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Emergency Medicine Pitfalls

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161. First Trimester Vaginal Bleeding

University of Alabama at Birmingham, Birmingham, Alabama. m Valley Hospital, Ridgewood, New Jersey and NYU School of Medicine, New York, New York; American Congress of Obstetricians and Gynecologists. n Specialty Chair, University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through society representation on expert panels (...) due to unintentional imaging of the pregnancy [67]. Because of its ionizing radiation, CT is generally not performed to evaluate vaginal bleeding in the first trimester of pregnancy. CT may identify an ectopic pregnancy [68], but reported cases of ectopic pregnancy diagnosed on CT were often performed for other reasons or in patients not known to be pregnant [77,78]. When a patient is clinically unstable, emergent care should generally not be delayed by additional imaging with CT or MRI. RPOC may

2017 American College of Radiology

162. Chronic Liver Disease

]. a Principal Author, Northwestern University, Chicago, Illinois. b Co-Author and Panel Chair, Johns Hopkins University School of Medicine, Baltimore, Maryland. c University of Arizona, Banner University Medical Center, Tucson, Arizona. d Baylor University Medical Center, Dallas, Texas; American Association for the Study of Liver Diseases. e New York University Medical Center, New York, New York. f University of Texas, MD Anderson Cancer Center, Houston, Texas. g University of Alabama Medical Center (...) have been made to characterize liver lesions and HCC with elastography. No association was found between MR elastography stiffness and HCC presence in at least one study [146]. Emerging data indicate that elevation of stiffness is associated with future development of liver-related decompensation, HCC, and death [147]. FDG-PET/CT Positron emission tomography/CT (PET/CT) is not an appropriate screening test for HCC. PET/CT is also of limited utility in the diagnosis of HCC, because HCC uptake

2017 American College of Radiology

163. Cranial Neuropathy

that develop from the body somites; branchial motor innervates muscles derived from the branchial arches; and visceral motor innervates the viscera, glands, and smooth muscle [1-3]. Cranial nerves emerge in an orderly fashion from the rostral portion of the embryologically developing neural tube, which will subsequently mature to form the brain and brain stem. Anatomically, the 12 pairs of cranial nerves are designated by numbers and are organized most rostral to most caudal in descending order (...) of origin to their ultimate destinations, loss of a specific function may indicate involvement of potentially more than one cranial nerve. a Principal Author and Panel Vice-chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa. b Panel Chair, Emory University, Atlanta, Georgia. c Montefiore Medical Center, Bronx, New York. d Northwestern University Feinberg School of Medicine, Chicago, Illinois; American Academy of Otolaryngology-Head and Neck Surgery. e Rush University Medical Center

2017 American College of Radiology

164. Alcohol: Adult Unhealthy Drinking

to moderate alcohol consumption is associated with decreased risk of coronary heart disease and ischemic stroke, the association may not be causal and could be confounded by other characteristics of patients with low-level alcohol use. (This pitfall of observational data was demonstrated by the extensive observational literature showing a “benefit” of hormone replacement therapy in the 1980s that was disproven by later randomized controlled trials.) Therefore, patients should not be advised to drink (...) to ? Drink below recommended drinking limits (see Table 1), and educate the patient about those limits, or ? Abstain from drinking. Patients should be advised to abstain if they have alcohol use disorder or other contraindications to drinking (e.g., pregnancy, liver disease) or are taking medications that may interact with alcohol (e.g., benzodiazepines, warfarin). For more information about specific alcohol-drug reactions, see: pubs.niaaa.nih.gov/publications/Medicine/medicine.htm. Elicit response

2016 Kaiser Permanente Clinical Guidelines

165. A literature review of Training Needs Assessment (TRNA) methodology

with the objective of defining a two-year education fellowship in emergency medicine (EM). The priorities for discussion were decided through a modified Delphi method with a convenience sample of 23 participants of a breakout session held at a consensus conference for Academic Emergency Medicine in 2012. The sample was further broken down into smaller focus groups to facilitate discussions. The authors referred to the ‘common pitfall in conducting needs assessment [of] over-reliance on a single assessment (...) 7. Summary of the desk-based study domains 12 A literature review of Training Needs Assessment (TRNA) methodology TECHNICAL REPORT iv Abbreviations ADDIE Assessment, Design, Development, Implementation, Evaluation CSTE Council of State and Territorial Epidemiologists EU European Union EEA European Economic Area EM Emergency medicine ESPH Essential services of public health HERO Health Emergency Response Office IHR International Health Regulations TRNA Training needs assessment WHO World Health

2017 European Centre for Disease Prevention and Control - Literature Reviews

166. Diagnosis, Treatment, and Long-Term Management of Kawasaki Disease: A Scientific Statement for Health Professionals From the American Heart Association

of the interleukin (IL) 1, IL-6, and tumor necrosis factor (TNF) signaling pathways. Study of the adaptive immune response demonstrated that both proinflammatory and regulatory T cells can be found in the circulation in the first week after fever onset. Expansion of the regulatory T-cell population after IVIG administration is associated with cessation of fever and clinical improvement. The self-limited nature of the disease coupled with a low rate of recurrence suggests emergence of T- and B-cell memory (...) of clinical and laboratory signs (C-reactive protein [CRP], erythrocyte sedimentation rate [ESR]) of ongoing inflammation. (6) Typical peeling begins under the nail beds of fingers and toes. ALT indicates alanine transaminase; and WBC, white blood cells. Common Pitfalls in Diagnosis A high index of suspicion for the diagnosis is particularly important in certain clinical situations. In the infant <6 months of age, prolonged fever and irritability may be the only clinical manifestations of KD

2017 American Heart Association

167. 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

168. 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

169. 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 iucr.org (...) 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

170. 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

171. 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

172. 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

173. 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

174. 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

175. 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

176. 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

177. 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

178. 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

179. 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

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