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Failure to Thrive in the Elderly


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41. 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

42. 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

43. 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

46. 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

47. 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

48. 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

49. 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

52. Guidelines for the management of dyslipidaemias

, Italy. Tel: +39 02 5031 8302, Fax:+39 02 5031 8386, Email: † 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

53. 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

54. 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

55. The Spirochete Brachyspira pilosicoli, Enteric Pathogen of Animals and Humans (PubMed)

of Australian Aboriginal children showed that colonization was significantly associated with failure to thrive. B. pilosicoli has been detected in the bloodstream of elderly patients or individuals with chronic conditions such as alcoholism and malignancies. This review describes the spirochete and associated diseases. It aims to encourage clinicians and clinical microbiologists to consider B. pilosicoli in their differential diagnoses and to develop and use appropriate diagnostic protocols to identify

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2017 Clinical microbiology reviews

56. Another cancer quack dies…of cancer.

part of the treatment. While you might think that “cheating” on your cancer diet by 10% would only affect the effectiveness of your treatment by 10%, such is not the case with this protocol. The cancer patient must be fanatical about sticking to the diet, as it is an integral part of the treatment. The purpose of the diet is to create a highly alkaline inner terrain in which microbes cannot thrive. Because microbes are an integral part of cancer, the cancer diet is critical. Wow. There’s a heck (...) , and died on July 4. That’s not a particularly long time between diagnosis and death. It’s also not unexpected in an 84 year old man. Non-Hodgkins lymphoma, after all, tends to be nastier than Hodgkins lymphoma, and patients who are elderly tend not to do as well as children or young adults. Those are just facts. Another fact that we know is that Bill Henderson was being treated in Cancun, Mexico to be treated for “leukemia and lymphoma.” Ty Bollinger, however, will have none of it. It’s that cancer

2016 Respectful Insolence

57. The annals of “I’m not antivaccine,” part 20: “There is no safe vaccine” and excusing the murder of autistic children

Wakefield to walk away to their next project, leaving his mother with nothing when the hope they were sold proved false. Alex was murdered. Brutally murdered. By his mother and another caregiver. Alex was poisoned. When that failed to kill him, he was stabbed. Repeatedly. His wrist was slit to the bone. By his mother and caregiver. Alex bled to death, leaving a grisly scene for when his father, estranged from the mother, found him. The fact that Polly Tommey won’t face up to her abject failure with Alex (...) Spourdalakis is not surprising. It is also not surprising that Polly Tommey won’t judge the people who committed that brutal murder, or any other murder by a parent of an autistic child. Not surprising, but an example of the failure of Polly Tommey and other faux autism advocates to actually stand up and lead. How hard is it to say, “No! Murder is wrong”? Polly Tommey met Alex Spourdalakis. But she “won’t judge” the person who plunged a knife into his chest. She won’t judge the person who poisoned him. She

2016 Respectful Insolence

58. Guidelines for the Clinical and Operational Management of Drug-Resistant Tuberculosis

: the Green Light Committee and other international alliances 36 References 37 5 How drug resistance affects tuberculosis treatment outcome and monitoring parameters 39 Effect of drug resistance on treatment outcome 39 Effect on treatment monitoring parameters 42 References 45 6 High-risk groups for drug-resistant tuberculosis 47 Case ? nding and prioritisation of interventions 47 Failures, bacteriological relapses, defaulters and the dangers of poor adherence 51 References 52 7 Laboratory diagnosis

2013 International Union Against TB and Lung Disease

59. Guidelines for the Management of Hiatal Hernia

, belching, and vomiting have been suggested to be predisposing factors for anatomical failure and the need for revision 73 . Morbidity is substantially higher among elderly patients and those with co-morbidities when compared to younger patients, but with no increase in the recurrence rate. Mortality rate among elderly patients undergoing PEH repair continues to be high following emergency procedures 74 . The mortality is related mainly to pulmonary complications, thromboembolic events and hemorrhage 75 (...) the lesser and greater curvature, is less common. A combination of the two may exist. Primary gastric volvulus has no causative condition but the more common secondary gastric volvulus is associated with underlying conditions such as paraesophageal hernias, connective tissue disorders and anterior abdominal wall defects. Although gastric volvulus has been reported in all ages, it is more often diagnosed in elderly patients. Hiatal hernia with intrathoracic acute gastric volvulus usually presents

2013 Society of American Gastrointestinal and Endoscopic Surgeons

60. Clinical Practice Guidelines for Healthy Eating for the Prevention and Treatment of Metabolic and Endocrine Diseases in Adults: Cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology and The Obesity Society

the intake of vitamin B 12 in food (Grade A, BEL 1). • R7. The prevalence of vitamin D deficiency and insufficiency warrants case finding by measure - ment of 25-hydroxyvitamin D (25[OH]D) levels in populations at risk, including institutionalized elderly patients, people with hyperpigmented skin, and people with obesity (Grade B BEL 2). Older adults, people with increased skin pigmen- tation, and those exposed to insufficient sunlight should increase vitamin D intake from vitamin D-fortified foods (...) (OH)D should be measured in individuals at risk for vitamin D deficiency (e.g., elderly, institutionalized, or malnourished patients) and in those with known osteopenia or osteoporosis (Grade A, BEL 1). Vitamin D should be supplemented to keep the plasma 25(OH)D level greater than 30 ng/mL (Grade A, BEL 1). For most patients, a daily intake of at least 1,000 to 2,000 IU of ergocalciferol (D 2 ) or cholecalcif- erol (D 3 ) should be adequate (Grade A, BEL 1). For patients with advanced renal

2013 American Association of Clinical Endocrinologists

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