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Elderly Drivers with Cognitive Impairment


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101. Australian and New Zealand Guideline for Hip Fracture Care - Improving Outcomes in Hip Fracture Management of Adults

of administering initial analgesia and • hourly until settled on the ward and • regularly as part of routine nursing observations throughout admission. Offer immediate analgesia to patients presenting at hospital with suspected hip fracture, including people with cognitive impairment. The choice and dose of analgesia should be age appropriate with close monitoring for associated side effects. Ensure analgesia is sufficient to allow movements necessary for investigations (as indicated by the ability to tolerate (...) recommendation Offer total hip replacement to patients with a displaced intracapsular fracture who: • were able to walk independently out of doors with no more than the use of a stick and • are not cognitively impaired and • are medically fit for anaesthesia and the procedure. C 5.1 Consensus-based recommendation Use cemented stem implants in patients undergoing surgery with arthroplasty. - 5.2 Consensus-based recommendation Both extramedullary sliding hip screw devices and intramedullary nails are suitable

2014 Clinical Practice Guidelines Portal

102. Abuse and violence - working with our patients in general practice

apprehended domestic violence order AHPRA Australian Health Practitioner Regulation Agency AMA Australian Medical Association APVO apprehended personal violence order ASCA adults surviving child abuse ASP autism spectrum disorder CBT cognitive behavioural therapy FVO family violence order GBD global burden of disease GLBT gay, lesbian, bisexual, transgender GP general practitioner GRADE Grades of Recommendation, Assessment, Development and Evaluation IMG international medical graduate NATSISS National (...) partner abuse: identification and initial validation 8 Chapter 3. Safety and risk assessment 19 Chapter 4. Intimate partner abuse: responding and counselling strategies 24 Chapter 5. Dealing with perpetrators in clinical practice 35 Chapter 6. Child abuse 40 Chapter 7. Young people and bullying 49 Chapter 8. Adult survivors of child abuse 56 Chapter 9. Sexual assault 65 Chapter 10. Specific vulnerable populations: the elderly and disabled 73 Section 10.1 Elder abuse 73 Section 10.2 People

2014 Clinical Practice Guidelines Portal

103. Management of Stable Coronary Artery Disease

or considerations . . . . . . . . . . . . . . . . . . . .2994 9.1 Women (see web addenda) . . . . . . . . . . . . . . . . . . .2994 9.2 Patients with diabetes (see web addenda) . . . . . . . . . . .2994 9.3 Patients with chronic kidney disease (see web addenda) .2994 9.4 Elderly patients (see web addenda) . . . . . . . . . . . . . . .2994 9.5 The patient after revascularization (see web addenda) . . .2994 9.6 Repeat revascularization of the patient with prior coronary artery bypass graft revascularization (see (...) by the release of ischaemic metabolites—such as adenosine—that stimu- late sensitive nerve endings, although angina may be absent even with severe ischaemia owing, for instance, to impaired transmission of painful stimuli to the cortex and other as-yet-unde?ned potential mechanisms. 11 The functional severity of coronary lesions can be assessed by measuring coronary ?ow reserve (CFR) and intracoronary artery pressures (fractional ?ow reserve, FFR). More detailed descriptions can be found in the web addenda

2013 European Society of Cardiology

104. Diabetes, Pre-Diabetes and Cardiovascular Diseases Online publish-ahead-of-print 30 August 2013 -- -- --- -- -- --- -- --- -- -- --- -- -- --- -- -- --- -- -- --- -- -- --- -- --- -- -- --- -- -- --- --- - - - - - - --- -- -- --- -- -- --- -- --- -- -- --- -- -- --- -- -- --- -- -- --- -- -- --- -- --- -- -- -- Keywords Guidelines † Diabetes mellitus † Cardiovascular disease † Impaired glucose tolerance † Patient management † Prevention † Epidemiology † Prognosis † Diagnostics † Risk factors † Pharmacological treatment † Coronary (...) in Diabetes FINDRISC FINnish Diabetes RIsk SCore FPG fasting plasma glucose FREEDOM Future REvascularization Evaluation in patients with Diabetes mellitus: Optimal management of Multivessel disease GFR glomerular ?ltration rate GIK glucose-insulin-potassium GLP-1 glucagon-like peptide-1 GLUT-4 glucose transporter 4 HAS-BLED Hypertension, Abnormal renal/liver function (1 point each), Stroke, Bleeding history or predis- position, Labile INR, Elderly (.65), Drugs/ alcohol concomitantly (1 point each) HbA 1c

2013 European Society of Cardiology

105. Heart Disease and Stroke Statistics?2016 Update

predictive of CHD event risk across all age groups, suggesting that once CAC is known, chronological age has less importance. Compared with a CAC score of 0, CAC >100 imparted an increased multivariable-adjusted CHD event risk in younger individuals (45-54 years old) with an HR of 12.4. The respective risk was similar even in the very elderly (75-84 years of age) with an HR of 12.1. Coronary heart disease alone caused ≈1 of every 7 deaths in the United States in 2013. In 2013, 370 213 Americans died (...) to serious misinterpretation of time trends. Mortality Mortality data are generally presented according to the underlying cause of death. “Any-mention” mortality means that the condition was nominally selected as the underlying cause or was otherwise mentioned on the death certificate. For many deaths classified as attributable to CVD, selection of the single most likely underlying cause can be difficult when several major comorbidities are present, as is often the case in the elderly population

2014 American Heart Association

106. Optimal Method for Driving Assessment in Older Adults and in Patients who have had a Cerebrovascular Accident: Clinical Evidence, Cost-Effectiveness, and Guidelines

of fitness to drive in stoke survivors with moderate physical and cognitive impairments (without severe deficits). 6 In contrast, the cognitive test battery Nordic Stroke Driver Screening Assessment (NorSDSA) was unable to predict the outcome of on-road tests in persons with stroke, and was not recommended for use in isolation to determine fitness to drive. 5 The NorSDSA was also less successful at determining fitness to drive in patients suffering from cognitive deficits/dementia compared with stroke (...) , Classen S, Bedard M, Lanford D, Winter S. MMSE as a predictor of on-road driving performance in community dwelling older drivers. Accid Anal Prev. 2012 Nov;49:287-92. PubMed: PM23036408 4. Ferreira IS, Simoes MR, Maroco J. The Addenbrooke's Cognitive Examination Revised as a potential screening test for elderly drivers. Accid Anal Prev. 2012 Nov;49:278-86. PubMed: PM23036407 5. Selander H, Johansson K, Lundberg C, Falkmer T. The Nordic stroke driver screening assessment as predictor for the outcome

2013 Canadian Agency for Drugs and Technologies in Health - Rapid Review

107. DIY Home Modifications: Point-of-Sale Support for People with Disability and their Carers Positioning Paper

. August 2014 ISBN: 978-0-7334-3505-8 4 Contents Glossary 7 Executive Summary 8 Section 1: Introduction 9 Do-it-yourself home modifications 9 Structure of the paper 10 Theoretical framework 10 Aims and research questions 12 Conclusion 13 Section 2: Background to the research 14 Introduction 14 Economic drivers for home modifications 14 Home modification schemes 15 Reform context 16 Conclusion 17 Section 3: Review of DIY home modifications literature 18 Introduction 18 Methodology 18 (...) drivers to age in place and an overview of the existing home modification schemes in Australia to provide a context for researching DIY home modifications. This is followed by a review of relevant DIY home modification literature in Section 3. Section 4 outlines the research methodology (qualitative methods and economic modelling) employed. Finally, Section 5 concludes the paper by outlining the next stages of the project. Theoretical framework The theoretical framework that underpins this research

2014 Home Modification Information Clearinghouse

108. Home Modifications and Their Impact on Waged Care Substitution

and safety 31 Are there situations where home modifications do not benefit? 32 Home modifications and their impact on care needs 33 Self-care 34 Self-care: The added value of independence 34 Self-care and Bathing 35 Is self-care always the ultimate goal? 36 Self-care and learned helplessness 37 Drivers for a self-care alternative 38 Care substitution 39 Why substitute care 39 How care models substitute for one another 40 Home modifications and care substitution 41 4. A matter of cost: Waged home care (...) that: ? Substitution between home modifications and waged home care exists; ? The degree and direction of substitution is measurable by examination of cases where both occur; and ? Substitution is complex but that this can be determined by person-environment fit theory combined with an understanding of human function variables such as type of impairment, degree of impairment, functional prognosis etc. Leading on from these specific understandings our general aim involves conducting a rigorous empirical evaluation

2014 Home Modification Information Clearinghouse

109. Landscape Modification: an alternative to residential access ramps and lifts

will challenge an occupant’s perspective on all three of these aspects (Imrie, 2004). In terms of home entrance design, functional limitations that impact upon entrance accessibility include: ? Wheelchair/mobility aid use ? Ambulatory Mobility impairment ? Visual impairment ? Cognitive impairment ? Temporary impairment through injury For someone with limited mobility, an accessible, barrier-free entrance to their home plays a part in fostering greater community participation (White, Paine-Andrews, Mathews (...) 21 The Residential Landscape The residential landscape can be considered as a combination of building and outdoor elements, which might include the garden, external stairs or walkways leading to the home itself and any threshold or connection between the building and garden, and the garden and street/footpath. The home entrance The home entrance is intrinsically linked to privacy, sanctuary and security of the home (Smith, 2001) and the onset of functional limitations or impairment

2014 Home Modification Information Clearinghouse

110. Patient Modesty: Volume 88

with angina who insists that it is indigestion, may lead to unfavourable outcomes not only for the health care consumer, but also for the health care provider and the system. Then I wondered about other subcategories. What about the elderly, the infirm, the babies or the cognitively impaired? What about the 13-year-old who refuses treatment for severe pelvic inflammatory disease? The pregnant woman with a complicated pregnancy who insists on home delivery? Who is the client and who is the patient? Does (...) of grandeur used to justify paternalism and making the doctor work less. The reason for patient autonomy being legislated as a protected right and required by CMS is because societal expectations are is so technical, both cognitively and emotionally, based on published documentation (this blog, my blog) not readily understood by a physician that it becomes patently unfair to "dump" the final ensurement with regard to the specific activity (of shared decision making) onto the physician for an independent

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2018 Bioethics Discussion Blog

111. Tau-negative amnestic dementia masquerading as Alzheimer disease dementia. (PubMed)

Tau-negative amnestic dementia masquerading as Alzheimer disease dementia. To describe the phenomenon of tau-negative amnestic dementia mimicking Alzheimer disease (AD) clinically and radiologically and to highlight the importance of biomarkers in AD research.Eight participants with amnestic mild cognitive impairment or AD dementia were evaluated by a behavioral neurologist and had a standardized neuropsychological battery performed. All participants completed structural (MRI) and molecular (...) (amyloid and tau PET) imaging. AD-signature thickness and adjusted hippocampal volume served as structural biomarkers, while standardized uptake value ratios (SUVRs) from validated regions of interest for amyloid and tau PET were used to determine molecular biomarker status.All participants were thought to have AD as the primary driver of their symptoms before any PET imaging. All participants had hippocampal atrophy, and 2 participants fell below the AD-signature thickness cutoff for elderly controls

2018 Neurology

112. Patient Modesty: Volume 91

for drugs requires that observers be of the same gender as the person being observed. No exceptions. This is the rule for the D.o.T for truck drivers and for SAMSHA for other federal agency required observed drug tests. The Feds gave men the same protections as women. However those protections do not extend to non-Federal jurisdictions. Private employer, State & Local police, court, and Halfway House mandated observed drug tests do not mandate same gender observers. Women more or less universally

2018 Bioethics Discussion Blog

113. Is it time for a change? A cost-effectiveness analysis comparing a Multidisciplinary Integrated Care model for residential homes to usual care

Health Survey. The effectiveness data were from a multicentre cluster randomised controlled trial (RCT), conducted in 10 residential care homes, with 340 residents. The homes were matched before randomisation, based on the percentage of cognitively impaired residents; the two facilities with the highest percentages were matched, and so on. Patients were recruited from December 2006 to December 2007. Exclusion criteria were reported. Patient outcomes were assessed at the start and at six months (...) residential care homes for the elderly. Interventions The Multidisciplinary Integrated Care model started with a quarterly in-home, systematic, computerised assessment of functional health status and care needs. The interRAI Long-Term Care Facilities Assessment System was used to assess function, mental and physical health, social support, medication, and service use. The identified problem areas were the basis for an individual care plan. The outcomes of the assessment were discussed

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2012 NHS Economic Evaluation Database.

114. CVD Prevention in clinical practice

Introduction: why do individuals ?nd it hard to change their lifestyle? . . . . . . . . . . . . . . . . . . . . . . . . . .1660 4.1.2 Effective communication and cognitive-behavioural strategies as a means towards lifestyle change . . . .1660 4.1.3 Multimodal, behavioural interventions . . . . . . . . . .1661 4.2 Smoking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1661 4.2.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . .1661 4.2.2 Dosage and type (...) Global Secondary Prevention Strategies to Limit Event Recurrence After MI GRADE Grading of Recommendations Assessment, Development and Evaluation HbA 1c glycated haemoglobin HDL high-density lipoprotein HF-ACTION Heart Failure and A Controlled Trial Investigating Outcomes of Exercise TraiNing HOT Hypertension Optimal Treatment Study HPS Heart Protection Study HR hazard ratio hsCRP high-sensitivity C-reactive protein HYVET Hypertension in the Very Elderly Trial ICD International Classi?cation

2012 European Society of Cardiology

115. Vitamin D and health in adults in Australia and New Zealand: a position statement

, such as office workers, factory or warehouse workers, taxi drivers, night-shift workers 4 Key evidence that low serum 25-hydroxyvitamin D levels are associated with disease* Level I Vitamin D plus calcium supplementation reduces risk of falls , and fractures , - All-cause mortality Level II Insulin resistance , Level III Cancer (Level III-1) Influenza type A (Level III-1) Autoimmune disorders, rheumatoid arthritis, type 1 diabetes, multiple sclerosis, cardiovascular disease, , schizophrenia, cognitive (...) dietary sources, bone resorption increases under the influence of PTH, to maintain circulating calcium levels. Severe vitamin D deficiency causes impaired bone mineralisation, resulting in rickets in children and osteomalacia in adults. There is Level II evidence that optimal mineral metabolism, bone density and muscle function is achieved at serum 25-OHD concentrations of 50–60 nmol/L, - with no consistent evidence that higher levels are beneficial. Although most of these studies have been in older

2012 MJA Clinical Guidelines

116. Insulin therapy in type 1 diabetes

presents with a wide variety of symptoms, including hunger, anxiety or irritability, palpitations, sweating, or tingling lips. As the blood glucose levels fall lower, the person may experience weakness and lethargy, impaired vision, and confusion or irrational behaviour. Cognitive function deteriorates when blood glucose levels fall to less than 3.0 mmol/L. Severe hypoglycaemia may result in convulsions, loss of consciousness, and coma. People with severe hypoglycaemia are unable to self-manage (...) . People with severe hypoglycaemia are unable to self-manage a hypoglycaemic episode and require help from another person to achieve normoglycaemia. Impaired awareness of hypoglycaemia occurs when a person with diabetes loses the ability to recognize the usual symptoms of hypoglycaemia, or when these symptoms are absent or blunted. Management of hypoglycaemia includes: Giving oral glucose (if the person can swallow safely) or intramuscular glucagon (if the person has a decreased level of consciousness

2016 NICE Clinical Knowledge Summaries

117. Insulin therapy in type 2 diabetes

. As the blood glucose levels fall, the person may experience weakness and lethargy, impaired vision, and confusion or irrational behaviour. Cognitive function deteriorates when blood glucose levels fall below 3.0 mmol/L. Severe hypoglycaemia may result in convulsions, loss of consciousness, and coma. People with severe hypoglycaemia are unable to self-manage a hypoglycaemic episode and require help from another person to achieve normal blood glucose levels. Managing impaired awareness of hypoglycaemia (...) hunger, anxiety or irritability, palpitations, sweating, or tingling lips. Severe hypoglycaemia may result in convulsions, loss of consciousness, and coma. People with severe hypoglycaemia are unable to self-manage a hypoglycaemic episode and require help from another person to achieve normal blood glucose levels. Impaired awareness of hypoglycaemia occurs when a person with diabetes loses the ability to recognize the usual symptoms of hypoglycaemia, or when these symptoms are absent or blunted

2016 NICE Clinical Knowledge Summaries

118. Heart failure - chronic

Heart failure - chronic Heart failure - chronic - NICE CKS Clinical Knowledge Summaries Share Heart failure - chronic: Summary Heart failure is a complex syndrome in which the ability of the heart to maintain the circulation of blood is impaired as a result of a structural or functional impairment of ventricular filling or ejection. This results in symptoms including breathlessness, fluid retention, and fatigue; and signs including basal crepitations, and peripheral oedema. Heart failure (...) of renin-angiotensin system blocking agents is associated with an increased risk of hyperkalaemia, hypotension, and impaired renal function. The text has been updated to replace the Liverpool Care Pathway with new standards of care that have been issued by the Leadership Alliance for the Care of Dying People ( ). March 2014 — minor update. The text on the use of ivabradine in people with heart failure has been updated. Ivabradine is now only contraindicated in people who have acute or unstable heart

2016 NICE Clinical Knowledge Summaries

119. Meningitis - bacterial meningitis and meningococcal disease

%) 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 cognitive deficit plus hearing loss (39.1%) and cognitive deficit plus motor impairment (21.1%) [ ]. The all-cause risk of major sequelae was twice as high in Africa (25.1%) and Southeast Asia (21.6 (...) : stiff neck, altered mental state (confusion, delirium and drowsiness, impaired consciousness), non-blanching rash, back rigidity, bulging fontanelle (in children younger than 2 years of age), photophobia, Kernig's sign, Brudzinski's sign, coma, paresis, focal neurological deficit, and seizures. All suspected cases of meningitis are medical emergencies requiring immediate hospital admission by telephoning 999. For suspected meningococcal disease (meningitis with non-blanching rash or meningococcal

2016 NICE Clinical Knowledge Summaries

120. Dementia

impairment is cognitive impairment that does not fulfil the diagnostic criteria for dementia — for example, only one cognitive domain is affected, or ADLs are not significantly affected. The most common subtypes of dementia include: Alzheimer's disease (50–75%) which often co-exists with vascular dementia. Vascular dementia (up to 20%). Dementia with Lewy bodies (10–15%). Frontotemporal dementia (2%). Modification of specific risk factors (in particular, cardiovascular risk factors such as smoking (...) , diabetes and lack of physical activity) can delay or prevent the onset of dementia. Early diagnosis of dementia is important for treatment of reversible causes and advance planning while a person still has mental capacity. Dementia should be suspected if any of the following are reported by the person or their family/carer: Cognitive impairment leading to memory problems (such as difficulty learning new information), dysphasia and dyspraxia, disorientation to time and place and impairment of executive

2016 NICE Clinical Knowledge Summaries

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