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101. Refractory Anemia with Ring Sideroblasts (RARS) and RARS with Thrombocytosis (RARS-T) - "2019 Update on Diagnosis, Risk-stratification, and Management". (PubMed)

Refractory Anemia with Ring Sideroblasts (RARS) and RARS with Thrombocytosis (RARS-T) - "2019 Update on Diagnosis, Risk-stratification, and Management". Ring sideroblasts (RS) are erythroid precursors with abnormal perinuclear mitochondrial iron accumulation. Two myeloid neoplasms defined by the presence of RS, include refractory anemia with ring sideroblasts (RARS), now classified under myelodysplastic syndromes with RS (MDS-RS) and RARS with thrombocytosis (RARS-T); now called myelodysplastic (...) and are managed similar to lower-risk MDS and MPN. The advent of luspatercept, a first-in-class erythroid maturation agent will tremendously boost the ability to manage anemia. Aspirin therapy is reasonable in MDS/MPN-RS-T, especially in the presence of JAK2V617F, but the value of platelet-lowering drugs remains uncertain.© 2019 Wiley Periodicals, Inc.

2019 American journal of hematology

102. Managing the risk of Hendra virus spillover in Australia using ecological approaches: A report on three community juries. (PubMed)

Managing the risk of Hendra virus spillover in Australia using ecological approaches: A report on three community juries. Hendra virus (HeV) infection is endemic in Australian flying-fox populations. Habitat loss has increased the peri-urban presence of flying-foxes, increasing the risk of contact and therefore viral 'spillovers' into horse and human populations. An equine vaccine is available and horse-husbandry practices that minimize HeV exposure are encouraged, but their adoption (...) . Each jury was presented with balanced factual evidence, given time to ask questions of expert presenters and, after deliberation, come to well-reasoned conclusions.All juries voted unanimously that ecological strategies should be included in HeV risk management strategies but concluded that current interventions-including vaccination and changing horse-husbandry practices-must remain the priority. The key reasons given for adopting ecological approaches were: (i) they address underlying drivers

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2018 PLoS ONE

103. Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care. (PubMed)

Incidence, clinical management, and mortality risk following self harm among children and adolescents: cohort study in primary care. Objectives To examine temporal trends in sex and age specific incidence of self harm in children and adolescents, clinical management patterns, and risk of cause specific mortality following an index self harm episode at a young age.Design Population based cohort study.Setting UK Clinical Practice Research Datalink-electronic health records from 647 general (...) linkage were matched by age, sex, and general practice with up to 20 unaffected children and adolescents (n=170 274).Main outcome measures In the first phase, temporal trends in sex and age specific annual incidence were examined. In the second phase, clinical management was assessed according to the likelihood of referral to mental health services and psychotropic drug prescribing. In the third phase, relative risks of all cause mortality, unnatural death (including suicide and accidental death

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2017 BMJ

104. Fecal parasite risk in the endangered proboscis monkey is higher in an anthropogenically managed forest environment compared to a riparian rain forest in Sabah, Borneo. (PubMed)

Fecal parasite risk in the endangered proboscis monkey is higher in an anthropogenically managed forest environment compared to a riparian rain forest in Sabah, Borneo. Understanding determinants shaping infection risk of endangered wildlife is a major topic in conservation medicine. The proboscis monkey, Nasalis larvatus, an endemic primate flagship species for conservation in Borneo, is endangered through habitat loss, but can still be found in riparian lowland and mangrove forests (...) . Noninvasive measurement of fecal parasite stages is an important tool for assessing transmission dynamics and infection risks for endangered tropical wildlife. Findings will contribute to healthcare management in nature and in anthropogenically managed environments.

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2018 PLoS ONE

105. Risk assessment and spread of the potentially invasive Ceratitis rosa Karsch and Ceratitis quilicii De Meyer, Mwatawala & Virgilio sp. Nov. using life-cycle simulation models: Implications for phytosanitary measures and management. (PubMed)

Risk assessment and spread of the potentially invasive Ceratitis rosa Karsch and Ceratitis quilicii De Meyer, Mwatawala & Virgilio sp. Nov. using life-cycle simulation models: Implications for phytosanitary measures and management. Integrative taxonomy has resolved the species status of the potentially invasive Ceratitis rosa Karsch into two separate species with distinct ecological requirements: C. rosa "lowland type" and the newly described species Ceratitis quilicii De Meyer, Mwatawala (...) species. For spatial analysis of pest risk, three generic risk indices were visualized using the advanced Insect Life Cycle Modeling software. The study revealed that the highest fecundity, intrinsic rate of natural increase and net reproductive rate for C. rosa and C. quilicii was at 25 and 30°C, respectively. The resulting model successfully fits the known distribution of C. rosa and C. quilicii in Africa and the two Indian Ocean islands of La Réunion and Mauritius. Globally, the model highlights

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2018 PLoS ONE

106. Management of patients at risk of acute kidney injury. (PubMed)

Management of patients at risk of acute kidney injury. Acute kidney injury (AKI) is a multifaceted syndrome that occurs in different settings. The course of AKI can be variable, from single hit and complete recovery, to multiple hits resulting in end-stage renal disease. No interventions to improve outcomes of established AKI have yet been developed, so prevention and early diagnosis are key. Awareness campaigns and education for health-care professionals on diagnosis and management of AKI (...) -with attention to avoidance of volume depletion, hypotension, and nephrotoxic interventions-coupled with electronic early warning systems where available can improve outcomes. Biomarker-based strategies have not shown improvements in outcome. Fluid management should aim for early, rapid restoration of circulatory volume, but should be more limited after the first 24-48 h to avoid volume overload. Use of balanced crystalloid solutions versus normal saline remains controversial. Renal replacement therapy

2017 Lancet

107. Age Differences in Suicide Risk Screening and Management Prior to Suicide Attempts. (PubMed)

Age Differences in Suicide Risk Screening and Management Prior to Suicide Attempts. This study examined differences by age in suicide risk screening and clinical actions to reduce suicide risk among patients with visits to Veterans Health Administration (VHA) medical facilities in the year prior to an attempt.Ninety-three VHA patient records were reviewed specific to the last visit before an attempt. Information was extracted regarding documentation of individual suicide risk factors (...) and provider actions to reduce risk.The authors examined differences by patient age (≥50 versus 18-49). Older patients' medical records were less likely to have evidence of 1) screening for impulsivity and firearms access and 2) engagement in safety planning, referrals for mental health services, and consideration of psychiatric hospitalization. General medical providers were less likely to document these risk factors and action steps in comparison with mental health clinicians.Lethal means education

2019 The American Journal of Geriatric Psychiatry

108. Nonalcoholic Fatty Liver Disease: Identification and Management of High-Risk Patients. (PubMed)

Nonalcoholic Fatty Liver Disease: Identification and Management of High-Risk Patients. Nonalcoholic fatty liver disease (NAFLD) is an increasingly dominant cause of liver disease worldwide. The progressive subtype, nonalcoholic steatohepatitis, is a leading indication for liver transplantation and a noteworthy cause of hepatocellular carcinoma. The overall prevalence of NAFLD is on the rise, and even more concerning data modeling predicts that an increasing percentage of those with NAFLD (...) will develop advanced disease. This increased volume of patients with advanced liver disease will impose a significant health care burden in terms of resources and cost. Thus, the identification of patients with established fibrosis or at high risk of developing advanced liver disease is critical to effectively intervene and prevent overall and liver-related morbidity and mortality. Herein, we provide a framework to consider for the identification of patients with NAFLD at high risk of nonalcoholic

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2019 American Journal of Gastroenterology

109. Overview of evidence on risk factors and early management of acute carotid stent thrombosis during the last two decades. (PubMed)

Overview of evidence on risk factors and early management of acute carotid stent thrombosis during the last two decades. Acute carotid stent thrombosis (ACST) occurring in the first hours after the procedure is an exceedingly rare complication of carotid artery stenting, but it is potentially devastating. This review aimed to evaluate current literature, identifying all reported cases during the last two decades, with the final purpose of reporting predictive factors and early management.A (...) frequently reported risk factor. Emergency procedures seemed to be associated with greater risk for ACST, reaching 5.6% to 33% incidence. Dual-layer stents were also associated with greater risk (45% vs 3.7%; P = .0001; odds ratio, 21.3). Use of an overlapping stent as a bailout procedure because of dissection, malposition, or long lesions was correlated with increased risk (7.3% vs 0.002%), as were long stenotic lesions (22.9 ± 6.83 mm vs 14.2 ± 6.42 mm; P = .0034) and stent length (3.8 ± 0.4 cm vs 2.8

2019 Journal of Vascular Surgery

110. Clinical Intuition as a Risk Stratification Method for Provision of Care Management Services.

Clinical Intuition as a Risk Stratification Method for Provision of Care Management Services. Clinical Intuition as a Risk Stratification Method for Provision of Care Management Services. – Less Is More Search for: Simpler & Better Medicine Menu / Summary: For primary care practices seeking to enroll high-risk patients in care management, use of clinical intuition to identify high-risk patients may be associated with a compared to use of an algorithm, insurance claims, or electronic health

2018 Less Is More Blog

111. Risk of complications in patients with conservatively managed ovarian tumours (IOTA5): a 2-year interim analysis of a multicentre, prospective, cohort study. (PubMed)

Risk of complications in patients with conservatively managed ovarian tumours (IOTA5): a 2-year interim analysis of a multicentre, prospective, cohort study. Ovarian tumours are usually surgically removed because of the presumed risk of complications. Few large prospective studies on long-term follow-up of adnexal masses exist. We aimed to estimate the cumulative incidence of cyst complications and malignancy during the first 2 years of follow-up after adnexal masses have been classified (...) invasive malignancy at surgery was 0·4% (95% CI 0·1-0·6), 0·3% (<0·1-0·5) for a borderline tumour, 0·4% (0·1-0·7) for torsion, and 0·2% (<0·1-0·4) for cyst rupture.Our results suggest that the risk of malignancy and acute complications is low if adnexal masses with benign ultrasound morphology are managed conservatively, which could be of value when counselling patients, and supports conservative management of adnexal masses classified as benign by use of ultrasound.Research Foundation Flanders, KU

2019 Lancet Oncology

112. International Consensus on Risk Management of Diabetic Ketoacidosis in Patients with Type 1 Diabetes Treated with Sodium-Glucose Cotransporter (SGLT) Inhibitors. (PubMed)

International Consensus on Risk Management of Diabetic Ketoacidosis in Patients with Type 1 Diabetes Treated with Sodium-Glucose Cotransporter (SGLT) Inhibitors. Sodium glucose cotransporter (SGLT) inhibitors are new oral antidiabetic medications shown to effectively reduce glycated hemoglobin (A1C) and glycemic variability, blood pressure and body weight without intrinsic properties to cause hypoglycemia in people with type 1 diabetes. However, recent studies, particularly in individuals (...) with type 1 diabetes, have demonstrated increases in the absolute risk of diabetic ketoacidosis (DKA). Some cases presented with near-normal blood glucose levels or mild hyperglycemia, complicating the recognition/diagnosis of DKA and potentially delaying treatment. Several SGLT-inhibitors are currently under review by US Food and Drug Administration (FDA) and European regulatory agencies as an adjunct to insulin therapy in people with type 1 diabetes. Strategies must be developed and disseminated

2019 Diabetes Care

113. EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research. (PubMed)

EuGMS Task and Finish group on Fall-Risk-Increasing Drugs (FRIDs): Position on Knowledge Dissemination, Management, and Future Research. Falls are a major public health concern in the older population, and certain medication classes are a significant risk factor for falls. However, knowledge is lacking among both physicians and older people, including caregivers, concerning the role of medication as a risk factor. In the present statement, the European Geriatric Medicine Society (EuGMS) Task (...) and Finish group on fall-risk-increasing drugs (FRIDs), in collaboration with the EuGMS Special Interest group on Pharmacology and the European Union of Medical Specialists (UEMS) Geriatric Medicine Section, outlines its position regarding knowledge dissemination on medication-related falls in older people across Europe. The EuGMS Task and Finish group is developing educational materials to facilitate knowledge dissemination for healthcare professionals and older people. In addition, steps in primary

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2019 Drugs & Aging

114. The contribution of legal medicine in clinical risk management. (PubMed)

The contribution of legal medicine in clinical risk management. In advanced health services, a main objective is to promote the culture of safety and clinical risk management. In this regard, the reporting of sentinel events fits within a perspective of error analysis, attempting to propose solutions aimed at preventing a new occurrence of the harmful event. The purpose of this study is to analyze the contribution of medico-legal litigation in the management of clinical risk and to propose (...) an organizational model so as to coordinate the intervention of clinical risk management and medico-legal services.Retrospective review of 206 cases of medico-legal litigation, settled against a Hospital of a North-eastern city in Italy from January 1, 2014 and December 31, 2015.Approximately 20% of cases, that are classifiable as "sentinel events", were not reported due to various factors. The reason that these events are under-reported is mainly due to the latency between the event itself and its

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2019 BMC health services research

115. Diabetes is Associated with an Increased Risk of Wound Complications and Readmission in Patients with Surgically Managed Pressure Ulcers. (PubMed)

Diabetes is Associated with an Increased Risk of Wound Complications and Readmission in Patients with Surgically Managed Pressure Ulcers. The effect of diabetes on postoperative outcomes following surgical management of pressure ulcers is poorly defined despite evidence showing that patients with diabetes are at increased risk for developing pressure ulcers, as well as postoperative wound complications including delayed healing and infection. This study aimed to examine the impact of diabetes (...) on postoperative outcomes following surgical management of pressure ulcers using the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. In this retrospective analysis all CPT codes with ICD-9 diagnoses of pressure ulcers were reviewed. A total of 3,274 patients who underwent surgical management of pressure ulcers were identified, of which 1,040 (31.8%) had diabetes. Overall primary outcomes showed rates of superficial and deep incisional surgical site infection

2019 Wound Repair and Regeneration

116. 10. Cardiovascular Disease and Risk Management: <i>Standards of Medical Care in Diabetes-2019</i>. (PubMed)

10. Cardiovascular Disease and Risk Management: Standards of Medical Care in Diabetes-2019. The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating

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2019 Diabetes Care

117. 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

118. Risk factors and outcomes of management of delayed suprachoroidal haemorrhage following Ahmed glaucoma valve implantation in children. (PubMed)

Risk factors and outcomes of management of delayed suprachoroidal haemorrhage following Ahmed glaucoma valve implantation in children. To assess the incidence, risk factors and outcomes of management of delayed suprachoroidal haemorrhage (DSCH) in children who had undergone Ahmed glaucoma valve implantation.A retrospective case-control study of eyes which developed DSCH in children <18 years of age who underwent surgery between January 2009 and December 2017 with a follow-up of at least 2 (...) months was performed. Nine cases were compared with 27 age, gender and surgeon matched controls who had undergone surgery during this period.The incidence of DSCH was 4.7% (95% CL 1.5% to 7.7%, 9 eyes of 191 children). There were no significant differences between cases and controls in baseline details except for the number of intraocular pressure (IOP) lowering medications (p=0.01) and follow-up period (p=0.001). Risk factors identified on univariate analysis (p≤0.1) were axial length (p=0.02

2019 British Journal of Ophthalmology

119. Spontaneous Retroperitoneal and Rectus Sheath Hemorrhage-Management, Risk Factors and Outcomes. (PubMed)

Spontaneous Retroperitoneal and Rectus Sheath Hemorrhage-Management, Risk Factors and Outcomes. Spontaneous retroperitoneal and rectus sheath hemorrhage (SRRSH) is associated with high mortality in the literature, but studies on the subject are lacking. The objective of this study was to identify early predictors of the need for angiographic or surgical intervention (ASI) in patients with SRRSH and define risk factors for mortality.We conducted a retrospective cohort study at a tertiary

2019 World Journal of Surgery

120. Conditional Survival in Patients With Rectal Cancer and Complete Clinical Response Managed by Watch and Wait After Chemoradiation: Recurrence Risk Over Time. (PubMed)

Conditional Survival in Patients With Rectal Cancer and Complete Clinical Response Managed by Watch and Wait After Chemoradiation: Recurrence Risk Over Time. MINI: Organ-preservation has become an attractive alternative to select patients with rectal cancer. Conditional recurrence-free survival analyses suggest that the risk of recurrence after 2 years of successful organ-preservation is significantly low (<10%). Risk of recurrence over time may represent valuable information for surveillance (...) strategies among these patients.Analyze conditional recurrence-free survival (cRFS) for rectal cancer patients with complete clinical response (cCR) after neoadjuvant chemoradiation (nCRT) managed nonoperatively after each year without recurrence.Select patients with cCR after nCRT have been managed nonoperatively. Risk factors for local recurrence, the need for prolonged follow-up, and the risk of recurrence over time are not well defined.Retrospective review of patients with rectal cancer cT2-4N0-2M0

2019 Annals of Surgery

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