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181. The <i>BRCA1</i> c. 5096G&gt;A p.Arg1699Gln (R1699Q<u>)</u> intermediate risk variant: breast and ovarian cancer risk estimation and recommendations for clinical management from the ENIGMA consortium. (PubMed)

The BRCA1 c. 5096G>A p.Arg1699Gln (R1699Q) intermediate risk variant: breast and ovarian cancer risk estimation and recommendations for clinical management from the ENIGMA consortium. We previously showed that the BRCA1 variant c.5096G>A p.Arg1699Gln (R1699Q) was associated with an intermediate risk of breast cancer (BC) and ovarian cancer (OC). This study aimed to assess these cancer risks for R1699Q carriers in a larger cohort, including follow-up of previously studied (...) families, to further define cancer risks and to propose adjusted clinical management of female BRCA1*R1699Q carriers.Data were collected from 129 BRCA1*R1699Q families ascertained internationally by ENIGMA (Evidence-based Network for the Interpretation of Germline Mutant Alleles) consortium members. A modified segregation analysis was used to calculate BC and OC risks. Relative risks were calculated under both monogenic model and major gene plus polygenic model assumptions.In this cohort the cumulative

2017 Journal of Medical Genetics

182. Personalized thromboprophylaxis using a risk score for the management of pregnancies with high risk of thrombosis: a prospective clinical study. (PubMed)

Personalized thromboprophylaxis using a risk score for the management of pregnancies with high risk of thrombosis: a prospective clinical study. Essentials Pregnancy is a risk factor for thrombosis. Management of thrombosis risk in pregnancy remains a challenge. Prophylaxis needs to be personalized. Our score may be a helpful tool for the management of pregnancies at high risk of thrombosis.Background Patients with thrombophilia and/or a history of venous thromboembolism (VTE) are at risk (...) of thrombosis during pregnancy. A risk score for pregnancies with an increased risk of VTE was previously described by our group (Lyon VTE score). Objectives The aim of this prospective study was to assess the efficacy and safety of our score-based prophylaxis strategy in 542 pregnancies managed between 2005 and 2015 in Lyon University Hospitals. Patients/Methods Of 445 patients included in the study, 36 had several pregnancies during the study period. Among these 445 patients, 279 had a personal history

2017 Journal of Thrombosis and Haemostasis

183. Risk-stratified versus Non-Risk-stratified Diagnostic Testing for Management of Suspected Acute Biliary Obstruction: Comparative Effectiveness, Costs, and the Role of MR Cholangiopancreatography. (PubMed)

Risk-stratified versus Non-Risk-stratified Diagnostic Testing for Management of Suspected Acute Biliary Obstruction: Comparative Effectiveness, Costs, and the Role of MR Cholangiopancreatography. Purpose To analyze the cost-effectiveness of the American Society for Gastrointestinal Endoscopy (ASGE) risk stratification guidelines versus magnetic resonance (MR) cholangiopancreatography-based treatment of patients with possible choledocholithiasis. Materials and Methods A decision-analytic model (...) was constructed to compare cost and effectiveness of three diagnostic strategies for gallstone disease with possible choledocholithiasis: noncontrast MR cholangiopancreatography, contrast material-enhanced MR imaging/MR cholangiopancreatography, and ASGE risk stratification guidelines for diagnostic evaluation recommending endoscopy (high risk), MR cholangiopancreatography (intermediate risk), or no test (low risk). Analysis was performed from a U.S. health system perspective over 1-year and lifetime horizons

2017 Radiology

184. Advances in the management of cardiovascular risk for patients with type 2 diabetes: perspectives from the Academy for Cardiovascular Risk, Outcomes and Safety Studies in Type 2 Diabetes (PubMed)

Advances in the management of cardiovascular risk for patients with type 2 diabetes: perspectives from the Academy for Cardiovascular Risk, Outcomes and Safety Studies in Type 2 Diabetes Diabetes is a global health emergency projected to affect 642 million people by 2040. Type 2 diabetes (T2D) represents 90% of diabetes cases and is associated with a range of cardiovascular (CV) risk factors that are more than double the incidence of CV disease and significantly increase mortality rates (...) for Cardiovascular Risk, Outcomes and Safety Studies in Type 2 Diabetes (ACROSS T2D) brought together a respected faculty of international experts and 150 physicians from 14 countries to discuss the current unmet medical needs of patients with T2D, the results from the EMPA-REG OUTCOME study and the implications of these results for clinical practice. This article summarizes the current scientific evidence and the discussions that took place at the ACROSS T2D regional meeting, which was held in Vienna, Austria

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2017 Therapeutics and clinical risk management

185. How does genetic risk information for Lynch syndrome translate to risk management behaviours? (PubMed)

How does genetic risk information for Lynch syndrome translate to risk management behaviours? There is limited research on why some individuals who have undergone predictive genetic testing for Lynch syndrome do not adhere to screening recommendations. This study aimed to explore qualitatively how Lynch syndrome non-carriers and carriers translate genetic risk information and advice to decisions about risk managment behaviours in the Australian healthcare system.Participants of the Australasian (...) Colorectal Cancer Family Registry who had undergone predictive genetic testing for Lynch syndrome were interviewed on their risk management behaviours. Transcripts were analysed thematically using a comparative coding analysis.Thirty-three people were interviewed. Of the non-carriers (n = 16), 2 reported having apparently unnecessary colonoscopies, and 6 were unsure about what population-based colorectal cancer screening entails. Of the carriers (n = 17), 2 reported they had not had regular colonoscopies

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2017 Hereditary cancer in clinical practice

186. Management of atherosclerosis risk factors for patients at high cardiovascular risk in real-world practice: a multicentre study (PubMed)

Management of atherosclerosis risk factors for patients at high cardiovascular risk in real-world practice: a multicentre study Atherosclerotic cardiovascular disease is a global health burden. However, there are heterogeneities among countries or regions in the risk factors and clinical manifestations of atherosclerotic diseases as well as management patterns.We collected data from 25 centres in Thailand. Patients with documented coronary artery disease, cerebrovascular disease or peripheral (...) arterial disease, or with at least three atherosclerosis risk factors were enrolled between April 2011 and March 2014. Data on demographics, atherosclerosis risk factors and the management pattern of risk factors, including laboratory findings, were recorded.In total, 9,390 patients, including 4,861 patients with established atherosclerotic disease and 4,529 patients with multiple risk factors, were enrolled. The modifiable risk factors, other than current smoking habit (5.3%), were common

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2017 Singapore medical journal

187. Managing suicide risk in late life: access to firearms as a public health risk. (PubMed)

Managing suicide risk in late life: access to firearms as a public health risk. The authors assessed the prevalence of gun availability for elderly patients to determine whether gun availability is related to the presence of suicidal or depressive symptoms.This is a cross-sectional epidemiologic survey of firearm availability and safety practices. A random sample of older adults with a scheduled primary-care clinic appointment was selected and screened with the General Health Questionnaire

2017 The American Journal of Geriatric Psychiatry

188. Renal and ureteric stones: assessment and management

waiting after an informed discussion of the possible risks and benefits. Renal and ureteric stones: assessment and management (NG118) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 7 of 331.5.2 Follow the recommendations in table 1 for surgical treatment (including SWL) of renal stones in adults, children and young people. T T able able 1 Surgical treatment (including SWL) of renal stones in adults, children and 1 (...) analysis showed economic benefit for SWL even with lower SWL success rates. The committee therefore agreed to Renal and ureteric stones: assessment and management (NG118) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 20 of 33offer the less-invasive procedure of SWL to treat small ureteric stones (less than 10 mm) in adults. However, they acknowledged that prompt treatment of these stones is needed because of the risk

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

189. Prostate cancer: diagnosis and management

pathological stage predict risk of treatment failure. [2008] [2008] 1.1.8 Explain the reliability, validity and limitations of any predictions made using nomograms. [2008] [2008] 1.1.9 Discuss all relevant management options in this guideline with people with prostate cancer and their partners or carers, even if they are not available through their local services. [2008] [2008] 1.1.10 T ell people with prostate cancer: about treatment options and their risks and benefits in an objective, unbiased manner (...) they might affect practice, see rationale and impact. Staging Staging 1.2.14 Offer isotope bone scans when hormonal therapy is being deferred as part of watchful waiting to asymptomatic people who are at high risk of developing bone complications. [2008] [2008] Prostate cancer: diagnosis and management (NG131) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 11 of 511.2.15 Consider CT for people with histologically proven

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

190. Hypertension in pregnancy: diagnosis and management

is it for? 5 Recommendations 6 1.1 Reducing the risk of hypertensive disorders in pregnancy 6 1.2 Assessment of proteinuria in hypertensive disorders of pregnancy 8 1.3 Management of chronic hypertension in pregnancy 9 1.4 Management of gestational hypertension 13 1.5 Management of pre-eclampsia 17 1.6 Fetal monitoring 24 1.7 Intrapartum care 26 1.8 Medical management of severe hypertension, severe pre-eclampsia or eclampsia in a critical care setting 27 1.9 Antihypertensive treatment during the postnatal (...) of birth 46 Antihypertensive treatment during the postnatal period, including during breastfeeding 48 Risk of recurrence of hypertensive disorders of pregnancy and long-term cardiovascular disease 49 Context 50 Hypertension in pregnancy: diagnosis and management (NG133) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 3 of 54Finding more information and resources 52 Update information 53 Hypertension in pregnancy

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

191. Depression in children and young people: identification and management

://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 44Contents Contents Overview 4 Who is it for? 4 Recommendations 5 1.1 Care of all children and young people with depression 5 1.2 Stepped care 10 1.3 Step 1: Detection, risk profiling and referral 12 1.4 Step 2: Recognition of depression in children and young people 16 1.5 Step 3: Managing mild depression 16 1.6 Steps 4 and 5: Managing moderate to severe depression 19 1.7 Transfer to adult services 28 T erms used in this guideline 29 (...) this when we update the 2005 recommendations. The guidance follows these 5 steps: 1. Detection and recognition of depression and risk profiling in primary care and community settings. 2. Recognition of depression in children and young people referred to Children and Young People's Mental Health Services (including CAMHS). 3. Managing recognised depression in primary care and community settings – mild depression. 4. Managing recognised depression in tier 2 or 3 [1] CAMHS – moderate to severe depression

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

192. Urinary incontinence and pelvic organ prolapse in women: management

catheterisation. Discuss the practicalities, benefits and risks with the woman or, if appropriate, her carer. Indications for the use of long-term indwelling urethral catheters for women with urinary incontinence include: chronic urinary retention in women who are unable to manage intermittent self- catheterisation skin wounds, pressure ulcers or irritations that are being contaminated by urine distress or disruption caused by bed and clothing changes where a woman expresses a preference for this form (...) have not responded to non-surgical management and the woman does not wish to have other invasive treatments. [2019] [2019] 1.4.46 After a local MDT review, discuss the benefits and risks of treatment with botulinum toxin type A [4] with the woman and explain: the likelihood of complete or partial symptom relief the process of clean intermittent catheterisation, the risks, and how long it might need to be continued the risk of adverse effects, including an increased risk of urinary tract infection

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

193. Hypertension in adults: diagnosis and management

and management (NG136) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 6 of 401.2.5 While waiting for confirmation of a diagnosis of hypertension, carry out: investigations for target organ damage (see recommendation 1.3.3), followed by formal assessment of cardiovascular risk using a cardiovascular risk assessment tool (see the section on full formal risk assessment in NICE's guideline on cardiovascular disease). [2019 (...) ] 1.2.12 Consider the need for specialist investigations in people with signs and symptoms suggesting a secondary cause of hypertension. [2004, amended [2004, amended 2011] 2011] T o find out why the committee made the 2019 recommendations on diagnosing hypertension and how they might affect practice, see rationale and impact. 1.3 Assessing cardiovascular risk and target organ damage For guidance on the early identification and management of chronic kidney disease, see NICE's guideline on chronic

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

194. Fever in under 5s: assessment and initial management

professionals should identify any immediately life-threatening features, including compromise of the airway, breathing or circulation, and decreased level of consciousness. [2007] [2007] 1.2.2 Think "Could this be sepsis?" and refer to the NICE guideline on sepsis: recognition, diagnosis and early management if a child presents with fever and symptoms or signs that indicate possible sepsis. [2017] [2017] Assessment of risk of serious illness Assessment of risk of serious illness 1.2.3 Assess children (...) , and none of the high- or intermediate-risk features, are in a low-risk group for serious illness: normal colour of skin, lips and tongue responds normally to social cues [1] content/smiles stays awake or awakens quickly strong normal cry or not crying normal skin and eyes Fever in under 5s: assessment and initial management (NG143) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 7 of 35moist mucous membranes. [2013

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

195. Hyperparathyroidism (primary): diagnosis, assessment and initial management

1.1.1 Measure albumin-adjusted serum calcium for people with any of the following features, which might indicate primary hyperparathyroidism: symptoms of hypercalcaemia, such as thirst, frequent or excessive urination, or constipation osteoporosis or a previous fragility fracture (for recommendations on assessing the risk of fragility fracture in people with osteoporosis, see the NICE guideline on osteoporosis) a renal stone (for recommendations on assessing and managing renal stones, see the NICE (...) a bisphosphonate to reduce fracture risk for people with primary hyperparathyroidism and increased fracture risk. Hyperparathyroidism (primary): diagnosis, assessment and initial management (NG132) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 11 of 321.5.5 Do not offer bisphosphonates for chronic hypercalcaemia of primary hyperparathyroidism. T o find out why the committee made the recommendations on non-surgical management

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

196. Crohn’s disease: management

) options for managing their disease when they are in remission, including both no treatment and treatment. The discussion should include the risk of inflammatory exacerbations (with and without drug treatment) and the potential side effects of drug treatment. Record the person's views in their Crohn’s disease: management (NG129) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 10 of 22notes. [2012] [2012] 1.3.2 Offer (...) strictures 1.5.3 Consider balloon dilation, particularly for people with a single stricture that is short, straight and accessible by colonoscopy. [2012] [2012] 1.5.4 Discuss the benefits and risks of balloon dilation and surgical interventions for managing strictures [12] with: the person with Crohn's disease and their family members or carers (as appropriate) and and Crohn’s disease: management (NG129) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

197. Ulcerative colitis: management

Ulcerative colitis: management Ulcer Ulcerativ ative colitis: management e colitis: management NICE guideline Published: 3 May 2019 www.nice.org.uk/guidance/ng130 © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-of- rights).Y Y our responsibility our responsibility The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement (...) . Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Ulcerative colitis: management (NG130) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 2 of 28Contents Contents Overview 4 Who is it for? 4 Recommendations 5 1.1 Patient information and support 5 1.2

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

198. Stroke and transient ischaemic attack in over 16s: diagnosis and initial management

assessment and investigation, to be seen within 24 hours of onset of symptoms. [2019] [2019] 1.1.6 Do not use scoring systems, such as ABCD2, to assess risk of subsequent stroke or to inform urgency of referral for people who have had a suspected or confirmed TIA. [2019] [2019] Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (NG128) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 5 (...) are at significant risk of haemorrhagic transformation, stop anticoagulation Stroke and transient ischaemic attack in over 16s: diagnosis and initial management (NG128) © NICE 2019. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and- conditions#notice-of-rights). Page 11 of 38treatment for 1 week and substitute aspirin 300 mg. [2008] [2008] 1.4.19 Ensure that people with ischaemic stroke and symptomatic proximal deep vein thrombosis or pulmonary embolism receive anticoagulation

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

199. Ectopic pregnancy and miscarriage: diagnosis and initial management

' gestation or more or or a pregnancy of uncertain gestation. The urgency of this referral depends on the clinical situation. [2012] [2012] 1.3.10 Use expectant management for women with a pregnancy of less than 6 weeks' gestation who are bleeding but not in pain, and who have no risk factors, such as a previous ectopic pregnancy. Advise these women: to return if bleeding continues or pain develops Ectopic pregnancy and miscarriage: diagnosis and initial management (NG126) © NICE 2019. All rights reserved (...) -line management strategy for women with a confirmed diagnosis of miscarriage. Explore management options other than expectant management if: the woman is at increased risk of haemorrhage (for example, she is in the late first trimester) or or she has previous adverse and/or traumatic experience associated with pregnancy (for example, stillbirth, miscarriage or antepartum haemorrhage) or or she is at increased risk from the effects of haemorrhage (for example, if she has coagulopathies or is unable

2019 National Institute for Health and Clinical Excellence - Clinical Guidelines

200. Package of care for active management in labour for reducing caesarean section rates in low-risk women. (PubMed)

Package of care for active management in labour for reducing caesarean section rates in low-risk women. Approximately 15% of women have caesarean sections (CS) and while the rate varies, the number is increasing in many countries. This is of concern because higher CS rates do not confer additional health gain but may adversely affect maternal health and have implications for future pregnancies. Active management of labour has been proposed as a means of reducing CS rates. This refers (...) to a package of care including strict diagnosis of labour, routine amniotomy, oxytocin for slow progress and one-to-one support in labour.To determine whether active management of labour reduces CS rates in low-risk women and improves satisfaction.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (16 April 2013).Randomised controlled trials comparing low-risk women receiving a predefined package of care (active management) with women receiving routine (variable) care. Trials where

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2013 Cochrane

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