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McMurray Test

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301. Meniscal Tear and Osteoarthritis Risk (MenTOR)

: Male or female aged 30-60 years. Participant able and willing to give informed consent. Clinical assessment demonstrates mechanical symptoms suggestive of meniscal pathology (focal knee pain +/- 1 or more of: catching/locking, giving way, focal joint-line tenderness, effusion, McMurray's positive) within last 12 months. Evidence on clinical MRI knee of meniscal tear. Participant is either in secondary care or has the potential to be referred to secondary care due to severity of symptoms. Patient (...) of inflammatory/septic arthritis of index knee. Knee replacement or other non-arthroscopic knee surgery (e.g. high tibial osteotomy) - previous or planned within 1 year of study start. Index knee surgery within last 3 months, including meniscectomy. Steroid injection to index knee in last 3 months. Active other (treated) inflammatory disease or infection. Positive pregnancy test. Unable to provide blood samples. Unable to give informed written consent. Contacts and Locations Go to Information from

2016 Clinical Trials

302. Diabetes landmark outcome trials: Glycemic Control & Prevention Summary

that intensive glucose control increased mortality among adults in the ICU: a blood glucose target of 180 mg or less per deciliter resulted in lower mortality than did a target of 81 to 108 mg per deciliter. 31 Home PD, Pocock SJ, Beck-Nielsen H, Curtis PS, Gomis R, Hanefeld M, Jones NP, Komajda M, McMurray JJ; RECORD Study Team. Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial. Lancet. 2009 Jun (...) 20;373(9681):2125-35. {Commentary & limitations: http://www.medscape.com/viewarticle/704038 } Komajda M, McMurray JJ, Beck-Nielsen H, et al. Heart failure events with rosiglitazone in type 2 diabetes: data from the RECORD clinical trial. Eur Heart J 2010; DOI: 10.1093/eurheartj/ehp604. Home PD, Pocock SJ, Beck-Nielsen H, et al. Rosiglitazone evaluated for cardiovascular outcomes in oral agent combination therapy for type 2 diabetes (RECORD): a multicentre, randomised, open-label trial. Lancet

2010 RxFiles

303. Device Therapy in Heart Failure

device LVEDD left ventricular end-diastolic diameter LVEF left ventricular ejection fraction LVESi left ventricular stroke volume index LVESV left ventricular end-systolic volume 6MWT 6 min walk test NA not applicable NIH National Institutes of Health NS not signi?cant NYHA New York Heart Association OMT optimal medical therapy pVO 2 peak oxygen consumption QoL quality of life RBBB right bundle branch block RCT randomized clinical trial SR sinus rhythm VE/CO 2 ventilation/carbon dioxide ratio 1 (...) ¼ implantable cardioverterde?brillator; LV¼ leftventricular; LVEDD¼ left ventricularend diastolicdiameter; LVEF¼ left ventricularejectionfraction;LVESi¼ leftventricular strokevolumeindex,LVESV¼ leftventricularend-systolicvolume; 6MWT¼ 6 min walk test; NYHA¼ New York Heart Association; NS¼ not signi?cant; OMT¼ optimal medical therapy; pVO 2 ¼ peak oxygen consumption; QoL¼ quality of life; SR¼ sinus rhythm; VE/CO 2 ¼ ventilation/carbon dioxide ratio. ESC Guidelines 2685 Downloaded from https

2010 European Society of Cardiology

304. Grown-Up Congenital Heart Disease

Cardiopulmonary exercise testing . . . . . . . . . . . . . .2920 3.2.5 Cardiac catheterization . . . . . . . . . . . . . . . . . . . . .2920 3.3 Therapeutic considerations . . . . . . . . . . . . . . . . . . . . .2920 3.3.1 Heart failure . . . . . . . . . . . . . . . . . . . . . . . . . . . .2920 3.3.2 Arrhythmias and sudden cardiac death . . . . . . . . . . .2920 3.3.3 Surgical treatment . . . . . . . . . . . . . . . . . . . . . . . .2921 3.3.4 Catheter intervention (...) valve area AVSD atrioventricular septal defect BAV bicuspid aortic valve BNP B-type natriuretic peptide BSA body surface area CAD coronary artery disease ccTGA congenitally corrected transposition of the great arteries CHD congenital heart disease CMR cardiac magnetic resonance CoA coarctation of the aorta CPET cardiopulmonary exercise testing CRT cardiac resynchronization therapy CT computed tomography DCRV double-chambered right ventricle ECG electrocardiogram EF ejection fraction EP

2010 European Society of Cardiology

305. PHYSICAL EXAMINATIONS FOR DIAGNOSING MENISCAL INJURIES: CORRELATION WITH SURGICAL FINDINGS Full Text available with Trip Pro

PHYSICAL EXAMINATIONS FOR DIAGNOSING MENISCAL INJURIES: CORRELATION WITH SURGICAL FINDINGS A set of five maneuvers for meniscal injuries (McMurray, Apley, Childress and Steinmann 1 and 2) was evaluated and their sensitivity, specificity, accuracy and likelihood were calculated. The same methods were applied to each test individually.One hundred and fifty-two patients of both sexes who were going to undergo videoarthroscopy on the knee were examined blindly by one of five residents (...) at this hospital, without knowledge of the clinical data and why the patient was going to undergo an operation. This examination was conducted immediately before the videoarthroscopy and its results were recorded in an electronic spreadsheet. The set of maneuvers was considered positive when one was positive. In the individual analysis, it was enough for the test to be positive.The analysis showed that the set of five meniscal tests presented sensitivity of 89%, specificity of 42%, accuracy of 75%, positive

2015 Revista brasileira de ortopedia

306. Improving the Stewardship of Diagnostic Imaging Resources in Alberta Emergency Departments

diagnoses in low-risk patients, patient expectations, and the tendency to associate more testing with a higher quality of care. However, this rise in the use of diagnostic imaging, particularly in low-risk patients, may not be taking into account the risk of radiation exposure to patients, or the impact on finite health system resources. The objective of this project is to improve the appropriateness of CT imaging in Alberta Emergency Departments by advancing awareness of, and adherence to, evidence (...) for a period of 30 months (15 months pre-intervention administrative data, and 15 months of administrative date during the intervention) ] Proportion of patients with suspected pulmonary embolism who undergo a CTPA scan for which a CTPA scan is recommended after applying the Well's Score, the Pulmonary Embolism Rule-Out Criteria (PERC), and receiving D-Dimer test results. [ Time Frame: All presenting patients for a period of 30 months (15 months pre-intervention administrative data, and 15 months

2015 Clinical Trials

307. Arthroscopic Meniscal Repair: “Modified Outside-In Technique” Full Text available with Trip Pro

tenderness, absence of locking, negative McMurray test and no need for meniscectomy. Patients' satisfaction was evaluated using the visual analogue scale (VAS). Patients were followed for 26±1.7 months.Clinical success was achieved in 61 patients (92.4%) and 5 candidates required meniscectomy (7.6%). IKDC Subjective Knee Evaluation Form score increased significantly from 54.2±12.7 preoperatively to 90.8±15.6 postoperatively (P<0.001). Lysholm score was excellent and good in 49 (80.3%) patients and fair

2015 Archives of bone and joint surgery

308. Genetics of Colorectal Cancer

carries a pathogenic variant in a mismatch repair (MMR) gene associated with Lynch syndrome, the most common inherited CRC syndrome. These include the MMRpro, MMRpredict, and PREMM5 (PREdiction Model for gene Mutations) prediction models. Individuals with a quantified risk of 2.5% or greater on PREMM5 or 5% or greater on MMRpro and MMRpredict are recommended for genetic evaluation referral and testing. Associated Genes and Syndromes Hereditary CRC has two well-described forms: (1) polyposis (including (...) variant associated with an inherited cancer syndrome. are showing promise in identifying common, low-penetrance susceptibility alleles for many complex diseases, including CRCs, but the clinical utility of these findings remains uncertain. Clinical Management It is becoming the standard of care at many centers that all individuals with newly diagnosed CRC are evaluated for Lynch syndrome through molecular diagnostic tumor testing assessing MMR deficiency. A is supported, in which all CRC cases

2012 PDQ - NCI's Comprehensive Cancer Database

309. Colorectal Cancer Prevention

-controlled trial tested the effect of calcium supplementation (3 g calcium carbonate daily [1,200 mg elemental calcium]) on the risk of recurrent adenoma.[ ] The primary endpoint was the proportion of patients (72% of whom were male) in whom at least one adenoma was detected following a first and/or second follow-up endoscopy. A modest decrease in risk was found for both developing at least one recurrent adenoma (adjusted risk ratio [ARR], 0.81; 95% CI, 0.67–0.99) and in the average number of adenomas

2012 PDQ - NCI's Comprehensive Cancer Database

310. An economic model of adult smoking related costs and consequences for England

and discount rates were used to test the sensitivity of the results. The risk rate variations used the upper and lower bounds of the RR estimates, whilst the discount rate was varied between zero and 8% per annum. Rasmussen’s results showed that both direct and indirect costs for those who had ever smoked were higher than for those who had never smoked, a result which held across all age groups of both men and women. Direct and indirect cost ratios were highest at age 45 for women, and respectively at ages

2010 Public Health Research Consortium

311. General Recommendations for the Care of Homeless Patients

, Vanderbilt University School of Medicine, Nashville, Tennessee Health Care for the Homeless Clinicians’ Network ADAPTING YOUR PRACTICE: General Recommendations for the Care of Homeless Patients vi Table of Contents SUMMARY Homelessness & Health Care: Fundamental Issues vii Summary of Recommendations ix INTRODUCTION 1 DIAGNOSIS & EVALUATION History 5 Physical examination 9 Diagnostic tests 10 PLAN & MANAGEMENT Plan of care 13 Education, self-management 14 Medications 16 Associated problems, complications (...) and prolong homelessness. Exposure to the elements or to communicable dis- eases in shelters, victimization, nutritional deficiencies, co-morbidities and limited access to health care increase the likelihood that relatively minor impairments will become much more serious. As many as 80% of homeless persons tested have marked deficits in cognitive functioning. Cognitive impairments seen in homeless patients are often associated with traumatic brain injury, mental ill- ness, chronic substance abuse

2010 National Health Care for the Homeless Council

312. Guidelines on Diagnosis and Treatment of Pulmonary Hypertension

applicable to drugs and devices at the time of prescription. & The European Society of Cardiology 2009. All rights reserved. For permissions please email: journals.permissions@oxfordjournals.org. European Heart Journal (2009) 30, 2493–2537 doi:10.1093/eurheartj/ehp297 Downloaded from https://academic.oup.com/eurheartj/article-abstract/30/20/2493/426803 by guest on 02 April 20197.1.4 Pulmonary function tests and arterial blood gases . 2502 7.1.5 Echocardiography (...) . . . . . . . . . . . . . . . . . . . . . . 2502 7.1.6 Ventilation/perfusion lung scan . . . . . . . . . . . . . 2504 7.1.7 High-resolution computed tomography, contrast- enhanced computed tomography, and pulmonary angiography . . . . . . . . . . . . . . . . . . . . . . . . . . 2504 7.1.8 Cardiac magnetic resonance imaging. . . . . . . . . . 2505 7.1.9 Blood tests and immunology . . . . . . . . . . . . . . . 2505 7.1.10 Abdominal ultrasound scan . . . . . . . . . . . . . . . 2505 7.1.11 Right heart catheterization and vasoreactivity

2009 European Society of Cardiology

313. Management of Pulmonary Arterial Hypertension

HYPERTENSION (PAH) 9 Proposed Clinical indicators for quality management i. Exercise Capacity – 6 Minute Walk Distance Percentage of Number of PAH patients who show PAH patients improvement in 6MWD who show = _______________________________ x 100% improvement in Total number of PAH patients serial 6MWD* tested with 6MWD *Serial 6MWD at baseline and after 3 to 6 months post treatment ii. Survival Rate 2 year survival Number of PAH patients on therapy alive rate on therapy (...) . Contrast enhanced spiral CT and pulmonary angiography 32 6.4. PAH evaluation 34 6.4.1. Blood tests and immunology 34 6.4.2. Assessment of exercise capacity 34 6.4.3. Right-heart catheterisation 34 7. Treatment 36 7.1. Conventional treatment 36 7.1.1. Oxygen (Level of evidence C) 36 7.1.2. Anticoagulation (Level of evidence C) 36 7.1.3. Digoxin (Level of evidence C) 37 7.1.4 Diuretics (Level of evidence C) 37 7.1.5. Calcium channel blockers (Level of evidence C) 38 7.1.6. Vaccination (Level of evidence

2011 Ministry of Health, Malaysia

314. Ptosis, Adult (Treatment)

. Evaluation and Management of Blepharoptosis . 1st. New York, NY: Springer-Verlag; 2010. Golnik KC, Pena R, Lee AG, Eggenberger ER. An ice test for the diagnosis of myasthenia gravis. Ophthalmology . 1999 Jul. 106(7):1282-6. . Glatt HJ, Fett DR, Putterman AM. Comparison of 2.5% and 10% phenylephrine in the elevation of upper eyelids with ptosis. Ophthalmic Surg . 1990 Mar. 21(3):173-6. . Dutton JJ. Atlas of Clinical and Surgical Orbital Anatomy . Philadelphia: WB Saunders; 1994. 120-5. Levine MR. Manual (...) . . Waqar S, McMurray C, Madge SN. Transcutaneous blepharoptosis surgery - advancement of levator aponeurosis. Open Ophthalmol J . Dec 2010. 14:4:76-80. . Baroody M, Holds JB, Sakamoto DK, Vick VL, Hartstein ME. Small incision transcutaneous levator aponeurotic repair for blepharoptosis. Ann Plast Surg . jun 2004. 52(6):558-561. . Park DH, Baik BS. Advancement of the Müller muscle-levator aponeurosis composite flap for correction of blepharoptosis. Plast Reconstr Surg . 2008 Jul. 122(1):140-2. . Dinges

2014 eMedicine.com

315. Stroke Anticoagulation and Prophylaxis (Treatment)

) In patients with aortic atheromas identified on echocardiography, the ideal strategy for stroke prevention remains uncertain. Mixed outcomes have been reported for anticoagulation therapy; plaque stabilization with statins appears promising. Neither approach has been tested in randomized, controlled trials. [ ] Dissections of internal carotid and vertebral arteries The majority (85-95%) of ischemic symptoms after dissection of brain-supplying arteries are caused by emboli from the site of the dissection (...) anticoagulation to achieve a higher target INR (target INR, 2.5-3.5 or 3.0-4.0), switching from warfarin to therapeutic doses of unfractionated heparin or low-molecular weight heparin, or adding an antiplatelet agent to warfarin. [ ] Because the lupus anticoagulants may interfere with INR determination, monitoring these patients using the prothrombin-proconvertin time and the chromogenic factor-X assay would be preferable. However, these tests are expensive and are not widely available. Previous Next

2014 eMedicine.com

316. Ptosis, Adult (Overview)

. 1999 Oct. 10(5):335-9. . Beard C. Types of ptosis. Beard C, ed. Ptosis . 3rd ed. St. Louis: Mosby; 1981. 39-76. Cohen AJ, Weinberg DA, eds. Evaluation and Management of Blepharoptosis . 1st. New York, NY: Springer-Verlag; 2010. Golnik KC, Pena R, Lee AG, Eggenberger ER. An ice test for the diagnosis of myasthenia gravis. Ophthalmology . 1999 Jul. 106(7):1282-6. . Glatt HJ, Fett DR, Putterman AM. Comparison of 2.5% and 10% phenylephrine in the elevation of upper eyelids with ptosis. Ophthalmic Surg (...) ):623-30. . Emsen IM. A new ptosis correction technique: a modification of levator aponeurosis advancement. J Craniofac Surg . 2008 May. 19(3):669-74. . Waqar S, McMurray C, Madge SN. Transcutaneous blepharoptosis surgery - advancement of levator aponeurosis. Open Ophthalmol J . Dec 2010. 14:4:76-80. . Baroody M, Holds JB, Sakamoto DK, Vick VL, Hartstein ME. Small incision transcutaneous levator aponeurotic repair for blepharoptosis. Ann Plast Surg . jun 2004. 52(6):558-561. . Park DH, Baik BS

2014 eMedicine.com

317. Incontinence, Urinary: Nonsurgical Therapies (Overview)

urinary tract dysfunction (eg, delirium, psychiatric disorders, urinary infection, impaired mobility) See for more detail. Diagnosis Patients with urinary incontinence should undergo a basic evaluation that includes a history, physical examination, and urinalysis. In selected patients, the following may also be needed: Voiding diary Cotton swab test Cough stress test Measurement of postvoid residual (PVR) urine volume Cystoscopy Urodynamic studies (see the image below) Urinary incontinence. Urodynamic (...) of as a disease, because no specific etiology exists; most individual cases are likely multifactorial in nature. The etiologies of urinary incontinence are diverse and, in many cases, incompletely understood. Patients with urinary incontinence should undergo a basic evaluation that includes a history, physical examination, and urinalysis (see ). Additional information from a patient's voiding diary, cotton-swab test, cough stress test, measurement of postvoid residual (PVR) urine volume, cystoscopy

2014 eMedicine.com

318. Hypertensive Heart Disease (Overview)

, and monitoring the adverse effects of therapy. The tests to be ordered depend on clinical judgment regarding the etiology of hypertension. Recommendations from the Seventh Report of the Joint National Committee (JNC7) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure include carrying out the following baseline laboratory workup before initiating treatment for hypertension [ ] : Electrocardiogram Urinalysis Blood glucose and hematocrit levels Serum potassium, creatinine (...) (or the corresponding estimated glomerular filtration rate [GFR]), and calcium measurements Lipid profile after a 9- to 12-hour fast - Includes high density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides Optional tests - Include measurement of urinary albumin excretion or albumin/creatinine ratio Cardiovascular risk assessment New guidelines on the assessment of cardiovascular risk, released in late 2013 by the American Heart Association/American College of Cardiology

2014 eMedicine.com

319. Meniscus Injuries (Overview)

with a possible meniscus injury include the following: Joint line tenderness (77-86% of patients with a meniscal tear) Effusion (~50% of patients presenting with a meniscal tear) Impaired range of motion – A mechanical block to motion or frank locking can occur with displaced tears; restricted motion commonly results from pain or swelling Provocative maneuvers that may elicit characteristic results in the presence of a meniscal tear include the following: McMurray test – Pain or a reproducible click Steinmann (...) test – Asymmetric pain with external (medial meniscus) or internal (lateral meniscus) rotation Apley test – Pain at the medial or lateral joint Thessaly test – Pain or a locking or catching sensation at the medial or lateral joint line Similar tests, including those that elicit the Bragard, Böhler, Payr, Merke, Childress, and Finochietto signs See for more detail. Diagnosis Imaging studies that may be considered include the following: Plain radiography – Anteroposterior weight-bearing view

2014 eMedicine.com

320. Heart Failure (Overview)

by the following four stages [ ] : Stage A: High risk of heart failure but no structural heart disease or symptoms of heart failure Stage B: Structural heart disease but no symptoms of heart failure Stage C: Structural heart disease and symptoms of heart failure Stage D: Refractory heart failure requiring specialized interventions Testing The following tests may be useful in the initial evaluation for suspected heart failure [ , , ] : Complete blood count (CBC) Iron studies Urinalysis Electrolyte levels Renal (...) and liver function studies Fasting blood glucose levels Lipid profile Thyroid stimulating hormone (TSH) levels B-type natriuretic peptide levels N-terminal pro-B-type natriuretic peptide levels Electrocardiography Chest radiography Two-dimensional (2-D) echocardiography Nuclear imaging [ ] Maximal exercise testing Pulse oximetry or arterial blood gas See for more detail. Management Treatment includes the following: Nonpharmacologic therapy: Oxygen and noninvasive positive pressure ventilation, dietary

2014 eMedicine.com

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