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McMurray Test

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401. Myocardial infarction Full Text available with Trip Pro

pain , , , Causes Usually , , , , , (ECGs), blood tests, Treatment , Medication , , Prognosis STEMI 10% risk of death (developed world) Frequency 15.9 million (2015) Myocardial infarction ( MI ), commonly known as a heart attack , occurs when decreases or stops to a part of the , causing damage to the . The most common symptom is or discomfort which may travel into the shoulder, arm, back, neck, or jaw. Often it occurs in the center or left side of the chest and lasts for more than a few minutes (...) of an is usually the underlying mechanism of an MI. MIs are less commonly caused by , which may be due to , , and extreme cold, among others. A number of tests are useful to help with diagnosis, including (ECGs), blood tests, and . An ECG, which is a recording of the heart's electrical activity, may confirm an ST elevation MI (STEMI) if is present. Commonly used blood tests include and less often . Treatment of an MI is time-critical. is an appropriate immediate treatment for a suspected MI. or may be used

2012 Wikipedia

402. Basal metabolic rate

energy utilization. The anaerobic threshold is defined as the energy utilization level of heart rate exertion that occurs without oxygen during a standardized test with a specific protocol for accuracy of measurement, [ ] such as the Bruce Treadmill protocol (see ). With four to six weeks of targeted training the body systems can adapt to a higher perfusion of mitochondrial density for increased oxygen availability for the Krebs cycle, or tricarboxylic cycle, or the glycolitic cycle. [ ] This in turn (...) leads to a lower resting heart rate, lower blood pressure, and increased resting or basal metabolic rate. [ ] By measuring heart rate we can then derive estimations of what level of substrate utilization is actually causing biochemical metabolism in our bodies at rest or in activity. [ ] This in turn can help a person to maintain an appropriate level of consumption and utilization by studying a graphical representation of the anaerobic threshold. This can be confirmed by blood tests and gas analysis

2012 Wikipedia

403. Leprosy

during speech. Often, atrophy of the testes with resulting impotence occurs. There is no recommended test to diagnose latent leprosy in asymptomatic contacts. However few people with latent leprosy went on to develop a positive test. Classification [ ] Several different approaches for classifying leprosy exist, but parallels exist. The World Health Organization system distinguishes "paucibacillary" and "multibacillary" based upon the proliferation of bacteria. (" -" refers to a low quantity (...) .) The Ridley-Jopling scale provides five gradations. The , though developed by the WHO, uses Ridley-Jopling and not the WHO system. It also adds an indeterminate ("I") entry. In , three groupings are used. WHO Ridley-Jopling Description test Paucibacillary tuberculoid ("TT"), borderline tuberculoid ("BT") A30.1, A30.2 Tuberculoid It is characterized by one or more skin macules and patches where skin sensations are lost because of damaged peripheral nerves that have been attacked by the human host's immune

2012 Wikipedia

404. Diabetes mellitus Full Text available with Trip Pro

of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test. According to the current definition, two fasting glucose measurements above 7.0 mmol/l (126 mg/dl) is considered diagnostic for diabetes mellitus. Per the WHO, people with fasting glucose levels from 6.1 to 6.9 mmol/l (110 to 125 mg/dl) are considered to have . people with plasma glucose at or above 7.8 mmol/l (140 mg/dl), but not over 11.1 mmol/l (200 mg/dl), two hours after (...) in the in 1993. Test subjects all had diabetes mellitus type 1 and were randomized to a tight glycemic arm and a control arm with the standard of care at the time; people were followed for an average of seven years, and people in the treatment had dramatically lower rates of diabetic complications. It was as a landmark study at the time, and significantly changed the management of all forms of diabetes. The United Kingdom Prospective Diabetes Study (UKPDS) was a clinical study conducted by Z

2012 Wikipedia

405. Statin Full Text available with Trip Pro

are addressed, the potential for benefit from a statin is weighed against the potential for adverse effects or drug interactions and informed patient preference is elicited. Moreover, if a risk decision was uncertain, factors such as family history, coronary calcium score, , and an inflammation test ( ≥ 2.0 mg/L) were suggested to inform the risk decision. Additional factors that could be used were an LDL-C ≥ 160 or a very high lifetime risk. However, critics such as Steven E. Nissen say that the AHA/ACC (...) effectively, Merck had to demonstrate the dangers of high cholesterol. As a result of public campaigns, people in the United States became familiar with their cholesterol numbers and the difference between HDL and LDL cholesterol, and rival pharmaceutical companies began producing their own statins, such as pravastatin (Pravachol), manufactured by Sankyo and . In April 1994, the results of a Merck-sponsored study, the , were announced. Researchers tested , later sold by Merck as Zocor, on 4,444 patients

2012 Wikipedia

406. Rosuvastatin

the lipid profile data (surrogate end-points) and too little on hard clinical end-points, which are available for other statins that had been on the market longer. The manufacturer responded by stating that few drugs had been tested so successfully on so many patients. In correspondence published in The Lancet , AstraZeneca's CEO called the editorial "flawed and incorrect" and slammed the journal for making "such an outrageous critique of a serious, well-studied medicine." In 2004, the consumer interest (...) . ^ . RxList. 14 November 2012 . Retrieved 1 December 2012 . . LactMed . U.S. National Library of Medicine . Retrieved 1 December 2012 . . . ^ . The Food and Drug Administration. March 14, 2005. Archived from on 2005-03-05 . Retrieved 2005-03-20 . - This page is subject to change; the date reflects the last revision date. Sattar, N; Preiss, D; Murray, HM; Welsh, P; Buckley, BM; de Craen, AJ; Seshasai, SR; McMurray, JJ; Freeman, DJ; Jukema, JW; Macfarlane, PW; Packard, CJ; Stott, DJ; Westendorp, RG

2012 Wikipedia

407. Results of arthroscopic all-inside repair for lateral meniscus root tear in patients undergoing concomitant anterior cruciate ligament reconstruction. (Abstract)

, or positive McMurray provocation testing observed at the last follow-up. No statistically significant improvement was observed in the coronal plane in the 18 follow-up MRI scans (P = .096); however, sagittal extrusion improved significantly (P = .007). Posterior lateral meniscus root tears were classified based on arthroscopic findings: type I, oblique flap; type II, T shape; type III, longitudinal cleavage; or type IV, chronic inner loss. A type I tear was found in 7 patients, type II in 4, type III in 4

2010 Arthroscopy

408. Diagnostic Values of 3 Methods for Evaluating Meniscal Healing Status After Meniscal Repair: Comparison Among Second-Look Arthroscopy, Clinical Assessment, and Magnetic Resonance Imaging. (Abstract)

follow-up time of 25.4 months (SD, 6.0; range, 17.4-48.3 months). Defined criteria for unhealed meniscus were any symptoms such as joint-line tenderness, swelling, locking, or positive McMurray test for clinical assessment; cleft or instability on second-look arthroscopy; and grade 3 signal intensity shown at the repaired site on postoperative MRI.Seventy-seven menisci were confirmed completely healed by second-look arthroscopy, with a total healing rate of 86.5%. Clinical assessment found 63 menisci

2011 American Journal of Sports Medicine

409. Biotin

with multiple sclerosis. Other conditions . More evidence is needed to rate biotin for these uses. How does it work? Biotin is an important component of enzymes in the body that break down certain substances like fats, carbohydrates, and others. There isn't a good laboratory test for detecting low biotin levels, so this condition is usually identified by its symptoms, which include thinning of the hair (frequently with loss of hair color) and red scaly rash around the eyes, nose, and mouth. Other symptoms (...) . Laboratory tests : Taking biotin supplements might interfere with the results of many different blood lab tests. Biotin can cause falsely high or falsely low test results. This might lead to missed or incorrect diagnoses. Tell your doctor if you are taking biotin supplements, especially if you are having lab tests done as you may need to stop taking biotin before your blood test. Most multivitamins contain low doses of biotin, which are not likely to interfere with blood tests, but talk to your doctor

2009 National Centre for Complementary and Alternative Medicine

410. Meniscal Repair for Radial Tears of the Midbody of the Lateral Meniscus. (Abstract)

criteria were radial tears involving the red-red or red-white zone. All patients underwent all-inside meniscal repair using absorbable sutures. Postoperative evaluation was performed using joint-line tenderness, McMurray test, range of motion, and follow-up magnetic resonance imaging (MRI) scan at 6 months postoperatively. Lysholm knee score and Tegner activity level were evaluated at last follow-up. In 4 patients, second-look arthroscopies were performed.The average follow-up was 36.3 months (...) . No patient had joint-line tenderness. Three patients complained of pain or a click on McMurray test. The mean follow-up range of motion was 138.6°. Follow-up MRI scans demonstrated that 5 (35.7%) menisci were healed, 8 (57.1%) were partially healed, and 1 (7.1%) was not healed. The follow-up Lysholm score was 94.7 (range, 81-100; standard deviation [SD] = 6.4) and Tegner score was 5.7 (range, 3-7; SD = 1.4). Second-look arthroscopies in 4 patients showed partial healing of meniscal tears.Meniscal repair

2010 American Journal of Sports Medicine

411. Comparison of arthroscopic medial meniscal suture repair techniques: inside-out versus all-inside repair. (Abstract)

with absorbable sutures. Identical postoperative rehabilitation protocols were used. Postoperative evaluations included Lysholm knee scoring scale, Tegner activity levels, Lachman and pivot-shift tests, and KT-1000 arthrometer. Assessment of meniscal status was performed using joint line tenderness, McMurray test, and range of motion. Follow-up magnetic resonance imaging scans were obtained on all patients.Mean follow-up was 35.7 months. No patient had joint line tenderness or reported pain or clicking (...) on McMurray test. There was no significant difference in range of motion between groups. Follow-up magnetic resonance imaging scans demonstrated that 10 (71.4%) menisci were healed and 4 (28.6%) partially healed in the all-inside group; 24 (70.6%) menisci were healed and 10 (29.4%) partially healed in the inside-out group. There was no significant difference in meniscal healing between groups. There were no differences in Lachman test, KT-1000 arthrometer side-to-side differences measurements, Lysholm

2009 American Journal of Sports Medicine

412. Role of Natriuretic Peptides in Diagnosing Heart Failure

proBNP can be analyzed by so-called point-of-care methods that yield results within about 15 minutes. A rapid test result benefits the physician and patient alike, assuming that diagnostic quality is satisfactory. Primary question Does determining the concentration of B-type natriuretic peptides (BNP and N-terminal proBNP) in the blood facilitate and improve diagnostics in heart failure? Patient benefit Several studies have shown that natriuretic peptide testing has a high negative predictive value (...) , which means that one can rule out with considerable certainty that a patient has heart failure. This knowledge can help accelerate the diagnosis of other possible disorders. However, the positive predictive value of the test is not equally as high. Hence, it is necessary to complement the test with an assessment of cardiac function to determine, usually through echocardiography, whether or not the patient has heart failure. Further research is required to determine the optimum decision cut-points

2006 Swedish Council on Technology Assessement

413. Guidelines for the management of acute coronary syndromes

be given warning of incoming patients in whom there is a high suspicion of an ACS — particularly ST-segment-elevation myocardial infarction (STEMI) — or whose condition is unstable. Where appropriate, a 12-lead electrocardiogram (ECG) should be taken en route and transmitted to a medical facility. Where formal protocols are in place, prehospital treatment (including fibrinolysis in appropriate cases) should be facilitated. Investigations The ECG is the sole test required to select patients (...) levels are normal after a suitable period of observation should, where practicable, undergo provocative testing (eg, stress test) before discharge. Management of patients with ST-segment-elevation myocardial infarction Adjuvant therapy in association with reperfusion All patients undergoing reperfusion therapy for STEMI (PCI or fibrinolysis) should be given aspirin and clopidogrel unless these are contraindicated. Antithrombin therapy should be given in combination with PCI or fibrinolytic therapy

2006 MJA Clinical Guidelines

414. Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: a position statement Full Text available with Trip Pro

to identify asymptomatic kidney dysfunction at an earlier stage. eGFR correlates well with complications of CKD and an increased risk of adverse outcomes such as cardiovascular morbidity and mortality. We recommend that pathology laboratories automatically report eGFR each time a serum creatinine test is ordered in adults. As the accuracy of eGFR is suboptimal in patients with normal or near-normal renal function, we recommend that calculated eGFRs above 60 mL/min/1.73m 2 be reported by laboratories (...) to increase the detection of asymptomatic CKD is therefore problematical. GFR is widely accepted as the best measure of kidney function, yet in clinical practice beyond nephrology it is infrequently utilised. The main impediment to its regular clinical use has been the perception that it was necessary to estimate GFR by performing a creatinine clearance test that is dependent on a timed urine collection (usually 24 hours). More recently, calculating estimated GFR (eGFR) using an empirical mathematical

2005 MJA Clinical Guidelines

415. ACC/AHA/ESC 2006 Guidelines for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death

761 5.2.1. Resting electrocardiogram. 761 5.2.2. Exercise testing 761 5.2.3. Ambulatory electrocardiography 762 5.2.4. Electrocardiographic techniques and measurements. 762 5.2.5. Left ventricular function and imaging . 763 5.2.5.1. Echocardiograph . 763 5.2.5.2. Cardiac magnetic resonance imaging 764 5.2.5.3. Cardiac computed tomography 764 5.2.5.4. Radionuclide techniques 764 5.2.5.5. Coronary angiography 764 5.3. Electrophysiological testing 764 5.3.1. Electrophysiological testing in patients (...) with coronary heart diseases 765 5.3.2. Electrophysiological testing in patients with dilated cardiomyopathy 765 5.3.3. Electrophysiological testing in repolarization anomalies due to genetic arrhythmia syndromes 765 5.3.3.1. Long QTsyndrome . 765 5.3.3.2. Brugada syndrome . 765 5.3.3.3. Hypertrophic cardiomyopathy 765 5.3.3.4. Arrhythmogenic right ventricular cardiomyopathy. . 765 5.3.4. Electrophysiological testing in patients with out?ow tract ventricular tachycardia 765 5.3.5. Electrophysiological

2006 European Society of Cardiology

416. Metaanalysis of recurrence after laparoscopic repair of paraesophageal hernia

Metaanalysis of recurrence after laparoscopic repair of paraesophageal hernia Metaanalysis of recurrence after laparoscopic repair of paraesophageal hernia Metaanalysis of recurrence after laparoscopic repair of paraesophageal hernia Rathore M A, Andrabi S I, Bhatti M I, Najfi S M, McMurray A CRD summary This review aimed to determine the true incidence of recurrence after laparoscopic-paraesophageal hernia (lap-PEH) repair and concluded that the true incidence was 25.5%. Concerns about (...) test and by visual assessment of a results plot; it was unclear how these calculations were made, as there appeared to be no comparator groups. Sensitivity analyses were conducted. An odds ratio and a risk ratio were calculated to compare pre- and post-2000 studies. Results of the review Thirteen retrospective case series were included in the review (n=965). Studies generally lacked a clear aim, were underpowered, had deficiencies in assessing outcomes and had high losses to follow up. Ninety-nine

2007 DARE.

417. The diagnosis of meniscus tears: the role of MRI and clinical examination Full Text available with Trip Pro

the magnetic field strength (Tesla), number of sequences obtained and criteria for a positive diagnosis. The included studies of clinical examinations used McMurray’s and Apley’s tests at 5 degrees flex, and Thessaly’s test at 5 or 20 degrees flex. Reference standard test against which the new test was compared The authors stated that studies in which all patients received the reference standard were eligible for inclusion. The included studies used arthroscopy as the reference standard. Participants (...) by an experienced orthopaedist. Five studies using McMurray’s, Apley’s, Ege’s or Thessaly’s test at 5 degrees flex indicated high specificity and low sensitivity. By comparison, the Thessaly’s test at 20 degrees flex indicated high sensitivity and specificity. Joint line test results had higher sensitivity but lower specificity (4 studies). Studies involving patients with acute injuries, patients with recurrent pain after a previous meniscal repair or partial meniscectomy, and studies involving adolescents

2007 DARE.

418. Diagnostic arthroplasty for conditions of the knee

in those late in their seventh decade (Wells et al 2002). Diagnosing knee conditions Initial screening usually involves a comprehensive patient history and preliminary physical examination. Physical tests for meniscal injuries include the McMurray test, the joint line tenderness test and the Apley compression test (Scholten et al 2007; Ryzewicz et al 2007). The three physical tests commonly used to assess ligamentous injuries are the anterior drawer test, the Lachman test and the pivot shift test (...) - Medical history Physical examination (for example, McMurray test) X-ray Mechanical problem suspected No mechanical problem suspected Medial-cruciate ligament tear Isolated anterior- cruciate ligament/ posterior-cruciate tear Locked knee due to meniscal tear Injury to postero-lateral complex Diagnostic arthroscopy Successful rehabilitation Unsuccessful rehabilitation Suspected OA/RA Further physical tests e.g. blood tests MRI/Ultrasound NOTE: In some cases surgeons bypass MRI when the patient has

2008 Publication 80

419. Treatment and Recommendations on Reproductive Health Care for Homeless Patients

and Recommendations on Reproductive Health Care for Homeless Patients vi Health Care for the Homeless Clinicians’ Network Table of Contents Summary of Recommendations vii Introduction 1 Case Study: Reproductive Health Care for a Homeless Adolescent 3 DIAGNOSIS AND EVALUATION History 4 Physical examination 5 Diagnostic tests 6 PLAN AND MANAGEMENT Education, self-management 7 Medications/contraceptive devices 8 Associated problems/complications 10 Follow-up 11 Primary Sources 12 Other References 12 Suggested (...) attitude Make every effort to convey openness to patient deci- sions regarding sexual behavior, desire to use contraception, and plans regarding pre- sent or future childbearing. Diagnostic tests ? STD screening Concurrently assess for and treat sexually transmitted diseases. Test for gonorrhea, chlamydia, syphilis, HIV (following local regulations regarding pa- tient consent), hepatitis B antigen, trichomonas, bacterial vaginosis, and monilia. Don’t neglect possibility of infection of multiple

2008 National Health Care for the Homeless Council

420. Treatment and recommendations for homeless people with with Otitis Media

Carolina. ADAPTING YOUR PRACTICE: Treatment & Recommendations for Homeless Children with Otitis Media Health Care for the Homeless Clinicians’ Network v Table of Contents Summary of Recommended Practice Adaptations vi Introduction 1 Case Study: Homeless Child with Otitis Media with Effusion 3 DIAGNOSIS AND EVALUATION History 4 Physical examination 7 Diagnostic tests 8 Case Study: Homeless Child with Acute Otitis Media 9 PLAN AND MANAGEMENT Education, self-management 10 Medications 12 Associated (...) . In evaluating ear pain, consider possibility of a foreign body in the ear. • Dental examination – Evaluate for dental caries and other oral health problems that may cause ear pain. (Homeless families often have unmet dental health needs.) Diagnostic tests • Pneumatic otoscopy/ typanometry/ acoustic reflectometry – Consider cost- effectiveness, accuracy, availability, and ease of use on outreach in selecting a device to confirm Dx of AOM/ OME. Pneumatic otoscopy recommended if other diagnostic technologies

2008 National Health Care for the Homeless Council

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