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McMurray Test

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141. Genetics of Colorectal Cancer (PDQ®): Health Professional Version

% or greater on MMRpro and MMRpredict are recommended for genetic evaluation referral and testing. Associated Genes and Syndromes Hereditary CRC has two well-described forms: (1) polyposis (including and (AFAP), which are caused by pathogenic variants in the gene; and , which is caused by pathogenic variants in the MUTYH gene); and (2) (often referred to as hereditary nonpolyposis colorectal cancer), which is caused by germline pathogenic variants in DNA MMR genes ( , , , and ) and . Other CRC syndromes (...) that all individuals with newly diagnosed CRC are evaluated for Lynch syndrome through molecular diagnostic tumor testing assessing MMR deficiency. A is supported, in which all CRC cases are evaluated regardless of age at diagnosis or fulfillment of existing clinical criteria for Lynch syndrome. A more cost-effective approach has been reported whereby all patients aged 70 years or younger with CRC and older patients who meet the revised Bethesda guidelines are tested for Lynch syndrome. Tumor

2018 PDQ - NCI's Comprehensive Cancer Database

142. Canadian Cardiovascular Society/Canadian Cardiovascular Critical Care Society/Canadian Association of Interventional Cardiology Position Statement on the Optimal Care of the Post Arrest Patient Full Text available with Trip Pro

“comatose” or “unresponsiveness” in postarrest patients as an absence of purposeful response to verbal commands. Which Patient Populations Benefit From TTM? OHCA patients with an initial shockable rhythm Two landmark randomized controlled trials were published in 2002 that tested TTM for 12-24 hours in comatose survivors of OHCA. x 17 Hypothermia after Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest [erratum in 2002;346:1756]. N Engl J Med

2016 Canadian Cardiovascular Society

143. 2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation Full Text available with Trip Pro

: a systematic review and meta-analysis of the literature. Circulation . 2012 ; 126 : 2381–2391 | | | There has been no suggestion of excess MI with apixaban, x 23 Granger, C.B., Alexander, J.H., McMurray, J.J. et al. Apixaban versus warfarin in patients with atrial fibrillation. N Engl J Med . 2011 ; 365 : 981–992 | | | rivaroxaban, x 24 Patel, M.R., Mahaffey, K.W., Garg, J. et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. N Engl J Med . 2011 ; 365 : 883–891 | | | or edoxaban x 25

2016 Canadian Cardiovascular Society

144. Canadian cardiovascular society guidelines for the diagnosis and management of stable ischemic heart disease

and Evaluation(GRADE)convention,whichprovidesadescriptor of the strength of the recommendation and the quality of evidence. 5 In the case of diagnostic testing, evidence evalua- tion considered bias, consistency, and precision of study re- sults but with a major emphasis on readily available methods in community practices. This article does not focus on aspects of cardiac care covered by other CCS guidelines, 6-14 but supports the access to specialty care and expertise framework oftheCCS 15 (...) - tivity for the detection of CAD, abnormalities such as gallops, bruits or absent pulses, or obvious chest wall problems might alter the probability of underlying disease. A normal electro- cardiogram (ECG) does not exclude the diagnosis, but an abnormal resting ECG increases the probability and might in?uence the choice of diagnostic tests. Routine laboratory tests should be obtained to determine the presence and severity of factors that might in?uence angina, choice of tests, or implementation

2014 CPG Infobase

145. Knee pain - assessment: Traumatic causes

hours after the injury. Over the following weeks, there may be recurrent swelling. Signs: There may be an effusion, joint line tenderness, and a block to full extension or flexion. The McMurray test is no longer recommended because of concerns that it exacerbates the injury and its low diagnostic accuracy. Medial collateral ligament injury Symptoms: The mechanism of injury may be a direct blow to the lateral aspect of the knee, or a twisting injury. Medial knee pain. The person can typically (...) [ ; ] and a BMJ Best Practice review [ ]. The recommendation that the McMurray test is not recommended is based on expert opinion from several CKS reviewers that this test can exacerbate meniscal injuries and is no longer taught in UK medical schools. There is also evidence from systematic reviews that the McMurray test has only moderate accuracy for diagnosing meniscal injuries [ ; ]. Medial collateral ligament injury information is based on a BMJ Best Practice review [ ]. Lateral collateral ligament injury

2018 NICE Clinical Knowledge Summaries

146. Knee pain - assessment: How should I examine a person with knee pain?

. Posterior draw test for posterior cruciate ligament injuries. The McMurray test for meniscal injuries is no longer recommended because of concerns that it exacerbates the injury and its low diagnostic accuracy. Assess for neurovascular damage, including loss of sensation or weakness in the lower leg or foot, absence or asymmetry of pulses, or acute compartment syndrome. Basis for recommendation General knee examination recommendations are based on expert opinion in review articles [ ; ], a BMJ Best (...) concluded that the Lachman test is the only test able to rule in or out a knee disorder [ ]. The Lachman test was found to be an accurate test to rule in or out an anterior cruciate ligament injury [ ], although another systematic review found it to have decreased sensitivity, particularly for partial ruptures [ ]. Expert opinion is that using a combination of tests may be more accurate [ ; ]. The recommendation that the McMurray test is not recommended for meniscal injuries is based on expert opinion

2018 NICE Clinical Knowledge Summaries

147. Cardiac Resynchronization Therapy in Heart Failure

Minnesota Living with Heart Failure Questionnaire MUHC McGill University Health Centre NICE National Institutes for Health and Clinical Excellence NYHA New York Heart Association OPT Optimal pharmacologic therapy QALY Quality adjusted life-year QOL Quality of life RCT Randomized controlled trial RR Risk ratio TAU MUHC Technology Assessment Unit 6-MWT 6-minute walk test CRT for heart failure xiv February 22, 2016 Technology Assessment Unit, MUHC EXECUTIVE SUMMARY BACKGROUND Since the first review

2016 McGill TAU reports

148. 2016 ACC/AHA Clinical Performance and Quality Measures for Adults With Atrial Fibrillation or Atrial Flutter Full Text available with Trip Pro

-for-performance programs (ie, contexts in which performance measures are used). New measures are initially evaluated for potential inclusion as performance measures. In some cases, a measure is insufficiently supported by the guidelines. In other instances, when the guidelines support a measure, the writing committee may decide it is necessary to have the measure tested to identify the consequences of measure implementation. Quality measures may then be promoted to the status of performance measures (...) . The writing committee acknowledges that the new measures created in this set will need to be tested and validated over time. By publishing this clinical performance and quality measure set, the writing committee encourages adoption of these performance and quality measures, which will help to facilitate the collection and analysis of data needed to assess the validity of these measures. In the future, the writing committee anticipates having data that will allow them to reassess whether any

2016 American Heart Association

149. Drugs That May Cause or Exacerbate Heart Failure Full Text available with Trip Pro

was caused mostly by HF. Another study, PALLAS (Permanent Atrial Fibrillation Outcome Study), tested whether dronedarone reduced cardiovascular events in patients with permanent atrial fibrillation. PALLAS was terminated prematurely after enrolling 3236 patients because dronedarone was associated with an increase in cardiovascular death, stroke, and hospitalization for HF (HR, 1.81; 95% CI, 1.10–2.99; P =0.02). Thus, the prescribing information for dronedarone carries a black box warning that the drug

2016 American Heart Association

150. Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

annotation (E) including genetic defect or underlying disease/sub- strate, and the functional status (S) of the disease using both the ACC/AHA HF stages and New York Heart As- sociation (NYHA) functional class. This nomenclature is endorsed by the World Heart Federation, is supported by an Internet-assisted application, and assists in the de- scription of cardiomyopathy in symptomatic or asymp- tomatic patients and family members in the context of genetic testing. 8,9 Classifications of cardiomyopathies (...) complexes with inverted T waves can also be present. 179 Diagnosis To confirm the diagnosis of PPCM, a full history, physical examination, and diagnostic testing should be completed to exclude a previous history of heart disease and other causes of cardiomyopathy. For the classic definition of PPCM, the history should confirm that the onset of HF began in the last months of pregnancy or the months after delivery, and cardiac evaluation should confirm the presence of LV dysfunction. 158,189 Usual HF

2016 American Heart Association

151. Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

all portend a poor prognosis. Submaximal exercise testing also predicts mortality in ambulatory patients with HF. Additionally, cognitive impairment is a predictor of mortality in HF and may affect self-care ability. Social environmental factors such as income, disability status, Medicaid insurance, unmarried status, living alone or at a distance from hospital care, and history of alcohol or drug abuse are independent predictors of poor outcomes, including survival in advanced HF. In the REMATCH (...) in the disease course. The early elicitation of patient preferences may be especially important in the CVD population, considering the numerous options for diagnostic testing and advanced therapies even in end-stage disease. Although the direct impact of hospice care on caregiver QOL remains uncertain, a relationship between caregivers’ QOL and their estimate of the patients’ QOL was shown when cancer patients received hospice services. , Limited and conflicting evidence supports the ability of palliative

2016 American Heart Association

152. Contributory Risk and Management of Comorbidities of Hypertension, Obesity, Diabetes Mellitus, Hyperlipidemia, and Metabolic Syndrome in Chronic Heart Failure: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

of recommendations and Level of Evidence A recommendation with Level of Evidence B or C does not imply that the recommendation is weak. Many important clinical questions addressed in the guidelines do not lend themselves to clinical trials. Although randomized trials are unavailable, there may be a very clear clinical consensus that a particular test or therapy is useful or effective. *Data available from clinical trials or registries about the usefulness/efficacy in different subpopulations, such as sex, age (...) Study. J Am Coll Cardiol. 2004;43:2236–2241. doi: 10.1016/j.jacc.2003.10.074. 122. Castagno D, Baird-Gunning J, Jhund PS, Biondi-Zoccai G, MacDonald MR, Petrie MC, Gaita F , McMurray JJ. Intensive glycemic control has no impact on the risk of heart failure in type 2 diabetic patients: evidence from a 37,229 patient meta-analysis. Am Heart J. 2011;162:938–948.e2. doi: 10.1016/j.ahj.2011.07.030. 123. Aguilar D, Bozkurt B, Ramasubbu K, Deswal A. Relationship of hemoglobin A1C and mortality in heart

2016 American Heart Association

153. Recommendations for the Implementation of Telehealth in Cardiovascular and Stroke Care: A Policy Statement From the American Heart Association Full Text available with Trip Pro

impact of telemonitoring on heart failure–related rehospitalization rates or on mortality. The BEAT-HF (Better Effectiveness After Transition–Heart Failure) randomized trial tested telemonitoring with electronic equipment that collected daily information about blood pressure, heart rate, symptoms, and weight with centralized registered nurses conducting telemonitoring reviews, protocol-driven actions, and telephone calls for patients hospitalized with heart failure. The intervention had no impact (...) and treatment of hypertension. In the past, Holter monitors, stress tests, and office-based electrocardiography studies were used to evaluate patients with suspected arrhythmias. In an era when every smartphone will be able to have an FDA-approved electrocardiography device built into the protective case or the wrist strap of a smartwatch, the role of this legacy equipment will evolve. As patients experience symptoms, they can touch their phone and capture a single-lead ECG, and it can be sent

2016 American Heart Association

154. Knee Surgery

, and nature of pain, including how it may manifest during sleep, and presence of any instability, locking, or problems with mobility and weight bearing are all important to assess. Clinical examination typically assesses and documents: range of motion, effusion, crepitus, tenderness, stability, and provocative tests e.g. McMurray’s, patellar apprehension, Apley’s, and Lachman’s tests. Clinically meaningful improvement in function is an improvement in pain and function of 30% over baseline [14] . This can (...) realignment procedure with or without lateral retinacular release Patellar dislocation History of acute traumatic dislocation Lateral tracking of the patella OR Recurrent effusion OR Positive patellar apprehension test OR Synovitis with or without crepitus OR Recurrent dislocations MRI (not x-ray or CT scan) shows: Medial Patellofemoral Ligament (MPFL) disruption OR Osseous contusion OR Cartilage injury 6 weeks of physical therapy is required for first time dislocation; physical therapy is not required

2016 Washington State Department of Labor and Industries

155. 2016 ACC/AHA/HFSA Focused Update on New Pharmacological Therapy for Heart Failure: An 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 Clinic Full Text available with Trip Pro

trials. 10 This ARNI has recently been approved for patients with symptomatic HFrEF and is intended to be substituted for ACE inhibitors or ARBs. HF effects 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 (...) . 1995;333:1670–6 . 15 . Cohn JN, Tognoni G, Valsartan Heart Failure Trial Investigators . A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure . N Engl J Med . 2001;345:1667–75 . Downloaded from by on March 27, 2019Heart Failure Focused Update on Pharmacological Therapy CLINICAL St AteMeNtS ANd GuIdeLINeS Circulation. 2016;134:e282–e293. DOI: 10.1161/CIR.0000000000000435 September 27, 2016 e289 16 . Pfeffer MA, McMurray JJV, Velazquez EJ, et al

2016 American Heart Association

157. Transplantation and Mechanical Circulatory Support in Congenital Heart Disease Full Text available with Trip Pro

a propensity score–weighted hazard ratio of 3.25 impact on mortality Troponin In CHD with PH, troponin, NT-proBNP, and RV function were determinants of death BNP/NT-proBNP Associated with poor outcomes and increased mortality in ACHD, ES Exercise testing 6-Min walk distance in ES predicts mortality Peak systolic blood pressure during exercise <180 mm Hg and increased RV end-diastolic volume index (>150 mL/m 2 ) is associated with increased risk in systemic RV (death, vascular events, tricuspid (...) of Fallot; , minute ventilation/carbon dioxide production; and VT, ventricular tachycardia. As in acquired HF, exercise testing including formal cardiopulmonary testing can provide prognostic information in ACHD. In the most comprehensive cardiopulmonary exercise study to date (1375 consecutive patients, with a mean follow-up of 5.8 years), after adjustment for clinical parameters, a combination of peak and heart rate reserve provided the greatest predictive power across a broad range of CHD diagnoses

2016 American Heart Association

158. Chronic Heart Failure in Congenital Heart Disease Full Text available with Trip Pro

evidence that categorizing patients with CHD by this system enables management decisions or improves outcome. However, portions of the guidelines should apply to patients with CHD. The guidelines are clear that HF is a clinical diagnosis and that the presence of ventricular dysfunction or the result of any other single diagnostic test is not sufficient to make the diagnosis. This definition of HF as a clinical diagnosis not based solely on a diagnostic test also applies to patients with CHD (...) between NYHA class based on subjective description of symptoms and exercise capacity on cardiopulmonary exercise testing has been described. Children may be unaware of any limitation. Therefore, objective assessment of exercise capacity is advocated for all patients with CHD, particularly those for whom management may be changed by results or who would benefit from understanding objective limitations to exercise. Patients with an objective reduction in exercise tolerance should be considered

2016 American Heart Association

159. Knowledge Gaps in Cardiovascular Care of the Older Adult Population Full Text available with Trip Pro

domains beyond chronological age, such as frailty and cognitive function, and the incorporation of patient preferences into shared decision making have not been assessed adequately. The utility of all cardiac preventative measures, diagnostic tests, and therapeutic interventions, including medications, invasive procedures, and other programs (eg, cardiac rehabilitation) in the management of older patients with CVD warrants careful scrutiny, especially in the context of multimorbidity, polypharmacy (...) adults have a high prevalence of 3-vessel and left main disease and that ischemic heart disease (IHD) is a prominent source of morbidity and mortality. The guideline highlights the limitations of exercise stress testing in older patients and endorses pharmacological testing as a more useful option for diagnosis and prognosis in many older patients. The guideline acknowledges that although there is strong rationale to treat IHD in older adults, there are limited data pertaining to older patients

2016 American Heart Association

160. Wearable Cardioverter-Defibrillator Therapy for the Prevention of Sudden Cardiac Death Full Text available with Trip Pro

responsiveness testing. This testing incorporates vibratory, audible, and visual alerts. If the patient presses a response button, the episode is aborted. If no patient response is recorded, the defibrillation electrodes discharge gel onto the skin and ultimately deliver a shock via an apex-posterior vector. Depending on the type of arrhythmia (VT or VF) and the device programming, the overall response time (detection to shock) can take between 25 and 60 seconds. WCD shock energies range between 75 and 150 J (...) and adolescents. Use of the WCD is approved by the FDA in selected patients at risk for sudden cardiac arrest. However, there are several important relative contraindications. Patients with unipolar pacing (atrial or ventricular) cannot use a WCD because the large-amplitude pacing stimuli can interfere with arrhythmia detection. Additionally, patients who cannot detect or respond to patient responsiveness testing stimuli are not appropriate candidates for the WCD. Beyond the contraindications to WCD therapy

2016 American Heart Association

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