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McMurray Test

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181. 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

With AF e210 3.1.1. Clinical History and Physical Examination e210 3.1.2. Investigations e210 3.1.3. Rhythm Monitoring and Stress Testing ………..e210 Prevention of Thromboembolism e211 4.1. Risk-Based Antithrombotic Therapy: Recommendations e211 4.1.1. Selecting an Antithrombotic Regimen—Balancing Risks and Benefits e212 4.1.1.1. Risk Stratification Schemes (CHADS 2 , CHA 2 DS 2 -VASc, and HAS-BLED) e213 4.2. Antithrombotic Options e214 4.2.1. Antiplatelet Agents e214 4.2.2. Oral Anticoagulants e215 (...) of the evidence and acting as an independent group of authors to develop, update, or revise written recommendations for clinical practice. Experts in the subject under consideration are selected from both organizations to examine subject-specific data and write guidelines. Writing committees are specifically charged to perform a literature review; weigh the strength of evidence for or against particular tests, treatments, or procedures; and include estimates of expected health outcomes where such data exist

2014 American Heart Association

182. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

several risk factors: age >1 month for full-term infants or 48 weeks’ postconceptional age for preterm infants, and absence of any previous apneic event at presentation to the hospital. Another large multicenter study found no association between the specific viral agent and risk of apnea in bronchiolitis. The literature on viral testing for bronchiolitis has expanded in recent years with the availability of sensitive polymerase chain reaction (PCR) assays. Large studies of infants hospitalized (...) for bronchiolitis have consistently found that 60% to 75% have positive test results for RSV, and have noted coinfections in up to one-third of infants. , , In the event an infant receiving monthly prophylaxis is hospitalized with bronchiolitis, testing should be performed to determine if RSV is the etiologic agent. If a breakthrough RSV infection is determined to be present based on antigen detection or other assay, monthly palivizumab prophylaxis should be discontinued because of the very low likelihood

2014 American Academy of Pediatrics

183. How Much Do We Know About HDL Cholesterol?

Pfizer was forced to halt phase III trials of torcetrapib, a CETP inhibitor, after it was shown to increase mortality . [5] Pfizer spent over $800 million on their failed HDL raising attempt. [6] Some suggested that the mortality increase was due to adverse effects such as raising blood pressure. However, subsequent data analysis found that , [7] further confirming its lack of efficacy in halting or reversing atherosclerosis. Another CETP inhibitor, dalcetrapib, was tested in the dal-OUTCOMES study (...) clearance. [10] Several trials have evaluated the effect of niacin on cardiovascular outcomes. The HATS trial evaluated the effect of simvastatin plus niacin and found not only a rise in HDL levels but a regression of atherosclerotic lesions as well as reduced incidence of coronary events. [11] This trial did not compare niacin plus a statin to statin alone, however, so the marginal benefit of raising HDL could not be tested. The ARBITER 6-HALTS study looked at statin plus niacin versus statin plus

2014 Clinical Correlations

184. 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

185. Management of Stable Coronary Artery Disease

investigations . . . . . . . . . . . . . . .2958 6.2.1 Basic testing . . . . . . . . . . . . . . . . . . . . . . . . . . .2958 6.2.1.1 Biochemical tests (see web addenda) . . . . . . . . .2958 6.2.1.2 Resting electrocardiogram . . . . . . . . . . . . . . . .2960 6.2.1.3 Echocardiography at rest (see web addenda) . . . .2960 6.2.1.4 Cardiac magnetic resonance at rest . . . . . . . . . . .2960 6.2.1.5 Ambulatory electrocardiogram monitoring . . . . . .2961 6.2.1.6 Chest X-ray (...) . . . . . . . . . . . . . . . . . . . . . . . . .2961 6.2.2 Three major steps used for decision-making . . . . . .2961 6.2.3 Principles of diagnostic testing . . . . . . . . . . . . . . .2961 6.2.4 Stress testing for diagnosing ischaemia . . . . . . . . . .2963 6.2.4.1 Electrocardiogram exercise testing . . . . . . . . . . .2963 6.2.4.2 Stress imaging (see web addenda) . . . . . . . . . . . .2965 6.2.4.2.1 Stress echocardiography . . . . . . . . . . . . . .2965 6.2.4.2.2 Myocardial perfusion scintigraphy (single photon emission computed

2013 European Society of Cardiology

186. Diabetes, Pre-Diabetes and Cardiovascular Diseases

dinucleotide phosphate hydrogen NDR National Diabetes Register NHANES NationalHealth and NutritionExamination Survey ESC Guidelines 3038 Downloaded from https://academic.oup.com/eurheartj/article-abstract/34/39/3035/503593 by guest on 02 April 2019NICE National Institute for Health and Clinical Excel- lence (UK) NNT number needed to treat NO nitric oxide NOAC new oral anticoagulants NYHA New York Heart Association OAT Occluded Artery Trial OGTT oral glucose tolerance test OMT optimal medical treatment (...) Health Organization (WHO) and the American Diabetes Associ- ation (ADA). 2– 6 Glycated haemoglobin A 1c (HbA 1c ) has been recommended as a diagnostic test for DM, 7,8 but there remain con- cerns regarding its sensitivity in predicting DM and HbA 1c values ,6.5% do not exclude DM that may be detected by blood glucose measurement, 7 –10 as further discussed in Section 3.3. Four main aetiological categories of DM have been identi?ed: type 1 diabetes (T1DM), T2DM, ‘other speci?c types’ of DM

2013 European Society of Cardiology

187. Management of Arterial Hypertension

) Abnormal glucose tolerance test Obesity [BMI =30 kg/m 2 (height 2 )] Abdominal obesity (waist circumference: men =102 cm; women =88 cm) (in Caucasians) Family history of premature CVD (men aged 3.5 mV; RaVL >1.1 mV; Cornell voltage duration product >244 mV*ms), or Echocardiographic LVH [LVM index: men >115 g/m 2 ; women >95 g/m 2 (BSA)] a Carotid wall thickening (IMT >0.9 mm) or plaque Carotid–femoral PWV >10 m/s Ankle-brachial index 7% (53 mmol/mol), and/or Post-load plasma glucose >11.0 mmol/L (198

2013 European Society of Cardiology

188. 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

189. Management of Acute ST Segment Elevation Myocardial Infarction (STEMI) ? (3rd Edition)

. This may be done by assessing: • L V function o Clinical, chest X-ray, echocardiogram, radionuclide studies or cardiac MRI. • Presence of myocardial ischaemia o Clinical (recurrent angina). o Exercise stress testing in asymptomatic patients. - This may be done from day 5 post-STEMI (sub-maximal stress test with a target heart rate of 70% of maximum predicted heart rate) up to 6 weeks post-STEMI (maximal with a target heart rate of 90% of maximumpredicted heart rate for age or symptom limited (...) ). - If the pre-discharge sub-maximal stress test is negative, the patient should be subjected to a maximal or symptom limited stress test within 6 weeks after discharge. - For those who cannot exercise, consider dobutamine stress echocardiogram, radionuclide perfusion studies or cardiac MRI. • Presence of malignant ventricular arrhythmias. In the presence of angina, inducible ischaemia or late ventricular arrhythmia early coronary angiography with a view to revascularisation is indicated. 80 In patients

2014 Ministry of Health, Malaysia

190. Management of Heart Failure  (3rd Edition)

and fluid intake, regular exercise and appropriate lifestyle changes such as smoking cessation and abstinence from alcohol. • Performance measures should be instituted to assess quality of care.9 Figure 1 : Algorithm for the diagnosis of Heart Failure or LV dysfunction Suspected Heart Failure because of symptoms/sign Tests abnormal Tests abnormal Treat accordingly Determine : • Underlying cause • Severity • Precipitating Factors • Type of LV Dysfunction (systolic +/- diastolic) Heart Failure or LV (...) dysfunction unlikely. Consider other diagnosis such as: • coronary artery disease (angina equivalent) • pulmonary disease • obesity Additional diagnostic tests where approprate (eg: Coronary Angiography, Nuclear Imaging & CMR) Tests normal Echocardiography Test normal but clinical suspicion high ECG Chest Radiograph Natriuretic Peptides (where available) Test normal but clinical suspicion low10 Flowchart I : Management of Acute HF NOTE: * It is important to look for tissue hypoperfusion - cool peripheries

2014 Ministry of Health, Malaysia

193. Home Modifications and Their Impact on Waged Care Substitution

of the key definitions and concepts underpinning waged home care substitution by home modifications, and then testing this by comparing outcome and process measures from cases—those with exposure to home modification and waged home care interventions. Thus we systematically search the literature to present both current work and then use this to refine and advance a person-environment fit theory relevant to waged home care substitution, collect cases to test it, and reflect on whether the theory (...) its real-life context, from which both generating and testing hypotheses become possible. The case study method was deemed an ideal supplementary methodology for this research because of its ability to describe and illustrate a complex situation. This report seeks to better understand the substitutive relationships that can develop surrounding care in the home, where health, available care support and degree of home modifications are all highly individualised and each come into play to varying

2014 Home Modification Information Clearinghouse

194. Ketamine Versus Electroconvulsive Therapy in Depression

subjects of childbearing potential must have a negative urine pregnancy test at enrolment (Visit 1) and be willing to use a reliable method of birth control (i.e., double-barrier method, oral contraceptive, implant, dermal contraception, long-term injectable contraceptive, intrauterine device, or tubal ligation) during the study. Abstain from consuming grapefruit juice (a potent 3A4 cytochrome inhibitor) on the day of the ketamine infusions as it may slow down the elimination of ketamine. Be able (...) function tests AST and ALT three times the upper normal limit at screening. Uncorrected hypothyroidism or hyperthyroidism. Subjects needing a thyroid hormone supplement to treat hypothyroidism must have been on a stable dose of the medication for 30 days prior to enrolment (Visit 1). Clinically significant deviation from the reference range in clinical laboratory test results as judged by the investigator(s). Including: Sodium under 135 or over 145 mmol/L Potassium under 3.5 or over 5.0 mmol/L Chloride

2018 Clinical Trials

195. 3D-MRI combined with signal-to-noise ratio measurement can improve the diagnostic accuracy and sensitivity in evaluating meniscal healing status after meniscal repair. (PubMed)

, swelling, locking, or positive McMurray test; on MRI, grade III signal intensity at the site of repair. Finally, the SNR on 3D-MRI of the healed and the unhealed groups were compared.On second-look arthroscopy, 68 (90.7%) menisci were found to be completely healed. With the arthroscopic healing rate as the standard, the clinical healing rate was 69.3% (63 menisci) [sensitivity, 85.7%; specificity, 75.0%; accuracy, 76.0%; positive predictive value (PPV), 26.1%; negative predictive value (NPV), 98.1

2018 Knee Surgery, Sports Traumatology, Arthroscopy

196. Impact of Body Mass Index on the Accuracy of N-Terminal Pro-Brain Natriuretic Peptide and Brain Natriuretic Peptide for Predicting Outcomes in Patients With Chronic Heart Failure and Reduced Ejection Fraction: Insights From the PARADIGM-HF Study (Prospect (PubMed)

Medical Center, Charleston (M.R.Z.); Institut de Cardiologie de Montréal, Université de Montréal, Canada (J.L.R.); Department of Molecular and Clinical Medicine, University of Gothenburg, Sweden (K.S.); and Novartis Pharmaceuticals Corporation, East Hanover, NJ (M.L., V.C.S., M.F.P.). McMurray John J JJ From Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (W.N., B.L.C., A.S.D., S.D.S.); Department of Internal Medicine, University of Campinas, Campinas, Brazil (W.N.); British Heart (...) Fragments blood Predictive Value of Tests Prospective Studies Protease Inhibitors adverse effects therapeutic use Risk Assessment Risk Factors Stroke Volume drug effects Time Factors Treatment Outcome Ventricular Function, Left drug effects BNP NT-proBNP heart failure natriuretic peptides obesity prognosis 2016 11 30 6 0 2016 11 30 6 0 2018 8 28 6 0 ppublish 27895026 CIRCULATIONAHA.116.024976 10.1161/CIRCULATIONAHA.116.024976

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2018 Circulation Controlled trial quality: uncertain

198. Electrocardiograms for Diagnosing Ischemia as a Precipitant to Acute Heart Failure

) 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 and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2012 Jul;33(14):1787-847. (7) National Institute for Health and Clinical Excellence. Chest pain of recent onset (...) : description of population. Eur Heart J. 2006 Nov;27(22):2725-36. (10) Davenport C, Cheng EY, Kwok YT, Lai AH, Wakabayashi T, Hyde C et al. Assessing the diagnostic test accuracy of natriuretic peptides and ECG in the diagnosis of left ventricular systolic dysfunction: a systematic review and meta-analysis. Br J Gen Pract. 2006 Jan;56(522):48-56. (11) Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR, Casey DE, Jr. et al. 2012 ACCF/AHA focused update of the guideline for the management of patients

2012 Health Quality Ontario

199. Inotropic and Vasoactive Agents for In-Hospital Heart Failure Management

: Literature Search Strategies 14 Appendix 2: GRADE Tables 16 References 17 . Inotropic and Vasoactive Agents for In-Hospital Heart Failure Management: A Rapid Review. December 2012; pp. 1–19. 5 List of Abbreviations AMSTAR Assessment of Multiple Systematic Reviews CI Confidence interval(s) HF Heart failure M-H Mantel-Haenszel test NYHA New York Heart Association RCT Randomized controlled trial RR Relative risk . Inotropic and Vasoactive Agents for In-Hospital Heart Failure Management: A Rapid Review (...) Management: A Rapid Review. December 2012; pp. 1–19. 17 References (1) Nohria A, Lewis E, Stevenson LW. Medical management of advanced heart failure. JAMA. 2002 Feb 6;287(5):628-40. (2) Metra M, Ponikowski P, Dickstein K, McMurray JJ, Gavazzi A, Bergh CH et al. Advanced chronic heart failure: a position statement from the Study Group on Advanced Heart Failure of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2007 Jun;9(6-7):684-94. (3) Gheorghiade M, Abraham WT

2012 Health Quality Ontario

200. ROCKET?AF: Rivaroxaban vs Warfarin in patients with Atrial Fibrillation

15mg* po daily versus dose-adjusted warfarin (INR 2-3 in patients <70 years of age & INR 1.6-2.6 in patients =70 years old). *rivaroxaban 10mg po daily in patients with CrCl 30-49 mL/min ? 22% of the patient population ? Safety: rivaroxaban was non-inferior to warfarin for the composite of major & non-major bleeding; individual composite endpoints not statistically significant when separated. Differences in location of bleeds were not tested for statistical significance. ? Efficacy: not powered (...) ://www.nejm.org/doi/full/10.1056/NEJMoa1009638 (ROCKET-AF) 2 Granger CB, Alexander JH, McMurray JJV et al. Apixaban versus Warfarin in Patients with Atrial Fibrillation. N Engl J Med August 28, 2011 http://www.nejm.org/doi/pdf/10.1056/NEJMoa1107039 (ARISTOTLE) 3 Jin M. RxFiles Trial Summary – ARISTOTLE: Apixaban versus warfarin in patients with atrial fibrillation. Saskatoon, SK: RxFiles; 2011. Available from: www.rxfiles.ca. Accessed April 30 th , 2012. 4 Connolly SJ, Ezekowitz MD, Yusuf S, et al. Dabigatran

2012 RxFiles

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