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McMurray Test

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61. Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

when tested in its original English version and 12 other languages among 3,851 critically ill adults from 28 countries ( ). This is less than reported for either the BPS or the CPOT because the feasibility and impact of its use once implemented in clinical practice remain to be investigated. By the time this implementation research is complete, it may be of use in countries/languages where neither the BPS nor CPOT has been validated ( ). Each of the other scales considered (i.e., the Face, Legs (...) were similar, they were significantly higher among nurses (vs patients) for position change, subcutaneous injection, blood sugar testing, and blood pressure (BP) measurement ( ). No statistical measure of agreement between nurse and ICU patient scores was reported. Finally, compared with seriously ill patients’ self-reports, surrogates correctly identified pain presence 74% of the time and pain severity 53% of the time, with a tendency to overestimate pain intensity ( ). There are families who may

2018 Society of Critical Care Medicine

62. The British Society for Rheumatology biologic DMARD safety guidelines in inflammatory arthritis

* Monitoring Monitor* Test* Connective tissue disease Drug induced vasculitis Drug AND induced AND lupus Drug induced lupus Haematological disorders Anaemia Neutropenia Pancytopenia Aplastic anaemia Lymphopeni* Thrombocytopeni* Psoriasis Drug induced psoriasis Peri-operative period Postoperative infection Surgery + infection Other terms Elderly Geriatric* Care of the elderly Mortality Safety Topic Search terms used in addition to either: ‘Rheumatoid + arthritis’, ‘Ankylosing spondylitis’, ‘Seronegative (...) Ischaemic heart disease Ischemic heart disease Myocardial infarct* Coronary artery bypass graft NSTEMI STEMI Acute coronary syndrome Respiratory disease Interstitial lung disease Fibrosis Pulmonary fibrosis Uveitis Uveitis Drug induced uveitis Demyelinating disease Demyelinat* Neuro* Optic neuritis Multiple sclerosis Diverticular disease Diverticul* Vaccinations Vaccin* Vaccine Pneumococcal vacc* Influenza vacc* Singles vacc* Hepattiis vac* Monitoring Monitor* Test* Connective tissue disease Drug

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2018 British Society for Rheumatology

65. Multidisciplinary guidelines for the management of paediatric tracheostomy emergencies

differences in paediatric management. Early versions were discussed among the Working Party and our multidisciplinary colleagues, and were tested using high‐fidelity medical simulation at local bespoke meetings using faculty and volunteers. Key steps were designed to address contributing factors to poorly managed emergencies, which include lack of access to information or emergency algorithms, loss of situational awareness and poor communication , . We recognised the role that simulation could play (...) in further refining the algorithm key steps and have previously described testing versions of the algorithm in over 450 volunteer healthcare professional encounters at national and international meetings, where the algorithm was also formally presented . We were able to demonstrate significant improvements in performance metrics when multidisciplinary responders followed the algorithm in similar scenarios. Scenarios were completed more quickly, the simulated children were less hypoxic and more candidates

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2018 Association of Paediatric Anaesthetists of Great Britain and Ireland

66. Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions

assessment, assessment of knee active range of motion, maximum voluntary isometric or isokinetic quadriceps strength testing, forced hyperextension, maximum passive knee flexion, McMurray's maneuver, and palpation for joint-line tenderness. Clinicians may administer the appropriate physical impairment assessments of body structure and function, at least at baseline and at discharge or 1 other follow-up point, for all patients with articular cartilage lesions to support standardization for quality (...) ) may be used to assess knee-related quality of life. Examination — Physical Performance Measures 2018 Recommendation Clinicians may administer appropriate clinical or field tests, such as single-legged hop tests (eg, single hop for distance, cross-over hop for distance, triple hop for distance, and 6-m timed hop), that can identify a patient's baseline status relative to pain, function, and disability; detect side-to-side asymmetries; assess global knee function; determine a patient's readiness

2018 American Physical Therapy Association

67. Management of Hypertension (5th Edition)

Korotkoff V is absent. 238(Level III) Measurement of BP is similar to that of the general population, as stated earlier. 37 8.8.1.1 Proteinuria Significant proteinuria in pregnancy is defined as =300 mg protein in a 24 hour urine sample, or a spot urine protein-creatinine ratio =30 mg/mmol. 238 If the dipstick is the only test available, 1+ (30 mg/dl) is often, but not always, associated with =300 mg/day proteinuria. 238 Significant proteinuria reflects advanced disease and is associated with poorer

2018 Ministry of Health, Malaysia

68. Anticoagulants in non-valvular atrial fibrillation

CHA2DS2-VASc scores according to conservative and liberal approach 138 Figure 29 - Percentage of patients by number of tests performed in the year following first OAC prescription for chronic use – Chronic AF users (period 2012-2014) 141 Figure 30 - Number of visits in the year following first OAC prescription for chronic use– Chronic AF users (period 2012-2014) 142 Figure 31 - First physician prescribing OAC (Period 2005-2014) 143 Figure 32 - Percentage of patients with a gap of at least 6-months (...) : systematic review. Asian and Western studies: data extracted from Joundi et al.(systematic review until April 2015). 9 Forest plots in the Appendix to this report. CHA2DS2-VASc showed a modest improvement in predictive value against CHADS2. 5, 10 The c-statistic, representing a measure of the predictive ability of the test to correctly classify an individual into low (score=0), intermediate (score=1) or high (score>1) risk for thromboembolism, is 0.586 (0.477- 0.695) for CHADS2 and 0.606 (0.513-0.699

2017 Belgian Health Care Knowledge Centre

69. British guideline on the management of asthma

and monitoring 8 2.2 Supported self management 9 2.3 Non-pharmacological management 10 2.4 Pharmacological management 10 2.5 Inhaler devices 10 2.6 Acute asthma 11 2.7 Difficult asthma 12 2.8 Asthma in pregnancy 12 2.9 Occupational asthma 12 3 Diagnosis 13 3.1 Definition and overarching principles 13 3.2 Predictive value of individual symptoms, signs and diagnostic tests 14 3.3 Practical approach to diagnosis 22 3.4 Organisation of diagnostic services 31 3.5 Wheezing in pre-school children and the future (...) , and organisation and delivery of care. 1• Introduction4 | British guideline on the management of asthma 1.2.4 SUMMARY OF UPDATES TO THE 2016 EDITION OF THE GUIDELINE, BY SECTION 2 Key recommendations New: 2.1.1 Diagnosis Updated: 2.5 Inhaler devices Minor updates: 2.3 Non-pharmacological management, 2.4 Pharmacological management, 2.6.1 Acute asthma in adults 3 Diagnosis New: 3.1 Definition and overarching principles, 3.2 Predictive value of individual symptoms, signs and diagnostic tests, 3.3 Practical

2016 SIGN

70. Management of chronic heart failure

pressure Peripheral oedema (ankle, sacral, scrotal) Hepatojugular reflux Pulmonary crepitations Third heart sound (gallop rhythm) Reduced air entry and dullness to percussion at lung bases (pleural effusion) Laterally displaced apical impulse Tachycardia Cardiac murmur Irregular pulse Tachypnoea (>16 breaths/min) Hepatomegaly Ascites Tissue wasting (cachexia) Reproduced from McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, et al. ESC guidelines for the diagnosis and treatment (...) are most useful rather than any of these in isolation. Basic early investigations are necessary to differentiate heart failure from other conditions and to provide prognostic information. Urinalysis, serum urea and creatinine tests may help to determine if there is kidney failure, since symptoms of kidney disease are similar to those of HF . Chest X-ray may indicate signs of HF such as cardiomegaly, pulmonary congestion or pleural effusion and also non-cardiac indications such as lung tumours which

2016 SIGN

71. Acute coronary syndrome

coronary intervention 20 6 Risk stratification and non-invasive testing 22 6.1 Risk stratification 22 6.2 Assessment of cardiac function 22 6.3 Stress testing 23 7 Invasive investigation and revascularisation 24 7.1 Invasive investigation 24 7.2 Access routes for percutaneous coronary intervention 25 7.3 Glycoprotein IIb/IIIa receptor antagonists 26 7.4 Coronary artery bypass grafting surgery 26 8 Early pharmacological intervention 28 8.1 Antiplatelet therapy 28 8.2 Anticoagulant therapy 29 8.3 Statin (...) to be admitted to hospital for serial testing. Use of a high-sensitivity cardiac troponin assay permits the use of lower diagnostic thresholds than standard troponin assays, and allows earlier testing that may reduce unnecessary hospital admissions, waiting times for test results and associated anxiety in patients and carers. 37 Early rule-out protocols typically involve serial cardiac troponin measurements on presentation and three hours later. 38 High-sensitivity cardiac troponin assays appear to improve

2016 SIGN

72. Should Beta Blockers be Used in Heart Failure with Preserved Ejection Fraction?

examined the role of beta-blockers in patients with heart failure, 95% of whom had a reduced ejection fraction. This investigation showed that the survival benefit for beta-blockers is associated with the magnitude of the reduction in heart rate but not the drug dosage [10]. Similarly, at least 3 large randomized control studies conducted in the United States, testing bisoprolol, carvedilol, and metoprolol in over 10,000 patients with HFrEF, have confirmed the [11]. In contrast, beta-blockers are more (...) of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines,” Journal of the American College of Cardiology, vol. 62, no. 16, pp. e147-e239, 2013. [8] J. J. V. McMurray, “Systolic heart failure,” New England Journal of Medicine, vol. 362, no. 3, pp. 228-238, 2010. [9] J. J. V. McMurray, S. Adamopoulos, S. D. Anker et al. , “ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012,” European

2017 Clinical Correlations

73. Management of Patients on Non?Vitamin K Antagonist Oral Anticoagulants in the Acute Care and Periprocedural Setting: A Scientific Statement From the American Heart Association

treatment for AIS patients re- ceiving NOACs must balance the anticoagulant effect of these agents and the ICH risk associated with reperfusion strategies. As has been mentioned previously, routinely performed blood coagulation studies do not reliably ex- clude a significant plasma concentration of the NOACs. Another difficulty in a time-sensitive setting is that the more sensitive blood tests are either not routinely avail- able or have an unacceptably long delay to results. In experimental studies (...) study 76 comprised 78 NOAC-treated patients undergoing intravenous throm- bolysis or intra-arterial therapy a median of 13 hours after the last NOAC dose compared with 441 warfarin- treated patients and 8938 on no anticoagulants. After propensity score matching, there was no significant dif- ference in rate of any ICH, symptomatic ICH, or death among the groups. In the absence of immediately avail- able blood tests sensitive to the presence of NOACs, determining which patients taking these agents

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2017 American Heart Association

74. 2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines

not have a high procedural risk. 43–46,48 Surgical series demonstrate improved symptoms after AVR, and most patients have an improvement in exercise tolerance, as documented in studies with pre- and post-AVR exercise stress testing. 43–46,48 The choice of prosthetic valve type is discussed in Section 11.1 of this focused update. I A Surgical AVR or TAVR is recommended for symptomatic patients with severe AS (Stage D) and high risk for surgical AVR, depending on patient-specific procedural risks, values

2017 American Heart Association

75. Dietary Fats and Cardiovascular Disease (PubMed)

, polyunsaturated fat or carbohydrates, differed among trials. Reviewers who evaluate these trials must take into account the specific nutritional experiment that was conducted and the level of its adherence throughout the follow-up period. Low Saturated, High Polyunsaturated Fat Diets In the mid-1950s, 4 research groups reported that replacing saturated fat from animal products with polyunsaturated fat from vegetable oils substantially reduced serum cholesterol levels. Soon, controlled trials followed to test (...) % to 70% of the full effect. , Trials of serum cholesterol–lowering agents show that a reduction in coronary heart disease (CHD) incidence occurs with a lag of 1 to 2 years. These systematic reviews , , together found and analyzed 6 additional trials , , that replaced saturated with polyunsaturated fat but did not have ≥1 of these characteristics crucial to testing the hypothesis. We also discuss these “noncore” trials and evaluate their potential impact on the overall result on dietary saturated

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2017 American Heart Association

76. 2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of Amer

and potential off-target effects may be complex with inhibition of the neprilysin enzyme, which has multiple biological targets. Use of an ARNI is associated with hypotension and a low-frequency incidence of angioedema. To facilitate initiation and titration, the approved ARNI is available in 3 doses that include a dose that was not tested in the HF trial; the target dose used in the trial was 97/103 mg twice daily. 147 Clinical experience will provide further information about the optimal titration (...) with NYHA class II–IV HFrEF and central sleep apnea, adaptive servo-ventilation causes harm. 203 NEW: New data demonstrate a signal of harm when adaptive servo-ventilation is used for central sleep apnea. See Online Data Supplement G. Mortality rate (all cause and cardiovascular) was higher with adaptive servo-ventilation plus GDMT than with GDMT alone in a single RCT to test the addition of adaptive servo-ventilation (=5 hours/night, 7 days/week) to GDMT in patients with HFrEF and central sleep apnea

2017 American Heart Association

77. Imaging Program Guidelines: Pediatric Imaging

Bryn Mawr Avenue South Tower – Suite 800 Chicago, IL 60631 P . 773.864.4600 www.aimspecialtyhealth.comTable of Contents – Pediatrics | Copyright © 2017. AIM Specialty Health. All Rights Reserved. 2 Table of Contents Description and Application of the Guidelines 4 Administrative Guidelines 5 Ordering of Multiple Studies 5 Pre-test Requirements 6 Head & Neck Imaging 7 CT of the Head – Pediatrics 7 MRI of the Head/Brain – Pediatrics 14 CTA/MRA Head: Cerebrovascular – Pediatrics 21 Functional MRI (fMRI (...) of clinical appropriateness under the guidelines for specific imaging exams is a determination that the following are true with respect to the imaging request: ? A clinical evaluation has been performed prior to the imaging request (which should include a complete history and physical exam and review of results from relevant laboratory studies, prior imaging and supplementary testing) to identify suspected or established diseases or conditions. ? For suspected diseases or conditions: ? Based

2017 AIM Specialty Health

78. 2017 Antithrombotic Therapy in Atrial Fibrillation Associated with Valvular Heart Disease: A Joint Consensus Document from EHRA and ESC Working Group on Thrombosis

(or procedure), and include estimates of expected health outcomes where data exist. Patient-specific modifiers, comorbidities, and issues of patient preference that might influence the choice of particular tests or therapies are considered, as are frequency of follow-up and cost effectiveness. In controversial areas, or with regard to issues without evidence other than usual clinical practice, a consensus was achieved by agreement of the expert panel after thorough deliberations. This document was prepared

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2017 Heart Rhythm Society

79. AIM Clinical Appropriateness Guidelines for Joint Surgery

program resulting in abstinence from tobacco for at least six (6) weeks prior to surgery is recommended. Documentation of nicotine-free status by laboratory testing (e.g., cotinine level or carboxyhemoglobin) is recommended. After six (6) weeks of tobacco cessation, labs should be performed with ample time afforded to submit this confirmation and complete the prior authorization process. Diabetes – It is recommended that a patient with history of diabetes maintain hemoglobin A1C 8% or less prior (...) activities. Copyright © 2017. AIM Specialty Health. All Rights Reserved. Joint Surgery 11 Indications and Criteria Rotator Cuff Repair Note: For primary rotator cuff repair, adherence to a tobacco-cessation program resulting in abstinence from tobacco for at least six (6) weeks prior to surgery is recommended. Documentation of nicotine-free status by laboratory testing (e.g., cotinine level or carboxyhemoglobin) is recommended. After six (6) weeks of tobacco cessation, labs should be performed with ample

2017 AIM Specialty Health

80. Childhood and Adolescent Adversity and Cardiometabolic Outcomes: A Scientific Statement From the American Heart Association

adversity may increase the risk of cardiometabolic (and other) diseases: behavioral, mental health, and biological. Behavioral Factors Evidence suggests that childhood adversity is associated with adverse health behaviors that increase the risk of cardiometabolic disease, including smoking, overeating, consumption of energy-dense foods, and inactivity. , , The association of childhood adversity with these behaviors was first tested by Felitti et al. In their retrospective ACE study, Felitti et al (...) childbirth would also capture intergenerational adversity and perinatal programming. Limited Identification of Mechanisms As discussed, childhood adversity may provoke unhealthy behaviors and poor mental health or produce neurobiological alterations that initiate relevant pathophysiological processes. Few studies have explicitly tested the mechanisms linking childhood adversity and cardiometabolic disease with comprehensive mediation models. Moreover, no study of which we are aware has tested a range

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2017 American Heart Association

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