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Failure to Thrive in the Elderly

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21. Atherosclerotic Cardiovascular Disease in South Asians in the United States: Epidemiology, Risk Factors, and Treatments: A Scientific Statement From the American Heart Association

failure, and peripheral arterial disease are very limited for South Asians in the United States. In addition, few studies have assessed the incidence or prevalence of these diseases in the South Asian population in the United States. As a result of this lack of literature in disease states other than ASCVD, this statement focuses only on ASCVD risk in South Asians. Cardiovascular Interventions and Outcomes Angiography South Asians undergoing angiography in the United States have been found to have (...) with chronic kidney disease (CKD) compared with the general population are at a significantly elevated risk of developing subsequent CVD. There is a paucity of data on CKD in South Asians living in the United States. The National Kidney Foundation states that Asian Americans are at a higher risk for kidney disease and kidney failure compared with NHWs, and the high prevalence of DM and hypertension appears to be a contributing factor, among others. Studies in the United Kingdom reported that the prevalence

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2018 American Heart Association

22. Pediatric Gastroesophageal Reflux Clinical Practice Guidelines: Joint Recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutritio

of children who have had anti-reflux surgery who are symptomatic with persistent typical or atypical reflux symptoms, dysphagia or pain; barium imaging can be helpful to differentiate an obstructing fundoplication with esophageal stasis from a slipped or loose fundoplication (35,36). TABLE 1. Symptoms and signs that may be associated with gastro- esophageal re?ux disease in infants and children 0 to 18 years old Symptoms Signs General General Discomfort/irritability Failure to Thrive Feeding refusal (...) obviously merits additional testing, the more difficult subgroup of patients is the group of infants presenting with fussiness, crying and arching with or without spitting but who otherwise are thriving. In this population, there is often intense pressure by families to start anti- reflux therapies or pursue diagnostic testing because of the per- ceived severity of symptoms. In the absence of warning signs, diagnostic testing and/or therapies including acid suppression are NOT needed

2018 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

23. End-of-Life Care for People Experiencing Homelessness

the following: a. PHQ2 & PHQ9: validated screening tool for depression in general populations https://www.uspreventiveservicestaskforce.org/Home/GetFileByID/218 b. Geriatric Depression Scale (GDS) Short Form: a 15-item screening tool for symptoms of depression in the elderly. http://www.npcrc.org/content/25/Measurement-and- Evaluation-Tools.aspx c. Geriatric Depression Scale (GDS) Long Form: a 30-item screening tool for symptoms of depression in the elderly. http://www.npcrc.org/files/news

2018 National Health Care for the Homeless Council

24. Spot the Diagnosis! The Case of the Dropsical Child

condition. 1 The only feature of this child that is inconsistent with the diagnosis is his well-nourished appearance. Generally, infants and children with cyanotic heart lesions experience failure to thrive. One speculation for this discrepancy is the artistic preference of the time, which includes depicting their subjects as healthy and robust. 1 What is the pathophysiology of the condition? VSD is an acyanotic heart defect at first. Oxygenated blood from the left ventricle is shunted to the right (...) What physical exam findings may you find in this diagnosis? With VSD, infants may appear dusky in color, lethargic, dyspneic, and cachexic due to failure to thrive. They often have a concurrent respiratory tract infection. However, many may also be asymptomatic. The precordial exam may reveal a holosystolic and diastolic murmur in keeping with the abnormal flow of blood through the defect during the cardiac cycle. 3 4 Once the child progresses to Eisenmenger syndrome, they develop a dusky-blue

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2018 CandiEM

25. CrackCAST E129 – Bacteria

from patients with trauma or infection. When there is doubt about the history, the age-appropriate vaccine according to CDC guidelines is administered. Neonates with suspected pertussis should be admitted to an intensive care setting. Botulism should be kept in the differential diagnosis for the infant with failure to thrive, constipation, or decreased muscle tone and for the injection drug user with neurologic symptoms. Patients with pneumococcemia, meningococcemia, and TSS can decompensate (...) poisoning, paresthesias are prominent, a history of shellfish ingestion is present, and recovery occurs within 24 hours. Toxin mediated disease Tick paralysis Infant botulism – Broad DDx: Sepsis, viral illnesses, dehydration, encephalitis, meningitis, and failure to thrive. Neurologic illnesses such as Guillain-Barré syndrome, myasthenia gravis, and poliomyelitis should also be considered. Hypothyroidism, hypoglycemia, diphtheria, and toxin exposures are all part of the differential diagnosis

2017 CandiEM

26. Chapter 135 – Tuberculosis

for deterioration E.g. failure to thrive, wasting Illness severity Hemoptysis Clincher: patient able to comply with DOTS (directly observed therapy) Rosen’s List: Acute Illness Elderly Requiring parental therapy HIV infection Concurrent medications with potential interactions Active or suspected MDR TB Homelessness Cohabitation with children / immunocompromised individuals Suspected poor compliance with DOTS – risk for spread of MDR-TB! (may need involuntary hospitalization) [14] Describe the management (...) this infection in anyone with constitutional symptoms!!! Cough Weight loss Fatigue Fever Night sweats Vague systemic disorder Fever of unknown origin Failure to thrive Add this onto your DDX of hemoptysis [1] Describe the 4 phases of TB infection According to … “Following TB exposure there are various potential outcomes No infection (70-90%) (immediate clearance) Infection (10-30%) Active TB (10%, half of these developing within 5 years) 98% cured if treated 50% die within 2 years if untreated Latent

2017 CandiEM

27. American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease

immunodeficiency virus; HoFH = homozygous familial hypercholesterolemia; HPS = Heart Protection Study; HPS2-THRIVE = Treatment of HDL to Reduce the Incidence of Vascular Events trial; HR = hazard ratio; HRT = hormone replacement therapy; hsCRP = high-sensitivity CRP; IMPROVE- IT = Improved Reduction of Outcomes: Vytorin Efficacy International Trial; IRAS = Insulin Resistance Atherosclerosis Study; JUPITER = Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating (...) for Managing Dyslidemia and Prevention of CVD, Endocr Pract. 2017;23(Suppl 2) 3 Copyright © 2017 AACE Post Coronary Artery Bypass Graft trial; PROSPER = Prospective Study of Pravastatin in the Elderly at Risk trial; QALY = quality-adjusted life-year; ROC = receiver-operator characteristic; SOC = standard of care; SHARP = Study of Heart and Renal Protection; T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus; TG = triglycerides; TNT = Treating to New Targets trial; V A-HIT = Veterans Affairs

2017 American Association of Clinical Endocrinologists

29. Treatment of Low Bone Density or Osteoporosis to Prevent Fractures in Men and Women: A Clinical Practice Guideline Update from the American College of Physicians

year by 2025 ( ). Risk factors for osteoporotic fracture include (but are not limited to) increasing age, female sex, postmenopause for women, hypogonadism or premature ovarian failure, low body weight, history of parental hip fracture, ethnic background (white persons are at higher risk than black persons), previous clinical or morphometric vertebral fracture, previous fracture due to minimal trauma (that is, previous osteoporotic fracture), rheumatoid arthritis, current smoking, alcohol intake (3 (...) showed that calcium plus vitamin D 3 reduced the risk for fracture among elderly women but not elderly men ( ). The other study showed no difference in fracture reduction for elderly men treated with intramuscular injection of ergocalciferol, whereas women had increased risk for wrist fractures ( ). Race/Ethnicity High-quality evidence from post hoc analysis of 2 RCTs showed that compared with placebo, raloxifene decreases the relative risk for vertebral fracture but not nonvertebral or hip fracture

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2017 American College of Physicians

30. Dyslipidaemias

glomerular filtration rate GISSI Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico GP general practitioner GWAS genome-wide association studies HAART highly active antiretroviral treatment HATS HDL-Atherosclerosis Treatment Study HbA1C glycated haemoglobin HeFH heterozygous familial hypercholesterolaemia HDL-C high-density lipoprotein cholesterol HF heart failure HHS Helsinki Heart Study HIV human immunodeficiency virus HMG-CoA hydroxymethylglutaryl-coenzyme A HPS Heart Protection (...) Study HPS2-THRIVE Heart Protection Study 2–Treatment of HDL to Reduce the Incidence of Vascular Events HoFH homozygous familial hypercholesterolaemia HTG hypertriglyceridaemia HR hazard ratio hs-CRP high-sensitivity C-reactive protein ICD International Classification of Diseases IDEAL Incremental Decrease In End-points Through Aggressive Lipid-lowering Trial IDL intermediate-density lipoproteins ILLUMINATE Investigation of Lipid Level Management to Understand its Impact in Atherosclerotic Events

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2016 European Society of Cardiology

31. Dementia, disability and frailty in later life - mid-life approaches to delay or prevent onset

(Gardener et al. 2006). Although many of these changes are inevitable at some point in life, the age at which they affect people – and how much they go on to become more serious health issues – will vary. Age-related changes can be made worse by personal, social and environmental circumstances. For example, having to care for an elderly parent, can lead to a reduced income and less time for leisure activities. Dementia, disability and frailty in later life affect individuals, families and society

2015 National Institute for Health and Clinical Excellence - Clinical Guidelines

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

pouch surgery, lower‐volume units tend to have a longer length of stay and higher pouch failure rates . Managing complications proactively requires experience, but this is difficult to accumulate at either individual surgeon or institutional level, given the extremely low volumes of pouch procedures carried out at the majority of institutions in the UK , . There is also significant variation among centres in other outcomes after pouch surgery, including rates of laparoscopic approach, undiverted (...) , the underlying principle has to be bowel sparing . Unfortunately, there are few high‐quality randomized controlled trials to assess different surgical techniques for surgery in small bowel Crohn's disease and much of the evidence is from small studies and historic data . Indications for surgery Failure of medical treatment Crohn's disease is a lifelong chronic inflammatory disease which is mainly treated medically. Biological therapies, including anti‐tumour necrosis factor α (TNFα) agents, are very

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2018 Association of Coloproctology of Great Britain and Ireland

33. Celiac Disease

countries is around 1% of the general population, but it is substantially increasing in other parts of the world. ? The female-to-male ratio has been variably reported, with prospective population studies rating from 1 : 3 to 1.5 : 1. ? Celiac disease is now known to affect all age groups, including the elderly; more than 70% of new patients are diagnosed above the age of 20 years [18]. ? The risk of having celiac disease is much greater in first-degree relatives (up to 10%) and lesser in second-degree

2016 World Gastroenterology Organisation

34. Recommendations for Management of Clinically Significant Drug-Drug Interactions With Statins and Select Agents Used in Patients With Cardiovascular Disease: A Scientific Statement From the American Heart Association

, and duration of therapy. Patient-specific factors include age, sex, lifestyle, genetic polymorphisms causing differences in enzyme expression or activity, and disease impairment affecting drug metabolism (eg, hepatic or renal impairment, cardiac failure) or predisposition to differences in efficacy or safety (eg, statin intolerance in patients with a history of myopathy). Clinically significant DDIs are usually preventable. To optimize patient safety, healthcare providers must have an understanding

2016 American Heart Association

35. Vascular Graft Infections, Mycotic Aneurysms, and Endovascular Infections: A Scientific Statement From the American Heart Association

VGI may have abdominal pain, fever, leukocytosis, failure to thrive, and sepsis. The aortic graft can erode into the third or fourth portion of the duodenum, resulting in intermittent, polymicrobial bacteremia of fecal flora with a combination of aerobic and anaerobic microorganisms. Some blood cultures will contain a mix of enteric microorganisms, whereas other blood cultures contain the same or different microorganisms. These often include Escherichia coli , enterococci, and anaerobic (...) to those of infective endocarditis (IE) with fever, chills, heart failure, and disruption of the anastomotic suture line of the aortic root. Because intrathoracic VGIs are most often caused by S aureus or coagulase-negative staphylococci, sepsis with a high-grade sustained bacteremia is common with a high-grade sustained bacteremia. If the VGI is associated with surgery for native or prosthetic valve endocarditis, the clinical picture reflects the microbiological cause. Patients with viridans group

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2016 American Heart Association

36. Float Tanks: Considerations for Environmental Public Health

for pathogens. However, this overstates the ability of the MgSO 4 solution to control pathogens, as can be demonstrated through evidence directly and indirectly related to float tanks. 3 Laboratory and field studies have shown that pathogenic organisms are able to survive (but not thrive) for relatively short- to medium-term periods in float solution. For the purposes of this paper, we focused on pathogen survival over a 30-minute period (data permitting), which is roughly consistent with the time between (...) required float tanks to use a halogen disinfectant, and in many facilities a halogen has been combined with UV irradiation and/or O 3 . As in drinking water treatment, using a multi-barrier approach lessens the probability of a disinfection failure. For example, in float systems that use halogen disinfection with UV, the use of a residual disinfectant may help to control free-living and biofilm-associated microbes in the tank and circulation/filtration system, while the use of UV 4 may help to reduce

2016 National Collaborating Centre for Environmental Health

37. Guideline on the management of premature ovarian insufficiency

Failure 1601 573 Gonadal dysgenesis 3057 408 Premature menopause 1011 228 Early menopause 620 170 Hypergonadotropic hypogonadism 346 86 Premature Ovarian Insufficiency 79 70 Ovarian dysgenesis 204 26 Primary ovarian failure 145 20 Hypergonadotropic amenorrhea 52 9 Climacterium praecox 5 0 Menopause praecox 1 0 An objective of the guideline development group was to reach consensus on the use of standard terminology. This would clarify information given to women, improve communication between health (...) professionals, greatly facilitate data collection and audit, and aid future research. The issue of terminology was discussed within the guideline development group and the advantages and disadvantages of the different terms used in the literature were weighed. From the number of papers retrieved “primary ovarian insufficiency” and “premature ovarian failure” seem to be the preferred terms in current research publications although ‘premature ovarian insufficiency’ has been increasingly used over the last

2015 European Society of Human Reproduction and Embryology

38. Budesonide (Jorveza) - to treat adults with eosinophilic oesophagitis

) and complications, such as food impaction. This is different from children, where a variety of nonspecific symptoms, such as feeding difficulty, nausea and vomiting, heartburn, and failure to thrive are observed. The final diagnosis of EoE is, however, only made after upper GI endoscopy, including biopsy of the oesophageal mucosa, the diagnosis of eosinophil infiltration of the oesophagus, and the exclusion of other disease entities, such as GERD, Achalasia, Coeliac disease, Crohn’s Disease, and several

2018 European Medicines Agency - EPARs

39. Asthma

, monophonic wheeze, or stridor). Persistent, non-variable breathlessness. Chronic sputum production. Unexplained restrictive spirometry. Chest X-ray shadowing. Marked blood eosinophilia. In children: Failure to thrive. Unexplained clinical findings (such as focal signs, abnormal voice or cry, dysphagia, and/or inspiratory stridor). Symptoms that are present from birth. Excessive vomiting or posseting. Evidence of severe upper respiratory tract infection. Persistent wet or productive cough. A family (...) — clinical features include persistent moist cough and gastrointestinal symptoms that are often present from birth, and failure to thrive in children. Dysfunctional breathing — clinical features include breathlessness, dizziness, light-headedness, and peripheral tingling. Foreign body aspiration — suggested by sudden-onset cough, stridor (upper airway) or reduced chest wall movement on the affected side, bronchial breathing, and reduced or diminished breath sounds (lower airway). Gastro-oesophageal

2017 NICE Clinical Knowledge Summaries

40. Management of schizophrenia

% with the most frequent adverse effects being headache, nausea and dizziness. The somnolence rate was =7%, the frequency of injection site reactions less than 5%, dystonia less than 2% and less than 5.5% of participants experienced akathisia. Aripiprazole has been associated with an increased risk of sudden death in elderly people with dementia-related psychosis and with orthostatic hypotension. 119 Systematic reviews have examined intramuscular (IM) olanzapine 120 and haloperidol plus promethazine 121

2013 SIGN

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