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Risk Management

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161. Management of patients with high-risk and advanced prostate cancer in the Middle East: resource-stratified consensus recommendations. (PubMed)

Management of patients with high-risk and advanced prostate cancer in the Middle East: resource-stratified consensus recommendations. Prostate cancer care in the Middle East is highly variable and access to specialist multidisciplinary management is limited. Academic tertiary referral centers offer cutting-edge diagnosis and treatment; however, in many parts of the region, patients are managed by non-specialists with limited resources. Due to many factors including lack of awareness and lack (...) of prostate-specific antigen (PSA) screening, a high percentage of men present with locally advanced and metastatic prostate cancer at diagnosis. The aim of these recommendations is to assist clinicians in managing patients with different levels of access to diagnostic and treatment modalities.The first Advanced Prostate Cancer Consensus Conference (APCCC) satellite meeting for the Middle East was held in Beirut, Lebanon, November 2017. During this meeting a consortium of urologists, medical oncologists

2019 World journal of urology

162. Management of tumor rupture and abdominal compartment syndrome in an infant with bilateral high risk stage 4 neuroblastoma: A case report. (PubMed)

Management of tumor rupture and abdominal compartment syndrome in an infant with bilateral high risk stage 4 neuroblastoma: A case report. Tumor rupture and bleeding at initial presentation of infants with neuroblastoma (NBL) is a rare, but life threatening condition and challenge in pediatric oncology. Here, we report successful multidisciplinary management of an abdominal compartment syndrome as a result of tumor rupture and bleeding in an infant with bilateral high risk stage 4 NBL.The (...) , antiinfective and TLS therapy were effective in stabilizing the patient's condition. This allowed initiation of the multimodal antineoplastic treatment according to protocol NB 2004.Mechanical ventilation was stopped after 11 days, the abdominal wall was closed 3 months after the start of therapy, and treatment according to the protocol be started and successfully completed.Only the immediate, coordinated multidisciplinary intervention managed to overcome the life-threatening abdominal compartment syndrome

2019 Medicine

163. The impact of care management for high-risk pediatric asthmatics on healthcare utilization. (PubMed)

The impact of care management for high-risk pediatric asthmatics on healthcare utilization. Introduction: From 2011 to 2015, a series of quality improvement interventions were developed that targeted pediatric persistent asthmatics that included recalls for those overdue for care and access to specialist care. The objective of this study was to assess the impact on urgent care and emergency department visits and hospitalizations from enrollment into at least one intervention during the time (...) period. Methods: Persistent asthmatics were identified through electronic medical records, with patients having an asthma designation containing "persistent," asthma control containing "poor", and asthma risk being "high risk." Asthma utilization events were identified for these patients between January 1, 2011, and June 30, 2015 using ICD-9 diagnosis codes. Evaluation focused on differences in utilization for patients before and after receiving interventions through the use of logistic regression

2019 Journal of Asthma

164. Clinical approach to the patient with Brugada Syndrome. Risk stratification and optimal management. (PubMed)

Clinical approach to the patient with Brugada Syndrome. Risk stratification and optimal management. The Brugada syndrome is an inherited cardiac ion channel disorder associated with increased risk of ventricular arrhythmias and mortality. Diagnosis is based on a characteristic electrocardiographic (ECG) pattern of coved type ST-segment elevation >2 mm followed by a negative T-wave in ≥1 of the right precordial leads V1 to V3. Since the first description of Brugada syndrome, the definition (...) of disease and underlying pathophysiological mechanisms have been significantly improved in recent years. Also, significant progress has been made in the field of genetic testing in these patients. Still, there are several open questions regarding the management and outcome of these patients. There is more information about patients who would need an implantable cardiac defibrillator for the primary prevention of sudden cardiac death (that is, those with spontaneous Type I Brugada ECG pattern

2019 Panminerva medica

165. The Role of Risk Prediction Models in Prevention and Management of AKI. (PubMed)

The Role of Risk Prediction Models in Prevention and Management of AKI. Acute kidney injury is a major health care problem. Improving recognition of those at risk and highlighting those who have developed AKI at an earlier stage remains a priority for research and clinical practice. Prediction models to risk-stratify patients and electronic alerts for AKI are two approaches that could address previously highlighted shortcomings in management and facilitate timely intervention. We describe

2019 Seminars in Nephrology

166. A Microsimulation Model for Evaluating the Effectiveness of Cancer Risk Management for BRCA Pathogenic Variant Carriers: miBRovaCAre. (PubMed)

A Microsimulation Model for Evaluating the Effectiveness of Cancer Risk Management for BRCA Pathogenic Variant Carriers: miBRovaCAre. To develop a validated model for evaluating the real-world effectiveness of long-term clinical management strategies for women with germline BRCA1 or BRCA2 pathogenic variants.A microsimulation model was developed that included a BRCA-specific natural history for breast and ovarian cancer, a clinical framework for carrier follow-up, and cancer risk management (...) modification by use of risk management strategies alone or in combination. Evaluations of breast screening in BRCA carriers may overestimate the benefits of screening programs unless adherence is considered. By incorporating real-world clinical practice and patient behavior, this model can assist in developing clinical services and improving clinical outcomes for carriers.Copyright © 2019 ISPOR–The Professional Society for Health Economics and Outcomes Research. Published by Elsevier Inc. All rights

2019 Value in Health

167. Complex Regional Pain Syndrome Management: An Evaluation of the Risks and Benefits of Spinal Cord Stimulator Use in Pregnancy. (PubMed)

Complex Regional Pain Syndrome Management: An Evaluation of the Risks and Benefits of Spinal Cord Stimulator Use in Pregnancy. We present a case of a young woman diagnosed with complex regional pain syndrome (CRPS) who underwent spinal cord stimulator (SCS) implantation. She had 2 successful pregnancies following implantation.We evaluated the electronic medical records of the patient following SCS implantation and while pregnant with her second and third children. A phone interview (...) was conducted after her third pregnancy to discuss her experience with SCS use during and after pregnancy.Physical medicine and rehabilitation pain management clinic and obstetrician clinic, affiliated with the Medical College of Wisconsin in Milwaukee, Wisconsin.A 26-year-old woman with history of CRPS type I.This 26-year-old woman was diagnosed with CRPS type I after left knee surgery. All conservative treatments had failed prior to her undergoing SCS implantation after the birth of her first child. SCS

2019 Pain Practice

168. Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery. (PubMed)

Perioperative anaesthetic management of patients with or at risk of acute distress respiratory syndrome undergoing emergency surgery. Patients undergoing emergency surgery may present with the acute respiratory distress syndrome (ARDS) or develop this syndrome postoperatively. The incidence of ARDS in the postoperative period is relatively low, but the impact of ARDS on patient outcomes and healthcare costs is relevant Aakre et.al (Mayo Clin Proc 89:181-9, 2014).The development of ARDS (...) as a postoperative pulmonary complication (PPC) is associated with prolonged hospitalisation, longer duration of mechanical ventilation, increased intensive care unit length of stay and high morbidity and mortality Ball et.al (Curr Opin Crit Care 22:379-85, 2016). In order to mitigate the risk of ARDS after surgery, the anaesthetic management and protective mechanical ventilation strategies play an important role. In particular, a careful integration of general anaesthesia with neuraxial or locoregional

2019 BMC Anesthesiology

169. Hepatitis B virus reactivation: Risk factors and current management strategies. (PubMed)

Hepatitis B virus reactivation: Risk factors and current management strategies. Hepatitis B virus (HBV) is a global disease with significant morbidity and mortality. Worldwide, an estimated 257 million people are chronically infected with HBV, defined as having a positive hepatitis B surface antigen, but millions more have prior HBV exposure indicated by positive hepatitis B core antibody. Reactivation of hepatitis B implies a sudden increase in viral replication in a patient with chronic HBV (...) treatment or result in clinical episodes of hepatitis, hepatic failure, or death. In this review factors associated with HBVr, particularly medication-related risks, will be explored. We review data involving rituximab and ofatumumab, doxorubicin, corticosteroids, tumor necrosis factor antagonists, tyrosine kinases, bortezomib, hematologic stem cell transplantation, and DAAs for HCV treatment. In addition, we will discuss screening strategies, choice of antiviral prophylaxis, and the optimal duration

2019 Pharmacotherapy

170. Risk of appendiceal cancer in patients undergoing appendectomy for appendicitis in the era of increasing nonoperative management. (PubMed)

Risk of appendiceal cancer in patients undergoing appendectomy for appendicitis in the era of increasing nonoperative management. Management practices for acute appendicitis are changing. In cases of nonoperative treatment, the risk of missed or delayed diagnosis of malignancy should be considered. We aimed to identify predictors associated with appendiceal cancer diagnosis after appendectomy for acute appendicitis.This retrospective cohort study was performed using the National Surgical (...) OR, 2.89, 95% CI, 1.72-4.83, P < .001; age 70-79 OR, 3.85, 95% CI, 2.08-7.12, P < .001; age >80 OR, 5.32, 95% CI, 2.38-11.9, P < .001). Other significant predictors included obesity, morbid obesity, normal preoperative white blood cell count, and imaging indeterminate for appendicitis.When counseling patients regarding operative vs nonoperative treatment options for management of acute appendicitis, the rising risk of a delayed or missed cancer diagnosis with increasing age must be discussed.© 2019

2019 Journal of Surgical Oncology

171. Cemented Proximal Femoral Replacement for the Management of Non-Neoplastic Conditions: A Versatile Implant but Not Without Its Risks. (PubMed)

Cemented Proximal Femoral Replacement for the Management of Non-Neoplastic Conditions: A Versatile Implant but Not Without Its Risks. The demand for revision arthroplasty continues to grow. Proximal femoral bone loss poses a significant challenge to surgeons and proximal femoral replacements (PFRs) are one option to address this problem. The aim of our study is to assess the reoperation, complication, and mortality rates following PFR for treatment of non-neoplastic conditions.A retrospective (...) bone cement implantation syndrome occurred in 4 patients. One-year mortality was 12.7%. Complications occurred in 22.8%.A cemented PFR is a versatile prosthesis in the armamentarium of a revision arthroplasty surgeon that allows immediate full weight-bearing. However, it may appropriately be considered a last resort procedure that poses specific risks that must be explained to patients and family. We present the short-term outcomes on one of the largest series of PFR to date.Copyright © 2019

2019 Journal of Arthroplasty

172. Preoperative Risk Assessment and Management in Adults Receiving Maintenance Dialysis and Those With Earlier Stages of CKD. (PubMed)

Preoperative Risk Assessment and Management in Adults Receiving Maintenance Dialysis and Those With Earlier Stages of CKD. With an increasingly aging population and improved mortality in individuals with end-stage kidney disease, more surgeries are being performed on patients with all stages of chronic kidney disease (CKD). This high-risk population carries unique risk factors that have been associated with increased adverse perioperative outcomes, including acute kidney injury, cardiovascular (...) events, and mortality. In this article, we review the literature describing absolute risks associated with common surgeries performed in patients with CKD and patients receiving maintenance dialysis. We also review perioperative optimization with special risk assessment including evaluation of cardiovascular and bleeding risk evaluation, hypertension management, and timing of dialysis. Predictive model scores are reviewed as a method to stratify risk for acute kidney injury, major adverse cardiac

2019 American Journal of Kidney Diseases

173. Clinical Management of Patients at Risk for Hereditary Breast Cancer with Variants of Uncertain Significance in the Era of Multigene Panel Testing. (PubMed)

Clinical Management of Patients at Risk for Hereditary Breast Cancer with Variants of Uncertain Significance in the Era of Multigene Panel Testing. Rising use of multigene panel testing has led to increased identification of variants of uncertain significance (VUS). Consensus guidelines state that clinicians should not make medical management decisions based on VUS findings. We sought to analyze how VUS affect management of patients at risk for hereditary breast cancer.All genetic testing (...) reports for indications of hereditary breast cancer risk from a single tertiary-care institution from 2015 to 2018 were reviewed. Variants were grouped by pathogenicity (benign/likely benign, VUS, or pathogenic/likely pathogenic [P/LP]) and by breast cancer susceptibility (high, moderate, or none). Patient and management characteristics were compared by variant pathogenicity and breast cancer risk.Overall, 563 patients underwent genetic testing for breast cancer risk; 336 VUS were identified in 228

2019 Annals of Surgical Oncology

174. Magnetic Sphincter Augmentation and Postoperative Dysphagia: Characterization, Clinical Risk Factors, and Management. (PubMed)

Magnetic Sphincter Augmentation and Postoperative Dysphagia: Characterization, Clinical Risk Factors, and Management. Magnetic sphincter augmentation (MSA) results in less severe side effects compared with Nissen fundoplication, but dysphagia remains the most common side effect reported by patients after MSA. This study aimed to characterize and review the management of postoperative dysphagia and identify the preoperative factors that predict persistent dysphagia after MSA.This (...) with the evolution of our patient management practices and modifications in surgical technique.A total of 380 patients underwent MSA, at a mean (SD) follow up of 11.5 (8.7) months, 59 (15.5%) patients were experiencing persistent dysphagia. Thirty-one percent of patients required at least one dilation for dysphagia or chest pain and the overall response rate to this procedure was 67%, 7 (1.8%) patients required device removal specifically for dysphagia. Independent predictors of persistent dysphagia based

2019 Journal of Gastrointestinal Surgery

175. Effect of a lifestyle-focused electronic patient support application for improving risk factor management, self-rated health, and prognosis in post-myocardial infarction patients: study protocol for a multi-center randomized controlled trial. (PubMed)

Effect of a lifestyle-focused electronic patient support application for improving risk factor management, self-rated health, and prognosis in post-myocardial infarction patients: study protocol for a multi-center randomized controlled trial. Cardiac rehabilitation (CR) programs addressing risk factor management, educational interventions, and exercise contribute to reduce mortality after myocardial infarction (MI). However, the fulfillment of guideline-recommended CR targets is currently (...) unsatisfactory. eHealth, i.e., the use of electronic communication for healthcare, including the use of mobile smartphone applications combined with different sensors and interactive computerized programs, offers a new array of possibilities to provide clinical care. The present study aims to assess the efficacy of a web-based application (app) designed to support persons in adhering to lifestyle advice and medication as a complement to traditional CR programs for improvement of risk factors and clinical

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2019 Trials

176. Protocol for evaluating the nationwide implementation of the VA Stratification Tool for Opioid Risk Management (STORM). (PubMed)

Protocol for evaluating the nationwide implementation of the VA Stratification Tool for Opioid Risk Management (STORM). Mitigating the risks of adverse outcomes from opioids is critical. Thus, the Veterans Affairs (VA) Healthcare System developed the Stratification Tool for Opioid Risk Management (STORM), a dashboard to assist clinicians with opioid risk evaluation and mitigation. Updated daily, STORM calculates a "risk score" of adverse outcomes (e.g., suicide-related events, overdoses (...) , overdose death) from variables in the VA medical record for all patients with an opioid prescription and displays this information along with documentation of recommended risk mitigation strategies and non-opioid pain treatments. In March 2018, the VA issued a policy notice requiring VA Medical Centers (VAMCs) to complete case reviews for patients whom STORM identifies as very high-risk (i.e., top 1% of STORM risk scores). Half of VAMCs were randomly assigned notices that also stated that additional

2019 Implementation Science

177. The Strategies to Reduce Injuries and Develop Confidence in Elders Intervention: Falls Risk Factor Assessment and Management, Patient Engagement, and Nurse Co-management. (PubMed)

The Strategies to Reduce Injuries and Develop Confidence in Elders Intervention: Falls Risk Factor Assessment and Management, Patient Engagement, and Nurse Co-management. In response to the epidemic of falls and serious falls-related injuries in older persons, in 2014, the Patient Centered Outcomes Research Institute (PCORI) and the National Institute on Aging funded a pragmatic trial, Strategies to Reduce Injuries and Develop confidence in Elders (STRIDE) to compare the effects (...) of a multifactorial intervention with those of an enhanced usual care intervention. The STRIDE multifactorial intervention consists of five major components that registered nurses deliver in the role of falls care managers, co-managing fall risk in partnership with patients and their primary care providers (PCPs). The components include a standardized assessment of eight modifiable risk factors (medications; postural hypotension; feet and footwear; vision; vitamin D; osteoporosis; home safety; strength, gait

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2017 Journal of the American Geriatrics Society

178. ASCIA Guide: Stepwise management of eczema (atopic dermatitis) management

ASCIA Guide: Stepwise management of eczema (atopic dermatitis) management INFECTIONS: Use times each day – dose for days See your doctor or nurse practitioner if eczema does not improve or if unwell with a fever OTHER TREATMENTS: TRIGGERS: Avoid or minimise exposure to triggers and irritants where possible, such as soap or perfumed products, overheating/over dressing or exposure to prickly fabrics www.allergy.org.au Stepwise management of eczema (atopic dermatitis) GUIDE © ASCIA 2018. ASCIA (...) per week - use as directed to reduce the risk of infected eczema • Cortisone and non-steroid creams or ointments – apply as soon as there is an eczema flare (redness, increased itch, dry rough areas) • Names of cream or ointment for the face: Use times each day • Names of cream or ointment for the body: Use times each day • Continue to apply cream or ointment until skin feels smooth and the eczema has completely gone • Wet dressings - use as directed, on arms, legs, feet, chest, back, neck

2018 Australasian Society of Clinical Immunology and Allergy

179. An evidence synthesis of risk identification, assessment and management for young people using tier 4 inpatient child and adolescent mental health services

An evidence synthesis of risk identification, assessment and management for young people using tier 4 inpatient child and adolescent mental health services An evidence synthesis of risk identification, assessment and management for young people using tier 4 inpatient child and adolescent mental health services An evidence synthesis of risk identification, assessment and management for young people using tier 4 inpatient child and adolescent mental health services Hannigan B, Edwards D, Evans N (...) , Gillen E, Longo M, Pryjmachuk S, Trainor G Record Status This is a bibliographic record of a published health technology assessment from a member of INAHTA. No evaluation of the quality of this assessment has been made for the HTA database. Citation Hannigan B, Edwards D, Evans N, Gillen E, Longo M, Pryjmachuk S, Trainor G. An evidence synthesis of risk identification, assessment and management for young people using tier 4 inpatient child and adolescent mental health services. Health Services

2015 Health Technology Assessment (HTA) Database.

180. A new evidence-based risk stratification system for cutaneous squamous cell carcinoma into low, intermediate, and high risk groups with implications for management. (PubMed)

A new evidence-based risk stratification system for cutaneous squamous cell carcinoma into low, intermediate, and high risk groups with implications for management. Most primary cutaneous squamous cell carcinomas are cured with surgery. A subset, however, may develop local and nodal metastasis that may eventuate in disease-specific; death. This subset has been variably termed high risk. Herein, we review; an emerging body of data on the risks of these outcomes and propose an evidence-based (...) ; risk stratification for low-, intermediate-, and high-risk tumors that takes into; account both tumor and patient characteristics. Finally, we discuss a framework for; management of these tumors on the basis of data, when available, and our; recommendations when data are sparse.Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

2017 Journal of American Academy of Dermatology

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