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Failure to Thrive in the Elderly

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181. Updated consensus statement on the diagnosis and treatment of pediatric pulmonary hypertension Full Text available with Trip Pro

and echocardiography. If these investigations suggest the presence of PH/PHVD, chest X-ray and/or chest CT should be considered, followed by additional investigations. If PH/PHVD is severe, and the patient presents severely ill in overt heart failure and/or pulmonary vascular crisis, cardiac catheterization may be postponed and pharmacotherapy including intravenous prostanoids started immediately. CPET, cardiopulmonary exercise testing; CT, computed tomography; CTEPH, chronic thromboembolic pulmonary hypertension (...) be referred to a lung transplantation center for LuTx evaluation when they remain in an intermediate- or high-risk category despite maximal PAH therapy. In experienced centers, the 1-year survival rates after LuTx now exceed 90%. A pre-transplant rehabilitation program may be considered. Aside from sildenafil and bosentan (>1 year of age), all other agents are considered off-label drugs in children with PH in Europe. Sildenafil dosing recommendations should follow EMA-approved dosing for children

2019 International Society for Heart and Lung Transplantation

182. Diagnosis and Management of Glycogen Stored Diseases type VI and IX a practice resource of ACMG

and GSD IX 22,23 thatispartiallydueto increasedfattyacidoxidationin compensation for low energy. Hepatomegaly is the most commonpresenting featureforpatientswithGSDsVIand IX usually found during routine health maintenance exams between 6 and 18 months of age. Growth retardation is also common. Patients are often diagnosed when hepatic transaminase elevation, hyperlipidemia, or ketotic hypogly- cemia are found during laboratory evaluation for failure to thrive or during an acute illness. Sleep (...) , because they had low phosphorylase activity in addition to PhK deficiency. 18,19 The term GSD IX, first designated by Hug et al., 20 was ultimately used to describe patients with primary PhK deficiency, regardless of the inheritance pattern. Nomenclature In older literature, GSD VI has sometimes been referred to as type VIII and IX, and GSD IX has been called GSD VIa and VIII. 21 To standardize the nomenclature in this guideline paper, GSD VI will be used here to describe liver glycogen phosphorylase

2019 American College of Medical Genetics and Genomics

183. SCAI/ACVP expert consensus statement on cardiovascular catheterization laboratory economics: Full Text available with Trip Pro

% to hospitals with excess readmissions of myocardial infarction and heart failure patients. The 30‐day readmission rate is significantly higher in patients who experienced a complication during angiography or reperfusion/revascularization during the index MI as compared to those without complication. 3.4 Maximizing quality Maintaining positive operating margins has become more difficult for hospitals due to declining reimbursement, increasing capitation, worsening payer mix (commercial patients aging (...) failure I5031, I5033 Acute diastolic heart failure I5041, I5043 Acute systolic and diastolic heart failure I6310‐I6349 Cerebral infarction due to embolism I7772 Dissection of iliac artery J810 Acute pulmonary edema J9582 Post‐procedural respiratory failure N170‐N178 Acute kidney failure Q200‐Q283 Miscellaneous congenital heart malformations R570 Cardiogenic shock S35511‐S35513 Injury of iliac artery T790xxA, T800xxA Air embolism — A PCI procedure using >/= 4 stents qualifies as an MCC Note

2019 Society for Cardiovascular Angiography and Interventions

184. Primary Prevention of ASCVD and T2DM in Patients at Metabolic Risk Full Text available with Trip Pro

changes should be supported by a comprehensive program led by trained interventionists and reinforced by primary care providers. Pharmacological and medical therapy can be used in addition to lifestyle modification when recommended goals are not achieved. List of Recommendations Definitions and diagnosis 1.1 In individuals aged 40 to 75 years in the office setting, we suggest providers screen for all five components of metabolic risk at the clinical visit. The finding of at least three components (...) glucose, or 2-hour glucose with a second test for confirmation using a new blood sample. Testing for additional biological markers ( e.g., high-sensitivity C-reactive protein) associated with metabolic risk should be limited to subpopulations. This recommendation is specifically for adults aged 40 to 75 years, those for whom the interventions have the greatest impact and evidence for efficacy. This does not restrict screening for appropriate individuals outside of this age range, especially those who

2019 The Endocrine Society

185. BTS/SIGN British Guideline on the Management of Asthma

, respectively, and in section 4.3 on predicting future risk of asthma attacks, each recommendation has been graded and the supporting evidence assessed for adults and adolescents over 12 years old, children 5–12 years, and children under 5 years. Further information on managing asthma in adolescents (10–19 years of age as defined by the World Health Organization) 3 is given in section 11.2 British guideline on the management of asthma The guideline considers diagnosis of asthma and management in all (...) patients with a diagnosis of asthma, although there is less evidence available for people at either age extreme. The guideline does not cover patients whose primary diagnosis is not asthma, for example those with chronic obstructive pulmonary disease (COPD) or cystic fibrosis, but patients with these conditions can also have asthma. Under these circumstances many of the principles set out in this guideline will apply to the management of their asthma symptoms. 1.2.2 Target users of the guideline

2019 British Thoracic Society

186. Heart Disease and Stroke Statistics Full Text available with Trip Pro

. The prevalence of cardiopulmonary resuscitation training was lower in Hispanic/Latino people, older people, people with less formal education, and the lower-income group. Incidence of emergency medical services–assessed out-of-hospital cardiac arrest in people of any age was 110.8 per 100 000 population (95% CI, 108.9–112.6), or 356 461 people (quasi-CI, 350 349–362 252) based on extrapolation from the ROC registry (Resuscitation Outcomes Consortium) of out-of-hospital cardiac arrest to the total population (...) could be attributed to modifiable risk factors (such as high BP, obesity, hyperglycemia, hyperlipidemia, and renal dysfunction), and 74% could be attributed to behavioral risk factors, such as smoking, sedentary lifestyle, and an unhealthy diet. Globally, 29% of the risk of stroke was attributable to air pollution. Although global age-adjusted mortality rates for ischemic and hemorrhagic stroke decreased between 1990 and 2015, the absolute number of people who have strokes annually, as well

2019 American Heart Association

187. AIM Clinical Appropriateness Guidelines for Sleep Disorder Management

, poor concentration, memory impairment, irritability, decreased libido, and nocturia. Although OSA may occur in all age groups, it is most common in patients between 40 and 70 years old. The incidence of OSA in obese patients is considerably higher than in non-obese individuals. OSA is associated with higher mortality because patients with OSA are more likely to have cardiac arrhythmias, coronary artery disease, congestive heart failure, stroke, diabetes, and treatment-resistant hypertension (...) , respiratory airflow, and respiratory effort (e. g., thoracoabdominal movement) 95807 Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist 95808 Polysomnography; Any age, sleep staging with 1-3 additional parameters of sleep, attended by a technologist 95810 Polysomnography; Age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist 95811 Polysomnography; Age 6 years

2019 AIM Specialty Health

188. Appropriate Use Criteria: Imaging of the Abdomen and Pelvis

for evaluation of symptoms persisting 2 or more weeks when ANY of the following are present: ? Failure of medical management ? Failure to thrive ? Fever ? Vomiting ? Following barium enema or anal manometry when there is suspicion for ANY of the following: o Anal stenosis o Impaction in patients younger than 1 year of age o Tight empty rectum IMAGING STUDY - Radiographs required for initial evaluation - CT or MRI abdomen and/or pelvis Rationale Constipation is a common problem in children and largely (...) Cystic liver disease 33 Failure to thrive 33 Gastroenteritis 33 Hirschsprung’s disease (congenital aganglionosis) 34 Hypospadias 34 Irritable bowel syndrome 34 Jejunal or ileal stenosis 34 Meckel’s diverticulum or diverticulitis 34 Midgut volvulus 34 Neonatal jaundice: biliary atresia and neonatal hepatitis 34 Piriformis syndrome 34 Posterior urethral valve 34 Pyloric stenosis 34 Small left colon syndrome 34 Urinary tract infection 35 Vesicoureteral reflux 35 References 35 Codes 39 History 40 Imaging

2019 AIM Specialty Health

189. Clinical Practice Guideline for the Management of Infantile Hemangiomas

; and risk of leaving permanent scarring or distortion of anatomic landmarks Life-threatening Complications Life-threatening lesions include obstructing IHs of the airway, liver IHs associated with high-output congestive heart failure and severe hypothyroidism, and, rarely, profuse bleeding from an ulcerated IH. Obstructing IHs of the airway typically involve the subglottis, further compromising the narrowest portion of the pediatric airway. Although the mean age at the time of diagnosis is about 4 (...) an even greater risk for morbidity and mortality. Infants who are affected typically present before 4 months of age with severe hepatomegaly, which can lead to potentially lethal abdominal compartment syndrome attributable to compromised ventilation, renal failure attributable to renal vein compression, or compromised inferior vena cava blood flow to the heart. , A consumptive form of hypothyroidism caused by the inactivation of thyroid hormones by type 3 iodothyronine deiodinase present in IH tissue

2019 American Academy of Pediatrics

190. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

and stop the statin. With the knowledge that all statins rarely cause myopathy/rhabdomyolysis, it is natural to expect them to also cause muscle adverse effects that are less serious but more common. Muscle symptoms are commonly designated as statin-associated muscle symptoms (SAMS), a term that does not indicate or imply a causal relationship between the statin and the symptoms. Muscle symptoms are common in middle-aged and older people when not treated with statins. SAMS are usually not accompanied (...) and women separately. However, the ULN is substantially lower for women, presumably because of their smaller muscle mass. In a cohort of 1016 people all 70 years of age in Uppsala, Sweden, Carlsson et al found that the ULN for men was 4.98 microkatals per liter (298 U/L), compared with 3.01 microkatals per liter (180 U/L) for women. This should be taken into account when interpreting CK values. In addition, CK values are considerably higher in people of African ancestry than in whites, especially when

2019 American Gastroenterological Association Institute

191. Brexit: the implications for health and social care

Brexit: the implications for health and social care Brexit: the implications for health and social care | The King's Fund Main navigation Health and care services Leadership, systems and organisations Patients, people and society Policy, finance and performance Search term Apply Brexit: the implications for health and social care This content relates to the following topics: Jump link block Jump to section Share this content Authors for organisations to prepare contingency plans and has (...) . In the event of a no-deal Brexit, for an interim period EU citizens would be able to enter the UK as they do now but if they wish to stay longer than three months they would have to apply for permission under a new European Temporary Leave to Remain scheme. People who obtain this status would be entitled to live, work and study in the country for a further three years. Other workforce issues that will need to be addressed include: mutual recognition of qualifications: the current EU withdrawal bill

2019 The King's Fund

192. ASCIA Guidelines for Diagnosis and Management of Severe Combined Immunodeficiency (SCID) in Australia and New Zealand: A TAPID Consensus Guideline

a genetically identifiable cause (~90%) 2 . SCID is typically fatal in the first two years of life without definitive intervention. In the absence of NBS, patients typically present within the first few months of life with severe, recurrent or persistent and opportunistic infections, particularly of the respiratory and gastrointestinal tract, as well as persistent or extensive oral or napkin candidiasis. They can have enteropathy with failure to thrive, persistent diarrhea following rotavirus vaccine (...) is used the parents shouldn't put the pacifier in their own mouth). • If the mother is seropositive and the infant is CMV PCR positive, breast feeding should be encouraged/restarted. 7. Supportive care • Monitor height, weight and head circumference on a regular basis. • Infants with SCID may present with failure to thrive and diarrhoea. Good nutrition is vital moving into HSCT. Involve the nutrition team and consider parenteral nutrition early if there are any concerns. • Attention to skin care

2019 Australasian Society of Clinical Immunology and Allergy

193. Paediatric Urology

of the indications and morbidity of circumcision in children. Eur Urol, 1985. 11: 184. 37. Morris, B.J., et al. A ‘snip’ in time: what is the best age to circumcise? BMC Pediatr, 2012. 12: 20. 38. Ross, J.H., Circumcision: Pro and con., in Pediatric urology for the general urologist, J.S. Elder, Editor. 1996, Igaku-Shoin: New York. 39. Weiss, H.A., et al. Complications of circumcision in male neonates, infants and children: a systematic review. BMC Urol, 2010. 10: 2. 40. Homer, L., et al. Meatal stenosis in boys (...) surgery may improve the fertility index in undescended testes: a prospective randomized trial. J Urol, 2005. 173: 974. 72. Cortes, D., et al. Hormonal treatment may harm the germ cells in 1 to 3-year-old boys with cryptorchidism. J Urol, 2000. 163: 1290. 73. Ritzen, E.M. Undescended testes: a consensus on management. Eur J Endocrinol, 2008. 159 Suppl 1: S87. 74. Kollin, C., et al. Surgical treatment of unilaterally undescended testes: testicular growth after randomization to orchiopexy at age 9 months

2019 European Association of Urology

194. AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm Full Text available with Trip Pro

be individualized based on numerous factors, such as age, life expectancy, comorbid conditions, duration of diabetes, risk of hypoglycemia or adverse consequences from hypoglycemia, patient motivation, and adherence. Glycemic control targets include fasting and postprandial glucose as determined by self-monitoring of blood glucose (SMBG). In recent years, continuous glucose monitoring (CGM) has become more available for people with T2D and has added a considerable degree of clarity for the patient's (...) approaches. In ADVANCE, the starting A1C was 7.5% (58 mmol/mol), and rates of hypoglycemia were higher in the intensive therapy group ( ). In the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial, intensive glycemic control significantly reduced the risk and/or progression of retinopathy, nephropathy, and neuropathy ( , ). However, in ACCORD, which involved older and middle-aged patients with long-standing T2D who were at high risk for or had established ASCVD and a baseline A1C >8.5% (69

2019 American Association of Clinical Endocrinologists

195. Incorporating Recognition and Management of Perinatal Depression Into Pediatric Practice

, and lower activity levels. The infants have poor orientation skills and tracking, lower activity level, and irritable temperament. There is an increased risk of feeding and sleeping problems as well as failure to thrive. , , Infants of mothers with untreated perinatal depression cry a lot because of difficulty with both self-comforting and being soothed by others. They may be apathetic, avoidant, clingy, or indifferent, and they tend not to exhibit any maternal preference or anxiety around strangers (...) of age. , , In addition to primary associations with poor long-term outcomes for the child, untreated perinatal depression is also strongly tied with other unfavorable states and events that may add to the adverse effect on a child’s overall health and development, including the following: child abuse and neglect; failure to implement the injury-prevention components from anticipatory guidance (eg, car safety seat and electrical plug covers) , ; failure to implement preventive health practices

2019 American Academy of Pediatrics

196. Critical Foundation

are part of that review. I was one of the very first FY1 doctors in ICM. It came at a perfect time - my plan through medical school had always been surgery but I had thoroughly fallen out of love with it during my surgical job and was feeling a bit lost. I loved every minute of working in intensive care. Watching physiology unfold in front of my eyes was a revelation, and the senior doctors I worked with were inspiring - nothing seemed to stress them and they always had time to teach and explain what (...) Flanders, Edinburgh “ “ “ 7 My placement on Critical Care has been the hidden gem of the Foundation Programme options. I applied for this placement as an FY2 to explore Critical Care as a career option, however I ended up with a far more rounded experience. Currently I work in a busy Critical Care. We host a large range of different specialties on site. Consultants closely lead every decision and this creates a safe environment knowing there is large, easily accessible senior input. Going forward from

2019 Faculty of Intensive Care Medicine

197. Canadian Urological Association/Pediatric Urologists of Canada guideline on the investigation and management of antenatally detected hydronephrosis

hydronephrosis requiring surgery presented symptomatically with abdom- inal pain, urinary infection, hypertension, hematuria, or failure to thrive. Antenatal hydronephrosis (AHN) became one of the most commonly detected ultrasound (US) find - ings, affecting 1?5% of pregnancies. 1 The majority of AHN in the third trimester is discovered due to US for maternal indications. The benefits of this early detection of urinary tract dilation include a reduction in the renal damage due to obstruction and infection (...) grades of AHN can resolve postnatally and conversely low grades can deteriorate; not- withstanding, most centres use a cutoff of 7 mm in the third trimester for indicating a postnatal evaluation. Postnatal data on magnetic resonance imaging (MRI), not US, suggest that the normal APD in children is 3 mm at one year of age, 6 mm at 18 years, with the 99th percentile for children 10 mm. 8 This clas- sification is mostly descriptive and has not been submitted to much scrutiny. The dilated fetal bladder

2018 Canadian Urological Association

198. Lactase deficiency

brush border (microvilli) of the small intestine, usually at the age of weaning. Matthews SB, Waud JP, Roberts AG, et al. Systemic lactose intolerance: a new perspective on an old problem. Postgrad Med J. 2005 Mar;81(953):167-73. https://pmj.bmj.com/content/81/953/167.long http://www.ncbi.nlm.nih.gov/pubmed/15749792?tool=bestpractice.com Heyman MB; American Academy of Pediatrics, Committee on Nutrition. Lactose intolerance in infants, children, and adolescents. Pediatrics. 2006 Sep;118(3):1279-86 (...) and rate of lactose reaching the colon, as well as the type and amount of colonic flora. Matthews SB, Waud JP, Roberts AG, et al. Systemic lactose intolerance: a new perspective on an old problem. Postgrad Med J. 2005 Mar;81(953):167-73. https://pmj.bmj.com/content/81/953/167.long http://www.ncbi.nlm.nih.gov/pubmed/15749792?tool=bestpractice.com History and exam presence of risk factors symptoms after ingestion of dairy products diarrhoea distension lethargy mouth ulceration headache poor short-term

2017 BMJ Best Practice

199. Laryngomalacia

. http://www.ncbi.nlm.nih.gov/pubmed/7436240?tool=bestpractice.com Werner JA, Lippert BM, Dunne AA, et al. Epiglottopexy for the treatment of severe laryngomalacia. Eur Arch Otorhinolaryngol. 2002 Oct;259(9):459-64. http://www.ncbi.nlm.nih.gov/pubmed/12386747?tool=bestpractice.com History and exam presence of risk factors stridor onset within 2 weeks of birth features of airway obstruction resolution of symptoms by 2 years of age normal cry feeding difficulties weight loss or failure to thrive

2017 BMJ Best Practice

200. Pyloric stenosis

Pyloric stenosis Pyloric stenosis - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Pyloric stenosis Last reviewed: February 2019 Last updated: December 2017 Summary Recurrent projectile non-bilious vomiting, typically in a 3- to-6-week-old infant (usually male), but may occur on older infants. Features may include a history of feeding intolerance with multiple formula changes. Failure to thrive/weight loss may (...) sphincter results in narrowing of the pyloric canal. It is the most common cause of gastric outlet obstruction in the 2- to 12-week-old age group. Aspelund G, Langer JC. Current management of hypertrophic pyloric stenosis. Semin Pediatr Surg. 2007 Feb;16(1):27-33. http://www.ncbi.nlm.nih.gov/pubmed/17210480?tool=bestpractice.com Pyloric stenosis leads to progressive and projectile vomiting. History and exam first-born male infant non-bilious projectile vomiting 3 to 6 weeks old upper abdominal mass

2017 BMJ Best Practice

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