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461. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke Full Text available with Trip Pro

Population Adult Population Prevalence of ischemic stroke Lower0.63–1.2/100 000 , 1.2/100 000 per year , Higher, doubles for each decade after 55 y of age , <64 y: 2.4/100 00065–74 y: 7.6/100 000>75 y: 11.2/100 000 Clinical presentation Seizures, coma, and hemiparesis also common in nonvascular origins Seizures or coma at onset is less common in adults Stroke mechanism: prothrombotic factors 1/3 of stroke in newborns and 50% of stroke in children Less common Plasminogen levels Reduced (neonates) Normal (...) , American College of Chest Physicians; ESO, European Stroke Organisation; RCT, randomized, controlled trial; and tPA, tissue-type plasminogen activator. The initial diagnosis of stroke in children may be challenging considering the diverse presenting symptoms (eg, coma, seizures, and hemiparesis) common to nonvascular causes of stroke. All major randomized trials evaluating the benefits of intravenous alteplase have excluded stroke patients ≤18 years of age. , Stroke mechanisms in children differ from

2015 American Heart Association

462. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage Full Text available with Trip Pro

of patients with ICH is crucial, because early deterioration is common in the first few hours after ICH onset. More than 20% of patients will experience a decrease in the Glasgow Coma Scale (GCS) of 2 or more points between the prehospital emergency medical services (EMS) assessment and the initial evaluation in the emergency department (ED). 6 Furthermore, another 15% to 23% of patients demonstrate continued deterioration within the first hours after hospital arrival. 7,8 The risk for early neurological (...) - tory, physical examination, and diagnostic studies that should be obtained in the ED. A routine part of the evaluation should include a stan- dardized severity score, because such scales can help stream- line assessment and communication between providers. The National Institutes of Health Stroke Scale (NIHSS) score, commonly used for ischemic stroke, may also be useful in ICH. 24,25 However, ICH patients more often have depressed consciousness on initial presentation, and this may diminish

2015 American Heart Association

463. Clinical Practice Guideline on management of patients with diabetes and chronic kidney disease stage 3b or higher (eGFR <45 mL/min) Full Text available with Trip Pro

the inclusion criteria. Any discrepancies at this stage were resolved by consensus. In a second round, full texts of potentially relevant studies were retrieved and independently examined for eligibility and final inclusion in the data extraction step. Any discrepancies were resolved by consensus. If no consensus could be reached, the disagreement was settled by group arbitrage. The flow of the paper selection is presented for each question in Appendix 5. 6.6.3. Data extraction and critical appraisal

2015 European Renal Best Practice

464. Management of Traumatic Brain Injury

Management of Traumatic Brain Injury ACS TQIP BEST PRACTICES IN THE MANAGEMENT OF TRAUMATIC BRAIN INJURYTable of Contents Introduction 3 Using the Glasgow Coma Scale 3 Triage and Transport 5 Goals of Treatment 5 Intracranial Pressure Monitoring 6 Management of Intracranial Hypertension 9 Advanced Neuromonitoring 12 Surgical Management 13 Nutritional Support 14 Tracheostomy 15 Timing of Secondary Procedures 15 Timing of Pharmacologic Venous Thromboembolism Prophylaxis 17 Management (...) been compiled, but the paucity of high-quality studies limits the strength and scope of their counsel. The TQIP Best Practice Guidelines for the Management of Traumatic Brain Injury present recommendations regarding care of the TBI patients based on the best available evidence or, if evidence is lacking, based upon the consensus opinion of the expert panel. USING THE GLASGOW COMA SCALE Key messages: z The Glasgow Coma Scale (GCS) provides a reliable tool for assessing disturbances of consciousness

2015 American College of Surgeons

465. Quality Improvement Guidelines for Adult Diagnostic Cervicocerebral Angiography: Update Cooperative Study between the Society of Interventional Radiology (SIR), American Society of Neuroradiology (ASNR), and Society of NeuroInterventional Surgery (SNIS)

objects placed in the hand, repeat, and producespeech. Theintubated patient should be asked to write. Patient in a coma (question 1a, 3) will arbitrarily score 3 on this item. The examiner must choose a score for the patient with a stupor or limited cooperation but a score of 3 should be used only if the patient is mute and follows no one-step commands. 0, No aphasia, normal; 1, mild to moderate aphasia; some obvious loss of ?uency or facility of comprehension, without signi?cant limitation on ideas (...) provides the capability to produce a much more sophisticated examination, including such tools as three-dimensional (3D) imaging, sophisticated roadmapping, and theabilitytochooseoptimalprojections.Asaresult,theconceptofthe “complete diagnostic cervicocerebral angiogram” has become out- dated. In evaluating success rates, the standard should not be whether a “complete” examination was performed, but rather whether the examination provided the information for which it was performed while minimizing

2015 Society of Interventional Radiology

466. Management of Orthopaedic Trauma

tissue damage within six hours of impaired perfusion.  Caution regarding the estimation of elapsed time is important, as the time of precise onset is often uncertain. z Compartment syndrome is a dynamic process and, in patients with high-risk injuries, an evaluation should occur every one to two hours for a 24 to 48 hour period.  Sequential physical examinations should be performed for individuals at risk for compartment syndrome, as a single exam at one point in time is unreliable. z The most (...) clinical exam may benefit from measurement of intracompartmental pressures. A gradient of 48 hours after admission are reviewed by the trauma PIPS or equivalent committee in the hospital, unless a specific contraindication is documented in the medical record. Geriatric Hip Fractures z All geriatric (=65 years of age) patients with hip fractures and multiple co-morbidities are evaluated by a multidisciplinary team, including, at minimum, personnel with expertise in the care of the geriatric patients. z

2015 American College of Surgeons

467. Society of Gynecologic Oncology statement on risk assessment for inherited gynecologic cancer predispositions

inthesestudies,the trueriskmaybehigherinwomenwithanintactuterus.Inadditionto endometrialcancerrisk,womenwithgermlinemutationsinthePTEN gene haveup to a 50% risk of breast cancerand 3–10% riskof thyroid cancer [28–31]. Women who carry germline mutations in the TP53 gene,associatedwithLiFraumenisyndrome,haveuptoa60%lifetime riskofbreastcancer,inadditiontoother“core”cancersthatincludesar- comas, brain, and adrenocortical carcinomas [32]. The less common Peutz–Jegherssyndrome,causedbymutationsinSTK11/LKB1gene (...) type, displays frequent inactivating germline and somatic mutations in SMARCA4. Nat Genet 2014;46(5):427–9. [45] Kriege M, et al. Ef?cacy of MRI and mammography for breast cancer screening in womenwithafamilialorgeneticpredisposition.NEnglJMed2004;351(5):427–37. [46] WarnerE, etal. Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA 2004;292(11):1317–25. [47] Jarvinen HJ, et al. Controlled 15-year trial

2015 Society of Gynecologic Oncology

468. Haematological malignancies and ITU

Medicine, Society of Critical Care Medicine, ). Over the last decade, as new data have emerged, it has become clear that this statement requires re‐examination: A large 2009 study across 178 ICUs in England, Wales and Northern Ireland showed, ICU mortality of 43·1% and in‐hospital mortality of 59·2% among patients with a HM; substantially lower than previous studies had suggested (Hampshire et al , ). This guideline aims to provide an up‐to‐date, evidence‐based review of the literature on outcome (...) consideration of ICU admission. A larger study (428 ICU admissions over an 11 year period) examined survival of cancer patients, of whom two‐thirds had HM, admitted to ICU with severe sepsis or septic shock, in the presence of neutropenia (Legrand et al , ). Older age and need for inotropic support predicted inferior survival on multivariate analysis. Improved survival was predicted by admission after 2003 (study period 1998–2008), use of combination antibiotics including an aminoglycoside, and early

2015 British Committee for Standards in Haematology

469. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection

Solà, David Rigau Comas (Centre Cochrane Iberoamericà, Spain); Victoria Wakefield, Charlotta Karner (BMJ – Technology Assessment Group, London, UK); Emmanouil Tsochatzis (Royal Free Sheila Sherlock Liver Centre and UCL Institute for Liver and Digestive Health, UCL and Royal Free Hospital, UK). We appreciate the contribution from Grammati Sarri and Jill Parnham (National Clinical Guideline Centre [NCGC], Royal College of Physicians, UK) for providing technical presentations and sharing their network

2015 World Health Organisation Guidelines

470. Community management of opioid overdose

) with the ability to induce analgesia, euphoria and, in higher doses, stupor, coma and respiratory depression. The term opiate excludes synthetic opioids. See also: opioid. opioid A generic term applied to alkaloids from the opium poppy (Papaver somniferum), their synthetic analogues and compounds synthesized in the body, which interact with the same specific receptors in the brain, have the capacity to relieve pain and produce a sense of well-being (euphoria). The opium alkaloids and their synthetic analogues (...) also cause stupor, coma and respiratory depression in high doses. opioid maintenance treatment Also referred to as opioid agonist maintenance treatment or opioid substitution treatment. Examples of opioid maintenance therapies are methadone and buprenorphine maintenance treatment. Maintenance treatment can last from several months to more than 20 years, and is often accompanied by other treatment (such as psychosocial treatment). overdose The use of any drug in such an amount that acute adverse

2015 World Health Organisation Guidelines

471. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada

).In this way, they provide a convenient summary of the evidence to facilitate clinicians in the task of “weighting” and incorporating ever increasing evidence into their daily clinical decision making. They also facilitate the ability of clinicians, healthcare planners, healthcare providers and society, in general, to critically examine anyrecommendationandarriveattheirownconclusionsregarding its appropriateness. Thus, these guidelines facilitate their own (...) scrutinybyothersaccordingtothesameprinciplesthattheyuseto scrutinize the literature. It is important to note that the system chosen for grading recommendations differs from the approach used in some other guideline documents, such as the one pertaining to the periodic health examination in Canada, in which harmful practices were assigned a grade of D (8). In this Canadian Diabetes Association guidelines document, recommendation to avoid any harmful practices would be graded in the same manner as all other recommendations.However

2013 CPG Infobase

472. Transthoracic Echocardiography in Adult Patients with Ischemic Stroke

and less well tolerated, more time-consuming and costly, and potentially less readily available. Both procedures are considered to have low diagnostic yields in identifying cardiac sources of emboli in patients with no other identifiable reason for stroke, but they do enable intervention in patients with positive findings. This report examines the clinical and cost effectiveness of using TTE with clinical evidence to identify cardiac sources of emboli in adult patients with ischemic stroke, alone (...) and potentially relevant articles were retrieved and assessed for inclusion. The final selection of full-text articles was based on the inclusion criteria presented in Table 1. Table 1: Selection Criteria Population Adult patients that experienced an ischemic stroke (cerebral ischemia) Intervention Transthoracic echocardiography (TTE) Comparator Q1+Q3: Clinical evidence (medical history, abnormal examination, abnormal chest x-ray, abnormal electrocardiogram) Q2+Q4: Transesophageal echocardiography (TOE

2014 Canadian Agency for Drugs and Technologies in Health - Rapid Review

473. Kadcyla (trastuzumab emtansine (genetical recombination))

] In the meeting held on August 26, 2013, the Second Committee on New Drugs concluded that the product may be approved and that this result should be presented to the Pharmaceutical Affairs Department of the Pharmaceutical Affairs and Food Sanitation Council. The re-examination period is 8 years, the drug substance and the drug product are both classified as powerful drugs, and the product is classified as a biological product. *Japanese Accepted Name (modified INN) This English version of the Japanese review (...) .(2) Shelf life of drug substance and drug product The applicant had proposed a shelf life of 36 months for both drug substance and drug product, based on the data of the following long-term testing and examination thereof. However, the shelf life of the drug substance and the drug product should be based on long-term stability data on at least 3 batches. Therefore, PMDA requested the applicant to re-determine the shelf life based on the most updated long-term stability data. ? Results of long

2013 Pharmaceuticals and Medical Devices Agency, Japan

474. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada : Hyperglycemic emergencies in adults

as opposed to hyperosmolar nonketotic coma (HONKC) since less than one-third of people with HHS actually present with a coma . Risk factors for DKA include new diagnosis of diabetes mellitus, insulin omission, infection, myocardial infarction (MI), abdominal crisis, trauma and, possibly, continuous subcutaneous insulin infusion (CSII) therapy, thyrotoxicosis, cocaine, atypical antipsychotics and, possibly, interferon. HHS is much less common than DKA . In addition to the precipitating factors noted above (...) . There is no conclusive evidence supporting the use of an initial insulin bolus in adults and it is not recommended in children. Although the use of an initial bolus of intravenous insulin is recommended in some reviews , there has been only 1 randomized controlled trial in adults examining the effectiveness of this step . In this study, there were 3 arms: a bolus arm (0.07 units/kg, then 0.07 units/kg/h), a low-dose infusion group (no bolus, 0.07 units/kg/h) and a double-dose infusion group (no bolus, 0.14 units/kg

2013 CPG Infobase

475. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada : Diabetes in the elderly

episodes of prolonged asymptomatic hypoglycemia . If these data are replicated in subsequent studies, the assumptions underlying higher A1C targets for functionally impaired people with diabetes will need to be revisited. The consequences of a moderate-to-severe hypoglycemic episode could include a fall and injury, seizure or coma, or a CV event . A1C values <6.5% and >8.0% are associated with an increased risk of fractures . Episodes of severe hypoglycemia may increase the risk of dementia , although

2013 CPG Infobase

476. Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection

Solà, David Rigau Comas (Centre Cochrane Iberoamericà, Spain); Victoria Wakefield, Charlotta Karner (BMJ – Technology Assessment Group, London, UK); Emmanouil Tsochatzis (Royal Free Sheila Sherlock Liver Centre and UCL Institute for Liver and Digestive Health, UCL and Royal Free Hospital, UK). We appreciate the contribution from Grammati Sarri and Jill Parnham (National Clinical Guideline Centre [NCGC], Royal College of Physicians, UK) for providing technical presentations and sharing their network

2015 World Health Organisation HIV Guidelines

477. Diagnosis and Management of Acute Pulmonary Embolism

that have examined VTE as a whole. The epidemiology of PE is dif?cult to determine because it may remain asymptomatic, or its diagnosis may be an incidental ?nding; 2 in some cases, the ?rst presentation of PE may be sudden death. 7,8 Overall, PE is a major cause of mortality, morbidity, and hospitaliza- tion in Europe. As estimated on the basis of an epidemiological model, over 317 000 deaths were related to VTE in six countries of the European Union (with a total population of 454.4 million) in 2004 (...) embolism. a Low or intermediate clinical probability, or PE unlikely, depending on the studies. ESC Guidelines 3042 Downloaded from https://academic.oup.com/eurheartj/article-abstract/35/43/3033/503581 by guest on 02 April 2019The incidental discovery of clinically unsuspected PE on CT is an in- creasingly frequent problem, arising in 1–2% of all thoracic CT exam- inations, most often in patients with cancer, but also among those with paroxysmal atrial ?brillation or heart failure and history of atrial

2014 European Society of Cardiology

478. ESC/EACTS Guidelines in Myocardial Revascularisation

and intravenousenoxaparinOrUFHtoLower is- chaemic and bleeding events at short- and Long-term follow-up AVR aortic valve replacement AWESOME Angina With Extremely Serious Operative Mortality Evaluation b.i.d. bisin diem (twice daily) BARI-2D Bypass Angioplasty Revascularization Inves- tigation 2 Diabetes BASKET–PROVE BASKET–Prospective Validation Examin- ation BMS bare-metal stent BRAVE Bavarian Reperfusion Alternatives Evalu- ation BRIDGE Bridging Anticoagulation in Patients who RequireTemporaryInterruptionofWarfarin Therapy (...) -segment elevation acute coronary syndrome ECG electrocardiogram EF ejection fraction EMS emergency medical service ESC European Society of Cardiology EUROMAX European Ambulance Acute Coronary Syndrome Angiography EXAMINATION Everolimus-eluting stent vs. BMS in ST-segment elevation myocardial infarction EXCELLENT Ef?cacy of Xience/Promus vs. Cypher in re- ducing Late Loss After stenting FAME Fractional Flow Reserve vs. Angiography for Multivessel Evaluation FFR fractional ?ow reserve FINESSE

2014 European Society of Cardiology

479. Aortic Diseases

, including the medical, endovascular, and surgical approaches,which areoften combined. In addition, genetic disorders, congenital abnormalities, aortic aneurysms, and AD are discussedinmoredetail. In the following section, the normal- and the ageing aorta are described. Assessment of the aorta includes clinical examination and laboratory testing, but is based mainly on imaging techniques usingultrasound,computedtomography(CT),andMRI.Endovascu- lar therapies are playing an increasingly important role (...) /article-abstract/35/41/2873/407693 by guest on 02 April 2019dilationovermid-to-lateadulthoodisthoughttobeaconsequence of ageing, related to a higher collagen-to-elastin ratio, along with increasedstiffnessandpulsepressure. 20,23 Currentdatafromathletessuggestthatexercisetraining per sehas onlyalimitedimpactonphysiologicalaorticrootremodelling,asthe upperlimit(99thpercentile)valuesare40 mminmenand34 mmin women. 27 4. Assessment of the aorta 4.1 Clinical examination While aortic diseases may

2014 European Society of Cardiology

480. Guidelines for the treatment of malaria. Third edition

red cells per unit volume of blood, the number of parasites seen in one field on high power microscopy examination of a thick blood film, or the number of parasites seen per 200–1000 white blood cells on high-power examination of a thick blood film. Asymptomatic parasitaemia. The presence of asexual parasites in the blood without symptoms of illness. Cerebral malaria. Severe P. falciparum malaria with coma (Glasgow coma scale 30 min after a seizure. Combination treatment. A combination of two (...) should be secured in unconscious patients and breathing and circulation assessed. The patient should be weighed or body weight estimated, so that medicines, including antimalarial drugs and fluids, can be given appropriately. An intravenous cannula should be inserted, and blood glucose (rapid test), haematocrit or haemoglobin, parasitaemia and, in adults, renal function should be measured immediately. A detailed clinical examination should be conducted, including a record of the coma score. Several

2015 World Health Organisation Guidelines

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