The “Highlights of the 2015-2020 American Heart Association Guidelines for CPR and ECC “

Highlights of the 2015 American Heart Association 

Guidelines Update for CPR and EEC 2015

Guidelines Highlights

The 2015 Guidelines Highlights provides a summary by topic of the 2015 changes to resuscitation guidelines.

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Classification and staging of diabetic neuropathy

Class I Subclinical Neuropathy*

Abnormal electrodiagnostic tests (EDX)

Decreased nerve conduction velocity

Decreased amplitude of evoked muscle or nerve action potential

Abnormal quantitative sensory testing (QST)

Vibratory/tactile

Thermal warming/cooling

Other

Abnormal autonomic function tests (AFT)

Diminished sinus arrhythmia (beat-to-beat heart rate variation)

Diminished sudomotor function

Increased pupillary latency

Class II Clinical Neuropathy

Diffuse neuropathy

Distal symmetric sensorimotor polyneuropathy

Primarily small fiber neuropathy

Primarily large fiber neuropathy

Mixed

Autonomic neuropathy

Abnormal pupillary function

Sudomotor dysfunction

Genitourinary autonomic neuropathy

Bladder dysfunction

Sexual dysfunction

Gastrointestinal autonomic neuropathy

Gastric atony

Gall bladder atony

Diabetic diarrhea

Hypoglycemic unawareness (adrenal medullary neuropathy)

Cardiovascular autonomic neuropathy

Hypoglycemic unawareness

Focal neuropathy

Mononeuropathy (upper or lower extremity)

Mononeuropathy multiplex

Plexopathy

Polyradiculopathy (can occur with diffuse neuropathy)

Cranial mononeuropathy

* Neurological function tests are abnormal, but no neurological symptoms or clinically detectable neurological deficits indicative of a diffuse or focal neuropathy are present. Class I "Subclinical neuropathy" is further subdivided into Class Ia if an AFT or QST abnormality is present, Class Ib if EDX or AFT and QST abnormalities are present, and Class Ic if an EDX and either AFT or QST abnormalities or both are present.

Adapted from Consensus Panel: Report and Recommendations of the San Antonio Conference on Diabetic Neuropathy. Diabetes 1988; 37:1000.

Management of Rotator Cuff Syndrome in the Workplace

In developed countries, managing rotator cuff syndrome in the workplace presents significant challenges for health care providers and industry employers. Rotator cuff syndrome can substantially affect a person’s health and functioning with pain and/or weakness arising from the injury often restricting a person’s ability to carry out their daily activities and to work. Rotator cuff syndrome frequently results in lost productivity and significant financial costs for industry and employers. It is therefore imperative that appropriate evidence-based management of rotator cuff syndrome is adopted to enhance functioning and minimise negative outcomes for affected individuals, their families and the workplace.

The guidelines have been developed using a rigorous methodology for searching, appraising and grading evidence. Recommendations have been developed using research evidence in conjunction with a multidisciplinary working party. Flowcharts and resources have been developed to support the use of the guidelines. Resources include: assessment and review flowcharts, rotator cuff syndrome information sheet (for injured workers) and return to work (RTW) guides for employers and GPs.

The guidelines are applicable to GPs, medical specialists and other health care providers involved in the treatment of people with rotator cuff syndrome, including physiotherapists, occupational therapists, psychologists, ergonomists, chiropractors and osteopaths. The guidelines can also be used by the injured worker and workplace-based employees involved in coordinating and supporting the RTW for injured workers with rotator cuff syndrome.

The cycle of development, publication, and implementation of clinical practice guidelines

The cycle of development, publication, and implementation of clinical practice guidelines. Implementation or translation into practice should contribute to the development of a subsequent guideline, primarily through health services research. Clinical decision support is shown as the implementation method that bridges the gap between the evidence synthesized by clinical practice guidelines and patient care delivered through the electronic health record. The three major components of information technology in health care are shown: the personal health record, the electronic health record, and the population health record. The arrows represent the flow of information. The arrow between the patient and the personal health record is mostly in the direction of the patient, as patient input into the electronic health record is currently limited.

Criteria for the Diagnosis of Amyotrophic Lateral Sclerosis (ALS)

The diagnosis of Amyotrophic Lateral Sclerosis (ALS) requires:

A. the presence of:

(A:1) evidence of lower motor neuron (LMN) degeneration by clinical, electrophysiological or neuropathologic examination,

(A:2) evidence of upper motor neuron (UMN) degeneration by clinical examination, and

(A:3) progressive spread of symptoms or signs within a region or to other regions, as determined by history or examination, together with

B. the absence of:

(B:1) electrophysiological and pathological evidence of other disease processes that might explain the signs of LMN and/or UMN degeneration, and

(B:2) neuroimaging evidence of other disease processes that might explain the observed clinical and electrophysiological signs.

Diagnostic Categories

Clinically Definite ALS: is defined on clinical evidence alone by the presence of UMN, as well as LMN signs, in three regions.

Clinically Probable ALS: is defined on clinical evidence alone by UMN and LMN signs in at least two regions with some UMN signs necessarily rostral to (above) the LMN signs.

The terms Clinically Probable ALS - Laboratory-supported and Clinically Possible ALS are used to describe these categories of clinical certainty on clinical and criteria or only clinical criteria:

Clinically Probable - Laboratory-supported ALS: is defined when clinical signs of UMN and LMN dysfunction are in only one region, or when UMN signs alone are present in one region, and LMN signs defined by EMG criteria are present in at least two limbs, with proper application of neuroimaging and clinical laboratory protocols to exclude other causes.

Clinically Possible ALS: is defined when clinical signs of UMN and LMN dysfunction are found together in only one region or UMN signs are found alone in two or more regions; or LMN signs are found rostral to UMN signs and the diagnosis of Clinically Probable - Laboratory-supported ALS cannot be proven by evidence on clinical grounds in conjunction with electrodiagnostic, neurophysiologic, neuroimaging or clinical laboratory studies. Other diagnoses must have been excluded to accept a diagnosis of Clinically possible ALS.

Clinically Suspected ALS: it is a pure LMN syndrome, wherein the diagnosis of ALS could not be regarded as sufficiently certain to include the patient in a research study. Hence, this category is deleted from the revised El Escorial Criteria for the Diagnosis of ALS.

References:

1. Brooks BR. El Escorial World Federation of Neurology criteria for the diagnosis of amyotrophic lateral sclerosis. Subcommittee on Motor Neuron Diseases/Amyotrophic Lateral Sclerosis of the World Federation of Neurology Research Group on Neuromuscular Diseases and the El Escorial "Clinical limits of amyotrophic lateral sclerosis" workshop contributors. J Neurol Sci. 1994 Jul;124 Suppl:96-107. [Medline]
2. Mitsumoto H. Diagnosis and progression of ALS. Neurology 1997; 48(S4):2S-8S.
3. Ross MA, Miller RG, Berchert L, Parry G, Barohn RJ, Armon C, Bryan WW, Petajan J, Stromatt S, Goodpasture J, McGuire D. Toward earlier diagnosis of amyotrophic lateral sclerosis: revised criteria. rhCNTF ALS Study Group. Neurology. 1998 Mar;50(3):768-72. [Medline]

Diagnostic Criteria for Alcohol Dependence

A maladaptive pattern of alcohol use, leading to clinically significant impairment or distress, as manifested by three or more of the following seven criteria, occurring at any time in the same 12-month period:

1.       Tolerance, as defined by either of the following:

a)      A need for markedly increased amounts of alcohol to achieve intoxication or desired effect.

b)      Markedly diminished effect with continued use of the same amount of alcohol.

2.       Withdrawal, as defined by either of the following:

a)      The characteristic withdrawal syndrome for alcohol (refer to DSM-IV for further details).

b)      Alcohol is taken to relieve or avoid withdrawal symptoms.

3.       Alcohol is often taken in larger amounts or over a longer period than was intended.

4.       There is a persistent desire or there are unsuccessful efforts to cut down or control alcohol use.

5.       A great deal of time is spent in activities necessary to obtain alcohol, use alcohol or recover from its effects.

6.       Important social, occupational, or recreational activities are given up or reduced because of alcohol use.

7.       Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the alcohol (e.g., continued drinking despite recognition that an ulcer was made worse by alcohol consumption).

References:

1. DSM-IV. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC.

Diagnostic Criteria for Alcohol Abuse

1. A maladaptive pattern of alcohol abuse leading to clinically significant impairment or distress, as manifested by one or more of the following, occurring within a 12-month period:

a)      Recurrent alcohol use resulting in failure to fulfil major role obligations at work, school, or home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions or expulsions from school; or neglect of children or household).

b)      Recurrent alcohol use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine).

c)      Recurrent alcohol-related legal problems (e.g., arrests for alcohol-related disorderly conduct).

d)      Continued alcohol use despite persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the alcohol (e.g., arguments with spouse about consequences of intoxication or physical fights).

2. These symptoms must never have met the criteria for alcohol dependence.

References:

1. DSM-IV. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC.