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Elderly Drivers with Cognitive Impairment


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141. 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

142. 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

143. 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

144. 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 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

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

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 (...) Considerations and Clinical Indications. COMPONENT ASSOCIATED PATHOPHYSIOLOGICAL INVOLVEMENT ASSESSMENT CONSIDERATIONS CLINICAL INDICATIONS Sensory ¦ Myelin sheath is disrupted by hyperglycemia ¦ Disruption leads to the segmental demyelinization process accompanied by a slowing of motor nerve conduction and an impairment of sensory perception ¦ Pressure perception testing using a 10-gr* (5.07 Semmes-Weinstein) monofilament, is recommended ¦ Vibration perception (using a tuning fork) ¦ Tactile sensation

2013 Registered Nurses' Association of Ontario

146. 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

148. 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

149. 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

150. EFNS?ENS Guidelines on the diagnosis and management of disorders associated with dementia

management guidelines in dementia and original scientific papers published in peer‐reviewed journals before June 2011. The search strategy sought only studies published in English. The principal search term was dementia. Other terms entered into the search included diagnosis, guideline, management, recommendation, review, treatment. For each topic, the evidence was sought in MEDLINE according to pre‐defined search protocols 1 *Searching terms used in the search strategy: vascular cognitive impairment (...) , fluctuating attention and cognition, and motor features of parkinsonism . Suggestive features include neuroleptic sensitivity, changes in dopamine transporter SPECT imaging and REM sleep behaviour disturbance . Most previous studies observed a more severe impairment in visual‐spatial abilities, attention and executive functions in persons with DLB compared with persons with AD (class IV evidence). The complex visual hallucinations with emotional responses to these experiences, which vary from intense fear

2012 European Academy of Neurology

151. The Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease

in the elderly. ARF still occurs from time to time in affluent populations, and the persistently high rates of ARF in some middle-class regions of the USA 1 highlight the need to remain aware of this disease in all populations. To support this in Australia, an evidence-based review for the diagnosis and management of ARF and RHD was published by the Heart Foundation and the Cardiac Society of Australia and New Zealand (CSANZ) in 2006. 2 This second edition of the original evidence-based review has again (...) ? pericardial friction rub or effusion • Expanded discussion on cognitive dysfunction with chorea • Upper limits of normal (ULN) for serum streptococcal antibody titres expanded to include children and adults based on Fiji data (Table 3.6) Table 1.1 Levels of evidence for clinical interventions, and grades of recommendation Level of evidence Study design Grade of recommendation I Evidence obtained from a systematic review of all relevant RCT A Rich body of high quality RCT data II Evidence obtained from

2012 Clinical Practice Guidelines Portal

152. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease

in symptomatic patients, diabetes, diagnosis, dobutamine stress echocardiography, echocardiography, elderly, electrocardiogram (ECG) and chronic stable angina, emergency department, ethnic, exercise, exercise stress testing, follow-up testing, gender, glycemic control, hypertension, intravascular ultrasound, fractional flow reserve (FFR), invasive coronary angiography, kidney disease, low-density lipoprotein (LDL) lowering, magnetic resonance imaging (MRI), medication adherence, minority groups, mortality

2011 American Heart Association

153. Supportive care in multiple myeloma

be observed and some will become less anaemic as the myeloma is controlled with chemotherapy. ESA treatment is recommended for anaemic patients with myeloma with associated renal impairment ( ). ESA doses of <20 000 iu/week may be adequate in patients where renal disease is the main cause of the anaemia. In the UK, it may be necessary to refer the patient to a renal physician to access NHS funding for ESAs. Data from randomized trials, which have included patients with myeloma, suggest that ESAs increase (...) If no risk factors (RF) or only 1 RF consider aspirin If 2 or more RF present consider either: LMWH (high risk prophylactic dose e.g. enoxaparin 40 mg od) or Warfarin (target INR 2·5) Obesity (Body Mass Index ≥ 30) Co‐morbidities: cardiac, diabetes, renal impairment, chronic inflammatory disease Immobility (acute or chronic) Thrombophilias, myeloproliferative disorders, haemoglobinopathies Recent surgery (within 6 weeks): neuro‐, trauma, orthopaedic, general, other Medications: erythropoiesis stimulating

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2011 British Committee for Standards in Haematology

154. General Palliative Care Guidelines for the Management of Pain at the End of Life in Adult Patients

benefit from co-codamol 8/500 in comparison to paracetamol alone 38 . Dihydrocodeine - one tenth the potency of oral morphine. Maximum dose: 60mg Qds is approximately equivalent to 24mg oral morphine daily. a void in renal impairment Tramadol - Centrally acting with both opioid and non-opioid properties. the dose used should be the lowest dose that provides pain relief in the elderly, adjustment in the dosage or dose interval may be required. Maximum dose of 400mg /24hrs, is approximately equivalent (...) , deteriorating renal and/or hepatic function , hypercalcaemia. Symptoms and signs: Include drowsiness, myoclonic jerks, pinpoint pupils (poor discriminating sign), confusion/ agitation, hallucinations, vivid dreams, cognitive impairment and respiratory depression. Management • Mild opioid toxicity: reduce the dose of opioid; ensure adequate hydration and treat any underlying cause. If agitation / confusion problematic haloperidol 1.5mg - 3 mg orally or subcutaneously can be given. • Moderate opioid toxicity

2011 Regulation and Quality Improvement Authority

155. Summary of General Palliative Care Guidelines for the Management of Pain at the End of Life for Adults

modified and immediate release morphine. • Stop regular weak opioid and consult opioid conversion charts for appropriate starting dose • Commence modified-release morphine e.g. 12 hourly morphine 10-20 mg Bd. lower doses (5mg Bd) should be used in patients who are opioid-naïve, elderly or have renal impairment. • Prescribe approximately 1/6 of this total daily dose as immediate release morphine for breakthrough pain. • if pain control is inadequate after 24-36hrs, and there is no evidence of opioid (...) Summary of General Palliative Care Guidelines for the Management of Pain at the End of Life for Adults Summary of General Palliative Care GuidelineS for the manaGement of Pain at the end of life for adultS Opioid for moderate to severe pain ± Non-opioid ± Adjuvant Opioid for mild to moderate pain ± Non-opioid ± Adjuvant Non-opioid ± Adjuvant WHO Pain Relief Ladder Step 3 Step 2 Step 1 Pain For patients with hepatic impairment or renal impairment consult full text version of Pain Guidelines Step

2011 Regulation and Quality Improvement Authority

156. Preventing and Mitigating Nurse Fatigue in Health Care

and patient safety 1 defines nurse fatigue as: “A subjective feeling of tiredness (experienced by nurses) that is physically and mentally penetrative. It ranges from tired- ness to exhaustion, creating an unrelenting overall condition that interferes with individuals’ physical and cognitive ability to function to their normal capacity. It is multidimensional in both its causes and manifestations; it is influenced by many factors: physiological (e.g. circadian rhythm), psychological (e.g. stress, alertness (...) , organi- zational performance and societal outcomes. External Socio-Cultural Factors Physical/Structural Policy Components Cognitive/Psycho/ Socio/Cultural Components Professional/ Occupational Components Cognitive/Psycho/Social Work Demand Factors Organizational Social Factors External Professional/Occupational Factors Individual Nurse Factors Organizational Professional/Occupational Factors External Policy Factors Physical Work Demand Factors Organizational Physical Factors Individual Work Context

2011 Registered Nurses' Association of Ontario

157. CPG on sleep disorders in childhood and adolescence in primary care

practices and behavioral interventions that at least include stimulus control is recommended for treating insomnia. Another intervention that could be recommended is cognitive restructuring. B For adolescents, sleep education and management programmes are recommended, including guidelines on sleep hygiene practices, instructions on stimulus control and information about consuming substances and the impact that sleep problems can have on mood and academic performance. B To reduce cognitive activation (...) receive supervision when they perform potentially dangerous activities (such as swimming). Adolescents who are diagnosed with narcolepsy and who have driver’s licenses will be advised not to drive and to notify their status to the Department of Motor Vehicles. They will also be informed about legislation in force, which states that persons with narcolepsy may not obtain or extend a driver’s license, unless a favourable medical report is issued, in which case the validity period of the license can

2011 GuiaSalud

158. Effects of Age and Task Load on Drivers’ Response Accuracy and Reaction Time When Responding to Traffic Lights (PubMed)

information and respond accurately. Both prolonged RT and increased no-response rate, especially for difficult tasks, might attest an impairment of cognitive abilities in relation to aging. Accordingly, casual driving conditions for young drivers may be particularly complex and stressful for elderly people who should thus be informed about the effects of normal aging upon driving. (...) Effects of Age and Task Load on Drivers’ Response Accuracy and Reaction Time When Responding to Traffic Lights Due to population aging, elderly drivers represent an increasing proportion of car drivers. Yet, how aging alters sensorimotor functions and impacts driving safety remains poorly understood. This paper aimed at assessing to which extent elderly drivers are sensitive to various task loads and how this affects the reaction time (RT) in a driving context. Old and middle-aged people

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2016 Frontiers in aging neuroscience

159. Anticipating and Tracking: Pack of Gerontological Assessment Embedded

aging" theme one of its priorities. This image of driver of innovation in this area can only be enhanced by a program like ARPEGE. Beyond the scientific and technological results expected, one can imagine the potential socio-economic benefits if this tracking solution is deployed on a large scale. Condition or disease Intervention/treatment Phase Elderly Other: evaluation of frailty Not Applicable Study Design Go to Layout table for study information Study Type : Interventional (Clinical Trial (...) or 6 Consenting to participate in the study Exclusion Criteria: Severe cognitive impairment ( MMSE < 10) Major neurosensory disorders Full hospitalization or not (acute care and rehabilitation..) Non- affiliation to a social security scheme Major protected by law (guardianship, trusteeship) Informed consent not provide Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using

2016 Clinical Trials

160. 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

2018 Bioethics Discussion Blog

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