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81. Recent Innovations, Modifications, and Evolution of ACC/AHA Clinical Practice Guidelines: An Update for Our Constituencies

disease Extracranial carotid and vertebral artery disease Thoracic aortic disease Prevention High blood pressure Blood cholesterol Prevention of cardiovascular disease Secondary prevention Congenital heart disease Adult congenital heart disease Perioperative Perioperative cardiovascular evaluation and management The 2 new guidelines, which fill gaps in the portfolio of guidelines, are indicated in red. The second area of perceived need is a comprehensive guideline on the approach to cardiovascular (...) as a treatment for reflex-mediated syncope, management of patients with asymptomatic preexcitation, targets for blood pressure lowering during antihypertensive therapy, and the impact of the use of implantable cardioverter-defibrillators for primary prevention in older patients and patients with significant comorbidities, physiologic versus right ventricular pacing among patients with left ventricular ejection fraction >35%, management of secundum atrial septal defects, and the magnitude of benefit of adding

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2019 American Heart Association

82. Serum Soluble Transferrin receptor

in the concentration of red blood cells or haemoglobin, resulting in lowered ability of the blood to carry oxygen. The two most common forms of anaemia are IDA and ACD (or anaemia of chronic inflammation). The proposed test is an in-vitro diagnostic assay, which quantifies the levels of sTfR in serum and/or plasma samples. sTfR is a marker of iron deficiency when tissue iron stores are depleted in the absence of other causes of abnormal erythropoiesis. sTfR levels are not affected by inflammation, thus sTfR (...) level is 30–100 µg/L, then the full iron study could be done as a reflex test. 12 ESC suggested that MSAC could investigate potential options for the future, such as the use of ferritin tests for specific indications, or the potential to incorporate sTfR into a different pathway, as a bundle with iron studies rather than as an additional test. ESC queried whether there should be different item numbers for different populations, for ease of service provision. 15. Other significant factors Nil 16

2018 Medical Services Advisory Committee

83. Point of Care in General Haematology

, ; Gavala & Myrianthefs, ). Underestimation of Hb/Hct may lead to erroneous transfusion trigger activation and inappropriate transfusion with packed red cells. Conversely, some authors report overestimation of Hct and Hb when measured by BGAs. One study concluded 21% of patients in the study would not have been transfused based on the Hct calculated by the BGA while the laboratory method would have indicated transfusion (Bosshart et al , ). Similarly, a 2017 publication investigating the comparability (...) limitations of the method (1A). International normalised ratio POCT methods should be assessed for comparability with central laboratory analysers using warfarinsed samples in order to establish a reflex testing algorithm for confirmation of supra‐therapeutic levels (1B) The activated clotting time (ACT) should be used for monitoring high doses of heparin where standard activated partial thromboplastin time (aPTT) methods are insensitive. (1A) POC aPTT measurement should not be used for monitoring heparin

2019 British Committee for Standards in Haematology

84. Masitinib mesylate (Alsitek) - Amyotrophic Lateral Sclerosis

include spasticity and exaggerated reflexes (hyperreflexia) including an overactive gag reflex. An abnormal reflex commonly called Babinski’s sign (the large toe extends upward as the sole of the foot is stimulated in a certain way) also indicates upper motor neuron damage. Symptoms of lower motor neuron degeneration include muscle weakness and atrophy, muscle cramps, and fasciculations. To be diagnosed with ALS, people must have signs and symptoms of both upper and lower motor neuron damage

2018 European Medicines Agency - EPARs

85. Inotersen sodium (Tegsedi) - Amyloidosis

-LL Neuropathy Impairment Score-Lower Limb NIS-R NIS-reflexes NIS-S NIS-sensation of big toe and index finger NIS-W NIS-muscle strength n/N Number of subjects Norfolk QoL-DN Norfolk Quality of Life-Diabetic Neuropathy ns Not significant NSC Neuropathy Symptoms and Change NT-proBNP N-terminal prohormone of brain natriuretic peptide OAEI Other adverse events of interest OAT Organic anion transporter OATP1 Organic anion transporter protein OCT Organic cation transporter OLE Open-label extension OLT

2018 European Medicines Agency - EPARs

87. Guidelines for the Management of Genital, Anal and Throat HPV Infection in New Zealand

infection and is not recommended. Genital warts are visible lesions that occur in the anogenital area and there is good correlation between physical findings and histological studies. There are four variants of genital warts: 1. Skin-coloured filiform warts (condyloma acuminata) occur on moist mucosal skin. 2. Skin-coloured raised papules with a rough warty surface (verruca vulgaris) arise on drier areas of genital skin. 3. On either dry or moist skin, smooth flat-topped papules which may be pink, red (...) , brown or black, can develop (carpet warts). 4. Giant condyloma up to 4cm in size with a cauliflower surface and red or pink in colour usually arise on dry genital skin. 48 Genital warts are frequently multifocal (one or more lesions at one anatomic site, e.g. vulva), or multicentric (lesions on disparate anatomic sites, e.g. perineum and cervix). 49-51 It is important to examine the entire lower genital tract for the presence of multicentric visible warts before treatment. Perianal lesions

2017 New Zealand Sexual Health Society

88. CRACKCast E152 – Cardiovascular Drugs

in the myocardium and vascular smooth muscle, leading to coronary and peripheral vasodilation. They also reduce cardiac contractility, depress SA nodal activity, and slow AV conduction. In cases of overdose, verapamil has the deadliest profile , combining severe myocardial depression and peripheral vasodilation. Both verapamil and diltiazem act on the heart and blood vessels, whereas dihydropyridine calcium channel blockers (such as nifedipine) cause primarily vasodilation and subsequent reflex tachycardia (...) in infants up to 4 months old. Methemoglobin is incapable of carrying oxygen, thus it alters the shape of the hemoglobin-dissociation curve shifting it to the left, causing functional anemia via impaired oxygen delivery. 1. What are 2 common clinical presentations of Nitrate/Nitrite toxicity? Hypotension (due to vasodilation) – with reflex tachycardia and headache Low SP02 & cyanosis occurs commonly if the percentage of methemoglobin exceeds 10%. Higher concentrations of methemoglobin may result

2018 CandiEM

89. Voretigene Neparvovec for Biallelic RPE65-Mediated Retinal Disease: Effectiveness and Value

to investigational agent) MLMT Multi-Luminance Mobility Testing OCT Optical Coherence Tomography PDUFA Prescription Drug User Fee Act PLR Pupillary Light Reflex PP Per Protocol RP Retinitis Pigmentosa RPE Retinal Pigment Epithelium SAE Serious Adverse Event SECORD Severe Early Childhood Onset Retinal Dystrophy TEAE Treatment Emergent Adverse Event VA Visual Acuity VF Visual Field VN Voretigene Neparvovec vg Vector Genomes, units in VN product ©Institute for Clinical and Economic Review, 2018 Page ES1 Evidence (...) with intraocular pressure and optic atrophy – 1 pt Myopia requiring correction of >10 diptres and retinal thinning – 1 pt ©Institute for Clinical and Economic Review, 2018 Page 86 Evidence Report – Voretigene Neparvovec Author & Year of Publication (Trial Name) Quality rating Study Design and Duration of Follow-up Interventions (n) & Dosing Schedule Major Inclusion & Exclusion Criteria Patient Characteristics Key Outcomes Harms Pupillary light reflex improvement in all patients Humoral and cell- mediated

2018 California Technology Assessment Forum

90. CRACKCast E147 – General Approach to the Poisoned Patient

collateral information as possible! Aspects of the physical exam not to overlook (clues toward a specific toxin or toxidrome): Airway! Breathing! Circulation… Full vitals, rectal core temperature, glucose LOC, pupillary size, Seizure activity, clonus, reflexes, muscle tone Skin moisture Odour Finally, just because we’re talking Tox, don’t forget about a comprehensive approach to altered mental status! DIMES Lifeinthefastlane has a great mnemonic: R – R – S – I – D – E – A – D – Note: Most tox icologic (...) catecholamines: hypertension, tachycardia, tachypnea, hyperthermia, mydriasis, diaphoresis. Risk for arrhythmias and shock MDMA, Cocaine, amphetamines, cathinones, ephedrine, pseudoephedrine, phenylpropanolamine, theophylline, caffeine Benzo’s Fluids Supportive Anticholinergic “Red as a beet Dry as a bone Blind as a bat Mad as a hatter Hot as hell The bladder keeps its tone and the heart runs alone” Antimuscarinic and antinicotinic properties – leading to a relative sympathomimetic (sympathetic overdrive

2018 CandiEM

91. Management of Immune-Related Adverse Events in Patients Treated With Immune Checkpoint Inhibitor Therapy

continue to offer ICPi. Should treat skin with topical emollients (if predominately dry skin is observed) and/or mild to moderate potency (hydrocortisone 2.5% or equivalent to triamcinolone 0.1% or equivalent) topical corticosteroids (signs of inflammation/redness with or without itching). Should counsel patients to avoid skin irritants and sun exposure. It is recommended that clinicians manage grade 2 toxicities, including intermittent pruritus, as follows: May hold ICPi and monitor weekly

2018 American Society of Clinical Oncology Guidelines

92. Evaluation and Management of Right-Sided Heart Failure: A Scientific Statement From the American Heart Association

) geometry in health and disease. Three-dimensional reconstructions of the RV illustrating its complex shape in a normal subject ( A ). RV remodeling in diseased hearts can result in profound shape change with RV dilation caused by chronic volume or pressure overload ( B ). The red mesh surface is the left ventricle (LV), and the solid blue surface is the RV. P indicates pulmonary valve; and T, tricuspid valve. Reprinted from Sheehan and Redington with permission from BMJ Publishing Group, Ltd. Copyright

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2018 American Heart Association

95. Appropriate Use Criteria: Imaging of the Spine

of compression ? In a patient with mid-back or radicular pain and red flag signs including: ? Reflex abnormality ? Objective muscle weakness ? Objective sensory abnormality in the thoracic dermatome distribution ? Spasticity Note: Imaging in patients with polyneuropathy without additional abnormalities on neurological exam is not indicated 1-4 Non-specific mid-back pain ? In a patient where focused history and physical exam suggest non-specific thoracic pain and/or referred posterior chest pain and all (...) ? Including but not limited to the following: ? Abscess ? Osteomyelitis ? Discitis Mid-back pain with signs of compression ? In a patient with mid-back or radicular pain and red flag signs including: ? Reflex abnormality ? Objective muscle weakness ? Objective sensory abnormality in the thoracic dermatome distribution ? Spasticity Note: Imaging in patients with polyneuropathy without additional abnormalities on neurological exam is not indicated 1-4 Magnetic Resonance Imaging (MRI) Thoracic SpineMRI

2018 AIM Specialty Health

96. Standards and guidelines for clinical genetics laboratories - cytogenetics

for potential mosaicism. If XX and XY cells are observed: Analyze 15 male colonies if available. If a mixture of XX and XY cells is present, it may be helpful to consult with the referring physician about evidence of a twin pregnancy. Laboratories should have a protocol stating when to reflex to additional studies, such as increased counts, 7 and/or FISH, and/or a recommendation for high-resolution ultrasound, uniparental disomy, microarray, and study of a second tissue. While CVS may appear as colonies (...) ) or amniocentesis. In general, diagnostic testing should be appropriate for the suspected anomaly (i.e., chromosomal microarray (CMA) for smaller copy-number changes). Some laboratories may opt to perform fluorescence in situ hybridization (FISH) for the aneuploidy or copy-number change in question and then reflex to either chromosome analysis or CMA, dependent on the FISH results. While FISH is possible for either type of copy-numberchange,itmaynotbeasaccurate,dependingon the exact size of the anomaly

2018 American College of Medical Genetics and Genomics

97. Exam Series: Guide to the Back Exam

roots exit above the corresponding vertebrae, while thoracic and lumbar nerve roots exit below the corresponding vertebrae. Approach to the History The history and physical examination are essential in the evaluation of back pain. Most investigations are only indicated once there is a suspicion of a back pain emergency, therefore a thorough clinical evaluation is needed to identify patients at risk. In particular, “red flags” on history can point to an emergent pathology. History of Presenting (...) as hematogenous spread of bacteria is the most common source. Immunosuppression also increases the risk of spinal infection. Medications : Anticoagulants increase the risk of an epidural hematoma. Prolonged glucocorticoid increase the risk of fragility fractures. In summary, red flags for neurologically significant back pain include bladder and bowel dysfunction, saddle anesthesia, neurologic deficits (esp. if bilateral), constitutional symptoms, and infectious symptoms. Patient characteristics including age

2018 CandiEM

98. A Guide to Utilization of the Microbiology Laboratory for Diagnosis of Infectious Diseases: 2018 Update by the Infectious Diseases Society of America and the American Society for Microbiology

the preferred or indicated approach for use or application. Future modifications of the document are to be expected, as diagnostic microbiology is a dynamic and rapidly changing discipline. Pediatric parameters have been updated in concordance with Pediatric Clinical Practice Guidelines and Policies , 16th ed., and The Red Book (2015), both published by the American Academy of Pediatrics. Comments and recommendations have been integrated into the appropriate sections. I. BLOODSTREAM INFECTIONS

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2018 Infectious Diseases Society of America

99. Evaluation and Management of Right-Sided Heart Failure

shape change with RV dilation caused by chronic volume or pressure overload ( B ). The red mesh surface is the left ventricle (LV), and the solid blue surface is the RV. P indicates pulmonary valve; and T, tricuspid valve. Reprinted from Sheehan and Redington with permission from BMJ Publishing Group, Ltd. Copyright © 2008, BMJ Publishing Group, Ltd. Physiology of the RV Normal RV function is governed by systemic venous return, PA load (RV afterload), pericardial compliance, and native contractility

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2018 International Society for Heart and Lung Transplantation

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

: 1) an exploration of the affect of sociodemographic variables such as age, gender, and ethnicity that may affect pain and response to pharmacologic intervention; 2) identification of pharmacokinetic, pharmacogenomic, and gender-associated factors that influence analgesic responses; 3) a determination of what pain -related behaviors predict self-reported pain ; 4) the development and study of objective measures (e.g., pupillary reflex dilatation response) to determine pain before and during (...) Nociception Index) (76, 77) or incorporating simultaneously different physiologic parameters (e.g., Nociception Level Index) ( ) may be relevant. Pupillary reflex dilation using video pupillometry has shown promising results in pain assessment of critically ill adults ( ), but future research is necessary to investigate the benefits, harms, and feasibility of implementation in the ICU. | Pharmacologic Adjuvants to Opioid Therapy Opioids remain a mainstay for pain management in most ICU settings. However

2018 Society of Critical Care Medicine

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