risk assessment

Vaccination has prevented serious illness and death in children and adults for more than 200 years. However, conflicting statements and misleading information about the benefits and risks of vaccines are becoming more common. This is especially true on the internet and social media. Many of these conflicting statements appear to come from experts, which can lead to confusion about which information to trust. Finding accurate information about vaccines is important for people trying to make healthy decisions for themselves and their families.

Author/s:

Michael A. Incze, Jerard Z. Kneifati-Hayek

Screening for Depression and Suicide Risk in Adults US Preventive Services Task Force Recommendation Statement

Aubrey Delammermore — Sat, 24 Jun 2023 05:00:00 +0000

Date Added:

June 24, 2023

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

June 20, 2023

Issue:

Volume:

329

Pages:

2057-2067

URL:

Screening for Depression and Suicide Risk in Adults US Preventive Services Task Force Recommendation Statement

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2023.9297

Keywords

PMID (1):

37338872

MeSH

Depression / diagnosis

Depressive Disorder, Major* / diagnosis

Mass Screening / adverse effects

Suicide*

pregnancy

Final recommendations from the USPSTF regarding screening adults for depression (just do it). However, there is still insufficient evidence to screen for suicide risk apparently. James W. Mold, MD, MPH

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IMPORTANCE Major depressive disorder (MDD), a common mental disorder in the US, may
have substantial impact on the lives of affected individuals. If left untreated, MDD can
interfere with daily functioning and can also be associated with an increased risk of
cardiovascular events, exacerbation of comorbid conditions, or increased mortality.

OBJECTIVE The US Preventive Services Task Force (USPSTF) commissioned a systematic
review to evaluate benefits and harms of screening, accuracy of screening, and benefits and
harms of treatment of MDD and suicide risk in asymptomatic adults that would be applicable
to primary care settings.

POPULATION Asymptomatic adults 19 years or older, including pregnant and postpartum
persons. Older adults are defined as those 65 years or older.

EVIDENCE ASSESSMENT The USPSTF concludes with moderate certainty that screening for
MDD in adults, including pregnant and postpartum persons and older adults, has a moderate
net benefit. The USPSTF concludes that the evidence is insufficient on the benefit and harms
of screening for suicide risk in adults, including pregnant and postpartum persons and older
adults.

RECOMMENDATION The USPSTF recommends screening for depression in the adult
population, including pregnant and postpartum persons and older adults. (B
recommendation) The USPSTF concludes that the current evidence is insufficient to assess
the balance of benefits and harms of screening for suicide risk in the adult population,
including pregnant and postpartum persons and older adults. (I statement)

Author/s:

US Preventive Services Task Force, Barry, M. J., Nicholson, W. K., Silverstein, M., Chelmow, D., Coker, T. R., Davidson, K. W., Davis, E. M., Donahue, K. E., Jaén, C. R., Li, L., Ogedegbe, G., Pbert, L., Rao, G., Ruiz, J. M., Stevermer, J. J., Tsevat, J., Underwood, S. M., Wong, J. B.

A pragmatic approach to the management of menopause

Aubrey Delammermore — Wed, 17 May 2023 05:00:00 +0000

Date Added:

May 17, 2023

Journal/Publication:

CMAJ

Publisher:

CMA Impact Inc

Publication Date:

May 15, 2023

Issue:

Volume:

195

Pages:

E677-72

URL:

A pragmatic approach to the management of menopause

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

37188372

Keywords

PMID (1):

10.1503/cmaj.221438

MeSH

A nice review of treatment options for patients with menopausal symptoms. James W. Mold, MD, MPH

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Menopause is defined as 1 year of amenorrhea caused by
declining ovarian reserve or as the onset of vasomotor
symptoms in people with iatrogenic amenorrhea. It is preceded
by perimenopause or the menopause transition, which can last
for as long as 10 years. Although many treatments exist for
menopausal symptoms, fears around the risks of menopausal
hormone therapy and lack of knowledge regarding treatment
options often impede patients from receiving treatment. In this
review, we summarize the evidence for treating menopausal
symptoms and discuss their risks and benefits to help guide
clinicians to evaluate and treat patients during the menopausal
transition (Box 1).
• Menopausal symptoms can occur for as long as 10 years before
the last menstrual period and are associated with substantial
morbidity and negative impacts on quality of life.
• Menopausal hormone therapy is indicated as first-line
treatment of vasomotor symptoms, and is a safe treatment
option for patients with no contraindications.
• Though less effective, nonhormonal treatments also exist to
treat vasomotor symptoms and sleep disturbances.
• It is critical that clinicians inquire about symptoms during the
menopause transition and discuss treatment options with
their patients.

Author/s:

Lega, I. C., Fine, A., Antoniades, M. L., Jacobson, M.

Recommendations on screening for primary prevention of fragility fractures

Aubrey Delammermore — Wed, 10 May 2023 05:00:00 +0000

Date Added:

May 10, 2023

Journal/Publication:

Canadian Medical Association Journal

Publisher:

CMA Impact Inc

Publication Date:

May 8, 2023

Issue:

Volume:

195

Pages:

E639-E649

URL:

Recommendations on screening for primary prevention of fragility fractures

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.221219

Keywords

PMID (1):

37156553

MeSH

Absorptiometry, Photon

Osteoporotic Fractures* / prevention & control

Bone Density

primary prevention

quality of life

A rational approach to screening to reduce hip fractures in older women from the Canadians. James W. Mold, MD, MPH

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Background: Fragility fractures are a major health concern for older adults and can result in disability, admission to hospital and long-term care, and reduced quality of life. This Canadian Task Force on Preventive Health Care (task force) guideline provides evidence-based recommendations on screening to prevent fragility fractures in community-dwelling individuals aged 40 years and older who are not currently on preventive pharmacotherapy.

Methods: We commissioned systematic reviews on benefits and harms of screening, predictive accuracy of risk assessment tools, patient acceptability and benefits of treatment. We analyzed treatment harms via a rapid overview of reviews. We further examined patient values and preferences via focus groups and engaged stakeholders at key points throughout the project. We used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach to determine the certainty of evidence for each outcome and strength of recommendations, and adhered to Appraisal of Guidelines for Research and Evaluation (AGREE), Guidelines International Network and Guidance for Reporting Involvement of Patients and the Public (GRIPP-2) reporting guidance.

Recommendations: We recommend "risk assessment-first" screening for prevention of fragility fractures in females aged 65 years and older, with initial application of the Canadian clinical Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD). The FRAX result should be used to facilitate shared decision-making about the possible benefits and harms of preventive pharmacotherapy. After this discussion, if preventive pharmacotherapy is being considered, clinicians should request BMD measurement using dual-energy x-ray absorptiometry (DXA) of the femoral neck, and re-estimate fracture risk by adding the BMD T-score into FRAX (conditional recommendation, low-certainty evidence). We recommend against screening females aged 40-64 years and males aged 40 years and older (strong recommendation, very low-certainty evidence). These recommendations apply to community-dwelling individuals who are not currently on pharmacotherapy to prevent fragility fractures.

Interpretation: Risk assessment-first screening for females aged 65 years and older facilitates shared decision-making and allows patients to consider preventive pharmacotherapy within their individual risk context (before BMD). Recommendations against screening males and younger females emphasize the importance of good clinical practice, where clinicians are alert to changes in health that may indicate the patient has experienced or is at higher risk of fragility fracture.

Author/s:

Thériault, G., Limburg, H., Klarenbach, S., Reynolds, D. L., Riva, J. J., Thombs, B. D., Tessier, L. A., Grad, R., Wilson, B. J., Canadian Task Force on Preventive Health Care

Confidently rule out CAP in the outpatient setting

Aubrey Delammermore — Thu, 13 Oct 2022 05:00:00 +0000

Date Added:

October 13, 2022

Journal/Publication:

The Journal of Family Practice

Publisher:

The Family Physicians Inquiries Network

Publication Date:

April 1, 2021

Issue:

Volume:

Pages:

140-142

URL:

Confidently rule out CAP in the outpatient setting (Select PDF to view whole article)

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.12788/jfp.0174

Keywords

Physician-Patient Relations

Health Status

risk assessment

community-acquired pneumonia

outpatients

PMID (1):

34314338

MeSH

Ambulatory Care / organization & administration*

Community-Acquired Infections / diagnosis*

Family Practice / methods*

Practice Patterns

Physicians' / organization & administration*

Outpatients / statistics & numerical data

It is possible to accurately rule-out pneumonia in outpatients without a CXR. James W. Mold, MD, MPH

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A focus on specific signs and symptoms-without imaging-may rule out community-acquired pneumonia in outpatients.

Author/s:

Mott, T., Echeverri, D., Fondren, L., Hunter, A.

Preoperative Evaluation Before Noncardiac Surgery

John Bayhi — Wed, 20 Nov 2019 21:00:21 +0000

Date Added:

November 20, 2019

Journal/Publication:

Mayo Clinic Proceedings

Publisher:

Mayo Foundation for Medical Education and Research / Elsevier, Inc.

Publication Date:

November 18, 2019

URL:

Preoperative Evaluation Before Noncardiac Surgery

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.mayocp.2019.04.029

Keywords

surgery

preoperative evaluation

MeSH

This is a fairly comprehensive review of the preoperative considerations and evaluation components for a patient undergoing non-cardiac surgeries. James W. Mold, MD, MPH

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The medical complexity of surgical patients is increasing and medical specialties are frequently asked to assist with perioperative management surgical patients. Effective pre-anesthetic medical evaluations are a valuable tool in providing high-value, patient-centered surgical care and should systematically address risk assessment and identify areas for risk modification. This review outlines a structured approach to the pre-anesthetic medical evaluation, focusing on the asymptomatic patient. It discusses the evidence supporting the use of perioperative risk calculation tools and focused preoperative testing. We also introduce important key topics that will be explored in greater detail in upcoming reviews in this series.

Author/s:

Bierle, DM, Raslau, D, Regan, DW, Sundsted, KK, Mauck, K.F.

Final Update Summary: Breast Cancer: Medication Use to Reduce Risk

John Bayhi — Wed, 04 Sep 2019 17:50:29 +0000

Date Added:

September 4, 2019

Journal/Publication:

US Preventative Services Task Force / JAMA

Publisher:

American Medical Association

Publication Date:

September 3, 2019

Issue:

322

Volume:

Pages:

857-867

URL:

Final Update Summary: Breast Cancer: Medication Use to Reduce Risk

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2019.11885

Keywords

PMID (1):

31479144

MeSH

breast neoplasms

risk reduction behavior

biopsy

risk assessment

tamoxifen

Raloxifene Hydrochloride

aromatase inhibitors

It looks like all women need to be assessed for risk of breast cancer so that high-risk women can be offered medications to reduce risk. James W. Mold, MD, MPH

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IMPORTANCE:

Breast cancer is the most common nonskin cancer among women in the United States and the second leading cause of cancer death. The median age at diagnosis is 62 years, and an estimated 1 in 8 women will develop breast cancer at some point in their lifetime. African American women are more likely to die of breast cancer compared with women of other races.

OBJECTIVE:

To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on medications for risk reduction of primary breast cancer.

EVIDENCE REVIEW:

The USPSTF reviewed evidence on the accuracy of risk assessment methods to identify women who could benefit from risk-reducing medications for breast cancer, as well as evidence on the effectiveness, adverse effects, and subgroup variations of these medications. The USPSTF reviewed evidence from randomized trials, observational studies, and diagnostic accuracy studies of risk stratification models in women without preexisting breast cancer or ductal carcinoma in situ.

FINDINGS:

The USPSTF found convincing evidence that risk assessment tools can predict the number of cases of breast cancer expected to develop in a population. However, these risk assessment tools perform modestly at best in discriminating between individual women who will or will not develop breast cancer. The USPSTF found convincing evidence that risk-reducing medications (tamoxifen, raloxifene, or aromatase inhibitors) provide at least a moderate benefit in reducing risk for invasive estrogen receptor-positive breast cancer in postmenopausal women at increased risk for breast cancer. The USPSTF found that the benefits of taking tamoxifen, raloxifene, and aromatase inhibitors to reduce risk for breast cancer are no greater than small in women not at increased risk for the disease. The USPSTF found convincing evidence that tamoxifen and raloxifene and adequate evidence that aromatase inhibitors are associated with small to moderate harms. Overall, the USPSTF determined that the net benefit of taking medications to reduce risk of breast cancer is larger in women who have a greater risk for developing breast cancer.

CONCLUSIONS AND RECOMMENDATION:

The USPSTF recommends that clinicians offer to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer and at low risk for adverse medication effects. (B recommendation) The USPSTF recommends against the routine use of risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, in women who are not at increased risk for breast cancer. (D recommendation) This recommendation applies to asymptomatic women 35 years and older, including women with previous benign breast lesions on biopsy (such as atypical ductal or lobular hyperplasia and lobular carcinoma in situ). This recommendation does not apply to women who have a current or previous diagnosis of breast cancer or ductal carcinoma in situ.

Author/s:

US Preventive Services Task Force, Owens, Douglas K., Davidson, Karina W., Krist, Alex H., Barry, Michael J., Cabana, M, Caughey, AB, Doubeni, Chyke A., Epling, John W. Jr., Kubik, M, Landefeld, CS, Mangione, Carol M., Pbert, L, Silverstein, Michael, Tseng, Chien-Wen, Wong, JB

Periprocedural Bridging in Patients with Venous Thromboembolism: A Systematic Review

Brian Desmarais — Wed, 19 Jun 2019 20:00:05 +0000

Date Added:

June 19, 2019

Journal/Publication:

The American Journal of Medicine

Publication Date:

June 16, 2019

Issue:

Volume:

132

Pages:

722-732.e7

URL:

Periprocedural Bridging in Patients with Venous Thromboembolism: A Systematic Review.

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.amjmed.2019.01.004

Keywords

MeSH

Venous Thromboembolism

This systematic review of 28 cohort studies suggests that anticoagulation bridging in patients on warfarin for procedures is probably both unwise (increased bleeding) and unnecessary (no reduction in thromboembolic risk) .

James W. Mold, MD, MPH

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Abstract

BACKGROUND:

Vitamin K antagonists (VKA) are the most widely used anticoagulants, and bridging is commonly administered during periprocedural VKA interruption. Given the unclear benefits and risks of periprocedural bridging in patients with previous venousthromboembolism, we aimed to assess recurrent venous thromboembolism and bleeding outcomes with and without bridging in this population.

METHODS:

We performed a systematic review searching the PubMed and Embase databases from inception to December 7, 2017 for randomized and nonrandomized studies that included adults with previous venous thromboembolism requiring VKA interruption to undergo an elective procedure, and that reported venous thromboembolism or bleeding outcomes. Quality of evidence was graded by consensus.

RESULTS:

We included 28 cohort studies (20 being single-arm cohorts) with, overall, 6915 procedures for analysis. In 27 studies reporting perioperative venous thromboembolism outcomes, the pooled incidence of recurrent venous thromboembolism with bridging was 0.7% (95% confidence interval [CI], 0.4%-1.2%) and 0.5% (95% CI, 0.3%-0.8%) without bridging. Eighteen studies reported major or nonmajor bleeding outcomes. The pooled incidence of any bleeding was 3.9% (95% CI, 2.0%-7.4%) with bridging and 0.4% (95% CI, 0.1%-1.7%) without bridging. In bridged patients at high thromboembolic risk, the pooled incidence for venous thromboembolism was 0.8% (95% CI, 0.3%-2.5%) and 7.5% (95% CI, 3.1%-17.4%) for any bleeding. Quality of available evidence was very low, primarily due to a high risk of bias of included studies.

CONCLUSIONS:

Periprocedural bridging increases the risk of bleeding compared with VKA interruption without bridging, without a significant difference in periprocedural venous thromboembolism rates.

KEYWORDS:

Anticoagulants; Bleeding; Bridging; PROSPERO; Periprocedural; Venous thromboembolism; registration number CRD42017074710

Author/s:

Baumgartner, C., de Kouchkovsky, I., Whitaker, E., Fang, M.C.