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Elderly Drivers with Cognitive Impairment

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261. The Effects on Re?offending of Custodial vs. Non?custodial Sanctions: An Updated Systematic Review of the State of Knowledge Full Text available with Trip Pro

after any type of intervention. Thus, the relevant question may be to what extent improvement differs by type of sanction. Therefore, future studies should look at rates of improvement (or reductions in offending) rather than merely at “recidivism” as such. 5) Rehabilitation in other relevant areas, such as health, employment, family and social networks, is rarely considered, despite century‐old claims that short custodial sentences are damaging with respect to social integration in these other (...) sanction group and a non‐custodial sanction group; 2) The sanctions to be compared were imposed following a conviction for a criminal offense; 3) There was at least one outcome measure of recidivism (new arrests, reconvictions, re‐incarceration or self‐report data); 4) The study was completed after 1960 and 2002, and between 2003 and 2013 for the update. No restriction about type of publication, geographical area, language, type of delinquency, age, or gender has been applied. Looking for studies

2015 Campbell Collaboration

262. Public health guidance on HIV and STI prevention among men who have sex with men

have sex with men (MSM) i are disproportionately affected by HIV and other STIs [1, 2]. In 2013, 29 157 people were newly diagnosed with HIV in the European Union/European Economic Area (EU/EEA) [3]. Sex between men was the most common mode of HIV transmission, representing 42% of newly diagnosed HIV cases. There was a 33% increase in HIV diagnoses among MSM observed in the EU/EEA between 2004 and 2013. There is a corresponding cumulative increase in the number of MSM that are living with HIV (...) global HIV prevention guidance, such as the WHO guidelines on prevention and treatment of HIV and other sexually transmitted infections among MSM and transgender people, and the comprehensive guidelines on prevention among key populations [36, 37], while providing additional information on STI and hepatitis and including regionally-specific guidance, tailored to the European situation. Figure 1. HIV diagnoses attributed to MSM per 100 000 male population, EU/EEA, 2013 Source: ECDC/WHO (2014) i

2015 European Centre for Disease Prevention and Control - Public Health Guidance

263. Bipolar disorder

episodes. Incomplete recovery leads to an increased risk of relapse, greater functional impairment, and reduced quality of life. Evidence suggests that, over time, episodes may become more frequent with shorter intervals in between. Some people may experience chronic, subsyndromal symptoms, most commonly of depression. Bipolar disorder appears to be associated with progressive deficits in cognition and functioning, even during periods of remission. Mortality is higher among people with bipolar disorder (...) be transferred back to primary care for ongoing management once their condition has stabilised. Have I got the right topic? Have I got the right topic? From age 14 years onwards. This CKS topic is largely based on the National Institute for Health and Care Excellence (NICE) guideline Bipolar disorder: assessment and management [ ]. This CKS topic covers the recognition and management in primary care of people with bipolar disorder. This CKS topic does not provide detailed information about secondary care

2019 NICE Clinical Knowledge Summaries

264. Heart failure - chronic

of heart failure slowly increases with age until about 65 years of age, and then more rapidly. In the UK, the prevalence of heart failure is estimated to be about [ ]: 1 in 35 people 65–74 years of age. 1 in 15 people 75–84 years of age. Just over 1 in 7 people 85 years of age or older. The average age at first diagnosis is 76 years of age [ ]. People with heart failure with preserved ejection fraction (HF-PEF) are more likely to be older and female than those with heart failure with reduced ejection (...) of heart failure [ ]. The recommendation to ask about family history of sudden cardiac death is based on expert opinion in a narrative review article 10 steps before you refer for palpitations [ ] which states that deaths under the age of 40 years are significant as the likelihood of an inherited cardiac condition is much greater in this age group than in older people. How to manage suspected How should I manage a person with suspected heart failure? Review the person's medication and if appropriate

2019 NICE Clinical Knowledge Summaries

265. Atrial fibrillation

million people in England were living with AF. Of these 425,000 were estimated to be undiagnosed and untreated. Prevalence was higher in men (2.9%) than in women (2.0%). A population-based cohort analysis (the Framingham heart study) investigated the lifetime risk for development of AF in 3,999 men and 4,726 women aged 40 years and older. The participants were followed up from 1968 to 1999, for a total of 176,166 person-years: The lifetime risk of developing AF was similar for both men and women (...) with 82,476 participants). AF is also associated with reduced quality of life: AF can result in reduced exercise tolerance and impaired cognitive function. A systematic review of 49 studies found that people with AF have significantly poorer quality of life than healthy controls, the general population, and people with coronary heart disease. The risks from AF are thought to be similar to those from or AF. Anticoagulation treatment reduces the risk of stroke by about two-thirds. [ ; ; ; ; ; ; ] Diagnosis

2019 NICE Clinical Knowledge Summaries

266. Meningitis - bacterial meningitis and meningococcal disease

cause of morbidity and mortality, particularly affecting young children, immunocompromised, and elderly people. Consequently, pneumococcal vaccination is now offered to all adults older than 65 years of age and to all children (as part of the routine UK childhood immunization programme), as well as to other high-risk groups. For further information, see the CKS topics on and . Although over 90 different capsular types have been characterized, only 8-10 types are responsible for serious infections (...) bacterial meningitis has fallen in recent years, there has been no change in the rate of complications [ ; ]. Common complications include [ ]: Hearing loss (33.6%) Seizures (12.6%) Motor deficit (11.6%) Cognitive impairment (9.1%) Hydrocephalus (7.1%) Visual disturbance (6.3%) A systematic review of data from 3408 people with a history of pneumococcal meningitis found that multiple sequelae were reported in a significant proportion (about 20%). The most common multiple impairment combinations were

2019 NICE Clinical Knowledge Summaries

267. Chronic obstructive pulmonary disease

insidiously. Most people are not diagnosed until they are 50 years of age or older. The prevalence of COPD increases with age and varies significantly by region. COPD is linked to social deprivation; however, it is unclear whether this pattern reflects exposure to cigarette smoke or to air pollutants, poor nutrition, crowding, or other factors related to low socioeconomic status [ ]. COPD is more common in men. However, in recent years, the prevalence has reached a plateau in men but has increased (...) older than 65 years of age. Exacerbations of COPD requiring hospital admission are associated with an inpatient mortality rate of 3–4%, which increases to 11–24% for people who require treatment in an intensive care unit [ ]. The true mortality rate due to COPD is difficult to quantify, as many people with COPD die with the disease rather than because of it. Nevertheless, mortality from COPD increases with age, severity of disease, and socioeconomic deprivation. [ ; ] Complications What

2019 NICE Clinical Knowledge Summaries

268. Epilepsy

but the reasons for this are not clear [ ]. Incidence varies with age, with the highest risk in infants and people over the age of 50 years [ ]. The incidence of new onset epilepsy in elderly people is increasing [ ]. People with learning difficulties have higher rates of epilepsy than the general population; making up about 25% of the total of people with epilepsy and 60% of people with treatment-resistant epilepsy [ ]. Risk factors What are the risk factors? Risk factors causing a predisposition (...) , if appropriate. Specialist advice should be sought for a person with confirmed epilepsy with: Poor seizure control or poorly tolerated treatment. Previous prolonged or recurrent seizures, who have not been prescribed emergency treatment for use in the community, if appropriate. Possible cognitive impairment. A seizure-free history for the last 2 years, who would like to consider tapering or withdrawal from drug treatment. Plans for pregnancy. Have I got the right topic? Have I got the right topic? From birth

2019 NICE Clinical Knowledge Summaries

269. Dementia

disorders (such as chronic hypocalcaemia and recurrent hypoglycaemia). Vitamin deficiencies (such as B12 and thiamine deficiency). For further information, see the CKS topic on . Infections (such as HIV infection and syphilis). For further information, see the CKS topic on . [ ; ; ; ; ; ; ] Risk factors What are the risk factors? Risk factors for dementia include: Ageolder age is the strongest risk factor for dementia. Mild cognitive impairment — 50% of people with mild cognitive impairment (...) in people with dementia in the first year after diagnosis are more than 3 times higher than that of people without dementia [ ]. The length of time between diagnosis and death varies widely, depending on individual characteristics (such as on age at onset, sex, and dementia subtype) [ ; ]. One survival analysis estimated the median survival time from when a person is first assessed as having ‘cognitive impairment or dementia at moderate need’ to be 3 years 6 months [ ]. Several population-based studies

2019 NICE Clinical Knowledge Summaries

270. Opioid dependence

to those in other chronic medical illnesses, such as diabetes, hypertension, and asthma. The mortality risk of people dependent on illicit diamorphine is around 12 times that of the general population. People with other coexisting conditions have a poorer prognosis, for example: Mental health problems. Cognitive impairment. Of 121,332 people who exited the drug and alcohol treatment system in England in 2017–2018, 48% (58,718) successfully completed treatment and were free from dependence. However (...) . Outcome measures Outcome measures No outcome measures were found during the review of this topic. Audit criteria Audit criteria No audit criteria were found during the review of this topic. QOF indicators QOF indicators No QOF indicators were found during the review of this topic. QIPP - Options for local implementation QIPP - Options for local implementation No QIPP indicators were found during the review of this topic. NICE quality standards NICE quality standards People aged 14 and over

2019 NICE Clinical Knowledge Summaries

271. Benzodiazepine and z-drug withdrawal

, reduced coping skills, and amnesia. Reduced social functioning due to effects on memory, reduced ability to remember new people, appointments etc. Depression, either for the first time, or aggravation of pre-exisiting depression with possible precipitation of suicidal tendencies. Note: older people are more vulnerable to the CNS depressant effects of benzodiazepines, possibly leading to confusion, night wandering, amnesia, ataxia, and hangover effects. Impaired cognitive function and memory may (...) . If a person does not succeed on their first attempt, they should be encouraged to try again. People who do not wish to stop taking benzodiazepines or z-drugs should: Be advised of the benefits of stopping. Be listened to, and any concerns about stopping should be addressed. Not be pressurized. Be reviewed at a later date, if appropriate. Have I got the right topic? Have I got the right topic? From age 16 years onwards. This CKS topic covers the assessment of a person who is being prescribed long-term

2019 NICE Clinical Knowledge Summaries

272. Better Endings: Right care, right place, right time

Library.5 NIHR Themed Review: Better Endings Evidence at a glance RIGHT CARE ? More people are dying, at older ages and with complex long-term conditions. General staff in the community and in hospital provide most of the every- day care for people in the last years, months and weeks of life. They need time, training and support to do this well. Much care is provided by general practi- tioners and community nurses, but most people also have two or more unplanned hospital admissions in their last (...) an ‘extra layer of support’ for the frail elderly with advanced non-malignant conditions at points of unstable/deteriorating symptoms and concerns. We will see how well the new service compares with usual care in improving the older people’s well-be- ing, reducing carers’ burden and any differences in the services used and costs.” For more information on this NIHR funded evaluation: NIHR oNGoING sTuDy FIVE Over a fifth of deaths now happen in care homes. An NIHR funded study was able to assess the expe

2015 NIHR Dissemination Centre - Themed Reviews

273. Dual chamber pacemakers for symptomatic bradycardia due to sick sinus syndrome without atrioventricular block

). Page 5 of 53effective treatment is permanent implantation of a pacemaker. Most people who need a pacemaker implanted are older than 60 years. 2.5 The prevalence of sick sinus syndrome is thought to be about 0.03% of the whole population, and increases with age. However, both the prevalence of bradyarrhythmias due to sick sinus syndrome needing permanent pacemaker implant, and the prevalence of sick sinus syndrome with atrioventricular block, is unknown. Hospital episode statistics data from October (...) 2012 to September 2013 included 2490 patients with a primary diagnosis of sick sinus syndrome in NHS hospitals in England. Sick sinus syndrome usually occurs in older adults, but it can affect people of any age, and affects men and women equally. The incidence of atrioventricular conduction abnormalities also increases with increasing age. Current management 2.6 Pacemakers are electrical devices that consist of a small battery-powered generator and 1 or more pacing leads that are in contact

2014 National Institute for Health and Clinical Excellence - Technology Appraisals

274. Childhood Astrocytomas Treatment (PDQ®): Health Professional Version

months vs. 11 months). Mutations in ACVR1 , which is also the mutation observed in the genetic condition fibrodysplasia ossificans progressiva, are present in a high proportion of H3.1K27M cases.[ - ] Rarely, K27M mutations are also identified in H3.2 ( HIST2H3C ) cases.[ ] H3.3 ( H3F3A ) mutation at G34: The H3.3G34 subtype presents in older children and young adults (median age, 14–18 years) and arises exclusively in the cerebral cortex.[ , ] H3.3G34 cases commonly have mutations in TP53 and ATRX (...) exceeding 20%.[ ] IDH1 mutation: IDH1 -mutated cases represent a small percentage of pediatric high-grade gliomas (approximately 5%), and pediatric high-grade glioma patients whose tumors have IDH1 mutations are almost exclusively older adolescents (median age in a pediatric population, 16 years) with hemispheric tumors.[ ] IDH1 -mutated cases often show TP53 mutations, MGMT promoter methylation, and a glioma-CpG island methylator phenotype (G-CIMP).[ , ] Pediatric patients with IDH1 mutations show

2018 PDQ - NCI's Comprehensive Cancer Database

275. Childhood Acute Lymphoblastic Leukemia Treatment (PDQ®): Health Professional Version

.[ , ] In the United States, ALL occurs at an annual rate of approximately 41 cases per 1 million people aged 0 to 14 years and approximately 17 cases per 1 million people aged 15 to 19 years.[ ] There are approximately 3,100 children and adolescents younger than 20 years diagnosed with ALL each year in the United States.[ ] Since 1975, there has been a gradual increase in the incidence of ALL.[ , ] A sharp peak in ALL incidence is observed among children aged 2 to 3 years (>90 cases per 1 million per year (...) ), with rates decreasing to fewer than 30 cases per 1 million by age 8 years.[ , ] The incidence of ALL among children aged 2 to 3 years is approximately fourfold greater than that for infants and is likewise fourfold to fivefold greater than that for children aged 10 years and older.[ , ] The incidence of ALL appears to be highest in Hispanic children (43 cases per 1 million).[ , , , ] The incidence is substantially higher in white children than in black children, with a nearly threefold higher incidence

2018 PDQ - NCI's Comprehensive Cancer Database

276. Neuroblastoma Treatment (PDQ®): Health Professional Version

in the incidence of advanced-stage neuroblastoma with unfavorable biological characteristics in older children, nor did it reduce overall mortality from neuroblastoma.[ , ] No public health benefits have been shown from screening infants for neuroblastoma at these ages. (Refer to the PDQ summary on for more information.) Evidence (against neuroblastoma screening): A large population-based North American study, in which most infants in Quebec were screened at the ages of 3 weeks and 6 months, has shown (...) %.[ ] In a study of children older than 12 months who had unresectable primary neuroblastomas without metastases, segmental chromosomal aberrations were found in most, and older children were more likely to have them and to have more of them per tumor cell. In children aged 12 to 18 months, the presence of segmental chromosomal aberrations had a significant effect on event-free survival (EFS) but not on overall survival (OS). However, in children older than 18 months, there was a significant difference in OS

2018 PDQ - NCI's Comprehensive Cancer Database

277. The role of biomarkers in ruling out cerebral lesions in mild cranial trauma

. Its main causes include falls, motor vehicle accidents, assaults, alcohol consumption and sports injuries. Cranial trauma may lead to a temporary or permanent impairment of cognitive, physical, or psychosocial functions. They represent one of the most critical public health problems around the world with an estimated annual incidence rate in Europe of 262 per 100 000 population. 1 Populations more at risk of cranial trauma include children below 4 years of age, young adults (aged below 25 (...) ) and the elderly (aged over 75). 1 There is a distinction between mild (or light), moderate and severe cranial trauma. Such distinction is most often based on the Glasgow Coma Scale (GCS): a 3 to 15-point scale used to assess patients’ level of consciousness and neurologic functioning after a head injury (see Table 1). Mild cranial trauma (mCT) often defined as GCS 13-15 is by far, the most frequent, accounting for as many as 71% to 98% of cases and is the subject of interest of this review. 5 Biomarkers

2016 Belgian Health Care Knowledge Centre

278. Cirrhosis

of cirrhosis. Referral to an appropriate specialist for people with decompensated liver disease, people who misuse alcohol, and people with end-stage liver disease requiring symptom control or palliative care. Have I got the right topic? Have I got the right topic? From age 16 years onwards. This CKS topic is largely based on the National Institute for Health and Care Excellence (NICE) guideline on Cirrhosis in over 16s: assessment and management [ ]. This CKS topic covers the primary care identification (...) , depend on a number of factors including age, HBV DNA testing and the results of liver function tests [ ]. CKS, therefore, is of the opinion that it is reasonable to refer to the person's specialist for confirmation of a diagnosis of cirrhosis if they have hepatitis B as this is beyond the scope of primary care. Testing for cirrhosis in people who are obese or have type 2 diabetes This recommendation reflects the NICE guideline Cirrhosis in over 16s: assessment and management [ ]. People with obesity

2018 NICE Clinical Knowledge Summaries

279. Parkinson's disease

for elderly people with Parkinson's disease is 2–5 times higher than for age-matched controls. People with early-onset disease may have a later onset of motor complications and cognitive impairment. The risk of dementia is 2–6 times higher in people with Parkinson's disease than in healthy controls. The complications of Parkinson’s disease include: Motor complications (usually related to the use of anti-parkinsonian medication), such as immobility, slowness, communication difficulties, motor fluctuations (...) disease every 3.3 years [ ]. Prognosis What is the prognosis? Typically, Parkinson's disease is slowly progressive, but the rate of progression is variable [ ]. Factors such as older age at onset and longer disease duration have been independently associated with a higher prevalence of motor and non-motor complications in a retrospective study (n = 401) [ ]. People with early-onset disease may have a later onset of motor complications and cognitive impairment [ ]. Life expectancy is reduced

2018 NICE Clinical Knowledge Summaries

280. Obsessive-compulsive disorder

: Cognitive-behavioural therapy (CBT), ideally including exposure and response prevention (ERP). A selective serotonin reuptake inhibitor (SSRI) or clomipramine. SSRIs should only be prescribed to people under 18 years of age following assessment and diagnosis by a child and adolescent psychiatrist. Specialist referral (depending on factors including the person's age, severity of symptoms, and previous treatment failures). Referral for urgent psychiatric assessment should be made for people at suspected (...) is based on expert opinion in the BMJ Best Practice guideline Obsessive-compulsive disorder [ ]. Management Management : covers the assessment and management of people with OCD. Scenario: Management Scenario: Management of obsessive-compulsive disorder From age 8 years onwards. Management How should I manage a person with obsessive-compulsive disorder? For all people with obsessive-compulsive disorder (OCD) assess their degree of distress and functional impairment as mild, moderate, or severe: Ask

2018 NICE Clinical Knowledge Summaries

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