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Risk Management

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181. Central Venous Catheter Management in High-risk Children With Bloodstream Infections. (Abstract)

Central Venous Catheter Management in High-risk Children With Bloodstream Infections. National guidelines recommend removal of central venous catheters (CVCs) for central line-associated bloodstream infections (CLABSIs) caused by Staphylococcus aureus, Pseudomonas aeruginosa, and fungi. Data regarding guideline compliance and rates of associated treatment failures in pediatric patients with attempted CVC salvage are limited.We performed a retrospective analysis of high-risk children (age ≤ 21 (...) years) hospitalized from 1/2009 to 12/2015 with a long-term CVC and CLABSI due to S. aureus, Pseudomonas spp., and Candida spp. Enterococcus spp. was included given differing management recommendations between short and long-term CVCs. Compliance with national guideline recommendations, as well as treatment failures including infection relapse, recurrence, and death were evaluated in relation to CVC retention or removal. Multivariate logistic regression modeling was performed to account

2020 Pediatric Infectious Dsease Journal

182. Reoperation for Bleeding After Thyroid and Parathyroid Surgery: Incidence, Risk Factors, Prevention, and Management. Full Text available with Trip Pro

Reoperation for Bleeding After Thyroid and Parathyroid Surgery: Incidence, Risk Factors, Prevention, and Management. Bleeding after thyroid and/or parathyroid surgery is a life-threatening emergency. The aim of this study was to determine the rates of reoperation following bleeding, identify risk factors, assess management strategies and outcomes, and develop protocols to reduce risk and improve management of bleeding.A retrospective cohort study of all consecutive patients who underwent (...) -operative bleeding cannot be determined in patients undergoing thyroid surgery. Based on this experience, we developed protocols to reduce the risk of bleeding (the ITSRED Fred protocol) and for the early detection and management of bleed (the SCOOP protocol) following thyroid and/or parathyroid surgery.

2020 World Journal of Surgery

183. The earlier, the better or the worse? Towards accurate management of patients with arthralgia at risk for RA. Full Text available with Trip Pro

The earlier, the better or the worse? Towards accurate management of patients with arthralgia at risk for RA. The favourable long-term results of early treatment in patients with classified rheumatoid arthritis have resulted in an increasing interest in the diseases phases preceding clinical arthritis. The hypothesis to test is that an intervention in these early phases may better prevent or reduce disease persistence than an intervention when arthritis has become clinically manifest. While

2020 Annals of the rheumatic diseases

184. Roles and recommendations from primary care physicians towards managing low-risk breast cancer survivors in a shared-care model with specialists in Singapore-a qualitative study. Full Text available with Trip Pro

Roles and recommendations from primary care physicians towards managing low-risk breast cancer survivors in a shared-care model with specialists in Singapore-a qualitative study. Breast cancer is prevalent and has high cure rates. The resultant increase in numbers of breast cancer survivors (BCS) may overwhelm the current oncology workforce in years to come. We postulate that primary care physicians (PCPs) could play an expanded role in comanaging survivors, provided they are given (...) in managing acute and non-cancer issues, optimizing comorbidities and preventive care. PCPs aspired to expand their role to include cancer surveillance, risk assessment and addressing unmet psychosocial needs. PCPs preferred to harmonize cancer survivorship management of their primary care patients who are also BCS, with defined role distinct from oncologists. Training to understand the care protocol, enhancement of communication skills, confidence and trust were deemed necessary. PCPs proposed selection

2020 Family Practice

185. Temporal Trends of the Management and Outcome of Patients With Myocardial Infarction According to the Risk for Recurrent Cardiovascular Events. (Abstract)

Temporal Trends of the Management and Outcome of Patients With Myocardial Infarction According to the Risk for Recurrent Cardiovascular Events. Some patients are at higher risk for recurrent cardiovascular events following a myocardial infarction because of their clinical characteristics and comorbidities. Still, they are less often treated with guideline-recommended therapies. We examined trends for more than a decade in the treatment and outcome of patients with myocardial infarction (...) according to the risk for recurrent cardiovascular events, using the Thrombolysis in Myocardial Infarction (TIMI) risk score for secondary prevention.This is a retrospective cohort study of patients after acute myocardial infarction who underwent percutaneous coronary intervention. Temporal trends were examined in the early (2004-2010) and late (2011-2016) time periods. Patients were stratified to low, intermediate, or high risk for recurrent cardiovascular events. Clinical outcomes included 30-day

2020 American Journal of Medicine

186. Prevalence and Risk of Metastatic Thyroid Cancers and Management Outcomes: A National Perspective. (Abstract)

Prevalence and Risk of Metastatic Thyroid Cancers and Management Outcomes: A National Perspective. Examine the prevalence and risk of metastasis in thyroid cancers and management outcomes.Retrospective analysis of the National Cancer Database, 2004-2014.The study population included adult (≥ 18 years) patients with thyroid cancer. Analysis included multivariate logistic regression and Cox hazard ratio modeling.A total of 152,979 patients were included. Distant metastasis was reported in 1,867 (...) of distant metastasis, while controlling for tumor pathology and size, included older age, male gender, non-White minorities, presence of multiple comorbidities, minimal, gross extrathyroidal extension (ETE), lymphovascular invasion (LVI), and concomitant central and lateral lymph node metastasis (LNM) (P < .05 each). The risk of distant metastasis in the absence of nodal metastasis, ETE, and LVI was highest for FTC > 4 cm.Although the risk of metastasis in well-differentiated thyroid carcinoma (WDTC

2020 Laryngoscope

187. Tracking implementation strategies in the randomized rollout of a Veterans Affairs national opioid risk management initiative. Full Text available with Trip Pro

Tracking implementation strategies in the randomized rollout of a Veterans Affairs national opioid risk management initiative. In 2018, the Department of Veterans Affairs (VA) issued Notice 2018-08 requiring facilities to complete "case reviews" for Veterans identified in the Stratification Tool for Opioid Risk Mitigation (STORM) dashboard as high risk for adverse outcomes among patients prescribed opioids. Half of the facilities were randomly assigned to a Notice version including additional (...) oversight. We evaluated implementation strategies used, whether strategies differed by randomization arm, and which strategies were associated with case review completion rates.Facility points of contact completed a survey assessing their facility's use of 68 implementation strategies based on the Expert Recommendations for Implementing Change taxonomy. We collected respondent demographic information, facility-level characteristics, and case review completion rates (percentage of high-risk patients who

2020 Implementation Science

188. Limitations of Contemporary Guidelines for Managing Patients at High Genetic Risk of Coronary Artery Disease. (Abstract)

Limitations of Contemporary Guidelines for Managing Patients at High Genetic Risk of Coronary Artery Disease. Polygenic risk scores (PRS) for coronary artery disease (CAD) identify high-risk individuals more likely to benefit from primary prevention statin therapy. Whether polygenic CAD risk is captured by conventional paradigms for assessing clinical cardiovascular risk remains unclear.This study sought to intersect polygenic risk with guideline-based recommendations and management patterns (...) for CAD primary prevention.A genome-wide CAD PRS was applied to 47,108 individuals across 3 U.S. health care systems. The authors then assessed whether primary prevention patients at high polygenic risk might be distinguished on the basis of greater guideline-recommended statin eligibility and higher rates of statin therapy.Of 47,108 study participants, the mean age was 60 years, and 11,020 (23.4%) had CAD. The CAD PRS strongly associated with prevalent CAD (odds ratio: 1.4 per SD increase in PRS; p

2020 Journal of the American College of Cardiology

189. Hepatocellular Carcinoma Risk in Patients With NASH Cirrhosis and Diabetes: Insufficient for Individual Management. (Abstract)

Hepatocellular Carcinoma Risk in Patients With NASH Cirrhosis and Diabetes: Insufficient for Individual Management. We read with interest the article by Ju Dong Yang et al.(1) The study demonstrated that diabetes is associated with an increased risk of hepatocellular carcinoma (HCC) in patients with nonalcoholic steatohepatitis (NASH) cirrhosis and validated their findings in an external cohort.© 2020 by the American Association for the Study of Liver Diseases.

2020 Hepatology

190. Negative Pressure Wound Therapy For The Management Of High Risk Surgical Incisions Or High Risk Patients: Clinical Effectiveness, Cost-Effectiveness, and Guidelines

Negative Pressure Wound Therapy For The Management Of High Risk Surgical Incisions Or High Risk Patients: Clinical Effectiveness, Cost-Effectiveness, and Guidelines TITLE: Negative Pressure Wound Therapy For The Management Of High Risk Surgical Incisions Or High Risk Patients: Clinical Effectiveness, Cost-Effectiveness, and Guidelines DATE: 07 November 2013 RESEARCH QUESTIONS 1. What is the clinical effectiveness of negative pressure wound therapy for the management of high risk surgical (...) incisions or for patients at high risk of infection or wound dehiscence? 2. What is the cost-effectiveness of negative pressure wound therapy as compared to traditional wound management for the management of high risk surgical incisions or for patients at high risk of infection or wound dehiscence? 3. What are the evidence-based guidelines regarding the use of negative pressure wound therapy for the management of high risk surgical incisions or for patients at high risk of infection or wound dehiscence

2013 Canadian Agency for Drugs and Technologies in Health - Rapid Review

191. CCS guidelines on perioperative cardiac risk assessment and management for patients undergoing noncardiac surgery Full Text available with Trip Pro

CCS guidelines on perioperative cardiac risk assessment and management for patients undergoing noncardiac surgery Canadian Cardiovascular Society Guidelines on Perioperative Cardiac Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery - Canadian Journal of Cardiology Email/Username: Password: Remember me Search Terms Search within Search Share this page Access provided by Volume 33, Issue 1, Pages 17–32 Canadian Cardiovascular Society Guidelines on Perioperative Cardiac (...) Risk Assessment and Management for Patients Who Undergo Noncardiac Surgery x Emmanuelle Duceppe Affiliations Department of Medicine, University of Montreal, Montreal, Quebec, Canada Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada Population Health Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada , MD a , b , c , x Joel Parlow Affiliations Department of Anesthesiology and Perioperative Medicine

2016 Canadian Cardiovascular Society

192. Recommendations for the management of early breast cancer in women with an identified BRCA1 or BRCA2 gene mutation or at high risk of a gene mutation

Recommendations for the management of early breast cancer in women with an identified BRCA1 or BRCA2 gene mutation or at high risk of a gene mutation Recommendations for the management of early breast cancer in women with an identified BRCA1 or BRCA2 gene mutation or at high risk of a gene mutation FEBRUARY 2014 | Incorporates published evidence to August 2013 A CLINICAL PRACTICE GUIDELINE DEVELOPED BY CANCER AUSTRALIA This document supplements information contained in the Clinical practice (...) guidelines for the management of ad- vanced breast cancer, 2001. 1 ISBN Online: 978-1-74127-268-0 © Cancer Australia 2014 Purpose This guideline includes statements and recommendations based on available evidence about the management of early breast cancer in women with an identified BRCA1 or BRCA2 gene mutation or at high risk of such a gene mutation predisposing to breast cancer. The guideline provides health professionals with information designed to assist in making management recommendations

2015 Cancer Australia

193. Data-supported timely management in cooperation with a centre for telemedicine for patients with advanced cardiac failure - rapid report

Data-supported timely management in cooperation with a centre for telemedicine for patients with advanced cardiac failure - rapid report 1 Translation of Chapters 1 to 8 and Appendix A of the rapid report N19-01 Datengestütztes, zeitnahes Management in Zusammenarbeit mit einem ärztlichen telemedizinischen Zentrum bei fortgeschrittener Herzinsuffizienz (Version 1.0; Status: 27 September 2019 [German original], 28 November 2019 [English translation]). Please note: This document is provided (...) as a service by IQWiG to English-language readers. However, solely the German original text is absolutely authoritative and legally binding. Extract IQWiG Reports – Commission No. N19-01 Data-supported timely management in cooperation with a physician-staffed centre for telemedicine in advanced cardiac failure 1 Extract of rapid report N19-01 Version 1.0 Telemonitoring in advanced cardiac failure 27 September 2019 Institute for Quality and Efficiency in Health Care (IQWiG) - i - Publishing details

2019 Institute for Quality and Efficiency in Healthcare (IQWiG)

194. Adjuvant therapy with antidepressants for the management of inflammatory bowel disease. (Abstract)

Adjuvant therapy with antidepressants for the management of inflammatory bowel disease. Symptoms of anxiety and depression are common in inflammatory bowel disease (IBD). Antidepressants are taken by approximately 30% of people with IBD. However, there are no current guidelines on treating co-morbid anxiety and depression in people with IBD with antidepressants, nor are there clear data on the role of antidepressants in managing physical symptoms of IBD.The objectives were to assess (...) the efficacy and safety of antidepressants for treating anxiety and depression in IBD, and to assess the effects of antidepressants on quality of life (QoL) and managing disease activity in IBD.We searched MEDLINE; Embase, CINAHL, PsycINFO, CENTRAL, and the Cochrane IBD Group Specialized Register from inception to 23 August 2018. Reference lists, trials registers, conference proceedings and grey literature were also searched.Randomised controlled trials (RCTs) and observational studies comparing any type

2019 Cochrane

195. Recommendations for the management of the incidental renal mass in adults: endorsement and adaptation of the 2017 ACR Incidental Findings Committee white paper by the Canadian Association of Radiologists Incidental Findings Working Group

, Canada d Canadian Association of Radiologists, Ottawa, Ontario, Canada e Imaging Institute, Cleveland Clinic, Cleveland, Ohio, Canada f Department of Medical Imaging, University of Saskatchewan, Saskatoon, Saskatchewan, Canada Since the publication of the ?rst landmark paper by the American College of Radiology (ACR) Incidental Findings Committee in 2010, that committee has been providing valuable guidance to radiologists throughout the world on how to manage incidental imaging ?ndings [1]. In 2017 (...) correlate to risk of malignancy [6,8]. Management of the Incidental Renal Mass: Outline The document has been divided into 6 sections, each detailing a ?owchart for the management of a particular incidental renal ?nding. The ?rst 3 ?owcharts deal with the workup of masses identi?ed by modality, whereas the ?nal 3 ?owcharts address the workup by the category of lesion (cystic versus solid versus solid containing fat). Flowcharts 1e3 frequently continue into ?owcharts 4e6 once basic

2019 CPG Infobase

196. Managing opioid use disorder in primary care: PEER simplified guideline

, the management of chronic pain in patients taking OAT remains unclear. One RCT found that all patients with chronic pain ran- domized to tapering off OAT dropped out of the study. A second RCT suggested that buprenorphine was not different from methadone for pain symptoms. 22 Beyond maintaining patients on OAT, the evidence does not pro- vide adequate guidance on the issue of chronic pain. Other examples of comorbidities that add complex- ity to the care of patients with OUD include insomnia, anxiety (...) Managing opioid use disorder in primary care: PEER simplified guideline Vol 65: MAY | MAI 2019 | Canadian Family Physician | Le Médecin de famille canadien 321 CLINICAL PRACTICE GUIDELINES Editor’s key points ? This simplified guideline for managing opioid use disorder (OUD) was developed with a primary care focus using a systematic review of systematic reviews design. Recommendations are accompanied by practice pearls and additional resources to support primary care practitioners and shared

2019 CPG Infobase

197. British guideline on the management of asthma

British guideline on the management of asthma SIGN158 British guideline on the management of asthma A national clinical guideline First published 2003 Revised edition published July 2019Key to evidence statements and recommendations Levels of evidence 1 ++ High-quality meta-analyses, systematic reviews of RCTs, or RCTs with a very low risk of bias 1 + Well-conducted meta-analyses, systematic reviews, or RCTs with a low risk of bias 1 – Meta-analyses, systematic reviews, or RCTs with a high risk (...) Predicting future risk of asthma attacks 32 4.4 Physiological measures 36 4.5 Other approaches 37 5 Supported self management 38 5.1 Effectiveness of supported self management 38 5.2 Components of a self-management programme 38 5.3 Self management in specific patient groups 42 5.4 Adherence and concordance 45 5.5 Implementation in practice 48 6 Non-pharmacological management 50 6.1 Primary prevention 50 6.2 Secondary prevention 557 Pharmacological management 62 7.1 Intermittent reliever therapy 63 7.2

2019 SIGN

198. Calcium, vitamin D or recombinant parathyroid hormone for managing post-thyroidectomy hypoparathyroidism. (Abstract)

. The management of post-thyroidectomy hypoparathyroidism however has not been extensively evaluated. Routine use of calcium and vitamin D supplements in the postoperative period may reduce the risk of symptoms, temporary hypocalcaemia and hospital stay. However, this may lead to overtreatment and has no effect on long-term hypoparathyroidism. Current recommendations on the management of post-thyroidectomy hypoparathyroidism is based on low-quality evidence. Existing guidelines do not often distinguish between (...) Calcium, vitamin D or recombinant parathyroid hormone for managing post-thyroidectomy hypoparathyroidism. Post-surgical hypoparathyroidism is a common complication after thyroid surgery. The incidence is likely to increase given the rising trend in the annual number of thyroid operations being performed. Measures to prevent post-thyroidectomy hypoparathyroidism including different surgical techniques and prophylactic calcium and vitamin D supplements have been extensively studied

2019 Cochrane

199. Computer and mobile technology interventions to promote medication adherence and disease management in people with thalassemia. (Abstract)

Computer and mobile technology interventions to promote medication adherence and disease management in people with thalassemia. Thalassemia syndromes are inherited hemoglobin disorders that result when the synthesis of normal hemoglobin is lacking or significantly reduced. For people with thalassemia, long-term red blood cell transfusion remains the mainstay of therapy, which may lead to iron overload causing severe complications and damage in different body organs. Long-term iron chelation (...) therapy is essential for people with thalassemia to minimize the ongoing iron-loading process. In addition, suboptimal adherence can increase adverse events associated with iron overload and result in increased morbidity, mortality, healthcare utilization and cost of care.To identify and assess the effects of computer and mobile technology interventions designed to facilitate medication adherence and disease management in individuals with thalassemia, including:- evaluating the effects of using

2019 Cochrane

200. Conservative management following closed reduction of traumatic anterior dislocation of the shoulder. (Abstract)

Conservative management following closed reduction of traumatic anterior dislocation of the shoulder. Acute anterior shoulder dislocation, which is the most common type of dislocation, usually results from an injury. Subsequently, the shoulder is less stable and is more susceptible to re-dislocation or recurrent instability (e.g. subluxation), especially in active young adults. After closed reduction, most of these injuries are treated with immobilisation of the injured arm in a sling or brace (...) . Primary outcomes were re-dislocation, patient-reported shoulder instability measures and return to pre-injury activities. Secondary outcomes included participant satisfaction, health-related quality of life, any instability and adverse events.Both review authors independently selected studies, assessed risk of bias and extracted data. We contacted study authors for additional information. We pooled results of comparable groups of studies. We assessed risk of bias with the Cochrane 'Risk of bias' tool

2019 Cochrane

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