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McMurray Test

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141. Treatment of Hypertension in Patients With Coronary Artery Disease

receive moderate-intensity statin therapy such as simvastatin 20 to 40 mg/d, atorvastatin 10 to 20 mg/d, or rosuvastatin 5 to 10 mg/d to decrease LDL cholesterol by 30% to 50%. According to the guideline, nonstatin therapies do not provide acceptable CVD risk reduction benefits compared with their potential for adverse effects in the routine prevention of CVD. 1.1.5. Diabetes Mellitus Type 2 diabetes mellitus is defined as a fasting plasma glucose ≥126 mg/dL, a 2-hour oral glucose tolerance test value

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2015 American Heart Association

142. Basic Concepts and Potential Applications of Genetics and Genomics for Cardiovascular and Stroke Clinicians

format, that can ascertain the genotypes of up to millions of polymorphisms in a person’s genomic DNA sample in a single experiment. This is the technique used by commercial DNA testing services. Such services extract genomic DNA from the cells in a person’s saliva sample and then apply the DNA to a genotyping chip to determine the genotypes of a large number of SNPs and CNVs distributed across the genome. One disadvantage of this methodology is that it can ascertain the genotypes of only

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2015 American Heart Association

143. Sex Differences in the Cardiovascular Consequences of Diabetes Mellitus

research is needed to determine sex differences in the biological, social, and cultural factors that lead to worse cardiovascular outcomes for many minority populations with DM. CHD and heart failure in women Most contemporary recommendations for the prevention, diagnostic testing, and medical and surgical treatments of CHD in women are extrapolated from studies conducted predominantly in middle-aged men. Underrepresentation of women in trials of cardiovascular clinical procedures and therapies (...) first in the Framingham Heart Study in which heart failure risk was 2-fold higher in men ( P <0.05) and 5-fold higher in women with DM ( P <0.01) compared with the respective nondiabetic population. There was no statistical test for effect modification by sex in this analysis. In a more recent report, despite no difference in hospitalization among women with DM compared with men, the association between the diagnosis of heart failure and that of DM had a characteristic horseshoe shape over a 70-year

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2015 American Heart Association

144. Scientific Rationale for the Inclusion and Exclusion Criteria for Intravenous Alteplase in Acute Ischemic Stroke

of normal Current use of anticoagulant with INR >1.7 or PT >15 s Current use of direct thrombin inhibitors or direct factor Xa inhibitors with elevated sensitive laboratory tests (eg, aPTT, INR, platelet count, ECT, TT, or appropriate factor Xa activity assays) Blood glucose concentration <50 mg/dL (2.7 mmol/L) CT demonstrates multilobar infarction (hypodensity >1/3 cerebral hemisphere) Relative exclusion criteria Recent experience suggests that under some circumstances, with careful consideration (...) without recent use of OACs or heparin, treatment with intravenous rtPA can be initiated before availability of coagulation test results but should be discontinued if INR is >1.7 or PT is abnormally elevated by local laboratory standards. In patients without a history of thrombocytopenia, treatment with intravenous rtPA can be initiated before availability of platelet count but should be discontinued if platelet count is <100 000/mm 3 aPTT indicates activated partial thromboplastin time; AVM

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2015 American Heart Association

145. Guidelines for the management of spontaneous intracerebral hemorrhage

such as the National Institutes of Health Stroke Scale can be completed in minutes and provides a quantification that allows easy communication of the severity of the event to other caregivers. GCS score is similarly well known and easily computed. Serum and urine tests Complete blood count, electrolytes, blood urea nitrogen and creatinine, and glucose Higher serum glucose is associated with worse outcome , Prothrombin time (with INR) and an activated partial thromboplastin time Warfarin-related hemorrhages (...) are associated with an increased hematoma volume, greater risk of expansion, and increased morbidity and mortality , Cardiac-specific troponin Elevated troponin levels are associated with worse outcome , Toxicology screen to detect cocaine and other sympathomimetic drugs of abuse Cocaine and other sympathomimetic drugs are associated with ICH Urinalysis and urine culture, as well as a pregnancy test in a woman of childbearing age Other routine tests Neuroimaging CT or MRI; consider contrast-enhanced

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2015 American Academy of Neurology

146. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

information. Also, this Table 1. Applying Classification 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 (...) be associated with coagulopathy Physical examination Vital signs A general physical examination focusing on the head, heart, lungs, abdomen, and extremities A focused neurological examination A structured examination such as the National Institutes of Health Stroke Scale can be completed in minutes and provides a quantification that allows easy communication of the severity of the event to other caregivers. GCS score is similarly well known and easily computed. Serum and urine tests Complete blood count

2015 Congress of Neurological Surgeons

147. Physical Activity and Exercise During Pregnancy and the Postpartum Period

loss counseling revisited. JAMA 2003;289:1747–50. [ ] [ ] Alexander SC, Cox ME, Boling Turer CL, Lyna P, Ostbye T, Tulsky JA, et al. Do the five A’s work when physicians counsel about weight loss? Fam Med 2011;43:179–84. [ ] [ ] McMurray RG, Mottola MF, Wolfe LA, Artal R, Millar L, Pivarnik JM. Recent advances in understanding maternal and fetal responses to exercise. Med Sci Sports Exerc 1993;25:1305–21. [ ] Persinger R, Foster C, Gibson M, Fater DC, Porcari JP. Consistency of the talk test (...) to exercise have been reported in pregnant women, the use of ratings of perceived exertion may be a more effective means to monitor exercise intensity during pregnancy than heart-rate parameters ( ). For moderate-intensity exercise, ratings of perceived exertion should be 13–14 (somewhat hard) on the 6–20 Borg scale of perceived exertion (Table 1). Using the “talk test” is another way to measure exertion. As long as a woman can carry on a conversation while exercising, she is likely not overexerting

2015 American College of Obstetricians and Gynecologists

149. Clinical Practice Guideline on management of patients with diabetes and chronic kidney disease stage 3b or higher (eGFR <45 mL/min)

). Management of cardiovascular risk in patients with diabetes and CKD stage 3b or higher (eGFR <45 mL/min). 6.3. Development of review questions The methods support team assisted in developing review questions, i.e. framing the clinical questions into a searchable format. This required detailed specification of the patient group (P), intervention (I), comparator (C) and outcomes (O) for intervention questions and the patient group, index tests, reference standard and target conditions for questions (...) of diagnostic test accuracy [ ]. For each question, the guideline development group agreed upon explicit review question criteria including study design features (see Appendices for detailed review questions and PICO tables). 6.4. Assessment of the relative importance of the outcomes For each intervention question, the guideline development group compiled a list of outcomes, reflecting both benefits and harms of alternative management strategies. They ranked the outcomes as critical, highly important

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2015 European Renal Best Practice

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

% 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 aspirin 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 aspirin, ARUs are 550 or greater. When examining ARU changes after administration (...) which is a cell adhesion molecule found on activated endothelial cells and platelets. It reduces thromboxane production and platelet factor 4 and platelet-derived growth factor release. Some ex-vivo tests indicated that cilostazol may inhibit platelet aggregation to a greater degree than aspirin. Cilostazol is used to treat lower extremity claudication. It has also been used to prevent stent thrombosis, and for the prevention of stroke. In the field of cardiology, cilostazol is used to augment

2015 American Society of Regional Anesthesia and Pain Medicine

151. The Second ASRA Practice Advisory on Neurologic Complications Associated With Regional Anesthesia and Pain Medicine

limitations of diagnostic imaging and neurophysiologic testing. Furthermore, orthopedic surgery literature rarely designates nerve injury as a primary outcome, is often retrospective, and therefore lacks sufficient granularity to fully understand the mechanism of injury. These limitations likely result in underreporting. Thus, although the literature affords a glimpse into the “overall baseline nerve injury” associated with specific surgeries, precise determination of causation is often speculative

2015 American Society of Regional Anesthesia and Pain Medicine

152. American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis

is recommended beyond 6 months of therapy. Adapted from ref. 6. † Listed alphabetically. ‡ The panel indicated that patients with comorbidities, abnormal laboratory results, and/or multiple therapies may require more frequent laboratory testing than what is generally recommended laboratory monitoring for disease-modifying antirheumatic drugs in the table. § See ref. 6 for baseline monitoring recommendations. ACR RA Treatment Recommendations 13Figure 6. Tuberculosis (TB) screening algorithm for biologics (...) or tofacitinib (endorsed and modified from the 2012 American College of Rheumatology RA treatment recommendations). The Voting Panel reviewed and endorsed the 2012 TB screening algorithm with 1 change, that tofacitinib should be included alongside biologics. * 5 anergy panel testing is not recommended. ** 5 interferon-gamma release assay (IGRA) is preferred if patient has a history of BCG vaccination. †5 risk factors for TB exposure are definedbasedonapublicationfromthe US Centers for Disease Control

2015 American College of Rheumatology

154. Task Force 7: Pediatric Cardiology Fellowship Training in Pulmonary Hypertension, Advanced Heart Failure, and Transplantation

in patients with PH with and with- out congenital heart disease. • Identify the common presenting signs and symptoms of right and left heart failure. • Indications, risks, and benefits of techniques commonly used to evaluate patients with PH, including electrocardi- ography, echocardiography, cardiac magnetic resonance imaging, cardiac computed tomography, ventilation, and perfusion lung scans • Indications, risks, and benefits of cardiac catheterization and vasodilator testing 2.2.2.3. Classification (...) • Understand the World Health Organization Classification of PH. 2.2.2.4. Genetics • Understand patterns of heritable PAH. • Understand genetic tests relevant to heritable PH. 2.2.2.5. Treatment • Cardiovascular pharmacology. Understand the indi- cations, mechanisms of action, appropriate routes of administration, and adverse effects of the following med- ications used to treat PAH and understand the potential drug–drug interactions between the specific PAH thera- pies and other medications used to treat

2015 American Heart Association

155. Cardiac Arrest in Pregnancy

gauzes Bottles to collect blood samples suitable for low-volume blood testing ET indicates endotracheal; IO, intraosseous; and IV, intravenous. Breathing and Airway Management in Pregnancy Management of Hypoxia Current guidelines for the management of cardiac arrest in adults stress that oxygen delivery to vital organs is limited by blood flow during CPR and that chest compressions should not initially be interrupted for ventilation or airway placement. The pregnant patient has a very limited oxygen

2015 American Heart Association

156. Scientific rationale for the inclusion and exclusion criteria for intravenous alteplase in acute ischemic stroke

or PT >15 s Current use of direct thrombin inhibitors or direct factor Xa inhibitors with elevated sensitive laboratory tests (eg, aPTT, INR, platelet count, ECT, TT, or appropriate factor Xa activity assays) Blood glucose concentration <50 mg/dL (2.7 mmol/L) CT demonstrates multilobar infarction (hypodensity >1/3 cerebral hemisphere) Relative exclusion criteria Recent experience suggests that under some circumstances, with careful consideration and weighting of risk to benefit, patients may receive (...) with intravenous rtPA can be initiated before availability of coagulation test results but should be discontinued if INR is >1.7 or PT is abnormally elevated by local laboratory standards. In patients without a history of thrombocytopenia, treatment with intravenous rtPA can be initiated before availability of platelet count but should be discontinued if platelet count is <100 000/mm 3 aPTT indicates activated partial thromboplastin time; AVM, arteriovenous malformation; CT, computed tomography; ECT, ecarin

2015 American Academy of Neurology

157. Management of Traumatic Brain Injury

paralysis achieved with a bolus “test dose” of a neuromuscular blocking agent should be considered if the above measures fail to adequately lower ICP and restore CPP . If there is a positive response, continuous infusion of a neuromuscular blocking agent should be employed (Tier 3) If ICP remains = 20 - 25 mmHg proceed to Tier 3 TIER 3 (includes potential salvage therapies) z Decompressive hemi-craniectomy or bilateral craniectomy should only be performed if treatments in Tiers 1 and 2 (...) to aggressive measures to control malignant intracranial hypertension, however it should only be instituted if a test dose of barbituate or propofol results in a decrease in ICP , thereby identifying the patient as a “responder.” Hypotension is a frequent side effect of high dose therapy with these agents. Meticulous volume resuscitation should be ensured and infusion of vasopressor/inotropes may be required. Prolonged use or high dose of propofol can lead to propofol infusion syndrome. Continuous EEG may

2015 American College of Surgeons

158. Management of Anterior Cruciate Ligament Injuries

Evidence from two or more “Moderate” strength studies with consistent findings, or evidence from a single “High” quality study for recommending for or against the intervention. Limited Low Strength Evidence or Conflicting Evidence Evidence from two or more “Low” strength studies with consistent findings or evidence from a single study for recommending for or against the intervention or diagnostic test or the evidence is insufficient or conflicting and does not allow a recommendation for or against (...) reconstruction because it reduces activity related disability and recurrent instability which may lead to additional injury. Strength of Recommendation: Limited Description: Evidence from two or more “Low” strength studies with consistent findings or evidence from a single study for recommending for or against the intervention or diagnostic test or the evidence is insufficient or conflicting and does not allow a recommendation for or against the intervention. ACL YOUNG ACTIVE ADULT Moderate evidence supports

2014 American Academy of Orthopaedic Surgeons

159. Prevention of stroke in nonvalvular atrial fibrillation

) relative to that with warfarin (0.86%/y). Practice recommendation. C4. Clinicians might offer apixaban to patients with NVAF and GI bleeding risk who require anticoagulant medication (Level C). Other factors affecting administration of new oral anticoagulants. INR monitoring is not required for dabigatran, rivaroxaban, and apixaban for maintaining anticoagulation within the therapeutic window. Liberation from frequent periodic INR testing may be attractive to patients unwilling or unable to submit (...) to frequent periodic testing. Practice recommendation. C5. Clinicians should offer dabigatran, rivaroxaban, or apixaban to patients unwilling or unable to submit to frequent periodic testing of INR levels (Level B). Patients with NVAF who are at risk for stroke and unsuitable candidates for warfarin treatment are candidates for alternative treatment with aspirin, but the results are poor in view of the substantially lower level of protection conferred by aspirin (22% RRR) relative to that by warfarin (RRR

2014 American Academy of Neurology

160. Guidelines for the prevention of stroke in women

abnormalities, renal dysgenesis, pulmonary hypoplasia III/C ACE indicates angiotensin-converting enzyme; and LFTs, liver function tests. Modified from Umans et al with permission from Elsevier, Copyright © 2009. α-Blockers, β-blockers, CCBs, hydralazine, and thiazide diuretics have been used in pregnancy; all transfer across the placenta. There are no data from large, well-controlled, randomized controlled trials directly comparing specific antihypertensive agents in pregnancy. Methyldopa has been

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2014 American Academy of Neurology

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