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Common Clotting Pathway

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21. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management

ischaemic stroke without antiphospholipid syndrome [9] . [2008] [2008] Rev Reversal of anticoagulation tr ersal of anticoagulation treatment in people with haemorrhagic str eatment in people with haemorrhagic strok oke e 1.4.16 Return clotting levels to normal as soon as possible in people with a primary intracerebral haemorrhage who were receiving warfarin before their stroke (and have elevated international normalised ratio). Do this by reversing the effects of the warfarin using a combination (...) at this point. The committee agreed that CT is most useful when there is a clinical suspicion of an alternative diagnosis that CT could detect. It should not be routinely performed for everyone with a suspected TIA because it rarely confirms a diagnosis in these patients. Routine CT imaging is common in current practice and the committee agreed that this could waste resources, extend the length of stay in the emergency department, and expose people to unnecessary radiation. The committee discussed

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

22. Lead-I ECG devices for detecting symptomatic atrial fibrillation using single time point testing in primary care

The diagnostics and care pathways 6 3 The diagnostic tests 8 The interventions 8 The comparator 10 4 Evidence 12 Clinical effectiveness 12 Cost effectiveness 21 5 Committee discussion 30 Clinical effectiveness 31 Cost effectiveness 32 Research considerations 35 6 Recommendations for further research 37 7 Implementation 38 8 Diagnostics advisory committee members and NICE project team 39 Committee members 39 NICE project team 40 Lead-I ECG devices for detecting symptomatic atrial fibrillation using single time (...) in primary care with signs or symptoms of atrial fibrillation, and an irregular pulse. The condition Atrial fibrillation Atrial fibrillation 2.3 Atrial fibrillation is a type of arrhythmia that causes an irregular or abnormally fast heart rate. It is the most common arrhythmia and has a higher incidence in older people. When a person has atrial fibrillation the upper chambers of the heart (the atria) beat irregularly, making the heart less effective at moving blood into the ventricles. This can cause

2019 National Institute for Health and Clinical Excellence - Diagnostics Guidance

23. Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism

of venous thromboembolism (VTE or blood clots) and deep vein thrombosis (DVT) in people aged 16 and over in hospital. It aims to help healthcare professionals identify people most at risk and describes treatments and interventions that can be used to reduce the risk of VTE. Who is it for? Healthcare professionals People going into hospital who are at risk of VTE. This includes people discharged from hospital, (including from A&E) with lower limb devices such as plaster casts and braces, people attending

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

24. Diagnosis and Management of Acute Pulmonary Embolism

counselling and full risk assessment, these options are often proposed to women with a personal or strong family history of VTE. In post-menopausal women who receive hormone replacement therapy, the risk of VTE varies widely depending on the formulation used. Infection is a common trigger for VTE. , , Blood transfusion and erythropoiesis-stimulating agents are also associated with an increased risk of VTE. , In children, PE is usually associated with DVT and is rarely unprovoked. Serious chronic medical (...) conditions and central venous lines are considered likely triggers of PE. VTE may be viewed as part of the cardiovascular disease continuum, and common risk factors—such as cigarette smoking, obesity, hypercholesterolaemia, hypertension, and diabetes mellitus —are shared with arterial disease, notably atherosclerosis. However, this may be an indirect association mediated, at least in part, by the complications of coronary artery disease and, in the case of smoking, cancer. , Myocardial infarction

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2019 European Society of Cardiology

25. Arsenic trioxide for treating acute promyelocytic leukaemia

interruption, repeated for 5 weeks. Treatment with arsenic trioxide must be temporarily stopped before the scheduled end of therapy if a toxicity grade 3 or greater on the National Cancer Institute Common T oxicity Criteria is observed and judged to be possibly related to arsenic trioxide treatment. Treatment may be resumed at 50% of the preceding daily dose after the toxic event is resolved or after recovery to baseline status of the abnormality that prompted the interruption. Price Price £2,920 for 10 (...) or bleeding (which can sometimes be catastrophic at presentation because of severely disordered blood clotting), fatigue, feeling weak or breathless, bone or joint pain and sleeping problems. A patient group explained that these symptoms affect mobility and daily living such that they may impair education and employment. Current treatments also have high toxicity. For example, the long-term effects of chemotherapy can include a risk of secondary cancers and loss of fertility in younger people

2018 National Institute for Health and Clinical Excellence - Technology Appraisals

26. Diagnosis and management of epilepsy in adults

that such use would better serve the patient’s needs than an authorised alternative (if one exists) y be satisfied 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, and y take responsibility for prescribing the medicine and for overseeing the patient’ s care (...) THE RELEVANCE OF CLASSIFICATION IN CLINICAL PRACTICE It is important to make the distinction between genetic generalised epilepsies (GGEs, the new term for idiopathic generalised epilepsies) and focal epilepsies, as this affects treatment choices, investigation, prognosis and counselling. Identifying the aetiology is important in focal epilepsies. The onset of GGEs is unusual over the age of 25. 14 The most common GGEs in adolescence are juvenile myoclonic epilepsy (generalised tonic-clonic seizures

2018 SIGN

27. Bariatric surgery: an HTA report on the efficacy, safety and cost-effectiveness

by common assent by the Executive Board. ? Only the KCE is responsible for errors or omissions that could persist. The policy recommendations are also under the full responsibility of the KCE. Publication date: 13 June 2019 Domain: Health Technology Assessment (HTA) MeSH: Bariatric Surgery; Technology Assessment, Biomedical NLM Classification: WI 980 Language: English Format: Adobe® PDF™ (A4) Legal depot: D/2019/10.273/44 ISSN: 2466-6459 Copyright: KCE reports are published under a “by/nc/nd” Creative (...) Commons Licence http://kce.fgov.be/content/about-copyrights-for-kce-publications. How to refer to this document? Louwagie P, Neyt M, Dossche D, Camberlin C, ten Geuzendam B, Van den Heede K, Van Brabandt H. Bariatric surgery: an HTA report on the efficacy, safety and cost-effectiveness. Health Technology Assessment (HTA) Brussels: Belgian Health Care Knowledge Centre (KCE). 2019. KCE Reports 316. D/2019/10.273/44. This document is available on the website of the Belgian Health Care Knowledge Centre

2019 Belgian Health Care Knowledge Centre

28. Routine preoperative tests for elective surgery

count count Not routinely Not routinely Consider for people with cardiovascular or renal disease if any symptoms not recently investigated Haemostasis Haemostasis Not routinely Not routinely Consider in people with chronic liver disease If people taking anticoagulants need modification of their treatment regimen, make an individualised plan in line with local guidance If clotting status needs to be tested before surgery (depending on local guidance) use point-of-care testing 1 Routine preoperative (...) ull blood count count Yes Yes Yes Haemostasis Haemostasis Not routinely Not routinely Consider in people with chronic liver disease If people taking anticoagulants need modification of their treatment regimen, make an individualised plan in line with local guidance If clotting status needs to be tested before surgery (depending on local guidance) use point-of-care testing 1 Kidne Kidney y function function Consider in people at risk of AKI 2 Yes Yes Routine preoperative tests for elective surgery

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

29. New and emerging technologies in neurophysiology and operating theatres

- groups of medical technicians listed under ANSZCO codes as NEC (not elsewhere classified) are of interest — Neurophysiology technicians, Electroencephalographic Technicians, Sleep Technicians, Anaesthetic Technicians & Operating Theatre Technicians. This Evidence Check is intended as a scoping review of evidence regarding technological advancements in these fields that are currently entering common practice, or are likely to be adopted in private or public practice. The focus of the review is on both (...) that these challenges were being addressed by ongoing research and development. 9 It is likely that home EEG monitoring for disorders such as epilepsy will become more common over the next decade. The same applies for testing for sleep disorders (discussed below in Section 1.1.6). These developments will evidently lead to an increase in the amount of EEG monitoring performed over the coming decade. Continuous EEG monitoring of critical care patients This section summarises evidence that long-term EEG monitoring

2018 Sax Institute Evidence Check

30. Sirens to Scrubs: Subarachnoid Hemorrhage

pre-hospital providers with an opportunity to learn about the diagnostic pathways and ED management of common (or not-so-common) clinical presentations. By opening this dialogue, we hope that these new perspectives will be translated into practice to create a smoother, more efficient, and overall positive transition for patients as they pass through the ED doors. Objectives What are some common signs and symptoms of subarachnoid hemorrhage (SAH)? How can pre-hospital providers manage suspected SAH (...) will be inserted by interventional radiologythat will fill up the pouch and eventually clot and scar off. Sometimes a stent is placed in especially wide necked aneurysms to facilitate repair. The latter is preferred all else being equal as it does not require opening the skull. – on the left, a surgical clip, on the right, a coiling through interventional radiology. As the resident finishes her explanation. The Jennifer returns from CT and the following image is obtained, showing obvious bleeding

2019 CandiEM

31. Management of Stroke in Neonates and Children

and to indicate gaps in current knowledge. This scientific statement is based on expert consensus considerations for clinical practice. Results— Annualized pediatric stroke incidence rates, including both neonatal and later childhood stroke and both ischemic and hemorrhagic stroke, range from 3 to 25 per 100 000 children in developed countries. Newborns have the highest risk ratio: 1 in 4000 live births. Stroke is a clinical syndrome. Delays in diagnosis are common in both perinatal and childhood stroke (...) attributable to focal brain infarction or hemorrhage—applies to children as reflected by the National Institutes of Health (NIH) Common Data Elements definition. , However, in the neonatal period, the acute presentation can be missed. Thus, it is important for pediatric health professionals to be able to recognize stroke at different ages and to treat stroke to preserve brain function and to promote repair and recovery. Classification There are different ways of characterizing pediatric stroke. One

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2019 American Heart Association

32. Surgery

Table of Contents Search this document Portable Compression to Prevent Venous Thromboembolism After Hip and Knee Surgery : The ActiveCare System March (...) 2016 Summary Venous thromboembolism (VTE) (clots that form in a vein) is a common, but largely preventable, complication after orthopedic surgery . Preventive drug therapy (with anticoagulants or antiplatelets) is usually administered to lower the risk of VTE after orthopedic surgery . While the risk of major bleeding in orthopedic surgery (...) was developed by the American College of Obstetricians and Gynecologists’ Committee on Gynecologic Practice in collaboration with committee member Amanda N. Kallen (...) and Gynecologists has neither solicited nor accepted any commercial involvement in the development of the content of this published product. Perioperative Pathways: Enhanced Recovery After Surgery ABSTRACT: Gynecologic surgery is very common: hysterectomy alone is one of the most frequently performed operating room procedures each year

2018 Trip Latest and Greatest

33. Handbook on tuberculosis laboratory diagnostic methods in the European Union

and abbreviations in quality assurance 18 Table 4. List of national LTBI diagnosis guidelines 24 Table 5. QuantiFERON-TB Gold results interpretation 29 Table 6. QuantiFERON-TB Gold PLUS results interpretation 29 Table 7. Materials provided by the manufacturer 31 Table 8. Equipment required for smear preparation and staining 41 Table 9. Reporting of microscopy smears 43 Table 10. Common causes of error in smear microscopy 45 Table 11. Solvents and diluents 80 Table 12. Calculation of modal MIC value 82 Table 13 (...) are not mutually exclusive and both bring advanced diagnostics closer to the patient. The handbook is designed to meet the needs of both centralised and decentralised service delivery models and recognises that the role of national reference laboratories will change significantly over the next few years. How this handbook relates to other work available in this field This handbook presents a compilation of methods currently applied in EU/EEA Member States. It describes common work carried out and endorsed

2018 European Centre for Disease Prevention and Control - Technical Guidance

34. Management of Cardiovascular Diseases during Pregnancy

dissection, and myocardial infarction (MI) were the most common causes of maternal death in the UK over the period 2006–08. Knowledge of the risks associated with CVDs during pregnancy and their management in pregnant women who suffer from serious pre-existing conditions is of pivotal importance for advising patients before pregnancy. Since all measures concern not only the mother but the foetus as well, the optimum treatment of both must be targeted. A therapy favourable for the mother can be associated

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2018 European Society of Cardiology

36. Iron Deficiency and Anaemia in Adults

) is a widespread problem affecting an estimated two billion people worldwide and is the most common cause of anaemia seen in primary care. This guidance has been developed by expert nurses from several relevant specialties and is for the use of nurses, health care assistants (HCAs), midwives and health visitors from all specialties and backgrounds. Publication date: May 2019 Review date: May 2022 The Nine Quality Standards This publication has met the nine quality standards of the quality framework for RCN (...) publications.feedback@rcn.org.ukROYAL COLLEGE OF NURSING 3 Background 4 Definition 5 Iron homeostasis and pathophysiology 6 Iron 6 Dietary insufficiency 6 Measuring iron status 7 Common symptoms of anaemia 8 Important questions to ask 8 Examination 9 Managing iron deficiency 10 Dietary iron 10 Oral iron supplements 10 Intravenous iron: practical administration 11 Blood transfusion 15 References 17 Further reading 18 Useful websites and resources 18 Appendices: 19 1. Gastroenterology 19 2. Inflammatory bowel disease

2018 Royal College of Nursing

37. Clinical practice guideline on peri- and postoperative care of arteriovenous fistulas and grafts for haemodialysis in adults

grafts. AV access thrombosis Blood clot obstructing the AV access; indicates loss of anatomic, haemodynamic and clinical patency. AV fistula Surgically created autogenous vascular access used for chronic haemodialysis consisting of an anastomosis between an artery and a vein, with the vein serving as the accessible conduit (synonym: native AV fistula). AV graft Surgically created vascular access used for chronic haemodialysis, whereby an artificial or biological prosthetic segment is used to connect (...) or static dialyser outlet pressure, AV access recirculation or AV access duplex ultrasound assessment. Technical surveillance Assessment of an AV access at regular intervals using a specialized apparatus; distinct from clinical monitoring. AV access Overarching term referring to both AV fistulas and AV grafts. AV access thrombosis Blood clot obstructing the AV access; indicates loss of anatomic, haemodynamic and clinical patency. AV fistula Surgically created autogenous vascular access used for chronic

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2019 European Renal Best Practice

38. Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part II: Recommendations.

to retrospective series primarily focused on non–radiology-based procedures, with minimal availability of high-quality, randomized, controlled data. Nonetheless, clinical care decisions need to be made with the intent of minimizing risk and maximizing benefit for patients. Therefore, similar to how other specialty societies have addressed this topic, these guidelines are consensus-based ( x 3 Doherty, J.U., Gluckman, T.J., Hucker, W.J. et al. 2017 ACC Expert Consensus decision pathway for periprocedural (...) = venous thromboembolism; y = years. Unprovoked VTE may be associated with low or high risk after 3 mo and must be considered on a per-patient basis. Table 2 Assessment of Patient Bleeding Risk ( x 3 Doherty, J.U., Gluckman, T.J., Hucker, W.J. et al. 2017 ACC Expert Consensus decision pathway for periprocedural management of anticoagulation in patients with nonvalvular atrial fibrillation: a report of the American College of Cardiology Clinical Expert Consensus Document Task Force. J Am Coll Cardiol

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2019 Society of Interventional Radiology

39. Society of Interventional Radiology Consensus Guidelines for the Periprocedural Management of Thrombotic and Bleeding Risk in Patients Undergoing Percutaneous Image-Guided Interventions—Part I: Review of Anticoagulation Agents and Clinical Considerations

), which will shut down the tissue factor pathway; and second, thrombin will initiate the intrinsic pathway by activating factors XI and IX. Factor XIa will also convert factor IX to factor IXa, which, along with factor VIIIa, forms an intrinsic tenase to convert factor X to factor Xa. This is the main amplification pathway to generate thrombin. The thrombin converts fibrinogen to fibrin monomers. Factor XIIIa cross-links monomers to polymerize and stabilize the clot. Antithrombin ( AT ) inhibits (...) endothelium is mediated via glycoproteins Ib/IX/V and results in the release of thromboxane A2 and adenosine diphosphate (ADP), which initiate platelet aggregation through glycoprotein IIb/IIIa and fibrinogen. Secondary hemostasis involves activation of the coagulation cascade to form a fibrin clot. Figure 1 illustrates the coagulation pathways, and Figure 2 depicts how anticoagulant medications interact within the cascade. Figure 1 The coagulation cascade. The coagulation cascade is initiated

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2019 Society of Interventional Radiology

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