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stroke rehabilitation

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361. Treatment of cerebellar motor dysfunction and ataxia

ataxia type 2, 4-aminopyridine 15 mg/d probably reduces ataxia attack frequency over 3 months (1 Class I study). For patients with ataxia of mixed etiology, riluzole probably improves ataxia signs at 8 weeks (1 Class I study). For patients with Friedreich ataxia or spinocerebellar ataxia (SCA), riluzole probably improves ataxia signs at 12 months (1 Class I study). For patients with SCA type 3, valproic acid 1,200 mg/d possibly improves ataxia at 12 weeks. For patients with spinocerebellar (...) inpatient rehabilitation probably improves ataxia and function (1 Class I study); transcranial magnetic stimulation possibly improves cerebellar motor signs at 21 days (1 Class II study). For patients with multiple sclerosis–associated ataxia, the addition of pressure splints possibly has no additional benefit compared with neuromuscular rehabilitation alone (1 Class II study). Data are insufficient to support or refute use of stochastic whole-body vibration therapy (1 Class III study). Glossary AAN

2018 American Academy of Neurology

362. Patient self-testing and self-management of oral anti-coagulants with vitamin K antagonists Full Text available with Trip Pro

in a training programme by the patient (or for dependant patients, both the patient and their carer) is important. Failure of patients to successfully complete a training programme and demonstrate competency has been reported to be related to age, history of cerebrovascular accident (CVA), poor cognition, low literacy or poor manual dexterity (Fitzmaurice et al , ; Matchar et al , ). UK studies have demonstrated that training programmes can be successfully completed by 75% of patients (Fitzmaurice et al (...) with AF or venous thromboembolism (VTE) these new drugs are viable alternatives to warfarin (Connolly et al , ; Schulman et al , , ; Bauersachs et al , ; Granger et al , ; Buller et al , ; Agnelli et al , , ; Giugliano et al , ; Hokusai‐Investigators, ), and these drugs have received National Institute for Health and Care Excellence (NICE) approval for stroke prevention in AF and for the treatment and secondary prevention of VTE. They are not suitable for patients with mechanical heart valves

2014 British Committee for Standards in Haematology

363. Management of anaemia and red cell transfusion in adult critically ill patients

transfusion improves outcome in anaemic patients with brain injury and transfusion itself appears to be associated with unfavourable outcomes in several studies. The evidence is considered in the context of traumatic brain injury (TBI), subarachnoid haemorrhage (SAH) and ischaemic stroke. Traumatic brain injury Delayed cerebral ischaemia is a major cause of secondary injury following TBI (Dhar et al , ). Clinical markers of cerebral oxygenation are predictive of unfavourable outcome in these patients (...) , ; Kramer et al , ). Although high Hcts predispose to cerebral ischaemia and reduced reperfusion, RCTs have failed to show significant benefit from modest haemodilution (Asplund, ; Allport et al , ). An observational study examining CBF in patients with ischaemic stroke suggests that cerebral DO 2 is maximal with a Hct of 0·40–0·45, a similar range to that in healthy volunteers (0·42–0·45; Kusunoki et al , ; Gaehtgens & Marx, ). Diamond's study of 1012 patients with ischaemic stroke demonstrated

2012 British Committee for Standards in Haematology

364. Supportive care in multiple myeloma

disorder Platelet count <100 × 10 9 /l Acute stroke in previous month (haemorrhagic or ischaemic) Blood pressure >200 mmHg systolic or >120 mmHg diastolic Severe liver disease (abnormal PT or known varices) Severe renal disease (Creatinine clearance <30 ml/min) Undergoing procedure or intervention with high bleeding risk Other patients who are not receiving thalidomide or lenalidomide may also be at risk of VTE and thromboprophylaxis may be appropriate. This is particularly true of those admitted (...) , recombinant factor VIIa and splenectomy have been reported to be successful in the management of some bleeding episodes in patients with factor X deficiency due to AL amyloidosis ( ; ). There is no consensus on the management of acquired VWD in myeloma. Bleeding episodes have been managed with variable success with desmopressin (transient if any response), intravenous immunoglobulin infusions (usually result in both clinical and laboratory improvement), factor VIII/von Willebrand factor concentrates

2011 British Committee for Standards in Haematology

365. Positioning Tests

Arterial Dysfunction that is known and verified. ? Recent eye surgery (within the past three weeks). 5 3 Fractured odontoid peg: fractures of the odontoid peg of the axis (C2) may result from extension of the neck in a high velocity accident or a severe fall. 4 Atlanto-axial subluxation: refers to loss of ligamentous stability in the joint connecting the skull to the spine and is often associated with Down’s Syndrome, other syndromes, rheumatoid arthritis, or trauma. 5 Procedures that risk inducing (...) strong nystagmus are best avoided during this period (Personal communication, Opthalmology Department, Portsmouth Hospital NHS Trust, 2014). Recommended Procedure Positioning Tests BSA 2016 © BSA 2016 Page7 Caution is advised in patients with neck or cardiovascular problems (especially carotid sinus syncope and orthopnoea), who have had a recent stroke, or where there is a recent history of severe nausea or vomiting. Patients should be asked if they can adopt the position required for testing without

2016 British Society of Audiology

366. Red cell transfusion in sickle cell disease Part II

partial exchange transfusions. Eur J Obstet Gynecol Reprod Biol, 152, 138-142. NHLBI (2014) Evidence-Based Management of Sickle Cell Disease: Expert Panel Report, 2014. National Heart, Lung, and Blood Institute, Bethesda, MD. Available at NICE (2008) Stroke: Diagnosis and initial management of acute stroke and transient ischaemic attack (TIA). NICE clinical guideline 68. National Institute for Health and Care Excellence (...) crisis, parvovirus, sequestration (splenic, liver, hepatic), acute chest syndrome (ACS), stroke, silent cerebral infarcts, multi-organ failure, girdle syndrome, intrahepatic cholestasis, surgery, pregnancy and 4) transfusion complications (including alloimmunisation, haemolytic transfusion reactions, iron overload, viral infections). Opinions were also sought from experienced haematologists with a special interest in the care of SCD patients. The guideline was reviewed by the members of the General

2016 British Committee for Standards in Haematology

367. Early-Stage and Locally Advanced (non-metastatic) Non-Small-Cell Lung Cancer: ESMO Clinical Practice Guidelines

Pneumonectomy planned 1.5 Classgroupings A0 B 1–1.5 C 2–2.5 D >2.5 Ischaemic heart disease: history of myocardial infarction, history of posi- tive exercise test, current complaint of chest pain (myocardial ischae- mia), nitrate therapy, ECG with pathological Q waves. Cerebrovascular disease: transient ischaemic attack, stroke. ECG, electrocardiogram. Annals of Oncology Clinical Practice Guidelines Volume 28 | Supplement 4 | August 2017 doi:10.1093/annonc/mdx222 | iv9Systemictherapy In a period of about two (...) with ongoing cardiac care Institute any needed new medical interventions (i.e. beta-blockers, anticoagulants or statins) Cardiac consulation with non-invasive cardiac testing treatments as per AHA/ACC guidelines No History Physical examination Baseline ECG Calculate RCRI *RCRI weighted factors [138]: ? High risk surgery (including lobectomy or pneumonectomy) ? Ischaemic heart disease (prior myocardial infarction, angina pectoris) ? Heart failure ? Insulin-dependent diabetes ? Previous stroke or TIA

2017 European Society for Medical Oncology

368. Intermediate care including reablement

). Page 3 of 28This guideline is the basis of QS173. Ov Overview erview This guideline covers referral and assessment for intermediate care and how to deliver the service. Intermediate care is a multidisciplinary service that helps people to be as independent as possible. It provides support and rehabilitation to people at risk of hospital admission or who have been in hospital. It aims to ensure people transfer from hospital to the community in a timely way and to prevent unnecessary admissions (...) intermediate care teams. These might include: regular team meetings to share feedback and review progress shared notes opportunities for team members to express their views and concerns. 1.2.6 Ensure that the intermediate care team has a clear route of referral to and engagement with commonly used services, for example: general practice podiatry pharmacy mental health and dementia services specialist and longer-term rehabilitation services housing services voluntary, community and faith services specialist

2017 National Institute for Health and Clinical Excellence - Clinical Guidelines

369. Management of Acute Myocardial Infarction in patients presenting with ST-segment elevation Full Text available with Trip Pro

in Acute Myocardial Infarction CCNAP Council on Cardiovascular Nursing and Allied Professions CCP Council for Cardiology Practice CCU coronary care unit CHA 2 DS 2 -VASc Cardiac failure, Hypertension, Age ≥75 (Doubled), Diabetes, Stroke (Doubled) – VAScular disease, Age 65–74 and Sex category (Female) CI confidence interval CKD chronic kidney disease CMR cardiac magnetic resonance CPG Committee for Practice Guidelines CRISP AMI Counterpulsation to Reduce Infarct Size Pre-PCI-Acute Myocardial Infarction (...) In Myocardial Infarction 51 ATOLL Acute myocardial infarction Treated with primary angioplasty and inTravenous enOxaparin or unfractionated heparin to Lower ischaemic and bleeding events at short- and Long-term follow-up AV atrioventricular b.i.d. bis in die (twice a day) BMI body mass index BMS bare-metal stent BNP B-type natriuretic peptide CABG coronary artery bypass graft surgery CAD coronary artery disease CAPITAL AMI Combined Angioplasty and Pharmacological Intervention versus Thrombolytics ALone

2017 European Society of Cardiology

370. Management of Valvular Heart Disease Full Text available with Trip Pro

navigation 21 September 2017 Article Contents Article Navigation 2017 ESC/EACTS Guidelines for the management of valvular heart disease Helmut Baumgartner Corresponding authors: Helmut Baumgartner, Division of Adult Congenital and Valvular Heart Disease, Department of Cardiovascular Medicine, University Hospital Muenster, Albert Schweitzer Campus 1, Building A1, 48149 Muenster, Germany. Tel: +49 251 834 6110, Fax: +49 251 834 6109, E-mail: . Volkmar Falk, Department of Cardiothoracic and Vascular Surgery (...) , Germany. Tel: +49 251 834 6110, Fax: +49 251 834 6109, E-mail: . Volkmar Falk, Department of Cardiothoracic and Vascular Surgery, German Heart Center, Augustenburger Platz 1, D-133353 Berlin, Germany and Department of Cardiovascular Surgery, Charite Berlin, Charite platz 1, D-10117 Berlin, Germany. Tel: +49 30 4593 2000, Fax: +49 30 4593 2100, E-mail: . Search for other works by this author on: Jeroen J Bax Search for other works by this author on: Michele De Bonis Search for other works

2017 European Society of Cardiology

371. Diagnosis and Treatment of Peripheral Arterial Diseases Full Text available with Trip Pro

, demonstrated that DAPT vs. aspirin reduced silent cerebral micro-emboli by 37% after 7 days. No life-threatening intracranial or major bleeding was observed, but the sample size was small. For these reasons, DAPT may be considered within 24 h of a minor ischaemic stroke or transient ischaemic attack (TIA) and may be continued for 1 month in patients treated conservatively. DAPT is recommended in patients undergoing CAS. Two small RCTs comparing aspirin alone with DAPT for CAS were terminated prematurely (...) for Endarterectomy SAPT Single antiplatelet therapy SBP Systolic blood pressure SFA Superficial femoral artery SPACE Stent Protected Angioplasty versus Carotid Endarterectomy STAR Stent Placement in Patients With Atherosclerotic Renal Artery Stenosis and Impaired Renal Function TAMARIS Efficacy and Safety of XRP0038/NV1FGF in Critical Limb Ischaemia Patients With Skin Lesions TAVI Transcatheter aortic valve implantation TBI Toe-brachial index TcPO 2 Transcutaneous oxygen pressure TIA Transient ischaemic attack

2017 European Society of Cardiology

372. 2016 Canadian Cardiovascular Society guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult

-HDL-C or apoB in the future. Anderson et al. 1267 2016 CCS Dyslipidemia Guidelinesintervention or coronary artery bypass graft surgery), other arterial revascularization procedures, angina pectoris, cerebro- vascular disease including transient ischemic attack, or pe- ripheral arterial disease (claudication and/or ankle-brachial index 3.0 cm diameter); (3) diabetes mellitus (DM) with age 40 years,> 15-year duration for age 30 years (type 1 diabetes mellitus [DM]), or with the presence (...) , nonfatal myocardial infarction (MI), ischemic stroke, revascularization, and acute coronary syndromes hospitalizations. Number needed to treat (NNT): NNT to prevent 1 CVD event for 5 years of treatment per 1 mmol/L reduction in LDL-C. NNT of 20%).Despitethecontroversy,wecontinuetoadvocateforlow- density lipoprotein cholesterol targets for subjects who start therapy. Detailed recommendations are also presented for health behaviour modi?cation that is indicated in all subjects. Finally, recommendation

2016 CPG Infobase

373. Guidelines for the Evaluation of Dementia and Age-Related Cognitive Change

are not intended to be mandatory or exhaustive and may not be applicable to every professional situation. They are not de?nitive, and they are not intended to take precedence over the judgment of psychologists. Guidelines on this topic were originally developed by an APA Presidential Task Force, approved as policy of APA by the APA Council of Representatives, and pub- lished in 1998 (APA Presidential Task Force on the As- sessment of Age-Consistent Memory Decline and Demen- tia, 1998). Consistent with APA (...) . The Diagnostic and Statistical Manual of Mental Dis- orders (4th ed.; DSM–IV; American Psychiatric Associa- tion, 2000) outlines diagnostic criteria for the clinical syn- drome of dementia and additional criteria for diagnosing dementia of the Alzheimer type and vascular dementia, as well as briefer guidelines for diagnosing less common causes of dementia, such as head trauma, Parkinson’s dis- ease, and general medical disorders. Diagnostic guidelines for AD have also been provided by the National Institute

2012 American Psychological Association

375. Guidelines for Psychological Practice With Older Adults

, family, geropsy- chology, health, industrial/organizational, neuropsychol- ogy, rehabilitation, and others. The 2008 APA Survey of Psychology Health Service Providers found that 4.2% of respondents viewed older adults as their primary focus and 39% reported that they provided some type of psy- chological services to older adults (APA, Center for Workforce Studies, 2008). Relatively few psychologists, however, have received formal training in the psychol- ogy of aging. Fewer than one third of APA (...) the views that (a) with age inevitably comes demen- tia; (b) older adults have high rates of mental illness, particularly depression; (c) older adults are inef?cient in the workplace; (d) most older adults are frail and ill; (e) older adults are socially isolated; (f) older adults have no interest in sex or intimacy; and (g) older adults are in?ex- ible and stubborn (Edelstein & Kalish, 1999). These ste- reotypes are not accurate, since research has found that the vast majority of older adults

2014 American Psychological Association

376. Integrated care for older people (?ICOPE)?: guidance for person-centred assessment and pathways in primary care

CEREBROVASCULAR DISEASES See malnutrition pathway dentify cause (medical conditions, intoxication from substances, use of drugs) and treat Review medications and withdraw as appropriate Assess history of vascular disease in the brain (stroke/transient ischaemic event) and prevent further events 6 PASS ultimodal exercise Provide cognitive stimulation ASSESS COGNITIVE CAPACITY 1 FAIL FAIL cognitive decline likely PASS ASSOCIATED CONDITIONS ASSESS & MANAGE i SOCIAL AND PHYSICAL ENVIRONMENTS ASSESS & MANAGE (...) with the surgical team and anaesthetist before any future surgeries or anaesthesia. Cerebrovascular disease. Vascular disease in the brain is closely associated with cognitive decline. If the patient has a history of stroke/mini-stroke/transient ischaemic event, then prevention of further events is the primary approach to stop further declines in cognition. ASSESS & MANAGE ASSOCIATED DISEASES Uncovering a reversible medical cause of cognitive decline involves a full diagnostic work-up. It may be necessary

2019 World Health Organisation Guidelines

377. Age-Related Macular Degeneration

or progression of the disease. 35 6.3.2 Coronary and vascular disease People with AMD may be at increased risk of coronary heart disease (120, 125), stroke (126) and cardiovascular mortality (127, 128). However, findings have been inconsistent: and some studies have found no association between history of cardiovascular disease and AMD (118, 129). A systematic review (23) found a significant association when studies were pooled (OR 2.20; 95% CI 1.49 - 3.26), although what constituted cardiovascular disease (...) photography 5.3.2 Fundus Fluorescein angiography 5.3.3 Angiographic features of neovascular AMD 5.3.4 ICG angiography 5.3.5 Optical coherence tomography 5.3.6 Fundus autofluorescence 5.3.7 Structure and function 3 6. Risk factors 6.1 Ocular 6.1.1 Precursor lesions 6.1.2 Refractive status 6.1.3 Iris colour 6.1.4 Macular pigment 6.2 Lifestyle 6.2.1 Smoking habit 6.2.2 Alcohol intake 6.2.3 Diet and nutrition 6.2.4 Obesity 6.3. Medical 6.3.1 Hypertension 6.3.2 Coronary and vascular disease 6.3.3 Diabetes 6.4

2013 Royal College of Ophthalmologists

378. Management of Incidental Findings Detected During Research Imaging

Uterine mass Calcified pulmonary nodule Solid pancreas mass Absent kidney Calcified pleural plaques Undescended testis Pelvic kidney Lipoma Gall bladder mass Adrenal mass Bladder diverticulum Bilateral small kidneys Ureteric calculus Renal calculus Pneumothorax Bowel inflammation Degenerative spine changes Pulmonary embolism Emphysema Bone infarct Deep vein thrombosis Bronchiectasis Fatty liver Gastric mass Irregular nodular margin liver Renal cysts Oesophageal mass Air in the biliary tree

2011 Royal College of Radiologists

379. Guidelines on Chronic Coronary Syndromes Full Text available with Trip Pro

Events CASS Coronary Artery Surgery Study CCB Calcium channel blocker CCS Chronic coronary syndrome(s) CFR Coronary flow reserve CHA 2 DS 2 - VASc Cardiac failure, Hypertension, Age ≥75 [Doubled], Diabetes, Stroke [Doubled] – Vascular disease, Age 65–74 and Sex category [Female] CHD Coronary heart disease CI Confidence interval CKD Chronic kidney disease CMR Cardiac magnetic resonance COMPASS Cardiovascular Outcomes for People Using Anticoagulation Strategies COURAGE Clinical Outcomes Utilizing (...) anticoagulant o.d. Omni die (once a day) ORBITA Objective Randomised Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina PAD Peripheral artery disease PCI Percutaneous coronary intervention PCSK9 Proprotein convertase subtilisin-kexin type 9 PEGASUS- TIMI 54 Prevention of Cardiovascular Events in Patients with Prior Heart Attack Using Ticagrelor Compared to Placebo on a Background of Aspirin–Thrombolysis in Myocardial Infarction 54 PET Positron emission tomography PROMISE

2019 European Society of Cardiology

380. Management of Diabetic Foot

infection • critical limb ischaemia • gangrene • suspicion of an acute charcot neuroarthropathy or an unexplained hot, red, swollen foot with or without pain All patients with diabetes Foot assessment: • skin • neurological • vascular • musculoskeletal Active foot problem? Refer Algorithm B Previous history of ulceration, amputation or on renal replacement therapy? High risk* Early referral to Foot Protection Services NO YES YES NO Deformity/ neuropathy/ non-critical limb ischaemia Moderate risk* Low (...) ). On the other hand, ABI has a sensitivity and specificity of 45.16% and 92.68%. 24, level III In local setting, ABI is widely used due to its feasibility. The results of ABI may be misleading due to calcification of the arteries which give higher pressure ratio. The normal ratio is in the range of 0.9 - 1.3. Critical limb ischaemia is defined as rest pain with ulcers or tissue loss attributed to arterial occlusive disease. It is associated with great loss of limb and life. 25, level III Patients

2018 Ministry of Health, Malaysia


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