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Elderly Drivers with Cognitive Impairment


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241. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines, and the Heart Rhythm Society Full Text available with Trip Pro

%. Females reported a higher prevalence of syncope (22% versus 15%, P <0.001). The incidence follows a trimodal distribution in both sexes, with the first episode common around 20, 60, or 80 years of age and the third peak occurring 5 to 7 years earlier in males. Predictors of recurrent syncope in older adults are aortic stenosis, impaired renal function, atrioventricular or left bundle-branch block, male sex, chronic obstructive pulmonary disorder, heart failure, atrial fibrillation, advancing age (...) . The definition of older populations has been evolving. Age >75 years is used to define older populations or older adults in this document, unless otherwise specified. If a study has defined older adults by a different age cutoff, the relevant age is noted in those specific cases. Finally, the guideline addresses the management of syncope with the patient as a focus, rather than larger aspects of health services, such as syncope management units. The goals of the present guideline are: To define syncope

2017 American Heart Association

242. Syncope: Guideline For Evaluation and Management of Patients With

.ORTHOSTATIC HYPOTENSION: RECOMMENDATIONS . .. e73 6.1. Neurogenic Orthostatic Hypotension: Recommendations e73 6.2. Dehydration and Drugs: Recommendations e75 7.ORTHOSTATIC INTOLERANCE .. e76 8.PSEUDOSYNCOPE: RECOMMENDATIONS .. e76 9.UNCOMMON CONDITIONS ASSOCIATED WITH SYNCOPE .. e77 10.AGE, LIFESTYLE, AND SPECIAL POPULATIONS: RECOMMENDATIONS . .. e79 10.1. Pediatric Syncope: Recommendations ... e79 10.2. Adult Congenital Heart Disease: Recommendations e81 10.3. Geriatric Patients: Recommendations e81 (...) text (ideally, 75yearsisusedto de?neolderpopulationsorolderadultsinthisdocument, unless otherwise speci?ed. If a study has de?ned older adults by a different age cutoff, the relevant age is noted in those speci?c cases. Finally, the guideline ad- dresses the management of syncope with the patient as a focus,ratherthanlargeraspectsofhealthservices,suchas syncope management units. The goals of the present guidelineare: n Tode?ne syncope as a symptom,withdifferent causes, in different populations

2017 American College of Cardiology

243. The Learning Healthcare System and Cardiovascular Care: A Scientific Statement From the American Heart Association

approach is to implement and evaluate the LHS concept in one aspect of clinical medicine, using it as a “learning laboratory” environment in which to refine its concepts. Then, lessons from this experience can be extended to other aspects of medicine. Cardiovascular disease (CVD) care delivery, for a variety of reasons, is well suited to serve as a model for the LHS. First, CVD significantly affects the population: It is a highly prevalent condition, affects all ages and demographic groups (...) not consistently occur. For example, different providers may have different methods of coding encounters, which can limit interprovider comparability. In addition, consistent biases in coding such as “up-coding” can significantly impair the veracity of claims data insights. Nonetheless, International Classification of Diseases codes have demonstrated accuracy in characterizing CVD conditions and care. Second, aspects of care that are important clinically (such as patient preferences) but not relevant from

2017 American Heart Association

244. Recommendations for the Use of Mechanical Circulatory Support: Ambulatory and Community Patient Care: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

Increasing diuretic requirement Symptomatic despite CRT Inotrope dependence Low peak V o 2 (<14–16) End-organ dysfunction attributable to low cardiac output Contraindications Absolute Irreversible hepatic disease Irreversible renal disease Irreversible neurological disease Medical nonadherence Severe psychosocial limitations Relative Age >80 y for DT Obesity or malnutrition Musculoskeletal disease that impairs rehabilitation Active systemic infection or prolonged intubation Untreated malignancy Severe (...) PVD Active substance abuse Impaired cognitive function Unmanaged psychiatric disorder Lack of social support CRT indicates cardiac resynchronization therapy; DT, destination therapy; NYHA, New York Heart Association; Vo 2 , oxygen consumption; and PVD, peripheral vascular disease. As of July 2014, 158 centers in the United States offer long-term MCS. Patients often live a substantial distance from the implanting center, necessitating active involvement of local first responders (emergency medical

2017 American Heart Association

245. Management of Opioid Therapy (OT) for Chronic Pain

Reviewed, New- added V A / D o D Cli ni cal P r a cti ce G ui d el i n e f o r O p ioid T h e r a p y for Ch r on ic Pa in February 2017 Page 8 of 198 # Recommendation Strength* Category† 6. a) We recommend against long-term opioid therapy for patients less than 30 years of age secondary to higher risk of opioid use disorder and overdose. b) For patients less than 30 years of age currently on long-term opioid therapy, we recommend close monitoring and consideration for tapering when risks exceed (...) for “fun” or to “get high,” while 22% used the medication to relieve day-to-day stress.[18] Concurrent with the increase in prescription opioid use, the rate of heroin overdose deaths increased nearly four-fold between 2000 and 2013.[19] According to a survey of patients entering SUD treatment for heroin use, the prescription opioid epidemic has resulted in a marked shift in how and which opioids are abused. In the 1960s, 80% of people entering treatment for heroin use started using heroin

2017 VA/DoD Clinical Practice Guidelines

246. Rehabilitation of Lower Limb Amputation

with LLA is influenced by a variety of factors that include, but are not limited to, level of amputation, cognitive impairment, physical conditioning, social support, comorbidities, and psychological factors.[20] Amputations caused by vascular disease generally occur in aging populations with numerous other comorbidities such as cardiovascular disease, hypertension, renal 3 See Veterans Health Administration Directive 1410, Prevention of Amputation in Veterans Everywhere. Available at: https (...) Care 23 VII. Discussion of Recommendations 24 A. All Phases of Amputation Rehabilitation 24 B. Perioperative Phase 31 C. Pre-Prosthetic Phase 39 D. Prosthetic Training Phase 40 VIII. Knowledge Gaps and Recommended Research 46 A. Training programs 46 B. Rehabilitation dosing 47 C. Patient factors and considerations 47 D. Cognitive assessment 47 E. Perioperative LLA interventions 47 VA/DoD Clinical Practice Guideline for Rehabilitation of Individuals with Lower Limb Amputation September 2017 Page 4

2017 VA/DoD Clinical Practice Guidelines

247. Diagnosis and Treatment of Low Back Pain

Recent infection Immunosuppression MRI with contrast* ESR Fracture History of osteoporosis Chronic use of corticosteroids Older age (=75 years old) Recent trauma Younger patients with overuse at risk for stress fracture Lumbosacral plain radiography For inconclusive results, advanced imaging such as MRI ? , CT, or SPECT as appropriate Ankylosing spondylitis Morning stiffness Improvement with exercise Alternating buttock pain Awakening due to low back pain back pain during the second part of the night (...) or physical examination Cancer ? History of cancer with new onset of LBP ? Unexplained weight loss ? Failure of LBP to improve after one month ? Age greater than 50 years Infection ? Fever ? Intravenous drug use ? Recent infection ? Immunosuppression Fracture ? History of osteoporosis ? Chronic use of corticosteroids ? Older age (75 years or older) ? Recent trauma ? Younger patients with overuse at risk for stress fracture Ankylosing spondylitis ? Morning stiffness ? Improvement with exercise

2017 VA/DoD Clinical Practice Guidelines

248. Benign Paroxysmal Positional Vertigo (BPPV) Full Text available with Trip Pro

in older individuals, with a correspondingly more pronounced health and quality-of-life impact. It has been estimated that 9% of elderly patients undergoing comprehensive geriatric assessment for nonbalance-related complaints have unrecognized BPPV. More recent studies of symptomatic individuals have found BPPV to be present in 40% of geriatric patients seen for dizziness, with an overall general prevalence of 3.4% in individuals aged >60. , Older patients with BPPV experience a greater incidence (...) of falls, depression, and impairments of their daily activities. Persistent untreated or undiagnosed vertigo in the elderly leads to increased caregiver burden with resultant societal costs including decreased family productivity and increased risk of nursing home placement. Among an estimated 7.0 million elderly individuals reporting dizziness in the prior 12 months, 2.0 million (30.1%) reported vertigo, and there were 230,000 office visits among the elderly with a diagnosis of BPPV

2017 American Academy of Otolaryngology - Head and Neck Surgery

249. Clinical Practice Guideline for Diagnostic Testing for Adult Obstructive Sleep Apnea: An American Academy of Sleep Medicine Clinical Practice Guideline

and hypercapnea, intrathoracic pressure swings, and increased sympathetic nervous activity that accompanies disordered breathing during sleep. Individuals with OSA often feel unrested, fatigued, and sleepy during the daytime. They may suffer from impairments in vigilance, concentration, cognitive function, social interactions and quality of life (QOL). These declines in daytime function can translate into higher rates of job-related and motor vehicle accidents. Patients with untreated OSA may be at increased (...) exclude the possibility of OSA. Specificity tends to be lower, resulting in a higher number of false positives that further limit the utility of these clinical or morphometric rules and models in the diagnosis of OSA. It should also be noted that some of these studies were conducted in focused populations (e.g., commercial drivers, elderly, bariatric surgery patients, etc.), thus limiting generalizability. The following discussion has been organized to review the data by questionnaire or clinical

2017 American Academy of Sleep Medicine

250. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

With History of Prematurity Abnormal birth history—including preterm birth and low birth weight—has been identified as a risk factor for HTN and other CVD in adults ; only low birth weight has been associated with elevated BP in the pediatric age range. One retrospective cohort study showed a prevalence of HTN of 7.3% among 3 year olds who were born preterm. Researchers in another retrospective case series noted a high prevalence of HTN in older children with a history of preterm birth. It also appears (...) adult guideline and facilitate the management of older adolescents with high BP. The percentile-based values in and are provided to aid researchers and others interested in a more precise classification of BP. 3.2a. Simplified BP Table This guideline includes a new, simplified table for initial BP screening (see ) based on the 90th percentile BP for age and sex for children at the 5th percentile of height, which gives the values in the table a negative predictive value of >99%. This simplified table

2017 American Academy of Pediatrics

251. HTA of smoking cessation interventions

of HTA, HIQA (Chair) Dr Conor Teljeur Senior Statistician, HTA Directorate, HIQA Prof Michael Turner Clinical Lead, National Clinical Programme for Obstetrics and Gynaecology, HSE Dr Nicky Welton Reader in Statistical and Health Economic Modelling, University of Bristol, UK We would also like to acknowledge the following people and organisations that provided advice and information over the course of the assessment: Ms Kathryn Coyle and Dr Subhash Pokhrel, Brunel University, UK Cochrane Tobacco (...) implications of potential changes to the mix of treatments that people use to help them stop smoking. The key findings of the HTA that precede and inform HIQA’s advice are as follows: ? Smoking continues to be a major public health problem in Ireland, and is associated with a considerable burden on the public health system. The prevalence of smoking in Ireland is 22.7% in people aged 15 years and over. The prevalence is higher in men (24.3%) than in women (21.2%), and highest in people aged 25 to 29 years

2017 Health Information and Quality Authority

252. European Society of Endocrinology Clinical practice guidelines for the care of girls and women with Turner syndrome

SDS and +3 SDS, clinical judgment should guide further GH dose selection (⨁◯◯◯). R 2.6. We suggest concomitant treatment with oxandrolone from the age of 10 years or older at 0.03 mg/kg/day and maintained below 0.05 mg/kg/day, if the diagnosis of TS (and therefore GH treatment initiation) is delayed, and/or adult height outcome is likely to be unsatisfactory with the standard GH dose alone (⨁⨁⨁⨁). R 2.7. We suggest to not routinely add very-low-dose estrogen supplementation in the prepubertal (...) dilated aorta (ascending ASI ≥2.0 cm/m 2 ), avoidance of intense weight-training should be advised (⨁◯◯◯). R 4.18. We suggest that, for girls and women with normal aortic size (age <16 years; TS-specific Z-score of <2.5 or age ≥16 years and ASI <2.0 cm/m 2 ), it is reasonable to participate in all sports (⨁◯◯◯). R 4.19. We suggest that, for girls and women with a mild to moderately dilated aorta (age <16 years old (TS-specific Z-score of 2.5–3), or age ≥16 years (ASI 2.0–2.3 cm/m 2 )), participation

2017 European Society of Endocrinology

253. Palliative Care in the Outpatient Setting

patient QoL or had comparable improvements in QoL relative to usual care. Both study population (cancer vs. mixed) and timing of palliative care may be drivers of the variable findings on QoL. High Moderate Low No evidence ©Institute for Clinical and Economic Review, 2016 Page ES7 Mood Outcomes We identified a total of six studies evaluating mood outcomes, specifically anxiety and depression, using a number of validated instruments, including two good quality 10,21 and four fair quality 11,18,24,25 (...) survival, 10,12,26 and may in fact result in increased survival in populations with advanced cancer, 21 particularly when adjusting for potential confounders of the relationship between the intervention and survival (e.g., The Eastern Cooperative Oncology Group [ECOG] performance status score, or survival for less than one year). 10,21 Both target population (cancer) and timing of palliative care (early) may be drivers of variable findings on survival; however, these factors are inextricably linked

2017 California Technology Assessment Forum

254. Glasgow Coma Scale for Field Triage of Trauma: A Systematic Review

and Definitions Appendix G. Strength of Evidence Table Appendix H. Head-to-Head Studies for Predictive Utility Appendix I. Indirect Studies for Predictive Utility Appendix J. Studies of Reliability and Ease of Use Appendix K. Quality Assessment of Studies of Predictive Utility Appendix L. Quality Assessments of Studies of Reliability and Ease of Use xi Executive Summary Background Unintentional injuries are the leading cause of death among people in the United States ages 1 to 44, and the third leading cause (...) among people ages 45 to 64. 1 Among all age groups, motor vehicle crashes are the first or second leading cause of unintentional injury death. 2 In 2011, there were approximately 40,000,000 emergency department (ED) visits for injuries; of these approximately 2.5 million were due to trauma complications and unspecified injuries. 3 Approximately 18 percent of patients seen in the ED for an injury were transported by emergency medical services (EMS) personnel. 4 Traumatic brain injury (TBI

2017 Effective Health Care Program (AHRQ)

255. National Research Agenda on the Health Impacts of Non-Medical Cannabis Use

to engage stakeholders, particularly youth and their families, in the research process from beginning to end? ? Individual characteristics: How do the effects (e.g., brain, behaviour) of cannabis vary with differences in characteristics of individuals who use, including: ? Sex/gender, along the gender continuum; ? Age and across the life span, including children, youth, young adults (transitional age youth), adults, and older adults and seniors; ? Race and ethnicity, including specific discussion (...) effects of exogenous cannabinoids on the ECS? ? Do genetic variants of component parts of the ECS affect risk for psychosis, impaired development of cognitive functions and other adverse effects of THC and other phytocannabinoids? ? Do the composition differences among different strains or preparations of cannabis produce differences of ECS function that can give rise to adverse effects on health? ? Are there age, sex or ethnic differences in ECS function that might alter responses to cannabis

2017 Canadian Centre on Substance Abuse

256. Obstructive Sleep Apnea in Adults: Screening

with increased all-cause mortality; however, the role OSA plays in increasing overall mortality, independent from other risk factors (older age, higher body mass index [BMI], and other cardiovascular risk factors), is less clear. In addition to mortality, other adverse health outcomes associated with untreated OSA include cardiovascular disease and cerebrovascular events, diabetes, cognitive impairment, decreased quality of life, and motor vehicle crashes. Detection Evidence on the use of validated screening (...) , beyond the contributions of age, BMI, and other confounding factors. Other adverse outcomes have also been reported with OSA, such as increased risk of motor vehicle and other crashes; cognitive impairment; lost work days, work disability, and impaired work performance; and decreased quality of life. Scope of Review The USPSTF commissioned a systematic review , to evaluate the evidence on the accuracy, benefits, and potential harms of screening for OSA in asymptomatic adults seen in primary care

2017 U.S. Preventive Services Task Force

257. Vortioxetine for treating major depressive episodes

that its searches did not identify any evidence to include on 2 other relevant comparators (fluoxetine or mirtazapine) in the indirect treatment comparison. 3.10 Kasper et al. (2013) was a post-hoc analysis of the 'pre-treated' population from 2 trials of agomelatine in people with major depressive disorder. The number of patients enrolled in each of the 4 trials ranged from fewer than 100 (Kasper) to 789 (STAR*D). The mean age of patients was reported for 3 of the 4 trials and ranged from 41.8 years (...) team 59 8 Sources of evidence considered by the Committee 61 About this guidance 63 Vortioxetine for treating major depressive episodes (TA367) © NICE 2018. All rights reserved. Subject to Notice of rights ( conditions#notice-of-rights). Page 3 of 641 1 Guidance Guidance 1.1 Vortioxetine is recommended as an option for treating major depressive episodes in adults whose condition has responded inadequately to 2 antidepressants within the current episode. 1.2 People

2015 National Institute for Health and Clinical Excellence - Technology Appraisals

258. Sofosbuvir for treating chronic hepatitis C

outcome was sustained virological response 12 weeks after the end of treatment. The study did not include sites in the UK. A historical control rate of 60% for sustained virological response was used for peginterferon alfa-2a and ribavirin, taken from the phase III telaprevir (ADVANCE) and boceprevir (SPRINT-2) trials. The people in the study had a median age of 54 years (age range 19 to 70 years); 64% were men; 78% had baseline HCV RNA greater than 6 log 10 IU/ ml (viral load, or the number of virus (...) response at 12 weeks (primary end point) was tested. People in the study were randomised in a 1:1 ratio and stratified by the presence or absence of cirrhosis, HCV genotype (2 or 3) and baseline HCV RNA level (<6 log 10 IU/ml or =6 log 10 IU/ml). The people in the study had a median age of 50 years (range from 19 to 77 years); 66% were men; 57% had baseline HCV RNA levels greater than 6 log 10 IU/ml; 20% had cirrhosis; 72% had genotype 3 HCV. 3.9 Results from FISSION showed that at 12 weeks after

2015 National Institute for Health and Clinical Excellence - Technology Appraisals

259. Multiple sclerosis in adults: management

vitamin B 12 injections to treat fatigue in people with MS. 1.5.8 Consider a comprehensive programme of aerobic and moderate progressive resistance activity combined with cognitive behavioural techniques for fatigue in people with MS with moderately impaired mobility (an EDSS [5] score of greater than or equal to 4). Mobility Mobility 1.5.9 Ensure people with MS and mobility problems have access to an assessment to establish individual goals and discuss ways in which to achieve them. This would (...) Development Group's full set of research recommendations is detailed in the full guideline. 2.1 Cognitive rehabilitation What is the clinical and cost effectiveness of cognitive rehabilitation for people with MS? Wh Why this is important y this is important Cognitive impairment affects 43–70% of people with MS and can affect their ability to carry out everyday activities. People with MS who have cognitive problems often engage in fewer social and vocational activities, are less likely to be in employment

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

260. Managing medicines in care homes

) or have any type of resident (children, older people, people with cognitive impairment, young disabled people, people with a learning disability), but should be a registered provider of care (for example, in England with either the CQC or Ofsted). For the purposes of this guideline, the term 'care home staff' includes registered nurses and social care practitioners working in a care home. The term 'carer' is used for an informal or unpaid carer. The term 'health and social care practitioners' is used (...) of health or social care services should ensure that the following information is available for medicines reconciliation on the day that a resident transfers into or from a care home: resident's details, including full name, date of birth, NHS number, address and weight (for those aged under 16 or where appropriate, for example, frail older residents) GP's details details of other relevant contacts defined by the resident and/or their family members or carers (for example, the consultant, regular

2014 National Institute for Health and Clinical Excellence - Clinical Guidelines

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