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McMurray Test

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181. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage Full Text available with Trip Pro

information. Also, this Table 1. Applying Classification of Recommendations and Level of Evidence A recommendation with Level of Evidence B or C does not imply that the recommendation is weak. Many important clinical questions addressed in the guidelines do not lend 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 (...) be associated with coagulopathy Physical examination Vital signs A general physical examination focusing on the head, heart, lungs, abdomen, and extremities A focused neurological examination A structured examination such as the National Institutes of Health Stroke Scale can be completed in minutes and provides a quantification that allows easy communication of the severity of the event to other caregivers. GCS score is similarly well known and easily computed. Serum and urine tests Complete blood count

2015 American Heart Association

182. Clinical Practice Guideline on management of patients with diabetes and chronic kidney disease stage 3b or higher (eGFR <45 mL/min) Full Text available with Trip Pro

). Management of cardiovascular risk in patients with diabetes and CKD stage 3b or higher (eGFR <45 mL/min). 6.3. Development of review questions The methods support team assisted in developing review questions, i.e. framing the clinical questions into a searchable format. This required detailed specification of the patient group (P), intervention (I), comparator (C) and outcomes (O) for intervention questions and the patient group, index tests, reference standard and target conditions for questions (...) of diagnostic test accuracy [ ]. For each question, the guideline development group agreed upon explicit review question criteria including study design features (see Appendices for detailed review questions and PICO tables). 6.4. Assessment of the relative importance of the outcomes For each intervention question, the guideline development group compiled a list of outcomes, reflecting both benefits and harms of alternative management strategies. They ranked the outcomes as critical, highly important

2015 European Renal Best Practice

183. Management of Traumatic Brain Injury

paralysis achieved with a bolus “test dose” of a neuromuscular blocking agent should be considered if the above measures fail to adequately lower ICP and restore CPP . If there is a positive response, continuous infusion of a neuromuscular blocking agent should be employed (Tier 3) If ICP remains = 20 - 25 mmHg proceed to Tier 3 TIER 3 (includes potential salvage therapies) z Decompressive hemi-craniectomy or bilateral craniectomy should only be performed if treatments in Tiers 1 and 2 (...) to aggressive measures to control malignant intracranial hypertension, however it should only be instituted if a test dose of barbituate or propofol results in a decrease in ICP , thereby identifying the patient as a “responder.” Hypotension is a frequent side effect of high dose therapy with these agents. Meticulous volume resuscitation should be ensured and infusion of vasopressor/inotropes may be required. Prolonged use or high dose of propofol can lead to propofol infusion syndrome. Continuous EEG may

2015 American College of Surgeons

184. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

% of COX activity is inhibited over 6 to 12 days. Antiplatelet effects have also been studied in healthy volunteers through platelet aggregation tests including optical aggregometry and aspirin reaction units (ARUs). Aspirin reaction units is a whole blood assay test to aid in the detection of platelet inhibition and ARU is calculated as a function of the rate and extent of platelet aggregation. In individuals not taking aspirin, ARUs are 550 or greater. When examining ARU changes after administration (...) which is a cell adhesion molecule found on activated endothelial cells and platelets. It reduces thromboxane production and platelet factor 4 and platelet-derived growth factor release. Some ex-vivo tests indicated that cilostazol may inhibit platelet aggregation to a greater degree than aspirin. Cilostazol is used to treat lower extremity claudication. It has also been used to prevent stent thrombosis, and for the prevention of stroke. In the field of cardiology, cilostazol is used to augment

2015 American Society of Regional Anesthesia and Pain Medicine

185. Apixaban (new therapeutic indication) - Benefit assessment according to § 35a Social Code Book V

) 8084 560 (6.9) 0.85 [0.75; 0.96] Numbers in italics: subgroups (from primary subgroup analyses), that were combined; see also text below a: All percentages: Institute's calculation b: Interaction test (relative to original subgroups) c: Combination of the subgroups = 65 – 60 kg, deaths occurred statistically significantly more frequently under warfarin (6.94%) than under treatment with apixaban (5.9%; HR 0.85 [0.75; 0.96]). Stroke With respect to the outcome “stroke” (ischaemic, haemorrhagic (...) (0.1) 1.18 [0.53; 2.64] a: All percentages: Institute’s calculation b: Interaction test CI: confidence interval; HR: hazard ratio; N: number of analysed patients; n: number of patients with event Age The investigation across all 3 age groups showed an indication (p = 0.128) of an effect modification. The results of the adjacent subgroups, each with a low event rate and imprecise estimation, were not similar and therefore no paired interaction tests were conducted. In the individual age groups

2013 Institute for Quality and Efficiency in Healthcare (IQWiG)

186. Canadian Diabetes Association 2013 clinical practice guidelines for the prevention and management of diabetes in Canada

A) the population to which aguidelinewouldapply;B)thetest,riskfactororinterventionbeing addressed; C) the “gold standard” test or relevant intervention to whichthetestorinterventioninquestionwascompared;andD)the clinically relevant outcomes being targeted. This information was usedtodevelopspeci?c,clinicallyrelevantquestionsthatwerethe focusofliteraturesearches.Foreachquestion,individualstrategies were developed combining diabetes terms with methodological terms. A librarian with expertise in literature reviews (...) to the published studies Level Criteria Studies of diagnosis Level 1 a) Independent interpretation of test results (without knowledge of the result of the diagnostic or gold standard) b) Independent interpretation of the diagnostic standard (without knowledge of the test result) c) Selection of people suspected (but not known) to have the disorder d) Reproducible description of both the test and diagnostic standard e) At least 50 patients with and 50 patients without the disorder Level 2 Meets 4 of the Level 1

2013 CPG Infobase

187. Screening and Risk Stratification for Diabetic Foot Ulcers

of the critical appraisal of the included SR, using the AMSTAR tool, 6 is available in Appendix 5, Table A5.1. The clinical efficacy evidence for a DFU screening program identified by the SR consisted of two RCTs and four historically controlled trials. The RCTs were evaluated as having a CONSORT score of 65% for McCabe et al. (1998) 16 and 57% for McMurray et al., 2002. 17 The authors of the SR also state that the RCT by McCabe et al. (1998) 16 did not provide any information concerning baseline (...) characteristics of the populations, the index group was subdivided and reallocated multiple times on the basis of neuropathy and PVD, and the allocation protocol was breached. 5 The end points, blinding, and statistical methods were also unclear. 16,22 The SR provided in the guidelines from the University of Adelaide stated that this RCT had a moderate risk of bias and was of average quality. 10 The other RCT included in this SR, McMurray et al. (2002), 17 had a frequency of follow-up with a large proportion

2014 Canadian Agency for Drugs and Technologies in Health - Rapid Review

188. Apixaban and Rivaroxaban for Stroke Prevention in Atrial Fibrillation

Cardiol. 2013 Oct 26. PubMed: PM24211508 6. Garcia DA, Wallentin L, Lopes RD, Thomas L, Alexander JH, Hylek EM, et al. Apixaban versus warfarin in patients with atrial fibrillation according to prior warfarin use: results from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation trial. Am Heart J. 2013 Sep;166(3):549-58. PubMed: PM24016506 7. McMurray JJ, Ezekowitz JA, Lewis BS, Gersh BJ, van Diepen S, Amerena J, et al. Left ventricular systolic dysfunction (...) and of bleeding in atrial fibrillation: a secondary analysis of a randomised controlled trial. Lancet. 2012 Nov 17;380(9855):1749-58. PubMed: PM23036896 14. Connolly SJ, Eikelboom J, Joyner C, Diener HC, Hart R, Golitsyn S, et al. Apixaban in patients with atrial fibrillation. N Engl J Med. 2011 Mar 3;364(9):806-17. PubMed: PM21309657 15. Granger CB, Alexander JH, McMurray JJ, Lopes RD, Hylek EM, Hanna M, et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med. 2011 Sep 15;365(11

2014 Canadian Agency for Drugs and Technologies in Health - Rapid Review

189. ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management Full Text available with Trip Pro

. .2390 3.3 Functional capacity. . . . . . . . . . . . . . . . . . . . . . . . .2390 3.4 Risk indices . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2391 3.5 Biomarkers . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2392 3.6 Non-invasive testing. . . . . . . . . . . . . . . . . . . . . . . .2392 3.6.1 Non-invasive testing of cardiac disease . . . . . . . . .2393 3.6.2 Non-invasive testing of ischaemic heart disease. . . .2393 3.7 Invasive coronary angiography (...) failure, hypertension, age =75 (doubled), dia- betes, stroke (doubled)-vascular disease, age 65–74 and sex category (female) CI con?dence interval CI-AKI contrast-induced acute kidney injury CKD chronic kidney disease CKD-EPI Chronic Kidney Disease Epidemiology Collaboration C max maximum concentration CMR cardiovascular magnetic resonance COPD chronic obstructive pulmonary disease CPG Committee for Practice Guidelines CPX/CPET cardiopulmonary exercise test CRP C-reactive protein CRT cardiac

2014 European Society of Cardiology

190. ESC/EACTS Guidelines in Myocardial Revascularisation

-making (Heart Team) . . . . . . .2553 4.3 Timing of revascularization andadhoc percutaneous coronary intervention . . . . . . . . . . . . . . . . . . . . . . . . . .2553 5. Strategies for diagnosis: functional testing and imaging . . . . . .2554 5.1 Non-invasive tests . . . . . . . . . . . . . . . . . . . . . . . . .2554 5.2 Invasive tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2554 5.3 Detection of myocardial viability . . . . . . . . . . . . . . . .2555 6. Revascularization (...) April 201918.4.6 Duration of dual antiplatelet therapy after percutaneous coronary intervention . . . . . . . . . . . . . . .2604 18.4.7 Drug interactions: a clopidogrel-related topic . . . .2605 18.4.8 Renal dysfunction . . . . . . . . . . . . . . . . . . . . . .2605 18.4.9 Surgery in patients on dual antiplatelet therapy . . .2606 18.4.10 Antiplatelet therapy monitoring and genetic testing 2608 18.4.11 Patients with hypersensitivity to acetylsalicylic acid 2608 18.4.12 Heparin-induced

2014 European Society of Cardiology

191. Hypertrophic Cardiomyopathy

of ventricular morphology and function . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2745 5.5.2 Myocardial ?brosis . . . . . . . . . . . . . . . . . . . . . .2746 5.5.3 Late Gadolinium Enhancement and Prognosis . . . . .2746 5.5.4 Differential diagnosis . . . . . . . . . . . . . . . . . . . . .2746 5.6 Nuclear imaging and computerized tomography . . . . . .2747 5.7 Endomyocardial biopsy . . . . . . . . . . . . . . . . . . . . . .2747 5.8 Laboratory tests (...) . . . . . . . . . . . . . . . . . . . . . . . . . . .2747 6. Genetic testing and family screening . . . . . . . . . . . . . . . . . .2747 6.1 Counselling in probands . . . . . . . . . . . . . . . . . . . . . .2748 6.2 Methods for molecular genetic screening in probands . . .2748 6.3 Indications for genetic testing in probands . . . . . . . . . .2748 6.4 Genetic and clinical screening of relatives . . . . . . . . . . .2749 6.4.1 Families with de?nite disease causing genetic mutations 2749 6.4.2 Families without de?nite disease causing genetic

2014 European Society of Cardiology

192. The 2012 Canadian Cardiovascular Society heart failure management guidelines update: Focus on acute and chronic heart failure

Laboratory testing, electrocardiogram (ECG), chest x-ray, and echocardiogram are all important to ob- tain. 5 A slight mild elevation of cardiac troponin is not infrequently observed in acute decompensation and not necessarily indicative of myocardial infarction (MI). 7 The utility of natriuretic peptide (NP) to exclude (“rule out”) or con?rm (“rule in”) the diagnosis in the appropriate clinical scenario is well established. 5,8-10 NPs are best used when the diagnosis is uncertain; their clinical utility (...) and relevant cut points have been well established. 5 Several clinical scoring systems have been derived and validated and combine com- monly used clinical features with NP values to improve di- agnosis and decision-making. 11,12 The most commonly used clinical scoring system (Table 1) was developed by Baggish et al. (Supplemental Table S1). 11 Prospective trials are under way, testing variations of these systems. RECOMMENDATION 1. We recommend a thorough clinical evaluation of the pa- tient to assess

2013 CPG Infobase

193. Abnormal Blood Glucose and Type 2 Diabetes Mellitus: Screening

for abnormal glucose metabolism include overweight and obesity or a high percentage of abdominal fat, physical inactivity, and smoking. Abnormal glucose metabolism is also frequently associated with other cardiovascular risk factors, such as hyperlipidemia and hypertension. Screening Tests Glucose abnormalities can be detected by measuring hemoglobin A 1c or fasting plasma glucose or with an oral glucose tolerance test. Diagnosis of IFG, IGT, or type 2 diabetes should be confirmed with repeated testing (...) (the same test on a different day is the preferred method of confirmation). Screening Interval Evidence on the optimal rescreening interval for adults with an initial normal glucose test is limited. Studies suggest that rescreening every 3 y may be a reasonable approach. Treatment and Interventions Effective behavioral interventions combine counseling on a healthful diet and physical activity and involve multiple contacts over extended periods. There is insufficient evidence that medications have

2015 U.S. Preventive Services Task Force

194. The characteristic findings of an inverted-type discoid lateral meniscus tear: a hidden tear pattern. Full Text available with Trip Pro

(inverted group). We age-matched these patients with 12 controls who were extracted from many normal DLM tear cases in the same period (non-inverted group). The assessment items were traumatic history with the onset of pain, the mean duration between the appearance of symptoms and surgery, preoperative knee range of motion (ROM), positive findings on the McMurray test, knee locking or catching, and characteristic MRI findings. These items were compared between the two groups using χ2 and Student's t (...) -tests.All patients in the inverted group had clear trauma with the onset of pain during sports or daily life activities, and 7 of the 12 patients with a non-inverted type of DLM tear had clear trauma. There was a significantly higher rate of traumatic history in the inverted group than in the non-inverted group (P = 0.03). The mean duration between the appearance of symptoms and surgery, preoperative knee ROM, positive findings on the McMurray test, and knee locking or catching were not significantly

2019 BMC Musculoskeletal Disorders

195. Magnetic resonance imaging can increase the diagnostic accuracy in symptomatic meniscal repair patients. (Abstract)

included. All had undergone a primary meniscal repair followed by an MRI and re-arthroscopy due to clinical symptoms of a meniscal lesion. A validated semi-quantitative scoring system was employed for identifying MRI-diagnosed healing failure. The clinical assessment was divided into joint swelling, joint-line tenderness, locking and a positive McMurray's test. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRI and positive clinical findings were

2019 Knee Surgery, Sports Traumatology, Arthroscopy

196. The 2012 Canadian Hypertension Education Program recommendations for the management of hypertension: Blood pressure measurement, diagnosis, assessment of risk, and therapy

experts using prespecified levels of evidence. Recommendations Diagnosis and assessment A new recommendation this year relates to the diagnosis of white coat hypertension, which could be confirmed either by reliable repeated home blood pressure (BP) monitoring or 24-hour ambulatory BP monitoring (ABPM). Recommendations for BP measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes (...) on the CHEP recommendations is to provide timely evidence-based recommendations to primary care providers to improve hypertension prevention, detection, and control in Canadians. Key clinical questions addressed include: (1) How is hypertension diagnosed? (2) How do we diagnose white coat hypertension? (3)What frequency of follow-up and laboratory testing is necessary for hypertensive patients? (4) How is risk assessed for future cardiovascular events in these patients? (5) When should we start

2012 CPG Infobase

197. Antithrombotics: indications and management

with antithrombotics and their management should be evidence based. Developments since the publication of SIGN 36: Antithrombotic Therapy in 1999 include the introduction to clinical practice of novel antithrombotics (for example orally active inhibitors of thrombin and activated factor X), changes to models of care (including patient self testing and self dosing for warfarin) and exploration of new indications for antithrombotics (for example recurrent miscarriage). This guideline complements, and should be used (...) clinical assessment has demonstrated an indication for heparin treatment, the patient’s medical and drug history should be assessed and baseline blood tests including platelet count, coagulation screen (in order to check baseline APTT ratio is normal), urea, electrolytes and liver function tests should be obtained. These may reveal contraindications or risk factors for bleeding, such as anaemia, thrombocytopenia, renal failure, or coagulopathy (eg due to severe liver disease). 9 A baseline platelet

2012 SIGN

198. Chest X-rays for Diagnosing Pulmonary Infection as a Precipitant of Acute Heart Failure

precipitant of an HF exacerbation. (2) Technology Radiography is the application of x-rays to produce an image based on the internal physical properties of an object. By exploiting known physical properties of the human body, an image of internal structures and organs can be created. X-ray imaging tools are widely available and non-invasive. Pneumonia is typically diagnosed using a combination of clinical exams, chest x-ray, and laboratory tests. (9) Other diagnostic imaging tools for pneumonia include (...) , management during intercurrent illness or acute decompensation, and use of biomarkers. Can J Cardiol. 2007 Jan;23(1):21-45. (5) Lindenfeld J, Albert NM, Boehmer JP, Collins SP, Ezekowitz JA, Givertz MM, et al. HFSA 2010 comprehensive heart failure practice guideline. J Card Fail. 2010 Jun;16(6):e1-194. (6) McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Bohm M, Dickstein K, et al. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: the Task Force for the Diagnosis

2013 Health Quality Ontario

199. RE?LY: Dabigatran versus Warfarin in Patients with Atrial Fibrillation

were excluded. ? 77% of patients were managed at primary care centres. 15% were managed at anticoagulation clinics. ? Mean (SD): TTR 64% (20%), monthly frequency of INR testing 1.6 (1.3), time below therapeutic range 22% (19%) & above therapeutic range 13% (13%). - North American data (n=2167, 36%): mean (SD) TTR 67% (17%), algorithm consistency 64% (17%), time below therapeutic range 19% (15%) & above therapeutic range 14% (11%). ? Warfarin dose adjustments based on the above recommendations were (...) =diabetes ECG=electrocardiogram GI=gastrointestinal HF=heart failure Hgb=hemoglobin H 2 RA=histamine-2 receptor antagonist HTN=hypertension INR=international normalized ratio LFT=liver function test LVEF=left ventricular ejection fraction MI=myocardial infarction NNT=number needed to treat NNH=number needed to harm NS=not statistically significant NYHA=New York Heart Association PE=pulmonary embolism PPI=proton pump inhibitor TIA=transient ischemic attack VKA=vitamin K antagonist yr=year

2013 RxFiles

200. Symptoms, natural history and outcomes of early chronic kidney disease

(glomerular filtration rate (GFR) decline, cardiovascular events, etc.). BACKGROUND Chronic kidney disease is often detected as an incidental finding on pathology tests or during screening. In many patients it is asymptomatic until more advanced stages of CKD are reached. Despite the frequent paucity of symptoms, early stages of CKD are associated with an increased risk of adverse outcomes, and unrecognised complications may begin to develop in early stages of disease. Health provider and patient (...) . ________________________________________________________________________________________________________________________ Early Chronic Kidney Disease July 2012 Page 7 of 12 24. O'Hare AM, Bertenthal D, Covinsky KE et al. Mortality risk stratification in chronic kidney disease: one size for all ages? J Am Soc Nephrol. 2006; 17: 846-53. 25. Anavekar NS, McMurray JJ, Velazquez EJ et al. Relation between renal dysfunction and cardiovascular outcomes after myocardial infarction. N Engl J Med. 2004; 351: 1285-95. 26. McCullough PA, Nowak RM, Foreback C et al. Emergency evaluation of chest pain in patients with advanced

2013 KHA-CARI Guidelines

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