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Risk Management

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121. Long-term risk of recurrence in patients with a first unprovoked venous thromboembolism managed according to D-dimer results; a cohort study. (PubMed)

Long-term risk of recurrence in patients with a first unprovoked venous thromboembolism managed according to D-dimer results; a cohort study. The long-tem risk of recurrence in patients with a first unprovoked venous thromboembolism (VTE) who have negative D-dimer results is uncertain.To determine this risk, including in subgroups based on sex.ln a prospective interventional cohort study of 410 patients with a first unprovoked VTE, anticoagulants were stopped if D-dimer was negative on therapy (...) with estrogens, and 0.4% (95% CI 0.0% to 2.3%) in women with VTE associated with estrogens (p<0.001 for 3-group comparison). Risk of recurrence at 5 years was 21.5% (95% CI 16.4% to 26.5%) overall, 29.7% (95% CI 22.1% to 37.3%) in men, 17.0% (95% CI 8.1% to 25.9%) in non-estrogen women, and 2.3% (95% CI 0.0% to 6.8%) in estrogen-women.The long-term risk of recurrence in patients with a first unprovoked VTE who have negative D-dimer results is not low enough to justify stopping anticoagulant therapy in men

2019 Journal of Thrombosis and Haemostasis

122. Duration of antibiotic treatment and risk of recurrence after surgical management of orthopaedic device infections: a multicenter case-control study. (PubMed)

Duration of antibiotic treatment and risk of recurrence after surgical management of orthopaedic device infections: a multicenter case-control study. Device-related infections in orthopaedic and trauma surgery are a devastating complication with substantial impact on morbidity and mortality. Systemic suppressive antibiotic treatment is regarded an integral part of any surgical protocol intended to eradicate the infection. The optimal duration of antimicrobial treatment, however, remains unclear (...) treatment (OR 0.41, 95% CI 0.08 to 2.12) for up to 31 days, although the width of confidence intervals prohibited robust statistical and clinical inferences.The optimal duration of systemic antibiotic treatment with surgical concepts of curing wound and device-related orthopaedic infections is still unclear. The risk of reinfection in case of infected extramedullary fracture-fxation devices may be reduced with up to 31 days of systemic fluoroquinolones and rifampicin, although scientific proof needs

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2019 BMC Musculoskeletal Disorders

123. The Scottish Intercollegiate Guidelines Network: risk reduction and management of delirium. (PubMed)

The Scottish Intercollegiate Guidelines Network: risk reduction and management of delirium. Clinical and research interest in delirium has been rising over the last 15 years. The Scottish Intercollegiate Guidelines Network (SIGN) publication on delirium is a state-of-the-art synthesis of the field, and the first UK guideline since 2010. There is new guidance around delirium detection, particularly in recommending the 4 'A's Test (4AT). The 4AT has the advantage of being brief, embeds (...) and operationalises cognitive testing, and is scalable with little training. The guidelines highlight the importance of non-pharmacological management for all hospital presentations involving the spectrum of cognitive disorders (delirium, dementia but at risk of delirium, delirium superimposed on dementia). Pharmacotherapy has a minimal role, but specific indications (e.g. intractable distress) are discussed. Advances in delirium research, education and policy, have come together with steady changes

2019 Age and ageing

124. POEMS Syndrome: update on diagnosis, risk-stratification, and management. (PubMed)

POEMS Syndrome: update on diagnosis, risk-stratification, and management. POEMS syndrome is a paraneoplastic syndrome due to an underlying plasma cell neoplasm. The major criteria for the syndrome are polyradiculoneuropathy, clonal plasma cell disorder (PCD), sclerotic bone lesions, elevated vascular endothelial growth factor, and the presence of Castleman disease. Minor features include organomegaly, endocrinopathy, characteristic skin changes, papilledema, extravascular volume overload (...) of which must include polyradiculoneuropathy and clonal plasma cell disorder, and at least one of the minor criteria.Because the pathogenesis of the syndrome is not well understood, risk stratification is limited to clinical phenotype rather than specific molecular markers. Risk factors include low serum albumin, age, pleural effusion, pulmonary hypertension, and reduced eGFR.For those patients with a dominant sclerotic plasmacytoma, first line therapy is irradiation. Patients with diffuse sclerotic

2019 American journal of hematology

125. Risk Factors for Failure After 1-Stage Exchange Total Knee Arthroplasty in the Management of Periprosthetic Joint Infection. (PubMed)

Risk Factors for Failure After 1-Stage Exchange Total Knee Arthroplasty in the Management of Periprosthetic Joint Infection. One-stage exchange arthroplasty in the management of periprosthetic joint infection was introduced at our institution. The purpose of this study was to analyze the risk factors of failure after periprosthetic joint infection following total knee arthroplasty treated with 1-stage exchange.Ninety-one patients who underwent failed treatment following 1-stage exchange total (...) knee arthroplasty due to periprosthetic joint infection from January 2008 to December 2017 were included. From the same period, we randomly selected a 1:1 matched control group without a subsequent revision surgical procedure. Bivariate analyses, including preoperative, intraoperative, and postoperative factors, as well as logistic regression, were performed to identify risk factors for failure.Bivariate analysis yielded 10 predictors (variables with significance at p < 0.05) for failure involving

2019 The Journal of Bone and Joint Surgery. American Volume

126. Managing uncertainty in medicine quality in Ghana: The cognitive and affective basis of trust in a high-risk, low-regulation context. (PubMed)

Managing uncertainty in medicine quality in Ghana: The cognitive and affective basis of trust in a high-risk, low-regulation context. Where regulation is weak, medicine transactions can be characterised by uncertainty over the drug quality and efficacy, with buyers shouldering the greater burden of risk in exchanges that are typically asymmetric. Drawing on in-depth interviews (N = 220) and observations of medicine transactions, plus interviews with regulators (N = 20), we explore how people

2019 Social Science & Medicine

127. Prenatal Management of Pregnancies at Risk of Fetal Neonatal Alloimmune Thrombocytopenia (FNAIT): Scientific Impact Paper No. 61. (PubMed)

Prenatal Management of Pregnancies at Risk of Fetal Neonatal Alloimmune Thrombocytopenia (FNAIT): Scientific Impact Paper No. 61. WHAT IS IT?: Fetal neonatal alloimmune thrombocytopenia (FNAIT), also known as neonatal alloimmune thrombocytopenia (NAIT) or fetomaternal alloimmune thrombocytopenia (FMAIT), is a rare condition which affects a baby's platelets. This can put them at risk of problems with bleeding, particularly into the brain. One baby per week in the UK may be seriously affected (...) in the management of pregnancies at risk of FNAIT. Specifically, we discuss the role of screening, when IVIg should be started, what dose should be used, and what evidence there is for maternal steroids. We also consider in very rare selected cases, the use of fetal blood sampling and giving platelet transfusions to the baby before birth. Finally, we consider the approaches to blood testing mothers to tell if babies are at risk, which is offered in some countries, and development of new treatments to reduce

2019 BJOG

128. Risk Factors for Sedation-Related Events During Acute Agitation Management in The Emergency Department. (PubMed)

Risk Factors for Sedation-Related Events During Acute Agitation Management in The Emergency Department. To describe the incidence, nature and risk factors for adverse events (AEs) among patients who received parenteral sedation for acute agitation in an emergency department (ED) setting.We undertook a prospective observational study and a clinical trial of parenteral sedation for the management of acute agitation. We included agitated adult patients who required parenteral sedation from 2014 (...) patients, sedation with multiple sedatives within 60 minutes, and alcohol intoxication increased the risk. This article is protected by copyright. All rights reserved.This article is protected by copyright. All rights reserved.

2019 Academic Emergency Medicine

129. External validation of a risk classification at the emergency department of post-cardiac arrest syndrome patients undergoing targeted temperature management. (PubMed)

External validation of a risk classification at the emergency department of post-cardiac arrest syndrome patients undergoing targeted temperature management. There are no established risk classification for post-cardiac arrest syndrome (PCAS) patients at the Emergency Department (ED) undergoing targeted temperature management (TTM). The aim of this study was to externally validate a simplified version of our prognostic score, the "post-Cardiac Arrest Syndrome for Therapeutic hypothermia score (...) " (revised CAST [rCAST]) and estimate the predictive accuracy of the risk classification based on it.For the external validation, we used data from an out-of-hospital cardiac arrest (OHCA) registry of the Japanese Association for Acute Medicine (JAAM), which is a multicenter, prospective registry of OHCA patients across Japan. Eligible patients were PCAS patients treated with TTM at 33-36 °C between June 2014 and December 2015. We validated the accuracy of rCAST for predicting the neurological outcomes

2019 Resuscitation

130. Patient empowerment in risk management: a mixed-method study to explore mental health professionals' perspective. (PubMed)

Patient empowerment in risk management: a mixed-method study to explore mental health professionals' perspective. In the last years, patients' empowerment has been increasingly recognized as a crucial dimension of patient-centered healthcare and patient safety. Nevertheless, little work has been done so far in the field of patient safety to investigate strategies for empowering psychiatric patients. Therefore, the aim of this study was to identify, by using focus groups, whether and how (...) psychiatric patients' empowerment can improve risk management according to the perspective of healthcare providers (HPs).A mixed-method approach composed of a qualitative data collection method (i.e., focus groups) and a quantitative analysis technique (i.e., inductive content analysis) was applied. HPs working in mental health settings shared their perspectives on psychiatric patients' empowerment in risk management. After the transcription of the audio-taped discussions and the subsequent development

2019 BMC health services research

131. Aggressive T-cell lymphomas: 2019 updates on diagnosis, risk stratification, and management. (PubMed)

Aggressive T-cell lymphomas: 2019 updates on diagnosis, risk stratification, and management. Aggressive T-cell lymphomas continue to have a poor prognosis. There are over 27 different subtypes of peripheral T-cell lymphoma (PTCL) and we are now beginning to understand the differences between the various subtypes beyond histologic variations.Gene expression profiling can help in diagnosis and prognostication of various subtypes including PTCL-nos and anaplastic large cell lymphoma. In addition

2019 American journal of hematology

132. Use of Guideline-Recommended Risk-Reduction Strategies Among Patients with Diabetes and Atherosclerotic Cardiovascular Disease: Insights from Getting to an Improved Understanding of Low-Density Lipoprotein Cholesterol and Dyslipidemia Management (GOULD). (PubMed)

Use of Guideline-Recommended Risk-Reduction Strategies Among Patients with Diabetes and Atherosclerotic Cardiovascular Disease: Insights from Getting to an Improved Understanding of Low-Density Lipoprotein Cholesterol and Dyslipidemia Management (GOULD). Patients with atherosclerotic cardiovascular disease (ASCVD) and concomitant diabetes are at particularly high risk for new and recurrent ischemic events and heart failure and therefore derive greater absolute benefit from secondary prevention (...) therapies than patients without concomitant diabetes.1 Prior analyses reported suboptimal use of evidence-based therapies in this vulnerable group1, 2 but did not include data on newer lipid and glucose-lowering therapies. Given the emergence of non-statin LDL lowering agents and glucose-lowering medications with cardiovascular benefits, the number of evidence-based therapies for secondary prevention has expanded. Thus, we examined contemporary use of medications to reduce cardiovascular risk in a large

2019 Circulation

133. Serum Albumin Levels Predict Which Patients are at Increased Risk for Complications Following Surgical Management of Acute Osteoporotic Vertebral Compression Fractures. (PubMed)

Serum Albumin Levels Predict Which Patients are at Increased Risk for Complications Following Surgical Management of Acute Osteoporotic Vertebral Compression Fractures. Osteoporotic vertebral compression fractures (OVCF) account for a substantial portion of the US healthcare financial burden. With a growing elderly population, the number of fractures contributing to sagittal imbalance is expected to increase. For those patients undergoing surgery, pre-operative markers, such as albumin, may

2019 The Spine Journal

134. Risk factors for incident central serous retinopathy: case-control analysis of a US national managed care population. (PubMed)

Risk factors for incident central serous retinopathy: case-control analysis of a US national managed care population. To evaluate clinical comorbidities and steroid use as risk factors for central serous retinopathy (CSR).Using national insurance databases, we conducted a case-control study of beneficiaries with an incident diagnosis of CSR between 2007 and 2015 (n=35 492) and randomly selected controls matched on age-based and sex-based propensity scores (n=1 77 460).The mean age (SD) of cases (...) % CI 0.51 to 0.56, p<0.001). Patients with other previously hypothesised risk factors (including essential hypertension, pregnancy, other autoimmune disease, sleep disorders, Helicobacter pylori infection and gastro-oesophageal reflux disease) had lower odds of CSR.Male middle-aged patients with recent steroid exposure were significantly more likely to develop CSR. Other risk factors include diabetes mellitus, diabetic macular oedema and age-related macular degeneration. Other previously

2019 British Journal of Ophthalmology

135. Neutropenia during frontline treatment of advanced Hodgkin lymphoma: Incidence, risk factors, and management. (PubMed)

Neutropenia during frontline treatment of advanced Hodgkin lymphoma: Incidence, risk factors, and management. Neutropenia, specifically febrile neutropenia (FN), can have profound sequelae (infection, hospitalization, mortality), and the risk of its development differs across chemotherapy regimens/according to patient characteristics. We conducted a comprehensive literature review regarding neutropenia in frontline treatment of adults with advanced Hodgkin lymphoma. Guidelines state primary (...) prophylaxis (PP) with colony-stimulating factors (CSFs) should be implemented when the risk of FN is ≥20%; CSF PP is given with standard-of-care escalated BEACOPP, but the risk of FN with standard-of-care ABVD does not necessitate routine PP. Notably, the risk of neutropenia (including FN) is higher in clinical practice versus clinical studies, and physicians overestimate their adherence to CSF guidelines. ECHELON-1 demonstrated higher FN rates with brentuximab vedotin plus AVD (A + AVD) compared

2019 Critical reviews in oncology/hematology

136. Suicide Risk Assessment and Management Training Practices in Pediatric Residency Programs: A Nationwide Needs Assessment Survey. (PubMed)

Suicide Risk Assessment and Management Training Practices in Pediatric Residency Programs: A Nationwide Needs Assessment Survey. Youth suicide is a public health emergency, and its prevention is a national imperative. Pediatric providers are critical to risk assessment, triage, and intervention, yet little is known about the content, quality, and perceived adequacy of suicide prevention pediatric residency training. We thus sought to (1) characterize suicide risk assessment and management (...) ) completed the survey. Although 82% of respondents rated suicide prevention training in residency as "very" or "extremely" important, a minority (18% PDs and 10% CRs) reported adequate preparation relative to need. Formal training was not universal (66% PDs and 45% CRs) and practices varied across programs (PD median = 3 hours [interquartile range: 1-4.5 hours], CR median = 1.5 hours [interquartile range: 0-3 hours]). Top-ranked educational priorities included interviewing adolescents about risk, risk

2019 The Journal of Adolescent Health

137. Risk factors for and management of anterior chamber intravitreal dexamethasone implant migration. (PubMed)

Risk factors for and management of anterior chamber intravitreal dexamethasone implant migration. This study aimed to investigate the incidence of and risk factors for the anterior chamber migration of an intravitreal dexamethasone implant (Ozurdex®).A retrospective review of 640 consecutive intravitreal dexamethasone implant injections was conducted from February 2011 through February 2018 at the University Eye Hospital in Tübingen, Germany. Those patients who experienced anterior chamber (...) , and they had undergone prior vitrectomies. Three eyes had sclerally-fixated intraocular lenses, and one eye had a posterior chamber intraocular lens in the capsular bag, with a capsular tension ring due to partial zonular dehiscence. When comparing the vitrectomized eyes with reduced zonular/capsular bag complex integrity to the vitrectomized pseudophakic eyes with intact zonular/capsular bags, the former were significantly associated with an increased risk of anterior chamber implant migration (P = 0.008

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2019 BMC Ophthalmology

138. Conservative management of low-risk prostate cancer among young versus older men in the United States: Trends and outcomes from a novel national database. (PubMed)

Conservative management of low-risk prostate cancer among young versus older men in the United States: Trends and outcomes from a novel national database. Management for men aged ≤55 years with low-risk prostate cancer (LRPC) is debated given quality-of-life implications with definitive treatment versus the potential missed opportunity for cure with conservative management. The objective of this study was to define rates of conservative management for LRPC and associated short-term outcomes (...) in young versus older men in the United States.The nonpublic Surveillance, Epidemiology, and End Results Prostate with Active Surveillance/Watchful Waiting (AS/WW) Database identified 50,302 men who were diagnosed with LRPC from 2010 through 2015. AS/WW rates in the United States were stratified by age (≤55 vs ≥56 years). Prostate cancer-specific mortality and overall mortality were defined by initial management type (AS/WW vs definitive treatment [referent]) and age.AS/WW utilization increased from

2019 Cancer

139. The Opioid Wars-CON: The Risks of Opioids for Pain Management Outweigh the Benefits. (PubMed)

The Opioid Wars-CON: The Risks of Opioids for Pain Management Outweigh the Benefits. The entire field of medicine, not just anesthesiology, has grown comfortable with the risks posed by opioids; but these risks are unacceptably high. It is time for a dramatic paradigm shift. If used at all for acute or chronic pain management, they should be used only after consideration and maximizing the use of nonopioid pharmacologic agents, regional analgesia techniques, and nonpharmacologic methods (...) . Opioids poorly control pain, their intraoperative use may increase the risk of recurrence of some types of cancer, and they have a large number of both minor and serious side effects. Furthermore, there are a myriad of alternative analgesic strategies that provide superior analgesia, decrease recovery time, and have fewer side effects and risks associated with their use. In this article the negative consequences of opioid use for pain, appropriate alternatives to opioids for analgesia

2019 Clinical Journal of Pain

140. 2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy. (PubMed)

2019 HRS expert consensus statement on evaluation, risk stratification, and management of arrhythmogenic cardiomyopathy. Arrhythmogenic cardiomyopathy (ACM) is an arrhythmogenic disorder of the myocardium not secondary to ischemic, hypertensive or valvular heart disease. ACM incorporates a broad spectrum of genetic, systemic, infectious, and inflammatory disorders. This designation includes, but is not limited to, arrhythmogenic right/left ventricular cardiomyopathy, cardiac amyloid (...) and sarcoidosis, Chagas' disease and left ventricular noncompaction. The ACM phenotype overlaps with other cardiomyopathies, particularly dilated cardiomyopathy with arrhythmia presentation which may be associated with ventricular dilatation and/or impaired systolic function. This expert consensus statement provides the clinician with guidance on evaluation and management of ACM and includes clinically relevant information on genetics and disease mechanisms. PICO (Patient, Intervention, Comparison, Outcome

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2019 Heart Rhythm

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