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Elderly Drivers with Cognitive Impairment

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101. Acute Pain Management: Scientific Evidence

Paediatric pain assessment 412 9.3.1 Pain assessment in neonates 413 9.3.2 Observational and behavioural measures in infants and children 414 9.3.3 Self-report in children and adolescents 415 9.3.4 Children with cognitive impairment or intellectual disability 416 9.4 Analgesic agents 421 9.4.1 Paracetamol 421 9.4.2 Nonselective NSAIDs 424 9.4.3 Coxibs 429xix CONTENTS 9.4.4 Opioids and tramadol 430 9.4.5 Ketamine 438 9.4.6 Alpha-2-delta ligands (gabapentin/pregabalin) 440 9.4.7 Alpha-2 adrenergic agonists (...) Cognitive-behavioural interventions 262xvii CONTENTS 7.2 Transcutaneous electrical nerve stimulation 265 7.3 Acupuncture and acupressure 265 7.3.1 Postoperative pain 265 7.3.2 Other acute pain states 267 7.4 Physical therapies 269 7.4.1 Manual and massage therapies 269 7.4.2 Warming and cooling intervention 270 7.4.3 Other therapies 271 References 271 8. SPECIFIC CLINICAL SITUATIONS 279 8.1 Postoperative pain 279 8.1.1 Multimodal postoperative pain management 279 8.1.2 Procedure-specific postoperative

2015 Clinical Practice Guidelines Portal

102. Strategies for discontinuing benzodiazepines

deterioration, accidents and falls, deterioration of complex skills such as driving, and paradoxical behaviour. 2 benzodiazepine-induced severe cognitive deterioration in elderly patients can be mistaken for the onset of dementia. For this reason ben- zodiazepines should be avoided in the elderly, but other sedating drugs can also cause the same problems. 2 Adverse effects occur more frequently when long half- life drugs (over 24 h) are used, when the dose is higher than the recommended, when treatment (...) Psycotherapy This consists of supporting a withdrawal strategy through cognitive behavioural therapy. It requires identification and correction of behaviour problems and learning sleep hygiene habits (Appendix 2), control of stimuli or relaxation techniques. 22 Various studies support the efficacy of cognitive behavioural therapy in addition to a benzodiazepine tapering schedule. In two studies, 23-24 this intervention proved adequate for elderly patients with chronic insomnia, although benefits may

2015 Drug and Therapeutics Bulletin of Navarre (Spain)

103. Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention

such as CVD, T2DM, and depression, which, either individually or collectively, represent the leading causes of morbidity and mortality in the United States. More than 35% of US adults >20 years are obese, and >1 in 4 Americans have multimorbidity, which is associated with high healthcare use and costs, functional impairment, poor quality of life, psychological distress, and premature death. Sustained weight loss of 3% to 5% can delay or possibly prevent T2DM , and significantly improve CVD risk factors (...) age (SD):Int1: 37.7 (11.8) yInt2: 39.6 (12.2) yWomen:Int1: 68%Int2: 81%White:Int1: 85%Int2: 78%BMI:Int1: 31.8 (3.2) kg/m 2 Int2: 31.4 (4.1) kg/m 2 Retention:Int1: 90%Int2: 92% Int1: Social cognitive theory–based wt loss podcastDiet: Increase fruit and vegetable intake, decrease fat intakePA: Increase from baselineBehavior: Encourage tracking wt, calories, and exerciseInt2: Non–theory-based wt loss podcastDiet: Avoid overeatingPA: NRBehavior: NR Podcast via MP3 player or computer for Int1 and Int2

2015 American Heart Association

104. Engaging Clients Who Use Substances

a substance use disorder. The expert panel further delineated that all individuals who use substances, regardless of a diagnosis of a substance use disorder, require support in decreasing risky behaviours from their substance use. The expert panel adopted the definition of a substance use disorder found in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM–5; American Psychiatric Association [APA], 2013), which defines a substance use disorder as “a cluster of cognitive, behavioral (...) in problematic behaviour or effects; however, in certain situations and depending on the type of substances consumed, substance use may lead to physical and psychological health problems in individuals, regardless of their socio-economic status or their geographical location. A substance use disorder, in accordance with the DSM–5, is defined as “a cluster of cognitive, behavioral, and physiological symptoms indicating that the individual continues using the substance despite significant substance- related

2015 Registered Nurses' Association of Ontario

105. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer

, high-resolution ultrasound (US) can detect thyroid nodules in 19%–68% of randomly selected individ- uals, with higher frequencies in women and the elderly (3,4). The clinical importance of thyroid nodules rests with the need to exclude thyroid cancer, which occurs in 7%–15% of cases depending on age, sex, radiation exposure history, family history, and other factors (5,6). Differentiated thyroid cancer (DTC), which includes papillary and follicular cancer, com- prises the vast majority (>90

2015 Pediatric Endocrine Society

106. Management of Constipation in Adult Patients Receiving Palliative Care

identified to have unmet needs, with more healthcare resource utilisation, increased inpatient days and emergency admissions as a result. Indicators of unmet clinical needs were associated with a €2,501.47 incremental annual healthcare cost compared to patients without these indicators. This cost difference was mainly driven by hospitalisation and pharmacy costs (26). Resource utilisation associated with the diagnosis and management of constipation is a significant driver of increased cost ( 22). Much

2015 National Clinical Guidelines (Ireland)

107. The Management of Upper Extremity Amputation Rehabilitation (UEAR)

facilities and VA healthcare since 2001, approximately 30 percent in DoD and 18 percent in VA have involved one or both upper limbs. [3] The successful rehabilitation of patients with upper limb amputations is influenced by a variety of factors that include, but are not limited to, level of amputation, cognitive impairment, physical conditioning, nutritional status, social support, psychological factors and motivation. To maximize successful outcomes and return patients to independent living in home (...) Pain Assessment 29 Behavioral and Cognitive Health Assessment 32 Assessment of Patient’s Personal, Social, and Cultural Contexts 34 VA/DoD Evidence-Based Clinical Practice Guideline for the Management of Upper Extremity Amputation Rehabilitation Page 4 of 149 Learning Assessment 35 Residual Limb Assessment 35 Contralateral limb and trunk 36 Prosthetic Assessment (if applicable) 37 Vocational Rehabilitation 38 Annual Assessments 39 Outcome Measures 39 Core 3: Patient-Centered Care 41 Shared Decision

2014 VA/DoD Clinical Practice Guidelines

108. General practice management of type 2 diabetes 2014-15

? Assess (inclusive within an annual cycle of care) Risk factors for modification GP/practice nurse/diabetes educator Weight, height GP/practice nurse Cardiovascular risk assessment GP/practice nurse Foot examination Podiatrist/GP/practice nurse Presence of other complications GP/practice nurse/diabetes educator Psychological status GP/practice nurse/psychologist Eye examination GP/optometrist/ophthalmologist Dental review Dentist Consider other assessments where appropriate, e.g. cognitive impairment (...) diabetes 3. Screening, risk assessment, case finding and diagnosis 3.1 Identifying risk of diabetes in asymptomatic patients Recommendations Reference Grade* Individuals should be screened for risk of diabetes every 3 years from age 40 years using AUSDRISK (25) NHMRC, 2009 B Individuals at high risk and those with impaired glucose tolerance or impaired fasting glucose (not limited by age) should be tested: • with fasting blood glucose (25) NHMRC, 2009 B • every 3 years (25) NHMRC, 2009 C Aboriginal

2014 Clinical Practice Guidelines Portal

109. 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

110. 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

111. 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

112. Diabetes, Pre-Diabetes and Cardiovascular Diseases

www.escardio.org/guidelines 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

113. 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

114. 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

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

. August 2014 ISBN: 978-0-7334-3505-8 www.homemods.info 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

116. 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

117. 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 (...) www.homemods.info 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

118. 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

119. 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

120. 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

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