https://cdr.lib.unc.edu/downloads/9p290c48k

ACC/AHA Guidelines for Coronary Artery Bypass Graft Surgery A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery)

The aim of this new statement is to provide comprehensive and timely evidence-based recommendations on the prevention of ischemic stroke among survivors of ischemic stroke or transient ischemic attack Evidence-based recommendations are included for the control of risk factors, interventional approaches for atherosclerotic disease, antithrombotic treatments for cardioembolism, and the use of antiplatelet agents for noncardioembolic stroke Further recommendations are provided for the prevention of recurrent stroke in a variety of other specific circumstances, including arterial dissections; patent foramen ovale; hyperhomocysteinemia; hypercoagulable states; sickle cell disease; cerebral venous sinus thrombosis; stroke among women, particularly with regard to pregnancy and the use of postmenopausal hormones; the use of anticoagulation after cerebral hemorrhage; and special approaches for the implementation of guidelines and their use in high-risk populations

https://www.ahajournals.org/doi/pdf/10.1161/01.str.0000199147.30016.74?ijkey=567b368d4e69985fc2c1c99723b3d8de8e39c28a

Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic Attack : A statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke : Co-sponsored by the Council on Cardiovascular Radiology and Intervention : The American Academy of Neurology affirms the value of this guideline

ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: Summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (committee to update the 1999 guidelines for coronary artery bypass graft surgery)

Background. —Clinical prediction rules are decision-making tools for clinicians, containing variables from the history, physical examination, or simple diagnostic tests. Objective. —To review the quality of recently published clinical prediction rules and to suggest methodological standards for their development and evaluation. Data Sources. —Four general medical journals were manually searched for clinical prediction rules published from 1991 through 1994. Study Selection. —Four hundred sixty potentially eligible reports were identified, of which 30 were clinical prediction rules eligible for study. Most methodological standards could only be evaluated in 29 studies. Data Abstraction. —Two investigators independently evaluated the quality of each report using a standard data sheet. Disagreements were resolved by consensus. Data Synthesis. —The mathematical technique was used to develop the rule, and the results of the rule were described in 100% (29/29) of the reports. All the rules but 1 (97% [28/29]) were felt to be clinically sensible. The outcomes and predictive variables were clearly defined in 83% (24/29) and 59% (17/29) of the reports, respectively. Blind assessment of outcomes and predictive variables occurred in 41% (12/29) and 79% (23/29) of the reports, respectively, and the rules were prospectively validated in 79% (11/14). Reproducibility of predictive variables was assessed in only 3% (1/29) of the reports, and the effect of the rule on clinical use was prospectively measured in only 3% (1/30). Forty-one percent (12/29) of the rules were felt to be easy to use. Conclusions. —Although clinical prediction rules comply with some methodological criteria, for other criteria, better compliance is needed.

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=414118&pdfFileName=jama_277_6_034.pdf

Clinical prediction rules. A review and suggested modifications of methodological standards.

http://www.pediatrasandalucia.org/Pdfs/Childhood_Functional_Gastrointestinal_Disorders_NeonateToddler.pdf

Childhood Functional Gastrointestinal Disorders: Neonate/Toddler

Three hundred and fifty-two patients with atherosclerotic middle cerebral artery stenosis (MCAS, 53%) or occlusion (MCAO, 47%) have been systematically studied. The study involved all patients entered into the EC/IC Bypass Study with isolated MCA disease or a tandem lesion predominating in the MCA ipsilateral to the ischemic events (18 patients with a tandem lesion of greater magnitude in the internal carotid artery were not included). The Asian patients represented 58% of all Asians entered into the EC/IC Bypass Study, whereas the white patients represented 18% of all whites and the black patients 34% of all blacks. Isolated TIAs were less frequent in MCAO (12%) than in MCAS (34%). Warning TIAs before a stroke occurred in one third of the cases. Presentation with stroke or isolated TIA was not influenced by sex, age, level of MCA obstruction, collateral circulation nor associated carotid disease. In MCAS, no major difference in presentation was found between severe and moderate stenosis. Pure motor hemiparesis occurred in 15% and pure sensory stroke in 2% of the patients with stroke and 30% of the MCA territory infarcts were small and limited to the lenticulocapsular area, confirming that so-called lacunar infarcts may be due to large vessel disease. During follow-up (42 months) of 164 medically-treated patients, further cerebrovascular events (TIA and stroke) occurred in 11.7% of the patients per year. In MCAO the stroke rate was 10.1% per patient-year and the ipsilateral infarct rate was 7.1% per patient-year. In MCAS, the stroke rate was 9.5% per patient-year and the ipsilateral stroke rate was 7.8% per patient-year.(ABSTRACT TRUNCATED AT 250 WORDS)

Atherosclerotic disease of the middle cerebral artery.

• We studied 149 healthy children at 22 months of age and 74 at 40 months of age, employing a 24-hour dietary record based on premailed food measurement guide and telephone questionnaire. Parents cooperated in 94% of contacts. Chronic digestive complaints decreased from 27% to 5% of the sample over the study period: constipation from 16% to 3%, chronic diarrhea from 8% to 1%, and abdominal pain from 5% to 1%. Excessive fluid intake (1470±600 vs mL/d) correlated most strongly for seven children at 22 months experiencing alternating symptoms of chronic diarrhea and constipation or abdominal pain. Many other children tolerated dietary extremes without complaint. All macronutrient categories except dietary fiber intake increased over the study period. Thus, excessive fluid intake may provoke symptoms suggesting the irritable bowel syndrome in a susceptible group of younger children. Failure to increase fiber intake from 22 to 40 months of age leaves children on an immature diet whose effects require further study. ( AJDC 1987;141:679-682)

Are Chronic Digestive Complaints the Result of Abnormal Dietary Patterns?: Diet and Digestive Complaints in Children at 22 and 40 Months of Age

64 Carotid endarterectomy (CEA) is beneficial for severe symptomatic stenosis, but trial results for moderate stenosis have been conflicting. This may be due to the differences between trials in the method of measurement of carotid stenosis, differences in outcome definitions, or chance. We used the same definitions of outcomes and the same method of measurement of stenosis to pool individual patient data on over 95% of patients ever randomised in trials of CEA for symptomatic stenosis: European Carotid Surgery Trial (ECST); North American Symptomatic Carotid Endarterectomy Trial; Veterans Administration trial #309. The degree of stenosis was remeasured on the 3018 pre-randomisation ECST angiograms by the method used in the other two trials. Remeasurements correlated well with the original measurements (r=0.94, P any stroke or surgical death in patients with 50–69% stenosis (NNT = 14, 95% CI = 8–30), and this was consistent across the individual trials. Surgery was highly beneficial in patients with 70–99% stenosis (NNT = 8, 95% CI = 5–12), but had no effect on overall survival. Operative mortality was 1.1% (95% CI = 0.9–1.4) and the operative risk of stroke and death was 7.0% (95% CI = 6.2–8.0). In contrast to interpretations of the original trial reports, by using the same outcome definitions and the same method of measurement of stenosis we have demonstrated that the trial results are entirely consistent. By combining all available trial data we have determined the effect of surgery with greater precision. CEA reduces the risk of any stroke or death in patients with 50–99% carotid stenosis, although benefit is less than for 70–99% stenosis.

Overall results of a pooled analysis of individual patient data from trials of endarterectomy for symptomatic carotid stenosis

A suburban Ontario community hospital encountered 21 +/- 1 overdoses of children9s multiple vitamins yearly between 1978 and 1981. Of these, 35% involved one particular cartoon character preparation. Parents were surveyed to determine whether this particular preparation resulted in a disproportionate number of accidental overdoses. However, the use of vitamins with a cartoon character format did not lead to a greater risk of overdose than did conventional preparations. Of the 1051 families who had given multiple vitamins to their children 34 (3%) had experienced an overdose. The number of vitamin preparations used by each family was the most powerful determinant of overdose (p less than 0.001). The risk of accidental overdose increased from 1.5% with one multiple-vitamin preparation to 8% with four or more preparations. Among all the variables examined, exposure was the most important element in the risk of multiple-vitamin overdose.

Children's multiple vitamins: overuse leads to overdose

The carotid endarterectomy trial: on track

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