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Alcohol Tremor

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161. 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)

162. AIM Clinical Appropriateness Guidelines for Interventional Pain Management

of an isolated pars defect ? Use of MBB or RFN at the level of a posterolateral fusion or posterior instrumentation ? Use of non-thermal RF modalities for facet joint denervation, including chemical, low grade thermal energy ( 1°C), skin color changes or asymmetry o Sudomotor/edema: Evidence of edema, sweating changes, or sweating asymmetry o Motor/trophic: Evidence of decreased range of motion, motor dysfunction (eg, weakness, tremor, dystonia), or trophic changes (eg, hair, nail, skin) o No other diagnosis (...) questionnaires and/or psychological testing) that confirms no evidence of an inadequately controlled mental health problem (e.g., alcohol or drug dependence, depression, psychosis) that would negatively impact the success of a spinal cord stimulator or contraindicate its placement. Dorsal column stimulation may be indicated for the relief of chronic intractable neuropathic pain of the trunk and/or limbs in the following conditions: ? Lumbosacral arachnoiditis as documented by high levels of protein

2017 AIM Specialty Health

163. 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

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

164. 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

165. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Hea

with alcohol consumption, preinfarction angina, anterior infarct location, and complete coronary occlusion at the time of coronary angiography. In a select group of patients undergoing primary PCI in a clinical trial, 5.7% developed sustained VT or VF, with two thirds of these events occurring prior to the end of the catheterization, and 90% within 48 hours from the procedure. VT or VF after primary PCI was associated with lower blood pressure, higher heart rate, poor coronary flow at the end

2017 American Heart Association

166. 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: Executive Summary

relevant to this guideline, was conducted between February and August 2015. Key search words included but were not limited to the following: adherence; aerobic; 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

2017 American Heart Association

167. Deep brain stimulation in mental health

in neurological disorders such as Parkinson’s disease, intractable tremor and dystonia, and is less commonly used or under investigation for other disorders such as epilepsy and Tourette’s syndrome. 2-7 The indication for the use of DBS determines the placement of the individual stimulating electrodes. For many indications there are a number of neuroanatomical targets that provide therapeutic relief. For example, three DBS implantation sites have been shown to be clinically efficacious for Parkinson’s disease (...) applied to the NA. 58 All four patients appeared to achieve a substantial improvement in symptoms of anorexia with an average follow-up period of more than three years. Addiction A small literature has also explored the potential use of DBS for the treatment of addictive disorders, primarily with a focus on stimulation of the NA reward system. There have been a number of individual case reports suggesting remission of symptoms in the treatment of alcohol and heroin addiction 59, 60 and a small case

2016 Sax Institute Evidence Check

168. Opioid Use and Opioid Use Disorder in Pregnancy

as a risk factor for hepatitis C and other virus transmission in a group of pregnant women with hepatitis C ( ). Regular, long-term use of any opioid leads to predictable physiological dependence, which results in symptoms of withdrawal upon discontinuation of the drug. Typical symptoms of opioid withdrawal include generalized pain, muscle pain, nausea, diarrhea, sweating, rhinorrhea, tearing, dilated pupils, tremor, gooseflesh, restlessness, and anxiety. With short-acting opioids, such as heroin (...) , withdrawal symptoms may develop within 4–6 hours of use, peak at 1–3 days, and gradually subside over a period of 5–7 days. For long-acting opioids, such as methadone, withdrawal symptoms usually begin within 24–36 hours of use and may last for several weeks. Unlike alcohol withdrawal, opioid withdrawal is rarely associated with severe morbidity and can be readily treated. Effects of Opioid Use on Pregnancy and Pregnancy Outcome The safety of opioids during early pregnancy has been evaluated in a number

2017 American College of Obstetricians and Gynecologists

169. 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

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. Multiple sclerosis in adults: management

and swallowing, and these are referenced where appropriate. Many of the interventions used in a rehabilitation setting to alleviate symptoms such as tremor, weakness, cardiorespiratory fitness, sensory loss, visual problems (apart from oscillopsia), and secondary complications of immobility such as deconditioning and contractures have not been covered because these are beyond the scope of the guideline. Many of these problems are complex and need individual assessment and management strategies (...) healthcare professionals with expertise in specific areas of the review if needed. 1.6.3 T ailor the comprehensive review to the needs of the person with MS assessing: MS symptoms: mobility and balance including falls need for mobility aids including wheelchair assessment use of arms and hands muscle spasms and stiffness tremor bladder (see Urinary incontinence in neurological disease NICE clinical Multiple sclerosis in adults: management (CG186) © NICE 2018. All rights reserved. Subject to Notice

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

172. Bipolar disorder: assessment and management

functioning declines significantly treatment adherence is poor the person develops intolerable or medically important side effects from medication comorbid alcohol or drug misuse is suspected the person is considering stopping any medication after a period of relatively stable mood a woman with bipolar disorder is pregnant or planning a pregnancy. Monitoring ph Monitoring physical health ysical health 1.2.10 Develop and use practice case registers to monitor the physical and mental health of people (...) changes identify personal recovery goals. 1.3.3 T ake into account the possibility of differential diagnoses including Bipolar disorder: assessment and management (CG185) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 19 of 46schizophrenia spectrum disorders, personality disorders, drug misuse, alcohol-use disorders, attention deficit hyperactivity disorder and underlying physical disorders such as hypo

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

173. Transcranial magnetic resonance-guided focused ultrasound and deep brain stimulation for refractory depression

and deep brain stimulation; neither of these technologies are limited to the treatment of depression, but DBS for indications other than depression are also beyond the scope of this Brief. The efficacy and safety of DBS in treating neurological disorders of movement (e.g. Parkinson disease, essential tremor, dystonia), combined with its advantages over traditional ablative neurosurgical procedures (e.g. reversibility, easy modification of stimulation parameters), have more recently led to applications (...) for this indication, it would appear that interest for DBS for depression has dwindled from companies offering the technology since the BROADEN trial (sponsored by St Jude Medical) was terminated early due to futility. g No evidence was identified which suggested that tcMRg FUS is approved for the treatment of depression, however, the ExAblate system which uses this technology has been CE approved for thalamotomy and pallidotomy for essential tremor, tremor dominant Parkinson’s Disease and neuropathic pain

2016 COAG Health Council - Horizon Scanning Technology Briefs

174. Clearing the Smoke on Cannabis: Chronic Use and Cognitive Functioning and Mental Health ? An Update

, more robust longitudinal research is required to understand the nature of the relationships and ascertain whether they can be explained by other factors. Background After alcohol, cannabis, also referred to as marijuana, is the most widely used psychoactive substance in Canada. According to the 2013 Canadian Tobacco, Alcohol and Drugs Survey (CTADS), 10.6% of Canadians aged 15 years and older reported using cannabis at least once in the past year (Statistics Canada, 2015), virtually Clearing (...) sativa. Hashish or cannabis resin is the dried brown or black resinous secretion of the flowering tops of the cannabis plant. The acute effects of cannabis include euphoria and relaxation, changes in perception, time distortion, deficits in attention span and memory, body tremors, and impaired motor functioning. It is a controlled substance under the Controlled Drugs and Substances Act—meaning that the acts of growing, possessing, distributing and selling cannabis are illegal. The Canadian government

2016 Canadian Centre on Substance Abuse

175. Talking Pot with Youth: A Cannabis Communication Guide for Youth Allies

is one of the most common substances used by Canadian youth next to alcohol; it is natural for young people to feel curious and have questions about it. We need to engage with youth in conversations about cannabis, but these conversations must be of the right kind. This guide takes a harm reduction approach to talking with youth about cannabis. Its purpose is to help those who work with young people to have the right kind of conversations with them about cannabis: conversations that are safe (...) , fear or other emotion? • What is your current opinion on cannabis use? o Why do you think you feel this way? o What do you think contributed to your current opinion? o Do you feel you are properly informed about cannabis and cannabis use? • How do you manage stress and anxiety in your personal life? • Do you use substances such as alcohol or tobacco? If yes, why? o What type of relationship do you have with substances? In other words, would you consider it a positive or negative relationship? o

2016 Canadian Centre on Substance Abuse

176. Links between antipsychotics in pregnancy and harmful outcomes for baby may be influenced by mother’s lifestyle

child outcomes after poorer health and riskier lifestyles were taken into account. For pregnant women these were things like other medications, obesity, smoking, alcohol and taking illicit drugs. The study also provides further evidence against the use of valproate during pregnancy for epilepsy, bipolar disorder or schizophrenia because of the increased risk of poor outcomes for the child. The risk was double that of taking the alternatives, lamotrigine or carbamazapine during pregnancy. Mental (...) in nature. What did it find? Antipsychotic use during pregnancy did not increase the risk of caesarean section, prematurity or poor child outcomes after adjusting the results to take into account age, obesity, alcohol problems, smoking, illicit drug use and other psychotropic drug use. Anticonvulsant use during pregnancy compared to no use increased the risk of: Caesarean section from 18.3% to 21.4% (adjusted relative risk ratio [RRR] 1.14, 95% confidence interval [CI] 1.04 to 1.26). Major congenital

2018 NIHR Dissemination Centre

177. Clearing the Smoke on Cannabis - Respiratory Effects of Cannabis Smoking

of this uncertainty, caution should be exercised until the link between chronic regular use and COPD is better understood. • It is essential for healthcare professionals to be aware of the impact of cannabis smoking on respiratory health so that they can inform and advise their patients, as well as develop strategies to promote further awareness and general respiratory health. Background After alcohol, cannabis (also referred to as marijuana) is the most widely used psychoactive substance in Canada. According (...) to the 2013 Canadian Tobacco, Alcohol and Drugs Survey (CTADS), 10.6% of Canadians aged 15 years and older reported using cannabis at least once in the past year (Statistics Canada, 2015), virtually unchanged from 10.2% in 2012. The use of cannabis is generally more prevalent among young people, with 22.4% of youth aged 15 to 19 and 26.2% of young adults aged 20 to 24 reporting past- Clearing the Smoke on Cannabis Respiratory Effects of Cannabis Smoking – An Update Opal A. McInnis, Ph.D., Research

2016 Canadian Centre on Substance Abuse

178. Perinatal substance use: maternal

• Pharmacological treatment: o Morphine for opioid withdrawal o Phenobarbitone for non-opioid withdrawal Assessment • Detailed antenatal psychosocial assessment and history of substance use • Screening for blood borne viruses Support • Explore options for known carer and continuity of care models • Provide brief interventions for smoking and alcohol use • Link with appropriate services • Discussion with paediatrician including: o Care of baby o Length of stay o Monitoring o Potential for medication o Follow up (...) Pregnancy, fetal and neonatal exposure 8 1.3.2 Lactation and childhood 9 1.4 Psychostimulants exposure 10 1.4.1 Amphetamines/Methamphetamines 10 1.4.2 Nicotine 11 1.4.3 SSRI/SNRI 12 1.4.4 Cocaine 13 1.4.5 Ecstasy 13 1.5 Depressant exposure 14 1.5.1 Alcohol–maternal 14 1.5.2 Alcohol–fetal/neonatal 15 1.5.3 Benzodiazepines 15 1.5.4 Cannabis 16 1.6 Hallucinogens exposure 16 2 Antenatal screening 17 2.1 Psychosocial 17 2.2 Blood borne viruses 18 2.3 Substance use 19 2.4 Alcohol and tobacco 20 3 Management

2016 Queensland Health

179. Management of Concussion-mild Traumatic Brain Injury (mTBI)

including topics such as stimulus control, use of caffeine/tobacco/alcohol and other stimulants b. Non-pharmacologic interventions such as sleep hygiene education, dietary modification, physical therapy (PT), relaxation and modification of the environment (for specific components for each symptom, see Appendix B: Clinical Symptom Management) c. Pharmacologic interventions as appropriate both for acute pain and prevention of headache attacks Weak for Reviewed, New-replaced c. Dizziness and Disequilibrium (...) , New-added f. Sleep Disturbance 15. We suggest that treatment of sleep disturbance be individualized and tailored to the clinical features and patient preferences, including the assessment of sleep patterns, sleep hygiene, diet, physical activities and sleep environment. The treatment may include, in order of preference: a. Sleep education including education about sleep hygiene, stimulus control, use of caffeine/tobacco/alcohol and other stimulants b. Non-pharmacologic interventions

2016 VA/DoD Clinical Practice Guidelines

180. Drugs, Driving and Youth Highlights

on the particular substance used, dose ingested, extent of prior use and manner of use. Combining stimulants with other substances, including alcohol, can increase the detrimental effects on driving performance. ? Drivers who have been using stimulants often display one or more telltale signs of use: • Dilated pupils, • Body tremors, • Restlessness and agitation, and • Talkativeness. Opioids ? Depending on the dose, route of administration and extent of previous exposure, the effects of opioids begin within 15 (...) Drugs, Driving and Youth Highlights Canadian Centre on Substance Abuse • Centre canadien de lutte contre les toxicomanies Page 1 Drugs, Driving and Youth Highlights Why does this matter? Studies have found that the drug-impaired driving problem has become comparable to alcohol- impaired driving. In Canada, there has been an increase in the number of drivers who test positive for substances other than alcohol: a 2010 roadside survey in British Columbia of 2,840 randomly selected vehicles found

2016 Canadian Centre on Substance Abuse

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