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181. Guidelines for the prevention of stroke in women

2014 Stroke. 2014;45:1545–1588 You are viewing the most recent version of this article. Previous versions: Abstract Purpose— The aim of this statement is to summarize data on stroke risk factors that are unique to and more common in women than men and to expand on the data provided in prior stroke guidelines and cardiovascular prevention guidelines for women. This guideline focuses on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including (...) current evidence, research gaps, and recommendations on risk of stroke related to preeclampsia, oral contraceptives, menopause, and hormone replacement, as well as those risk factors more common in women, such as obesity/metabolic syndrome, atrial fibrillation, and migraine with aura. Conclusions— To more accurately reflect the risk of stroke in women across the lifespan, as well as the clear gaps in current risk scores, we believe a female-specific stroke risk score is warranted. Stroke has a large

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2014 American Academy of Neurology

182. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes

represent ACS? What is the likelihood of adverse clinical outcome(s)? Risk assessment scores and clinical prediction algorithms using clinical history, physical examination, ECG, and cardiac troponins have been developed to help identify patients with ACS at increased risk of adverse outcome(s). Common risk assessment tools include the TIMI (Thrombolysis In Myocardial Infarction) risk score, the PURSUIT (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (...) presents as a pressure-type chest pain that typically occurs at rest or with minimal exertion lasting ≥10 minutes. The pain most frequently starts in the retrosternal area and can radiate to either or both arms, the neck, or the jaw. Pain may also occur in these areas independent of chest pain. Patients “with NSTE-ACS may also present with diaphoresis, dyspnea, nausea, abdominal pain, or syncope. Unexplained new-onset or increased exertional dyspnea is the most common angina equivalent. Less common

2014 American Heart Association

183. Tinnitus

million people in the United States have reported experiencing tinnitus, resulting in an estimated prevalence of 10% to 15% in adults. 1,2 About 20% of adults who experience tinnitus will require clinical intervention. 3 Not a disease in and of itself, tinnitus is actually a symptom that can be associated with multiple causes and aggravating co-factors. Tinnitus is relatively common, but in rare cases it can be a symptom of serious disease such as vascular tumor or vestibular schwannoma (VS). Tinnitus (...) to evaluate and measure its effect as well as to determine the most appropriate interventions to improve symptoms and QOL for tinnitus sufferers. In formulating this guideline, a broad range of topics was identified as quality improvement opportunities by the GDG. These topics fall into the 3 broad domains of assessment, intervention/management, and education (Table 2). The group further prioritized these topics to determine the focus of the guideline. Health Care Burden Prevalence Tinnitus is a common

2014 American Academy of Otolaryngology - Head and Neck Surgery

184. The Management of Dyslipidemia for Cardiovascular Risk Reduction (Lipids)

of oxygenated blood and increasing the risk of chronic and acute ischemia. If a plaque ruptures within a vital artery, a blood clot forms on the plaque and may obstruct the flow of oxygenated blood to the heart or brain, resulting in an acute coronary syndrome (ACS), myocardial infarction (heart attack; MI) or stroke with potentially irreversible damage to the tissue of the heart or brain. Control and reduction of atherosclerotic cardiovascular disease (ASCVD) risk factors, including high cholesterol levels (...) hypertriglyceridemia this guideline does not address hypertriglyceridemia other than to look for secondary causes and non-pharmacologic interventions. Interested readers can refer to Lederle and Bloomfield’s 2012 article for additional information. [5] About this Clinical Practice Guideline The Department of Veterans Affairs (VA) and Department of Defense (DoD) Clinical Practice Guideline (CPG) for the Management of Dyslipidemia is intended to assist health care providers in the most common aspects of patient care

2014 VA/DoD Clinical Practice Guidelines

185. 2014 ACC/AHA Key Data Elements and Definitions for Cardiovascular Endpoint Events in Clinical Trials

collection by providing a platform of clinical terms with corresponding definitions and data elements. Broad agreement on a common vocabulary with reliable definitions used by all is vital to pool and/or compare data across clinical trials to promote interoperability with electronic health records (EHRs) and to assess the applicability of research to clinical practice. The ultimate purpose of clinical data standards is to contribute to the infrastructure necessary to accomplish the ACC’s mission (...) is restricted to the patient’s caregivers. Conversely, registries may not contain protected health information unless specific permission is granted by each patient. These fields are indicated as protected health information in the data standards. In clinical care, caregivers communicate with each other through a common vocabulary. In an analogous fashion, the integrity of clinical research depends on firm adherence to prespecified procedures for patient enrollment and follow-up; these procedures

2014 American Heart Association

186. Upper Extremity Swelling

such as an indwelling catheter, trauma, or extrinsic compression. Additionally, UEDVT involving the axillary vein or any more central vessel can be further described as proximal, with distal UEDVT affecting the brachial, radial, and ulnar veins. Secondary DVT of the upper extremity is by far the most common type. Indwelling venous devices such as catheters, pacemakers, and defibrillators put patients at the highest risk of thrombus [1,3-8]. Central venous catheters, which are difficult to place, such as those (...) to be at increased risk of UEDVT [14]. Although many of the same risk factors for lower-extremity DVT also increase the risk for UEDVT, research is helping to elucidate certain variables unique to thrombi in the upper extremity [1,15]. Primary UEDVT is less common and is diagnosed in about one-third of all UEDVT cases. Etiologies of primary UEDVT include thoracic outlet syndrome and effort-related thrombosis (Paget-Schroetter syndrome), and occasionally it is idiopathic. Patients who develop UEDVT often present

2014 American College of Radiology

187. Radiologic Management of Lower Gastrointestinal Tract Bleeding

bleeding or early rebleeding despite angiographic evidence of a successful embolization. Clinical success in recent series has ranged from 63% to 96%) [28-36] with rebleeding rates ranging from 11.1% to 50% [16,37-40]. However, in some series TAI has provided definitive treatment for 81%–86% of patients [30,33]. The efficacy of TAI varies depending on the location of the bleeding, small-bowel versus colon. Rebleeding is more common after small- bowel embolization than when treating colonic lesions (...) , likely because of the more robust vascular supply and greater number of potential collateral pathways in the small bowel [41]. The pathology causing the bleeding also affects success. A meta-analysis of 25 studies revealed that recurrent bleeding occurred in only 15% of cases of SSE for colonic diverticular bleeding but occurred in 45% of cases when the pathologic lesion (such as angiodysplasia or inflammatory bowel) had a more diffuse arterial blood supply [31]. Coagulopathy is also a well- known

2014 American College of Radiology

188. Venous thromboembolism (VTE) prophylaxis in pregnancy and the puerperium

of Queensland (Queensland Health) 2014 This work is licensed under a Creative Commons Attribution Non-Commercial No Derivatives 3.0 Australia licence. In essence, you are free to copy and communicate the work in its current form for non-commercial purposes, as long as you attribute Queensland Clinical Guidelines, Queensland Health and abide by the licence terms. You may not alter or adapt the work in any way. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc- nd/3.0/au/deed.en (...) ) and deep vein thrombosis (DVT) are the two components of a single disease called venous thromboembolism (VTE). 6,7 Pregnant women have an increased risk (4–5 fold 1,7 ) of developing a VTE, in comparison to non-pregnant women due to hypercoagulability, increased venous stasis, decreased venous outflow and compression of the inferior vena cava and pelvic veins by the enlarging uterus. 1 1.1 Incidence • Thromboembolism is a leading cause of maternal deaths in the developed world 8,9 o Second most common

2014 Queensland Health

189. BSHI/BTS for the detection and characterisation of clinically relevant antibodies in allotransplantation

immunosuppressive agents. Patient exposure to alloantigens of another individual is a common occurrence and takes place through pregnancies, blood transfusions or previous transplantation. An audit of the UK’s national kidney transplant waiting list in March 2009 showed that 41% of adult patients and 58% of paediatric patients were sensitised (calculated reaction frequency cRF >10%). A critical function of the histocompatibility laboratory is to identify sensitisation in patients to reduce the immunological (...) 19 of 94 6.1.2 Allorecognition In transplantation a unique process of T cell activation is observed. When the immune system is exposed to transplanted non-self HLA there is a vigorous T cell response. T cells recognise non-self HLA via two distinct pathways known as direct and indirect allorecognition. It is estimated that 1-5% of an individual’s T cell repertoire can react to foreign HLA through direct activation, a process where the recipient’s T cells interact directly with the foreign HLA

2014 British Society for Histocompatibility and Immunogenetics

190. Extravasation and infiltration

then surgical intervention eg fasciotomy may be required to prevent nerve compression and compromise of arterial circulation. A plastic surgeon referral should be sought immediately where large volumes of infiltrate have accumulated. Extravasation Extravasation is the inadvertent leakage of a vesicant solution from its intended vascular pathway (vein) into the surrounding tissue ( ). A vesicant refers to any medicine or fluid with the potential to cause blisters, severe tissue injury (skin/tendons/muscle (...) ) or necrosis if it escapes from the intended venous pathway ( ). Concentration of vesicant; the amount extravasated; and the type of vesicant are all factors which will influence the severity of the extravasation ( ). The degree of injury ranges from mild skin reaction to severe necrosis ( ). Other possible consequences include: infection; complex regional pain syndrome; and loss of function ( ). In severe cases extravasation injury may lead to amputation ( ). There has been little research

2014 Great Ormond Street Hospital

191. Fibromuscular Dysplasia: State of the Science and Critical Unanswered Questions

. There is an average delay from the time of the first symptom or sign to diagnosis of FMD of 4 to 9 years. , This is likely because of a multitude of factors: the perception that this is a rare disease and thus FMD is not considered in the differential diagnosis, the reality that FMD is poorly understood by many healthcare providers, and the fact that many of the signs and symptoms of FMD are nonspecific, thus leading the clinician down the wrong diagnostic pathway. A delay in diagnosis can lead to impaired (...) . However, it was not until Palubinskas and Wylie, Hunt, and Kincaid and Davis described in 1961 the arteriographic and clinical manifestations of what was then called fibromuscular hyperplasia that this systemic arteriopathy of obscure origin became widely recognized. McCormack and associates published a detailed pathological-arteriographic correlation of the different types of FMD and how they compared with atherosclerosis, a more common cause of renal artery stenosis. In 1971, Harrison and McCormack

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2014 American Heart Association

192. Standards of Practice for Superficial Femoral and Popliteal Artery Angioplasty and Stenting

, imaging, follow-up, and overall patient management are presented to guide endovascular practice in Europe. Keywords Imaging Angioplasty Stenting Arteriosclerosis Super?cial femoral artery Popliteal artery Introduction The femoropopliteal arteries are very common sites of involvement in patients with atherosclerotic peripheral arterial disease (PAD) [1]. A minority of those will require treatment for intermittent claudication (IC) or critical limb ischemia (CLI). PAD often is multilevel (...) of the anatomical extent of disease. Patients with TASC D and/or heavily calci?ed femoropopliteal lesions and a life-expec- tancy of [ 2 years may be ?rst considered for vein bypass surgery [4]. Patient Preparation Routine laboratory examinations, including a baseline full blood count, clotting pro?le, and renal function, are usually reviewed pre-procedure. Warfarin is usually interrupted a few days before the procedure and bridged to low-molecular weighted heparin (LMWH) or intravenous unfractionated heparin

2014 Cardiovascular and Interventional Radiological Society of Europe

193. 2014 AHA/ACC Guideline for the Management of Patients With Non?ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines

prediction algorithms using clinical history, physical examination, ECG, and cardiac troponins have been developed to help identify patients with ACS at increased risk of adverse outcome(s). Common risk assessment tools include the TIMI (Thrombolysis In Myocardial Infarction) risk score (42), the PURSUIT (Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy) risk score (43), the GRACE (Global Registry of Acute Coronary Events) risk score (44), and the NCDR (...) or with minimal exertion lasting =10 minutes (41). The pain most frequently starts in the retrosternal area and can radiate to either or both arms, the neck, or the jaw. Pain may also occur in these areas independent of chest pain. Patients with NSTE-ACS may also present with diaphoresis, dyspnea, nausea, abdominal pain, or syncope. Unexplained new-onset or increased exertional dyspnea is the most common angina equivalent. Less common presentations include nausea and vomiting, diaphoresis, unexplained fatigue

2014 Society for Cardiovascular Angiography and Interventions

195. Palliative and End-of-Life Care in Stroke

) effectively estimate prognosis; (3) develop appropriate goals of care; (4) be familiar with the evidence for common stroke decisions with end-of-life implications; (5) assess and effectively manage emerging stroke symptoms; (6) possess experience with palliative treatments at the end of life; (7) assist with care coordination, including referral to a palliative care specialist or hospice if necessary; (8) provide the patient and family the opportunity for personal growth and make bereavement resources (...) nearly 800 000 individuals have a stroke each year. Despite advances in treating stroke, however, death and severe disability remain common outcomes, and these numbers could double as the baby boomers reach the ages of highest stroke risk. 1 In 2010, there were nearly 130 000 stroke-related deaths contributing to >5% of all deaths in the United States; of these deaths, ˜73% were attributable to ischemic stroke, 16% to intracerebral hemorrhage (ICH), 13% to sequelae of stroke, and 4% to subarachnoid

2014 Congress of Neurological Surgeons

196. Venous Thromboembolism (VTE)

: • Anticoagulation – the most common form of treatment for both upper and lower extremity DVT and for PE. Thrombosis of superficial veins or those distal to the brachial vein (such as basilic or cephalic) do not require treatment with anticoagulation • Inferior vena cava filter – placed when anticoagulation is contraindicated or has failed • Aggressive clot removal: emergent thrombolytic therapy or (for DVT) more rarely thrombectomy – performed for “massive” PE or limb-threatening ileofemoral DVT when (...) (most common) • Factor V Leiden mutation • Prothrombin gene mutation • Protein S deficiency • Protein C deficiency • Antithrombin deficiency Antiphospholipid antibody syndrome (APS) Congestive heart failure Myeloproliferative disorders • Polycythemia vera • Essential thrombocytosis Inflammatory bowel disease Nephrotic syndrome Hyperhomocysteinemia Paroxysmal nocturnal hemoglobinuria Sources: UpToDate 2013 Bauer, Lip (literature review through May2013) 3 UMHS Venous Thromboembolism Guideline Update

2014 University of Michigan Health System

197. Guidelines for the Prevention of Stroke in Women: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

, Council on Epidemiology and Prevention, and Council for High Blood Pressure Research Originally published 6 Feb 2014 Stroke. 2014;45:1545–1588 You are viewing the most recent version of this article. Previous versions: Abstract Purpose— The aim of this statement is to summarize data on stroke risk factors that are unique to and more common in women than men and to expand on the data provided in prior stroke guidelines and cardiovascular prevention guidelines for women. This guideline focuses (...) on the risk factors unique to women, such as reproductive factors, and those that are more common in women, including migraine with aura, obesity, metabolic syndrome, and atrial fibrillation. Methods— Writing group members were nominated by the committee chair on the basis of their previous work in relevant topic areas and were approved by the American Heart Association (AHA) Stroke Council’s Scientific Statement Oversight Committee and the AHA’s Manuscript Oversight Committee. The panel reviewed relevant

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2014 American Heart Association

198. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

Association; SCAI, Society for Cardiovascular Angiography and Interventions; STS, Society of Thoracic Surgeons; and TOS, The Obesity Society. 2. Background and Pathophysiology AF is a common cardiac rhythm disturbance that increases in prevalence with advancing age. Approximately 1% of patients with AF are <60 years of age, whereas up to 12% of patients with AF are 75 to 84 years of age. More than one third of patients with AF are ≥80 years of age. , In the United States, the percentage of Medicare fee (...) compared with a patient without AF. It is estimated that treating patients with AF adds $26 billion to the US healthcare bill annually. AF affects between 2.7 million and 6.1 million American adults, and that number is expected to double over the next 25 years, adding further to the cost burden. , Table 3. 10 Most Common Comorbid Chronic Conditions Among Medicare Beneficiaries With AF Beneficiaries ≥65 y of Age (N=2 426 865) (Mean Number of Conditions=5.8; Median=6) Beneficiaries <65 y of Age (N=105

2014 American Heart Association

200. Guidelines for the screening, care and treatment of persons with hepatitis C infection

Sexual transmission Sexual transmission of HCV occurs infrequently in heterosexual couples. 39 It is more common in HIV-positive persons, particularly in men who have sex with men (MSM). 40 In several recent outbreaks of HCV infection among MSM in Europe, Australia and the US, transmission has been linked to sexual exposure as well as potentially to underreported use of non-injecting recreational drugs. 41,42 HIV-infected heterosexual partners of HCV-infected people are also more likely to acquire

2014 World Health Organisation Guidelines

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