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McMurray Test

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421. 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

422. 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

423. 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

424. 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.

425. 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.

426. 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

427. 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

428. 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

429. Treatment and recommendations for homeless people with asthma

of Contents Summary of Recommendations v Introduction 1 ADULT ASTHMA Case Study: Homeless Adult with Asthma 3 Diagnosis and Evaluation History 4 Physical examination 5 Diagnostic tests 6 Plan and Management Education, self-management 7 Medications 8 Associated problems/complications 9 Follow-up 10 PEDIATRIC ASTHMA Case Study: Homeless Child with Asthma 11 Diagnosis and Evaluation History 12 Physical examination 13 Diagnostic tests 13 Plan and Management Education, self-management 14 Medications 15 (...) for cognitive deficits, delusions, hallucinations, and signs and symptoms of psychoactive substance use that complicate treatment adherence. Diagnostic tests • Spirometry – Access to spirometry may be limited; history, physical examination, and peak flow measurement may be the only available options for diagnosis. • Tuberculin testing and chest X-ray – Maintain a high index of suspicion for tuberculosis as an alternative or co-existing condition. Screen for tuberculosis with purified protein derivative

2008 National Health Care for the Homeless Council

430. BPG for the Subcutaneous Administration of Insulin in Adults with Type 2 Diabetes

the project forward faster and stronger than ever imagined. The nursing community, with its commitment and passion for excellence in nursing care, is providing the knowledge and countless hours essential to the creation and evaluation of each guideline. Employers have responded enthusiastically to the request for proposals (RFP), and are opening their organizations to pilot test the NBPGs. Now comes the true test in this phenomenal journey: will nurses utilize the guidelines in their day-to-day practice (...) frequency of testing will vary according to diabetes treatment and the individual’s need and ability. 5. Individuals who self-monitor blood glucose should receive initial instruction and periodic re-education regarding self-testing technique, meter maintenance, and verification of accuracy of self-testing results. 6. Nurses should ensure clients taking insulin receive appropriate basic nutrition information. 7. Clients treated with insulin, and their caregivers, should be taught how to prevent

2004 Registered Nurses' Association of Ontario

431. Nursing Care of Dyspnea:The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease

the program forward faster and stronger than ever imagined. The nursing community, with its commitment and passion for excellence in nursing care, is providing the knowledge and countless hours essential to the creation and evaluation of each guideline. Employers have responded enthusiastically to the request for proposals (RFP), and are opening their organizations to pilot test the NBPGs. Now comes the true test in this phenomenal journey: Will nurses utilize the guidelines in their day-to-day practice (...) those most likely to be affected by COPD. As part of the basic dyspnea assessment, nurses should ask every patient: ¦ Do you have progressive activity-related shortness of breath? ¦ Do you have a persistent cough and sputum production? ¦ Do you experience frequent respiratory tract infections? 1.4 For patients who have a history of smoking and are over the age of 40, nurses IV should advocate for spirometric testing to establish early diagnosis in at risk individuals. *See pg. 13 for details

2005 Registered Nurses' Association of Ontario

432. Reducing Foot Complications for People with Diabetes

, with its commitment and passion for excellence in nursing care, is providing the knowledge and countless hours essential to the creation and evaluation of each guideline. Employers have responded enthusiastically to the request for proposals (RFP), and are opening their organizations to pilot test the NBPGs. Now comes the true test in this phenomenal journey: Will nurses utilize the guidelines in their day-to-day practice? Successful uptake of these NBPGs requires a concerted effort of four groups (...) of Ottawa Project Staff: Barbara Helliwell, BA(Hons); Marilyn Kuhn, MHA; Diana Ehlers, MA(SW), MA(Dem); Lian Kitts, RN; Elana Ptack, BA; Isabelle St-Pierre, BScN, MScN (cand) University of Ottawa RNAO sincerely acknowledges the leadership and dedication of the researchers who have directed the evaluation of the Nursing Best Practice Guidelines Project. The Evaluation Team is comprised of: RNAO wishes to acknowledge the following organizations in Sudbury, Ontario for their role in pilot testing

2004 Registered Nurses' Association of Ontario

433. Intimate Partner Violence During the Perinatal Period

appointment or does not provide funding for prescriptions or needs such as glucose test strips. • Partner interferes with woman obtaining the care she needs while in the health care system, e.g. never leaves the woman alone. • Partner describes woman as mentally ill and a danger to herself as a strategy to discredit and control her. 72 • Disabled women are sometimes forced to rely on their abusive partners as their primary caregivers, rendering them dependent on their abuser to get them the health care

2003 British Columbia Perinatal Health Program

434. Does this patient have a torn meniscus or ligament of the knee: value of the physical examination

. Specific interventions included in the review Studies that compared the performance of the physical examination of the knee with a reference standard were eligible for inclusion. The types of physical examination manoeuvres in the included studies were: general examination, anterior draw test, lateral pivot shift test, Lachmann test, joint line tenderness, posterior draw test, McMurray test, Apley compression test, medial-lateral grind test, joint effusion and combinations of these manoeuvres (...) LRs were 21.0 (95% CI: 2.1, 205.0) for a positive examination and 0.05 (95% CI: 0.01, 0.50) for a negative examination. Meniscal examination. Using the McMurray test (3 studies, n=344), the summary LRs were 1.3 (95% CI: 0.9, 1.7) for a positive examination and 0.8 (95% CI: 0.6, 1.1) for a negative examination. For joint line tenderness (2 studies, n=244), the summary LRs were 0.9 (95% CI: 0.8, 1.0) and 1.1 (95% CI: 1.0, 1.3) for a positive and negative examination, respectively. Using

2001 DARE.

435. Cost-effectiveness of different ACE inhibitor treatment scenarios post-myocardial infarction

Cost-effectiveness of different ACE inhibitor treatment scenarios post-myocardial infarction Cost-effectiveness of different ACE inhibitor treatment scenarios post-myocardial infarction Cost-effectiveness of different ACE inhibitor treatment scenarios post-myocardial infarction McMurray J J, McGuire A, Davie A P, Hughes D Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods (...) . Currency UK pounds Sterling (). Sensitivity analysis A one-way sensitivity analysis was carried out in order to test the variability in the data. The parameters on which the sensitivity analysis was based were the estimate of long-term survival, the direct incremental cost of treatment, and the incremental costs or savings associated with improved survival in the ACE inhibitor subgroups. Estimated benefits used in the economic analysis The life years gained with post-MI ACE inhibitor treatment

1997 NHS Economic Evaluation Database.

436. The West of Scotland coronary prevention study: economic benefit analysis of primary prevention with pravastatin

The West of Scotland coronary prevention study: economic benefit analysis of primary prevention with pravastatin The West of Scotland coronary prevention study: economic benefit analysis of primary prevention with pravastatin The West of Scotland coronary prevention study: economic benefit analysis of primary prevention with pravastatin Caro J, Klittich W, McGuire A, Ford I, Norrie J, Pettitt D, McMurray J, Shepherd J Record Status This is a critical abstract of an economic evaluation (...) -fatal MI, silent MI, fatal MI, etc., the cost of pravastatin (40 mg), and monitoring (liver function test, lipid profile, and a visit to the general practitioner every six months). The perspective adopted in the cost analysis was that of the National Health Service (NHS). The main source of resource use data was the WOSCOPS study. The sources of cost data were extra-contractual tariffs from over 200 Trusts. 1996 price data were used. The cost analysis did not cover the costs of subsequent hospital

1997 NHS Economic Evaluation Database.

437. Are the WOSCOPS clinical and economic findings generalizable to other populations? A case study for Belgium

utilised, as their primary source of effectiveness data, a good quality trial (WOSCOPS) and modelled effectiveness using epidemiological and demographic data for a Belgian population, which was an appropriate approach to test the generalisability hypothesis. In conjunction with the sensitivity analysis the results are likely to have high validity. Validity of estimate of measure of benefit The estimation of benefits was appropriately obtained directly from the effectiveness analysis. Validity (...) , Macfarlane P W, McKillop J H, Packard C J, for the West of Scotland Coronary Prevention Study Group. Prevention of coronary heart disease with pravastatin in men with hypercholesterolaemia. New England Journal of Medicine 1995;333:1301-7. Caro J, Klittich W, McGuire A, Ford I, Norrie J, Pettitt D, McMurray J, Shepherd J, for the West of Scotland Coronary Prevention Study Group. West of Scotland Coronary Prevention Study: weighing the costs and benefits of primary prevention with pravastatin. BMJ

2000 NHS Economic Evaluation Database.

438. Children and physical activity: a systematic review of barriers and facilitators

of interventions they should be developing and testing further and why (e.g. practitioners, service commissioners, policy specialists, researchers, research commissioners) may be most interested in reading chapters 7, 8 and 9. Chapter 8 contains a discussion of how the findings of the review relate to current policy and practice in physical activity promotion. Examples of physical activity promotion not covered in the in-depth review can be found in chapter 3. Readers interested in guidance on how best (...) behaviour, as the two studies testing this approach demonstrated changes in children’s knowledge only 3Children and Physical Activity: A Systematic Review of Barriers and Facilitators In-depth review: results from studies examining children’s views Studies of children’s views about physical activity appear to be rare. The five studies we identified were difficult to find: four were identified only through searches on specialist health promotion registers and one was found through contact with the author

2003 EPPI Centre

439. Use of Cidofovir for Recurrent Respiratory Papillomatosis

. For general information, Layout table for eligibility information Ages Eligible for Study: 5 Years and older (Child, Adult, Older Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: 4 surgeries for RRP in last 12 months Exclusion Criteria: Renal insufficiency Nephrotoxic drugs in the last 7 days Sulfa allergies Currently treated with systemic or topical HPV chemotherapeutic agents Females of childbearing potential with a positive pregnancy test Women who (...) are breast feeding Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor. Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00205374 Sponsors and Collaborators University of Wisconsin, Madison Investigators Layout table for investigator information Principal Investigator: J. Scott McMurray, MD University

2005 Clinical Trials

440. Arthroscopic meniscal repair: a comparative study between three different surgical techniques. (Abstract)

(group C) were managed by the all-inside technique using the Mitek RapidLoc soft tissue anchor (Mitek Surgical Products, Westwood, MA, USA). Anterior cruciate ligament (ACL) reconstruction was performed in 29 patients (51%). The criteria for clinical success included absence of joint line tenderness, locking, swelling, and a negative McMurray test. The minimum follow-up was one year for all groups. The mean follow-up was 23 months for group A, 22 months for group B, and 22 months for group C. All

2006 Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Controlled trial quality: uncertain

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