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McMurray Test

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81. 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

82. 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

83. 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

85. Hoarseness (Dysphonia) (Full text)

(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 PubMed abstract

86. AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol

clinical trials and other sources (Table 2) (S1.5-1). MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT Grundy SM, et al. 2018 Cholesterol Clinical Practice Guidelines Page 11 Table 2. Applying Class of Recommendation and Level of Evidence to Clinical Strategies, Interventions, Treatments, or Diagnostic Testing in Patient Care* (Updated August 2015) MANUSCRIPT ACCEPTED ACCEPTED MANUSCRIPT Grundy SM, et al. 2018 Cholesterol Clinical Practice Guidelines Page 12 1.6. Abbreviations Abbreviation Meaning/Phrase ABI (...) in lowering LDL-C further. Although no RCT specifically tested the strategy of ezetimibe first and then a PCSK9 inhibitor, ezetimibe was allowed at entry along with statin therapy in both PCSK9 inhibitor trials (FOURIER, ODYSSEY OUTCOMES). Even so, only very small numbers (3% and 5% respectively) were on ezetimibe during these trials. The strategy of ezetimibe before PCSK9 inhibitor is recommended because ezetimibe is widely available as a generic drug and has proven safety and tolerability (S4.1-15

2018 American College of Cardiology

88. 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

89. 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

90. Atrial Fibrillation Burden: Moving Beyond Atrial Fibrillation as a Binary Entity: A Scientific Statement From the American Heart Association (Full text)

; 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

2018 American Heart Association PubMed abstract

91. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association (Full text)

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

2018 American Heart Association PubMed abstract

93. Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions (Full text)

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 PubMed abstract

94. 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

95. 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

96. Clinical Practice Guidelines on Hypertension

. Grade D, Level 4 22 3 Evaluating high blood pressure No. Recommendation Grade, Level of Evidence CPG page no. 10 Routine clinical evaluation of a patient with elevated BP includes the following: 1. Clinical and family history 2. Full standard physical examination 3. Laboratory investigations, including: a) Urine analysis: Dipstick for hematuria/albumin, microscopic examination, and test for albuminuria b) Measurement of serum concentrations of electrolytes, creatinine, urea, fasting glucose (...) damage in hypertension. Journal of Hypertension. 1987; 5:93-8. 52 Investigators TS. Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. New England Journal of Medicine. 1991; 325:293-302. 53 de Vries RJ, van Veldhuisen DJ, Dunselman PH. Efficacy and safety of calcium channel blockers in heart failure: focus on recent trials with second-generation dihydropyridines. American Heart Journal. 2000; 139:185-94. 54 Granger CB, McMurray

2017 Ministry of Health, Singapore

97. 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

98. Optimization of Heart Failure Treatment

ejection fraction; HR¼ heart rate; NYHA¼ New York Heart Association. Yancy et al. JACC VOL. -,NO. -,2017 2017 Pathways for Optimization of Heart Failure Treatment -,2017:-–- 6Sacubitril/valsartan (7,8) was tested among patients with chronic HFrEF in a randomized controlled trial, PARADIGM HF (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure). The trial enrolled patients withNYHAclassIItoIVsymptomswithanEF #40% (modi?ed to#35% 1year (...) barrier to care,particularly for ARNI and ivabradine therapy. In such cases, if all solutions are exhausted, optimizing care with the most ?nancially manageable program is recommended (see answer to Issue 7). Clinical Assessment Figure 4 details a reasonable strategy for patient evalua- tion and management following a diagnosis of HFrEF. AfterGDMT isinitiated andtitratedwiththe goal of FIGURE 4 Testing and Medication Titration Following Diagnosis of HFrEF BNP¼B-typenatriureticpeptide;CBC

2017 American College of Cardiology

99. Periprocedural Management of Anticoagulation in Patients With Nonvalvular Atrial Fibrillation

cannot be extrapolated to these populations. For all patients taking anticoagulant therapy for stroke prophylaxis in NVAF who are scheduled for a procedure, it is important to carefully review the medical history; medication list, including over-the-counter medications and any supplements and herbal prepara- tions; and laboratory test results to identify factors that may increase bleed risk. On the basis of these ?ndings and the type of procedure to be performed, the risks and bene?ts of TI should (...) be used if appropriate. For some patients, there may be a need to provide prophylactic doses of anticoagulation prior to the resumption of therapeutic anticoagulation. During TI of DOAC therapy, it is reasonable in these cases to use pro- phylactic doses of an LMWH or UFH starting 6 to 8 hours followingtheprocedureforVTEprophylaxisprovidedthat adequatehemostasishasbeenachieved(46).Inthesetting of NVAF, only dabigatran has been speci?cally tested at a prophylactic dose after low bleed-risk procedures

2017 American College of Cardiology

100. Management of Bleeding in Patients on Oral Anticoagulants

Measurement of DOACs When Specialized Assays are Available Drug Clinical Objective Exclude Clinically Relevant* Drug Levels Measure On-Therapy or Above On-Therapy Drug Levels Suggested Test Interpretation Suggested test Dabigatran Dilute TT ECT ECA Normal result probably excludes clinically relevant* levels Dilute TT ECT ECA Apixaban, edoxaban, or rivaroxaban Anti-Xa Absent chromogenic anti-Xa assay activity probably excludes clinically relevant* levels Anti-Xa† *The term “clinically relevant” refers (...) acid for trauma patients within the ?rst 3 hours of pre- sentation is associated with decreased bleeding and overall mortality, and should be considered (32).The writing committee recommends further resuscitation using a goal-directed strategy guided by the results of laboratory testing. Careful attention should be given to comorbidities that could worsen bleeding and subsequent outcome.Because of their dependence on renal function for clearance, all of the DOACs have higher blood levels and longer

2017 American College of Cardiology

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