Management Of Adult Patients Research Articles

Rehabilitation Approaches and Strategies in the Management of Adult Patients Following Pelvic Fractures: Protocol for a Scoping Review.

Pelvic fractures can lead to disability and a poor health-related quality of life, thereby contributing to the burden of disease in South Africa. Rehabilitation plays an important role in improving the functional outcomes in patients with pelvic fractures. However, there is limited published research that presents optimal interventions and guidelines to improve outcomes in affected individuals. The purpose of this study is to examine and map the range of and gaps in rehabilitation approaches and strategies used by health care professionals globally in the management of adult patients with pelvic fractures. The synthesis of evidence will follow the framework outlined by Arksey and O'Malley and supported by the Joanna Briggs Institute. The identification of research questions; the identification of relevant studies; the selection of eligible studies; charting data; collating, summarizing, and reporting of the results; and consultation with relevant stakeholders will be undertaken. Peer-reviewed articles written in English; from quantitative, qualitative, and mixed methods studies; and searched through Google Scholar, MEDLINE, PubMed, and Cochrane Library will be considered. Studies eligible for selection will be full-text articles written in English about adult patients with pelvic fractures. Studies on children with pelvic fractures and on interventions following pathological pelvic fractures as well as opinion papers and commentaries will be excluded from the study. Rayyan software will be used for title and abstract screening to determine inclusion in the study and to improve collaboration between the reviewers. The Mixed Methods Appraisal Tool (version 2018) will be used to appraise the quality of the studies. This protocol will guide a scoping review to examine and map the range of and gaps in rehabilitation approaches and strategies used by health care professionals globally in the management of adult patients with pelvic fractures, irrespective of level of care. Impairments, activity limitations, and participation restrictions in patients with pelvic fractures will be highlighted, which will give an indication of the rehabilitation needs of the affected individuals. Results of this review might provide evidence for health care professionals, policy makers, and scholars to aid rehabilitative care and further integration of patients into health care systems and community. The rehabilitation needs of patients with pelvic fractures will be drawn from this review and will be presented in a flow diagram. Rehabilitation approaches and strategies in the management of patients with pelvic fractures will be identified to guide health care professionals in the promotion of quality health care for these patients. OSF Registries osf.io/k6eg8; https://osf.io/k6eg8. PRR1-10.2196/38884.

Post-craniotomy Pain: An Update

AbstractApproximately two-thirds of patients experience moderate to severe intensity pain following craniotomy. It is often undertreated due to fear of unfavorable side effects of commonly used analgesic drugs. The objectives of this review are to discuss the various aspects of acute and chronic post-craniotomy pain including its incidence, pathophysiology, diagnostic criteria, preventive strategies, and management in adult patients. The data have been consolidated based on our literature search from 1978 to 2021 using various databases including Google Scholar, Medline, and PubMed Central. We conclude that one must act at the earliest using various treatment modalities for post-craniotomy pain management.

Australian Atherosclerosis Society Position Statement on Lipoprotein(a): Clinical and Implementation Recommendations.

This position statement provides guidance to cardiologists and related specialists on the management of adult patients with elevated lipoprotein(a) [Lp(a)]. Elevated Lp(a) is an independent and causal risk factor for atherosclerotic cardiovascular disease (ASCVD) and calcific aortic valve disease (CAVD). While circulating Lp(a) levels are largely determined by ancestry, they are also influenced by ethnicity, hormones, renal function, and acute inflammatory events, such that measurement should be done after accounting for these factors. Further, circulating Lp(a) concentrations should be estimated using an apo(a)-isoform independent assay that employs appropriate calibrators and reports the results in molar units (nmol/L). Selective screening strategies of high-risk patients are recommended, but universal screening of the population is currently not advised. Testing for elevated Lp(a) is recommended in all patients with premature ASCVD and those considered to be at intermediate-to-high risk of ASCVD. Elevated Lp(a) should be employed to assess and stratify risk and to enable a decision on initiation or intensification of preventative treatments, such as cholesterol lowering therapy. In adult patients with elevated Lp(a) at intermediate-to-high risk of ASCVD, absolute risk should be reduced by addressing all modifiable behavioural, lifestyle, psychosocial and clinical risk factors, including maximising cholesterol-lowering with statin and ezetimibe and, where appropriate, PCSK9 inhibitors. Apheresis should be considered in patients with progressive ASCVD. New ribonucleic acid (RNA)-based therapies which directly lower Lp(a) are undergoing clinical trials.

Assessment and management of adult patients with neutropenic sepsis in the emergency department.

As cancer diagnoses rise, and more treatment options become available, doctors, nurses and allied health professionals will increasingly encounter more patients with acute oncological emergencies in the emergency department (ED). Neutropenia (low levels of neutrophils in the blood) is a common side effect of systemic anti-cancer therapy, particularly chemotherapy, and has a negative effect on patients' immune system, leaving them vulnerable to infection. Patients who develop neutropenia are at increased risk of developing neutropenic sepsis, a potentially life-threatening condition that requires urgent assessment and treatment within an hour of presentation. This article describes the risk factors for and signs and symptoms of neutropenic sepsis and outlines assessment and management of patients who present to the ED with this condition.

Survey of healthcare professionals' experiences of care delivery in patients with chronic intestinal failure: ATLAS of Variance

Chronic intestinal failure (IF) is a rare but life-altering condition, care delivery of which is complex. The ATLAS Programme was initiated in 2016 to increase disease awareness and address inconsistencies in delivery of care across Europe. We describe the results of a non-interventional study that aimed to explore how adult patients with chronic IF are managed across Europe. This mixed-methods, non-interventional, cross-sectional study comprised a desk-based landscape assessment (Phase 1), qualitative interviews (Phase 2), and an online quantitative survey (Phase 3) completed by healthcare professionals (HCPs) involved in the management of adult patients with chronic IF during the period November 2020 to January 2021. Data were collected from 12 European countries. Survey data were anonymised and pooled for analysis at European and country level. Responses were summarised as frequencies, ranks and percentage. The quantitative survey was carried out on 119 HCPs across an estimated 58 centres. Gastroenterology was the most frequent specialty of respondents (45%). Three-quarters of HCPs (N=119) reported that their department/unit had a multidisciplinary team for the management of patients with chronic IF. HCPs reported improving quality of life (QoL) to be the most important goal of treatment (39%), followed by reducing mortality (25%), intestinal rehabilitation (20%) and reducing morbidity (9%). Similarly, 63% of HCPs responded that improved QoL was the most important treatment goal from the perspective of their patients. Overall, 87% of HCPs reported that patients with chronic IF routinely receive home parenteral nutrition (HPN) in their country, which was more common in Western versus Eastern Europe. Meeting treatment goals (53%) and achieving better levels of support with HPN (44%) were reported as the main challenges faced by HCPs in the management of patients with chronic IF. A general lack of disease awareness of chronic IF among HCPs (46%), and insufficient accredited patient referral centres (41%) were considered the most important areas for improvement. HCPs specialising in treating chronic IF considered that improvement in QoL is needed for their patients. They reported a low level of awareness of chronic IF among non-specialist HCPs.

Management of adult patients with haematological malignancies in critical care.

There are a diverse range of haematological malignancies with varying clinical presentations and prognoses. Patients with haematological malignancy may require admission to critical care at the time of diagnosis or due to treatment related effects and complications. Although the prognosis for such patients requiring critical care has improved, there remain uncertainties in optimal clinical management. Identification of patients who will benefit from critical care admission is challenging and selective involvement of palliative care may help to reduce unnecessary and non-beneficial treatments. While patients with haematological malignancy can present a challenge to critical care physicians, good outcomes can be achieved. In this narrative review, we provide a brief overview of relevant haematological malignancies for the critical care physician and a summary of recent treatment advances. Subsequently, we focus on critical care management for the patient with haematological malignancy including sepsis; acute respiratory failure; prevention and treatment of tumour lysis syndrome; thrombocytopaenia; and venous thromboembolism. We also discuss immunotherapeutic-specific related complications and their management, including cytokine release syndrome and immune effector cell associated neurotoxicity syndrome associated with chimeric antigen receptor T-cell therapy. While the management of haematological malignancies is highly specialised and increasingly centralised, acutely unwell patients often present to their local hospital with complications requiring critical care expertise. The aim of this review is to provide a contemporary overview of disease and management principles for non-specialist critical care teams.

Perioperative right ventricular dysfunction in adult patients undergoing non-complex cardiac surgery: diagnosis and management

Even though there is no precise consensus on definition of the right ventricular dysfunction and the right ventricular failure, their reported incidence after cardiac surgery ranges from 0.04% to 2.9%. Right ventricular dysfunction is clinically important because it has been consistently shown to have a negative impact on the perioperative outcomes. In this article we explore current evidence on perioperative diagnosis and management of adult patients with right ventricular dysfunction who are undergoing non-complex cardiac surgery. We propose criteria for the right ventricular dysfunction, describe its pathophysiological mechanisms, diagnostic and therapeutic options as well as current challenges. The function of the right ventricle is determined by preload, afterload, contractility, ventricular interdependence, and heart rhythm. These five factors should all be assessed in a particular patient. Right ventricular dysfunction is not always easy to confirm. Transthoracic and transesophageal echocardiography are the mainstay of diagnosis. Also, clinical and laboratory findings should be considered especially when the patient approaches the extreme of right ventricular dysfunction spectrum—right ventricular failure. Right ventricular failure should be anticipated, and management focused on its prevention and treatment of the underlying cause. The clinical aim is to optimise the volume status, minimise the right ventricular afterload, optimise right ventricular free wall and interventricular septum performance, and to maximise the left heart pressure work. If the patient does not respond to conservative therapy, mechanical support should be promptly considered.

Cytopathological Evaluation of Paediatric Non-Thyroidal Neck Swelling–Experience in a Tertiary Care Children Hospital

Background and Objective: Fine needle aspiration cytology (FNAC) is well accepted as a useful diagnostic technique in the management of adult patients with head and neck lumps. However, until recently, few reports have been obtained regarding the role of FNAC in non-thyroidal neck masses in children. Therefore, the objective of our study was to determine the diagnostic value of fine needle aspiration cytology in the diagnosis of pediatric non-thyroidal neck masses. Methods: This descriptive study was conducted at the Department of Pathology of Bangladesh Shishu (Children) Hospital & Institute January 2019 to December 2021. Hundred patients with non-thyroidal neck masses fulfilling the inclusion criteria were included in the study. Fine needle aspirations were performed, smears prepared and stained by Hematoxylin and Eosin stain. Results: The most common non-neoplastic neck swelling seen in children were an enlarged lymph node due to inflammation 38(42.2%), i.e., reactive lymphadenitis. Others were TB lymphadenitis 25 (27.8%), non-TB granulomatous lymphadenitis 2(2.22%), chronic sialadenitis 2(2.22%), branchial cyst 4(4.44%) and epidermal cyst 3(3.33%) cases. Overall sensitivity, specificity, positive predictive value and negative predictive value of FNAC in our cases are 93.06%, 72.22%, 93.06% and 72.22%. Conclusion: FNA is an important diagnostic tool in the management of childhood neck lesion with the clinical presentation. The procedure decreases the requirement for more invasive and costly procedures like surgical biopsy.

Semaglutide (Wegovy)


 CADTH reimbursement reviews are comprehensive assessments of the clinical effectiveness and cost-effectiveness, as well as patient and clinician perspectives, of a drug or drug class.
 The assessments inform non-binding recommendations that help guide the reimbursement decisions of Canada's federal, provincial, and territorial governments, with the exception of Quebec.
 This review assesses semaglutide (Wegovy), 2.4 mg subcutaneous injection.
 Indication: As an adjunct to a reduced-calorie diet and increased physical activity for chronic weight management in adult patients with an initial body mass index (BMI) of 30 kg/m2 or greater (obesity), or 27 kg/m2 or greater (overweight) in the presence of at least 1 weight-related comorbidity such as hypertension, type 2 diabetes, dyslipidemia, or obstructive sleep apnea.

Management of Adult Patients with Gastrointestinal Symptoms from Food Hypersensitivity-Narrative Review.

The incidence of food hypersensitivity has increased dramatically over the years not only among children but also in adults. Adult patients are usually less suspected of food hypersensitivity symptoms since food allergies are more typical for small children, with a tendency to outgrow the condition. The aim of this article is to increase awareness of hypersensitivity to food symptoms and their diagnosis and treatment possibilities among gastroenterologists and other health care professionals dealing with this type of patient. Symptoms of many gastrointestinal disorders, especially functional, may be driven by different types of mechanisms, and food intolerance or allergy should be considered as a potential cause. This article presents the current understanding of the epidemiology, diagnosis and treatment of immune- and non-immune-mediated food-induced diseases. Diagnosis of food hypersensitivity is based mainly on medical history, different types of sensitivity tests, e.g., hydrogen breath test, specific IgE (sIgE) serum concentration, tissue eosinophil count, skin tests and oral food challenges considered as a "gold standard" for food allergy. Elimination diet and pharmacologic treatment for allergy symptoms are first-line therapies. Eosinophilic gastrointestinal diseases are often caused by non-IgE-mediated food allergies, require endoscopic biopsy samples to confirm diagnosis and proper elimination diet often combined with steroids or proton pump inhibitor agents for treatment. Mast cell activation syndrome (MCAS) derives from pathologic reaction of mast cells with increased tryptase serum level as a marker. Symptoms may occur in the digestive, respiratory, skin, neurologic and cardiovascular system. Treatment is based on histamine type 1, type 2 (H1, H2) receptor antagonists and other mast cell stabilizing agents. Carbohydrate intolerances are the most common type of food hypersensitivity in adult patients, and an elimination diet is effective for reducing symptoms. Food additives hypersensitivity remains difficult to diagnose, but use of a diet low in chemical substances alleviates symptoms and helps to diagnose the triggering factors.

Evaluation of Serum 25(OH) Vitamin D as a Risk Factor in Adult Recurrent Tonsillitis.

Background Studies have reported that the rate of upper respiratory tract infections in children and adults is inversely related to serum vitamin D levels and supplementation with vitamin D reduces the incidence of this infection. This study aimed to examine if vitamin D serum levels were a risk factor for recurrent tonsillitis among adult patients. Methods Retrospective comparative analysis was carried out on 100 patients diagnosed with recurrent tonsillitis with 100 age- and sex-matched individuals as controls between June 2016 and May 2022. Tonsillar size was assessed based on Brodsky grading system. Serum levels of 25-hydroxy (25(OH)) vitamin D, total calcium, iron, hemoglobin, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) were analyzed. Results There was a statistically significant low vitamin D levels in tonsil size grades III+IV compared to grade I+II (p <0.001) among cases. There was a significantly lower serum value for 25(OH) vitamin D in the cases as compared to the control group (p <0.001). A high percentage (68%) of cases had vitamin D deficiency (<20 ng/mL) and this was statistically significant (p <0.001). There were statistically significant higher values of CRP and ESR among cases compared to the control group (p <0.001). At a cut off (≤21.2), serum vitamin D levels achieved 78% sensitivity, 65% specificity (p <0.001) to differentiate cases from controls. Following logistic regression analysis, the level of vitamin D was the only significant risk factor. Conclusion Findings from our study also suggest an association between recurrent tonsillitis among our adult cohorts and low serum 25(OH) vitamin D levels. Therefore, we opine that serum vitamin D levels should be considered in the management of adult patients with tonsillitis.

Exercise interventions used along the continuum of cancer care: A scoping review protocol.

Cancer is one of the leading causes of death worldwide. Exercise is crucial for ameliorating the burden associated with cancer and its management. A broad review of exercise interventions for cancer patients is not available. Our study aims to review the documented exercise interventions prescribed for adult cancer patients aimed at ameliorating cancer-related and cancer treatment-induced symptoms in patients along the continuum of care. A three-step search strategy will be used, the research question was developed; the first step in the research process was identified and the search strategy was developed using the Participants-Concept-Context framework. English language publications from 15 electronic databases from 2011 to 2021 will be searched. The Joanna Briggs Institute methodology for scoping reviews will be to guide the review and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for scoping reviews will be used for the report. The search strategy incorporated terms relevant to the research question. The reference lists of articles included in the review will be screened for additional papers. Searched articles will be screened to determine their eligibility for inclusion and a pretested data extraction form will be used to chart the extracted evidence. This article presents a protocol for a scoping review on exercise interventions to affect symptoms in cancer patients from diagnosis to end-of-life care. A broad review of exercise interventions for cancer management in adult patients will elucidate the characteristics and context of exercises used along the cancer care continuum. Exercise interventions used as part of cancer management will be mapped out to provide an overview of such exercise interventions. This could enhance knowledge among exercise oncology experts regarding exercise interventions for different cancer patient populations.

Abstract #1313472: Adherence of Physicians to Evidence-Based Management Guidelines for Treating Type 2 Diabetes and Atherosclerotic Cardiovascular Disease in Ajman, United Arab Emirates

Good adherence by physicians to treatment guidelines for T2DM could improve therapy outcome for patients. In this retrospective, cross-sectional study, we assessed physicians’ adherence to evidence-based guidelines for T2DM management in adult patients (aged ≥18 years) with either confirmed atherosclerotic cardiovascular disease (ASCVD) or those at high risk of developing ASCVD at the Thumbay Hospital Ajman an Academic Health Center affiliated with Gulf Medical University - United Arab Emirates

Cast versus removable orthosis for the management of stable type B ankle fractures: a systematic review and meta-analysis

PurposeThere is currently no consensus on nonoperative management in adult patients after a stable type B ankle fracture. The aim of this review is to compare a removable orthosis versus a cast regarding safety and functional outcome in the NOM of stable type B ankle fractures.MethodsA systematic review and meta-analysis were performed using randomized clinical trials and observational studies. The methodological quality of the included studies was assessed with the methodological index for non-randomized studies instrument. Nonoperative management was compared using the number of complications and functional outcome measured using the Olerud and Molander Score (OMAS) or the American Academy of Orthopaedic Surgeons Ankle Score.ResultsFive studies were included. Two were randomized clinical trials, and three were observational studies, including a total of 516 patients. A meta-analysis showed statistically significant higher odds of developing complications in the cast group [odds ratio (OR), 4.67 (95% confidence interval (CI) 1.52–14.35)].Functional outcome in OMAS did not vary significantly at 6 weeks, mean difference (MD) − 6.64 (95% CI − 13.72 to + 0.45), and at 12 weeks, MD − 6.91 (95% CI − 18.73 to + 4.91). The mean difference of functional outcome in OMAS at 26 weeks or longer was significantly better in the removable orthosis group; MD − 2.63 (95% CI − 5.01 to − 0.25).ConclusionResults of this systematic review and meta-analysis show that a removable orthosis is a safe alternative type of NOM, as complication numbers are significantly lower in the orthosis group. In addition, no statistically significant differences were found in terms of functional outcome between a removable orthosis and a cast at 6 and 12 weeks. The 6-week and the 26-week OMAS results show that in patients with stable type B ankle fractures, a removable orthosis is non-inferior to a cast in terms of functional outcome.

Emoji-like structure in the right atrium: identified as blood cyst and removed by interventional venous drainage cannula.

Intracardiac blood cysts are thin-walled, blood-filled and round-shaped malformations, commonly located to the endocardium of semilunar or atrioventricular valves. Blood cysts with a diameter of a few millimetres are a frequent finding in neonates and infants 2 years of age or younger,1 but in adults they are rare. On echocardiography, blood cysts have usually a round or oval shape, about the half are pedunculated or mobile, their size varies in adults, but cysts up to a diameter of 40 mm have been reported, and usually the trapped blood within the cyst appears echo-free.2,3 The aetiology of acquired blood cysts in adults remains unknown. Furthermore, the management of adult patients with a blood cyst is controversial. We present a 56-year-old male patient in whom a mobile blood cyst in the right atrium was found by transesophageal echocardiography as part of preoperative diagnostic investigation in pocket infection of a cardiac contractility modulation device. The patient had a history with multiple lead implantations since 28 years due to AV block and dilatative cardiomyopathy. The blood cyst has been successfully removed by a venous drainage cannula (AngioVac system). In this case, the evolution of blood cyst is compatible with a possible mechanical injury of endocardium due to multiple insertions and high number of leads in the right heart. To the best of our knowledge, here we report for the first time on the removal of a blood cyst using a large venous drainage cannula (22 french size).

Semaglutide (Wegovy)

&#x0D; CADTH recommends that Wegovy should not be reimbursed by public drug plans for chronic weight management in adult patients.&#x0D; Even though results from 4 clinical trials showed that patients treated with Wegovy for 68 weeks lost more body weight compared to those who received placebo, there was no evidence to show this weight loss translates to improvements in weight-related comorbidities (e.g., cardiovascular complications, osteoarthritis [the most common form of arthritis], and sleep apnea) because they were not studied.&#x0D; Although results showed improvements in health-related quality of life (HRQoL), the minimally important difference (MID) was not met, and it remains unknown if the differences were clinically meaningful.&#x0D; Wegovy is effective for weight loss for up to 2 years with an acceptable side effect profile, but it is unclear whether it meets patient needs for reduced weight-related comorbidities and improved HRQoL.&#x0D;

Nutritional Management in Adult Patients With Dysphagia: Position Paper From Japanese Working Group on Integrated Nutrition for Dysphagic People.

This position paper prepared by the Japanese Working Group on Integrated Nutrition for Dysphagic People (JWIND) aims to summarize the need for nutritional management in adult patients with dysphagia, the issues that nutrition professionals should address, and the promising approaches as well as to propose a vision for the future of nutritional care for adult patients with dysphagia. JWIND is a joint certification system recognized by the Japan Dietetic Association and the Japanese Society of Dysphagia Rehabilitation; its members are mostly experts known as "Certified Specialist of Registered Dietitian for Dysphagia Rehabilitation." Malnutrition and dysphagia are associated with each other. Therefore, malnutrition detection and intervention are essential for patients with dysphagia. However, evidence on the usefulness nutritional assessment and intervention to ensure appropriate nutritional care remains insufficient. Here, we present current knowledge of the relationship between primary diseases causing dysphagia and malnutrition, the indicators used for nutritional assessment, and nutritional interventions such as texture-modified diet (TMD) quality improvement, oral nutritional supplementation, and comprehensive intervention. We also discuss the current status and issues in nutritional care for adult patients with dysphagia. Furthermore, we have proposed measures that nutrition professionals should consider based on 3 perspectives: nutritional assessment, TMD, and nutritional intervention. Individualized and specialized nutritional management by registered dietitians (RDs) through appropriate assessment of the nutritional status of adult patients with dysphagia is needed. To maintain and improve swallowing function and nutritional status, RDs should intervene from the state of risk or early dysphagia onset, providing individualized care per their expertise as part of a multidisciplinary team. However, systematic clinical practice and research regarding the association of nutrition with dysphagia are currently insufficient. Therefore, further clinical practice and evidence building, including the verification of the efficacy on nutritional support through intervention research, are needed.

What are we missing in adult obstructive sleep apnea clinical evaluation? Review of official guidelines

Purpose: This article presents a narrative review of current recommendations for the clinical evaluation and management of adult patients with obstructive sleep apnea (OSA) to identify points missing from a myofunctional perspective. Methods: The authors reviewed current official guidelines for adult patients with OSA, searching clinical evaluation and treatment recommendations for myofunctional therapy. Results: None of the current guidelines for evaluation of adult OSA recommend performing a myofunctional evaluation. Only two guidelines consider myofunctional therapy (MFT) as a treatment modality for adult patients with OSA. Conclusion: Despite the role of the pharyngeal dilator muscles as an essential contributor to the pathogenesis of OSA, this review has shown that myofunctional assessment is still not a standard recommendation in current guidelines for adult OSA. Recent guidelines occasionally include MFT as a therapeutic tool for OSA. To strengthen the knowledge base and evidence for including MFT treatment for adult patients with OSA, the authors encourage physicians to incorporate myofunctional evaluation into their regular clinical practice.

Acupuncture versus massage for pain in patients living with advanced cancer: a protocol for the IMPACT randomised clinical trial

IntroductionPain, comorbid fatigue and sleep disturbances are common and distressing symptoms for patients with advanced cancer, negatively impacting their quality of life. Clinical guidelines recommend non-pharmacological interventions, including acupuncture and...

A Southeast Asian expert consensus on the management of major depressive disorder with suicidal behavior in adults under 65 years of age

BackgroundThe high prevalence of suicidal behavior among individuals with major depressive disorder (MDD) in Southeast Asia (SEA) underscores the need for optimized management to address depressive symptoms, reduce suicide risk and prevent suicide in these individuals. Given the lack of clear guideline recommendations for assessing and managing these patients, regional consensus-based recommendations which take into account diverse local contexts across SEA may provide useful guidance for clinical practice.MethodsA narrative literature review and pre-meeting survey were conducted prior to the consensus meeting of an SEA expert panel comprising 13 psychiatrists with clinical experience in managing patients with MDD with suicidal behavior. Utilizing the RAND/UCLA Appropriateness Method, the expert panel developed consensus-based recommendations on the assessment and treatment of adult patients with MDD with suicidal behavior under 65 years.ResultsScreening of adult patients under 65 years with MDD for suicide risk using both a validated assessment tool and clinical interview is recommended. An improved suicide risk stratification – incorporating both severity and temporality, or using a prevention-focused risk formulation – should be considered. For a patient with an MDD episode with low risk of suicide, use of antidepressant monotherapy, and psychotherapy in combination with pharmacological treatment are both recommended approaches. For a patient with an MDD episode with high risk of suicide, or imminent risk of suicide requiring rapid clinical response, or for a patient who had received adequate AD but still reported suicidal behavior, recommended treatment strategies include antidepressant augmentation, combination use of psychotherapy or electroconvulsive therapy with pharmacological treatment, and inpatient care. Suicide-specific psychosocial interventions are important for suicide prevention and should also be part of the management of patients with MDD with suicidal behavior.ConclusionsThere are still unmet needs in the assessment of suicide risk and availability of treatment options that can deliver rapid response in patients with MDD with suicidal behavior. These consensus recommendations on the management of adult patients with MDD with suicidal behavior under 65 years may serve as a useful guidance in diverse clinical practices across the SEA region. Clinical judgment based on careful consideration of individual circumstances of each patient remains key to determining the most appropriate treatment option.