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The American Medical Society for Sports Medicine convened a panel of experts to provide an evidence-based, best practices document to assist sports medicine physicians and other members of the athletic care network with the detection, treatment and prevention of mental health issues in competitive athletes. This statement discusses how members of the sports medicine team, including team physicians, athletic trainers and mental health providers, work together in providing comprehensive psychological care to athletes. It specifically addresses psychological factors in athletes including personality issues and the psychological response to injury and illness. The statement also examines the athletic culture and environmental factors that commonly impact mental health, including sexuality and gender issues, hazing, bullying, sexual misconduct and transition from sport. Specific mental health disorders in athletes, such as eating disorders/disordered eating, depression and suicide, anxiety and stress, overtraining, sleep disorders and attention-deficit/hyperactivity disorder, are reviewed with a focus on detection, management, the effect on performance and prevention. This document uses the Strength of Recommendation Taxonomy to grade level of evidence.
Cancer Council Australia Colorectal Cancer Guidelines Working Party. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. Sydney: Cancer Council Australia. [Version URL: =216678, cited 2023 Dec 22]. Available from: :Colorectal_cancer.
Mastitis is the most frequent disease of dairy cows and has well-recognized detrimental effects on animal wellbeing and dairy farm profitability. Since the beginning of modern dairy farming, producers have sought effective methods to minimize the occurrence of mastitis in their herds. The objective of this paper is to review and highlight important advances in detection, management, and prevention of mastitis that have occurred since the first volume of the Journal of Dairy Science was published in 1917. Initial research efforts were directed at understanding the nature of pathogenic bacteria that were responsible for most intramammary infections. For decades, researchers worked to identify effective strategies to control mastitis caused by Streptococcus agalactiae and Staphylococcus aureus. To develop successful control programs, mastitis workers first had to identify mechanisms of infection, define the clinical and subclinical states of the disease, discover appropriate screening tests, determine likely points of exposure, identify pathogen-specific characteristics, and develop effective procedures for machine milking. Pioneering researchers eventually recognized that mastitis control was based on preventing new infections from occurring in healthy cows and reducing the duration that cows remained infected. Development of a control program that incorporated post-milking teat dipping, hygienic milking procedures, and strategic use of antibiotic therapy at dry-off resulted in widespread control of contagious pathogens. As herd management changed, researchers were tasked with defining control of mastitis caused by opportunistic pathogens originating from environmental sources. As mastitis pathogens have evolved, researchers have sought to define antimicrobial usage that will maintain animal wellbeing while minimizing unnecessary usage. During the last century, tremendous significant advances in mastitis control have been made but changing herd structure and more rigorous processor standards ensure that mastitis will remain an important subject focus of future research.
The incidence of subarachnoid haemorrhage (SAH) is 6-8 per 100 000 person years, peaking in the sixth decade. SAH, mostly due to rupture of an intracranial aneurysm, accounts for a quarter of cerebrovascular deaths. Aneurysms increase in frequency with age beyond the third decade, are 1.6 times more common in women and are associated with a number of genetic conditions. Prospective autopsy and angiographic studies indicate that between 3.6 and 6% of the population harbour an intracranial aneurysm. Studies have found an increased rate of SAH in first degree relatives of SAH patients (relative risk 3.7-6.6). In affected families, the most frequent relationship between sufferers is sibling to sibling. The rupture rate of asymptomatic aneurysms was thought to be 1-2% per annum, but the recent International Study of Unruptured Intracranial Aneurysms found that the rupture rate of small aneurysms was only 0.05% per annum in patients with no prior SAH, and 0.5% per annum for large (>10 mm diameter) aneurysms and for all aneurysms in patients with previous SAH. Non-invasive tests such as magnetic resonance angiography (MRA), computed tomographic angiography (CTA) and transcranial Doppler (TCD) have been advocated as alternatives to intra-arterial digital subtraction angiography to screen for aneurysms. Although all are promising techniques, the quality of data testing their accuracy is limited. Overall reported sensitivity for CTA and MRA (TCD is poorer) was 76-98% and specificity was 85-100%, but many subjects had an aneurysm or recent SAH, which could overestimate accuracy. CTA and MRA are much poorer methods for the detection of aneurysms
Ultrasound imaging is a commonly used modality for breast cancer detection and diagnosis. In this review, we summarize ultrasound imaging technologies and their clinical applications for the management of breast cancer patients. The technologies include ultrasound elastography, contrast-enhanced ultrasound, 3-D ultrasound, automatic breast ultrasound and computer-aided detection of breast ultrasound. We summarize the study results seen in the literature and discuss their future directions. We also provide a review of ultrasound-guided, breast biopsy and the fusion of ultrasound with other imaging modalities, especially magnetic resonance imaging (MRI). For comparison, we also discuss the diagnostic performance of mammography, MRI, positron emission tomography and computed tomography for breast cancer diagnosis at the end of this review. New ultrasound imaging techniques, ultrasound-guided biopsy and the fusion of ultrasound with other modalities provide important tools for the management of breast patients.
Few guidelines on the topic of respiratory depression associated with neuraxial opioids are available, and none have comprehensively identified patients at risk for respiratory depression, or developed strategies for the prevention, detection, and management of respiratory depression associated with neuraxial opioids.
These updated guidelines focus on the management of all patients receiving epidural or spinal opioids in inpatient (e.g., operating rooms, intensive care units, labor and delivery suites, postoperative surgical floors, hospital wards) or ambulatory (e.g., stand-alone outpatient facilities) settings. These guidelines do not apply to patients with chronic or cancer pain (except those with acute postoperative pain), patients with preexisting implantable drug delivery systems, or patients with contraindications to spinal or epidural opioids (e.g., coagulopathy, sepsis).
These updated guidelines are intended for use by anesthesiologists. They also may serve as a resource for other physicians administering neuraxial opioids and other healthcare providers involved in the management of patients receiving neuraxial opioids.
Introduction: Metabolic syndrome represents a cluster of related metabolic abnormalities, including central obesity, hypertension, dyslipidemia, hyperglycemia, and insulin resistance, with central obesity and insulin resistance in particular recognized as causative factors. These metabolic derangements present significant risk factors for cardiovascular disease, which is commonly recognized as the primary clinical outcome, although other outcomes are possible. Metabolic syndrome is a progressive condition that encompasses a wide array of disorders with specific metabolic abnormalities presenting at different times. These abnormalities can be detected and monitored via serum biomarkers. This review will compile a list of promising biomarkers that are associated with metabolic syndrome and this panel can aid in early detection and management of metabolic syndrome in high risk populations, such as in West Virginia.
Conclusion: Based on the evidence presented within the literature, the aforementioned biomarkers correlate significantly with metabolic syndrome and could provide a minimally-invasive means for early detection and specific treatment of these disorders. Further research is encouraged to determine the efficacy of applying these biomarkers to diagnosis and treatment in a clinical setting.
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EMA has also published ___________________ on Screening for adverse reactions in EudraVigilance for use by the Agency, national competent authorities and MAHs. The guidance discusses the methods recommended and implemented in EudraVigilance for screening for adverse reactions. It updates and supersedes the previous Guideline on the use of statistical signal-detection methods in the EudraVigilance data-analysis system. 5376163bf9
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