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Elderly Drivers with Cognitive Impairment

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121. Peginterferon beta-1a for treating relapsing–remitting multiple sclerosis

reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 6 of 18gait, speech problems, incontinence, visual disturbance and cognitive impairment. The committee noted that reducing the frequency of relapses was a key outcome for people with the condition. It considered whether there was a clinically meaningful reduction in the number of relapses. The patient and clinical experts explained that even 1 mild relapse can be devastating and can affect (...) . All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 12 of 18noted that older people were more likely to be in a higher EDSS score group in the model (in which higher EDSS scores were associated with a worse utility value), and that the Orme et al. and Thompson et al. studies differed with respect to age, which could have led to different model predictions. The committee agreed that, because the utility values seemed to be a key

2020 National Institute for Health and Clinical Excellence - Technology Appraisals

122. Suspected neurological conditions: recognition and referral

of 73Contents Contents Overview 6 Who is it for? 6 Recommendations for adults aged over 16 7 1.1 Blackouts in adults 7 1.2 Dizziness and vertigo in adults 7 1.3 Facial pain, atraumatic 9 1.4 Gait unsteadiness 10 1.5 Handwriting difficulties 11 1.6 Headaches in adults 12 1.7 Limb or facial weakness in adults 12 1.8 Memory failure and cognitive deterioration 14 1.9 Posture distortion in adults 16 1.10 Sensory symptoms including tingling or numbness in adults 16 1.11 Sleep disorders in adults 19 1.12 Smell (...) 1.31 Tics and involuntary movements in children 38 1.32 Tremor in children 39 T erms used in this guideline 40 Refer immediately 40 Refer urgently 40 Refer 40 Consider referring 40 Dizziness 40 Functional neurological disorder 40 Radiculopathy 40 Rationale: recommendations for adults aged over 16 41 Blackouts in adults 41 Dizziness and vertigo in adults 41 Facial pain, atraumatic 43 Gait unsteadiness 44 Handwriting difficulties 45 Limb or facial weakness in adults 45 Memory failure and cognitive

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

123. Specialist neonatal respiratory care for babies born preterm

than 2 standard deviations [SD] below normal on validated assessment scales, or a score of less than 70 on the Bayley II scale of infant development mental developmental index [MDI] or psychomotor developmental index [PDI], or complete inability to assign score because of cerebral palsy or severe cognitive delay) moderate (score of 1 to 2 SD below normal on validated assessment scales, or a score of 70 to 84 on the Bayley II scale of infant development MDI or PDI) neurosensory impairment (reported (...) as presence or absence of condition, not severity): severe hearing impairment (for example, deaf) severe visual impairment (for example, blind). Specialist neonatal respiratory care for babies born preterm (NG124) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 22 of 53Non-in Non-invasiv vasive v e ventilation entilation Administration of respiratory support using a ventilator or flow driver, but not via an endotracheal

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

124. Cognitive reserve

cognitive testing. Conversely anyone who has used these instruments clinically knows that they can yield false positives in people with very low reserve. From this point of view the concept of "adequate level of challenge" easily emerges. Conceivably one could measure cognitive reserve and then offer specifically tailored tests that would pose enough level of challenge to accurately detect early cognitive impairment both in individuals with high and low reserve. This has implications for treatment (...) : a study of aging male twins. Journals of Gerontology Series B: Psychological Sciences and Social Sciences . 57(2):P133-43 Plomin R, Pedersen NL, Lichtenstein P, McClearn GE (1994). "Variability and stability in cognitive abilities are largely genetic later in life". Behavioral Genetics . 24 (3): 207–15. : . . Bennett DA; et al. (Jan 2014). . Acta Neuropathol . 127 (1): 137–50. : . . . Richards M, Sacker A (2003). "Lifetime antecedents of cognitive reserve". Journal of Clinical and Experimental

2012 Wikipedia

125. Canadian Stroke Best Practice recommendations: rehabilitation, recovery, and community participation following stroke. Part one: rehabilitation and recovery following stroke; 6th edition update 2019

, essential for helping patients to regain lost skills, relearn tasks, and regain independence. Following a stroke, many people typically require rehabilitation for persisting deficits related to hemiparesis, upper-limb dysfunction, pain, impaired balance, swallowing, and vision, neglect, and limitations with mobility, activities of daily living, and communication. This module addresses interventions related to these issues as well as the structure in which they are provided, since rehabilitation can (...) , spasticity, dysphagia, aphasia, visual perception Received: 11 November 2019; accepted: 25 November 2019 Introduction Globally, new data from the Global Burden of Disease reports one in four people will have a stroke in their lifetime. 1 In 2013, stroke was the second most common cause of all deaths (11.8%), behind ischemic heart dis- ease (14.8%). 2 In 2017, the age standardized mortality rate for stroke was 80.5 per 100,000 population, repre- senting a 13.6% decline since 2007. 3 The drop in mor

2020 CPG Infobase

126. Chronic heart failure in adults: diagnosis and management

://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 24 of 37Conte Context xt Key facts and figures Heart failure is a complex clinical syndrome of symptoms and signs that suggest the efficiency of the heart as a pump is impaired. It is caused by structural or functional abnormalities of the heart. Around 920,000 people in the UK today have been diagnosed with heart failure. Both the incidence and prevalence of heart failure increase steeply with age, and the average age at diagnosis is 77 (...) in adults: diagnosis and management (NG106) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 4 of 37This guideline replaces CG108. This guideline is the basis of QS167, QS9 and QS181. Ov Overview erview This guideline covers diagnosing and managing chronic heart failure in people aged 18 and over. It aims to improve diagnosis and treatment to increase the length and quality of life for people with heart failure. NICE has

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

127. Dementia: assessment, management and support for people living with dementia and their carers

in the Elderly (IQCODE) or the Functional Activities Questionnaire (FAQ). 1.2.6 Refer the person to a specialist dementia diagnostic service (such as a memory clinic or community old age psychiatry service) if: reversible causes of cognitive decline (including delirium, depression, sensory Dementia: assessment, management and support for people living with dementia and their carers (NG97) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice (...) care This guideline offers best-practice advice on care and support for people living with dementia and their families and carers. The principles of person-centred care underpin good practice in dementia care, and they are reflected in the recommendations. These principles assert: the human value of people living with dementia (regardless of age or cognitive impairment) and their families and carers the individuality of people living with dementia, and how their personality and life experiences

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

128. Brain tumours (primary) and brain metastases in adults

://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 4 of 60Ov Overview erview This guideline covers diagnosing, monitoring and managing any type of primary brain tumour or brain metastases in people aged 16 or over. It aims to improve diagnosis and care, including standardising the care people have, how information and support are provided, and palliative care. Who is it for? Healthcare professionals involved in the multidisciplinary care of people with primary brain tumours or brain metastases (...) and how they might affect practice, see rationale and impact. F Further management of newly diagnosed low-gr urther management of newly diagnosed low-grade glioma ade glioma 1.2.6 After surgery, offer radiotherapy followed by up to 6 cycles of PCV chemotherapy (procarbazine, CCNU [lomustine] and vincristine) for people who: have a 1p/19q codeleted, IDH-mutated low-grade glioma (oligodendroglioma) and and are aged around 40 or over, or have residual tumour on postoperative MRI. 1.2.7 After surgery

2018 National Institute for Health and Clinical Excellence - Clinical Guidelines

129. Genome-Wide Sequencing for Unexplained Developmental Disabilities or Multiple Congenital Anomalies

developmental disabilities or multiple congenital anomalies. BACKGROUND Health Condition Developmental disability includes developmental delay and intellectual disability. Developmental delay is a term used exclusively for children younger than 5 years of age whose development is substantially behind expected development in at least two of the following: gross motor skills, fine motor/vision, speech and language, cognition, and personal/social activities of daily living. 1,2 Approximately 1% of Canadians (...) have a developmental delay. 3 Intellectual disability, sometimes referred to as intellectual developmental disorder, denotes impaired adaptive functioning. People are said to have an intellectual disability if they have deficits in reasoning, if they fail to meet standards for independence and social responsibility, and if these deficits occurred during the developmental period. 2 Given the overlap between the terms, people with global developmental delay or intellectual disability are often

2020 Health Quality Ontario

130. Continual Long-Term Physiotherapy After Stroke

is expected to increase by 80% over the next two decades because of the aging population and improvements in acute care. 2 Each year, more than 50,000 people in Canada are estimated to have a first stroke. A majority of strokes occur in people over the age of 65 years. 3 Most people (83%) survive their first stroke, but with substantial morbidity. 4 It is common for people to experience weakness of the upper and lower limbs after stroke, in addition to a loss of cognitive functions. This weakness can (...) Series; Vol. 20: No. 7, pp. 1–70, March 2020 9 people should be assessed by an interprofessional team and that people “with residual impairment identified as having further rehabilitation needs should receive therapy services to set new goals and improve task-oriented activity.” 16 The clinical handbook also recommended that patients be given two to three physiotherapy sessions each week for 8 to 12 weeks (combined with community-based clinic services, including from hospitals, whenever appropriate

2020 Health Quality Ontario

131. Mental Health Considerations during COVID-19 Outbreak

with cognitive decline/dementia, may become more anxious, angry, stressed, agitated, and withdrawn during the outbreak/while in quarantine. Provide practical and emotional support through informal networks (families) and health professionals. 23. Share simple facts about what is going on and give clear information about how to reduce risk of infection in words older people with/without cognitive impairment can understand. Repeat the information whenever necessary. Instructions need to be communicated (...) to seek more attachment and be more demanding on parents. Discuss COVID-19 with your children using honest and age- appropriate way. If your children have concerns, addressing those together may ease their anxiety. Children will observe adults’ behaviors and emotions for cues on how to manage their own emotions during difficult times. Additional advice available here Older adults, care providers and people with underlying health conditions 22. Older adults, especially in isolation and those

2020 WHO Coronavirus disease (COVID-19) Pandemic

132. British guideline on the management of asthma

, respectively, and in section 4.3 on predicting future risk of asthma attacks, each recommendation has been graded and the supporting evidence assessed for adults and adolescents over 12 years old, children 5–12 years, and children under 5 years. Further information on managing asthma in adolescents (10–19 years of age as defined by the World Health Organization) 3 is given in section 11.2 British guideline on the management of asthma The guideline considers diagnosis of asthma and management in all (...) patients with a diagnosis of asthma, although there is less evidence available for people at either age extreme. The guideline does not cover patients whose primary diagnosis is not asthma, for example those with chronic obstructive pulmonary disease (COPD) or cystic fibrosis, but patients with these conditions can also have asthma. Under these circumstances many of the principles set out in this guideline will apply to the management of their asthma symptoms. 1.2.2 Target users of the guideline

2019 SIGN

133. Strimvelis for treating adenosine deaminase deficiency?severe combined immunodeficiency

recurrent infections. The systemic metabolic defect also causes non-immunological manifestations, including insufficient weight and height gain, cognitive and behavioural problems, and deafness. ADA–SCID has a profound effect on health-related quality of life and, if left untreated, infants die before school age. Quality of life is affected by developmental delay, chronic diarrhoea, failure to thrive, recurrent infections and neurological impairments. People whose condition is untreated must be isolated (...) is an ultra-rare condition caused by inheritance of a faulty gene from both parents, which impairs production of the enzyme ADA. The main features of SCID are due to a lack of lymphocytes resulting in a compromised immune system. 2.2 Signs and symptoms of ADA–SCID typically occur in the first year of life (although about 10% to 15% of people with ADA–SCID have a later onset). Immunodeficiency has the greatest effect on morbidity and mortality, and leads to a high risk of serious and life-threatening

2018 National Institute for Health and Clinical Excellence - Highly specialised technology

134. Parkinson?s disease in adults

and promoting a feeling of optimism. [2006] [2006] 1.1.3 Because people with Parkinson's disease may develop impaired cognitive ability, communication problems and/or depression, provide them with: both oral and written communication throughout the course of the disease, which should be individually tailored and reinforced as necessary consistent communication from the professionals involved. [2006] [2006] 1.1.4 Give family members and carers (as appropriate) information about the condition (...) in people with Parkinson's disease who have no cognitive impairment. [2017] [2017] 1.5.17 If standard treatment is not effective, offer clozapine to treat hallucinations and delusions in people with Parkinson's disease. Be aware that registration with a patient monitoring service is needed. [2017] [2017] 1.5.18 Be aware that lower doses of quetiapine [4] and clozapine are needed for people with Parkinson's disease than in other indications. [2017] [2017] 1.5.19 Do not offer olanzapine to treat

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

135. Glaucoma: diagnosis and management

with CO eople with COA AG, suspected CO G, suspected COA AG and OHT G and OHT 1.4.9 At each assessment, re-evaluate risk of conversion to COAG and risk of sight loss to set time to next assessment. [2017] [2017] 1.4.10 At each assessment, ask about general health and, if appropriate, factors affecting adherence to treatment, including cognitive impairment and any treatment side effects. [2017] [2017] P People with tr eople with treated OHT (baseline IOP 24 eated OHT (baseline IOP 24 mmHg or mor mmHg (...) a copy to their GP and, with patient consent, copy the relevant information to the primary eye care professional nominated by the patient. Advise people to take their discharge summary with them when attending future sight tests. [2017] [2017] 1.5 Treatment 1.5.1 T ake into account any cognitive and physical impairments when making decisions about management and treatment. [2017] [2017] 1.5.2 Check that there are no relevant comorbidities or potential drug interactions before offering pharmacological

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

136. Individualized funding interventions to improve health and social care outcomes for people with a disability: A mixed?methods systematic review

a personal budget, with any form or level of lifelong disability (physical, sensory, intellectual or developmental disability, level of mental health problem, disorder or illness, or dementia), residing in any country and any type of residential setting (own home, group home, residential care setting, nursing home, hospital, institution). Studies in any language were included. Minors and older people without a lifelong disability (i.e., no disability in 10 years prior to reaching the age of 65) were (...) to population ageing and a greater prevalence of more chronic health conditions, whilst people with disabilities also have less access to health care services and, therefore, more unmet needs than ever before. There is further evidence to suggest that people with disabilities have lower life expectancies (Patja, Iivanainen, Vesala, Oksanen, & Ruoppila, ). The many different needs of people with a disability, learning difficulty or mental health problems tend to be met through a range of activities, which

2019 Campbell Collaboration

137. Guidelines on Chronic Coronary Syndromes Full Text available with Trip Pro

Events CASS Coronary Artery Surgery Study CCB Calcium channel blocker CCS Chronic coronary syndrome(s) CFR Coronary flow reserve CHA 2 DS 2 - VASc Cardiac failure, Hypertension, Age ≥75 [Doubled], Diabetes, Stroke [Doubled] – Vascular disease, Age 65–74 and Sex category [Female] CHD Coronary heart disease CI Confidence interval CKD Chronic kidney disease CMR Cardiac magnetic resonance COMPASS Cardiovascular Outcomes for People Using Anticoagulation Strategies COURAGE Clinical Outcomes Utilizing (...) 8.1.2 Valvular heart disease (including planned transcatheter aortic valve implantation) 44 8.1.3 After heart transplantation 44 8.2 Non-cardiovascular comorbidities 45 8.2.1 Cancer 45 8.2.2 Diabetes mellitus 45 8.2.3 Chronic kidney disease 46 8.2.4 Elderly 46 8.3 Sex 46 8.4 Patients with refractory angina 47 9. Key messages 48 10. Gaps in the evidence 49 10.1 Diagnosis and assessment 49 10.2 Assessment of risk 49 10.3 Lifestyle management 49 10.4 Pharmacological management 49 10.5 Revascularization

2019 European Society of Cardiology

138. Management of Dyslipidaemias Full Text available with Trip Pro

of illustrating risk than as a guide to treatment, because therapeutic trials have been based on a fixed follow-up period and not on lifetime risk. Another problem relates to older people. In some age categories, the majority of people, especially males, will have estimated 10 year cumulative CV death risks exceeding the 5–10% level, based on age only, even when other CV risk factor levels are relatively low. Therefore, before initiating treatment in the elderly, clinicians should evaluate patients carefully (...) for low-density lipoprotein cholesterol 22 Recommendations for pharmacological low-density lipoprotein cholesterol lowering 35 Recommendations for drug treatment of patients with hypertriglyceridaemia 38 Recommendations for the detection and treatment of patients with heterozygous familial hypercholesterolaemia 40 Recommendations for the treatment of dyslipidaemias in older people (aged >65 years) 43 Recommendations for the treatment of dyslipidaemias in diabetes mellitus 45 Recommendations for lipid

2019 European Society of Cardiology

139. Hot spots policing of small geographic areas effects on crime Full Text available with Trip Pro

opportunistic arrests and investigations. Putting police officers in high crime locations may be an old and well‐established idea; however, in the long history of policing, police crime prevention strategies did not focus systematically on crime hot spots until only very recently (Braga & Schnell, ). The availability of powerful crime mapping software packages has allowed police departments to identify and address problem places more easily than was previously possible in the days when pin maps were (...) , the offender's cognitive abilities, and by the availability of relevant information, exhibited limited rather than normative rationality” (Cornish & Clarke, , p. 933). This perspective is often combined with routine activity theory to explain criminal behavior during the crime event (Clarke & Felson, ). Routine activities theory posits that a criminal act occurs when a likely offender converges in space and time with a suitable target (e.g., victim or property) in the absence of a capable guardian (Cohen

2019 Campbell Collaboration

140. Patent foramen ovale (PFO) closure in patients with cryptogenic ischaemic stroke

survivors fear having another stroke 23 . A study conducted in Scotland in 2000-2001 explored the fear of stroke recurrence through structured and semi-structured interviews with stroke survivors 24 . Participants had been admitted to a specialist stroke unit and had a confirmed diagnosis of stroke. Patients with aphasia or substantial cognitive impairment were excluded. The median age of participants was 71 years (range 32 to 90). One month after a stroke over half of the participants (56%, 50/89 (...) = incremental cost-effectiveness ratio It should also be noted that utility weights for post-stroke health states in the published economic models were derived from an older population (mean age 75 years) whose index stroke was not necessarily cryptogenic. It is likely that recurrent ischaemic stroke in people of working age has a bigger negative impact on quality of life due to decreased earnings and social activities. As such, the incremental benefit following a reduction in ischaemic stroke rates may

2020 SHTG Advice Statements

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