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Failure to Thrive in the Elderly


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61. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults

mg/dL S14 4.5. Primary Prevention in Individuals With Diabetes S16 4.6. Primary Prevention in Individuals Without Diabetes and With LDL-C 70 to 189 mg/dL S16 4.7. Risk Assessment in Primary Prevention S17 4.8. Heart Failure and Hemodialysis S17 5. Safety: Recommendations S18 6. Managing Statin Therapy: Recommendations S21 6.1. Monitoring Statin Therapy S21 6.2. Optimizing Statin Therapy S21 6.3. Insufficient Response to Statin Therapy S21 6.3.1 Testing S21 6.3.2 Nonstatins Added to Statins (...) focused on these statin RCTs to develop evidence-based guidelines for the reduction of ASCVD risk. We recognize that this represents a significant departure from current strategies. This should not come as a surprise to clinicians. The recent guideline on heart failure has changed long-standing paradigms on the basis of the evidence, and this guideline does as well. Future RCTs will be needed to determine the optimal treatment strategy to provide the greatest reduction in ASCVD events with best margin

2013 American Heart Association

64. Quantitative serum immunoglobulin tests

to detect the presence of any monoclonal band (also called ‘paraprotein’ or ‘M spike’) and urine protein electrophoresis for Bence-Jones protein. Full blood count (FBC) is important to identify lymphopenia, anaemia, and thrombocytopenia (all can occur with hypogammaglobulinaemia) and to exclude neutropenia. Lymphocytosis may be seen in CLL or lymphoma. Lymphopenia in infants with infections, diarrhoea and/or failure to thrive is an important finding as it suggests severe combined immunodeficiency (...) . myeloma), serum immunoglobulin tests may also be ordered periodically to monitor disease progression. When shouldn’t the test be ordered? Otherwise healthy thriving children with frequent ‘colds’ do not need their immunoglobulin levels measured. In Australia, normal healthy toddlers can have up to 12 infections a year. The number of infections increases if the child attends childcare, has older siblings and/or parents who smoke. How does the test work? Nephelometry and turbidimetry are the most widely

2013 Clinical Practice Guidelines Portal

65. Guidelines for Responsible Opioid Prescribing in Chronic Non-Cancer Pain

is considered as low dose, 41 to 90 mg of morphine equivalent as a moderate dose, and greater than 91 mg of morphine equivalence as high dose. (Evidence: fair) C) In reference to long-acting opioids, titration must be carried out with caution and overdose and misuse must be avoided. (Evidence: good) 8. A) Methadone is recommended for use in late stages after failure of other opioid therapy and only by clinicians with specific training in the risks and uses. (Evidence: limited) B) Monitoring recommendation (...) necessary. (Evidence: good) 11. Chronic opioid therapy may be continued, with continuous adherence monitoring, in well-selected populations, in conjunction with or after failure of other modalities of treatments with improvement in physical and functional status and minimal adverse effects. (Evidence: fair) Disclaimer: The guidelines are based on the best available evidence and do not constitute inflexible treatment recommendations. Due to the changing body of evidence, this document is not intended

2012 American Society of Interventional Pain Physicians

66. Acute Diarrhea in Adults and Children: A Global Perspective

malnutrition, chronic liver disease, or lymphoproliferative disorders. — Invasive intestinal amebiasis. — Symptomatic giardiasis (anorexia and weight loss, persistent diarrhea, failure to thrive). • Consider antimicrobial treatment for: — Shigella, Salmonella, Campylobacter (dysenteric form) or parasitic infections. — Nontyphoidal salmonellosis among at-risk populations (malnutrition, infants and elderly, immunocompromised patients, and those with liver diseases and lymphoproliferative disorders (...) — Salmonella enterica serovar Typhi and Paratyphi A, B, or C (typhoid fever); fever lasts for 3 weeks or longer; patients may have normal bowel habits, constipation or diarrhea. • Animals are the major reservoir for salmonellae. Humans are the only carriers of typhoidal Salmonella. • In nontyphoidal salmonellosis (Salmonella gastroenteritis), there is an acute onset of nausea, vomiting, and diarrhea that may be watery or dysenteric in a small fraction of cases. • The elderly and people with immune

2012 World Gastroenterology Organisation

67. Toolkit: Implementation of Best Practice Guidelines, Second Edition

supports the implementation of best practice guidelines (BPG) developed by RNAO to date. It is a comprehensive resource manual, grounded in theory, research and experience. It brings practical processes, strategies and tools to clinicians and others committed to initiating and sustaining practice change in health care, and supporting the creation of healthy and thriving work environments. RNAO is delighted to provide this key resource. We offer our heartfelt thanks to the Government of Ontario

2012 Registered Nurses' Association of Ontario

68. My Story: When the Signs of Sepsis are Missed

the odds. We understand now that my Disney half marathon training is what prepared my heart for the real life marathon I was to endure. It took a new medical team, two additional surgeries, another full year of supplemental IV nutrition, countless hours of physical therapy and sheer determination to get me where I am today. I am lucky to be alive, and thriving, and grateful for the ICU team that saved my life, but reminded that more has to be done to educate families, nurses, and doctors to so (...) will be in pain daily stomack cramps its hell. But sepsis honestly scares the life out of me and I think has changed me as a person Back in early March of 2014, I went in for surgery to get my C-section done to have my set of boy/girl twins. Never did I know that I would be setting myself up for failure. Not only did they go fishing around in my spine trying to give me a local after I told them I was born with congenital scoliosis and they weren’t going to find my spine, but then they weren’t even able to use

2016 CDC Safe Healthcare blog

69. Unintentional Weight Loss

Unintentional Weight Loss Aka: Unintentional Weight Loss , Geriatric Failure to Thrive , Cachexia , Wasting Syndrome , Malnutrition , Anorexia From Related Chapters II. Epidemiology: Incidence residents: 25-40% Overall over age 64 years: 13% III. Definition Unintentional Weight Loss of >5% of body weight within 6-12 months IV. Causes See V. Precautions Substantial weight loss should not be attributed to aging alone See VI. History How much weight loss over how much time? Patients down play weight changes (...) See See See or VII. Exam Record accurate weights on same scale at every visit Unexplained weight loss >5% should be investigated Anticipated time for 15% weight loss Complete starvation: 15% of weight lost in 3 weeks Half of normal food intake: 3 months Half food intake and comorbid conditions: 3 weeks clues (BMI) predicts mortality in elderly Women: BMI <22 kg/m2 predicts increased mortality Men: BMI <23.5 kg/m2 predicts increased mortality Head and neck changes Thyromegaly Other examination

2018 FP Notebook

70. Burden of Geriatric Events Among Older Adults Undergoing Major Cancer Surgery. (PubMed)

admissions for major cancer surgery among elderly patients (ie, age ≥ 65 years) and a referent group age 55 to 64 years. From these observations, we identified geriatric events that included delirium, dehydration, falls and fractures, failure to thrive, and pressure ulcers. We then estimated the collective prevalence of these events according to age, comorbidity, and cancer site and further explored their relationship with other hospital-based outcomes.Within a weighted sample of 939,150 patients, we

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2016 Journal of Clinical Oncology

71. Management of obesity

+ Liver disease Compared to healthy-weight patients, overweight and obese patients with abdominal fat distribution experience higher rates of hospitalisation and death due to cirrhosis. 43 37% of asymptomatic morbidly obese patients have histological non-alcoholic steatohepatitis (compared with 3% in the general population) and 91% have steatosis (compared with 20% in the general population). 44,45 In one study of subjects with acute liver failure, obese patients had an RR of 1.63 for transplantation (...) or death. 46 2 + Mortality Obesity is associated with excess mortality. 47,48,49 BMI (above 22.5-25 kg/m 2 ) is a strong predictor of overall mortality with most of the excess mortality likely to be causal and due to vascular disease. In the elderly (age =65), a BMI in the moderately obese range is associated with a modest increase in mortality risk regardless of sex, disease state and smoking status. 50 Physical inactivity and adiposity have both independent and dependent effects on all-cause

2010 SIGN

74. Ulcerative colitis

present with weight loss, failure to thrive in children, and chronic diarrhoea. For more information, see the CKS topic on . Anal fissure — may present with severe anal pain on defecation (with or without blood). For more information, see the CKS topic on . Pseudomembranous colitis — can present with abdominal pain and chronic diarrhoea, with or without blood in the stool. Infection is more likely if the person has recently taken antibiotics or been admitted to hospital. For more information, see (...) : Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (including a review of TA140 and TA262) National Institute for Health and Care Excellence. [ ] NICE (2015) TA342: Vedolizumab for treating moderately to severely active ulcerative colitis. National Institute for Health and Care Excellence [ ] Economic appraisals No new economic appraisals relevant to England since 1 July 2014. Systematic reviews and meta-analyses

2014 NICE Clinical Knowledge Summaries

75. Gastroenteritis

, or beverages contaminated by the faeces of infected humans or animals. Many cases are associated with recent foreign travel. The symptoms of giardiasis include acute and chronic diarrhoea (which can last for 2–6 weeks and occasionally longer), malabsorption, weight loss, and (in children) failure to thrive. Other symptoms include abdominal pain, anorexia, flatulence, bloating, and nausea. Vomiting and fever are uncommon. [ ; ; ; ; ] Prevalence How common is it? About 20% of the UK population develop (...) is variable, depending on the duration of symptoms and the causative pathogen [ ]. Dehydration is more likely to occur in young children than in teenagers. Haemolytic uraemic syndrome (HUS) HUS is a rare but serious complication of acute infectious gastroenteritis that occurs mostly in young children and the elderly [ ]. It is a potentially life-threatening complication [ ], characterized by acute renal failure, haemolytic anaemia, and thrombocytopenia may occur [ ]. Initial presenting features include

2014 NICE Clinical Knowledge Summaries

76. Kanuma - sebelipase alfa

and the scientific discussion within the Committee, issued a positive opinion for granting a Marketing Authorisation to Kanuma. 2. Scientific discussion 2.1. Introduction The target disease of the ERT product sebelipase alfa is known as LAL deficiency, and is a progressive multisystem disease which frequently manifests early in life leading to serious complications. In infants, these complications include failure to thrive with progressive liver injury, rapid development of liver fibrosis, and early death (...) plays a key role in the metabolism and degradation of cholesteryl esters and triglycerides, and its marked reduction or absence leads to accumulation of these lipid substrates in the lysosomes of various tissues and cell types throughout the body, particularly affecting the liver, leading to fibrosis, organ dysfunction and failure, as well as the intestine, leading to malabsorption and adverse effects on growth, and other issues that may result from these. LAL deficiency has two distinct forms

2015 European Medicines Agency - EPARs

77. Depression - antenatal and postnatal

[ ; ]. Depression in pregnancy, particularly if not treated, may affect the cognitive, emotional, social, educational, behavioural, and physical development of the infant, although a minority of children are affected [ ; ]. Peripartum depression is associated with failure to thrive, attachment disorder, and developmental delay at a year old [ ]. There is an association with depression in pregnancy and depression in adolescents and young adults [ ]. Depression in the postnatal period may be associated

2013 NICE Clinical Knowledge Summaries

78. Eczema - atopic

eczema that has not been controlled by optimum management, particularly if associated with gut dysmotility (colic, vomiting, altered bowel habit) or failure to thrive. Most people do not need allergy testing. Advise avoidance of over-the-counter tests as these are of no proven value. If a food allergy is suspected, manage in primary care if the expertise and support are available, otherwise refer to secondary care. If other types of allergies are suspected, refer to secondary care as appropriate

2013 NICE Clinical Knowledge Summaries

80. Telavancin (Vibativ)

levels between 30 mL/min to 50 mL/min. Several committee members noted that the renal effects would likely be a manageable toxicity, and all committee members advised more analysis regarding nephrotoxicity and explicit warnings related to the degree of renal impairment. One member expressed concern with the Applicant’s data showing congestive heart failure and multiple organ failure that was not discussed at the meeting, and noted that these should be looked at more closely to see (...) be minimized and rapid de-escalation criteria should be included in the study protocol. In Studies 0015 and 0019, the diagnosis of renal failure was left to the discretion of the investigator, and in some cases it is unclear whether some of the patients may have had acute as well as chronic renal failure. For patients with potential risk factors, renal status should be more specifically defined by standardized measures at entry and followed more closely for at least 28 days in future clinical trials

2013 FDA - Drug Approval Package

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