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161. Real-world study of efficacy, risk management and reasons for discontinuation of natalizumab for treatment of multiple sclerosis in Russia. Full Text available with Trip Pro

Real-world study of efficacy, risk management and reasons for discontinuation of natalizumab for treatment of multiple sclerosis in Russia. NTZ is approved in Russia for the treatment of highly active relapsing remitting multiple sclerosis and is reimbursed via federal budget program. However, no data about NTZ treatment in Russia and the effect of federal reimbursement have been performed so far.To characterize the population of patients receiving natalizumab and assess the efficacy and risk (...) -management plan (RMP) implementation of NTZ therapy in routine clinical practice in Russia.We analyzed data for 334 patients, who received at least one infusion of NTZ. Relapse rate, MRI activity, NEDA-3 status after 2 years were assessed. Anti-JC virus antibodies status and RMP implementation were evaluated. Drop-out rate and reasons for therapy discontinuation were analyzed.Patients switched to natalizumab in Russia are mainly female (63%), with median EDSS score of 3.5 and high disease activity: 93

2019 PLoS ONE

162. Cost-effectiveness of risk stratified medication management for reducing premature cardiovascular mortality in Kenya. Full Text available with Trip Pro

Cost-effectiveness of risk stratified medication management for reducing premature cardiovascular mortality in Kenya. Cardiovascular disease (CVD) is a major contributor to the burden from non-communicable diseases in Sub-Saharan Africa and hypertension is the leading risk factor for CVD. The objective of this modeling study is to assess the cost-effectiveness of a risk stratified approach to medication management in Kenya in order to achieve adequate blood pressure control to reduce CVD (...) future events (for individual who survive the initial event) and other causes. We present cost and DALYs gained due to medication management for men and women 25 to 69 years.Treating high risk individuals only was generally more cost-effective that treating high and moderate risk individuals. At the anticipated base levels of effectiveness, medication management was only cost-effective under the low cost scenario. The incremental cost per DALY gained with low cost ranged from $1,505 to $3,608, which

2019 PLoS ONE

163. The association between vitamin D status and clinical events in high-risk older patients with non-ST elevation acute coronary syndrome undergoing invasive management. Full Text available with Trip Pro

The association between vitamin D status and clinical events in high-risk older patients with non-ST elevation acute coronary syndrome undergoing invasive management. There is a higher incidence of vitamin D deficiency in older adults. This may play a plausible mechanistic role in the occurrence of increased adverse events after non-ST elevation acute coronary syndrome (NSTEACS). This study investigated whether total vitamin D levels at the time of presentation predicted adverse outcomes (...) in older adults undergoing invasive management of NSTEACS. Of the 629 patients screened, 300 high-risk older adults with NSTEACS managed by an invasive strategy were recruited. Serum total 25-hydroxyvitamin D was measured at index presentation. The primary outcome was defined as 1-year composite of all-cause mortality, acute coronary syndrome (ACS), unplanned repeat revascularisation, significant bleeding or stroke. Mean age was 80.5±4.8 years (61.9% male). Median vitamin D level was 29.5nmol/L

2019 PLoS ONE

164. Relationship Between Physiological and Perceived Fall Risk in People With Multiple Sclerosis: Implications for Assessment and Management Full Text available with Trip Pro

Relationship Between Physiological and Perceived Fall Risk in People With Multiple Sclerosis: Implications for Assessment and Management This study evaluated the relationship between physiological and perceived fall risk in people with multiple sclerosis (MS).Secondary analysis of data from prospective cohort studies undertaken in Australia, the United Kingdom, and the United States.Community.Ambulatory people with MS (N=416) (age 51.5±12.0 years; 73% female; 62% relapsing-remitting MS; 13.7 (...) ±9.9 years disease duration).Not applicable.All participants completed measures of physiological (Physiological Profile Assessment [PPA]) and perceived (Falls Efficacy Scale-international [FESi]) fall risk and prospectively recorded falls for 3 months.155 (37%) of the participants were recurrent fallers (≥2 falls). Mean PPA and FESi scores were high (PPA 2.14±1.87, FESi 34.27±11.18). The PPA and the FESi independently predicted faller classification in logistic regression, which indicated

2018 EvidenceUpdates

165. Use of Conservative Management for Low-Risk Prostate Cancer in the Veterans Affairs Integrated Health Care System From 2005-2015 Full Text available with Trip Pro

Use of Conservative Management for Low-Risk Prostate Cancer in the Veterans Affairs Integrated Health Care System From 2005-2015 29800017 2018 07 10 2018 12 02 1538-3598 319 21 2018 06 05 JAMA JAMA Use of Conservative Management for Low-Risk Prostate Cancer in the Veterans Affairs Integrated Health Care System From 2005-2015. 2231-2233 10.1001/jama.2018.5616 Loeb Stacy S Manhattan Veterans Affairs Medical Center, New York, New York. Byrne Nataliya N Department of Urology, New York University (...) Conservative Treatment statistics & numerical data trends Delivery of Health Care, Integrated Humans Logistic Models Male Middle Aged Multivariate Analysis Prostate-Specific Antigen blood Prostatic Neoplasms therapy Risk Factors United States United States Department of Veterans Affairs Veterans Watchful Waiting 2018 5 26 6 0 2018 7 11 6 0 2018 5 26 6 0 ppublish 29800017 2681802 10.1001/jama.2018.5616 PMC6134433 JAMA Oncol. 2017 Oct 1;3(10):1393-1398 27768168 BJU Int. 2017 Jul;120(1):32-39 27611479 J Clin

2018 JAMA

166. Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. Full Text available with Trip Pro

Labor Induction versus Expectant Management in Low-Risk Nulliparous Women. The perinatal and maternal consequences of induction of labor at 39 weeks among low-risk nulliparous women are uncertain.In this multicenter trial, we randomly assigned low-risk nulliparous women who were at 38 weeks 0 days to 38 weeks 6 days of gestation to labor induction at 39 weeks 0 days to 39 weeks 4 days or to expectant management. The primary outcome was a composite of perinatal death or severe neonatal (...) complications; the principal secondary outcome was cesarean delivery.A total of 3062 women were assigned to labor induction, and 3044 were assigned to expectant management. The primary outcome occurred in 4.3% of neonates in the induction group and in 5.4% in the expectant-management group (relative risk, 0.80; 95% confidence interval [CI], 0.64 to 1.00). The frequency of cesarean delivery was significantly lower in the induction group than in the expectant-management group (18.6% vs. 22.2%; relative risk

2018 NEJM Controlled trial quality: predicted high

167. Impact of Primary Care Intensive Management on High-Risk Veterans' Costs and Utilization: A Randomized Quality Improvement Trial. (Abstract)

Impact of Primary Care Intensive Management on High-Risk Veterans' Costs and Utilization: A Randomized Quality Improvement Trial. Primary care models that offer comprehensive, accessible care to all patients may provide insufficient resources to meet the needs of patients with complex conditions who have the greatest risk for hospitalization.To assess whether augmenting usual primary care with team-based intensive management lowers utilization and costs for high-risk patients.Randomized quality (...) improvement trial. (ClinicalTrials.gov: NCT03100526).5 U.S. Department of Veterans Affairs (VA) medical centers.Primary care patients at high risk for hospitalization who had a recent acute care episode.Locally tailored intensive management programs providing care coordination, goals assessment, health coaching, medication reconciliation, and home visits through an interdisciplinary team, including a physician or nurse practitioner, a nurse, and psychosocial experts.Utilization and costs (including

2018 Annals of Internal Medicine Controlled trial quality: uncertain

168. Cardiovascular Disease and Risk Management: Review of the American Diabetes Association Standards of Medical Care in Diabetes 2018. Full Text available with Trip Pro

Cardiovascular Disease and Risk Management: Review of the American Diabetes Association Standards of Medical Care in Diabetes 2018. The American Diabetes Association (ADA) annually updates its Standards of Medical Care in Diabetes to provide clinicians, patients, researchers, payers, and other interested parties with evidence-based recommendations for the diagnosis and management of patients with diabetes.For the 2018 standards, the ADA Professional Practice Committee searched MEDLINE through (...) to cardiovascular disease and risk management in nonpregnant adults with diabetes. Recommendations address diagnosis and treatment of cardiovascular risk factors (hypertension and dyslipidemia), aspirin use, screening for and treatment of coronary heart disease, and lifestyle interventions.

2018 Annals of Internal Medicine

169. Addressing the risk domain in the long-term management of pediatric asthma. Full Text available with Trip Pro

Addressing the risk domain in the long-term management of pediatric asthma. There is growing concern regarding the long-term outcomes of early and poorly controlled childhood asthma, either of which can potentially lead to the development of severe asthma in adults and irrecoverable loss of lung function leading to chronic obstructive pulmonary disease. These outcomes of inadequately controlled asthma should prompt a change in practice to better and/or earlier identify children at risk (...) of adverse respiratory outcomes of asthma, to monitor disease progression, and to design intervention strategies that could either prevent or reverse asthma progression in children. The careful follow-up of spirometry over time-in the form of lung function trajectories, the application of biomarkers to assist in the diagnosis of early asthma and medication selection for these patients, as well as methods to identify patients at risk of asthma attacks-can be used to develop individualized management

2020 Pediatric Allergy and Immunology

170. Risk and Management of Patients with Mastocytosis and MCAS in the SARS-CoV-2 (COVID-19) Pandemic: Expert Opinions. Full Text available with Trip Pro

Risk and Management of Patients with Mastocytosis and MCAS in the SARS-CoV-2 (COVID-19) Pandemic: Expert Opinions. The COVID-19 (SARS-CoV-2) pandemic has massively distorted our health care systems and caused catastrophic consequences in our affected communities. The number of victims continues to increase and patients at risk can only be protected to a degree, since the virulent state may be asymptomatic. Risk factors concerning COVID-19-induced morbidity and mortality include advanced age (...) , an impaired immune system, cardiovascular or pulmonary diseases, obesity, diabetes mellitus, and cancer treated with chemotherapy. Here within, we discuss the risk and impact of COVID-19 in patients with mastocytosis and mast cell activation syndromes. As no published data are yet available, expert opinions are, by necessity, based on case experience and reports from patients. Whereas the overall risk to acquire the SARS-CoV-2 virus may not be elevated in mast cell disease, certain conditions may increase

2020 Journal of Allergy and Clinical Immunology

171. Care management of patients with high cardiovascular risk in Hungary an international and Hungarian longitudinal comparison of target level achievement. Full Text available with Trip Pro

Care management of patients with high cardiovascular risk in Hungary an international and Hungarian longitudinal comparison of target level achievement. Patients with high cardiovascular risk are usually cared for in primary care settings. Assessment of the effectiveness of long-time care was a subject of many European studies in the last two decades. This paper aims to present two Hungarian primary care cross sectional surveys and to compare their results to the primary care arms (...) (in diabetics) were recorded and analyzed. Further cardiovascular risk factors, such as smoking, BMI, waist-circumference were also evaluated.There was a statistically significant improvement in the management of blood-pressure and plasma LDL-cholesterol levels among high risk patients, while there was no change in the plasma triglyceride values. The effectiveness of diabetes care deteriorated. In international relation, the management of blood pressure and plasma LDL-cholesterol values were better

2020 BMC Family Practice

172. Lifetime risk assessment in cholesterol management among hypertensive patients: observational cross-sectional study based on electronic health record data. Full Text available with Trip Pro

Lifetime risk assessment in cholesterol management among hypertensive patients: observational cross-sectional study based on electronic health record data. In hypertensive patients, reducing plasma low-density lipoprotein cholesterol level (LDL-C) is one of the main interventions for preventing chronic cardiovascular diseases (CVD). However, LDL-C control remains generally insufficient, also in patients with hypertension. We analyzed Electronic Health Record (EHR) data of 7117 hypertensive (...) patients to find the most potential age and sex subgroups in greatest need for improvement in real life dyslipidemia treatment. Taking into account the current discussion on lifetime CVD risk, we focused on the age dependence in LDL-C control.In this observational cross-sectional study, based on routine electronic health record (EHR) data, we investigated LDL-C control of hypertensive, non-diabetic patients without renal dysfunction or CVD, aged 30 years or more in Finnish primary care setting.More

2020 BMC Family Practice

173. Real-world data on cervical cancer risk stratification by cytology and HPV genotype to inform the management of HPV-positive women in routine cervical screening. Full Text available with Trip Pro

Real-world data on cervical cancer risk stratification by cytology and HPV genotype to inform the management of HPV-positive women in routine cervical screening. HPV16/18 detection may improve cervical cancer risk stratification and better guide which HPV-positive women warrant immediate colposcopy/biopsy. We estimated risks of cervical precancer and cancer by HPV genotype and cytology during the implementation phase of primary HPV testing in Norway.A total of 3111 women, aged 34-69 years (...) significance or worse], immediate risks were 57.8% (95%CI = 53.0-62.6%) for HPV16, 40.2% (95%CI = 32.3-49.2%) for HPV18, and 31.4% (95%CI = 28.7-34.3%) for other high-risk HPV. Among those with normal cytology, CIN3+ risks were 19.9% (95%CI = 15.0-26.1%) for HPV16 positives, 10.8% (95%CI = 5.6-20.5%) for HPV18 positives, and 5.5% (95%CI = 4.2-7.1%) for other high-risk HPV.The benefits and harms of managing women based on HPV positivity and cytology results can be better balanced by inclusion of HPV

2020 British Journal of Cancer

174. Risks, Benefits, and Effects on Management for Biopsy of the Papilla in Patients with Familial Adenomatous Polyposis. (Abstract)

Risks, Benefits, and Effects on Management for Biopsy of the Papilla in Patients with Familial Adenomatous Polyposis. Ampullary and duodenal cancer are the leading causes of death in patients with familial adenomatous polyposis (FAP) after colectomy has been performed. Risk of duodenal cancer is determined based on Spigelman stage (SS) of duodenal polyposis. Guidelines recommend endoscopic surveillance of the duodenum and visualization of the papilla to stage duodenal polyposis (...) . There is no consensus on whether biopsies should be routinely collected from duodenal papilla and findings included in SS. Additionally, there are no data on the risk of pancreatitis after biopsy collection from papilla of patients with FAP. We studied the incidence of pancreatitis after biopsy of the papilla in patients with FAP and effects of biopsy findings on SS.We identified consecutive patients with FAP at a single center from January 2011 through December 2018 with >1 endoscopy with biopsy of the papilla

2020 Clinical Gastroenterology and Hepatology

175. Serial clinical observation for management of newborns at risk of early-onset sepsis. (Abstract)

Serial clinical observation for management of newborns at risk of early-onset sepsis. Current management approaches for asymptomatic neonates at risk of early onset sepsis remain controversial. Strategies based entirely on clinical observation (SCO, serial clinical observation) have gained consensus.We briefly compare different strategies for managing asymptomatic newborns suggested in four high-income countries. Then this review details the existing differences in carrying out the SCO

2020 Current opinion in pediatrics

176. New developments in diagnosis, risk assessment and management in systemic amyloidosis. (Abstract)

New developments in diagnosis, risk assessment and management in systemic amyloidosis. Amyloidosis is a group of disorders characterized by a misfolded protein that deposits in organs and compromise their function. Clinician should have a high index of suspicion because in most cases, the clinical picture is non-specific. Typing of amyloid is of utmost importance and should be an integral part of accurately diagnosing a patient. AL amyloidosis is the most common systemic amyloidosis

2020 Blood reviews

177. Risk assessment of endometrial cancer and endometrial intraepithelial neoplasia in women with abnormal bleeding and implications for clinical management algorithms. (Abstract)

Risk assessment of endometrial cancer and endometrial intraepithelial neoplasia in women with abnormal bleeding and implications for clinical management algorithms. Most endometrial cancer cases are preceded by abnormal uterine bleeding, offering a potential opportunity for early detection and cure of endometrial cancer. Although clinical guidelines exist for diagnostic workup of abnormal uterine bleeding, consensus is lacking regarding optimal management for women with abnormal bleeding (...) to diagnose endometrial cancer.We report the baseline data from a prospective clinical cohort study of women referred for endometrial evaluation at the Mayo Clinic, designed to evaluate risk stratification in women at increased risk for endometrial cancer. Here, we introduce a risk-based approach to evaluate diagnostic tests and clinical management algorithms in a population of women with abnormal bleeding undergoing endometrial evaluation at the Mayo Clinic.A total of 1163 women aged ≥45 years were

2020 American Journal of Obstetrics and Gynecology

178. Efficacy of an Electronic Health Management Program for Patients With Cardiovascular Risk: Randomized Controlled Trial. Full Text available with Trip Pro

Efficacy of an Electronic Health Management Program for Patients With Cardiovascular Risk: Randomized Controlled Trial. In addition to medication, health behavior management is crucial in patients with multiple risks of cardiovascular mortality.This study aimed to examine the efficacy of a 3-month Smart Management Strategy for Health-based electronic program (Smart Healthing).A 2-arm randomized controlled trial was conducted to assess the efficacy of Smart Healthing in 106 patients (...) with the control group (72.7% vs 35.7%; P<.05). There was a significant reduction in HbA1c in the intervention group compared with the control group (difference=0.54%; P≤.05). In the intervention group, 20% of patients with diabetes exhibited a ≥1% decrease in HbA1c (vs 0% among controls; P≤.05).A short-term self-management strategy-based electronic program intervention may improve clinical outcomes among patients with cardiovascular risks.ClinicalTrials.gov NCT03294044; https://clinicaltrials.gov/ct2/show

2020 Journal of medical Internet research

179. Chronic kidney disease in type 2 diabetes: Implications for managing glycaemic control, cardiovascular and renal risk. Full Text available with Trip Pro

Chronic kidney disease in type 2 diabetes: Implications for managing glycaemic control, cardiovascular and renal risk. This review examines the current literature relating to diabetes related kidney disease (DKD) and the optimal management of cardio-renal risk. DKD develops in approximately 40% of patients with type 2 diabetes mellitus. The mainstay of therapy is to reduce the progression of DKD by optimising hyperglycaemia, blood pressure, lipids and lifestyle. Evidence supports the role (...) for renin-angiotensin system blockade in limiting the progression of DKD. Recent data from diabetes related cardiovascular outcome trials and renal specific trials have provided a novel insight on the additional benefits of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in reducing the progression of DKD as well as cardiovascular risk. Lessons have been learnt from CREDENCE and there are expectations that DAPA-CKD and EMPA-KIDNEY will further support the benefits of SGLT2 inhibition in relation

2020 obesity & metabolism

180. Acute myocardial infarction in a high-risk cancer population: Outcomes following conservative versus invasive management. (Abstract)

Acute myocardial infarction in a high-risk cancer population: Outcomes following conservative versus invasive management. The benefits of invasive versus noninvasive management in oncology patients with acute myocardial infarction (AMI) are unclear. We aimed to retrospectively determine outcome differences between conservative and invasive management of AMI in cancer patients.Patients from our institution between March 2016 and December 2018 with type 1 and type 2 AMI (excluding STEMI) were

2020 International journal of cardiology

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