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Failure to Thrive in the Elderly

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41. 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

42. 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

43. Guidance on the clinical management of depressive and bipolar disorders, specifically focusing on diagnosis and treatment strategies

Disorders Clinical Practice Guideline (Mood Disorders CPG) has been developed by the Royal Australian and New Zealand College of Psychiatrists (RANZCP) to guide the clinical management of real-world depressive and bipolar disorders and to advise specifically on diagnosis and treatment strategies. The guideline focuses primarily on adults and briefly addresses special populations such as children and adolescents, pregnant and post-partum women, the elderly and those with common medical illnesses (...) assessment for (hypo)manic symptoms is essential. Cognitive impairment in mood disorders. The issue of cognitive impairment in mood disorders has been recognised for many years, particularly in the elderly in whom the phenomenon has been described as pseudodementia. However, while it has been clear for some time now that episodes of mood disturbance are associated with significant cognitive impairment, two issues are becoming increasingly clear. Firstly, it is clear that in recurrent mood disorders some

2015 Royal Australian and New Zealand College of Psychiatrists

44. 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

45. 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

46. 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

47. Secondary Prevention After Coronary Artery Bypass Graft Surgery

in the incidence of stroke (1.3% versus 2.6%; P =0.01), a 74% reduction in the incidence of renal failure (0.9% versus 3.4%; P <0.001), and a 62% reduction in the incidence of bowel infarction (0.3% versus 0.8%; P =0.01). Moreover, the authors reported that aspirin administration within 48 hours of surgery was safe, without an increase in the risk of hemorrhage, gastritis, infection, or impaired wound healing (odds ratio [OR] for adverse events, 0.63; 95% confidence interval [CI], 0.54–0.74). In a study (...) ) trials. Although a potential benefit with high-intensity statin therapy was suggested, these subgroup analyses were limited by the lack of graft patency data and the lengthy time span between surgery and study recruitment. More recently, several studies have evaluated the impact of intensive lipid reduction early after CABG. In a cohort study of 418 CABG patients, Ouattara et al noted a significant reduction in the incidence of perioperative cardiovascular events (heart failure, malignant arrhythmia

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2015 American Heart Association

48. Irritable Bowel Syndrome (IBS)

and differentiating it from IBS-D are assays of fecal bile acid concentration, 23-seleno-25-homo-taurocholic acid (SeHCAT) testing, and high-performance liquid chromatography for serum 7- a- OH-4-cholesten-3-one (C4)—in addition to the use of therapeutic trials (with the bile acid sequestering agents cholestyramine and colesevelam), and heightened awareness of the likelihood of bile acid malabsorption [9]. Celiac disease Main symptoms and/or findings: • Chronic diarrhea • Failure to thrive (in children) • Fatigue (...) , and urinary symptoms was found in 43% of women with ovarian cancer, but in only 8% of a control population. Other considerations for the differential checklist • Colitis associated with nonsteroidal anti-inflammatory drugs (NSAIDs). This may account for diarrhea in elderly patients who are receiving treatment from neurologists and rheumatologists. 4.4 Comorbidity with other diseases Patients with overlap syndromes tend to have more severe IBS. • Fibromyalgia in 20–50% of IBS patients (although

2015 World Gastroenterology Organisation

49. Diagnosis of B12 and folate deficiency

in infancy are failure to thrive, movement disorders, developmental delay and megaloblastosis. Neurological symptoms and signs can develop without haematological abnormalities. Early recognition and treatment of cobalamin deficiency is important because, despite treatment, long‐term consequences may remain in the form of poor intellectual performance (Graham et al , ; Bjorke‐Monsen & Ueland, ). True cobalamin deficiency, with significant clinical problems, is considered to be rare in infants in developed (...) ‐pregnancy folate supplements are important to reduce risk of neural tube defects Low cobalamin levels found in third trimester may be physiological Neurocognitive impairment in the elderly Low cobalamin levels of uncertain significance in the elderly may be associated with neurocognitive impairment. Low cobalamin or folate levels may reflect poor diet as part of poor general condition The Guidelines Writing Group (GWG) reviewed publications up to 2013 identified via the Pubmed and Cochrane databases

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2014 British Committee for Standards in Haematology

52. Guidelines for the Primary Prevention of Stroke: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association

Stroke Profile (FSP) uses a Cox proportional hazards model with risk factors as covariates and points calculated according to the weight of the model coefficients. 16 Independent stroke predictors include age, systolic blood pressure (SBP), hypertension, diabetes mellitus, current smoking, established cardiovascular disease (CVD; myocardial infarction [MI], angina or coronary insuffi- ciency, congestive heart failure, and intermittent claudication), atrial fibrillation (AF), and left ventricular (...) themselves to clinical trials. Although randomized trials are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective. *Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as sex, age, history of diabetes, history of prior myocardial infarction, history of heart failure, and prior aspirin use. †For comparative effectiveness recommendations (Class I and IIa; Level of Evidence A and B

2014 American Heart Association

53. Guidelines for the Prevention of Stroke in Patients with Stroke and Transient Ischemic Attack (Secondary Stroke Prevention)

predictor of DM, 174 and simpler risk stratification instruments, such as the Framingham risk score, are at least as accurate for CVD. 175,176 Furthermore, the metabolic syndrome has not been associated with the risk of developing CVD in the elderly (70–82 years of age), which limits its generalizability in a typical stroke population. 167,174 The metabolic syndrome is also associated with increased risk for ischemic stroke and silent brain infarction. More than 15 cohort studies have reported (...) is discussed extensively in the AHA/American Stroke Association’s “Guidelines for the Primary Prevention of Stroke.” 53 In contrast to the exten- sive data on the association between smoking and risk for first stroke, data on an association with recurrent stroke are sparse. In the Cardiovascular Health Study, however, smoking was associated with a substantially increased risk for stroke recur- rence in the elderly (HR, 2.06; 95% CI, 1.39–3.56). 30 Newer research has extended concerns about smoking

2014 Congress of Neurological Surgeons

54. Royal Flying Doctor Service Western Operations Clinical manual part 1.Clinical guidelines

(Paediatric) 5 1.5 The Deteriorating Patient 7 2 CARDIOVASCULAR 1 2.1 Acute Coronary Syndromes 1 2.2 Acute Pulmonary Oedema 6 2.3 Cardiac Arrhythmias 8 3 ENDOCRINE 1 3.1 Diabetic Ketoacidosis 1 3.2 Hypoglycaemia 3 3.3 Hypocalcaemia 5 4 GASTROINTESTINAL 1 4.1 Acute Pancreatitis 1 4.2 Haematemesis and Melaena 3 4.3 Intestinal Obstruction 5 5 GENITOURINARY 1 5.1 Acute / Chronic Renal Failure 1 6 INFECTIOUS DISEASES 1 6.1 Bacterial Meningitis 1 6.2 Meningococcal Infection 3 6.3 Tuberculosis 5 6.4 Meliodosis 6 (...) failure SAH Subarachnoid haemorrhage MAP Mean arterial pressure SaO 2 Saturation MC&S Microscopy, culture and sensitivity SBP Systolic blood pressure MCI Mass Casualty Incident SC Subcutaneous Mg 2+ Magnesium SHICC State Health Incident Control Centre MI Myocardial infarction SpO 2 Oxygen saturation MIMMS Major Incident Medical Management and Support Course SROM Spontaneous rupture of membranes MRSA Methicillin resistant staphylococcus aureus SVT Supraventricular tachycardia RFDS Western Operations

2014 Clinical Practice Guidelines Portal

55. Diabetes, Pre-Diabetes and Cardiovascular Diseases

(EAPCI), European Heart Rhythm Association (EHRA), Heart Failure Association (HFA) Working Groups: Coronary Pathophysiology and Microcirculation, Thrombosis, Cardiovascular Surgery Councils: Cardiovascular Nursing and Allied Professions, Council for Cardiology Practice, Council on Cardiovascular Primary Care, Cardiovascular Imaging The content of these European Society of Cardiology (ESC) Guidelines has been published for personal and educational use only. No commercial use is authorized. No part (...) . . . . . . . . . . . . . . . . . . . . .3067 7.2.3. Speci?c aspects of percutaneous and surgical revascularization in diabetes mellitus . . . . . . . . . . . . . . .3069 7.2.4. Myocardial revascularization and glucose-lowering treatments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3069 7.2.5. Gaps in knowledge . . . . . . . . . . . . . . . . . . . . . .3069 7.2.6. Recommendations for coronary revascularization of patients with diabetes . . . . . . . . . . . . . . . . . . . . . . . .3070 8. Heart failure and diabetes

2013 European Society of Cardiology

58. Guidelines for the management of dyslipidaemias

, Italy. Tel: +39 02 5031 8302, Fax:+39 02 5031 8386, Email: Alberico.Catapano@unimi.it † Other ESC entities having participated in the development of this document: Associations: Heart Failure Association. Working Groups: Cardiovascular Pharmacology and Drug Therapy, Hypertension and the Heart, Thrombosis. Councils: Cardiology Practice, Primary Cardiovascular Care, Cardiovascular Imaging. The content of these European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS (...) dysbetalipoproteinaemia. . . . . . . . . .1800 10.1.4 Familial lipoprotein lipase de?ciency . . . . . . .1800 10.1.5 Other genetic disorders of lipoprotein metabolism . . . . . . . . . . . . . . . . . . . . . . .1800 10.2 Children . . . . . . . . . . . . . . . . . . . . . . . . . . . .1801 10.3 Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1801 10.4 The elderly . . . . . . . . . . . . . . . . . . . . . . . . . .1802 10.5 Metabolic syndrome and diabetes . . . . . . . . . . . .1803 10.6 Patients

2011 European Society of Cardiology

59. Patient Modesty: Volume 78

off target but I was perusing the 2016 OIGs list of criminal, civil and state actions and was stunned to see just how many females (RNs, LPNs, CNAs, citizens) were involved in State level crimes, including physical abuse of the elderly in nursing homes. The physical abuse crimes were caught because of facility cameras. Not all facilities have such invasive cameras, so needless to say these represent but a fraction of abuse occurring to elderly males and females in senior homes. Frightening. https (...) as a complex social and psychological entity. Suffering can include physical pain but is by no means limited to it. The relief of suffering and the cure of disease must be seen as twin obligations of a medical profession that is truly dedicated to the care of the sick. Physicians' failure to understand the nature of suffering can result in medical intervention that (though technically adequate) not only fails to relieve suffering but becomes a source of suffering itself. At , said... Notice in this NEMJ

2017 Bioethics Discussion Blog

60. Nothing could help my patient, but ministering to him helped me

of the cereal and even drinks a few gulps of orange juice. I leave his room feeling triumphant. I feel as good as if I have just performed a complicated procedure or confirmed a difficult diagnosis. It seems laughable to consider feeding a cup of raisin bran to an elderly patient with dementia as something noteworthy. I know that what I just did probably made absolutely no difference in the course of his medical treatment. A meager breakfast of cereal and orange juice will not reverse his failure to thrive

2017 KevinMD blog

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