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121. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage

) Rehabilitation and Recovery Given the potentially serious nature and complex pattern of evolving disability and the increasing evidence for efficacy, it is recommended that all patients with ICH have access to multidisciplinary rehabilitation (Class I; Level of Evidence A). (Revised from the previous guideline) BP indicates blood pressure; CT, computed tomography; DVT, deep vein thrombosis; EEG, electroencephalography; ICH, intracerebral hemorrhage; INR, international normalized ratio; MRI, magnetic (...) and control of secondary brain injury and intracranial pressure, the role of surgery, outcome prediction, rehabilitation, secondary prevention, and future considerations. Results of new phase 3 trials were incorporated. Conclusions—Intracerebral hemorrhage remains a serious condition for which early aggressive care is warranted. These guidelines provide a framework for goal-directed treatment of the patient with intracerebral hemorrhage. (Stroke. 2015;46:2032-2060. DOI: 10.1161/STR.0000000000000069.) Key

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2015 American Heart Association

122. Heart Failure Management in Skilled Nursing Facilities

(the American Heart Association [AHA] and the Heart Failure Society of America) identified specific members of the writing group, and others were selected on the basis of known expertise. A literature search was performed using the key words skilled nursing facility , long-term care facility , nursing home , palliative medicine , rehabilitation , exercise , discharge , post-hospital , and post-acute meshed with the key word heart failure in PubMed and Ovid. Peer review was performed by experts from (...) into 3 groups based on different clinical scenarios and goals. One, the “rehabilitation group,” includes patients recently discharged from the hospital (with any diagnosis) with the goal to recover independent function and return to their prior residence after several weeks of skilled care. The second group, the “uncertain prognosis group” of patients, are often discharged from the hospital with complications, frailty, or multiple comorbidities, with hope of improvement, but recovery is less certain

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2015 American Heart Association

123. Eligibility and Disqualification Recommendations for Competitive Athletes With Cardiovascular Abnormalities: Task Force 15: Legal Aspects of Medical Eligibility and Disqualification Recommendations

was consistent with the then-current 26th Bethesda Conference guidelines), established the current legal framework for resolving athlete challenges to medical disqualification based on cardiovascular abnormalities or events. Nicholas Knapp sued Northwestern University, claiming that its refusal to allow him to play on its basketball team violated the Rehabilitation Act, a federal law prohibiting educational institutions that receive federal funds from discriminating against people with covered disabilities (...) and rational” and consistent with other specialists’ recommendations in federal disability discrimination litigation by a medically disqualified intercollegiate athlete against a university. These 2 cases hold that the federal disability discrimination laws (the Americans With Disabilities Act and the Rehabilitation Act) require only that a student-athlete’s exclusion from an interscholastic or intercollegiate sport be based on an individualized medical evaluation and that disqualification must have

2015 American Heart Association

124. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: Management of asymptomatic disease and claudication

the urgent need for comparative effectiveness research in PAD. Emphasis is placed on risk factor modification, medical therapies, and broader use of exercise programs to improve cardiovascular health and functional performance. Screening for PAD appears of unproven benefit at present. Revascularization for IC is an appropriate therapy for selected patients with disabling symptoms, after a careful risk-benefit analysis. Treatment should be individualized based on comorbid conditions, degree of functional (...) for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society

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2015 Society for Vascular Surgery

125. Clinical Practice Guideline for the Treatment of Intrinsic Circadian Rhythm Sleep-Wake Disorders: Advanced Sleep-Wake Phase Disorder (ASWPD), Delayed Sleep-Wake Phase Disorder (DSWPD), Non-24-Hour Sleep Wake Rhythm Disorder (N24SWD), and Irregular Sleep-W

with the children's parents, and 65% of participants continued to use the medication daily. A follow-up open-label prospective study of subjects with neurodevelopmental disabilities comorbid with DSWPD who received controlled-release melatonin (max dosage 15 mg) up to 3.8 years similarly described no adverse events. , Patients and caregivers are nevertheless frequently wary to use this supplement, due to concerns related to potential adverse effects on growth hormone regulation (10 mg dose), and on reproductive

2015 American Academy of Sleep Medicine

126. Task Force 6: Pediatric Cardiology Fellowship Training in Adult Congenital Heart Disease

• Hematology • Gastroenterology • Cardiac pathology • Rehabilitation services • Social services • Vocational services • Financial counselors Adapted from the 2008 ACC/AHA Guidelines for the Management of Adults With Congenital Heart Disease. 2 ACC indicates American College of Cardiology; ACHD, adult congenital heart disease; and AHA, American Heart Association. Downloaded from http://ahajournals.org by on March 27, 2019e94 Circulation August 11, 2015 fellowship training should include an understanding (...) Although reports of employment status vary with CHD, no more than 10% are considered totally disabled. 35 As many adults with CHD pre- pare to enter the job market and establish a career, 36 careful consideration of both physical and psychological capabilities should be discussed with their cardiologist so that realistic employment options are explored. Crossland et al. 37 dem- onstrated that structured career and employment advice has been shown to be associated with a higher rate of employment (73

2015 American Heart Association

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

in 1996 and remains the only medication proven to affect outcomes when given in the hyperacute time frame after ischemic stroke. Since the pivotal alteplase trial was published, numerous other trials and governmental stroke registries have confirmed the benefit of alteplase in improving rates of disability after ischemic stroke. Unfortunately, although the benefit of alteplase is well established, the minority of patients with acute ischemic stroke actually receive this medication across the United (...) that this scientific statement will assist the clinician to better engage with patients experiencing an acute stroke and their families in a shared decision-making model with an up-to-date understanding of the current literature. Age Issues According to the FDA label, intravenous thrombolysis with alteplase is indicated within 3 hours after the onset of stroke symptoms for the management of acute ischemic stroke in adults for improving neurological recovery and reducing the incidence of disability after exclusion

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2015 American Heart Association

128. Alcohol Abuse and Other Substance Use Disorders: Ethical Issues in Obstetric and Gynecologic Practice

practices. This principle requires that routine screening for substance use disorder should be applied equally to all people, regardless of age, sex, race, ethnicity, or socioeconomic status. Physicians may fail to apply principles of universal routine screening. When women are less likely to be screened or referred for treatment for substance use disorder, their burden of disability is increased and health status decreased. Another source of injustice is that punitive measures related to substance use (...) level to make treatment of substance use disorder more readily available to pregnant women has been bolstered by federal regulations requiring that pregnant women be provided with priority access to programs ( ). Physicians are encouraged to continue to advocate the creation of treatment and rehabilitation centers that prioritize options for pregnant women, and it is hoped that policy makers, legislators, and physicians will work collaboratively to retract punitive legislation and identify evidence

2015 American College of Obstetricians and Gynecologists

130. Recommendations for the Implementation of Telehealth in Cardiovascular and Stroke Care: A Policy Statement From the American Heart Association

, telehealth may increase access and convenience for patients with CVD and stroke. This is especially true for vulnerable patients with CVD or stroke who, because of their geographical location, physical disability, advanced chronic disease, or difficulty with securing transportation, may not otherwise access specialty healthcare services. , Yet, telehealth is underused for the management of CVD and stroke, and several barriers to the successful implementation of telehealth interventions for CVD and stroke (...) -growing telehealth intervention of the past decade for acute stroke treatment, in which lack of access to stroke expertise placed thrombolytic therapy out of reach for many patients. Telestroke can provide an effective solution for many small or underresourced hospitals to access acute stroke expertise on demand through its ability to promote the use of thrombolysis, which greatly reduces the risk of long-term disability and its attendant costs. , , Telestroke-assisted thrombolysis therapy compares

2016 American Heart Association

132. Evidence-Based Policy Making: Assessment of the American Heart Association?s Strategic Policy Portfolio

in acute care processes and medical and procedural secondary prevention therapies. These comprise short- and long-term care (including rehabilitation) for cardiovascular and stroke events—before hospital admission, in the hospital, and after discharge—and interventions to control the same health behaviors and factors noted above. Key data for monitoring the leading indicators of the mortality reduction goal, especially incidence, survival, and recurrence rates of cardiovascular and stroke events (...) /state) Not available Explore evidence-based opportunities for integration with mobile health technologies in delivery systems of care (federal) Not available Postevent rehabilitation: increase referral to, use of, adequate reimbursement for, and completion of CR and SR Increase referral and use of CR by decreasing copays, increasing the healthcare professionals who can supervise CR, expanding coverage for heart failure patients, and allowing patients to move more easily between intensive CR

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2016 American Heart Association

133. Knowledge Gaps in Cardiovascular Care of the Older Adult Population

functional capacity, reduce disability and fall risk, preserve independence, decrease hospital and long-term care admissions, and lower healthcare costs in older patients with IHD.* Studies are also needed to improve referral and adherence to cardiac rehabilitation among older adults, including patients with multimorbidity, noncardiovascular functional limitations, and frailty.* Studies are needed to assess the effectiveness and comparative effectiveness of various antithrombotic regimens in older (...) –2122 You are viewing the most recent version of this article. Previous versions: Abstract The incidence and prevalence of most cardiovascular disorders increase with age, and cardiovascular disease is the leading cause of death and major disability in adults ≥75 years of age; however, despite the large impact of cardiovascular disease on quality of life, morbidity, and mortality in older adults, patients aged ≥75 years have been markedly underrepresented in most major cardiovascular trials

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2016 American Heart Association

134. Pediatric Chronic Home Invasive Ventilation: An Official ATS Clinical Practice Guideline

to live with their families in their own communities, and to share in the everyday experiences most Americans take for granted. We must make a commitment to provide the kinds of health care these children require, in ways that allow them to participate as fully as possible in all aspects of family and community life.” The United States national objectives for improving health, Healthy People 2010 and 2020, both have explicit goals of reducing the number of children and youth with disabilities living

2016 American Thoracic Society

135. Lumbar Fusion Guideline (arthrodesis)

for lumbar fusion There are important contraindications for lumbar fusions, even when patients meet the criteria described in the previous sections: A. Absolute contraindications 1. Lumbar fusion is not indicated with an initial laminectomy/diskectomy related to unilateral compression of a lumbar nerve root. B. Relative contraindications 1. Severe physical de-conditioning 2. Current smoking 1,2 3. Multiple level degenerative disease of the lumbar spine 4. Greater than 12 months of disability (e.g. time (...) related to lumbar fusion outcomes among injured workers in Washington State A. Studies among injured workers in Washington State showed the following postoperative outcomes 3,4 : 1. The chance of an injured worker no longer being disabled 2 years after lumbar fusion is 32%. Updated March 7, 2016 Page 4 2. More than 50% of workers who received lumbar fusion through the Washington workers’ compensation program felt that both pain and functional recovery were no better or were worse after lumbar fusion

2016 Washington State Department of Labor and Industries

136. AAN Guideline on Botulinum Neurotoxin

.), Stanford University, Palo Alto, CA; and Division of Physical Medicine and Rehabilitation (S.A.Y.), University of Alberta, Edmonton, Canada. Mark Hallett From the Department of Neurology (D.M.S., M.W.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute of Neurological Disorders and Stroke (B.P.K.), National Institutes of Health, Bethesda, MD; Department of Neurology (E.J.A.), Bronson Neuroscience Center, Bronson Methodist Hospital, Kalamazoo (...) College of Medicine, Houston, TX; Department of Neurology and Clinical Neurophysiology (M.N.), Klinikum Augsburg, Germany; Department of Neurology and Neurological Sciences (Y.T.S.), Stanford University, Palo Alto, CA; and Division of Physical Medicine and Rehabilitation (S.A.Y.), University of Alberta, Edmonton, Canada. Eric J. Ashman From the Department of Neurology (D.M.S., M.W.G.), Icahn School of Medicine at Mount Sinai, New York, NY; Human Motor Control Section (M.H.), National Institute

2016 American Association of Neuromuscular & Electrodiagnostic Medicine

137. Knee Surgery

a good result afterward [73] . The Bree Collaborative (see Appendix B) has issued a set of minimal standards for evaluating an individual’s “Fitness for Surgery,” and it is strongly recommended that providers follow these. This can help ensure a patient’s safety and commitment to actively participate in their recovery and return to function. VI. Rehabilitation, and Return to Work Recovery and return to work is expected after most occupational knee injuries. Length of disability or time off work (...) Procedures 13 A. Marrow Stimulation Procedures 13 B. Autologous Chondrocyte Implantation 14 C. Patellar Tendon Realignment Procedure 14 D. Meniscal Disorders 15 E. Anterior Cruciate Ligament Reconstruction (ACL) 16 F. Osteochondral Autograft/Allograft Transplantation 17 G. Arthroplasty 18 VI. Rehabilitation, and Return to Work 19 VII. Appendices 20 Appendix A - Assessment Tools 20 Appendix B – The Bree Collaborative 23 VIII. Acknowledgements 24 IX. References 25 2 Washington State Department of Labor

2016 Washington State Department of Labor and Industries

138. ICU Admission, Discharge, and Triage Guidelines

does occur in hospital wards, usually during the activation of a RRS, deploying a rapid response team, or when a critical care bed is not immediately available to an acutely ill general ward patient. In some institutions, chronic critically ill patients are transferred from the ICU to the general ward for such processes as weaning from mechanical ventilation or starting rehabilitation. Although a randomized controlled trial would be difficult, several retrospective and observational studies have

2016 Society of Critical Care Medicine

139. Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science

and risk behaviors (eg, psychosocial risk factors, physical inactivity [PI], cardiac rehabilitation participation, obesity, and tobacco use) that play a far greater role in outcomes among women with IHD than biological sex differences, given that 80% of heart disease is preventable. These differences affect the mechanism and expression of CVD between the sexes. Sex differences in the cardiovascular system are summarized in . Table 1. Sex-Related Differences in the Cardiovascular System Parameter (...) behave singly or interact multiplicatively to influence IHD. Pooled data from cohort studies support that women have substantially worse outcomes than men after acute IHD events, including greater levels of disability. , Thus, diagnosing and treating IHD in women are costly and contribute to escalating healthcare expenditures. Age IHD is vast, affecting ≈15.5 million Americans ≥20 years of age, with a lower prevalence rate for women (5.0%) compared with men (7.6%). However, after 45 years of age

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2016 American Heart Association

140. Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association

(1995) 9777 Men completing 2 health evaluations 5±4 y apart 16% Survival increased in subjects who improved exercise capacity with serial testing Dorn et al (1999) 315 Post-MI men randomized to a 6-month exercise program 8%–14% Increase in exercise capacity during cardiac rehabilitation had sustained benefits up to 19 y Goraya et al (2000) Elderly (514) vs younger (2593) subjects referred for exercise testing 14% and 18% 14% and 18% survival benefit per MET for younger and elderly subjects (...) variables Kavanagh et al (2003) 2300 Women referred for rehabilitation 35% Peak V o 2 increase during cardiac rehabilitation Balady et al (2004) 3043 Asymptomatic men and women, Framingham study 13% Reduction in risk of events per MET among high-risk men in Framingham Offspring Study Myers et al (2004) >6000 Clinically referred subjects, VETS cohort 20% 1-MET increment in exercise capacity roughly equivalent to 1000 kcal/wk adulthood activity Kokkinos et al (2008) 15 660 Clinically referred subjects 13

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2016 American Heart Association

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