Adventure Therapy With Youth.

Abstract This state of knowledge article provides an overview of Adventure Therapy (AT) as it is practiced with adolescents in North America, presenting (a) current findings in AT research with adolescents, (b) critical issues in AT, (c) the need for training and professional development in AT, and (d) professionalization in AT. Implications of current findings in AT research for practitioners, researchers, and consumers of AT services are also discussed

Atherosclerotic vascular disease conference: Executive summary: Atherosclerotic vascular disease conference proceeding for healthcare professionals from a special writing group of the American Heart Association

Atherosclerosis is one of the most important and common causes of death and disability in the United States and throughout the world. More than 25 million persons in the United States have at least one clinical manifestation of atherosclerosis, and in many more, atherosclerosis remains an occult but important harbinger of significant cardiovascular events. Throughout the last half of the past century, coronary artery atherosclerosis has been a major focus for basic and clinical investigation. As a result, considerable strides have been made in the development of programs to prevent and treat the clinical manifestations of coronary artery disease. The development of lipid-lowering, antithrombotic, thrombolytic, and catheter-based therapies in particular has had considerable impact in reducing death and disability from coronary atherosclerosis. Yet atherosclerosis is a systemic disease with important sequelae in many other regional circulations, including those supplying the brain, kidneys, mesentery, and limbs. Persons with cerebral atherosclerosis are at increased risk for ischemic stroke. Those with renal artery atherosclerosis are at risk for severe and refractory hypertension as well as renal failure. Patients with atherosclerosis affecting the limb, ie, peripheral arterial disease (PAD), can develop disabling symptoms of claudication or critical limb ischemia and its associated threat to limb viability. Moreover, once disease is apparent in one vascular territory, there is increased risk for adverse events in other territories. For example, patients with PAD have a 4-fold greater risk of myocardial infarction and a 2- to 3-fold greater risk of stroke than patients without PAD

ACR Appropriateness Criteria® acute chest pain--suspected pulmonary embolism

Pulmonary embolism (PE) remains a common and important clinical condition that cannot be accurately diagnosed on the basis of signs, symptoms, and history alone. In the absence of high pretest probability and with a negative high-sensitivity D-dimer test, PE can be effectively excluded; in other situations, diagnostic imaging is necessary. The diagnosis of PE has been facilitated by technical advancements and multidetector computed tomography pulmonary angiography, which is the major diagnostic modality currently used. Ventilation and perfusion (V/Q) scans remain largely accurate and useful in certain settings. Lower-extremity ultrasound can substitute by demonstrating deep vein thrombosis; however, if negative, further studies to exclude PE are indicated. In all cases, correlation with the clinical status, particularly with risk factors, improves not only the accuracy of diagnostic imaging but also overall utilization. Other diagnostic tests have limited roles. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 2 years by a multidisciplinary expert panel. The development and review of the guidelines include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances in which evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment