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461. Resources for flooding and poor water sanitation

Collection. The burden caused by natural disasters adds to the existing burden of morbidity and mortality from diarrhoeal diseases. According to the World Health Organization (WHO), diarrhoeal disease is the second leading cause of death in children under five years old and kills 1.5 million children each year.(2) Cochrane systematic reviews can contribute to the use of effective interventions to prevent and treat water-related diseases, and they have also examined interventions to improve sanitation (...) for effectiveness in an RCT. Japanese encephalitis is a viral disease of the central nervous system with general symptoms of headache, fever, vomiting, and diarrhoea. Most people recover within a week without further complications, but approximately 1 in 300 suffers additional and severe symptoms such as disorientation, seizures, paralysis, and coma. Around 30% of the severe cases are fatal, and most survivors are left with serious and often chronic disabilities such as mental impairment, limb paralysis

2014 Evidence Aid

462. Management of Multiple Sclerosis

Demyelinating Encephalomyelitis (ADEM) 47, level III; 63, level III • An acute autoimmune demyelinating disease of CNS • Triggered by viral infections and immunisations • Usually a monophasic course • Characterised by: ? subacute encephalopathy evolving over one week to three months, disturbance of consciousness and/or behavioural abnormality ? seizures or coma ? multifocal symptoms and signs: cerebellar or cerebral ? ON or TM ? MRI brain shows symmetrical multifocal or diffuse brain lesions - supra (...) -examined the MS disease phenotypes and revised its clinical descriptions of relapsing and progressive MS. While retaining core features above, it included assessment of disease activity based on clinical relapses, imaging findings and disease progression as the 2013 revisions.The progressive relapsing category was eliminated and it is now called primary progressive MS with disease activity. CIS is now included under the spectrum of MS. 67, level III Refer to Appendix 5.Management of Multiple Sclerosis

2015 Ministry of Health, Malaysia

463. Early Management of Head Injury in Adults

Appendix 3 Glasgow Coma Scale and Score 52 Appendix 4 Head Chart 53 Appendix 5 Discharge Advice for Head Injury 54 Appendix 6 Canadian Cervical Rule (CCR) 55 Appendix 7 The NEXUS Low-Risk Criteria for 56 Low Probability of Cervical Injury Early Management of Head Injury in Adults Appendix 8 Equipments for Transfer 57 Appendix 9 Transfer Checklist for Neurosurgical Patients 58 Appendix 10 Safe Extubation Criteria in Head Injury 59 Appendix 11 Drug Dosing Regimen for Initial Management 60 List (...) ecchymosis (“Battle’s sign”), cerebrospinal fluid leakage either from the nose [cerebral spinal fluid (CSF) rhinorhoea] or ear (CSF otorhoea), or seventh and eighth cranial nerves deficits causing facial paralysis and hearing loss respectively.5 Early Management of Head Injury in Adults 3. CLASSIFICATION OF SEVERITY The severity of head injury can be classified according the presenting Glasgow Coma Score (GCS): 9 level III • mild head injury (MHI): GCS 13 - 15 • moderate head injury: GCS 9 - 12 • severe

2015 Ministry of Health, Malaysia

464. Management of Dengue Infection in Adults

(consider acute - HIV seroconversion illness) Co-morbidities (consider sepsis particularly in patients with diabetes - mellitus) 2. Physical examination i. Assess mental state and GCS score ii. Assess hydration status iii. Assess haemodynamic status Skin colour (C), capillary refill time (normal 3 times over 24 hours) Persistent diarrhoea ( • >3 times over 24 hours) Third space fluid accumulation (such as ascites, pleural and • pericardial effusion) Spontaneous bleeding tendency • Lethargy/restlessness (...) Absence of warning signs (refer to Table 3) 2. Physical examination: 3. Haemodynamically stable • No tachypnoea or acidotic breathing • No tender liver or abdominal tenderness • No bleeding manifestation • No sign of third space fluid accumulation • No alterations in mental state • Investigation: 4. Stable serial HCT • No other criteria for admission (i.e. co-morbidities, pregnancy, social 5. factors)16 CPG Management of Dengue Infection In Adults (Third Edition) 2015 17 7.2 P A TIENT TRIAGING A T

2015 Ministry of Health, Malaysia

465. Consolidated guidelines on HIV testing services

other health services, such as TB, STI or viral hepatitis services, antenatal care (ANC), contraceptive and other family planning services and screening and care for other conditions, including noncommunicable diseases. In vitro diagnostic (IVD) medical device: a medical device, used alone or in combination, intended by the manufacturer for the examination of specimens derived from the human body solely or principally to provide information for diagnostic, monitoring or compatibility purposes

2015 World Health Organisation HIV Guidelines

466. Brain injury rehabilitation in adults

prognosis in people with brain injuries correlates to different extents with various factors including levels of consciousness, duration of post-traumatic amnesia, age, gender and pre-injury education and employment. The most widely used index of injury severity is the Glasgow Coma Score (GCS) which classifies injuries into mild, moderate or severe categories based on level of consciousness post injury (see Table 1). It should be noted that severity of symptoms associated with an injury may (...) systematic evidence to support it in practice, denying services randomly in order to conduct an RCT could be considered unethical. 16 Few rehabilitation-focused, observational studies control for selection bias. A systematic review of multidisciplinary rehabilitation services in post-acute care across a range of populations concluded that adjusting for case mix when examining the influence of two or more interventions on an outcome does not necessarily sufficiently reduce the selection bias associated

2013 SIGN

467. The Neurology and Neuropsychiatry of COVID-19 Full Text available with Trip Pro

enhancement. LP demonstrated a lymphocytic pleocytosis and was positive for SARS-CoV-2 PCR. Publication date / reference: 30/05/20 Summary: 51-year-old female with SARS-CoV-2 (negative in CSF) developed coma, left hemiparesis and impaired unilateral oculocephalic response. She had multiple acute demyelinating lesions on MRI. Publication date / reference: 29/05/20 Summary: 35-year-old SARS-CoV-2 positive patient with intractable seizures from a presumed glial cell tumour. However, the resultant cause (...) in the brain (six ischaemic strokes and two TIAs). Publication date / reference: 08/06/20 Summary: retrospective case control study of stroke patients with (n=31) and without (n=99) SARS-CoV-2 infection. Patients with COVID-19 were older had more large vessel and more severe strokes on average. Publication date / reference: 05/06/20 Summary: Case report of an 81-year-old man receiving non-invasive respiratory support, who developed confusion progressing subacutely to coma. CT angiogram suggested partial

2020 JNNP blog

468. Evaluation and Management of Gallstone-Related Diseases in Non-Pregnant Adults

The evaluation for gallstone-related disease is summarized in Table 1. The evaluation routinely includes 1. Complete physical exam 2. Laboratory evaluation – CBC, comprehensive metabolic panel, amylase/lipase 3. Imaging – Right upper quadrant (RUQ) ultrasound In the vast majority of patients with acute cholecystitis, the diagnosis can be made based upon the history, physical findings, laboratory tests, and ultrasound (see Table 3 for the sonographic diagnostic criteria for acute cholecystitis In rare cases (...) dysfunction (Elevated PT/INR >1.5) Hematological dysfunction (Platelet count 55 years Glucose >200 mg/dL LDH >350 mg/dL AST >250 units/L WBC >16 K/mm3 BISAP Criteria BUN >25 mg/dl Impaired mental status (any): - disorientation, lethargy, coma, somnolence, stupor SIRS* Age >60 years Pleural Effusion Severity Classification Mild Gallstone Pancreatitis a. Clinical stability with admission to non-monitored bed • No significant hypovolemia • BUN 38º C OR 90; RR > 20 OR Pa CO2 12,000 OR 10% bands 9 UMHS

2015 University of Michigan Health System

469. Thyroid Dysfunction: Screening

Thyroid gland disorders are among the most common endocrine conditions evaluated and treated by clinicians. Thyroid dysfunction represents a continuum from asymptomatic biochemical changes to clinically symptomatic disease. In rare cases, it can produce life-threatening complications, such as myxedema coma or thyroid storm. , Subclinical hypothyroidism is defined as an asymptomatic condition in which a patient has a serum thyroid-stimulating hormone (TSH) level exceeding the upper threshold (...) that evaluated the benefits of treatment of subclinical hyperthyroidism on final health outcomes, such as fractures, cancer, or cardiovascular morbidity or mortality. Except for 1 small ( n = 67) nonrandomized study that examined bone mineral density, no evidence was found on the effects of treatment of “overt” hyperthyroidism (with or without symptoms). , Potential Harms The harms of treatment of thyroid dysfunction have not been well-studied. The most important potential harms are false-positive results

2015 U.S. Preventive Services Task Force

470. Heart Failure Management in Skilled Nursing Facilities Full Text available with Trip Pro

begins with accurate identification of residents diagnosed with HF. The clinical diagnosis of HF may largely rely on data from care before SNF admission. Residents without an HF diagnosis who develop pulmonary congestion or volume overload should have a physical examination, chest radiograph, and blood chemistry tests to confirm congestion and volume overload within the SNF setting if possible. Results from laboratory tests may take 24 hours or longer to return in SNFs; thus, appropriate clinical (...) for potential adverse effects (including drug-drug and drug-disease interactions). On Medicare-reimbursed units, the SNF bears medication costs, which adds further incentive for an appropriate pharmacological regimen. HF With Reduced Ejection Fraction Numerous randomized controlled trials have examined a wide range of pharmacological agents for the treatment of HF with reduced ejection fraction (HF r EF), usually defined as an ejection fraction <45%. A detailed review of agents shown to be effective

2015 American Heart Association

471. 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

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. 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

474. 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

475. 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

476. Guidelines for Transport of Critically Ill Patients

history and clinical examination findings of their patients. Documentation should include an ongoing record of physiological status, clinical procedures, and any subsequent interventions. A copy of this patient record should be provided to the receiving hospital along with the clinical record and investigations from the referring facility, where available. For intrahospital transport, this documentation may form part of the inpatient notes. 10. MONITORING Monitoring of certain physiological variables (...) , measurement of the arterial blood pressure and assessment of peripheral perfusion. 10.1.2 Respiration Respiratory rate should be assessed and recorded at frequent and clinically appropriate intervals. 10.1.3 Oxygenation The patient’s oxygenation should be assessed at frequent and clinically appropriate intervals by observation and use of pulse oximetry. 10.1.4 Level of consciousness by Glasgow Coma Scale and pupil reaction. 10.1.5 Pain score Patients’ pain should be monitored including regular assessment

2015 Australian and New Zealand College of Anaesthetists

477. Update on Prevention of Cardiovascular Disease in Adults With Type 2 Diabetes Mellitus in Light of Recent Evidence Full Text available with Trip Pro

diabetes mellitus is needed to elucidate the role of physical activity and weight loss in reducing clinical CVD end points. Another study examining the role of intensive lifestyle management on CVD risk factors was the Italian Diabetes and Exercise Study (IDES). The IDES was an RCT designed to examine the effects of an intensive exercise intervention strategy on modifiable CVD risk factors in 606 sedentary subjects with type 2 diabetes mellitus enrolled in 22 outpatient diabetes mellitus clinics across (...) to reduce the risk of stroke. Trials examining the effect of aspirin for primary prevention in patients with diabetes mellitus are summarized: 6 trials were conducted in the general population that also included patients with diabetes mellitus, and 3 other trials specifically examined patients with diabetes mellitus. Trials ranged from 3 to 10 years in duration and have examined a wide range of aspirin doses. Participants were mainly late middle-aged adults; 3 trials , , included only men. The range

2015 American Heart Association

478. 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

479. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

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 Congress of Neurological Surgeons

480. Guidelines for the management of spontaneous intracerebral hemorrhage Full Text available with Trip Pro

. 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). Furthermore, another 15% to 23% of patients demonstrate continued deterioration within the first hours after hospital arrival. , The risk for early neurological deterioration and the high rate of poor long-term outcomes underscore the need for aggressive early (...) should be contacted as quickly as possible while the patient is in the ED, and the clinical evaluation should be performed efficiently, with physicians and nurses working in parallel. Consultation via telemedicine can be a valuable tool for hospitals without on-site presence of consultants. , describes the integral components of the history, physical examination, and diagnostic studies that should be obtained in the ED. Table 4. Integral Components of the History, Physical Examination, and Workup

2015 American Academy of Neurology

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