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541. Selincro - nalmefene

the “complete or partial reversal of opioid effects, including natural or synthetic opioid-induced respiratory depression” or for “known or suspected opioid overdose or poisoning, first aid awaking, acute brain and spinal cord injury, cerebral ischaemia, cerebral infarction and other neurological dysfunction disease, coma, shock, postoperative wake-up anaesthesia, alcoholism, and drug treatment relapse after release” in Mexico and China, respectively. 1.2. Manufacturers H. Lundbeck A/S Ottiliavej 9 DK-2500 (...) , conducted in 1993 in order to examine the influence of Selincro CHMP assessment report Page 22/73 hepatic impairment after 2 mg i.v. bolus administration of NMF. Selincro is contraindicated in patients with severe renal impairment. Based on the available data, differentiated dose recommendations or warning notes for various degrees of renal impairment could not be formulated. This is reflected in Sections 4.2 and 4.4 of the SmPC. Hepatic impairment The impact of hepatic impairment was examined in Study

2013 European Medicines Agency - EPARs

543. Abilify Maintena (aripiprazole)

by stimulation of the parafascicular nucleus of the thalamus, were examined. Although aripiprazole alone was without effect, dopamine-, SKF 38393- and quinpirole- induced inhibition of spike generation in Acc neurons tended to be antagonized during simultaneous application of aripiprazole. Aripiprazole, as well as domperidone, a selective D 2 receptor antagonist, Abilify Maintena EMA/737723/2013 Page 15/70 show significant inhibition of striatal neuronal firing elicited by stimulation of dopaminergic inputs

2013 European Medicines Agency - EPARs

544. Telavancin (Vibativ)

not identify a respiratory pathogen (or if baseline respiratory cultures were not available), then an organism known to cause pneumonia that was identified from baseline blood cultures would qualify a patient for the MAT population. Adequacy of respiratory specimens: The Applicant provided criteria for a uniform examination of sputum and endotracheal aspirates. A reliable sputum specimen was defined as having > 25 white blood cells and 2 days. A patient was defined as having received potentially effective

2013 FDA - Drug Approval Package

545. Severity Assessment Tools for Patients With Community-Acquired Pneumonia

Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database, for studies published from January 1, 2008, until June 24, 2013. Abstracts were reviewed by a single reviewer and, for those studies meeting the eligibility criteria, full-text articles were obtained. Reference lists were also examined for any additional relevant studies not identified through the search. Inclusion Criteria ? English-language full reports ? published between January 1, 2008 (...) . Community-acquired pneumonia requiring admission to an intensive care unit: a descriptive study. Medicine (Baltimore) 2007; 86(2):103-111. (33) Renaud B, Coma E, Labarere J, Hayon J, Roy PM, Boureaux H et al. Routine use of the Pneumonia Severity Index for guiding the site-of-treatment decision of patients with pneumonia in the emergency department: a multicenter, prospective, observational, controlled cohort study. Clin Infect Dis 2007; 44(1):41-49. (34) Renaud B, Coma E, Hayon J, Gurgui M, Longo C

2013 Health Quality Ontario

546. Clinical guidance for responding to suffering in adults with cancer

follow-up care. 8, 13, 43 Understanding the possible emotional and spiritual responses that patients may have at different stages of cancer can help healthcare professionals anticipate when individual patients are likely to need more support. 9 For exam- ple, studies have shown that acknowledging a terminal prognosis earlier rather than later ultimately contributes to relief of suffering. 4 The recognition of death can offer a shift in perspective from small concerns to a deep appre- ciation of life

2014 Cancer Australia

547. Depression (PDQ®): Health Professional Version

. One study conducted in a group of 86 mostly late-stage cancer patients suggested that maladaptive coping styles and higher levels of depressive symptoms are potential predictors of the timing of disease progression.[ ] Another study examining coping strategies in women with breast cancer (n = 138) concluded that patients with better coping skills such as positive self-statements have lower levels of depressive and anxiety symptoms.[ ] The same study found racial differences in the use of coping (...) BK, Nanda JP, Campbell L, et al.: Examining the influence of coping with pain on depression, anxiety, and fatigue among women with breast cancer. J Psychosoc Oncol 23 (2-3): 137-57, 2005. [ ] Beresford TP, Alfers J, Mangum L, et al.: Cancer survival probability as a function of ego defense (adaptive) mechanisms versus depressive symptoms. Psychosomatics 47 (3): 247-53, 2006 May-Jun. [ ] Nelson CJ, Rosenfeld B, Breitbart W, et al.: Spirituality, religion, and depression in the terminally ill

2017 PDQ - NCI's Comprehensive Cancer Database

548. How Useful are Clinical Findings in Patients With Blunt Abdominal Trauma?

of Emergency Medicine Grand Rapids Medical Education Partners/Michigan State University College of Human Medicine Grand Rapids, MI Results Table 1. Likelihood ratios for useful examination and diagnostic tests in blunt abdominal trauma. Finding (nNo. of Studies) Positive LR (95% CI) Negative LR (95% CI) Examination ?ndings Seat belt sign (n2) 5.6–9.9 0.53–0.55 Rebound tenderness (n1) 6.5 (1.8–24) 0.96 (0.91–1.0) Hypotension (systolic blood pressure90 mm Hg) (n1) 5.2 (3.5–7.5) 0.90 (0.87–0.94) Laboratory (...) testing Base de?cit6 mEq/L (n1) 18 (11–30) 0.12 (0.06–0.24) AST or ALT130 (n1) 5.2 (3.5–7.9) 0.46 (0.33–0.65) Ultrasonography Abnormal FAST (adjusted for publication bias) (n22) 30 (20–46) 0.26 (0.19–0.34) AST, aspartate aminotransferase; ALT, alanine aminotransferase. Table 2. Less useful ?ndings (both LR less than 5 and LR– greater than 0.2). Examination Type Findings (nNo. of Studies) Clinical examination Abdominal pain as a symptom (n1) Abdominal tenderness to palpation (n5) Costal margin

2013 Annals of Emergency Medicine Systematic Review Snapshots

549. Safety and quality issues associated with the care of patients with cognitive impairment in acute care settings

Drawing Test (CDT) are less sensitive and specific than the Mini-Mental State Examination (MMSE) for the detection of CI. 56 The Mini-Mental State Examination 57 is one of the most widely used and studied instruments for screening for CI, including in the inpatient setting. 56 Although it has some limitations, it is suggested as a screening test in the hospital setting by the Royal College of Psychiatrists. 47 The Rowland Universal Dementia Assessment Scale (RUDAS) 58 is a culture fair test

2013 Sax Institute Evidence Check

550. The Use of Spine Boards in the Pre-Hospital Setting for the Stabilization of Patients Following Trauma

for pre-hospital spinal cord immobilization. 5 The National Association of EMS Physicians and the American College of Surgeons Committee on Trauma stated that, “patients for whom spinal immobilization has not been deemed necessary include those with all of the following: normal level of consciousness (Glasgow Coma Score [GCS] 15), no spine tenderness or anatomic abnormality, no neurologic findings or complaints, no distracting injury, and no intoxication.” 6 Spinal immobilization has also been (...) for exclusion included inappropriate populations (mixed populations of healthy volunteers and trauma patients), inappropriate outcomes (examining pre-hospital assessments of SCI, rather than spinal board effectiveness), and inappropriate comparators (cervical spinal collars). A PRISMA diagram demonstrating the study selection process is presented in APPENDIX 1. Additional references that did not meet the inclusion criteria but may be of potential interest are provided in the APPENDIX 2. CONCLUSIONS

2013 Canadian Agency for Drugs and Technologies in Health - Rapid Review

551. Weakness, head trauma, and an abnormal ECG

Weakness, head trauma, and an abnormal ECG Dr. Smith's ECG Blog: Weakness, head trauma, and an abnormal ECG Sunday, May 27, 2018 Written by Pendell Meyers, with edits by Steve Smith A man in his 50s with history of CAD s/p CABG, CHF, and COPD presented after several falls attributed to acute generalized weakness. Several had reportedly resulted in head trauma. There was a normal neurologic exam. Here is his ECG: What do you think? Sinus rhythm at around 60 bpm. There is STD with "down-up" T (...) ++); and 3-CNS catastrophe (ie, stroke, seizure, coma, tumor, trauma, bleed, etc). Ischemia/Infarction/Conduction defects are other common reasons for seeing a long QT/QU — but these entities will usually be suggested by other associated findings on the ECG. When the ONLY thing wrong with an ECG is a long QT/QU — Think Drugs/Lytes/CNS, or some combination of these as the cause. iii) As per Dr. Meyers — this ECG just “looks” like moderate-to-severe hypokalemia — because of the very long QT/QU with ST

2018 Dr Smith's ECG Blog

552. Poisoning or overdose

poisoned involves assessing their level of consciousness, breathing and circulation; taking a history and performing an examination. Assess the person's consciousness. The Glasgow coma scale is the method most commonly used. Measure respiratory rate. If a pulse oximeter is available, measure oxygen saturations. Note this may not be accurate if there is poor peripheral perfusion, or carboxyhaemoglobin or methaemoglobin. Measure the person's pulse, blood pressure and temperature. Arrange emergency (...) , paracetamol is the medication most commonly used in cases of deliberate overdose. Around 170,000 people are admitted hospital in the UK each year with suspected poisoning. Prognosis depends on the type of poison, the quantity taken, and associated comorbidity. Assessment involves assessing the person's level of consciousness, breathing and circulation; taking a history and performing an examination. The history should include: Why was the substance taken? What substance(s) were taken? When was it taken

2017 NICE Clinical Knowledge Summaries

553. Dyspepsia - pregnancy-associated

on . Treatments already tried, especially over-the-counter medication (for example antacids). Examination is usually normal. Investigations are generally not necessary. Where they are required, they are usually carried out in secondary care and may include: Manometry and pH probes. An upper GI endoscopy. Non-invasive testing for Helicobacter pylori , which may be delayed until after delivery. Basis for recommendation Basis for recommendation The information that dyspepsia in pregnancy is predominantly caused (...) by gastro-oesophageal reflux disease is based on expert opinion in a review article [ ]. The recommendation that the diagnosis can be made on symptoms alone is based on World Gastroenterology Organisation Global guidelines: Global perspective on gastroesophageal reflux disease [ ] and expert opinion in review articles [ ; ]. History and examination The recommendation to: Ask about presenting symptoms is extrapolated from guidelines from the National Institute for Health and Care Excellence (NICE

2017 NICE Clinical Knowledge Summaries

554. Stroke and TIA

and the area of the brain affected and may include: Confusion, altered level of consciousness and coma. Headache – sudden, severe and unusual headache which may be associated with neck stiffness. Sentinel headache(s) may occur in the preceding weeks. Weakness − sudden loss of strength in the face or limbs. Sensory loss – paraesthesia or numbness. Speech problems such as dysarthria. Visual problems – visual loss or diplopia. Dizziness, vertigo or loss of balance — isolated dizziness is not usually a symptom (...) events suggesting inherited or acquired thrombophilia. Family history of stroke — family history of stroke, especially at a young age, may indicate familial hyperlipidaemia or hypercoagulability. Current medications such as anticoagulants. Examine the person to assess: Airway, breathing and circulation (ABC). Vital signs including blood pressure, heart rate, oxygen saturation, and temperature. The cardiovascular system — look for signs of heart failure, arrhythmias (such as atrial fibrillation

2017 NICE Clinical Knowledge Summaries

555. Scabies

presents during the winter months. In classical scabies, person-to-person spread occurs predominantly via direct contact with the skin. Untreated scabies is often associated with secondary bacterial infection, which may lead to cellulitis, folliculitis, boils, impetigo, or lymphangitis. Scabies is curable if treated; however, if not treated it may persist indefinitely. The diagnosis of scabies is usually made from the history and examination of the affected individual, as well as from the history (...) , insomnia, nausea, blood disorders, bronchospasm, liver dysfunction, rashes, agitation, alopecia, anorexia, anxiety, blurred vision, coma, confusion, convulsions (with high doses), depression, diarrhoea, drowsiness, extrapyramidal effects, flushing, hallucinations, hypotension, impotence, labyrinthitis, menstrual disturbances, myalgia, palpitation, priapism, psychomotor impairment, sleep disturbance, tachycardia, tinnitus, tremor (with high doses), urinary retention, ventricular arrhythmia, vertigo

2017 NICE Clinical Knowledge Summaries

556. Meniere's disease

, predominantly vertigo, or both. Other symptoms that may be described include: Otholitic crises of Tumarkin — drop attacks without loss of consciousness that occur without warning. Normal activities can be resumed immediately afterwards. These affect less than 1 in 10 people with Meniere's disease. Balance or gait problems, particularly during attacks of vertigo. Postural instability. Perform a complete physical examination . In a person with Meniere's disease: Head and neck examination findings are usually (...) Meniere's disease based on key features, the characteristics of an acute attack, and other symptoms that may be described is based on an international consensus document on diagnostic criteria for Meniere's disease [ ], guidelines on the definition, diagnosis, and evaluation of therapy in Meniere's disease from the American Academy of Otolaryngology - head and neck surgery foundation [ ; ], and expert opinion in review articles [ ; ; ; ; ; ; ]. Physical examination findings The information on typical

2017 NICE Clinical Knowledge Summaries

557. Malaria

. Severe malaria Untreated severe malaria is fatal in the majority of cases. Progression to severe malaria may take days or occur within a few hours. Poor prognostic factors include high levels of parasitaemia, peripheral P. falciparum blood schizonts, pigment deposits in leucocytes, metabolic acidosis, older age, coma and renal impairment. Most cases of severe malaria are due to P. falciparum infection but other species (such as P. vivax and P. knowlesi ) can also cause serious illness. Infections (...) declines when exposure to Plasmodium stops for example when a person moves from an endemic to non-endemic country. Travel for tourism. [ ; ; ; ; ; ; ; ; ] Complications What are the complications? Complications of malaria include: Cerebral malaria — severe malaria due to P. falciparum with coma ( less than 11 or less than 3) or malaria with coma persisting for more than 30 minutes after a seizure. Acute respiratory distress syndrome. Spontaneous bleeding and coagulopathy. Septicaemia. Severe anaemia

2017 NICE Clinical Knowledge Summaries

558. Vertigo

. It is important to differentiate peripheral from central vertigo. Peripheral vertigo is more common and is usually caused by a problem with the inner ear affecting the labyrinth or vestibular nerve (for example benign paroxysmal positional vertigo, vestibular neuronitis, labyrinthitis, and Meniere’s disease). Central vertigo is uncommon and is usually caused by pathology in the brainstem and cerebellum (for example stroke, transient ischaemic attack, cerebellar tumour, and multiple sclerosis). Examination (...) should include looking for facial asymmetry, examination of the ear, testing of cranial nerves and cerebellar function, examination of the eyes, and checking for signs of peripheral neuropathy and abnormal gait. Specific tests such as Romberg’s test, the Dix-Hallpike manoeuvre, the head impulse test, Unterberger’s test and the alternate cover test can give useful information on the origin of vertigo. If peripheral vertigo is suspected, the history and examination findings can be used to differentiate

2017 NICE Clinical Knowledge Summaries

559. Vestibular neuronitis

neuronitis from a central lesion. Hearing and otoscopy are normal on examination. Vestibular neuronitis is a clinical diagnosis — a careful history and examination are all that is usually required. Investigations are not usually necessary, unless another cause of vertigo is suspected. For more information, see the CKS topic on . Head impulse test Head impulse test Use caution if the person has neck pathology (for example cervical spine disease), as the head impulse test involves rapid repositioning (...) of the head . Always start by asking the person to rotate their neck themselves to assess for any limitation of neck movement. If in doubt about the safety of the manoeuvre, seek specialist advice or refer the person to a balance specialist. To carry out the head impulse test: Advise the person to sit upright and to fix their gaze on the examiner. Then rapidly turn the head 10–20 degrees to one side and watch the person's eyes. In a normal response (indicating a normal peripheral vestibular system

2017 NICE Clinical Knowledge Summaries

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