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341. Poststroke Fatigue: Emerging Evidence and Approaches to Management: A Scientific Statement for Healthcare Professionals From the American Heart Association

absent in patients with continuous-flow LVADs, it is important to understand the differences in the physical examination and in methods that can help rescuers determine if an unresponsive or mentally altered patient is, in fact, in cardiac arrest or circulatory collapse. Pulsatile-Flow LVADS Most early generations of LVADs had pulsatile pumps, which filled and emptied a volume-displacement chamber sequentially, generating pulsatile flow similar to the native heart. Given the advantages of continuous (...) on the pump preload. The pumps maintain decompression of the LV by pumping more quickly when preload increases and pumping less quickly when preload decreases. The native heart continues to contract in patients with a continuous-flow device, but the filling and emptying of the device is not synchronous with the heart. Because the flow from pulsatile-flow LVADs mimics that of the native heart, these patients have a detectable pulse on physical examination that reflects forward cardiac output and perfusion

2017 American Heart Association

342. Treatment and Outcome of Hemorrhagic Transformation After Intravenous Alteplase in Acute Ischemic Stroke: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (Full text)

stroke unit. The recommended monitoring includes blood pressure measurement and neurological examination every 15 minutes for the first 2 hours after the alteplase infusion, then every 30 minutes for the next 6 hours, and then every hour for the next 16 hours. Because an excessively high blood pressure may increase hemorrhagic complications, a blood pressure goal of <180/105 mm Hg is recommended for 24 hours after the infusion. In addition, an emergent brain computed tomography (CT) is recommended (...) the risk of hematoma expansion against the risk of stroke recurrence. Timing of Postthrombolytic ICH In early large trials of thrombolysis for myocardial ischemia, sICH occurred within 12 hours after thrombolytic therapy in 65% of patients, within 12 to 24 hours in 17%, within 24 to 48 hours in 9%, and after 48 hours in 9%. In acute ischemic stroke, several studies have examined sICH timing but with variable time thresholds, thereby limiting comparability. , , , One recent review of stroke clinical

2017 American Heart Association PubMed abstract

343. Management of Brain Arteriovenous Malformations: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association (Full text)

and bAVM hemorrhagic groups. The authors noted that independent predictors of death at 1 year were primary ICH (OR, 21; 95% CI, 4–104) and increasing ICH volume (OR, 1.03; 95% CI, 1.01–1.05) and independent predictors of death or dependence at 1 year were primary ICH (OR, 11; 95% CI, 2–62) and Glasgow Coma Scale score on admission (OR, 0.79; 95% CI, 0.67–0.93). More recently, Appelboom et al examined the utility of a historical ICH scale and a new bAVM-based scale, shifted in age and hemorrhagic volume (...) (0.9–1.75) 1.0 (0.4 -1.6) 2.4 (1.4–3.4 ) 1.8 (1.6–2.0 ) 1.4 (0.6–2.1) 1.0 (0.8–1.2) bAVMs indicates brain arteriovenous malformations; and CI, confidence interval. Boldface type indicates statistical significance. Unruptured bAVMs Many observational cohorts have examined the natural history of bAVMs. Ondra et al and Hernesniemi et al followed up 160 and 238 patients for a mean of 23.7 and 13.4 years, yielding the often-cited 2% to 4% annual risk of hemorrhage. In a meta-analysis of 3923 patients

2017 American Heart Association PubMed abstract

344. Venous Thromboembolism Prophylaxis, Pediatric Trauma Patients - Joint between EAST and PTS

; Petrillo, Toni M. MD; Faustino, E. Vincent S. MD, MHS Objectives The primary objective of this guideline was to evaluate whether pharmacologic or mechanical prophylaxis reduces the incidence of VTE in children hospitalized after trauma and whether active surveillance with ultrasound (versus daily physical examination alone) results in earlier detection of VTE in this population. Our PICO (population [P], intervention [I], comparator [C], and outcome [O]) questions were as follows: PICO Question 1 (...) with ultrasound be performed (I), compared with daily physical examination alone (C), to detect VTE earlier (O)? A secondary objective was to evaluate putative risk factors for VTE in children hospitalized after trauma. The findings for this question were incorporated in PICO Question 1. Inclusion Criteria for this Review Study Types We included case series, cross-sectional studies, case-control studies, cohort studies, and randomized controlled trials. Original studies from meta-analyses and reviews were

2017 Eastern Association for the Surgery of Trauma

345. Damage control resuscitation in patients with severe traumatic hemorrhage

severely injured patients. The landmark publication by Borgman et al. [18] examining the role of a more balanced transfusion strategy in combat casualties demonstrated improved survival. Numerous subsequent reports have suggested that early transfusion of PLAS and RBC in a balanced ratio of 1:1 to 1:1.5 is associated with lower mortality and less MSOF in patients who receive an MT. [47][77] Some have suggested the mortality may increase in a U-shaped curve as the ratio approaches 1:1, [50][78][79 (...) in Afghanistan reported in MATTERs and MATTERs II. [24][61] The CRASH-2 and MATTERs studies include patients with significant disparities in mechanism and injury severity. In CRASH-2, 68% of patients had a blunt mechanism of injury compared to MATTERs, which reported only patients injured by gunshot wound (30%) or explosion (70%). In CRASH-2, injury severity was not reported; however, only 18% had a Glasgow Coma Scale score of 8 or less compared to 29% in MATTERs. Additionally, less than half of CRASH-2

2017 Eastern Association for the Surgery of Trauma

346. Management of brain arteriovenous malformations

year were primary ICH (OR, 11; 95% CI, 2–62) and Glasgow Coma Scale score on admission (OR, 0.79; 95% CI, 0.67–0.93). More recently, Appelboom et al examined the utility of a historical ICH scale and a new bAVM-based scale, shifted in age and hemorrhagic volume, in their ability to predict poor (modified Rankin Scale score ≥3) clinical outcomes. The authors reported good agreement between the scales and increased specificity of the novel scale to predict outcome (87.9% versus 68.2%; P <0.001 (...) observational cohorts have examined the natural history of bAVMs. Ondra et al and Hernesniemi et al followed up 160 and 238 patients for a mean of 23.7 and 13.4 years, yielding the often-cited 2% to 4% annual risk of hemorrhage. In a meta-analysis of 3923 patients, Gross and Du reported overall (3.0%) ICH rates and those in the setting of no (2.2%) and prior (4.5%) rupture. The authors noted prior hemorrhage (hazard ratio [HR], 3.2; 95% CI, 2.1–4.3), deep AVM location (HR, 2.4; 95% CI, 1.4–3.4), exclusively

2017 American Academy of Neurology

347. Treatment and outcome of hemorrhagic transformation after intravenous alteplase in acute ischemic stroke

, disruption of the blood-brain barrier, and reperfusion injury. Diagnosis of sICH Monitoring After Thrombolytic Therapy In patients who receive intravenous alteplase for acute ischemic stroke, the American Heart Association (AHA)/American Stroke Association guidelines recommend close monitoring during and for at least 24 hours after the infusion in an intensive care or acute stroke unit. The recommended monitoring includes blood pressure measurement and neurological examination every 15 minutes (...) trials of thrombolysis for myocardial ischemia, sICH occurred within 12 hours after thrombolytic therapy in 65% of patients, within 12 to 24 hours in 17%, within 24 to 48 hours in 9%, and after 48 hours in 9%. In acute ischemic stroke, several studies have examined sICH timing but with variable time thresholds, thereby limiting comparability. , , , One recent review of stroke clinical trials found that the majority of sICHs occurred within 24 hours but that ≈10% to 15% occur after 24 hours

2017 American Academy of Neurology

349. The Association of Coloproctology of Great Britain and Ireland Consensus Guidelines in Surgery for Inflammatory Bowel Disease (Full text)

with 37 000 patients undergoing cancer surgery . The strongest predictors of thromboembolic complications after surgery for IBD were stoma formation, with an adjusted OR of 1.95 (95% CI: 1.34–2.84), preoperative steroid administration [adjusted OR 1.57 (95% CI: 1.19–2.08)], ileoanal pouch formation [adjusted OR 2.66 (95% CI: 1.65–4.29)] and longer length of stay [adjusted OR 1.89 (95% CI: 1.41–2.52)] . In a large population‐based study examining venous thromboembolism after colectomy for a variety (...) trials as major research gaps . The latter concern is partly met by the ongoing PISA trial in fistulating perianal Crohn's disease that offers randomization among three arms of (i) standard care with long‐term seton placement and oral immunosuppression, (ii) biological therapy with timed seton removal and (iii) seton drainage with limited biological therapy and then advancement flap . A recent randomized trial has been published examining stem cell therapy in fistulizing perianal Crohn's disease

2018 Association of Coloproctology of Great Britain and Ireland PubMed abstract

350. Clinical Practice Guideline for the Management of Communication and Swallowing Disorders following Paediatric Traumatic Brain Injury

Videofluoroscopy An x-ray that examines the ability to swallow Visi-pitch Software that records the voice and provides visual and auditory feedback in real time GLOSSSARY CONTINUEDClinical Practice Guideline for the Management of Communication and Swallowing Disorders following Paediatric Traumatic Brain Injury 8 AAC Augmentative and alternative communication ABI Acquired brain injury CBR Consensus-based recommendation EBR Evidence-based recommendation GCS Glasgow Coma Scale TBI Traumatic brain injury NHMRC (...) data is limited to guide speech, language and swallowing disorders. The following variables may be considered by speech-language pathologists and medical specialists when determining prognosis: • Extent and severity of brain damage (including size and site of lesion(s)) and other proxy measures e.g., Glasgow Coma Scale score, length of ventilation and intubation, loss of consciousness and length of post traumatic amnesia, brain surgery required post-injury, raised intracranial pressure • Cause

2017 Clinical Practice Guidelines Portal

351. Calling 911 in Drug Poisoning Situations

The Importance of Calling 911 in an Overdose Situation The probability of surviving a drug-related poisoning (overdose) depends, in part, on the speed with which the person receives appropriate care or an emergency intervention. While this is true for all drug poisoning situations, the remainder of this bulletin focuses on opioid overdose situations. Signs of an opioid overdose include respiratory depression, drowsiness or coma, unconsciousness, and pinpoint pupils. 1 Opioid-related death or brain damage (...) assistance at any time. The policy is consistent with the recommendation in the 2016 report by the B.C. Coroners Service’s Child Death Review Panel 16 that BCEHS help reduce barriers for people seeking immediate medical assistance when an overdose has occurred. These policies appear to be influencing the likelihood of calling 911 in an overdose situation (see Table 1). When examining data from surveys completed by individuals replacing used take-home naloxone kits, the authors found that people were more

2017 Canadian Centre on Substance Abuse

352. Preeclampsia: Screening

is more clearly defined, screening tools targeting its various subtypes and different study populations may be necessary. Descriptive studies that characterize variations in current preeclampsia screening practices in various types of health care settings would be helpful for identifying alternative screening approaches to evaluate in clinical studies. Research examining screening algorithms and new markers for screening are needed. Studies are needed to further develop and validate tools for risk (...) by seizures and complications such as brain damage, aspiration pneumonia, pulmonary edema, placental abruption, disseminated coagulopathy, acute renal failure, cardiopulmonary arrest, and coma. , Fetal and neonatal complications of preeclampsia include intrauterine growth restriction, oligohydramnios, placental abruption, neonatal intensive care unit admission, stillbirth, and neonatal death. Delivery of the fetus is the definitive treatment of preeclampsia; as a result, preeclampsia is a leading cause

2017 U.S. Preventive Services Task Force

353. Clinical practice guideline for the rehabilitation of adults with moderate to severe TBI - section 1: components of the optimal TBI rehabilitation system

· Etiology of TBI · Severity of TBI · Glasgow Coma Scale · Duration of post-traumatic amnesia · Others (INESSS-ONF, 2015) A 1.11 In order to support the continuous quality improvement of their services, traumatic brain injury rehabilitation programs should monitor key aspects of their processes and efficiency, including but not limited to: · Injury onset days to start of rehabilitation · Length of stay in rehabilitation · Intensity of services · Measures of functional change progression (ex. FIM, FAM (...) . (INESSS-ONF, 2015) Note: The interdisciplinary team may include the following core professionals: intensivist, neurologist, neurosurgeon, physiatrist, clinical nutritionist, respiratory therapist, physiotherapist, occupational therapist, neuropsychologist, social worker and speech- language pathologist, etc., as appropriate. B 1.2 Where individuals remain in a coma or minimally conscious state following traumatic brain injury, a period of treatment/management in a specialized tertiary centre should

2016 CPG Infobase

354. CATMAT statement on disseminated strongyloidiasis: prevention, assessment and management guidelines

in a Strongyloides-endemic area who undergo iatrogenic immunosuppression or have intercurrent human T-lymphotropic virus (HTLV-1) infection. Diagnosis of strongyloidiasis is based on serologic testing and/or examination of stools and other clinical specimens for larvae. Referral to a tropical medicine specialist with expertise in the management of strongyloidiasis is recommended for suspected and confirmed cases. A diagnosis and treatment algorithm for strongyloidiasis has been developed as a reference tool (...) screening decisions. Due to the low sensitivity of stool examination for ova and parasites (O&P) arising from low larval burden and intermittent shedding in the stool, serologic testing is the diagnostic method of choice in the patient suspected to have simple intestinal strongyloidiasis. It is important to note that sensitivity of serology may be reduced in the patient with immunosuppression, especially due to HTLV-1 infection or hematologic malignancy and associated chemotherapy (18,19

2016 CPG Infobase

355. Assessment, diagnosis and interventions for autism spectrum disorders

and 3). Siblings of individuals with ASD also have an increased risk (RR 13.40, CI 6.93 to 25.92). 5 Secondary screening is dependent on an awareness that a child is at higher risk of ASD and the application of sound clinical knowledge and skills. Several structured instruments for use in secondary screening have been examined in a number of studies using relatively small cohorts. 36-42 With all these instruments, the findings of the studies have not been replicated outwith the study settings. See

2016 SIGN

356. Diagnosis of elevated intracranial pressure in critically ill adults: systematic review and meta-analysis. (Full text)

(ROC) model.40 studies (n=5123) were included. Of physical examination signs, pooled sensitivity and specificity for increased ICP were 28.2% (95% confidence interval 16.0% to 44.8%) and 85.9% (74.9% to 92.5%) for pupillary dilation, respectively; 54.3% (36.6% to 71.0%) and 63.6% (46.5% to 77.8%) for posturing; and 75.8% (62.4% to 85.5%) and 39.9% (26.9% to 54.5%) for Glasgow coma scale of 8 or less. Among CT findings, sensitivity and specificity were 85.9% (58.0% to 96.4%) and 61.0% (29.1% to 85.6 (...) Diagnosis of elevated intracranial pressure in critically ill adults: systematic review and meta-analysis. To summarise and compare the accuracy of physical examination, computed tomography (CT), sonography of the optic nerve sheath diameter (ONSD), and transcranial Doppler pulsatility index (TCD-PI) for the diagnosis of elevated intracranial pressure (ICP) in critically ill patients.Systematic review and meta-analysis.Six databases, including Medline, EMBASE, and PubMed, from inception to 1

2019 BMJ PubMed abstract

358. Employment Interventions for Return to Work in Working Aged Adults Following Traumatic Brain Injury (TBI): A Systematic Review (Full text)

most common worldwide causes of TBI are traffic accidents and falls, with traffic accidents declining in predominance and falls rising due to aging populations (Bražinova et al., 2015; ; ; ; ; ; ; ). 1.1.2 Severity and Sequelae Levels of TBI range from mild to severe and are determined by measures such as duration of coma or post‐traumatic amnesia (PTA), Glasgow Coma Scale (GCS) scores, and the nature and extent of functional impairments following the injury. Individuals with TBI experience various (...) systematic reviews have not compared the efficacy of different types of VR interventions on competitive employment. Instead, they have examined the effectiveness of specific interventions for individuals with TBI regarding their community integration ( ); cognitive rehabilitation ( ; ); quality of life ( ); functional independence ( ); community participation ( ; ); and physical, psychological, and social functioning ( ; ; ; ). There also have been systematic reviews that have examined the effectiveness

2016 Campbell Collaboration PubMed abstract

359. Management of Toxicities from Immunotherapy: ESMO Clinical Practice Guidelines

diseases, baseline laboratory tests and radiological exams (Supplementary Table S1, available at Annals ofOncology online) [mostly computed tomography (CT) scans of the chest, abdomen/pelvis and often brain magnetic resonance imaging (MRI)]. Patients with a history of autoimmune disease, or who are being actively treated for an autoimmune disease, are at risk for worsening of their autoimmune disease while on im- mune checkpoint blockade [16]. Similarly, patients that have had irAEs on ipilimumab

2017 European Society for Medical Oncology

360. Update: Do Patients With Minor Head Trauma Require Neuroimaging?

references, and textbook references for additional articles. STUDY SELECTION English-language studies with greater than50%oftheparticipants older than 18 years and with a minor head injury, de?ned as a Glasgow Coma Scale (GCS) score of 13 to 15, were included. All studies measured the performance of history and physical examination ?ndings for identifying intracranial injury, with a reference standard of neuroimaging or follow-up evaluation. The authors de?ned intracranial injury a priori as any (...) . Concerning physical examination features— signs of skull fracture, vomiting more than once, declining GCS score, or pedestrian struck by vehicle—suggest that neuro- imaging should be performed. Although these represent higher- risk signs and symptoms for detecting severe intracranial injury, many have LRs that would indicate moderate ability to pre- dicttheseinjuries,highlightingthe challenges with consistently iden- tifying high-risk patients. Applying a clinical decision rule after excluding

2016 Annals of Emergency Medicine Systematic Review Snapshots

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