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Alcohol Tremor

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161. CRACKCast E151 – Antidepressants

criteria for Serotonin Syndrome? Hunter criteria Exposure to a known serotonergic agent; AND Any of the following: Spontaneous clonus Inducible clonus and agitation or Diaphoresis Ocular clonus and agitation or Diaphoresis Tremor and hyperreflexia Hypertonic w/ Temp > 38 o C and ocular clonus or inducible clonus “The descending ladder of hyper-reflexia” As the hyper-reflexia gets less and less impressive, the additional criteria become more pronounced [5] How can you discern between NMS and Serotonin (...) Syndrome? Both look the same = FARM Fever Autonomic instability Rigidity / rhabdo Mental status changes However, the major differentiating features: NMS = parkinsonian type lead pipe rigidity; slower onset; similar presentation to the unwell septic patient SS = spastic rigidity – agitation / tremor / CLONUS / increased motor activity; rapid onset Onset: SS relatively rapid within hours NMS over days potentially Course: NMS may wax and wane. SS peaks then declines Obviously hyper-reflexia is the most

2018 CandiEM

162. CRACKCast E165 – Sedative Hypnotics

blocker. Endotracheal intubation to protect against emesis, aspiration pneumonitis, and hypoxia is often necessary for patients with significant CNS or respiratory depression from GHB overdose. Withdrawal from GHB or its precursors begins with anxiety, tremor, and insomnia, but it can progress to a severe syndrome characterized by delirium and autonomic instability. Management of this syndrome often requires high-dose benzodiazepine or barbiturate therapy (because they are GABA depleted). Rosens (...) for noncardiogenic pulmonary edema & aspiration pneumonitis ***Note: Barbiturate withdrawal syndrome includes: Tremors Hallucinations Seizures delirium (similar to the delirium tremens of ethanol withdrawal) [5] How are barbiturate overdoses managed? Investigations / Supportive care / Invasive ventilation as needed Labs: The therapeutic level of phenobarbital is 15 to 40 μg/mL (65 to 172 μmol/L) A serum level greater than 50 μg/mL can be associated with coma, especially in a patient who is not a chronic user

2018 CandiEM

164. Improving Quality of Life: Substance Use and Aging

. Eglit and Dilip V. Jeste Epidemiology of Psychoactive Substance Use Among Older Adults Scott B. Patten The Aging Brain and Substance Use Tarek Rajji and Simon Davies Consequences of Alcohol and Drug Use in Older Adults Jonathan Bertram and David K. Conn Considerations for Co-occurring Health Conditions Karolina Kozak and Tony George Detection, Screening and Assessment David K. Conn Substance Use Treatment for Older Adults Frederic C. Blow A Call to Action Franco J. Vaccarino, Elysia Vaccarino (...) use, as we do in this report, is key to developing new and more tailored strategies for reducing the harms of alcohol and drugs on older adults. Since 2005, the series now known as Substance Use in Canada has highlighted alcohol- and drug-related issues that are in need of greater attention. For this seventh edition, we began with two questions: How can we help people age in a healthy way? and How can we ensure they have the supports they need to sustain a good quality of life in their later years

2018 Canadian Centre on Substance Abuse

165. Baricitinib (Olumiant) - rheumatoid arthritis

core are: microcrystalline cellulose, croscarmellose sodium, magnesium stearate and mannitol. Ingredients of the film-coating are: iron oxide red (E172), lecithin (soya) (E322), macrogol, polyvinyl alcohol, talc and titanium dioxide (E171). The product is available in polyvinylchloride/polyethylene/polychlorotrifluoroethylene - aluminium blisters and polyvinylchloride/aluminium/oriented polyamide - aluminium perforated unit dose blisters as described in section 6.5 of the SmPC. 2.2.2. Active

2017 European Medicines Agency - EPARs

167. Management of menopausal symptoms in women with a history of breast cancer

. Caution should be taken for patients with conditions such as congenital Management of menopausal symptoms in women with a history of breast cancer page 79 of 181Generic name (brand names) Indications Contraindications Common side effects (occurring in =1% of patients) Drug interactions Precautions / Comments Headache Insomnia Somnolence Tremor *for side effects occurring in between 1% and 10% of patients please see specific PI efficacy long QT syndrome; acquired long QT syndrome; a family history (...) symptoms in women with a history of breast cancer page 80 of 181Generic name (brand names) Indications Contraindications Common side effects (occurring in =1% of patients) Drug interactions Precautions / Comments Gabapentin Epilepsy Neuropathic pain Hypersensitivity to gabapentin Side effects occurring in >5% of participants* Fatigue Nausea Vomiting Somnolence Dizziness Ataxia Nystagmus Headache Tremor Diplopia Asthenia Cimetidine Antacids may reduce gabapentin bioavailability Antiepileptic drugs

2017 Cancer Australia

168. Hypersexuality: fluoxetine

[n=25], fluoxetine [n=17] or fluvoxamine [n=16]) at a sexual behaviours clinic in Canada between 1991 and 1995. Seventy-nine percent of the participants were also receiving some receiving some form of psychosocial intervention. It was reported that 31% of participants had a personality disorder, 28% had depression, 17% had alcohol dependence and 16% had adjustment disorders. Outcomes measured included severity of illness and global improvement (using a 7-point Clinical Global Impression Scale (...) in 10 or more) adverse reactions: fatigue, nausea, diarrhoea, headache and insomnia. Common (between 1 in 10 and 1 in 100) adverse reactions are reported to include: decreased appetite and weight loss, anxiety, nervousness, restlessness, sleep disorders and abnormal dreams, disturbances in attention, dizziness, lethargy, tremor, blurred vision, palpitations, vomiting, dry mouth, dyspepsia, flushing, rash and urticaria, arthralgia, frequent urination and chills. Fluoxetine is contra-indicated

2015 National Institute for Health and Clinical Excellence - Advice

169. Clearing the Smoke on Cannabis: Cannabis Use and Driving ? An Update

Clearing the Smoke on Cannabis: Cannabis Use and Driving ? An Update Key Points • Among young drivers, driving after using cannabis is more prevalent than driving after drinking. • Cannabis impairs the cognitive and motor abilities necessary to operate a motor vehicle and doubles the risk of crash involvement. • After alcohol, cannabis is the most commonly detected substance among drivers who die in traffic crashes. • The police have the tools and authority required to detect and arrest drivers (...) who are impaired by cannabis. Background After alcohol, cannabis, also referred to as marijuana, is the most widely used psychoactive substance in Canada. According to the 2015 Canadian Tobacco, Alcohol and Drugs Survey (CTADS), 12.3% of Canadians aged 15 years and older reported using cannabis at least once in the past year (Statistics Canada, 2016), significantly higher than the 10.6 in 2013. The use of cannabis is generally more prevalent among youth, with 20.6% of youth aged 15 to 19 and 29.7

2017 Canadian Centre on Substance Abuse

170. Complex regional pain syndrome in adults. UK guidelines for diagnosis, referral and management in primary and secondary care 2018 (2nd edition)

as a symptom ? 2 ‘Vasomotor’ Temperature asymmetry and/or skin colour changes and/or skin colour asymmetry If you notice temperature asymmetry: must be >1°C ? ? 3 ‘Sudomotor/oedema’ Oedema and/or sweating changes and/or sweating asymmetry ? ? 4 ‘Motor/trophic’ Decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair/nail/skin) ? ? † A third diagnostic subtype called CRPS-NOS (not otherwise specified) can be considered for patients who have abnormalities (...) tissue, joint or skin) ? orthopaedic mal-fixation ? joint instability ? arthritis or arthrosis ? bone or soft tissue injury (including stress fracture, instability or ligament damage) ? compartment syndrome ? neural injury (peripheral nerve damage, including compression or entrapment, or central nervous system or spinal lesions), or neuropathy (such as from diabetes, alcohol misuse) ? thoracic outlet syndrome (due to nerve or vascular compression) ? arterial insufficiency (usually after preceding

2018 British Society of Rehabilitation Medicine

171. Parkinson's disease in adults.

inform the Driver and Vehicle Licensing Agency (DVLA) and their car insurer of their condition when PD is diagnosed. [2006] Diagnosing Parkinson's Disease Definition and Differential Diagnosis Suspect Parkinson's disease people presenting with tremor, stiffness, slowness, balance problems and/or gait disorders. [2006] If Parkinson's disease is suspected, refer people quickly and untreated to a specialist with expertise in the differential diagnosis of this condition. [2006, amended 2017] Clinical (...) with Parkinson's disease should be seen at regular intervals of 6 to 12 months to review their diagnosis.) [2006] Single Photon Emission Computed Tomography (SPECT) Consider 123 I-FP-CIT [(N-omega-fluoropropyl-2beta-carboxymethoxy-3beta-(4-iodophenyl)tropane)] SPECT for people with tremor if essential tremor cannot be clinically differentiated from parkinsonism. [2006, amended 2017] 123 I-FP-CIT SPECT should be available to specialists with expertise in its use and interpretation. [2006] Positron Emission

2017 National Guideline Clearinghouse (partial archive)

172. Interventions Targeting Sensory Challenges in Children with Autism Spectrum Disorder - An Update

-011-9089-0. PMID: 21818630.X-1 701. Kohls G, Peltzer J, Schulte-Rüther M, et al. Atypical Brain Responses to Reward Cues in Autism as Revealed by Event-Related Potentials. Journal of Autism & Developmental Disorders. 2011;41(11):1523-33 11p. doi: 10.1007/s10803-011-1177-1. PMID: 104703794. Language: English. Entry Date: 20111109. Revision Date: 20150711. Publication Type: Journal Article.X-1 702. Komoto Y, Hashimoto N, Ikegami Y. [Effects of autism features on alcoholism--especially from

2017 Effective Health Care Program (AHRQ)

173. CRACKCast E099 – Urological Disorders

options for uncomplicated and complicated pyelonephritis. Pyelonephritis = UTI involving the renal collecting system or parenchyma Fever, chills, flank pain, CVA tenderness, N/V, +/- cystitis In the elderly: altered mental status, lethargy, abdominal pain, generalized weakness Uncomplicated (same treatment as complicated UTI) Ciprofloxacin 500 mg bid 7 days GI disturbance, headache, dizziness, tremors, restlessness, confusion, rash, Candida infections Levofloxacin 750 mg once daily 5 days Same (...) Cough, abdominal pain, nausea, vomiting Ciprofloxacin 400 mg every 12 hours GI disturbance, headache, dizziness, tremors, restlessness, confusion, rash, Candida infections Levofloxacin 500 mg every 24 hours Same as for ciprofloxacin [6] What are safe antibiotic options for bacteriuria in pregnancy? How is pyelonephritis managed in pregnancy? A couple key points about the pregnant patient with a UTI: Bacteriuria in pregnancy – gets treated even if the patient is asymptomatic If the patient

2017 CandiEM

174. CRACKCast E126 – Diabetes Mellitus and Disorders of Glucose Homeostasis

become unarousable. They may have a seizure or show focal neurologic signs, which resolve with glucose administration. For most other patients: signs and symptoms of hypoglycemia are caused by excessive secretion of epinephrine and CNS dysfunction; these include Sweating Nervousness/Tremor Tachycardia Hunger Neurologic symptoms, ranging from bizarre behavior and confusion to seizures and coma. [10] List 10 causes of hypoglycemia Causes of hypoglycemia in the non-diabetic can be thought about in terms (...) that can cause congenital hyperinsulinism Causes of hypoglycemia in the diabetic: Consider their own medications, such as with excess insulin or other oral hypoglycemic agents Use the “DIMES” approach (coupled with how UpToDate does it): Drugs: Insulin Insulin secretagogues: Alcohol Others – e.g. indomethacin, quinine Infection / illnesses: Sepsis Metabolic: Liver, renal failure Adrenal insufficiency Type 1 diabetic – without glucagon Environmental: Accidental, surreptitious, or malicious hypoglycemia

2017 CandiEM

176. Ecstasy or Molly (MDMA) (Canadian Drug Summary)

memory deficits; 7,9,12,13 and attention deficits. 9 Effects of synthetic cathinones ? Short-term: The short-term effects of synthetic cathinones include euphoria; 14,15 increased energy; 15 increased heart rate and blood pressure; 16,17,18 sweating; 18 muscle tremors; 15,18 chest pains; 15,16,17 hallucinations; 15,16,17,18 paranoia; 15,16,17,18 agitation; 15,17,18 and aggressive behaviour. 15,18 ? Long-term: The long-term effects of synthetic cathinone use are not well known. 19,20,21 Legal Status (...) by half since 2008. 22,23,24,25,26,27 The most recent estimate, taken from the 2015 Canadian Tobacco, Alcohol and Drugs Survey (CTADS), indicates that 0.7% of Canadians aged 15 and older reported using ecstasy in the past year. 28 Students (grades 7–12): Findings from the 2014–2015 Canadian Student Tobacco, Alcohol and Drugs Survey indicate that 2.4% of Canadian students in grades 7–12 reported using ecstasy in the past 12 months. Students in grades 10–12 had a higher prevalence of past-year ecstasy

2017 Canadian Centre on Substance Abuse

178. Delirium in Adult Cancer Patients: ESMO Clinical Practice Guidelines

- mary tumour or metastasis) in 36 patients (6%). Study limitations include a low overall incidence of delirium (3.5 per 100 admis- sions) and retrospective design. Other delirium risk factors have been implicated in other studies, including age, dementia, depres- sion, alcohol abuse, poor functional status, organ dysfunction and abnormal levels of serum sodium, potassium or glucose, among others [40–44]. Moreover, many medications are implicated as risk factors for delirium, in particular opioids (...) Continued Table 1. Continued Indirectriskfactorsfordelirium Otherstatusorpredisposingcomorbidities[5,39] Visual impairment Urinary retention or use of urinary catheter Constipation Alcohol or drug abuse, or withdrawal (including nicotine) CNS diseases or trauma; history of stroke or transient ischaemia Liver failure Renal failure End-stage cardiac disease End-stage lung disease Endocrinopathy CNS, central nervous system; NSAID, non-steroidal anti-in?ammatory drug; SIADH, syndrome of inappropriate

2018 European Society for Medical Oncology

179. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults

and Obesity e28 5.2.2. Sodium Intake e29 5.2.3. Potassium e29 5.2.4. Physical Fitness e29 5.2.5. Alcohol e29 5.3. Childhood Risk Factors and BP Tracking e31 5.4. Secondary Forms of Hypertension e32 5.4.1. Drugs and Other Substances With Potential to Impair BP Control e32 5.4.2. Primary Aldosteronism e32 5.4.3. Renal Artery Stenosis e34 5.4.4. Obstructive Sleep Apnea e34 6. Nonpharmacological Interventions e35 6.1. Strategies e35 6.2. Nonpharmacological Interventions e35 7. Patient Evaluation e38 7.1 (...) ; alcohol intake; ambulatory care; antihypertensive: agents, drug, medication, therapy; beta adrenergic blockers; blood pressure: arterial, control, determination, devices, goal, high, improve, measurement, monitoring, ambulatory; calcium channel blockers; diet; diuretic agent; drug therapy; heart failure: diastolic, systolic; hypertension: white coat, masked, ambulatory, isolated ambulatory, isolated clinic, diagnosis, reverse white coat, prevention, therapy, treatment, control; intervention; lifestyle

2017 American Heart Association

180. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Gui Full Text available with Trip Pro

than monomorphic VT. Risk factors for VT/VF include prior history of hypertension, prior MI, ST-segment changes at presentation, and chronic obstructive pulmonary disease. A nationwide Danish study found that 11.6% of patients with ST-segment elevation MI who underwent PCI had VF prior to the PCI, and that VF was associated with alcohol consumption, preinfarction angina, anterior infarct location, and complete coronary occlusion at the time of coronary angiography. In a select group of patients

2017 American Heart Association

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