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81. Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU Full Text available with Trip Pro

with prior opioid exposure. Such findings emphasize the importance of preprocedural pain assessment and preemptive analgesia, when appropriate, for procedures known to cause pain . Indeed, severe procedural pain is associated with severe adverse events (e.g., tachycardia, bradycardia, hypertension, hypotension, desaturation, bradypnea, and ventilator distress) ( ) that may be prevented with appropriate pain assessment and preemptive analgesia. Evidence Gaps: Future research should include the following (...) in Supplemental Table 5 (Supplemental Digital Content 7, ), and the psychometric scores and the quality of evidence supporting each pain scale are described in Supplemental Table 6 (Supplemental Digital Content 8, ). The CPOT and the BPS remain the most robust scales for assessing pain in critically ill adults unable to self-report. Each has very good psychometric properties with scores of 16.7 and 15.1, respectively. The BPS-NI obtained a psychometric weighted score of 14.8. Although both the BPS

2018 Society of Critical Care Medicine

82. Examining the Impact of Decriminalizing or Legalizing Cannabis for Recreational Use

in chemotherapy patients, treatment of acute epilepsy in children, and treatment of anorexia associated with weight loss in AIDS patients.(55) In Canada, the Task Force on Cannabis Legalization and Regulation has recommended maintaining a separate system for medical cannabis, where a physician prescription would be required.(1) Currently, medical cannabis is not covered by provincial health insurance plans, but there is coverage for select derivatives from public drug programs such as the coverage of Nabilone (...) on prevalence of injuries and accidents One primary study found that the decriminalization of cannabis has resulted in a 52 per cent increase in emergency department visits across all states in the U.S., and a 31 per cent increase in calls made to poison control centres due to cannabis-related causes in states that had decriminalized cannabis between 2005 and 2011.(31) This is compared to states in which cannabis has not been legalized, where no change was observed during the same time period. One

2017 McMaster Health Forum

83. Atezolizumab (Tecentriq) - Non-Small-Cell Lung Carcinoma or Transitional Cell Carcinoma

of initial diagnosis, poor performance status (PS), and a history of unintentional weight loss. More than half of the patients with NSCLC are diagnosed with distant metastatic disease, which directly contributes to poor survival prospects. UC The overall 5-year survival rate for patients diagnosed with metastatic UC is approximately 5.5% (Surveillance, Epidemiology, and End Results [SEER] 2015). Poor prognostic factors for survival in patients with metastatic UC include advanced stage of disease (...) indication: Tecentriq is indicated for the treatment of adult patients with locally advanced or metastatic urothelial carcinoma after prior chemotherapy or who are considered cisplatin ineligible. 2.1.2. Epidemiology NSCLC Lung cancer remains the leading cause of cancer deaths worldwide in men and the second leading cause of cancer deaths worldwide in women. It accounted for approximately 13% of all new cancers in 2012 (Torre et al. 2015). Non-small cell lung cancer is the predominant subtype, accounting

2017 European Medicines Agency - EPARs

84. Frailty in Older Adults - Early Identification and Management

frailty, so it is important to conduct a further review. Table 1: Possible warning signs of frailty 1,7,15,19,20 Signs indicated with bold * may raise a higher level of suspicion of frailty. Medical: unintentional weight loss* (esp. if ≥ 10lbs/4.5kg over past year) incontinence* loss of appetite loss of muscle/strength (sarcopenia) osteoporosis impaired vision/hearing chronic pain repeated ER visits/hospitalization Psychological: delirium* cognitive impairment/ dementia* depression irrational fears (...) with the patient and/or family/caregivers/representatives, and with other key care providers. Initiate advance care planning discussions for patients with frailty or vulnerable to frailty. Definition Frailty is broadly seen as a state of increased vulnerability and functional impairment caused by cumulative declines across multiple systems. 1–4 Frailty has multiple causes and contributors 5 and may be physical, psychological, social, or a combination of these. Frailty may include loss of muscle mass

2017 Clinical Practice Guidelines and Protocols in British Columbia

85. When and how to treat hyponatremia in the ED

polydipsia, and water intoxication (intentional or unintentional). In infants and children, GI fluid loss and unintentional ingestion of excessive water are most common 5 . Besides thiazide and SSRIs, medications that can cause hyponatremia include other anti-depressants, anti-psychotics, anti-epileptics, and NSAIDs 1 . Why does this matter? Pathophysiology and Complications of Hyponatremia Left untreated, hyponatremia can be a life-threatening condition. Hypotonic plasma leads to a shift of water from (...) Additional testing can be performed to identify whether the hyponatremia is hypo-, hyper-, or euvolemic. which is crucial in identifying the underlying etiology and guide treatment. Failure to identify the underlying cause of hyponatremia can lead to therapy that harms the patients 4 . Hypovolemic Euvolemic Hypervolemic Definition Loss of sodium and relatively lesser loss of body water Normal total body sodium and excess total body water Increased sodium with relatively greater increase in body water

2018 CandiEM

86. Exam Series: Guide to the Knee Exam

, tender to palpation. May mimic a joint effusion or a septic knee. Ultrasound may help differentiate between bursitis and a joint effusion. Aspiration is required if there is any suspicion of infection. Systemic disease (ex. Rheumatoid Arthritsi) Known history of disease of systemic symptoms including fever, chills, night sweats, fatigue, or unintentional weight loss. Insidious onset pain with morning stiffness. Often associated with effusions and Baker’s cysts. Bony erosions, typically first seen (...) to form an overall impression of the case. History of Presenting Illness: Understanding the mechanism of injury is essential in the assessment of knee pain. An acute and traumatic etiology suggests a structural cause of pain. It is also important to determine whether the patient has been able to weight bear, as this guides imaging decisions. Pain characteristics: Identify the onset, position (anterior vs. posterior, medial vs. lateral), quality, radiation, severity, and duration of the pain

2018 CandiEM

87. Outcome Measures Framework: Information Model Report

of the category description. Within survival, case-specific mortality was prominent in the review of included registries. It represents a specific type of mortality measure attributable to a specific cause which was recommended to be specifically named in the OMF. The Disease Response category was renamed to “Clinical Response” to more broadly cover outcomes for non-disease conditions or after trauma. Exacerbation and Improvement were added 13 to Recurrence as examples that demonstrate the range of outcomes

2018 Effective Health Care Program (AHRQ)

88. Imaging Guidelines

patients presenting with an altered or depressed mental status, a history of loss of consciousness, or significant post-traumatic amnesia need a head CT scan. z A negative initial head CT scan in a patient not on anticoagulant therapy has a negative predictive value of greater than 99.97 percent for the need of any subsequent neurosurgical intervention, allowing safe discharge from the emergency department (ED). z A repeat head CT is needed in 6-12 hours when a patient of any age has a persistently (...) altered mental status. Urgent repeat head CT scanning is needed for the patient of any age with any worsening changes on neurologic exam. z Patients with supra-therapeutic international normalized ratio (INR) or thrombocytopenia may benefit from repeat head CT, despite a normal initial head CT, if they take oral anticoagulant or antiplatelet drugs. z Indications for head CT in children should follow the PECARN decision guide. Children with non-frontal soft tissue hematoma or brief loss

2018 American College of Surgeons

89. Stroke Prevention in Patients With Atrial Fibrillation: A Systematic Review Update

. Observational studies: hemorrhagic stroke—dabigatran 150mg or 110mg vs. warfarin 114 Table 47. Observational studies: major bleeding—dabigatran 150mg or 110mg vs. warfarin .. 115 Table 48. Observational studies: any bleeding—dabigatran 150mg or 110mg vs. warfarin 118 Table 49. Observational studies: intracranial bleeding—dabigatran 150mg or 110mg vs. warfarin 119 Table 50. Observational studies, GI bleeding—dabigatran 150mg or 110mg vs. warfarin 120 Table 51. Observational studies: all-cause mortality (...) , or edoxaban vs. warfarin 156 Table 61. Observational studies: GI bleeding—apixaban, rivaroxaban, or edoxaban vs. warfarin 158 Table 62. Observational studies, all-cause mortality—apixaban, rivaroxaban, or edoxaban vs. warfarin 161 Table 63. Observational studies: myocardial infarction—apixaban, rivaroxaban, or edoxaban vs. warfarin 164 Table 64. Observational studies: medication non-persistence—apixaban, rivaroxaban, or edoxaban vs. warfarin 166 Table 65. Strength of evidence—factor Xa inhibitors vs

2018 Effective Health Care Program (AHRQ)

90. Quality Improvement Guidelines for Mesenteric Angioplasty and Stent Placement for the Treatment of Chronic Mesenteric Ischemia

present with nonspeci?c abdominal pain and weight loss. Postprandial epigastric abdominal pain occurring 30 minutes after a meal and lasting for 1–3 hours is classic for CMI. Atypical presenting symptoms including nausea, vomiting, and diarrhea can be associated with ischemic gastropathy and suggest a poor prognosis. Physical examination is usually unremarkable except for weight lossandoccasionalaudiblebruitovertheepigastrium.Resultsoflaboratory tests including blood chemistry and hematologic (...) : a comparative experience. J Vasc Surg 2007; 45:1162–1171. 20. Silva JA, White CJ, Collins TJ, et al. Endovascular therapy for chronic mesenteric ischemia. J Am Coll Cardiol 2006; 47:944–950. 21. van Petersen AS, Meerwaldt R, Kolkman JJ, et al. The in?uence of respiration on criteria for transabdominal duplex examination of the splanchnic arteries in patients with suspected chronic splanchnic ischemia. J Vasc Surg 2013; 57:1603–1611. 22. Lankisch P, Gerzmann M, Gerzmann JF, Lehnick D. Unintentional weight

2018 Society of Interventional Radiology

91. Atherosclerotic Cardiovascular Disease in South Asians in the United States: Epidemiology, Risk Factors, and Treatments: A Scientific Statement From the American Heart Association

studies using BMI versus waist-to-hip ratio (WHR). One limitation of relying on BMI is that it does not take into account the distribution of body fat differentials, which may be better assessed with WHR. The MASALA study done in the United States showed that compared with NHWs, South Asians were less physically active and had lower adiponectin and higher resistin levels. South Asians had lower BMI, body weight, and waist circumference compared with all other racial/ethnic minority groups except (...) , although variations across the genome and patterns within that variation are complex and different in these subgroups, the majority of studies have suggested that the underlying biological pathways are actually similar. Thus, although the genetics of CVD in ethnic subpopulations can be characterized by allelic heterogeneity (in which different variants in the same genetic locus cause the same phenotype), the genes and resulting biology are common, with differences in risk reflecting differences

2018 American Heart Association

92. Health Literacy and Cardiovascular Disease: Fundamental Relevance to Primary and Secondary Prevention: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

in relation to obesity and diet. Community- and school-based educational programs provide avenues for educating youth in communities vulnerable to limited health literacy. The life course impact of limited health literacy on obesity merits examination. Making weight loss, exercise, and diet education programs accessible and available to individuals with limited health literacy is essential. Interventions and programs that incorporate mobile health offer novel opportunities but must be developed so (...) had adjusted IRR of 0.73 (95% CI, 0.39–1.36) favoring multisession vs single-session group. Wu et al Multisite RCT 595 S-TOFHLA Ambulatory Hospitalization, mortality 12 mo Limited HL, all-cause hospitalization and mortality IRR of 1.43 (95% CI, 1.00–2.05). Mixon et al Prospective cohort 471 S-TOFHLA Hospitalization Medication errors NA Higher HL (OR, 0.84; 95% CI, 0.74–0.95) and subjective numeracy (OR, 0.77; 95% CI, 0.63–0.95) reduced medication error. McNaughton et al Retrospective, hospital

2018 American Heart Association

93. Practical Assessment and Management of Vulnerabilities in Older Patients Receiving Chemotherapy Full Text available with Trip Pro

of function, comorbidity, falls, depression, cognition, and nutrition. The Panel recommends instrumental activities of daily living to assess for function, a thorough history or validated tool to assess comorbidity, a single question for falls, the Geriatric Depression Scale to screen for depression, the Mini-Cog or the Blessed Orientation-Memory-Concentration test to screen for cognitive impairment, and an assessment of unintentional weight loss to evaluate nutrition. Either the CARG (Cancer and Aging (...) Scale (GDS) to screen for depression, the Mini-Cog or the Blessed Orientation-Memory-Concentration test (BOMC) to screen for cognitive issues, and assessment of unintentional weight loss to evaluate nutrition. Either the Cancer and Aging Research Group (CARG) or Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) tool is best used to obtain specific estimates on risk of chemotherapy toxicity, while short tools such as Geriatric-8 or Vulnerable Elders Survey-13 (VES-13) can help

2018 American Society of Clinical Oncology Guidelines

94. Physiologic Predictors of Severe Injury: Systematic Review

of Evidence Appendix I. Meta-Analysis Results for Studies of Predictive Utility in the Emergency Room Setting ES-1 Evidence Summary Background Unintentional injury is the fourth leading cause of death in the United States, the leading cause for people 1 to 44 years of age, 1 and the reason for millions of emergency department (ED) visits. 2 Trauma is the primary reason emergency medical services (EMS) transport people to the hospital. 3 Out-of-hospital care includes the early interventions and life

2018 Effective Health Care Program (AHRQ)

95. Improving Quality of Life: Substance Use and Aging

services. This chapter provides an overview of some of the harmful consequences of substance use among the aging population, including hospitalization, falls, vehicular accidents, cognitive impairment, depression, substance withdrawal and death, including by suicide. Mortality rates are much higher among older adults who have substance use disorders. Because the use of alcohol and medication, whether prescribed or misused, causes greater harm in older adults than illicit drugs, this chapter focuses (...) on the term as clinical indicators and outcomes. Whenever the sources use these terms, they are reflected in the text of the report by being included in quotation marks to indicate they come from another source. These terms are left intact to preserve the integrity of the original research being cited. Addiction: 1 A health condition characterized by compulsive drug use, despite harmful consequences. Someone suffering from addiction is unable to consistently abstain from substance use, even when it causes

2018 Canadian Centre on Substance Abuse

96. Unhealthy Alcohol Use in Adolescents and Adults: Screening and Behavioral Counseling Interventions

an estimated $249 billion in loss in workplace productivity, health care expenses, criminal justice expenses, and motor vehicle collisions. Alcohol use during pregnancy can result in preterm birth and low birth weight. It is a major preventable cause of birth defects and developmental disabilities, including fetal alcohol spectrum disorders, and affects development of the fetal brain, endocrine system, gastrointestinal tract, heart, kidney, and liver. The 2011-2013 Behavioral Risk Factor Surveillance (...) these diagnoses. Currently, there is no firm consensus worldwide regarding the definition of risky drinking. In addition, the definition of a standard drink differs by country. Any alcohol use is considered unhealthy in pregnant women and adolescents. In adolescents, the definition of moderate- or high-risk alcohol use varies by age, based on days of use per year. Excessive alcohol use is one of the most common causes of premature mortality in the United States. From 2006 to 2010, an estimated 88,000 alcohol

2018 U.S. Preventive Services Task Force

97. Coexisting severe mental illness and substance misuse: community health and social care services

are invited to the multi- agency and multidisciplinary meetings (see recommendation 1.3.9) and the discharge or transfer meeting. There is support to meet the person's housing needs. The discharge plan includes strategies for ongoing safety or risk management and details of how they can get back in contact with services. There are crisis and contingency plans in place if the person's mental or physical health deteriorates (including for risk of suicide or unintentional overdose). Providers share (...) the consequences of contact with statutory services. 1.6.5 Ensure any loss of contact or non-attendance at any appointment or activity is viewed by all practitioners involved in the person's care as a matter of concern. Follow-up actions could include: contacting the person to rearrange an appointment visiting the person at home contacting any other practitioners involved in their care, or family or carers identified in the person's care plan (see recommendation 1.2.4) contacting the person's care coordinator

2016 National Institute for Health and Clinical Excellence - Clinical Guidelines

98. Peptest for diagnosing gastro-oesophageal reflux

, and a report is sent to the patient and doctor. Current NHS options Current NHS options NICE guidance on dyspepsia makes recommendations on the diagnosis, management and treatment of GORD. The aims are to control symptoms, heal oesophagitis and prevent recurrent oesophagitis or other complications. The guideline recommends referral for endoscopy if there are any red-flag symptoms, which include: gastrointestinal bleeding persistent vomiting progressive unintentional weight loss aged 55 years or older (...) have an increased risk of becoming cancerous in time. Conversion of Barrett's oesophagus to oesophageal adenocarcinoma has a lifetime risk of 5% in men and 3% in women (Jankowski 2010). GORD is normally diagnosed empirically with a trial of proton pump inhibitors or by endoscopy, manometry or pH testing when more serious disease is suspected. It may present with atypical symptoms, including chronic cough, hoarseness, loss of voice, laryngeal pain or ear, and nose and throat symptoms caused

2015 National Institute for Health and Clinical Excellence - Advice

99. Screening and Diagnosis of Obstructive Sleep Apnea

. Clinical symptoms for OSA include unintentional sleep episodes during wakefulness, daytime sleepiness, unrefreshing sleep, fatigue, insomnia, and snoring. If other causes have been ruled out (for example, thyroid disease, gastroesophageal reflux disease, or other respiratory diseases), further evaluation for OSA may be warranted in patients with daytime sleepiness, which is the clinically relevant OSA symptom most responsive to treatment. Evidence is lacking on the effect of CPAP on improving other (...) prediction rules can be used to effectively predict OSA diagnosis, the applicability of these rules to the general population cannot be determined from the existing literature, adds the ACP. Areas of Difference Screening The ACP recommends that clinicians target their assessment of OSA to individuals with unexplained daytime sleepiness, the clinically relevant OSA symptom most responsive to treatment. Additional common presenting symptoms cited by the developer include unintentional sleep episodes during

2017 National Guideline Clearinghouse (partial archive)

100. Interventions Targeting Sensory Challenges in Children with Autism Spectrum Disorder - An Update

and high ROB) of interventions with sensory-related components (tactile stimulation exercises, weighted blankets) reported few significant differences between treatment groups. Conclusions. Some interventions targeting sensory challenges may produce modest short-term ( 70), both groups received active treatment that included either SI therapy or eclectic group therapy. 39 Treatment lasted for 8 to 10 months. Participants in the SI group improved significantly more than those in the control group (...) parents. Augment Altern Commun. 2011 Dec;27(4):256-66. doi: 10.3109/07434618.2011.587830. PMID: 22136364.X-1 672. Hodgetts S, Magill-Evans J, Misiaszek J. Effects of weighted vests on classroom behavior for children with autism and cognitive impairments. Research in Autism Spectrum Disorders. 2011 2015-12- 09;5(1):495-505. doi: 10.1016/j.rasd.2006.08.006 PMID: 815571560; 2010-22960-053. X-1, X-3 673. Hodgetts S, Magill-Evans J, Misiaszek JE. Weighted vests

2017 Effective Health Care Program (AHRQ)

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