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Failure to Thrive in the Elderly

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21. Asthma

: Prominent systemic features (such as myalgia, fever, and weight loss). Unexpected clinical findings (such as crackles, finger clubbing, cyanosis, evidence of cardiac disease, 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 (...) the Prodigy topic on . Ciliary dyskinesia — clinical features include persistent moist cough present from birth. Cystic fibrosis — 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

2017 Prodigy

22. Life science

are more likely to provide value gain in healthcare in the future. They will be crucial for early diagnostics and maintaining quality of life after drugs start to fail, and reaching the elderly who often live away from hospitals (e.g. in the countryside). o Networks across the UK (rather than focussing only in the South East) to better match patient needs. ? Those developing the Life Sciences Industrial Strategy are looking for examples of countries that have delivered a successful life sciences (...) . ? Access and uptake of medicines by the healthcare systems are important factors for investment decisions by companies. There was a debate on the extent of this problem and the difficulty of quantifying the issue with the current NHS payment system. ? Industry has highlighted the failure to provide a contemporary standard of care that meets FDA and other regulatory standards for market authorisation across the UK as a reason for not investing in late stage clinical R&D. It was suggested, however

2017 Academy of Medical Sciences

23. Depression: Adult and Adolescent

. Emotional regulation groups are also being offered in several BHS specialty clinics. Online cognitive behavioral therapy (CBT) may be an attractive option as access to psychotherapy may be a significant barrier to care. Kaiser Permanente offers a free online CBT based program—Thrive— which offers modules on behavioral activation, cognitive restructuring and social skills training and uses interactive tools and branching logic to create a personalized curriculum for each patient. Combination therapy (...) elderly or very elderly patients compared to younger patients. Individuals vary widely in their response and tolerance to specific therapies and drugs, and it is difficult to predict which medication will be both effective and tolerable for an individual patient. Overall, SSRIs and SNRIs (such as venlafaxine) all have similar efficacy. The decision of which SSRI to start with may be based on patient or provider preference or on previous trials with a medication. If the first SSRI isn’t successful

2017 Kaiser Permanente Clinical Guidelines

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

32. 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

33. 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

34. Guidance on the clinical management of deliberate self-harm (DSH) and on the organisation and delivery of services

, PsycINFO and EMBASE (2007–2013) using the following search terms: suicide, deliberate self-harm, suicide ideation, attempted suicide, old, elderly and old age. Studies were included if they focused on older adults aged 60 years and over and were written in English. Of the 384 articles yielded, 46 abstracts were examined and five articles relevant were identified and included. Included trials are summarised in Table iv (see Appendix C). Special populations: Maori Sources. Searches of bibliographic

2016 Royal Australian and New Zealand College of Psychiatrists

35. Guidance addressing all aspects of the care of people with schizophrenia and related disorders. Includes correct diagnosis, symptom relief and recovery of social function

of schizophrenia: a framework for clinical care). The intrusion of psychosis at this stage may result in a severely truncated repertoire of social skills, and disrupted vocational and developmental trajectory, which can create lifelong socioeconomic disadvantage and failure to achieve the person’s full potential. Both the positive and negative symptoms of the disease can interfere with the person’s capacity to cope with the expectations of daily life. People with schizophrenia experience particular cognitive (...) and recreational activities. The lack of improvement in workforce participation is very disappointing, given that many people with schizophrenia express a desire to work, and most likely reflects a failure to develop effective vocational rehabilitation services. Improved vocational outcomes would have economic benefits, as well as improving social inclusion and quality of life. Early intervention for psychotic disorders has been shown to be cost-effective (Hastrup et al., 2013; McCrone et al., 2009). Further

2016 Royal Australian and New Zealand College of Psychiatrists

36. 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

37. 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

38. 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

39. 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

40. 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

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