multiple minor changes, also fixing large error in DBP in brain attack sheet

README.md

@@ -15,6 +15,11 @@ If you are interested in contributing you can do so via:
 #### related free and open source medical resources:
 
 * [Cureus](http://www.cureus.com/) - free and open source medical journal with CC-BY license
+* EMRs:
+    * [OpenMRS](https://openmrs.org/) [[git]](https://github.com/openmrs) - MPL-2 license (GPL-compatible)
+    * [FreeMED](http://freemedsoftware.org/) [[git]](https://github.com/freemed) - GPL license
+    * [OpenEMR](https://www.open-emr.org/) [[git]](https://github.com/openemr) - GPL license
+    * [GNU Health](http://health.gnu.org/) [git?] - website confusing, can't find git page
 * [OpenBCI](http://openbci.com/) - free and open source software and hardware for a rudimentary/experimental EEG setup
 
 #### the FREE in open source

behavioral_clinic_template.md

@@ -126,7 +126,7 @@ Differential includes:
 
 ## Plan
 
-labs: CBC       renal       LFTs       S-TSH         B12/MMA / folate       thiamine       RPR  
+labs: CBC       renal       LFTs       S-TSH         B12/MMA / folate       thiamine       RPR (AAN: VDRL non-routine, only if "clinically indicated")
 
 EKG (consider if e.g. anticholinesterase inhibitor)
 
@@ -136,6 +136,8 @@ memory education       brain-tips sheet
 
 neuropsych (consider if MMSE > 15 & not done within last yr)
 
+psych (if e/o depression)
+
 sleep study (consider if snoring, non-restorative sleep, RBD symptoms)
 
 rtnv (time frame?)?  

stroke_evaluation.md

@@ -242,8 +242,8 @@ Three most prevalent categories:
         * dual antiplalelet therapy for 90 days (e.g. ASA 81 + clopidogrel 75) then monotherapy thereafter
 * cholesterol lower agents - controversy re LDL targeting or not
     * general recommendations have been to target LDL < 70
-    * new focus to use high or medium potency statins that lower cholest by ~30-50%
-    * most likely to benefit are those w:
+    * new focus to use high or medium potency statins that lower cholest by >=%50 or ~30-50%, respectively
+    * most likely to benefit from high/medium potency are those w:
         * clinical atherosclerotic cardiovascular disease (atherosclerotic stroke/TIA or h/o coronary artery disease)
         * LDL > 190 mg/dL
         * DM age 40-75yo and LDL > 70
@@ -268,9 +268,16 @@ Three most prevalent categories:
         * cerebral venous thrombosis
     * specific agents
         * new oral anticoagulants with reported improved efficacy & safety over warfarin
+            * note w trials many exclude pts w recent stroke (e.g. in 2 wks prior)
     * timing on initiation related to risk of intracranial hemorrhage:
         * minimum of 24 hrs post-tPA
         * increased size of infarct - generally longer time waited prior to anticoagulation initiation
+    * bridging:
+        * may use ASA (most commonly; w dc once therapeutic), heparin, or lovenox
+    * size infarct correlates w risk of hemorrhagic transformation - for vit K agents (expecting delay in full effect)
+        * consider 3-5 days small infarcts (less than ~1/3 MCA), 7-10 moderate (up to ~1/3 MCA), 14 days large (complete/near-complete MCA)
+        * not evidenced based
+* no e/o benefit to ASA on top of coumadin
 * glucose control
     * target A1c < 7% (American Diabetes Association genreal recommendations)
     * initial PO regimen: metformin 500 bid (don't start in hospital if doing more testing re contrast/renal-protection)
@@ -295,12 +302,12 @@ Three most prevalent categories:
 
 ### cholesterol lowering agents (mainly from 2/2017 continuum)
 
-#### high potency statins
+#### high potency statins (estimated >= 50% reduction in LDL)
 
 * atorvastatin 40-80
 * rosuvastatin 20-40
 
-#### moderate potency statins
+#### moderate potency statins (estimated 30-50% reduction in LDL)
 
 * atorvastatin 10-20
 * rosuvastatin 5-10