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Elderly Drivers with Cognitive Impairment

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121. Diabetes - type 1

1 diabetes. This CKS topic does not cover the prescribing of insulin or the management of women with type 1 diabetes who are pregnant, planning a pregnancy, or breastfeeding. It also does not cover the diagnosis and management of impaired glucose regulation, or make detailed recommendations on the diagnosis and management of other types of diabetes. There are separate CKS topics on , , and . The target audience for this CKS topic is healthcare professionals working within the NHS in the UK (...) should be made after an informed discussion with the person about the risks and benefits of treatment, taking into account factors such as co-morbidities, potential benefits from lifestyle intervention, the person's preference, and life expectancy. December 2013 — minor update. Text has been removed from the section on antiplatelet treatment and links added to the updated CKS topic on Antiplatelet treatment . July 2013 — minor update. Links to the Driver and Vehicle Licensing Agency (DVLA) website

2016 NICE Clinical Knowledge Summaries

122. Parkinson's disease

is variable. The mortality rate 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 (...) and cognitive impairment [ ]. Life expectancy is reduced — the mortality rate for elderly people aged 70–89 years with Parkinson's disease is 2-5 times higher than for age-matched controls in some studies [ ]. The risk of dementia is about 2–6 times higher in people with Parkinson's disease than in healthy controls [ ]. Complications What are the complications? People with Parkinson's disease may develop a range of motor and non-motor complications. — are usually related to the use of anti-parkinsonian

2016 NICE Clinical Knowledge Summaries

123. Exploring potential reasons for Glasgow's 'excess' mortality: results of a three-city survey of Glasgow, Liverpool and Manchester

there is some evidence that Glasgow’s population may be more risk-seeking). It is probably still unknown whether the ‘anomie’ hypothesis holds true: the data presented here suggest it is unlikely, but whether this kind of population survey is the best means by which to examine the hypothesis is unclear; similarly, it is probably fair to say that data weaknesses impair our ability to assess the evidence of the impact of political effects (albeit some evidence of more negative perceptions of the 1980s did (...) , to understand and address this situation – the ultimate aim of this continuing programme of research. This, however, must be alongside, not in place of, efforts to reduce poverty and deprivation, the fundamental drivers of poor health in any society. Introduction11 1. Introduction Background – ‘excess’ mortality in Scotland and Glasgow The poor health profile of Scotland, and particularly that of its largest city, Glasgow, has been much documented. Traditional explanations have focused on the effects

2013 Health Economics Research Unit

124. Psychological, social and biological determinants of ill health (pSoBid)

study also reported a significantly higher prevalence of cognitive and functional impairment in elderly individuals living in socioeconomically deprived areas regardless of their own socioeconomic status (Basta et al., 2007). A small number of research studies have shown that ethnic minority status is also a risk factor for poorer cognitive function in older age (Zsembik and Peek, 2001; Masel and Peek, 2009) but the impact of ethnicity on the rates of cognitive decline in old age remains unclear. 21 (...) to explain the potential association between low socioeconomic status and cognitive decline. Evidence is now well established that vascular risk factors, such as blood pressure (Singh-Manoux and Marmot, 2005) and indicators of vascular disease are associated with cognitive impairment and dementia (Muller et al., 2007). Vascular disease has been reported to be predictive of poor cognitive function in the general population. The presence of vascular disease was associated with diminished cognitive function

2013 Glasgow Centre for Population Health

125. High Quality Women?s Health Care

their expectations. In addition, the service must be efficient, local and one in which the woman’s informed choice is respected, where practical. I believe there is a window of opportunity to change the face of women’s health care very significantly. Some of the drivers for this opportunity include the proposed changes in the health system, the ramifications of the Working Time Regulations and the variation in clinical services and outcomes in all parts of the UK. In the UK, the majority of out-of-hours acute (...) in training, particularly since the introduction of the WTR, have required different approaches to staffing the acute 24/7 service in obstetrics and gynaecology. This issue has also had to be considered in neonatology, anaesthesia, midwifery and nursing. There is also a planned reduction in trainee numbers by the Centre for Workforce Intelligence, which potentially will act as a major driver for change. While the WTR provided a driver for further consultant expansion with more consultants directly

2011 Royal College of Obstetricians and Gynaecologists

126. Guidelines for the management of dyslipidaemias

dysbetalipoproteinaemia. . . . . . . . . .1800 10.1.4 Familial lipoprotein lipase de?ciency . . . . . . .1800 10.1.5 Other genetic disorders of lipoprotein metabolism . . . . . . . . . . . . . . . . . . . . . . .1800 10.2 Children . . . . . . . . . . . . . . . . . . . . . . . . . . . .1801 10.3 Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1801 10.4 The elderly . . . . . . . . . . . . . . . . . . . . . . . . . .1802 10.5 Metabolic syndrome and diabetes . . . . . . . . . . . .1803 10.6 Patients (...) proprotein convertase subtilisin/Kexin 9 ESC/EAS Guidelines 1771PPAR peroxisome proliferator-activated receptor PPP Pravastatin Pooling Project PROCAM Prospective Cardiovascular Munster study PROSPER Prospective Study of Pravastatin in the Elderly at Risk PROVE-IT Pravastatin or Atorvastatin Evaluation and Infection Therapy PUFA polyunsaturated fatty acid RAAS system renin–angiotensin–aldosterone system RCT randomized controlled trial REVEAL Randomized Evaluation of the Effects of Anacetrapib Through

2011 European Society of Cardiology

127. Alcohol-use disorders: prevention

of the following has occurred. They: show signs of moderate or severe alcohol dependence have failed to benefit from structured brief advice and an extended brief intervention and wish to receive further help for an alcohol problem show signs of severe alcohol-related impairment or have a related co-morbid condition (for example, liver disease or alcohol-related mental health problems). [1] Department of Health (2007) Safe. Sensible. Social. The next steps in the national alcohol strategy. London: Department

2010 National Institute for Health and Clinical Excellence - Clinical Guidelines

128. Richard Lehman’s journal review—19 December 2016

prescribed. And there is a good reason for that, because this study also shows that ß-blockers speed decline in those with existing functional or cognitive impairment. Lancet 10-17 Dec 2016 Vol 388 Another Alzheimer’s drug bombs , the failure rate in trials for new Alzheimer’s drugs was found to be 99.6%. Here is another for the bin list: . It did not meet its primary end-point in a large trial. However, the time may not have come to forget this egregious name altogether, since there is another trial (...) sick patients. In the end, a radical rehumanizing of medicine can be the only answer to burnout. I look forward very much to Ron Epstein’s forthcoming book, Attending: Medicine, Mindfulness, and Humanity. End of life agitati on — a re drugs the answer? One driver of burnout is not being able to deliver the kind of care that you would like to give to patients. Or maybe I should have put that the other way round—not being able to deliver the care of kindness. . “Distressing behavioral, communication

2016 The BMJ Blog

129. Briviact - brivaracetam

% of epilepsy cases), and generalised seizures which represent approximately 30 % of cases. In the remaining 10 % the classification is uncertain. Partial seizures used to be subdivided in Type IA simple partial seizures (consciousness not impaired), Type IB complex partial seizures (with impairment of consciousness) and Type IC partial seizures evolving to secondarily generalised seizures (ILAE 1981). However, such classification for focal seizures was subsequently abandoned by ILAE and later reports (...) recommended instead description of manifestation or degree of disability (Berg et al. Epilepsia, 2010). The lifetime risk of developing epilepsy (defined as a history of epilepsy regardless of the frequency of seizures or use of antiepileptic medication) is between 3% and 5%, with the highest incidence reported in neonates, young children, and the elderly (Banerjee et al, Epilepsy Research, 2009). The prevalence of active epilepsy is estimated at 5-8 per 1000 people in high-income countries and 10 per

2016 European Medicines Agency - EPARs

130. An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain - Part 2 - Guidance and Recommendations

the findings among multiple authors, Hoy et al (48) showed a variable prevalence of spinal pain with a significant recur- rence of 24% to 80%. Studies of the prevalence of low back and neck pain and its impact in the general popula- tion have shown 23% of patients reporting Grade II to IV low back pain (50) with a high pain intensity and disability compared to 15% with neck pain (51) (Fig. 1). Furthermore, the prevalence of persistent pain is highly prevalent in the elderly and closely associated

2013 American Society of Interventional Pain Physicians

131. Clinical Practice Guidelines for Healthy Eating for the Prevention and Treatment of Metabolic and Endocrine Diseases in Adults: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology and The Obesity Society

every hour on the hour dur- ing the waking hours of the day achieves the same caloric expenditure as a 30-minute walk once (assuming the same velocity) (4 [EL2, NRCT]; 5 [EL4, NE]; 6 [EL1, RCT]). Healthy eating and physical activity must be accom- panied by proper sleep (ideally 7 to 8 hours a night; less than 6 hours a day is associated with metabolic derange- ments and cognitive impairment) and adequate time for recreation and play and for stress reduction and happiness (7 [EL3, SS]; 8 [EL3, CCS (...) the intake of vitamin B 12 in food (Grade A, BEL 1). • R7. The prevalence of vitamin D deficiency and insufficiency warrants case finding by measure - ment of 25-hydroxyvitamin D (25[OH]D) levels in populations at risk, including institutionalized elderly patients, people with hyperpigmented skin, and people with obesity (Grade B BEL 2). Older adults, people with increased skin pigmen- tation, and those exposed to insufficient sunlight should increase vitamin D intake from vitamin D-fortified foods

2013 American Association of Clinical Endocrinologists

132. 2013 ACCF/AHA Guideline for the Management of Heart Failure

; NHLBI, National Heart, Lung, and Blood Institute; NICE, National Institute for Health and Clinical Excellence; PCNA, Preventive Cardiovascular Nurses Association; SCAI, Society for Cardiovascular Angiography and Interventions; STS, Society of Thoracic Surgeons; and WHF, World Heart Federation. 2. Definition of HF HF is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. The cardinal manifestations of HF are dyspnea (...) a clinical diagnosis based on a careful history and physical examination. The clinical syndrome of HF may result from disorders of the pericardium, myocardium, endocardium, heart valves, or great vessels or from certain metabolic abnormalities, but most patients with HF have symptoms due to impaired left ventricular (LV) myocardial function. It should be emphasized that HF is not synonymous with either cardiomyopathy or LV dysfunction; these latter terms describe possible structural or functional reasons

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2013 American Heart Association

133. Alcohol impacts health: A rapid Review of the Evidence

in their background report: weight gain, cognitive decline with age, coronary heart disease (CHD), bone health, and 16 unintentional injury. The Committee limited the reviews to studies with greater methodological rigour and only conducted systematic reviews of observational prospective studies and randomized control trials. There were two exceptions: (1) alcohol intake and unintentional injury because cross- sectional or case control studies are of equal or better validity; and (2) alcohol intake related to CHD (...) for same disease condition. Please see synthesis tables in Appendix H for the confidence intervals for relative risks (where available). ** Effect sizes not available for exact alcohol consumption for cognitive decline; effect sizes not provided for diabetes, alcohol use disorder, suicide attempt/ideation. More details are available in Appendix H and I. †Risk per 100 drinkers – data from Australian guidelines which set risk at this level. For example, a man who has 4 standard drinks daily (40 g) has

2013 Peel Health Library

134. Encouraging Travellers to take Preventive Measures Against Travel-Related Communicable Diseases: A Rapid Review of the Literature

quality Study 1: 1++ Mass Media 10, 11 Effect of community-wide mass media interventions on physical activity. 11 Positive Variable quality Study 1: 2- 17 Intervention Description of Intervention Effect Quality of Evidence Attribute Effect of mass media campaigns on reducing alcohol-impaired driving and crashes. 11 Positive Variable quality Study 1: 2- Environmental Interventions and Supports: Includes environmental design or the use of prompts. Behavioural Supports 11 Effect of removing social (...) to be on the decline, traditional media, such as television, radio, magazines and newspapers, still reach a large audience. 10 Radio, in particular, is one of the most customizable media available, effectively targeting different markets. 10 In general, mass media interventions have demonstrated a small to moderate effect in changing knowledge, attitudes and behaviour for tobacco use, physical exercise, alcohol-impaired driving and healthy eating (quality: 1++, 2-, 2-, 2-). 11 20 ENVIRONMENTAL INTERVENTIONS

2013 Peel Health Library

135. Manipulating the sleep-wake cycle and circadian rhythms to improve clinical management of major depression

or early neurodegenerative dis- orders. Here, our data shows that greater nocturnal wakefulness as measured by actigraphic monitoring Figure 3 The normal synchronous relationships between sleep and daytime activity and cortisol, melatonin and body temperature. Hickie et al. BMC Medicine 2013, 11:79 Page 11 of 27 http://www.biomedcentral.com/1741-7015/11/79relates to neuropsychological dysfunction in late-life de- pression [43], mild cognitive impairment [257], and REM sleep behavior disorder (...) and the degree of resultant impairment [8-10]. To reduce that burden, earlier identification and enhanced long-term care of those who are at risk or are in the early phases of life threatening or chronic disorders has been prioritized [8,11-15]. However, this key ‘pre-emptive’approachis compromised by poorly-validated and entirely descriptive diagnostic systems [11-15]. Further, these systems were based on the experiences of middle or older age cohorts with recurrent or persistent disorders. By contrast, one

2013 Clinical Practice Guidelines Portal

136. Assessment and Management of Foot Ulcers for People with Diabetes, Second Edition

with Diabetes There are multiple co-morbidities and complications associated with diabetes (CDA CPG Expert Committee, 2008). The following discussion will focus on co-morbidities of renal impairment, hypertension and retinopathy. Early identification of co-morbidities and complications allows the health-care professional to initiate appropriate referrals and develop a comprehensive interprofessional plan of care. Renal Impairment Renal impairment is a prevalent microvascular complication. Fifty percent (...) of people with diabetes have renal impairment (CDA CPG Expert Committee, 2008). In a retrospective observational study, Eggers, Gohdes and Pugh (1999) identified that amputation rates for people with diabetes and end-stage renal disease increased 10-fold compared to people with diabetes alone. Furthermore, the post-amputation survival rate for clients with diabetes and end-stage renal disease was approximately 33% (Eggers et al., 1999). Hypertension The majority of people with diabetes will develop

2013 Registered Nurses' Association of Ontario

137. Heart Disease and Stroke Statistics?2012 Update

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. It is useful, therefore, to know the extent of mortality attributable to a given cause regardless of whether it is the underlying cause or a contributing cause (ie, its “any-mention” status). The number of deaths in 2008 with any mention of specific causes of death was tabulated by the NHLBI from the NCHS public-use electronic files on mortality. The first

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2012 American Heart Association

139. 2012 KDIGO Clinical Practice Guideline for the Evaluation and Management of CKD

to control volume status or blood pressure; a progressive deterioration in nutritional status refractory to dietary intervention; or cognitive impairment. This often but not invariably occurs in the GFR range between 5 and 10ml/min/1.73 m 2 .(2B) 5.3.2: Living donor preemptive renal transplantation in adults should be considered when the GFR iso20ml/min/ 1.73 m 2 , and there is evidence of progressive and irreversible CKD over the preceding 6–12 months. (Not Graded) 5.4: STRUCTURE AND PROCESS (...) the elderly, such as infection and impairments in physical function and cogni- tion. In addition, CKD is associated with increased risk from adverse effects of drugs, intravascular radiocontrast admin- istration, surgery and other invasive procedures. Altogether, these complications are associated with higher morbidity, mortality and cost. If CKD is detected early, the associated complications and the progression to kidney failure can be delayedorevenpreventedthrough appropriate interventions. Regular

2012 National Kidney Foundation

140. Guidelines for Responsible Opioid Prescribing in Chronic Non-Cancer Pain

. Cluster 2 dealt with conducting an opioid trial with titration and driving, stepped opioid selection, op- timal dose, watchful dose, and opioid misuse. Cluster 3 described monitoring of long-term opioid therapy with monitoring, switching or discontinuing opioids, impact on driving, revisiting opioid trial steps, and collabora- tive care. Cluster 4 described treating specific popu- lations with long-term opioid therapy including the elderly, adolescents, pregnant patients, and patients suffering (...) exer- cise programs, physical therapy, occupational therapy; cognitive behavioral therapy with psychological in- terventions, surgical interventions, or interventional techniques. In interventional pain management, patients may receive not only opioid analgesics, but also other con- trolled or non-controlled drugs, to manage comorbid psychiatric and psychological disorders. Consequently, the effectiveness studies of opioids published thus far may not apply in the majority of interventional pain

2012 American Society of Interventional Pain Physicians

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