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181. Cholecystitis - acute

Cholecystitis - acute Cholecystitis - acute - NICE CKS Clinical Knowledge Summaries Share Cholecystitis - acute: Summary Acute cholecystitis is inflammation of the gallbladder, the most common cause of which is gallstones. Approximately 5% of people who present with acute cholecystitis do not have gallstones. Acalculous cholecystitis may affect people admittted to hospital with multiple trauma or acute non-biliary illness. Risk factors for developing gallstones include obesity, increasing age (...) with acute cholecystitis have laparoscopic cholecystectomy within 1 week of diagnosis. See . [ ] Background information Background information Definition What is it? Acute cholecystitis is inflammation of the gallbladder [ ; ]. There are a number of pathological classifications of acute cholecystitis, including oedematous, necrotizing, suppurative, and chronic [ ; ]. Causes What causes it? The most common cause of acute cholecystitis is gallstones, accounting for 90–95% of cases [ ; ; ]. In a minority

2017 NICE Clinical Knowledge Summaries

182. Management of Hepatitis C

REMIT of THE GuIDElINE 1.2.1 o VER ALL o BJEC TIVES The guideline provides evidence based recommendations covering all stages of the patient care pathway; screening, testing, diagnosis, referral, treatment, care and follow up of infants, children and adults with, or exposed to, HCV infection. The remit encompasses prevention of secondary transmission of the virus but specifically excludes primary prevention of HCV infection. Primary prevention of hepatitis C infection is an important public health (...) that there is sufficient evidence/experience of using the medicines to show its safety and efficacy, seeking the necessary information from appropriate sources y record in the patient’s clinical notes the medicine prescribed and, when not following common practice, the reasons for the choice y take responsibility for prescribing the medicine and for overseeing the patient’ s care, including monitoring the effects of the medicine. Non-medical prescribers should ensure that they are familiar with the legislative

2013 SIGN

183. Guideline on Clinical Genetics Services for Haemophilia

testing and relate to an individual’s understanding of how their genetic information may be used within the family. We have tried to offer guidance for the more common situations based on our understanding of current legislation and good clinical practice. We have recommended the establishment of family genetic files as well as formal genetic family registers in Haemophilia Centres. 1.3 Information and Informed Consent Even before a blood sample is taken for genetic testing it is essential (...) in some of the less common heritable bleeding disorders. 1.7 Required resources Implementation of the recommendations of this report will require additional resources to be invested in haemophilia services. The family files and genetic registers will need to be established to record both factual genetic information and details of clinical consultations with patients and family members. Much of this could be developed with the expertise of genetic counsellors who will bring experience of arrangements

2015 United Kingdom Haemophilia Centre Doctors' Organisation

184. Systematic review of needs for medical devices for ageing populations

elements of service delivery would remain similar, although the availability and cost of different parts of the service could vary widely and be dependent on current skills and infrastructure in each country. It is intended that this report will inform future research, with the aim of improving access to devices of elderly people across the different countries of the Western Pacific Region. To achieve effective clinical management of any health condition, all aspects of the management pathway must (...) rates and the longevity of the population in Japan, which has the world’s highest life expectancy. Consequently, the most common causes of death in Japan have shifted from infectious diseases to malignant neoplasms, heart diseases and cerebrovascular diseases (5). The aged population is also characterized by an overrepresentation of women. In the Western Pacific Region there are approximately 90 men for every 100 women over the age of 60 years. The preponderance of women in the aged population has

2015 ASERNIP-S

185. Social Determinants of Risk and Outcomes for Cardiovascular Disease

on cardiovascular outcomes. Such interventions might be directed at individual’s underlying abilities to develop and maintain relationships or might be directed at a social milieu rather than at individuals. Finally, the possibility remains that low social support does not lie in the causal pathway. Further investigation of the mechanisms linking low support and CVD may be helpful. The degree to which low social support interacts with other social determinants of cardiovascular health remains somewhat unclear (...) of beliefs and behaviors characteristic of a definable group that is transmitted without biological inheritance. Despite the difficulties, the concept is useful for understanding some differences in prevalence and treatment of illness. Poor control of type 2 diabetes mellitus is particularly common among Mexican American farm workers. Researchers from Stanford University interviewed adult patients with diabetes mellitus at 2 farm worker clinics, 1 in California and 1 in Oregon, and found that many

2015 American Heart Association

186. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

/seizure management, and other medical complications; procedures, including management of intracranial pressure (ICP), intra- ventricular hemorrhage, and the role of surgical clot removal; outcome prediction; prevention of recurrent ICH; rehabilita- tion; and future considerations. Each subcategory was led by a primary author, with 1 or 2 additional authors making contri- butions. Full PubMed searches were conducted of all English language articles regarding relevant human disease treatment from 2009 (...) 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

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2015 American Heart Association

187. State-of-the-Art Methods for Evaluation of Angiogenesis and Tissue Vascularization

. , These tunnel spaces represent matrix conduits for EC motility, tube remodeling, and recruitment of mural cells to the abluminal surface of developing vessels to enable processes such as vessel remodeling and vascular basement membrane matrix assembly. In vitro models have been used as a primary discovery tool to identify critical regulators of the EC lumen and tube formation pathway, which were later confirmed with in vivo models. They have also have been extensively used to confirm in vivo findings (...) into a collagen or fibrin matrix. A common strategy to focally seed ECs into a matrix is to coat beads with ECs and then embed these EC-coated beads into a 3D matrix. Alternatively, ECs can be allowed to form 3D spheroidal aggregates that can similarly be delivered as focal starting points into a 3D matrix. Spheroidal aggregates of human ECs have also been transplanted in a 3D matrix into immunocompromised mice to generate a 3D capillary network that anastomoses with the mouse vasculature and is perfused

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2015 American Heart Association

188. Basic Concepts and Potential Applications of Genetics and Genomics for Cardiovascular and Stroke Clinicians

of this article. Previous versions: Introduction Although genetics and genomics play an increasingly large role in the practice of medicine, the clinical care of patients suffering from cardiovascular disease or stroke has not been significantly affected. This is despite the tremendous strides being made to understand the genetic basis of both rare and common cardiovascular and stroke disorders through techniques such as genome-wide association studies (GWASs) and next-generation sequencing studies. Much (...) is that their DNA variants affect the function of genes. There are rare variants that have a large effect on the function of a gene by either significantly increasing or decreasing the activity of the gene; these are the kind of variants that cause disease in many members of a single family and are known as mutations. Classic examples include hypertrophic cardiomyopathy and Marfan syndrome. There are common variants (>1% of the general population) that have a small effect on the function of a gene

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2015 American Heart Association

189. Adult Sinusitis

topical or systemic antifungal agents Introduction Sinusitis affects about 1 in 8 adults in the United States, resulting in over 30 million annual diagnoses. , The direct cost of managing acute and chronic sinusitis exceeds $11 billion per year, , with additional expense from lost productivity, reduced job effectiveness, and impaired quality of life. - More than 1 in 5 antibiotics prescribed in adults are for sinusitis, making it the fifth most common diagnosis responsible for antibiotic therapy (...) %), and the individuals surveyed were almost as likely to receive a diagnosis of rhinosinusitis as they were of asthma (13%). The broad category of rhinosinusitis in the preceding paragraph includes ARS and CRS. Most ARS begins when a viral upper respiratory infection (URI) extends into the paranasal sinuses, which may be followed by bacterial infection. About 20 million cases of presumed bacterial ARS (ABRS) occur annually in the United States, rendering it one of the most common conditions encountered by clinicians

2015 American Academy of Otolaryngology - Head and Neck Surgery

190. Practice Guidelines for Perioperative Blood Management

. Observational studies and case reports indicate that certain congenital or acquired conditions ( e.g. , sickle-cell anemia, clotting factor deficiency, hemophilia, and liver disease) may be associated with blood transfusion complications (Category B3/B4-H evidence ) In addition, observational studies indicate that findings from pertinent preoperative laboratory tests ( e.g. , hemoglobin, hematocrit, coagulation tests) may be predictive of perioperative blood loss, the risk of transfusion, or other adverse (...) or “pathways” during a procedure whereby certain interventions should be employed. Literature Findings: RCTs comparing multimodal protocols or algorithms using coagulation tests or hemoglobin concentrations with routine blood management practices report variable findings regarding blood and blood product transfusions when such protocols are implemented (Category A2-E evidence ). RCTs demonstrate reduced blood transfusions and percentage of patients transfused when thromboelastrography (TEG)-guided

2015 American Society of Anesthesiologists

191. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

, arteriovenous malformation; CT, computed tomography; ECT, ecarin clotting time; FDA, US Food and Drug Administration; INR, international normalized ratio; OAC, oral anticoagulant; PT, partial thromboplastin time; rtPA, recombinant tissue-type plasminogen activator; SAH, subarachnoid hemorrhage; and TT, thrombin time. Reprinted from Jauch et al. Copyright © 2013, American Heart Association, Inc. Some of these exclusions are much more common than others, and some are potentially treatable, modifiable (...) have already undergone extensive scientific study such as the clear benefit of alteplase treatment in elderly stroke patients, those with severe stroke, those with diabetes mellitus and hyperglycemia, and those with minor early ischemic changes evident on computed tomography. Some exclusions such as recent intracranial surgery are likely based on common sense and sound judgment and are unlikely to ever be subjected to a randomized, clinical trial to evaluate safety. Most other contraindications

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2015 American Heart Association

192. Guidelines for the management of spontaneous intracerebral hemorrhage

compression stockings did not reduce DVT, pulmonary embolism (PE), or death. CLOTS 2 found that DVT was more common in patients who had below-knee graduated compression stockings than in those with thigh-high graduated compression stockings. Finally, CLOTS 3 enrolled 2876 patients (376 with ICH) and found that intermittent pneumatic compression begun as early as the day of hospital admission reduced the occurrence of proximal DVT, with the effect being particularly prominent in patients with hemorrhagic (...) and assessment of ICH and its causes; hemostasis and coagulopathy; blood pressure (BP) management; inpatient management, including general monitoring and nursing care, glucose/temperature/seizure management, and other medical complications; procedures, including management of intracranial pressure (ICP), intraventricular hemorrhage, and the role of surgical clot removal; outcome prediction; prevention of recurrent ICH; rehabilitation; and future considerations. Each subcategory was led by a primary author

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2015 American Academy of Neurology

193. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

/seizure management, and other medical complications; procedures, including management of intracranial pressure (ICP), intra- ventricular hemorrhage, and the role of surgical clot removal; outcome prediction; prevention of recurrent ICH; rehabilita- tion; and future considerations. Each subcategory was led by a primary author, with 1 or 2 additional authors making contri- butions. Full PubMed searches were conducted of all English language articles regarding relevant human disease treatment from 2009 (...) 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

2015 Congress of Neurological Surgeons

194. Secondary Prevention After Coronary Artery Bypass Graft Surgery

hemostasis by averting the activation and consumption of clotting factors and platelets associated with bypass. However, the clotting disorders and platelet dysfunction induced by cardiopulmonary bypass may actually have desirable effects by protecting anastomosis patency and preventing graft thrombosis. Several reports have documented the existence of a relative hypercoagulable state after off-pump surgery, associated with higher levels of postoperative platelet activity and a decrease in platelet

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2015 American Heart Association

195. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

are mainly found in anterior and lateral aspects of the epidural space. Furthermore, the fragility of these vessels increases with age. Igarashi et al demonstrated blood vessel trauma in 28% of patients who underwent an epidural puncture at L2 to L3. The size of the venous plexus changes with the segmental localization of the anastomoses. Large diameter anastomoses exist at the C6 to C7, superior thoracic, and entire lumbar regions. These vessels are often located at sites of common interventional pain (...) effects, including dose-dependent inhibition of platelet function, suppression of plasma coagulation, and enhancement of fibrinolysis. Secondary hemostasis and thrombus stability is also impaired, due to aspirin’s acetylation of fibrinogen and its enhancement of fibrinolysis. Aspirin, unlike non–aspirin NSAIDs, decreases thrombin formation in clotting blood. Aspirin at higher doses prevents endothelial cell prostacyclin production by inhibiting COX-2. Prostacyclin inhibits platelet coagulation

2015 American Society of Regional Anesthesia and Pain Medicine

196. Use of Biomarkers to Guide Decisions on Systemic Therapy for Women With Metastatic Breast Cancer

skeletal tissue, so that at least some of the tumor can be processed without having to undergo decalcification, would be clearly advantageous, but may not be practical on small-needle biopsy specimens. For needle biopsies of metastatic breast cancer to bone, submitting the accompanying blood clot in the specimen container separately from the fragments of bony tissue may yield viable tumor that would not have to undergo decalcification and could be used for the analysis of HER2 in breast cancer (...) sequencing of the tumor to initiate systemic therapy or direct selection of a new systemic therapy regimen outside of a research setting. However, the Panel notes that therapeutic clinical trials investigating specific pathways are ongoing, and study eligibility may require documentation of a specific genetic profile. This scenario is considered investigational and warrants detailed discussion with the patient about the lack of clinical utility of next-generation sequencing. Clinical Interpretation

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2015 American Society of Clinical Oncology Guidelines

197. ACS/ASCO Breast Cancer Survivorship Care Guideline

and Journal of Clinical Oncology . Copyright © 2015 American Cancer Society and American Society of Clinical Oncology. All rights reserved. No part of this document may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without written permission by the American Cancer Society or the American Society of Clinical Oncology. INTRODUCTION Section: Breast cancer is the most common noncutaneous (...) malignancy among women, representing 4 in 10 female cancer survivors in the United States. Long-term survival is common after breast cancer treatment, with a 5-year survival rate of almost 90% ; thus, addressing survivors' unique post-treatment needs is critical to providing quality health care. Nearly a decade ago, two landmark publications from the Institute of Medicine highlighted the importance of surveillance, health promotion, and assessing and managing the myriad of physical, psychological

2015 American Society of Clinical Oncology Guidelines

198. Surgical Management of Osteoarthritis of the Knee

), and the burden is increasing both as the prevalence of OA increases and also as patient expectations for treatment rise. Twenty seven million adults (more than 10 percent) of the US adult population had clinical osteoarthritis (OA) in 2005, and in 2009 OA was the fourth most common cause of hospitalization (Murphy & Helmick, 2012). OA is the leading indication for joint replacement surgery; 905,000 knee and hip replacements were performed in 2009 at a cost of 42.3 billion dollars (Murphy & Helmick, 2012 (...) genetic factors, trauma, prior meniscectomy, overuse, and infection. INCIDENCE AND PREVALENCE Twenty seven million adults (more than 10 percent) of the US adult population had clinical osteoarthritis (OA) in 2005, and in 2009 OA was the fourth most common cause of hospitalization (Murphy & Helmick, 2012). The incidence of knee osteoarthritis is estimated to affect 240 persons per 100,000/year. It is estimated that 9.9 million adults had symptomatic osteoarthritis of the knee in 2010. 29 With rising

2015 American Academy of Orthopaedic Surgeons

199. Radiologic Management of Thoracic Nodules and Masses

; Tan-Lucien H. Mohammed, MD 10 ; Jason W. Pinchot, MD 11 ; Anthony G. Saleh, MD 12 ; Henning Willers, MD 13 ; Eric J. Hohenwalter, MD. 14 Summary of Literature Review Introduction/Background Lung cancer causes more deaths than the next 3 most common cancers combined (colon, breast, and prostate). An estimated 162,460 deaths from lung cancer occur in the United States each year, and the incidence of the disease is rising [1]. The diagnosis of lung cancer carries a very poor prognosis; the expected 5 (...) complication rates compared to solid organ biopsy. The Society of Interventional Radiology has published guidelines stating that an overall complication rate of 10% is acceptable for lung biopsies, compared to 2% for all other organ systems [10]. The most common complication of percutaneous lung biopsy is bleeding (hemoptysis, chest wall, parenchymal); however, the most common complication requiring intervention is pneumothorax (10%–30%). Chest tube insertion is needed in approximately ACR Appropriateness

2015 American College of Radiology

200. Hormone Therapy for the Menopause after Endometriosis Surgery – Friend or Foe?

of the condition is reserved to keyhole surgery and laboratory analysis of biopsies as ultrasound scans have limited accuracy. The pathway to get referred to a hospital specialist and then get referred for keyhole surgery results in an average waiting time of 10 years between first symptoms and diagnosis. Endometriosis – what can be done about it? The Mirena progesterone-releasing coil can reduce pain but prevents conception The disease is believed to be dependent on oestrogen which is a hormone produced from (...) a woman’s ovaries. Common treatments aim to prevent cyclical fluctuation in these hormones by inhibiting ovulation and the most readily used treatment is the combined contraceptive pill. A found that the progesterone releasing coil, Mirena, has beneficial effects on pain, but like other coils prevents conception. Surgically treating these cells via keyhole surgery with techniques to burn or cut out the lesions of endometriosis has a beneficial effect on pain and fertility. However, the recurrence rate

2015 Evidently Cochrane

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