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Elderly Drivers with Cognitive Impairment

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42. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update

with insomnia perform more poorly on complex cognitive tasks, an e?ect which normalizes following cognitivebehaviouraltherapy(CBT)intervention. Thereisanincreasedriskofsubsequentdepressionandanx- ietydisorderinprimaryinsomnia.Insomniahasbeenassociated with:(1)anincreasedriskofdevelopingsubsequentdepression; (2) an increased duration of established depression; and (3) Difficulty going to Patient complains of sleep problems sleep or staying asleep with impairment of daytime functioning Are sleep habits (...) proposed varying de?- nitions of insomnia that share three key elements (see Diagnostic criteria). They all agree insomnia is a condition of unsatisfactory sleep, either in terms of sleep onset, sleep maintenance or early waking. They also agree that insomnia is a disorder that impairs daytime well-being and subjective abilitiesandfunctioning,andsocanbeconsidereda‘24-hour’ disorder. It is important to recognize that insomnia is a subjective disorder, and its diagnosis is through clinical observations

2019 British Association for Psychopharmacology

43. Assessment and Interventions for Perinatal Depression

interventions, including non-directive counselling, for persons with perinatal depression . Ia, Ib Recommendation 2.7: Provide or facilitate access to psychotherapies, such as cognitive behavioural therapy or interpersonal therapy, for perinatal depression . Ia, Ib Recommendation 2.8: Support informed decision-making and advocate for access to pharmacological interventions for perinatal depression, as appropriate . Ia, Ib Recommendation 2.9: Facilitate informed decision-making regarding the use (...) and sleep, a perception of being overwhelmed and uncertain, and irritability (6). Despite this, postpartum blues is not a mild form of depression, and it is not part of the perinatal mood disorders spectrum. It is unrelated to stress or psychiatric history and it does not impair the person’s ability to take care of themselves or their infant or cause suicidal ideations (6). Postpartum blues can be attributed to the rapid decrease in estrogen and progesterone levels following childbirth as the symptoms

2018 Registered Nurses' Association of Ontario

44. Heart Failure

decisions should carefully consider individual patient characteristics with known associations with poor prognosis due to vulnerability. These include cultural and linguistic diverse populations including recent migrants; Indigenous Australians; the cognitively impaired; those living in rural or remote areas; people of advanced age; and those who are incarcerated or institutionalised. 3. Definition and Classification of Heart Failure 3.1. Epidemiology of Heart Failure Heart failure currently affects (...) the final article Text & data mine Translate the article (private use only, not for distribution) Reuse portions or extracts from the article in other works Not Permitted Sell or re-use for commercial purposes Distribute translations or adaptations of the article | ---- Figure 1 Drivers and potential targets for treatment in heart failure with reduced ejection fraction. ---- | ---- Figure 2 Diagnostic workup of a patient with suspected heart failure. ---- | ---- Figure 3 Management of patients

2018 Cardiac Society of Australia and New Zealand

45. Atrial Fibrillation

fibrillation: prevalence, incidence, risk factors, and mortality in the community. Lancet . 2015 ; 386 : 154–162 | | | | ], and often leads to an impaired quality of life [ x [10] Thrall, G., Lane, D., Carroll, D., and Lip, G.Y. Quality of life in patients with atrial fibrillation: a systematic review. Am J Med . 2006 ; 119 ( 448.e1–19 ) | | | | | ] [10] . The risk of dying from stroke can largely be mitigated by oral anticoagulants (OACs), but all-cause mortality and deaths from complications (...) driver [ x [12] Stewart, S., Murphy, N., Walker, A., McGuire, A., and McMurray, J.J.V. Cost of an emerging epidemic: an economic analysis of atrial fibrillation in the UK. Heart . 2004 ; 90 : 286–292 | | ] [12] . Between 10% and 30% of patients with AF are admitted to hospital each year for cardiovascular and non-cardiovascular causes [ x [13] DeVore, A.D., Hellkamp, A.S., Becker, R.C., Berkowitz, S.D., Breithardt, G., Hacke, W. et al. Hospitalizations in patients with atrial fibrillation

2018 Cardiac Society of Australia and New Zealand

47. Low back pain and radicular pain: evaluation and management

was proposed by physiotherapists and focused on non-invasive interventions (medication not included) in the treatment of chronic low back pain. It appeared indeed that several conservative multidisciplinary therapeutic programs based on physical reactivation (exercise) and cognitive-behavioral interventions existed without a definition of the precise composition of such programs and without consensual recommendations (see list of interventions in Appendix 2). However, the cost of surgery for low back pain (...) (suitable for primary care management according to guidelines), medium risk subgroup (high levels of physical prognostic indicators, appropriate for physiotherapy), and high risk subgroup (high levels of psychosocial prognostic indicators, appropriate for a combination of physical and cognitive-behavioural treatments). By contrast, the Örebro tool did not make any distinction between physical and psychosocial risk factors, making specific treatment allocation more difficult. ? The Belgian GDG

2017 Belgian Health Care Knowledge Centre

49. Active travel in Glasgow: what we?ve learned so far

of the research, data analysis and evidence reviews also have a wider focus on Scotland, the UK or internationally. Where appropriate, relevant research or data from other sources have also been cited. There are some important aspects of transport and active travel that relate to health that are not covered in detail in this report, including public transport, parking, traffic congestion, driver education and specific details of appropriate infrastructure developments. This is not because (...) health 16 and can contribute to improved mental wellbeing 17 and better cognitive function in older people 18 . 2.2 Healthy weight Physical activity helps maintain a healthy weight. Countries with higher levels of active travel have lower self-reported obesity rates and vice versa (see Figure 2). Figure 2: Relationship between adult obesity and active transport in Australia and 13 countries in Europe and North America: 2000–2006. Source: Pucher J, Buehler R, Bassett DR, Dannenberg AL. Walking

2017 Glasgow Centre for Population Health

50. Driving and pain

accident. Benzodiazepines with long half lives may be particularly implicated in causing crashes. Opioids Opioids are associated with a number of side effects that may impair the ability to drive including: sedation, fatigue, cognitive and visual disturbance. Elderly drivers who are not habituated to opioids show signs of impairment even at relatively low doses of a weak opioid such as codeine. 8 It is of no surprise that stronger opioids when given to opioid naïve drivers also show evidence (...) and duloxetine are also associated with an increased risk of crashing, although objective tests of driving function often fail to demonstrate a deleterious effect. 7 Antiepileptic drugs Anticonvulsant medications such as carbamazepine and gabapentin can cause sedation, cognitive impairment and visual disturbance and are associated with a significantly increased risk of crashing. 7 Reducing the dose of anti- epileptic medication appears to reduce the risk of an accident. NSAIDS Although not commonly

2017 Faculty of Pain Medicine

51. ABCD position statement on standards of care for management of adults with type 1 diabetes

of ageing leads to progressive losses which affect physical and cognitive performance and impact on diabetes management. Activity levels fall, muscle bulk reduces and appetite may decrease, leading to weight loss and frailty, with increased insulin sensitivity The risks of hypoglycaemia (particularly neurological damage and falls) are increased in this age group. Cognitive decline and visual impairment may make self- management decisions more difficult. Many people with type 1 diabetes will have decades (...) of experience in managing their condition – such knowledge cannot be passed on to carers and the loss of independence and the control of their diabetes can be very distressing. Factors affecting diabetes management in older people ? Comorbidities and geriatric syndromes including depression ? Impaired cognition leading to insulin errors, missed meals and reduced ability to identify and manage hypoglycaemia ? Visual, hearing and functional impairment ? Polypharmacy ? Falls and fractures ? Vulnerability

2017 Association of British Clinical Diabetologists

52. CRACKCast E102 – Seizures

damage Rhabdomyolysis Autonomic discharge & bulbar muscle involvement may result in Urinary or fecal incontinence Vomiting Tongue biting Potential airway impairment. Posterior shoulder dislocations or fractures [9] Describe the legal implications of diagnosis of new seizure According to the Government of British Columbia New onset seizure has a private driving restriction: With a seizure free period up to 6 months; Or Medical clearance to drive by a Neurologist Professional Drivers must be: Seizure (...) will see seizures! Bimodal age distribution with vast majority being in infants (febrile seizures) and the elderly over age 75 (structural brain abnormalities). For neurons to work properly, we need a balance milieu inside and out of the cell membrane. This includes the balance between excitatory neurotransmitters (think glutamate and acetylcholine) and inhibitory neurotransmitters (think GABA). So things like infection, infection, toxins, electrolyte imbalances, and other pathologic processes come

2017 CandiEM

54. Key policies for addressing the social determinants of health and health inequities

for improving population health, and especially important for more vulnerable children. Evidence indicates that actions to improve early child development have the most cost-effective impact on health equity (9,10,12,20). Children’s social, educational and health care needs are closely intertwined. Thus, inadequate socioeconomic conditions, care, health, nutrition and physical and emotional nurturing can reduce educational attainment by impairing cognitive and behavioural capacities, delaying motor (...) programmes should be considered (Case study 3). The most successful programmes place a strong focus on cognitive outcomes, which are more malleable earlier in life. More information on the importance of these approaches for SROI is provided in the linked report on investment for health and well-being (12). Such programmes provide disadvantaged children with an enriched out-of-family environment while also working to raise the quality of the home environment (22). Home visiting improves service uptake

2017 WHO Health Evidence Network

55. Care at the Scene: Research for ambulance services

and injuries. But the majority of 999 calls are not traffic accidents and heart attacks. More typical- ly, calls involve people with complex and ongoing health problems experiencing a crisis. This could be an elderly person with heart failure and diabetes having had a fall, someone with lung disease experiencing breathlessness or a person at risk of suicide ringing in distress. Patient needs have become more complex, there is an ageing population and the number of 999 calls has risen. At the same time (...) arrangements. It is sometimes difficult to know which option is best. And we need to understand what encourages people to choose one service over another. The question of where patients go is addressed in part of an NIHR review looking at published research on drivers for increased demand for emergency care (Turner 2015, NIHR published study one). The reasons were complex and difficult to synthesise from the 38 relevant papers, but included issues such as access to, and confidence in, primary care

2016 NIHR Dissemination Centre - Themed Reviews

56. Influencing the trajectories of ageing

, declines are markedly faster in the overweight and obese. 14 By comparing otherwise similar individuals with contrasting muscle quality, Dr Ferrucci and colleagues identified 8 Katsimpardi L, et al. (2014). Vascular and neurogenic rejuvenation of the aging mouse brain by young systemic factors. Science 344(6184), 630–634. 9 Smith LK, et al. (2015). ß2-microglobulin is a systemic pro-aging factor that impairs cognitive function and neurogenesis. Nat Med. 21(8), 932–937. 10 Bjedov I, et al. (2010 (...) ). Prevalence of frailty and disability: findings from the English Longitudinal Study of Ageing. Age Ageing. 44(1), 162–165. The Academy of Medical Sciences 12 Two complementary approaches are most commonly used to identify and quantify frailty. The frailty index approach identifies generalised frailty and involves determining the proportion of deficits experienced by an individual, which include the following: the presence of long-term conditions; physical, cognitive or sensory impairments

2016 Academy of Medical Sciences

57. Recommendations for the Use of Mechanical Circulatory Support: Ambulatory and Community Patient Care: A Scientific Statement From the American Heart Association

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 (...) to assist patients with MCS with device-related care on a daily basis. A multidisciplinary plan involving medical and psychosocial care, including psychopharmacology and counseling, may contribute to positive outcomes for both patients and caregivers. Cardiac-related cognitive dysfunction often resolves after MCS, which may significantly improve the quality of life for the patient and family. In elderly destination therapy patients, dementia can become an issue, and follow-up cognitive assessment

2017 American Heart Association

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

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 (...) Environmental Protection Agency air quality monitoring network to assess the relationship between coarse particular matter levels and cardiovascular hospitalizations among 110 large urban US counties. Researchers found that increased air pollution levels were associated with higher rates of hospitalizations in elderly patients, suggesting that actions such as counseling patients to remain indoors during high-pollution days may have an impact on overall cardiac health. Other environmental data sources

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2017 American Heart Association

59. 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

tone, with rapid and spontaneous recovery. The presumed mechanism is cerebral hypoperfusion. , There should not be clinical features of other nonsyncope causes of loss of consciousness, such as seizure, antecedent head trauma, or apparent loss of consciousness (ie, pseudosyncope). , Loss of consciousness A cognitive state in which one lacks awareness of oneself and one’s situation, with an inability to respond to stimuli. Transient loss of consciousness Self-limited loss of consciousness can (...) %. 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

2017 American Heart Association

60. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope

recovery. The presumed mechanism is cerebral hypoperfusion. , There should not be clinical features of other nonsyncope causes of loss of consciousness, such as seizure, antecedent head trauma, or apparent loss of consciousness (ie, pseudosyncope). , Loss of consciousness A cognitive state in which one lacks awareness of oneself and one’s situation, with an inability to respond to stimuli. Transient loss of consciousness Self-limited loss of consciousness can be divided into syncope and nonsyncope (...) age of 62 years (all age >45 years), 364 reported an episode of syncope in their lifetime; the estimated prevalence of syncope was 19%. 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

2017 American Heart Association

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