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361. 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

362. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition Full Text available with Trip Pro

. For information regarding this article, E-mail: This document represents the first collaboration between two organizations, American Society of Parenteral and Enteral Nutrition (ASPEN) and the Society of Critical Care Medicine (SCCM), to describe best practices in nutrition therapy in critically ill children. Guideline Limitations. These SCCM-ASPEN Clinical Guidelines are based on general consensus among a group of professionals who, in developing such guidelines , have examined the available literature (...) by at least two reviewers to examine eligibility for inclusion in guideline development. After careful review, 16 RCTs and 37 cohort studies appeared to answer one of the eight preidentified question groups for this guideline. These studies were then reviewed, and the relevant data were abstracted by the authors using a standardized form. After review of the abstracted data, evidence tables were generated for each question. Based on the evidence tables, the authors used an iterative process to develop

2017 Society of Critical Care Medicine

363. Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU

and inclusion. | GRADE Process for Grading the Evidence GRADE assigns the strength of a recommendation based on the priority of a problem; balance of benefits and harms; certainty of the evidence of effect; values and preferences; equity; acceptability; and feasibility ( ). Two or three investigators examined and summarized the literature relevant to each PICO question. To avoid intellectual conflict, guidelines writing group members who had authored a study of interest did not perform the GRADE analysis (...) of the summary of recommendations for future research can be found in Appendix 1 . Note that this list is not exhaustive in nature. | Family Presence With Patients in the ICU. PICO question 1.1. In the critical care environment, does open family presence at the bedside (also called “open visiting”) affect family satisfaction? Evidence Summary : The majority of literature examining the effect of open family presence at the bedside (defined as no or minimal restrictions on presence at the bedside

2017 Society of Critical Care Medicine

364. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient Full Text available with Trip Pro

. Each citation was reviewed by at least 2 reviewers to examine eligibility for inclusion in guideline development. After careful review, 16 RCTs and 37 cohort studies appeared to answer 1 of the 8 preidentified question groups for this guideline. We then reviewed these studies and abstracted the relevant data with a standardized form. After review of the abstracted data, evidence tables were generated for each question. Given the evidence tables, we used an iterative process to develop practical (...) of malnutrition showing independent impact on duration of MV. Limitations: single‐center study; methodologic issues with sample size calculation. Delgado et al Retrospective, observational; single center To evaluate the incidence of malnutrition in the first 72 hr after PICU admission. Examine differences in IL‐6, CRP, LOS, sepsis, and mortality between the malnourished and well‐nourished groups. n = 1077 Malnutrition based on weight‐for‐age z score: moderate, −1 to −2; severe, <−2 Median age: malnourished

2017 American Society for Parenteral and Enteral Nutrition

366. Palliative Care

support the family when providing care in accordance with the patient’s wishes. Bereavement support is invaluable after the patient dies, but that specialized support might not be available in many medical centers. Trauma care providers need to be able to ensure a reasonable degree of family comfort (physical and emotional). They need to be conversant with the process and help prepare the family for the next steps following death, including the possibility of medical examiner involvement. Referrals

2017 American College of Surgeons

367. Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder

in the RTI-UNC Systematic Review. Its authors concluded that the research evidence was insufficient to determine treatment effect heterogeneity by many of the subgroups that were examined. Members of the current guideline development panel agreed that the randomized trials included in the review do not sufficiently address the important issue of which treatments are best for which patients and constitutes an important future research need. Generalizability (applicability) of systematic review findings (...) be assumed. Panel members agree however that examination of treatment effect heterogeneity with diverse samples should be prioritized for future research. Community members on the GDP shared what they considered to be important patient values and preferences for PTSD treatment. These included such things as having a psychotherapist who is aware of and knowledgeable about trauma, who offers information about treatment, teaches coping skills, works from a personalized approach, and is sensitive to cultural

2017 American Psychological Association

368. Bone sarcomas: ESMO?PaedCan?EURACAN: Clinical Practice Guidelines for diagnosis, treatment and follow-up

the periosteum, but they are often later signs. The differential diagnosis of a bone sar- coma includes osteomyelitis, benign tumours and bone metasta- ses, all of which outnumber primary bone sarcomas [10–12]. The diagnosis can be strongly oriented by patient age. For patients 60%. In general, ChT is administered before and after surgery, although a formal proof that giving ChT preoperatively improves survival is lacking. The extent of histological response to preoperative ChT predicts sur- vival [25–27 (...) in the ?nal pathological examination. If en bloc R0 resection is not feasible, the patient is inoperable or surgical sequelae are not accepted by the patient, de?nitive RT Annals of Oncology Clinical Practice Guidelines Volume 29 | Supplement 4 | October 2018 doi:10.1093/annonc/mdy310 | iv87 Downloaded from by guest on 26 March 2019alone (without debulking) is an alternative [V, C]. Particle ther- apy (high-dose protons

2018 European Society for Medical Oncology

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

Diagnostic criteria CRPS is the term given to a group of painful conditions formerly termed as listed in Table 2. The diagnosis of CRPS is based on clinical examination and is given when patients meet the ‘New IASP ? diagnostic criteria’ (or Budapest criteria) described in Table 1. CRPS is a diagnosis of exclusion, and differentials are listed in Box 1 below. ? International Association for the Study of Pain 3 © Royal College of Physicians 2018 Box 1: Differential diagnoses ? ? infection (bone, soft

2018 British Society of Rehabilitation Medicine

370. 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

371. 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

372. 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

373. Clinical management of patients with COVID-19: second interim guidance

rapid onset of hypotension occurs. Table 1 Footnote a If altitude is higher than 1000m, then correction factor should be calculated as follows: PaO 2 /FiO 2 x barometric pressure/760. Table 1 Footnote b The SOFA score ranges from 0 to 24 and includes points related to six organ systems: respiratory (hypoxemia defined by low PaO 2 /FiO 2 ); coagulation (low platelets); liver (high bilirubin); cardiovascular (hypotension); central nervous system (low level of consciousness defined by Glasgow Coma (...) therapy immediately to patients with COVID-19 who have severe acute respiratory infection and respiratory distress, hypoxaemia or shock, and target saturations of 90-96% SpO 2 during resuscitation. Adults with a worsening clinical presentation (obstructed or absent breathing, severe respiratory distress, central cyanosis, shock, coma or convulsions) should receive airway management and oxygen therapy. Initiate oxygen therapy at 5 L/min and titrate flow rates to reach target SpO 2 ≥ 94% during

2020 Public Health Agency of Canada

374. Physical Therapy Evaluation and Treatment After Concussion/Mild Traumatic Brain Injury

have ex- perienced a concussive event for mental health, cognitive impairment, and other potential coinciding diagnoses and refer for additional evaluation and services as indicated. F For patients not deemed appropriate for a comprehen- sive physical therapy examination (ie, those who present with severe mental health concerns or health conditions that re- quire medical clearance prior to comprehensive physical exam- ination), physical therapists should provide education regarding concussion (...) Impairment/Function-Based Diagnosis CPG16 Screening and Diagnosis CPG18 Examination CPG21 Interventions CPG30 DECISION TREE CPG36 AUTHOR/REVIEWER AFFILIATIONS AND CONTACTS ...CPG40 REFERENCES CPG42 APPENDICES (ONLINE) CPG50 REVIEWERS: Roy D. Altman, MD • Paul Beattie, PT , PhD • Kate E. Berz, DO • Bradley Bley, DO, FAAP , RMSK, CSCS Amy Cecchini, DPT , MS • John Dewitt, DPT • Amanda Ferland, DPT • Isabelle Gagnon, PT , PhD • Kathleen Gill-Body, DPT , MS, NCS, FAPTA Sandra Kaplan, PT , PhD • John J. Leddy

2020 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

375. ED Patients in Police Custody

instructions should be provided to police personnel to ensure the well-being of the patient. • It is not the role of the ED Staff to act as surrogate Forensic Medical Examiners. Page 3 Scope This guideline has been developed to help medical and nursing staff within Emergency Departments (EDs) manage adult patients (18 or over) who attend whilst in the custody of the police. It includes recommendations on where to treat a patient, the timeliness of management and what information is required (...) observations). Most custody officers or detention officers who are responsible for monitoring detainees in police cells, will have no more than Basic Life Support training. Pulse, blood pressure, neuro-observations (including Glasgow Coma Score), blood glucose and oxygen saturation cannot be monitored regularly in police stations. 30 minute rousing to speech is generally the most intensive monitoring that can be achieved. CCTV or close personal observation is generally used for those at risk of self-harm

2016 Royal College of Emergency Medicine

376. Employment Interventions for Return to Work in Working Aged Adults Following Traumatic Brain Injury (TBI): A Systematic Review Full Text available with Trip Pro

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

377. 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

378. Does Mannitol Reduce Mortality From Traumatic Brain Injury?

% mannitol vs placebo 1.75 (0.48–6.38) RR, Relative risk; CI, con?dence interval; TBI, traumatic brain injury; GCS, Glasgow Coma Scale; ICP, intracranial pressure. METHODS DATA SOURCES TheauthorssearchedtheCochrane InjuriesGroupSpecializedRegister, CENTRAL,MEDLINE,EMBASE, PubMed,ISIWebofScience,and ConferenceProceedingsCitation IndexfrominceptionuntilApril 2009.Thereferencelistsofrelevant articleswerealsoreviewedandthe ?rstauthorofselectedarticleswas contactedforassistancewith (...) in cerebral blood ?ow and oxygenation. 6 The Brain Trauma Foundation Guidelines Task Force provided a level II recommen- dation (moderate clinical cer- tainty) for administering mannitol in cases of elevated intracranial pressure. 7 A recent survey re- ported that a majority of Canadian emergency physicians in one province use mannitol for pa- tients with severe traumatic brain injury in accordance with physical examination ?ndings or computed tomography evidence ofherniation. 8 Despite mannitol’s long

2016 Annals of Emergency Medicine Systematic Review Snapshots

379. Can Ocular Ultrasonography Be Used to Assess Intracranial Pressure?

tomography: a systematic review and meta-analysis. J Ultrasound Med. 2015;34:1285-1294. 1. Hansen HC, Helmke K. The subarachnoid space surrounding the optic nerves. An ultrasound study of the optic nerve sheath. Surg Radiol Anat. 1996;18: 323-328. 2. Wu EH, Fagan MJ, Reinert SE. Self- con?dence in and perceived utility of the physical examination: a comparison of medical students, residents, and faculty internists. J Gen Intern Med. 2007;22:1725-1730. 3. Helmke K, Hansen HC. Fundamentals of transorbital (...) patients. Ann Emerg Med. 2007;49:508-514. 6. Eisenberg HM, Gary HE Jr, Aldrich EF, et al. InitialCT ?ndingsin753patientswithsevere head injury. A report from the NIH Traumatic Coma Data Bank. J Neurosurg. 1990;73:688-698. 7. KimberlyHH,ShahS,MarillK,etal.Correlation ofopticnervesheathdiameter withdirect measurementofintracranialpressure.Acad EmergMed.2008;15:201-204. 8. Rajajee V, Vanaman M, Fletcher JJ, et al. Optic nerve ultrasound for the detection of raised intracranial pressure. Neurocrit Care

2016 Annals of Emergency Medicine Systematic Review Snapshots

380. 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

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