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McMurray Test

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141. 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

142. 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

143. 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

144. 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

145. 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

146. 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

147. 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

148. 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

149. 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 http://ahajournals.org 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

151. 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

152. 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

153. 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

154. 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

155. U.S. Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations for the management of nontuberculous mycobacteria in individuals with cystic fibrosis Full Text available with Trip Pro

in rates of skin test reactivity to NTM antigens in US population-based testing studies, potentially indicating increasing exposure to NTM (see below). Furthermore, the relative frequency of M. abscessus detection in NTM-positive samples from individuals with CF has increased remarkably over time both in the USA and in Europe, , , , , , suggesting real changes in NTM acquisition rates (rather than increased sampling). Possible reasons for the potential increased frequency of NTM-positive cultures (...) in the same household for more than 10 years, have unique strains, , suggesting a lack of person-to-person transmission. However, a case report from the University of Washington described a possible outbreak of M. a. massiliense in five patients with potential transmission occurring during synchronous clinic visits. Recently, whole genome sequencing and antimicrobial susceptibility testing performed on 168 consecutive isolates of M. abscessus from 31 patients attending an adult CF centre in the UK

2016 Cystic Fibrosis Foundation

156. American Association of Clinical Endocrinologists and American College of Endocrinology Clinical Practice Guidelines for Comprehensive Medical Care of Patients with Obesity

prospective or case-controlled trials; MRI = magnetic resonance imaging; MUFA = monoun- saturated fatty acid; NAFLD = nonalcoholic fatty liver disease; NASH = nonalcoholic steatohepatitis; NES = night eating syndrome; NHANES = National Health and Nutrition Examination Surveys; NHLBI = National Heart, Lung, and Blood Institute; NHS = Nurses’ Health Study; NICE = National Institute for Health and Care Excellence; OA = osteoarthritis; OGTT = oral glucose tolerance test; OR = odds ratio; OSA = obstructive

2016 American Association of Clinical Endocrinologists

157. Delirium, Dementia, and Depression in Older Adults: Assessment and Care, Second Edition

, PhD Candidate Associate Professor Laurentian University Sudbury, Ontario Jessica Po Ying Lok, RN, BScN, MN Clinical Educator, Nursing and Personal Support VHA Home HealthCare Toronto, Ontario Shirley Marr, RN, BScN, MHEd, MHScN, CNCC(C) Clinical Nurse Educator, ICU William Osler Health System Toronto, Ontario Leah Masin, RN Staff Nurse Southlake Regional Health Center Newmarket, Ontario Elizabeth McMurray, RN, BScN Professional Practice Consultant Lead for a review group from St. Joseph’s Health

2016 Registered Nurses' Association of Ontario

158. Reasanz - serelaxin

times are used. Where 0-t is shown as t this denotes the AUC under a dosing interval Area under the serum concentration-time curve from time zero to infinity. For extrapolation to infinity Clast / ?z is used, where Clast is the estimated concentration at the last sample time point above LLOQ from linear regression of the terminal elimination phase Bacterial endotoxins test BNP B-type natriuretic peptide BP Blood Pressure bpm beats per minute BUN Blood urea nitrogen C48hr The observed serum (...) control Iso-Asp Isoaspartate, isoaspartic acid IU International units IV Intravenous(ly) JVP Jugular venous pulse kDA kilo Dalton K-M Kaplan-Meier LFT Liver function test LGR7 Leucine-rich repeat-containing G-protein-coupled receptor 7 LLOQ Lower limit of quantification LO Low volume light obscuration LOD Limit of detection LoQ List of questions LOS Length of Stay LVEF Left ventricular ejection fraction M Methionine MAA Marketing authorisation application MAP Mean arterial pressure MAPK Mitogen

2014 European Medicines Agency - EPARs

159. Classification of Anemias

, sulfacetamide, sulfamethoxazole, sulfanilamide & sulfapyridine. Drug induced Hemolytic anemia: ACEI, acetaminophen, ASA/NSAIDs, cephalosporins, chlorpromazine, chlorpropamide, diclofenac, hydrochlorothiazide, interferon a2a&2b , isoniazid, levodopa, levofloxacin, mefenamic acid, methadone, methyldopa, penicillins, probenecid, procainamide, quinine, quinidine, ribavirin, rifampin, sulfonamides, & tetracycline. (Direct antiglobulin test-DAT or Coomb’s test is used to detect cause of hemolytic anemia) Drug (...) agent ESRD=end-stage renal dx FeSO4=ferrous sulfate Hct=hematocrit HD-CKD=dialysis-CKD HF=heart failure Hgb=hemoglobin HRQL=health-related QOL ITT=intention to treat LFT=liver function tests LVMI=left ventricular mass index LVVI=left ventricular volume index LVCVI=left ventricular cavity volume index MCV=Mean corpuscular volume MI=myocardial infarction ND-CKD=non-dialysis CKD OL=open label pt=patient QALY=quality-adjusted life year QOL=quality of life RCT=randomized control trial RDW=Red cell

2014 RxFiles

160. Systematic review of needs for medical devices for ageing populations

, including tests used during the course of the study. In many cases, there may be a range of options of devices for a specific indication. The clinical application of the information from these studies in a real-world context may not always be clear, and a specific comment on the comparative safety and effectiveness of the alternative devices was not possible. Although the list of topics was based on the top five causes of losses of DALYs for older people in the Western Pacific Region, regionality has (...) be shifts in research priorities to accommodate the aged population, such as towards minimally invasive technologies or home and self-care devices (3). New medical devices are frequently developed and tested in high-resource settings, and hence their applicability to low- or medium-resource settings needs to be considered. The factors involved in setting priority health care areas and identifying the medical devices needed to address them are many and complex. The focus of this project is to identify

2015 Publication 80

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