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241. Guidelines for the Prevention of Stroke in Women

Table 1. Applying Classification of Recommendation 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 the usefulness/efficacy

2014 Congress of Neurological Surgeons

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

among individuals who have not previously experienced a stroke or transient ischemic attack. Evidence- based recommendations are included for the control of risk factors, interventional approaches to atherosclerotic disease of the cervicocephalic circulation, and antithrombotic treatments for preventing thrombotic and thromboembolic stroke. Further recommendations are provided for genetic and pharmacogenetic testing and for the prevention of stroke in a variety of other specific circumstances (...) for primary stroke prevention. 14,15 Some of the goals of such risk assessment tools are to identify people at elevated risk who might be unaware of their risk, to assess risk in the presence of >1 condition, to measure an individual’s risk that can be tracked and lowered by appropri- ate modifications, to estimate risk for selecting treatments or stratification in clinical trials, and to guide appropriate use of further diagnostic testing. Although stroke risk assessment tools exist, the complexi- ties

2014 American Heart Association

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

that enhance insulin sensitivity have also been shown to produce many of these improvements among people with the metabolic syndrome. 188,190–194 No adequately powered RCTs have tested the effective- ness of weight loss, diet, or exercise for primary prevention of stroke or other vascular clinical events among patients with the metabolic syndrome. No randomized trial of secondary preventive therapy has been conducted among patients who have had a stroke with the metabolic syndrome. Metabolic Syndrome (...) activity are associated with a 10% to 30% reduction in the incidence of stroke and CHD in both men and women. 195,199–201,208,209 These observations from epidemiological work, however, have not been tested in adequately designed clinical trials. In particular, no RCTs have examined the effectiveness of exercise for secondary prevention of stroke. Two trials using multimodal approaches that include physical activity are in progress and may help clarify the role of physical activity in secondary

2014 Congress of Neurological Surgeons

245. Psychological, social and biological determinants of ill health (pSoBid)

and to the participants themselves. This study was funded by the Glasgow Centre for Population Health which is a partnership between NHS Greater Glasgow and Clyde, Glasgow City Council and the University of Glasgow, supported by the Scottish Government. Jennifer McLean July 2013 3Abbreviations and glossary AVLT Auditory Verbal Learning Test: assesses short-term auditory-verbal memory BMI Body mass index BP Blood pressure CHD Coronary heart disease cIMT Carotid intima-media thickness: a surrogate marker (...) from the most and least deprived communities of Glasgow. This study also illustrates the willingness of subjects to volunteer for a variety of investigations involving psychological, behavioural, sociological and medical questions and tests. The depth and range of the data collected and the analyses undertaken in this study yield important information concerning the relationships between health and socioeconomic status, inflammation, atherosclerosis, mental outlook, cognitive performance

2013 Glasgow Centre for Population Health

246. 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

247. Global Strategy for Diagnosis, Management, and Prevention of COPD

on multiple scienti?c and clinical achievements in the 10yearssincethe2001GOLDreportwaspublished,thisrevised editionprovidesanewparadigmfortreatmentofstableCOPD. Thismajorrevisionbuildsonthestrengthsfromtheoriginalrec- ommendations and incorporates new knowledge to make three important new recommendations: 1. One of the strengths was the treatment objectives. These have stood the test of time, but are now organized into two groups: objectives that are directed toward immedi- ately relievingand reducingthe (...) , with the aim that future studies will test the value of this system. Summary of New Recommendations A summary of the new issues presented in this report follows: 1. Thisdocumenthasbeenconsiderablyshortenedinlength by limiting section 1 to the essential background data on COPD. Readers who wish to access more comprehensive information are referred to a variety of excellent text- books that have appeared in the last decade. 2. Section 2 includes information on diagnosis and assess- ment of COPD. The de

2015 European Respiratory Society

248. Treatment and Recommendations for Homeless Patients with Chlamydial or Gonococcal Infections

. ADAPTING YOUR PRACTICE Treatment & Recommendations for Homeless Patients with Chlamydial/Gonococcal Infections Health Care for the Homeless Clinicians’ Network 7 Table of Contents Summary of recommended practice adaptations 9 Introduction 14 CHLAMYDIAL OR GONOCOCCAL INFECTIONS IN ADULTS AND ADOLESCENTS Case Study: Homeless Adolescent with Chlamydia 18 Case Study: Homeless Young Adult with Gonorrhea 19 Diagnosis and Evaluation History 20 Physical examination 21 Diagnostic tests 22 Plan and Management (...) Education/self-management 23 Medications 24 Associated problems/complications 25 Follow-up 26 CHLAMYDIAL/GONOCOCCAL INFECTIONS IN INFANTS AND CHILDREN UNDER 3 YEARS OF AGE Case Study: Homeless Infant with Chlamydia 27 Diagnosis and Evaluation History 28 Physical examination 28 Diagnostic tests 28 Plan and Management Education/self-management 29 Medications 29 Associated problems/complications 29 Follow-up 29 ADAPTING YOUR PRACTICE Treatment & Recommendations for Homeless Patients with Chlamydial

2013 National Health Care for the Homeless Council

249. 2013 ACCF/AHA Guideline for the Management of Heart Failure (Full text)

, Frederick A. Masoudi , Patrick E. McBride , John J.V. McMurray , Judith E. Mitchell ACCF/AHA representative. , Pamela N. Peterson ACCF/AHA representative. , Barbara Riegel ACCF/AHA representative. , Flora Sam ACCF/AHA representative. , Lynne W. Stevenson , W.H. Wilson Tang , Emily J. Tsai ACCF/AHA representative. , and Bruce L. Wilkoff and WRITING COMMITTEE MEMBERS Originally published 5 Jun 2013 Circulation. 2013;128:e240–e327 You are viewing the most recent version of this article. Previous versions (...) Patient e253 6.1. Clinical Evaluation e253 6.1.1. History and Physical Examination: Recommendations e253 6.1.2. Risk Scoring: Recommendation e253 6.2. Diagnostic Tests: Recommendations e253 6.3. Biomarkers: Recommendations e255 6.3.1. Natriuretic Peptides: BNP or NT-proBNP e256 6.3.2. Biomarkers of Myocardial Injury: Cardiac Troponin T or I e256 6.3.3. Other Emerging Biomarkers e256 6.4. Noninvasive Cardiac Imaging: Recommendations e256 6.5. Invasive Evaluation: Recommendations e258 6.5.1. Right-Heart

2013 American Heart Association PubMed abstract

250. Treatment and recommendations for homeless people with Diabetes Mellitus

and patterns including nutrition status, weight history, and food sources (e.g., soup kitchens). Ask patients if they are able to follow an appropriate diabetic diet. Many food sources supply only one meal a day so that the homeless person must visit multiple places for food. Some shelters are able to provide alternatives to persons with special dietary needs. ? Determine if/where patients are getting medical help, advice, syringes, and test strips. Home glucose meters can often be obtained at no cost from (...) companies as samples. In addition, many stores carry lancets and test strips at very affordable prices. These options should be researched and recommended as appropriate. ? Assess for medical and mental health comorbidities and associated medications. ? Explore the use of tobacco, alcohol and illicit drugs, and the frequency and route of use. Past Medical History ? Ask patients if they have ever had foot sores or ulcers or any problems with their feet. ? Assess and often reassess how much walking

2013 National Health Care for the Homeless Council

251. 2013 ACC/AHA Guideline for the Management of ST-Elevation Myocardial Infarction - Focused Update

THROMBOCYTOPENIA .e111 9.7.2. Bleeding Complications .e111 TREATMENT OF ICH .e112 VASCULAR ACCESS SITE BLEEDING .e112 9.8. Acute Kidney Injury .e112 9.9. Hyperglycemia .e112 10. Risk Assessment After STEMI .e113 10.1. Use of Noninvasive Testing for Ischemia Before Discharge: Recommendations . .e113 10.2. Assessment of LV Function: Recommendation .e114 10.3. Assessment of Risk for SCD: Recommendation .e114 11. Posthospitalization Plan of Care .e114 11.1. Posthospitalization Plan of Care (...) are asked to perform a formal literature review; weigh the strength of evidence for or against particular tests, treatments, or procedures; and include estimates of expected outcomes where such data exist. Patient-speci?c modi?ers, comorbidities, and issues of patient preference that may in?uence the choice of tests or therapies are considered. When available, information from studies on cost is consid- ered, but data on ef?cacy and outcomes constitute the primary basis for the recommendations contained

2013 Society for Cardiovascular Angiography and Interventions

252. 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

with proton-pump inhibitors or H2-receptor blockers (Grade B, BEL 2). For best absorption, calcium supplements should be lim- ited to no more than 500 mg of elemental calcium per dose, since there is decreasing absorption with increasing doses (Grade A, BEL 1). A 24-hour urine calcium collection should be measured in patients with osteoporosis or patients at risk for bone loss in order to check calcium adequacy and test for hypercalciuria or malabsorption (Grade B, BEL 2). 3.Q7.2 Vitamin D • R33. Serum 25 (...) intervention (lower fat intake, higher fiber intake) and increased daily physical activity. After 4 years, the cumulative incidence of DM defined by oral glucose tolerance testing (OGTT) was 11% in the intervention group and 23% in the control subjects. The Diabetes Prevention Program (DPP) randomized 3,234 adults (mean age, 51 years; mean BMI, 34 kg/m 2 ) who had impaired fasting glucose and were at high risk for the development of T2DM into placebo, metformin, or lifestyle modification groups

2013 American Association of Clinical Endocrinologists

253. Screening, Monitoring, and Treatment of Stage 1-3 Chronic Kidney Disease: A Clinical Practice Guideline from the American College of Physicians

clinical practice guidelines grading system. Recommendation 1: ACP recommends against screening for chronic kidney disease in asymptomatic adults without risk factors for chronic kidney disease. (Grade: weak recommendation, low-quality evidence) Recommendation 2: ACP recommends against testing for proteinuria in adults with or without diabetes who are currently taking an angiotensin-converting enzyme inhibitor or an angiotensin II–receptor blocker. (Grade: weak recommendation, low-quality evidence (...) albuminuria, as indicated by a urinary albumin–creatinine ratio of 3 mg/mmol or greater [≥30 mg/g]) or a glomerular filtration rate (GFR) less than 60 mL/min/1.73 m 2 for 3 or more months. Traditionally, CKD is categorized into 5 stages that are based on disease severity defined by GFR ( ); stages 1 to 3 are considered to be early-stage CKD. People with early stages of the disease are typically asymptomatic, and the diagnosis is made by using laboratory tests or imaging. In 2013, KDIGO revised CKD staging

2013 American College of Physicians

254. Heart Failure: Guideline For the Management of

; Frederick A. Masoudi, MD, MSPH, FACC, FAHAy#; Patrick E. McBride, MD, MPH, FACC**; John J. V. McMurray, MD, FACC*y; Judith E. Mitchell, MD, FACC, FAHAy; Pamela N. Peterson, MD, MSPH, FACC, FAHAy; Barbara Riegel, DNSc, RN, FAHAy; Flora Sam, MD, FACC, FAHAy; Lynne W. Stevenson, MD, FACC*y; W. H. Wilson Tang, MD, FACC*y; Emily J. Tsai, MD, FACCy; Bruce L. Wilkoff, MD, FACC, FHRS*yy *Writingcommitteemembersarerequiredtorecusethemselvesfromvotingonsectionstowhichtheirspeci (...) this writing effort. This document was approved by the American College of Cardiology Foundation Board of Trustees and the American Heart Association Science Advisory and Coordinating Committee in May 2013. The American College of Cardiology Foundationrequests that this documentbe citedas follows: Yancy CW,Jessup M, BozkurtB, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel

2013 American College of Cardiology

255. Guidelines for the Management of Hiatal Hernia

hiatal hernia and symptoms of gastroesophageal reflux. pH testing has limited relevance in the diagnosis of a hiatal hernia, but is critical to identify the presence of increased esophageal acid exposure in patients with sliding hiatal hernias that might benefit from antireflux surgery. Confirmation of abnormal gastroesophageal reflux either by the identification of erosive esophagitis or Barrett’s esophagus on upper endoscopy, or by demonstration of increased esophageal acid exposure on pH

2013 Society of American Gastrointestinal and Endoscopic Surgeons

256. Long-term Cardiovascular Toxicity in Children, Adolescents, and Young Adults Who Receive Cancer Therapy: Pathophysiology, Course, Monitoring, Management, Prevention, and Research Directions (Full text)

cardiomyopathy by testing lower cumulative doses and alternative dosing schedules and methods of administration, , as well as by adding potentially cardioprotective agents. Similarly, to reduce the risk of cardiac disease and second malignant neoplasms (eg, breast cancer), the use, dose, and volume of radiation to the heart has decreased substantially in frontline trials for children with hematological and low-stage, biologically favorable solid malignancies. Current therapy for childhood malignancies has

2013 American Heart Association PubMed abstract

257. Cardiovascular Function and Treatment in ß-Thalassemia Major (Full text)

. Diagnostic Strategies for Cardiac Involvement in TM 3.1 Basic Tests New-onset electrocardiographic abnormalities are usually evident in TM patients with HF and may include supraventricular arrhythmias, electrocardiographic findings that suggest right-sided heart involvement (S 1 Q 3 pattern and right-axis deviation), new-onset T-wave inversion beyond lead V 1 , and a consistent decrease in QRS height. In patients without HF, an abnormal ECG was found in 46% (T-wave abnormalities in 34% and right bundle (...) . CMR with late gadolinium enhancement should be considered in any patient who has a positive test result for hepatitis C, has abnormal cardiac function in the absence of cardiac iron, or has other known cardiovascular risk factors, such as chronic diabetes mellitus. Diastolic cardiac function is measured in clinical practice by echocardiography, and CMR is not generally used for this assessment despite the fact that it provides absolute peak filling rates from the volume-time curves

2013 American Heart Association PubMed abstract

258. Guidelines for the Management of Absolute Cardiovascular Disease Risk

: In adults at low absolute risk of CVD, blood test results within five years may be used for review of absolute cardiovascular risk unless there are reasons to the contrary. Treatment Lifestyle modification PP 9: All adults should be supported to follow the current Dietary Guidelines for Australian Adults. PP 10: All smokers should be offered advice about methods to aid smoking cessation, including counselling services, and if assessed as nicotine dependent, nicotine replacement therapy or other (...) a normal level. A result of 5.5–6.0 mmol/L may be normal but some people will show diabetes or impaired glucose tolerance in an oral glucose tolerance test (OGTT). A value of = 6.1 mmol/L but = 6.9 mmol/L is diagnostic of impaired fasting glucose and requires an OGTT to confirm diabetes or impaired glucose tolerance. A value of = 7.0 mmol/L on two separate occasions is diagnostic of diabetes and does not require an OGTT. When a fasting sample is not possible non-fasting glucose can be measured

2012 Stroke Foundation - Australia

259. ST-Elevation Myocardial Infarction: Guideline For the Management of

. Hyperglycemia .e112 10. Risk Assessment After STEMI .e113 10.1. Use of Noninvasive Testing for Ischemia Before Discharge: Recommendations . .e113 10.2. Assessment of LV Function: Recommendation .e114 10.3. Assessment of Risk for SCD: Recommendation .e114 11. Posthospitalization Plan of Care .e114 11.1. Posthospitalization Plan of Care: Recommendations .e114 11.1.1. The Plan of Care for Patients With STEMI .e114 11.1.2. Smoking Cessation .e116 11.1.3. Cardiac Rehabilitation .e116 11.1.4. Systems of Care (...) evidence to develop balanced, patient-centric rec- ommendations for clinical practice. Experts in the subject under consideration are selected by the ACCF and AHA to examine subject-speci?c data and write guidelines in partnership with representatives from other medical organizations and specialty groups. Writing committees are asked to perform a formal literature review; weigh the strength of evidence for or against particular tests, treatments, or procedures; and include estimates of expected

2012 American College of Cardiology

260. Recommendations for the Use of Mechanical Circulatory Support: Device Strategies and Patient Selection (Full text)

walk test, with the majority (83%) of patients in New York Heart Association (NYHA) functional class I or II. Improvement in quality of life was also recorded in patients treated as BTT. This device showed improved durability, with pump replacement required in only 4% of patients. The MicroMed DeBakey, a continuous, axial-flow pump, is not approved by the FDA for use in adults but is available for use in children 5 to 16 years of age. Because of its small size, the MicroMed DeBakey provides (...) clinical trial and the later HeartMate II DT clinical trial supported the use of DT. In addition to improved survival, the majority of patients experience significant improvement in both functional status (NYHA classification and 6-minute walk tests) and quality of life (Minnesota Living With Heart Failure questionnaire and Kansas City Cardiomyopathy questionnaire) after MCS. In the HeartMate II DT clinical trial, 80% of patients had NYHA class I or II symptoms at 24 months and a doubling of the mean

2012 American Heart Association PubMed abstract

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