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301. BSR guideline Management of Adults with Primary Sjögren's Syndrome Full Text available with Trip Pro

to replace tear film oil layer Punctal plugging—punctal or intracanalicular plugs (ophthalmology only) Nutritional tear substitutes Secretagogues Autologous or allogeneic serum eye drops (available via specialist commissioned centres only) Oral pilocarpine max 5 mg 4× per day (start with 2.5 mg od and build up) Permanent punctal occlusion via cautery of all four puncta Pilocarpine 4% (3 drops = 5 mg) for those who are unable to swallow (palliative care pathway [ ]) Periorbital botulinum toxin (...) commissioned centres only) Oral pilocarpine max 5 mg 4× per day (start with 2.5 mg od and build up) Permanent punctal occlusion via cautery of all four puncta Pilocarpine 4% (3 drops = 5 mg) for those who are unable to swallow (palliative care pathway [ ]) Periorbital botulinum toxin for significant blepharospasm Bandage contact lenses Amniotic membrane overlay or corneal grafting for significant corneal ulceration and corneal melt or perforation Based upon the DEWS workshop and the Meibomian Gland

2017 British Society for Rheumatology

302. Mental health of adults in contact with the criminal justice system

, safety, personal historical and criminological factors assessing multiple areas of need, including social and personal circumstances, physical Mental health of adults in contact with the criminal justice system (NG66) © NICE 2019. All rights reserved. Subject to Notice of rights ( conditions#notice-of-rights). Page 18 of 39health, occupational rehabilitation, education and previous and current care and support developing an increased understanding of the function (...) , stroke, and neurodegenerative disorders such as dementia. Appropriate adult Appropriate adult A person who is responsible for protecting (or 'safeguarding') the rights and welfare of a child or 'mentally vulnerable' adult who is either detained by police or is interviewed under caution voluntarily. The role was created alongside the Police and Criminal Evidence Act (PACE) 1984. Carer Carer A person who provides unpaid support to someone who is ill, having trouble coping or who has disabilities

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

303. Management of Concussion-mild Traumatic Brain Injury (mTBI)

) • Any alteration in mental state at the time of the injury (e.g., confusion, disorientation, slowed thinking, alteration of consciousness/mental state) • Neurological deficits (e.g., weakness, loss of balance, change in vision, praxis, paresis/plegia, sensory loss, aphasia) that may or may not be transient • Intracranial lesion External forces may include any of the following events: the head being struck by an object, the head striking an object, the brain undergoing an acceleration/deceleration (...) of Injury. The Centers for Disease Control and Prevention (CDC) estimate that approximately 2.2 million emergency department visits and 50,000 deaths occur annually due to TBI.[2] In the 2014 CDC Report to Congress “Traumatic Brain Injury In the United States: Epidemiology and Rehabilitation,” according to data from the DoD, 235,046 Service Members (or 4.2% of the 5,603,720 who served in the Army, Air Force, Navy, and Marine Corps) were diagnosed with a TBI between 2000 and 2011.[2] Similarly

2016 VA/DoD Clinical Practice Guidelines

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

) are often used in combination for the management of cerebral vascular disease including secondary prevention of stroke and transient ischemic attacks. Dipyridamole inhibits PDE-3 and PDE-5. By inhibiting cAMP and cGMP PDEs, cAMP and cGMP levels increase which result in a reduction in platelet aggregation and an increase in vasodilation. Also, extracellular adenosine levels are increased by blocking adenosine reuptake by vascular and blood cells. An increase in adenosine levels leads to further (...) plasma concentration occurs in 30 minutes with a median half-life of 3.7 hours. Prasugrel causes 90% inhibition of platelet function compared with 60% to70% for clopidogrel. The superior antiplatelet effect of prasugrel is secondary to its improved metabolism, resulting in more active metabolites being delivered to the platelet. Patients older than 75 years, those with history of transient ischemic attack or stroke, or those with small body mass index are at risk for increased bleeding. Platelet

2018 American Society of Regional Anesthesia and Pain Medicine

305. The Non-Surgical Management of Hip & Knee Osteoarthritis (OA)

the degree of weight-bearing support they should apply to their ambulation aids. Furthermore, gait pattern(s) required for cane ambulation also decreases the efficiency of walking. Walking aids are associated with a large number of accidents (frequently falls) requiring urgent medical treatment. Thus, the patient's functional requirements should be matched with the proper walking aid and the clinician must consider whether the patient has sufficient strength, exercise tolerance, balance, coordination

2014 VA/DoD Clinical Practice Guidelines

306. Diagnosis and Treatment of Non-Neurogenic Overactive Bladder (OAB) in Adults: AUA/SUFU Guideline

the period of sleep, which is age-dependent with 20% for younger individuals and 33% for elderly individuals), 28 low nocturnal bladder capacity or both. In nocturnal polyuria, nocturnal voids are frequently normal or large volume as opposed to the small volume voids commonly observed in nocturia associated with OAB. Sleep disturbances, vascular and/or cardiac disease and other medical conditions are often associated with nocturnal polyuria. As such, it is often age-dependent, increasing in prevalence (...) . Patients may avoid certain activities (e.g., travel, situations that do not allow easy access to a toilet) because of their bladder symptoms. Co-morbid conditions should be completely elicited as these conditions may directly impact bladder function. Patients with co-morbid conditions and OAB symptoms would be considered complicated OAB patients. These co-morbid conditions include neurologic diseases (i.e., stroke, multiple sclerosis, spinal cord injury), mobility deficits, medically complicated

2014 American Urological Association

307. Diagnosis and Treatment Interstitial Cystitis/Bladder Pain Syndrome

for endometriosis Exclusion criteria: bladder cancer, urethral diverticulum, spinal cord injury, stroke, Parkinson's disease, multiple sclerosis, spina bifida, cyclophosphamide treatment, radiation treatment to pelvic area, tuberculosis affecting the bladder, uterine cancer, ovarian cancer, vaginal cancer, genital herpes, pregnancy Berry et al. (2011) used the questionnaire to determine prevalence of IC/BPS among adult females in the US. 13 This study yielded prevalence estimates of from 2.7% to 6.53

2014 American Urological Association

308. Non-ST-Elevation Acute Coronary Syndromes: Guideline For the Management of Patients With

,AgencyforHealthcareResearchandQualityReports, and other selected databases relevant to this CPG. The rele- vant data are included in evidence tables in the Online Data Supplement. Key search words included but were not limited to the following: acute coronary syndrome, anticoag- ulant therapy, antihypertensives, anti-ischemic therapy, anti- platelet therapy, antithrombotic therapy, beta blockers, biomarkers, calcium channel blockers, cardiac rehabilitation, conservative management, diabetes mellitus, glycoprotein IIb/ IIIa inhibitors (...) to secondary prevention rather than detailed reiteration. Throughout, the goal was to provide the clinician with concise, evidence-based contemporary recommendations and the supporting documentation to encourage their application. 2. OVERVIEW OF ACS 2.1. De?nition of Terms ACShasevolvedasausefuloperationaltermthatrefersto a spectrum of conditions compatible with acute myocar- dial ischemia and/or infarction that are usually due to an abrupt reduction in coronary blood ?ow (Figure 1). A key branch point

2014 American College of Cardiology

309. Diagnosis and Treatment of Fetal Cardiac Disease Full Text available with Trip Pro

on Cardiovascular and Stroke Nursing Mary T. Donofrio , Anita J. Moon-Grady , Lisa K. Hornberger , Joshua A. Copel , Mark S. Sklansky , Alfred Abuhamad , Bettina F. Cuneo , James C. Huhta , Richard A. Jonas , Anita Krishnan , Stephanie Lacey , Wesley Lee , Erik C. MichelfelderSr , Gwen R. Rempel , Norman H. Silverman , Thomas L. Spray , Janette F. Strasburger , Wayne Tworetzky , and Jack Rychik and on behalf of the American Heart Association Adults With Congenital Heart Disease Joint Committee of the Council (...) on Cardiovascular Disease in the Young and Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Council on Cardiovascular and Stroke Nursing Originally published 24 Apr 2014 Circulation. 2014;129:2183–2242 You are viewing the most recent version of this article. Previous versions: Abstract Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis

2014 American Heart Association

310. Assessment of the 12-Lead ECG as a Screening Test for Detection of Cardiovascular Disease in Healthy General Populations of Young People (12?25 Years of Age) Full Text available with Trip Pro

cardiovascular disease include bronchial asthma, ruptured cerebral aneurysm, use of performance-enhancing or other drugs and substances, heat stroke, and pulmonary embolus. The mechanism of death in the vast majority of these events is a ventricular tachyarrhythmia, with the major exception being Marfan syndrome and related disorders associated with aortic dilatation, in which SD usually occurs because of aortic dissection/rupture. SDs occur in a wide variety of sports, most commonly football and basketball (...) with exercise-related cardiovascular collapse and SD, and often in association with rhabdomyolysis in military recruits and competitive athletes (predominantly college football players). Unlike SD attributable to underlying cardiovascular disease and ventricular tachyarrhythmia, sickle cell trait–related collapse probably results from a more gradual deterioration and cascade of events, with intravascular sickling leading to vascular occlusion, endothelial damage, and impaired blood flow to muscles, which

2014 American Heart Association

311. 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery: Executive Summary

Publication Year (Reference) CPGs Management of patients with atrial fibrillation AHA/ACC/HRS 2014 Management of valvular heart disease AHA/ACC 2014 Management of heart failure ACC/AHA 2013 Performing a comprehensive transesophageal echocardiographic examination ASE/SCA 2013 Management of ST-elevation myocardial infarction ACC/AHA 2013 Diagnosis and management of patients with stable ischemic heart disease ACC/AHA/AATS/PCNA/SCAI/STS 2012 2014 Focused update incorporated into the 2007 guidelines (...) . ‡Society for Vascular Medicine Representative. §ACC/AHA Task Force on Practice Guidelines Liaison. ‖American Society of Nuclear Cardiology Representative. ¶American Society of Echocardiography Representative. #Heart Rhythm Society Representative. **American College of Surgeons Representative. ††Patient Representative/Lay Volunteer. ‡‡American Society of Anesthesiologists/Society of Cardiovascular Anesthesiologists Representative. §§ACC/AHA Task Force on Performance Measures Liasion. ‖‖Society

2014 American Heart Association

313. Role of Noninvasive Testing in the Clinical Evaluation of Women With Suspected Ischemic Heart Disease Full Text available with Trip Pro

marker who is otherwise classified as being at intermediate IHD risk should be reclassified as at high IHD risk. Table 2. High IHD Clinical Risk Markers for Symptomatic Women Peripheral arterial disease Diabetes mellitus: 10-y history or poorly controlled in a woman >40 y of age Chronic obstructive lung disease Transient ischemic attacks or cerebrovascular accident Chronic kidney disease Functional disability: inability to perform activities of daily living or <5 estimated DASI METs DASI METS (...) years of age. Moreover, myocardial ischemia is associated with higher IHD mortality among symptomatic women than among men. The concept that symptoms in women are correlated with coronary vascular dysfunction in the setting of arterial expansive remodeling and nonobstructive plaque is a critical component for understanding female-specific patterns in symptom presentation and elevated IHD risk. , , Thus, the contemporary perspective highlights the importance of documented myocardial ischemia

2014 American Heart Association

314. Management of Benign Anorectal Disorders

with DD 65 Balloon defecation training Biofeedback superior DD, defecatory disorder; PEG, polyethylene glycol. © 2014 by the American College of Gastroenterology The American Journal of GASTROENTEROLOGY 7 ACG Guidelines Fecal Incontinence mass index, diarrhea, rectal urgency, cholecystectomy, anal fi stula, non-childbirth anal injury, urinary incontinence, chronic illnesses (e.g., diabetes mellitus or stroke), and psychoactive medications are associated with FI ( 64 – 70 ). Among women (...) syndrome In? ammatory conditions: radiation proctitis, Crohn’s disease, ulcerative colitis Central nervous system disorders: dementia, stroke, brain tumors, multi- ple sclerosis, spinal cord lesions Diarrhea: irritable bowel syndrome, post-cholecystectomy diarrhea Other: fecal retention with over? ow, behavioral disorders Reproduced and modi? ed with permission from Bharucha ( 160 ). © 2014 by the American College of Gastroenterology The American Journal of GASTROENTEROLOGY 9 ACG Guidelines Fecal

2014 American College of Gastroenterology

315. 2014 AHA/ACC Guideline for the Management of Patients With Non?ST-Elevation Acute Coronary Syndromes: Executive Summary

. (Level of Evidence: C ) Class III: Harm Prasugrel should not be administered to patients with a prior history of stroke or transient ischemic attack. (Level of Evidence: B ) PCI—GP IIb/IIIa Inhibitors Class I In patients with NSTE-ACS and high-risk features (eg, elevated troponin) and not adequately pretreated with clopidogrel or ticagrelor, it is useful to administer a GP IIb/IIIa inhibitor (abciximab, double-bolus eptifibatide, or high-dose bolus tirofiban) at the time of PCI. (Level (...) therapy, beta blockers, biomarkers, calcium channel blockers, cardiac rehabilitation, conservative management, diabetes mellitus, glycoprotein Ilb/IIIa inhibitors, heart failure, invasive strategy, lifestyle modification, myocardial infarction, nitrates, non-ST-elevation, P2Y 12 receptor inhibitor, percutaneous coronary intervention, renin-angiotensin-aldosterone inhibitors, secondary prevention, smoking cessation, statins, stent, thienopyridines, troponins, unstable angina, and weight management

2014 American Heart Association

316. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes Full Text available with Trip Pro

, antihypertensives, anti-ischemic therapy, antiplatelet therapy, antithrombotic therapy, beta blockers, biomarkers, calcium channel blockers, cardiac rehabilitation, conservative management, diabetes mellitus, glycoprotein IIb/IIIa inhibitors, heart failure, invasive strategy, lifestyle modification, myocardial infarction, nitrates, non-ST-elevation, P2Y 12 receptor inhibitor, percutaneous coronary intervention, renin-angiotensin-aldosterone inhibitors, secondary prevention, smoking cessation, statins, stent (...) (but rather HF, which has many etiologies), they add prognostic value. Electrocardiogram The 12-lead ECG is pivotal in the decision pathway for the evaluation and management of patients presenting with symptoms suggestive of ACS. , , Transient ST changes (≥0.5 mm [0.05 mV]) during symptoms at rest strongly suggest ischemia and underlying severe CAD. Patients without acute ischemic changes on ECG have a reduced risk of MI and a very low risk of in-hospital life-threatening complications, even

2014 American Heart Association

317. Tinnitus

million people in the United States have reported experiencing tinnitus, resulting in an estimated prevalence of 10% to 15% in adults. 1,2 About 20% of adults who experience tinnitus will require clinical intervention. 3 Not a disease in and of itself, tinnitus is actually a symptom that can be associated with multiple causes and aggravating co-factors. Tinnitus is relatively common, but in rare cases it can be a symptom of serious disease such as vascular tumor or vestibular schwannoma (VS). Tinnitus (...) Division of Geriatric Medicine and Aging, Columbia University, New Y ork, New Y ork, USA; 11 National Center for Rehabilitative Auditory Research, Portland VA Medical Center, Portland, Oregon, USA; 12 ENT Specialists of Northern Virginia, Falls Church, Virginia, USA; 13 Ochsner Health System, Kenner, Louisiana, USA; 14 Mitchell & Cavallo, P .C., Houston, T exas, USA; 15 Department of Otology and Neurotology, The George Washington University, Washington, DC, USA; 16 Department of Surgery, Cleveland

2014 American Academy of Otolaryngology - Head and Neck Surgery

319. Congenital Heart Disease in the Older Adult Full Text available with Trip Pro

and may require specialized mapping for ablation. Vascular complications include the development of pulmonary hypertension, aortic root dilation, aneurysm formation, and venous insufficiency. Importantly, with age, and in this older ACHD population, management will need to encompass acquired heart disease. In the general population, mortality rates for all cardiovascular disease, coronary heart disease, and stroke are, respectively, 10, 9, and 13 times higher in people ≥65 years old than in those 45 (...) , poor ostial imaging on echocardiography, or computed tomography (CT) to assess the anatomy and physiology of proximal segment narrowing. The risk of coronary occlusion, ischemia, or arrhythmia should be recognized by the operator when these studies are undertaken. Coronary CTA has become the “gold standard” for assessment of anomalous coronary origin and course in the older adult. In experienced hands, it offers anatomy and coronary course assessment in a cross section of the coronary ostium

2015 American Heart Association

320. 2015 ACC/AHA/SCAI Focused Update on Primary Percutaneous Coronary Intervention for Patients With ST-Elevation Myocardial Infarction: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention and the 2013 ACCF/AHA Guideline for t Full Text available with Trip Pro

PCI during the index hospitalization (72% underwent multivessel primary PCI). The composite primary outcome of death, reinfarction, heart failure, and ischemia-driven revascularization at 12 months occurred in 15 patients (10%) who underwent multivessel PCI, compared with 31 patients (21%) receiving culprit artery–only PCI (HR: 0.49; 95% CI: 0.24 to 0.84; P =0.009). In the DANAMI 3 PRIMULTI (Third Danish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction (...) . The preceding discussion and recommendations apply to the strategy of routine PCI of noninfarct related arteries in hemodynamically stable patients. Recommendations in the 2013 STEMI guideline with regard to PCI of a non–infarct-related artery at a time separate from primary PCI in patients who have spontaneous symptoms and myocardial ischemia or who have intermediate- or high-risk findings on noninvasive testing (Section 6.3 of that guideline) remain operative. Although several observational studies

2015 American Heart Association


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