal to 86%. Fertl et al 97 examined 47 patients (63 hands) with CTS confirmed by NCS and 20 healthy controls (39 hands) and found that combining a timed Phalen test (timed to appearance of symptoms) and the manual carpal compression test im- proved all diagnostic statistics resulting in a PPV of 95% and an NPV of 88%. In a retrospective, unblinded chart review, LaJoie et al 157 reviewed data from 81 patients (162 wrists

2019 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

200. Patellofemoral Pain

musculoskeletal- related condition that is characterized by insidious onset of poorly defined pain, localized to the anterior retropatellar and/or peripatellar region of the knee. 80 The onset of symp- toms can be slow or acutely develop with a worsening of pain accompanying lower-limb loading activities (eg, squatting, prolonged sitting, ascending/descending stairs, jumping, or running, especially with hills). 154,234,254 Symptoms can restrict participation in physical activity, sports, and work. 74 Symp (...) of symptoms with functional tasks in their long-term follow-up of about 4 years, with 50% of participants reporting PFP on a weekly or more frequent basis. Half of the cohort reported pain with stair climbing and 39% with sport participation at the 4-year follow-up. Although symptoms of PFP may become less frequent over time, 94% still reported some degree of PFP , either at rest or with other activities such as walking. Pain dur- ing running was not assessed. 254 Sandow and Goodfellow 254 also reported

2019 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

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