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321. Care of the Patient with Accommodative and Vergence Dysfunction

hyperdeviations are usually small in magnitude and nonprogressive over time. Congenital fourth nerve palsies, which will decompensate over time, may be first noted after insult such as high fever or trauma. A newly acquired fourth nerve palsy occurs after a vascular, infectious, traumatic, or neoplastic incident. 75 Depending on the etiology of the vertical deviation, its course may change. Deviations that occur secondary to vascular or ischemic Statement of the Problem 19 involvement tend to improve (...) on the basis of responses to occlusion. In simulated DE, occlusion dramatically affects slow vergence, increasing the angle of deviation slightly at distance and significantly at near. Occlusion does not affect true DE. c. Basic Exophoria The patient with basic exophoria has a deviation of similar magnitude at both distance and near. 20, 21 d. Convergence Excess The patient with convergence excess (CE) has a near deviation at least 3 PD more esophoric than the distance deviation. 22 The etiology

2010 American Optometric Association

322. Cardiovascular Risk in Asymptomatic Adults: Guideline For Assessment of

from consideration patients with a diagnosis of CVD or a coronary event, for example, angina or anginal equivalent, myocardial infarction (MI), or revascularization with percutaneous coronary in- tervention or coronary artery bypass graft surgery. It also excludes testing for patients with known peripheral artery disease (PAD) and cerebral vascular disease. This guideline is not intended to replace other sources of information on cardiovascular risk assessment in speci?c disease groups or higher (...) PATIENTS OR GUIDING THERAPY e66 2.5. Cardiac and Vascular Tests for Risk Assessment in Asymptomatic Adults e66 2.5.1. Resting Electrocardiogram e66 2.5.1.1. RECOMMENDATIONS FOR RESTING ELECTROCARDIOGRAM e66 2.5.1.2. GENERAL DESCRIPTION e67 2.5.1.3. ASSOCIATION WITH INCREASED RISK AND INCREMENTAL RISK e67 2.5.1.4. USEFULNESS IN MOTIVATING PATIENTS, GUIDING THERAPY, AND IMPROVING OUTCOMES e68 2.5.2. Resting Echocardiography for Left Ventricular Structure and Function and Left Ventricular Hypertrophy

2010 American College of Cardiology

323. Nutrition Therapy in the Adult Hospitalized Patient

of the nares, an increase in aspiration pneumonia, sinusitis, and esophageal ulceration or stricture ( 85 ). Certain institutional prac- tices may dictate early placement of a tracheostomy and percuta- neous gastrostomy tube in trauma patients. Early gastrostomy tube placement in stroke patients may be needed to facilitate transfer to a rehabilitation center. More than any other patient population, those with a cerebral vascular accident benefi t from percutaneous gastrostomy placement as a bridge to oral (...) obstruction of the GI tract, uncontrolled peritonitis, and ischemic bowel ( 33 ). Many conditions that were previously con- sidered to be contraindications to enteral feeding may be situa- tions where it is appropriate to provide EN with caution in order to improve outcome. Such conditions include ileus, open abdomen, recent gut anastomoses, GI bleeding, bowel-wall edema, and a stable patient on vasopressor therapy to maintain adequate mean arterial blood pressure ( 34 ). PN via a central line catheter

2016 American College of Gastroenterology

324. 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 Full Text available with Trip Pro

, alcohol consumption, and obesity, limited data are available regarding the potential prophylactic role of CRF in reducing the incidence of cerebrovascular events. Nevertheless, according to a 10.9-year follow-up study of older men, there was a strong, inverse dose-response association between time spent walking and risk of stroke, independent of walking pace (intensity) and established and novel risk factors. More than a decade ago, researchers examined the association between CRF and stroke mortality (...) , PT, FAHA , MD, MPH, PhD , PhD, FAHA , PhD, FAHA , PhD , PhD, FAHA , MD, FAHA , MD , PhD, FAHA , MD, PhD, MBA , MD , PhD , and MD, MPH, PhD PhDOn behalf of the American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Cardiovascular and Stroke Nursing; Council on Functional Genomics and Translational Biology; and Stroke Council Robert Ross , Steven N. Blair , Ross

2016 American Heart Association

325. ICU Admission, Discharge, and Triage Guidelines Full Text available with Trip Pro

, the literature does not support a survival benefit for specialized over general ICU care in the case of common admitting diagnoses such as acute coronary syndrome, ischemic stroke, intracranial hemorrhage, pneumonia, abdominal surgery, or coronary artery bypass graft surgery. Admission to a specialized ICU of a patient with a primary diagnosis not associated with that specialty (i.e., “boarding”) is associated with increased risk-adjusted mortality ( ). Although there are notable limitations in published (...) 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

326. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

, and hypotension, and thus are at increased risk for subclinical ischemia/reperfusion injuries involving the intestinal microcirculation. Ischemic bowel is a very rare complication associated with EN ( ). In a retrospective review of patients requiring stable low doses of vasopressors, those patients receiving early delivery of EN had lower ICU mortality (22.5% vs 28.3%, p = .03) and hospital mortality (34% vs 44%, p < 0.001) than those receiving late EN, respectively. The beneficial effect of early EN (...) assessment include an evaluation of comorbid conditions, function of the gastrointestinal (GI) tract, and risk of aspiration. We suggest not using traditional nutrition indicators or surrogate markers, as they are not validated in critical care. Rationale: In the critical care setting, the traditional serum protein markers (albumin, prealbumin, transferrin, retinol-binding protein) are a reflection of the acute phase response (increases in vascular permeability and reprioritization of hepatic protein

2016 Society of Critical Care Medicine

327. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient

withdrawal of vasopressor support. Rationale: At the height of critical illness, EN is being provided to patients who are prone to GI dysmotility, sepsis, and hypotension and thus are at increased risk for subclinical ischemia/reperfusion injuries involving the intestinal microcirculation. Ischemic bowel is a very rare complication associated with EN. In a retrospective review of patients requiring stable low doses of vasopressors, those patients receiving early delivery of EN had lower ICU mortality (...) of aspiration. We suggest not using traditional nutrition indicators or surrogate markers, as they are not validated in critical care. Rationale: In the critical care setting, the traditional serum protein markers (albumin, prealbumin, transferrin, retinol‐binding protein) are a reflection of the acute‐phase response (increases in vascular permeability and reprioritization of hepatic protein synthesis) and do not accurately represent nutrition status in the ICU setting. Anthropometrics are not reliable

2016 American Society for Parenteral and Enteral Nutrition

328. Medical Training to Achieve Competency in Lifestyle Counseling: An Essential Foundation for Prevention and Treatment of Cardiovascular Diseases and Other Chronic Medical Conditions: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

; the Exercise, Cardiac Rehabilitation, and Secondary Prevention Committee of the Council on Clinical Cardiology; and the Council on Cardiovascular and Stroke Nursing Marie-France Hivert , Ross Arena , Daniel E. Forman , Penny M. Kris-Etherton , Patrick E. McBride , Russell R. Pate , Bonnie Spring , Jennifer Trilk , Linda V. Van Horn , and William E. Kraus and On behalf of the American Heart Association Physical Activity Committee of the Council on Lifestyle and Cardiometabolic Health; the Behavior Change (...) Committee, a joint committee of the Council on Lifestyle and Cardiometabolic Health and the Council on Epidemiology and Prevention; the Exercise, Cardiac Rehabilitation, and Secondary Prevention Committee of the Council on Clinical Cardiology; and the Council on Cardiovascular and Stroke Nursing Originally published 6 Sep 2016 Circulation. 2016;134:e308–e327 You are viewing the most recent version of this article. Previous versions: Introduction A healthy lifestyle is fundamental for the prevention

2016 American Heart Association

329. Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

that nonischemic cardiomyopa- thy can include cardiomyopathies caused by volume or pressure overload (such as hypertension or valvular heart disease) that are not conventionally accepted under the definition of DCM. 1,5 Again, in general practice and clinical research trials, the term ischemic cardiomyopathy is defined as cardiomyopathy caused by ischemic heart disease. Current use of ischemic cardiomyopathy terminol- ogy implies ventricular dilation and depressed myocardial contractility caused by ischemia (...) demonstrated in patients with sinus rhythm when the atria develop mechanical “stand- still” as a result of amyloid infiltration of the atrial walls. High left atrial pressures in the setting of HF also likely contribute to atrial dysfunction. The benefit of anticoagu- lation should be weighed against the potential increased risk of bleeding in patients with amyloid angiopathy. Anticoagulation is indicated in patients with atrial fibril- lation and in those with a history of embolic stroke or transient

2016 American Heart Association

330. 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

140/90 mm Hg. The prevalence of hypertension is steadily increasing, even with the expanded use of antihypertensive medications. 16 It is widely recognized that hypertension is associated with increased cardiovascular and all-cause mortality independently of other risk factors. 14,17 Specific HF mortality attributable to hypertension is probably underreported because of the competing adjudication for stroke or myocardial infarction (MI) at the end of the spectrum of hypertensive cardiovascular (...) may be accentuated through its confounding effect on ischemic heart disease and other cardiovascular outcomes such as stroke. Fur- thermore, these studies predate current HF management strategies and guidelines and may no longer reflect the risk in the current population treated for hypertension. However, they underscore the importance of hyperten- sion as a cause of HF when left untreated. The residual lifetime risk for hypertension for middle-aged and elderly Table 1. Applying Classification

2016 American Heart Association

331. Cervical Radiculopathy and Myelopathy

is intended as a community standard for health care providers who treat injured or ill workers in the Washington workers’ compensation system under Title 51 RCW, and as review criteria for the department’s utilization review team, to help ensure that diagnosis and treatment of cervical neck conditions are of the highest quality. The emphasis is on accurate diagnosis and curative or rehabilitative treatment (see WAC 296-20-01002 for definitions). This guideline was developed in 2014 by a subcommittee (...) of the statutory Industrial Insurance Medical Advisory Committee (IIMAC). Subcommittee members are actively practicing physicians specializing in rehabilitation medicine, occupational medicine, orthopedic surgery, neurology, and pain management. The subcommittee based its recommendations on the weight of the best available clinical and scientific evidence from a systematic review of the literature, and on a consensus of expert opinion when scientific evidence was insufficient. The emphasis of this guideline

2016 Washington State Department of Labor and Industries

332. Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science Full Text available with Trip Pro

as appropriate. All members of the writing group had the opportunity to comment on and approved the final version of this document. The document underwent extensive external peer review and approval by the AHA Science Advisory and Coordinating Committee. Table 3. Search Terms 1. Chest pain OR myocardial infarction OR angina OR myocardial ischemia OR heart attack OR heart infarction OR heart muscle ischemia OR ischemic heart disease OR cardiovascular disease OR coronary heart disease OR coronary artery (...) you are agreeing to our use of cookies. Free Access article Share on Jump to Free Access article Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science A Scientific Statement From the American Heart Association , PhD, RN, FAHA, Chair , PhD, RN, FAHA, Vice Chair , PhD, RN, ACNS-BC , PhD, CNP, FAHA , PhD, MPH , MD, MSPH , MD , MD, MS, FAHA , MD, FAHA , and PhD, APRN, FAHA PhDon behalf of the American Heart Association Council on Cardiovascular and Stroke Nursing, Council

2016 American Heart Association

333. 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 (...) ; 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. Mark W. Green 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

2016 American Association of Neuromuscular & Electrodiagnostic Medicine

334. Lower Extremity Peripheral Artery Disease: Guideline on the Management of Patients With

lowering/hypertension, bypass graft/bypass grafting/ surgical bypass, cilostazol, claudication/intermittent claudication, critical limb ischemia/severe limb ischemia, diabetes, diagnostic testing, endovascular therapy, exercise rehabilitation/exercise therapy/exercise training/ supervised exercise, lower extremity/foot wound/ulcer, peripheral artery disease/peripheral arterial disease/pe- ripheral vascular disease/lower extremity arterial disease, smoking/smoking cessation, statin, stenting (...) . {ACC/AHA Task Force on Clinical Practice Guidelines Liaison. #Inter-Society Consensus for the Management of Peripheral Arterial Disease Representative. **Society for Vascular Medicine Representative. yySociety of Interventional Radiology Representative. zzSociety for Clinical Vascular Surgery Representative. xxSociety for Vascular Surgery Representative. kkAmerican Association of Cardiovascular and Pulmonary Rehabilitation Representative. {{Society for Vascular Nursing Representative. This document

2016 American College of Cardiology

335. Evidence-Based Policy Making: Assessment of the American Heart Association?s Strategic Policy Portfolio Full Text available with Trip Pro

, cardiovascular disease; LOE, level of evidence; NEMSIS, National EMS Information System; PCI, percutaneous coronary intervention; SR, stroke rehabilitation; and STEMI, ST-segment–elevation myocardial infarction. *Not available: the evidence reviews considered for this article did not address this policy priority, but individual studies, experiential evidence, or standard of care supports this work. The AHA develops its guidelines through a rigorous process, often in conjunction with the ACC, but also may (...) 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

2016 American Heart Association

336. Transplantation and Mechanical Circulatory Support in Congenital Heart Disease Full Text available with Trip Pro

at the time of transplantation, because VAD support to improve end-organ perfusion and allow for overall rehabilitation is rarely used. ACHD patients wait longer on the list despite a higher percentage of time spent as status 1/1A/1B than their non-CHD counterparts. The reasons for this are not entirely clear but may be related to a perceived need to find an ideal donor, the desire to reduce ischemic time by limiting distance of donor organ transport, the requirement for extra tissue at procurement (...) be the only therapeutic option for some patients. In addition to CHD expertise, evaluation for HLTx should include a multidisciplinary team with expertise in both heart and lung transplantation. There are increasing data on pulmonary hemodynamics in the risk assessment of HTx in adults and children with HF, although mainly in patients with dilated or ischemic cardiomyopathy. In CHD, however, not only the anatomic but also the hemodynamic conditions for pulmonary vascular remodeling are likely

2016 American Heart Association

337. Sedentary Behavior and Cardiovascular Morbidity and Mortality: A Science Advisory From the American Heart Association Full Text available with Trip Pro

and Prevention; Council on Functional Genomics and Translational Biology; and Stroke Council Deborah Rohm Young , Marie-France Hivert , Sofiya Alhassan , Sarah M. Camhi , Jane F. Ferguson , Peter T. Katzmarzyk , Cora E. Lewis , Neville Owen , Cynthia K. Perry , Juned Siddique , and Celina M. Yong and On behalf of the Physical Activity Committee of the Council on Lifestyle and Cardiometabolic Health; Council on Clinical Cardiology; Council on Epidemiology and Prevention; Council on Functional Genomics (...) and Translational Biology; and Stroke Council Originally published 15 Aug 2016 Circulation. 2016;134:e262–e279 You are viewing the most recent version of this article. Previous versions: Abstract Epidemiological evidence is accumulating that indicates greater time spent in sedentary behavior is associated with all-cause and cardiovascular morbidity and mortality in adults such that some countries have disseminated broad guidelines that recommend minimizing sedentary behaviors. Research examining the possible

2016 American Heart Association

338. Chronic Heart Failure in Congenital Heart Disease Full Text available with Trip Pro

the myocardium to prolonged ischemia or infarction either before or as a result of surgical repair. , Myocardial perfusion assessed by positron emission tomography was often abnormal in those with Fontan repairs, congenitally corrected TGA (ccTGA), and dextro-looped TGA (dTGA) after an atrial switch procedure. Even in the absence of coronary arterial abnormalities, tissue ischemia may be present. High wall stress from increased afterload in conjunction with decreased coronary flow reserve was associated (...) Mitral atresia SV (also called double inlet or outlet, common, or primitive) Pulmonary atresia (all forms) Pulmonary vascular obstructive disease TGA Tricuspid atresia Truncus arteriosus/hemitruncus Other abnormalities of atrioventricular or ventriculoarterial connection not included above (ie, crisscross heart, isomerism, heterotaxy syndromes, ventricular inversion) Moderately complex Aorto–left ventricular fistulas Anomalous pulmonary venous drainage, partial or total Atrioventricular septal

2016 American Heart Association

339. Knowledge Gaps in Cardiovascular Care of the Older Adult Population Full Text available with Trip Pro

, and this has been highlighted in the CHA 2 DS 2 -VASc (Congestive heart failure, Hypertension, Age ≥75, Diabetes mellitus, Stroke or transient ischemic attack, Vascular disease, Age 65-74, Sex category female) risk scoring system, which assigns 1 point for age 65 to 74 years and 2 points for age ≥75 years. Although most AF trials have enrolled patients without an upper age limit, the mean age of study cohorts is 5 to 10 years younger than the average age of patients with AF in the general population (...) . Alexander , Daniel E. Forman , Dalane W. Kitzman , Mathew S. Maurer , James B. McClurken , Barbara M. Resnick , Win K. Shen , David L. Tirschwell , and and on behalf of the American Heart Association Older Populations Committee of the Council on Clinical Cardiology, Council on Cardiovascular and Stroke Nursing, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council; American College of Cardiology; and American Geriatrics Society Originally published 11 Apr 2016 Circulation. 2016;133:2103

2016 American Heart Association

340. Management of Cardiac Involvement Associated With Neuromuscular Diseases: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

Pediatric Heart Failure Committee of the Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; Council on Cardiovascular Radiology and Intervention; Council on Functional Genomics and Translational Biology; and Stroke Council Brian Feingold , William T. Mahle , Scott Auerbach , Paula Clemens , Andrea A. Domenighetti , John L. Jefferies , Daniel P. Judge , Ashwin K. Lal , Larry W. Markham , W. James Parks , Takeshi Tsuda , Paul J. Wang , and Shi-Joon Yoo and On behalf (...) of the American Heart Association Pediatric Heart Failure Committee of the Council on Cardiovascular Disease in the Young; Council on Clinical Cardiology; Council on Cardiovascular Radiology and Intervention; Council on Functional Genomics and Translational Biology; and Stroke Council Originally published 24 Aug 2017 Circulation. 2017;136:e200–e231 You are viewing the most recent version of this article. Previous versions: Abstract For many neuromuscular diseases (NMDs), cardiac disease represents a major

2017 American Heart Association

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