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41. Patients Hospitalized with Heart Failure: Risk Assessment, Management, and Clinical Trajectory

College of Physicians. Rheumatologic diseases Treat according to current guidelines, recognize that some biological agents may have cardiotoxicity or adverse effects in HF patients. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis Amyloidosis Screen for cardiac or systemic amyloidosis with or without polyneuropathy, with genetic testing as appropriate; consider treatment for ATTR and AL. Guidelines on the management of AL amyloidosis Cancer Assess for cardiac (...) TRAJECTORY CHECK The near-term clinical trajectory during hospitalization represents responsiveness to therapy in terms of clinical HF symptoms and signs and laboratory and diagnostic tests. This trajectory helps de?ne the next steps for management, care coordination, health outcomes risk and prognosis, and disposition. We have also highlighted a long-term trajectory assessment as a speci?c evaluation of progress toward resolution of symptoms and signs of congestion, ade- quacy of perfusion, stability

2019 American College of Cardiology

42. BTS/SIGN British Guideline on the Management of Asthma

Acute asthma 8 2.8 Difficult asthma 9 2.9 Asthma in pregnancy 9 2.10 Occupational asthma 9 3 Diagnosis 10 3.1 Definition and overarching principles 10 3.2 Predictive value of individual symptoms, signs and diagnostic tests 11 3.3 Practical approach to diagnosis 20 3.4 Organisation of diagnostic services 28 3.5 Wheezing in preschool children and the future risk of developing persistent asthma 29 4 Monitoring asthma 30 4.1 Targeting care 31 4.2 Monitoring current asthma symptom control 31 4.3 (...) . The grade of recommendation relates to the strength of the supporting evidence on which the recommendation is based. It does not reflect the clinical importance of the recommendation. 2.1 Diagnosis C Compare the results of diagnostic tests undertaken whilst a patient is asymptomatic with those undertaken when a patient is symptomatic to detect variation over time. D Carry out quality-assured spirometry using the lower limit of normal to demonstrate airway obstruction, provide a baseline for assessing

2019 British Thoracic Society

44. Antiocoagulation - oral

the management of people receiving apixaban, dabigatran, edoxaban, rivaroxaban, and warfarin treatment in primary care, including brief advice about the place of self-testing and self-management of warfarin. This Prodigy topic does not cover the management of acenocoumarol or phenindione and does not cover secondary care management. There are separate Prodigy topics on , , , , and . The target audience for this Prodigy topic is healthcare professionals working within the NHS in the UK, and providing first (...) to include recommendations and supporting evidence on the place of self-testing and self-management of warfarin. Advice on the management of the drug interaction between selective serotonin reuptake inhibitors (SSRIs) and warfarin has also been added. July 2009 — updated to include target INRs and duration of treatment for all indications for warfarin. A change to the recommendation concerning management of potential drug interaction between warfarin and macrolide antibiotics has also been made. December

2017 Prodigy

45. Enhancing Equitable Access to Assistive Technologies in Canada

. Road traffic crashes: operationalizing equity in the context of health sector reform. Injury Control and Safety Promotion 2003;10(1-2): 11–12). It is being tested by the Cochrane Collaboration Health Equity Field as a means of evaluating the impact of interventions on health equity. McMaster Health Forum 9 Evidence >> Insight >> Action Categorizations for assistive technologies for the following functions includes but are not limited to those for: • personal use in daily living and self care

2017 McMaster Health Forum

46. Diagnosis and Treatment of Peripheral Arterial Diseases

testing 770 4.1.4 Diagnostic methods for PADs 770 4.2 Treatment approach 771 4.2.1 Smoking cessation 772 4.2.2 Lipid-lowering drugs 772 4.2.3 Antithrombotic drugs 772 4.2.4 Antihypertensive drugs 772 5. Antithrombotic drugs in PADs 773 5.1 Antithrombotic treatment in carotid artery disease 773 5.1.1 Single antiplatelet therapy 773 5.1.2 Dual antiplatelet therapy 773 5.2 Antithrombotic therapy in lower extremity artery disease 774 5.2.1 Single antiplatelet therapy 774 5.2.2 Dual and triple antiplatelet (...) Prognosis 788 9.6 Treatment 788 9.6.1 Medical therapy 788 9.6.2 Revascularization 788 10. Lower extremity artery disease 789 10.1. Clinical presentation and natural history 789 10.2 Diagnostic tests 790 10.2.1 Ankle-brachial index 790 10.2.2 Treadmill test 790 10.2.3 Imaging methods 790 10.2.4 Other tests 791 10.3 Medical treatment 791 10.4 Revascularization options: general aspects 791 10.5 Management of intermittent claudication 791 10.5.1 Exercise therapy 791 10.5.2 Pharmacotherapy to decrease

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2017 European Society of Cardiology

47. 2017 Focused update on Dual Antiplatelet Therapy (DAPT)

DES for Treatment of Coronary Revascularization INR International normalized ratio ISAR Intracoronary Stenting and Antithrombotic Regimen ISAR-SAFE Intracoronary Stenting and Antithrombotic Regimen: Safety and Efficacy of 6 Months Dual Antiplatelet Therapy After Drug-Eluting Stenting ISAR-TRIPLE Intracoronary Stenting and Antithrombotic Regimen–Testing of a 6-Week Versus a 6-Month Clopidogrel Treatment Regimen in Patients With Concomitant Aspirin and Oral Anticoagulant Therapy Following Drug (...) Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome TRILOGY ACS Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndromes TRITON-TIMI 38 Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel–Thrombolysis in Myocardial Infarction TROPICAL-ACS Testing Responsiveness to Platelet Inhibition on Chronic Antiplatelet Treatment For Acute Coronary Syndromes Trial VA Veterans

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2017 European Society of Cardiology

48. Treatment of Hypertension in Association With Heart Failure

. Should clinicians choose to use this combination, they should closely monitor serum potassium and creatinine . In reference to thiazides, in the absence of placebo-controlled trials testing thiazides in patients with hypertension who have systolic dysfunction, the recommendation supporting use of thiazides was based on extrapolation from multiple thiazide-based antihypertensive trials showing reductions in stroke, MI and death rates (and thus Grade B) . 2. An ARB is recommended if ACE inhibitors (...) clinical trials. J Am Coll Cardiol 1997;30:27-34. Doughty RN, Rodgers A, SharpeN, MacMahon S. Effects of beta-blocker therapy on mortality in patients with heart failure. Eur Heart J 1997;18:560-5. Packer M, Bristow MR, Cohn JN, et al., for the US Carvedilol Heart Failure Study Group. The effect of carvedilol on morbidity and mortality in patients with chronic heart failure. N Engl J Med 1996;334:1349-55. Zannad F, McMurray JJ, Krum H, et al. Eplerenone in patients with systolic heart failure and mild

2018 Hypertension Canada

49. Treatment of Hypertension in Association With Ischemic Heart Disease

from some but not all cohort studies . The only clinical trial to test this hypothesis in a prospective randomized fashion is the Hypertension Optimal Treatment (HOT) trial . In the HOT trial, 18,790 patients with diastolic hypertension were randomly allocated to three different DBP targets: 90 mm Hg, 85 mm Hg, or 80 mm Hg. During the trial, DBP was reduced by 20.3 mm Hg, 22.3 mm Hg, and 24.3 mm Hg in these three target groups, respectively. Among the 3080 patients with CAD at baseline, the number (...) . Safety of nifedipine in angina pectoris. A meta- analysis. Hypertension 1999;33:24-31. Mann JF, Schmieder RE, McQueen M, et al. Renal outcomes with telmisartan, ramipril, or both, in people at high vascular risk (the ONTARGET study): A multicentre, randomised, double-blind, controlled trial. Lancet 2008;372:547-53. McMurray JJV, Ostergren J, Swedberg K, et al. Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin converting

2018 Hypertension Canada

50. Choice of therapy for Adults With Hypertension Without Compelling Indications for Specific Agents

. In recognition of the need for multidrug therapy, combination and add-on therapy trials are emerging. For example, at the end of the 5-year follow-up in ALLHAT, 63% of patients required at least two antihypertensive agents . Also, evidence supports the recommendation that combination therapy should be used if there is only a partial response to standard-dose monotherapy (Grade B). In a meta-analysis of 50 placebo-controlled trials testing drugs of two different categories separately and in combination (...) :2534-44. Kannel WB, Wolf PA, Benjamin EJ, Levy D. Prevalence, incidence, prognosis, and predisposing conditions for atrial fibrillation: Population-based estimates. Am J Cardiol 1998;82:2N-9N. Jibrini MB, Molnar J, Arora RR. Prevention of atrial fibrillation by way of abrogation of the renin-angiotensin system: A systematic review and meta-analysis. Am J Ther 2008;15:36-43. Stewart S, Hart CL, Hole DJ, McMurray JJ. A population-based study of the long-term risks associated with atrial fibrillation

2018 Hypertension Canada

51. Erectile Dysfunction

, and psychosocial history; a physical examination; and selective laboratory testing. (Clinical Principle) For the man with ED, validated questionnaires are recommended to assess the severity of ED, to measure treatment effectiveness, and to guide future management. (Expert Opinion) Men should be counseled that ED is a risk marker for underlying cardiovascular disease (CVD) and other health conditions that may warrant evaluation and treatment. (Clinical Principle) In men with ED, morning serum total testosterone (...) levels should be measured. (Moderate Recommendation; Evidence Level: Grade C) For some men with ED, specialized testing and evaluation may be necessary to guide treatment. (Expert Opinion) Treatment : 6. For men being treated for ED, referral to a mental health professional should be considered to promote treatment adherence, reduce performance anxiety, and integrate treatments into a sexual relationship. (Moderate Recommendation; Evidence Level: Grade C) 7. Clinicians should counsel men with ED who

2018 American Urological Association

52. Exam Series: Guide to the Knee Exam

Likelihood Ratio MM LM MM LM MM LM Joint line tenderness 71% 78% 87% 90% 5.46 7.80 McMurray 48% 65% 94% 86% 8.00 4.64 Apley’s 41% 41% 93% 86% 5.85 2.93 Thessaly 89% 92% 97% 96% 29.7 23.0 Clinical Utility of Special Tests for Meniscal Injury 7,8 Neurovascular exam: It is essential, especially in the case of trauma or suspected knee dislocation, to conduct a neurovascular exam as injury to the popliteal artery can result in loss of limb in as little as 8 hours. At the bedside, this involves locating distal (...) of the knees can be assessed by bending both the knee and hips to 90° while the patient lies supine, and then asking them to point their toes inwards (up to 30°) and outwards (up to 20°) Power: Check for power bilaterally, assessing for any muscular atrophy or spasm. Special tests: ACL Tear Rest both of your forearms on the patient’s tibia with their knee flexed to 90° and foot resting on the table. Pull forwards to elicit any anterior displacement. : Place one hand on the femur and the other

2018 CandiEM

53. Atrial Fibrillation Burden: Moving Beyond Atrial Fibrillation as a Binary Entity: A Scientific Statement From the American Heart Association

; P =0.02) Multivariate model included adjustment for age, sex, creatinine (log transformed), hypertension, DM, and previous stroke/TIA/thromboembolism, and CAD SPORTIF III and V Aim: To test the hypothesis that stroke and SEEs in SPORTIF III and V are different between paroxysmal and persistent AFSize: 13 822 Inclusion criteria: Age ≥18 y, persistent or paroxysmal AF and ≥1 risk factor for stroke: hypertension; age ≥75 y; previous stroke, TIA, or SEE; LVD (EF <40% or symptomatic HF); age ≥65 y (...) , pattern of AF, and factor of interest, and then testing significance of the interaction term for pattern of AF and factor of interest. ACTIVE indicates Atrial Fibrillation Clopidogrel Trial With Irbesartan for Prevention of Vascular Events; AF, atrial fibrillation; AMADEUS, Evaluating the Use of SR34006 Compared to Warfarin or Acenocoumarol in Patients With Atrial Fibrillation; ARISTOTLE, Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation; BMI, body mass index; CAD

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2018 American Heart Association

54. Erectile Dysfunction

) Copyright © 2018 American Urological Association Education and Research, Inc.® Guideline Statements: Evaluation and Diagnosis: 1. Men presenting with symptoms of ED should undergo a thorough medical, sexual, and psychosocial history; a physical examination; and selective laboratory testing. (Clinical Principle) 2. For the man with ED, validated questionnaires are recommended to assess the severity of ED, to measure treat- ment effectiveness, and to guide future management. (Expert Opinion) 3. Men should (...) be counseled that ED is a risk marker for underlying cardiovascular disease (CVD) and other health conditions that may warrant evaluation and treatment. (Clinical Principle) 4. In men with ED, morning serum total testosterone levels should be measured. (Moderate Recommendation; Evi- dence Level: Grade C) 5. For some men with ED, specialized testing and evaluation may be necessary to guide treatment. (Expert Opin- ion) Treatment: 6. For men being treated for ED, referral to a mental health professional

2018 American Urological Association

55. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association

of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science through September 2017. The document is organized and classified according to the American Heart Association to provide specific suggestions, considerations, or reference to contemporary clinical practice recommendations. Results: Chronic RHF is associated with decreased exercise tolerance, poor functional capacity, decreased (...) with increased morbidity and mortality in HFpEF populations. Two-year mortality in 1 study was ≈45% for patients with RVD compared with 7% in those without RVD. Exercise intolerance is common in people with HFpEF, and those with evidence of RVD have lower New York Heart Association classification. In an exercise comparison between 50 patients with HFpEF and 24 control subjects, those with HFpEF had impaired RV systolic and diastolic functional enhancement measured by invasive cardiopulmonary exercise testing

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2018 American Heart Association

56. AACE/ACE Comprehensive Type 2 Diabetes Management Algorithm

, prescription-grade omega-3-fat - ty acid, and/or niacin to reduce triglyceride levels and to prevent pancreatitis. While no large clinical trials have been designed to test this objective, observational data and retrospective analyses support long-term dietary and lipid management of hypertriglyceridemia for prophylaxis against or treatment of acute pancreatitis (260,261). ACKNOWLEDGMENT Amanda M. Justice, BA, provided editorial support and medical writing assistance in the preparation of this document

2018 American Association of Clinical Endocrinologists

57. Hoarseness (Dysphonia)

(dysphonia) is based strictly on clinical criteria and does not require testing. Hoarseness is the patient- and/or proxy-reported symptom of altered voice quality. Dysphonia is diagnosed by the clinician for individuals who present with complaints of abnormal voice or voice changes or if a proxy/parent has recognized abnormal voice or voice changes. The clinician should assess the quality of the voice. For example, a breathy voice may signify vocal fold paralysis or another cause of incomplete vocal fold

2018 American Academy of Otolaryngology - Head and Neck Surgery

58. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

activity by 95% ± 4%. Repeated dosing results in a significant reduction in the required ASA platelet inhibitory dose. The 50% inhibitory dose decreased from 26 mg (single dose) to 3.2 mg after repeated dosing. After daily dosing with 20 to 40 mg of ASA, 92% to 95% of COX activity is inhibited over 6 to 12 days. Antiplatelet effects have also been studied in healthy volunteers through platelet aggregation tests including optical aggregometry and ASA reaction units (ARUs). Aspirin reaction units (...) is a whole blood assay test to aid in the detection of platelet inhibition, and ARU is calculated as a function of the rate and extent of platelet aggregation. In individuals not taking ASA, ARUs are 550 or greater. When examining ARU changes following administration of 4 ASA dosing regimens (enteric-coated 81 mg, uncoated 81 mg, enteric-coated 325 mg, and uncoated 325 mg in normal volunteers), the maximal reductions in ARUs ranged from 37% to 41% from baseline values. When examining the induced

2018 American Society of Regional Anesthesia and Pain Medicine

59. End-of-Life Care for People Experiencing Homelessness

Medical Director Oncology/Palliative Care Providence Health and Services Portland, OR Health Care for the Homeless Clinicians’ Network ADAPTING YOUR PRACTICE: Recommendations for End-of-Life Care for People Experiencing Homelessness vii Table of Contents INTRODUCTION 1 Summary of Major Recommendations 3 Patient Assessment and Evaluation History 9 Physical Examination 14 Assessment, Screening, and Diagnostic Testing 18 Plan and Management Goals of Care 25 Advance Care Planning 29 Pain and Symptom (...) walks, assess his or her gait, stability and risk for falls, ability to sit and stand, general strength, and nutritional status. Assess if the patient needs assistive devices, such as a cane, walker, or wheelchair. Perform focused exams as indicated. Consider the use of validated exams to evaluate strength or risk of falls, such as i. Get Up and Go Test: https://www.ons.org/sites/default/files/TUG_Test-a.pdf ii. Physical Performance Test (9 items): http://www.brightonrehab.com/wp- content/uploads

2018 National Health Care for the Homeless Council

60. Evaluation and Management of Right-Sided Heart Failure

. The purpose of this scientific statement is to provide guidance on the assessment and management of RHF. Methods: The writing group used systematic literature reviews, published translational and clinical studies, clinical practice guidelines, and expert opinion/statements to summarize existing evidence and to identify areas of inadequacy requiring future research. The panel reviewed the most relevant adult medical literature excluding routine laboratory tests using MEDLINE, EMBASE, and Web of Science (...) is common in people with HFpEF, and those with evidence of RVD have lower New York Heart Association classification. In an exercise comparison between 50 patients with HFpEF and 24 control subjects, those with HFpEF had impaired RV systolic and diastolic functional enhancement measured by invasive cardiopulmonary exercise testing and simultaneous echocardiography. Increased left- and right-sided filling pressures and limitations in CO reserve correlated with abnormal augmentation in biventricular

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2018 International Society for Heart and Lung Transplantation

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