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Emergency Medicine Pitfalls

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141. The Expressed Genome in Cardiovascular Diseases and Stroke: Refinement, Diagnosis, and Prediction: A Scientific Statement From the American Heart Association

Abstract There have been major advances in our knowledge of the contribution of DNA sequence variations to cardiovascular disease and stroke. However, the inner workings of the body reflect the complex interplay of factors beyond the DNA sequence, including epigenetic modifications, RNA transcripts, proteins, and metabolites, which together can be considered the “expressed genome.” The emergence of high-throughput technologies, including epigenomics, transcriptomics, proteomics, and metabolomics (...) that render the genetic code into the functional consequences that influence a person’s health, that is, the “expressed genome,” including gene-regulatory elements, RNA transcripts, proteins, metabolites, and circulating cells in the bloodstream ( ). Accordingly, the relationships between these factors and cardiovascular diseases and stroke are less well understood. The recent emergence of high-throughput technologies centered on transcriptomics, epigenomics, proteomics, metabolomics, etc, is now making

2017 American Heart Association

142. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents

pressure ED — emergency department EHR — electronic health record FMD — flow-mediated dilation HTN — hypertension LVH — left ventricular hypertrophy LVMI — left ventricular mass index MA — microalbuminuria MAP — mean arterial pressure MH — masked hypertension MI — motivational interviewing MRA — magnetic resonance angiography NF-1 — neurofibromatosis type 1 OSAS — obstructive sleep apnea syndrome PCC — pheochromocytoma PICOT — Patient, Intervention/Indicator, Comparison, Outcome, and Time PRA — plasma (...) intimamedia thickness (cIMT), flow-mediated dilation (FMD), left ventricular hypertrophy (LVH), and other markers of vascular dysfunction? To address these key questions, a systematic search and review of literature was performed. The initial search included articles published between the publication of the Fourth Report (January 2004) and August 2015. The process used to conduct the systematic review was consistent with the recommendations of the Institute of Medicine for systematic reviews

2017 American Academy of Pediatrics

143. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition - Mehta - 2017 - Journal of Parenteral and Enteral Nutrition - Wiley Online Library Search within Search term Search term The full text of this article hosted at (...) is unavailable due to technical difficulties. Clinical Guideline Free Access Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Pediatric Critically Ill Patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition Corresponding Author E-mail address: Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA Nilesh M. Mehta

2017 American Society for Parenteral and Enteral Nutrition

144. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of Amer

and preserved ejection fraction. Curr Heart Fail Rep. 2013;10:350–8. 71. Karayannis G, Triposkiadis F, Skoularigis J, et al. The emerging role of Ga- lectin-3 and ST2 in heart failure: practical considerations and pitfalls using novel biomarkers. Curr Heart Fail Rep. 2013;10:441–9. 72. Ahmad T, Fiuzat M, Neely B, et al. Biomarkers of myocardial stress and fibrosis as predictors of mode of death in patients with chronic heart fail- ure. J Am Coll Cardiol HF. 2014;2:260–8. 73. Bayes-Genis A, de AM, Vila J, et (...) interventions based on individual values, preferences, and associated conditions and comorbidities. Methodology and Modernization The ACC/AHA Task Force on Clinical Practice Guidelines (Task Force) continuously reviews, updates, and modi- fies guideline methodology on the basis of published standards from organizations including the Institute of Medicine 1,2 and on the basis of internal reevaluation. Similarly, the presentation and delivery of guidelines are reevaluated and modified on the basis of evolving

2017 American Heart Association

145. Imaging Program Guidelines: Pediatric Imaging

, nomenclature and other data are copyright by the American Medical Association. All Rights Reserved. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for the data contained herein or not contained herein. Description and Application of the GuidelinesGuideline Description and Administrative Guidelines | Copyright © 2017. AIM Specialty Health. All Rights Reserved. 5 Requests for multiple imaging studies to evaluate a suspected or identified condition (...) head injury: a prospective cohort study. Ann Emerg Med. 2014 Aug;64(2):145-152, 152.e1-5. 17. Edlow JA, Panagos PD, Godwin SA, Thomas TL, Decker WW. Clinical policy: Critical issues in the evaluation and management of adult patients presenting to the emergency department with acute headache. J Emerg Nurs. 2009;35(3):e43-e71. 18. Fisher RS, van Emde Boas W, Blume W, et al. Epileptic seizures and epilepsy: definitions proposed by the International League Against Epilepsy (ILAE) and the International

2017 AIM Specialty Health

146. Methodological Standards for Meta-Analyses and Qualitative Systematic Reviews of Cardiac Prevention and Treatment Studies: A Scientific Statement From the American Heart Association

in the broad cardiovascular field. A PubMed search with the terms meta-analysis and cardiovascular in the title/abstract yielded 53 results for the year 2000, 413 for the year 2010, and 1196 for the year 2014. The fundamental appeal of meta-analysis, which partly explains its popularity, is the idea of integrating evidence from multiple sources to provide reliable answers to important questions. The evidence-based medicine movement in general promotes a systematic approach to assessing the quality (...) of evidence, considering not only research design but also other characteristics of individual articles. Some evidence-based medicine hierarchies of evidence, however, assign the highest level (quality) of evidence to systematic reviews of randomized trials. Meta-analyses (and systematic reviews in general) are therefore sometimes automatically accorded a great deal of credibility. The placement of meta-analyses of randomized trials (and individual randomized trials) at the top of evidence hierarchies

2017 American Heart Association

147. Cerumen Impaction

, , MD 7 7Department of Otolaryngology, Tulane University, New Orleans, Louisiana, USA7Department of Otolaryngology, Tulane University, New Orleans, Louisiana, USA by this author for this author , , MD, MPH 8 8Georgetown University School of Medicine, Washington, DC, USA8Georgetown University School of Medicine, Washington, DC, USA by this author for this author , , MD, PhD 9 9Division of Otolaryngology, University of Connecticut Health Center, Farmington, Connecticut, USA9Division of Otolaryngology (...) of Nursing, Wayne State University, Detroit, Michigan, USA 7 Department of Otolaryngology, Tulane University, New Orleans, Louisiana, USA 8 Georgetown University School of Medicine, Washington, DC, USA 9 Division of Otolaryngology, University of Connecticut Health Center, Farmington, Connecticut, USA 10 University of Michigan Health System, East Ann Arbor Health Care Center, Ann Arbor, Michigan, USA 11 Consumers United for Evidence-Based Healthcare, Davis, California, USA 12 Cleveland Clinic Head

2017 American Academy of Otolaryngology - Head and Neck Surgery

148. Evaluation of the Neck Mass in Adults

; and promoting appropriate physical examination when cancer is suspected. The target patient for this guideline is anyone ≥18 years old with a neck mass. The target clinician for this guideline is anyone who may be the first clinician whom a patient with a neck mass encounters. This includes clinicians in primary care, dentistry, and emergency medicine, as well as pathologists and radiologists who have a role in diagnosing neck masses. This guideline does not apply to children. This guideline addresses (...) for this guideline is anyone who may be the first clinician whom a patient with a neck mass encounters. This includes clinicians in primary care, dentistry, and emergency medicine, as well as pathologists and radiologists who have a role in diagnosing neck masses. This guideline does not apply to children. This guideline addresses the initial broad differential diagnosis of a neck mass in an adult. However, the intention is only to assist the clinician with a basic understanding of the broad array of possible

2017 American Academy of Otolaryngology - Head and Neck Surgery

149. Counseling About Genetic Testing and Communication of Genetic Test Results

, MD, MSHQS, and Steven J. Ralston, MD, MPH. This document reflects emerging clinical and scientific advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Counseling About Genetic Testing and Communication of Genetic Test Results ABSTRACT: Given the increasing availability and complexity of genetic testing, it is imperative that the practicing obstetrician–gynecologist or other (...) clinically significant mutations with heritable potential, patients should be strongly encouraged to share the results with affected or at-risk family members. If an obstetrician–gynecologist or other health care provider does not have the necessary knowledge or expertise in genetics to counsel a patient appropriately, referral to a genetic counselor, medical or gynecologic oncologist, maternal–fetal medicine specialist, or other genetics specialist should be considered, as appropriate for the condition

2017 American College of Obstetricians and Gynecologists

150. Management of Diabetes Mellitus in Primary Care

of major clinical trials of intensive therapy, as well as advances in physiological, behavioral, nutritional, and pharmacological research have led to the emergence of new strategies to manage and treat patients with DM. Consequently, a recommendation to update the 2010 DM CPG was made and the update to the 2010 DM CPG was initiated in 2015. The updated CPG includes evidence-based recommendations and additional information on the management of DM. It is intended to assist healthcare providers in all (...) which Work Group members were recruited. The specialties and clinical areas of interest included endocrinology, internal medicine, nutrition, pharmacy, health education, nursing, medical management, ambulatory care, and family practice. The guideline development process for the 2017 CPG update consisted of the following steps: 1. Formulating and prioritizing KQs 2. Conducting a patient focus group 3. Conducting the SRVA/DoD Clinical Practice Guideline for the Management of Type 2 Diabetes Mellitus

2017 VA/DoD Clinical Practice Guidelines

151. Management of Opioid Therapy (OT) for Chronic Pain

: Patients Currently on Opioid Therapy V A / D o D Cli ni cal P r a cti ce G ui d el i n e f o r O p ioid T h e r a p y for Ch r on ic Pa in February 2017 Page 15 of 198 V. Background A. Opioid Epidemic Chronic pain is a national public health problem as outlined in the 2011 study by the National Academy of Medicine (previously the Institute of Medicine [IOM]).[3] At least 100 million Americans suffer from some form of chronic pain. Until recently, the treatment of chronic pain with opioids (...) providers.[5] In the emergency department, at least 17% of discharges included prescriptions for opioids.[6,7] There has been limited research on the effectiveness of LOT for non-end-of-life pain. At the same time, there is mounting evidence of the ill effects of LOT, including increased mortality, OUD, overdose, sexual dysfunction, fractures, myocardial infarction, constipation, and sleep-disordered breathing.[8-10] Despite increasing awareness of the known harms of opioids, 259 million opioid

2017 VA/DoD Clinical Practice Guidelines

152. Special Endocrine Testing

theme_12_frontend Farming, Natural Resources & Industry theme_2_collection theme_2_frontend theme_2_collection theme_2_frontend Health theme_9_collection theme_9_frontend theme_9_collection theme_9_frontend Housing & Tenancy theme_7_collection theme_7_frontend theme_7_collection theme_7_frontend Law, Crime & Justice theme_6_collection theme_6_frontend theme_6_collection theme_6_frontend Public Safety & Emergency Services theme_10_collection theme_10_frontend theme_10_collection theme_10_frontend Sports (...) on the lab report. A complete chart of reference intervals by age is available from St. Paul’s Hospital Department of Pathology and Laboratory Medicine, at website: . 6. Glucose Homeostasis | Insulin MSP cost: $27.55 Indications Non-Indications Investigation of hypoglycemia. Note that the specimen collected at the time of hypoglycemia must be analyzed. Fasting insulin may be useful in the investigation of PCOS in females. Not indicated for patients receiving insulin therapy. Not for the investigation

2016 Clinical Practice Guidelines and Protocols in British Columbia

153. Acute and Chronic Heart Failure

oxygenation ED emergency department EF ejection fraction eGFR estimated glomerular filtration rate EHRA European Heart Rhythm Association EMA European Medicines Agency EMB endomyocardial biopsy EMF endomyocardial fibrosis EMPHASIS-HF Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure EPA eicosapentaenoic acid EPHESUS Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study ESC European Society of Cardiology EU European Union EULAR European League (...) positive pressure ventilation PRISMA 7 seven-item, self-completion questionnaire to identify older adults with moderate to severe disabilities PROTECT II Prospective, Multi-center, Randomized Controlled Trial of the IMPELLA RECOVER LP 2.5 System Versus Intra Aortic Balloon Pump (IABP) in Patients Undergoing Non Emergent High Risk PCI PS-PEEP pressure-support positive end-expiratory pressure PV pulmonary vein PVR pulmonary vascular resistance QALY quality-adjusted life year QRS Q, R, and S waves

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2016 European Society of Cardiology

155. Clinical indications, image acquisition and data interpretation for white blood cells and anti-granulocyte monoclonal antibody scintigraphy

^ UniversityofRome, OspedaleS.Andrea,ViadiGrottarossa1035,00189Rome,Italy 2 DepartmentofNuclearMedicine,UniversitéCatholiquedeLouvain, Brussels,Belgium 3 DepartmentofNuclearMedicine,Rambam HealthCareCampus, Haifa,Israel 4 DepartmentofNuclearMedicine,CambridgeBiomedicalCampus, Cambridge,UK 5 NuclearMedicineDepartment,HospitalUniversitariodeBellvitge, Barcelona,Spain 6 RegionalCenterofNuclearMedicine,Azienda Ospedaliero-UniversitariaPisana,Pisa,Italy European Journal of Nuclear Medicine and Molecular Imaging https (...) ://, economic, legal and other aspects that need to be taken into consideration ineachcountry. Autologous WBC and anti-G-mAbs Autologous white blood cells (mainly neutrophils) can be radiolabelled ex-vivo using 99m Tc-HMPAO or 111 In-oxine as described elsewhere [7, 8] using sterile conditions in accordance with national regulation on the production of medicines. The recent availability of disposable sterile closed

2018 European Association of Nuclear Medicine

156. ESMO Consensus Conference Guidelines on testicular germ cell cancer: diagnosis, treatment and follow-up

, Manchester, UK; 8 Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden; 9 Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; 10 Department of Urology, Asklepios Klinik Altona, Hamburg, Germany; 11 Department of Cancer Medicine, Gustave Roussy, University of Paris Sud, Villejuif, France; 12 Department of Oncology, Oslo University Hospital Radiumhospitalet, Oslo, Norway; 13 Department of Medical Oncology (...) , Catalan Institute of Oncology (ICO), Barcelona University, Barcelona, Spain; 14 Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy; 15 Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands; 16 Department of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; 17 University of Bern, Bern, Switzerland; 18 Department of Oncology, University Hospital of North Norway, Tromsø; 19 Institute of Clinical Medicine, UIT

2018 European Society for Medical Oncology

157. The Association of Coloproctology of Great Britain and Ireland Consensus Guidelines in Surgery for Inflammatory Bowel Disease

, Asia, Oceania and South America, with a global prevalence now surpassing 0.3%, which represents a significant health burden . Multidisciplinary management of patients with IBD A multidisciplinary approach is essential to achieving good outcomes for patients with IBD , . The multidisciplinary team should function well in all settings where IBD patients have contact: community, outpatient clinics and ward‐based care in elective and emergency circumstances. Definition of the IBD multidisciplinary team (...) of recommendation: GP Consensus: 91.4% (SA 54.3%, A 37.1%) The chronicity of IBD means that patients may require multiple endoscopic and radiological investigations. Where possible, imaging modalities that do not involve ionizing radiation should be used: ultrasonography and especially magnetic resonance imaging (MRI) offer high diagnostic accuracy . Computed tomography (CT) is increasingly used to inform and direct management, especially in the emergency setting . A recent meta‐analysis concluded that 11

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2018 Association of Coloproctology of Great Britain and Ireland

158. Breast Imaging and Intervention

Quality Control Program 19 Protocols 20 High-spatial Resolution Sequences 20 Basic Requirements for Breast MRI 20 Quality Assurance 21 3.1. Diffusion Weighted Imaging 21 3.2. Spectroscopy 22 4. Alternative Imaging Methods 22 4.1. Thermography 22 TABLE OF CONTENTS2 5. Emerging Technologies 22 Section B: Breast Intervention 23 1. General Principles 23 2. Biopsies 23 2.1. Selection of Image Guidance Modality 23 Mammographic Guidance 23 Stereotactic Guidance 23 Ultrasound Guidance 23 MRI Guidance 23 2.2 (...) by the Canadian College of Physicists in Medicine (CCPM) in the specialty of Mammography, or its equiva- lent, or any relevant provincial/territorial license. Please visit for further information.6 Training and experience shall include knowledge of the physics of mammography, systems components and performance, safety procedures, acceptance testing, quality control and CAR Mammography Accreditation Program (MAP) requirements. For more specific information about medical physicist responsibilities

2016 Canadian Association of Radiologists

159. The role of biomarkers in ruling out cerebral lesions in mild cranial trauma

, Zisakis AK, Zimmermann H, Exadaktylos AK. What is the incidence of intracranial bleeding in patients with mild traumatic brain injury? A retrospective study in 3088 Canadian CT head rule patients. Biomed Res Int. 2013;2013:453978. 3. Calcagnile O, Unden L, Unden J. Clinical validation of S100B use in management of mild head injury. BMC Emergency Medicine. 2012;12((Calcagnile O., Dept of Paediatric Medicine, Halmstad Regional Hospital, Halmstad, Sweden). 4. Pandor (...) ; University of Ghent, Belgium 2015. 6. Ruan S, Noyes K, Bazarian JJ. The economic impact of S-100B as a pre-head CT screening test on emergency department management of adult patients with mild traumatic brain injury (Structured abstract). Journal of NeuroTrauma. 2009;26(10):1655- 64. 7. Muller B, Evangelopoulos DS, Bias K, Wildisen A, Zimmermann H, Exadaktylos AK. Can S-100B serum protein help to save cranial CT resources in a peripheral trauma centre? A study and consensus paper. Emergency Medicine

2016 Belgian Health Care Knowledge Centre

160. Guidelines for Laparoscopic Ventral Hernia Repair

, Robert Fanelli, MD 6 , Raymond Price, MD 7 , William S. Richardson, MD 8 , Dimitrios Stefanidis, MD, PhD 9 . SAGES Guidelines Committee Corresponding author: William S. Richardson, MD Ochsner Medical Center 1514 Jefferson Highway New Orleans, LA 70121 Baystate Medical Center, Tufts University School of Medicine, Springfield, MA University of Kentucky College of Medicine, Lexington, KY Weill Cornell Medical College, New York, NY NorthShore University HealthSystem, Evanston, IL Premier Surgical (...) of the defect. It is important to note that the thicker the abdominal wall, the larger the difference will be between measured and actual size of defect. Factors increasing this discrepancy include a fully insufflated abdomen, obesity, and a large hernia sac. In the setting of obesity and a large sac, the discrepancy will be greatest. Pitfalls of performing the external measurements include 1) angling the needle (either towards or away from the defect) through the abdominal wall rather than removing and re

2016 Society of American Gastrointestinal and Endoscopic Surgeons

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