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Elderly Drivers with Cognitive Impairment


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141. Delivering novel therapies in the 21st century

with neurodegenerative disease. Intrathecal treatment has introduced a new avenue for drug delivery to the brain. ASO technology has the potential to benefit patients with other neurodegenerative diseases including amyotrophic lateral sclerosis, Alzheimer’s disease, spinal muscular atrophy, and Parkinson’s disease. Image: Professor Sarah J Tabrizi FMedSci, UCL Institute of Neurology. “Huntington’s disease is genetic and I look after families. Eventually I want to do a clinical trial in 18 year olds, decades away (...) a multicomponent cancer biomarker for early detection, monitoring and therapy. Exosomes can be used to transfer therapeutic agents to cancer cells. Mutant KRAS protein is a well-established driver of pancreatic cancer but, despite many decades of effort, has proven to be intractable to small molecule drug discovery, making it a clear opportunity for delivery of new drug modalities by exosomes. Inhibitor exosomes (iExosomes) can be engineered to carry siRNA specific to a common mutation in pancreatic cancer

2019 Academy of Medical Sciences

142. Empowering Caregivers to Deliver Home-based Restorative Care

, with those over 65 being on track to represent 25% of the Canadian population by 2050. • This shift in population demographics is requiring significant changes in the delivery of health and social services including an increased focus on helping individuals to age well at home, and with the significant majority of older adults (93%) living at home, it is estimated that unpaid caregiving accounts for up to 75% of the care older adults receive, roughly equal to $24-$31 billion in unpaid work annually (...) individuals to age well at home.(1) However, despite provincial investments in home and community care, the transition away from acute care and towards the community has been relatively slow. An important part of the problem related to supporting such transitions is the large number of people classified as an alternative-level-of-care (ALC) patient, which refers to anyone who occupies an acute-care bed in a hospital and who is not acutely ill or does not require hospital-based care. For example, estimates

2019 McMaster Health Forum

143. Family Partnerships

communication and consistency in responses, and can assist in supporting children and young people’s mental wellbeing. Family–education partnerships have been found to have personal, social and academic benefits for students (1), families (2, 3) and educational settings, through enhanced staff retention. (4) A 2015 survey of the mental health of Australian children and adolescents called ‘Young Minds Matter‘ (5) identified that 40.5% of emotional or behavioural problems among children and young people aged (...) stage are significant risk factors predicting child internalising problems. (9) Observations from longitudinal life course studies lead to theoretical distinctions between child-onset and adolescent-onset pathways to youth mental health problems. Modifiable factors that influence child-onset problems include stress and trauma experiences early in the life course. These experiences can impair neurobiological development, with more severe impacts where children and young people have intense negative

2019 Sax Institute Evidence Check

144. Risk factors for in hospital falls

-Increasing Drugs. Fall-Risk-Increasing Drugs: A Systematic Review and Meta-Analysis: I. Cardiovascular Drugs. J Am Med Dir Assoc. 2018 Apr;19(4):371.e1-371.e9. 2. Deandrea S, Bravi F, Turati F, Lucenteforte E, La Vecchia C, Negri E. Risk factors for falls in older people in nursing homes and hospitals. A systematic review and meta-analysis. Arch Gerontol Geriatr. 2013 May-Jun;56(3):407-15. 3. Seppala LJ, van de Glind EMM, Daams JG, Ploegmakers KJ, de Vries M, Wermelink AMAT, van der Velde N; EUGMS Task (...) services/patient-care/older-people/falls-mobility/falls/falls-risks 12. López-Soto PJ, Manfredini R, Smolensky MH, Rodríguez-Borrego MA. 24-hour pattern of falls in hospitalized and long-term care institutionalized elderly persons: A systematic review of the published literature. Chronobiol Int. 2015 May;32(4):548-56. Rapid Literature Review – Risk Factors for Falls in hospital. 10 Appendix Figure 1. This diagram indicates the flow of identified and included articles from

2019 Monash Health Evidence Reviews

145. Canadian stroke best practice recommendations: secondary prevention of stroke, sixth edition practice guidelines

A]. ii. Echocardiography should be considered in cases where a stroke mechanism has not been identified [Evidence Level C]. 1.3 Functional assessment i. Selected patients with transient ischemic attack or ischemic stroke should be assessed for neurological impairments and functional limitations when appropriate (e.g. cognitive evaluation, screening for depression, screening of fitness to drive, need for potential rehabilitation therapy, and assistance with activities of daily living), especially (...) term are at increased risk for cardiovascular events over the long term. 3 Therefore, the opportunity to reduce the risk of recurrent strokes through aggres- sive vascular risk factor reduction e?orts represent a signi?cant opportunity to lower the total stroke burden. The Canadian Stroke Best Practice Recommendations have been developed to provide up-to-dateevidence-basedguidelinesfortheprevention and management of stroke, to promote optimal recov- ery and reintegration for people who have

2018 CPG Infobase

146. Diagnosis and management of epilepsy in adults

epilepticus 23 4.11 Patients with recurrent prolonged or serial seizures in the community 26 4.12 Drugs which exacerbate epileptic seizures 27 4.13 Management of patients with epilepsy in the perioperative period 27 4.14 Management of older people with epilepsy 27 4.15 Management of people with learning disability and epilepsy 29 5 Epilepsy and women’s health 31 5.1 Contraception 31 5.2 Preconceptual counselling 35 5.3 Risks of inheriting epilepsy 36 5.4 Pregnancy 38 5.5 Labour and birth 40 (...) for a guideline should not be underestimated. In Scotland there are 54,000 people with active epilepsy affecting all ages, 1, 2 and there will be between 2,000 and 3,500 new diagnoses each year. 1 The low number of epilepsy specialists in previous decades means that many people with epilepsy across the UK have been diagnosed and treated by non-specialists in both primary and secondary care. Up to a quarter of patients referred for specialist management of apparent drug-resistant epilepsy do not have epilepsy

2018 SIGN

147. Guidance on the clinical management of anxiety disorders, specifically focusing on diagnosis and treatment strategies

to get better instantly. Their most acute need is appropriate reas- surance that their disorder has been recognised and that help will be forthcoming. Initial treatment should be selected in collaboration with the patient, based on the severity of the disorder, previous response to treatment, availability and the person’s preference. It will usually take 4–6 weeks to see improvement, whether cognitive–behavioural therapy (CBT) or an antide- pressant is used, and most people can tolerate this. Only (...) to advise health professionals on the treatment of adults with panic disorder, SAD or GAD. The main target population is adults aged 18–65 years, but evidence for other age groups was included where available. The guidelines cover the management of mild, moder- ate and severe disorder including treatment-refractory dis- order, for which there is limited evidence to guide practice. Although anxiety disorders are the most prevalent men- tal health conditions in the community, many people with anxiety

2018 Royal Australian and New Zealand College of Psychiatrists

148. The experience of the transition to retirement: Rapid evidence review

could reduce problems adjusting to retirement. Retirement counselling also needs to account for the multidimensional nature of retirement processes and may therefore be relevant for the partners of older workers who experience their own adjustment. Clearly more investment and research is required if we are to adequately support people to be able to successfully adjust to retirement. 12 © Centre for Ageing Better 2018 Chapter 1. Background Retirement from work is a major life transition. For many (...) , people’s expectations about retirement are changing. A report for the DWP (YouGov PLC 2015) on attitudes to extending working lives found that nearly half of those aged 50 and over (49%) said that they expect to retire later than they had thought they would. However, although many older workers in the UK expect they will be working for longer, 38% said that they are looking forward to retiring, whereas just 13% said they are not. Moreover, 11% of respondents said that ‘they did not really want

2018 The Centre for Ageing Better

149. Management of Cardiovascular Diseases during Pregnancy Full Text available with Trip Pro

and cardiovascular toxicity, dyslipidaemias, atrial fibrillation (AF), and CVD prevention published in 2016 ( ). 2.5 What is new in the 2018 CVD in Pregnancy Guidelines? ( Figure ) Figure 1 Selected revised and new recommendations. Figure 1 Selected revised and new recommendations. 3. General considerations 3.1 Epidemiology In the western world, the risk of CVD in pregnancy has increased due to increasing age at first pregnancy. According to World Atlas, the 10 countries where mean age at first birth is highest (...) record a mean age between 28.8–31.2 years. The mild increase in maternal age does not justify an increase in CVD during pregnancy because of maternal age. However, pregnancies in the late reproductive years (or between ages of 40–50 years) are more frequently associated with an increasing prevalence of cardiovascular risk factors, especially diabetes, hypertension, and obesity. Additionally, an increasing number of women with congenital heart disease reach childbearing age. In western countries

2018 European Society of Cardiology

150. Masitinib mesylate (Alsitek) - Amyotrophic Lateral Sclerosis

will develop symptoms of dyspnea and dysphagia. When muscles in the diaphragm and chest wall fail, people lose the ability to breathe without ventilator support. Most people with ALS die from respiratory failure, usually within 3 to 5 years from the onset of symptoms. However, about 10% of those with ALS survive for 10 or more years. Although the disease usually does not impair a person’s mind or intelligence, it has been suggested that some persons with ALS may have depression or alterations in cognitive (...) that cannot be attributed to other causes. Although the sequence of emerging symptoms and the rate of disease progression vary from person to person, eventually individuals will not be able to stand or walk, get in or out of bed on their own, or use their hands and arms. Difficulty swallowing and chewing impair the person’s ability to eat normally and increase the risk of choking. Maintaining weight will then become a problem. Because cognitive abilities are relatively intact, some people are aware

2018 European Medicines Agency - EPARs

151. International evidence-based guideline for the assessment and management of polycystic ovary syndrome (PCOS)

One Screening, diagnostic assessment, risk assessment and life-stage 35 1.1 Irregular cycles and ovulatory dysfunction 36 1.2 Biochemical hyperandrogenism 38 1.3 Clinical hyperandrogenism 40 1.4 Ultrasound and polycystic ovarian morphology 42 1.5 Anti-Müllerian Hormone (AMH) 45 1.6 Ethnic variation 46 1.7 Menopause life-stage 47 1.8 Cardiovascular disease 48 1.9 Gestational diabetes, impaired glucose tolerance and type 2 diabetes 50 1.10 Obstructive sleep apnea 53 1.11 Endometrial cancer 55 (...) issue with reproductive, metabolic and psychological features. PCOS is one of the most common conditions in reproductive aged women affecting 8-13% of reproductive-aged women [1-4] with up to 70% of affected women remaining undiagnosed [3]. Presentation varies by ethnicity and in high-risk populations such as Indigenous women, prevalence and complications are higher [4, 5]. Women with PCOS present with diverse features including psychological (anxiety, depression, body image) [6-8], reproductive

2018 European Society of Human Reproduction and Embryology

152. The effect of non-injection drug use on sexual risk behaviours and ART adherence among men who have sex with men

). Substance use contributes to the spread of HIV in two primary ways: by impairing an individual’s ability to make safe choices when engaging in sexual activities, and by causing people to share needles and other drug equipment (20). This review does not focus on the particular risks associated with injection drug use; rather, evidence is presented on the physiological effects of substance use and how they may affect sexual risk behaviours and ART adherence among men who have sex with men. What we found (...) experiences (1-3). The majority of studies focus on the use of amphetamine-group substances (such as crystal meth); two systematic reviews have found enough evidence to associate this group of substances with sexual risk behaviours among men who have sex with men (4, 5). Some studies have found that the use of inhalants is associated with an increase in unprotected anal intercourse among men who have sex with men (6-8). Interventions involving motivational interviewing (9) and personalized cognitive

2018 Ontario HIV Treatment Network

153. Ocrelizumab (Ocrevus) - multiple sclerosis

as the age at which higher levels of disability are achieved are comparable between subtypes despite the later age of onset in PPMS. The actual rate of progression of disability seems not to differ between subtypes, once steady progression of disability has commenced. A higher proportion of PPMS patients present initially with motor impairment, cerebellar ataxia, and brainstem symptoms than relapsing-onset patients, and spastic paraparesis is a common early clinical presentation. The diagnosis of PPMS (...) Assessment report EMA/790835/2017 Page 4/180 List of abbreviations Quality 95/99 TI 95% confidence/99% probability tolerance interval AC Acceptance Criteria; ADA Anti-Drug Antibodies ADCC Antibody-Dependent Cellular Cytotoxicity ADCP Antibody-Dependent Cellular Phagocytosis ADI Acceptable Daily Intake ADI/EDI Acceptable And Estimated Daily Intake AEX anion-exchange AGE Advanced Glycation End product AIM Automatic Inspection Machine AR Acceptable Range ATS Attribute Testing Strategy AUC Analytical

2018 European Medicines Agency - EPARs

154. Examining the Costs and Cost-effectiveness of Policies for Reducing Alcohol Consumption

. Stockings E, Hall WD, Lynskey M, et al. Prevention, early intervention, harm reduction, and treatment of substance use in young people. Lancet Psychiatry 2016; 3(3): 280-96. 9. Knai C, Petticrew M, Durand MA, Eastmure E, Mays N. Are the Public Health Responsibility Deal alcohol pledges likely to improve public health? An evidence synthesis. Addiction 2015; 110(8): 1232-46. 10. Hahn RA, Kuzara JL, Elder R, et al. Effectiveness of policies restricting hours of alcohol sales in preventing excessive alcohol (...) • One recent overview of systematic reviews found mixed effects from server training and driver-home programs, suggesting that these intervention on their own may not be the most cost-effective policy options.(17) • One older primary study evaluating the cost-effectiveness of a multi-component alcohol- prevention intervention (including training in responsible beverage service, community awareness and mobilization, and stricter law enforcement) found cost savings, largely attributable to reductions

2018 McMaster Health Forum

155. Multimorbidity: a priority for global health research

aged 60 years and older is projected to almost double, reaching around 2.1 billion.8 As a consequence, ever-greater numbers of people are reaching middle and older ages when chronic physical conditions – including, but not limited to, cancers, cardiovascular diseases, chronic respiratory diseases, and type 2 diabetes – are most likely to occur. The impact of these changes are most pronounced in low- and middle-income countries (LMICs), where populations are not only ageing but also experiencing (...) The prevalence of multimorbidity appears to have increased in many regions of the world over the past 10 to 20 years, and it is anticipated to continue rising. Evidence from high-income countries (HICs) suggests that while multimorbidity is highly prevalent in older populations (typically those over 65 years of age), it also affects younger people. 11 As such, multimorbidity from chronic conditions is now the norm in most HICs, with at least 50 million people affected in the European Union (EU) alone. 12

2018 Academy of Medical Sciences

156. Depression and anxiety programs for children and young people

services) that are implemented in childhood and adolescence with the aim of preventing anxiety and depression disorders and symptoms. The report was commissioned for Beyond Blue by the Sax Institute. Review question What programs or services for children and young people have been shown to be effective in the prevention of, and early intervention for, mild depression and anxiety? Summary of methods Evaluations of interventions implemented in the 0 to 18 age period were included based on rigourous (...) for subsequent high or increasing internalising trajectories. These findings accord with theories of child-onset pathways to emotional problems. Parent behaviour, family stress and mental health are known to influence child behaviour and relationship difficulties. 9-11 DEPRESSION AND ANXIETY PROGRAMS FOR CHILDREN AND YOUNG PEOPLE | SAX INSTITUTE 11 Toxic stress risk process theories argue that stress and trauma experiences can impair neurobiological development early in the life course where children

2018 Sax Institute Evidence Check

157. Identifying Effective Approaches to Support Parents and Caregivers of Children with Fetal Alcohol Spectrum Disorder

and therapy • One recent low-quality review aimed to identify programs targeted at families of children with physical disabilities and/or intellectual impairments and found education and counselling services delivered either online and in group settings as one possible approach.(7) • Two primary studies conducted in Ontario found Acceptance and Commitment Therapy (ACT) improved depression and stress among caregivers, reported health status, and psychological flexibility, as well as reduced cognitive (...) , and internationally – and get the right programs, services and products to the people who need them. In doing so, we are building on McMaster’s expertise in advancing human and societal health and well-being. Authors Kerry Waddell, M.Sc., Co-Lead, Evidence Synthesis, McMaster Health Forum Michael G. Wilson, PhD, Assistant Director, McMaster Health Forum, and Associate Professor, McMaster University Cristina A. Mattison, PhD, Scientific Lead, Stakeholder Engagement and Systems Analysis, McMaster Health Forum

2018 McMaster Health Forum

158. Managing health and wellbeing in the workplace

and participation by senior leadership. There is strong agreement between these organisations and across the key components; the essential key components and principles identified in this Evidence Check were brought together and synthesised into a revised, third generation model for workplace wellness programs, Workplace Wellness 3.0. Q3: What are the main barriers or facilitators to successful implementation of the (identified) program, framework or model? Typical barriers identified at leadership/cultural (...) . mission statement), (ii) connecting the vision to organisational values, strategy, practice and policy (i.e. build a health culture); (iii) gaining budget and resource commitment, (iv) educating and engaging senior management; (v) sharing the vision with employees, (vi) serving as a role model (‘walk the talk’), (vii) ensuring accountability and responsibility (for instance, KPI’s for senior management), (viii) rewarding success (for example, incentives, public recognition), (ix) adapting the program

2018 Sax Institute Evidence Check

159. Impaired updating ability in drivers with Parkinson's disease. Full Text available with Trip Pro

Impaired updating ability in drivers with Parkinson's disease. Driving activity requires major involvement of executive functions. The main objective of our study was to determine whether mental flexibility and the updating of information in working memory are affected in drivers with mild to moderate Parkinson's disease (PD).The study included 25 patients, aged 58-76, with mild to moderate PD and 25 healthy controls matched for age, sex and education, with an average mileage of over 3000 km (...) -processing speed task) while driving.An updating impairment was found in PD patients in the n-back and simulator tasks; patients recalled significantly fewer road signs. No notable differences were observed between groups in the plus-minus task or in the simulator task evaluating flexibility. There was no significant difference between patients and controls in information-processing speed tasks. Regression analysis showed that the Trail-Making test (B-A) accounted for 40.7% of the variation in PD drivers

2010 Neurosurgery and Psychiatry

160. Prevention and Control of Methecillin-Resistant Staphylcoccus Aureus (MRSA)

. 2.1 Prevention and control (Recommendations 1-32) The following are responsible for implementation of recommendations 1-32: clinical teams, senior management and the Infection Prevention and Control Team (IPCT). Public health professionals and medical scientists have some specific roles as outlined in the relevant recommendations. 2.1.1 Screening Effective strategies for the prevention and control of MRSA rely on early detection so that appropriate measures may be implemented. Screening, linked (...) a relatively high risk of MRSA infection and consider pre-operative screening for those particular patient sub-sets. For example, it may be appropriate for hospitals to screen emergency orthopaedic admissions as many of these patients are elderly and have frequent contact with the healthcare system. Grade C • Patients admitted to critical care areas, e.g. intensive care unit (ICU) and special care baby unit (SCBU) with at least weekly screening thereafter. Grade D • Patients requiring renal dialysis. Grade

2019 National Clinical Guidelines (Ireland)

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