scholarly journals Predictive validity of the Short-Term Assessment of Risk and Treatability (START) for multiple adverse outcomes: The effect of diagnosis

2017 ◽  
Vol 256 ◽  
pp. 435-443 ◽  
Author(s):  
Rebecca Marriott ◽  
Laura E. O'Shea ◽  
Marco M. Picchioni ◽  
Geoffrey L. Dickens
Keyword(s):  
Predictive Validity ◽  
Adverse Outcomes ◽  
Short Term

scholarly journals Prospective Field Validation of the START:AV in a Dutch Secure Youth Care Sample

Assessment ◽  
2021 ◽  
pp. 107319112110632
Author(s):  
Tamara L. F. De Beuf ◽  
Vivienne de Vogel ◽  
Nick J. Broers ◽  
Corine de Ruiter
Keyword(s):  
Predictive Validity ◽  
Physical Aggression ◽  
Youth Care ◽  
Adverse Outcomes ◽  
Assessment Instrument ◽  
Short Term ◽  
Lifetime History ◽  
Risk Assessment Instrument ◽  
Risk Judgments

The Short-Term Assessment of Risk and Treatability: Adolescent Version (START:AV) is a risk assessment instrument for adolescents that estimates the risk of multiple adverse outcomes. Prior research into its predictive validity is limited to a handful of studies conducted with the START:AV pilot version and often by the instrument’s developers. The present study examines the START:AV’s field validity in a secure youth care sample in the Netherlands. Using a prospective design, we investigated whether the total scores, lifetime history, and the final risk judgments of 106 START:AVs predicted inpatient incidents during a 4-month follow-up. Final risk judgments and lifetime history predicted multiple adverse outcomes, including physical aggression, institutional violations, substance use, self-injury, and victimization. The predictive validity of the total scores was significant only for physical aggression and institutional violations. Hence, the short-term predictive validity of the START:AV for inpatient incidents in a residential youth care setting was partially demonstrated and the START:AV final risk judgments can be used to guide treatment planning and decision-making regarding furlough or discharge in this setting.

Prevalence, Risk Factors, and Short-Term Outcomes of Full-Term Low Birth Weight Infants Born at a Tertiary Academic Center: A Prospective Case–Control Study

2021 ◽  
Author(s):  
Heidi K. Al-Wassia ◽  
Shahd K. Baarimah ◽  
Asmaa H. Mohammedsaleh ◽  
Manal O. Alsulami ◽  
Ragad S. Abbas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Case Control Study ◽  
Case Control ◽  
Adverse Outcomes ◽  
Chromosomal Anomalies ◽  
Short Term ◽  
Term Infants ◽  
Control Study

Objective Low birth weight (LBW) infants (<2,500 g) continued to be a global health problem because of the associated short- and long-term adverse outcomes. The study aimed to determine the prevalence, risk factors, and short-term outcomes of term LBW infants Study Design A prospective and case–control study. All infants born consecutively from September 1, 2018 to August 31, 2019 were included. Cases, term LBW infants, were 1:1 matched to controls, appropriate for gestational age (AGA) term infants. Major congenital or chromosomal anomalies and multiple pregnancies were excluded. Results The prevalence of term LBW in the studied period was 4.8%. Mothers of term LBW infants had significantly lower body mass index (p = 0.05), gained less weight (p = 0.01), had a history of previous LBW (p = 0.01), and lower monthly income (p = 0.04) compared with mothers of term AGA infants even after adjustment for confounders. A nonsignificant higher number of term LBW infants needed NICU admission, while their need for phototherapy was deemed significant. Conclusion We identified nutritional and socioeconomic maternal factors that are significantly associated with LBW infants and should be targeted during antenatal visits to improve neonatal outcomes. Key Points

scholarly journals SPMSQ for risk stratification of older patients in the emergency department

2019 ◽  
Vol 52 (S4) ◽  
pp. 222-228 ◽  
Author(s):  
A. Schönstein ◽  
H.-W. Wahl ◽  
H. A. Katus ◽  
A. Bahrmann
Keyword(s):  
Emergency Department ◽  
Nursing Home ◽  
Risk Stratification ◽  
Predictive Validity ◽  
Older Patients ◽  
Area Under The Curve ◽  
Composite Endpoint ◽  
Adverse Outcomes ◽  
Nursing Home Admission ◽  
Initial Contact

Abstract Background Risk stratification of older patients in the emergency department (ED) is seen as a promising and efficient solution for handling the increase in demand for geriatric emergency medicine. Previously, the predictive validity of commonly used tools for risk stratification, such as the identification of seniors at risk (ISAR), have found only limited evidence in German geriatric patient samples. Given that the adverse outcomes in question, such as rehospitalization, nursing home admission and mortality, are substantially associated with cognitive impairment, the potential of the short portable mental status questionnaire (SPMSQ) as a tool for risk stratification of older ED patients was investigated. Objective To estimate the predictive validity of the SPMSQ for a composite endpoint of adverse events (e.g. rehospitalization, nursing home admission and mortality). Method This was a prospective cohort study with 260 patients aged 70 years and above, recruited in a cardiology ED. Patients with a likely life-expectancy below 24 h were excluded. Follow-up examinations were conducted at 1, 3, 6 and 12 month(s) after recruitment. Results The SPMSQ was found to be a significant predictor of adverse outcomes not at 1 month (area under the curve, AUC 0.55, 95% confidence interval, CI 0.46–0.63) but at 3 months (AUC 0.61, 95% CI 0.54–0.68), 6 months (AUC 0.63, 95% CI 0.56–0.70) and 12 months (AUC 0.63, 95% CI 0.56–0.70) after initial contact. Conclusion For longer periods of observation the SPMSQ can be a predictor of a composite endpoint of adverse outcomes even when controlled for a range of confounders. Its characteristics, specifically the low sensitivity, make it unsuitable as an accurate risk stratification tool on its own.

scholarly journals Persistent inflammation worsens short-term outcomes in massive stroke patients

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Duanlu Hou ◽  
Chunjie Wang ◽  
Xiaofei Ye ◽  
Ping Zhong ◽  
Danhong Wu
Keyword(s):  
Blood Glucose ◽  
Pulmonary Infection ◽  
Laboratory Data ◽  
Adverse Outcomes ◽  
Imaging Data ◽  
Stroke Patients ◽  
Short Term ◽  
Glucose Levels ◽  
Logistic Analysis ◽  
Persistent Inflammation

Abstract Background Persistent inflammation is an important driver of disease progression and affects prognosis. Some indicators of inflammation predict short-term outcomes. The relationship between prognosis, especially mortality, and persistent inflammation in massive stroke has not been studied, and this has been the subject of our research. Methods From April 1, 2017 to February 1, 2020, consecutive patients were prospectively enrolled. Clinical data, laboratory data, imaging data and follow-up infections morbidity were compared between 2 groups according to modified Rankin scale (mRS) scores (mRS < 3 and ≥ 3) at 1 month. The binomial logistic analysis was used to determine independent factors of 1-month prognosis. Short-term functional outcome, mortality and infection rates in massive stroke with and without persistent inflammation were compared. Results One hundred thirty-nine patients with massive stroke were included from 800 patients. We found that admission blood glucose levels (p = 0.005), proportions of cerebral hemispheric (p = 0.001), posterior circulatory (p = 0.035), and lacunar (p = 0.022) ischemia were higher in poor outcome patients; neutrophil-to-lymphocyte ratio (odd ratio = 1.87, 95%CI 1.14–3.07, p = 0.013) and blood glucose concentrations (odd ratio = 1.34, 95%CI 1.01–1.79, p = 0.043) can independently predict the short-term prognosis in massive stroke patients. We also found that the incidence of pulmonary infection (p = 0.009), one-month mortality (p = 0.003) and adverse outcomes (p = 0.0005) were higher in patients with persistent inflammation. Conclusions This study suggested that persistent inflammation is associated with poor prognosis, 1-month mortality and the occurrence of in-hospital pulmonary infection and that higher baseline inflammation level predicts short-term poor outcomes in massive stroke.

Abstract 3248: Is It Safe to Train Residents to Perform Cardiac Surgery? Intermediate Term Follow-up

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Billie Jean Martin ◽  
Dimitri Kalavrouziotis ◽  
Roger Baskett
Keyword(s):  
Cardiac Surgery ◽  
Hospital Mortality ◽  
Proportional Hazards ◽  
Artery Bypass ◽  
Cox Proportional Hazards ◽  
Adverse Outcomes ◽  
Short Term ◽  
Term Outcome ◽  
Teaching Case ◽  
Teaching Cases

Introduction While there are rigourous assessments made of trainees’ knowledge through formal examinations, objective assessments of technical skills are not available. Little is known about the safety of allowing resident trainees to perform cardiac surgical operations. Methods Peri-operative date was prospectively collected on all patients who underwent coronary artery bypass grafting (CABG), aortic valve replacement (AVR) or a combined procedure between 1998 and 2005. Teaching-cases were identified by resident records and defined as cases which the resident performed skin to skin. Pre-operative characteristics were compared between teaching and non-teaching cases. Short-term adverse events were defined as a composite of: in-hospital mortality, stroke, intra- or post-operative intra-aortic balloon pump (IABP) insertion, myocardial infarction, renal failure, wound infection, sepsis or return to the operating room. Intermediate adverse outcomes were defined as hospital readmission for any cardiac disease or late mortality. Logistic regression and Cox proportional hazard models were used to adjust for differences in age, acuity, and medical co-morbidities. Outcomes were compared between teaching and non-teaching cases. Results 6929 cases were included, 895 of which were identified as teaching-cases. Teaching-cases were more likely to have an EF<40%, pre-operative IABP, CHF, combined CABG/AVRs or total arterial grafting cases (all p<0.01). However, a case being a teaching-case was not a predictor of in-hospital mortality (OR=1.02, 95%CI 0.67–1.55) or the composite short-term outcome (OR=0.97, 95%CI 0.75–1.24). The Kaplan-Meier event-free survival of staff and teaching-cases was equivalent at 1, 3, and 5 years: 80% vs. 78%, 67% vs. 66%, and 58% vs. 55% (log-rank p=0.06). Cox proportional hazards regression modeling did not demonstrate teaching-case to be a predictor of late death or re-hospitalization (HR=1.05, 95%CI 0.94 –1.18). Conclusions Teaching-cases were more likely to have greater acuity and complexity than non-teaching cases. Despite this, teaching cases did no worse than staff cases in the short or intermediate term. Allowing residents to perform cardiac surgery does not appear to adversely affect patient outcomes.

A Comparative Study of Short-Term Blood Pressure Variability in Hemodialysis Patients with and without Intradialytic Hypertension

2018 ◽  
Vol 48 (4) ◽  
pp. 295-305 ◽  
Author(s):  
Athanasios Bikos ◽  
Elena Angeloudi ◽  
Evangelos Memmos ◽  
Charalampos Loutradis ◽  
Antonios Karpetas ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Risk ◽  
Blood Pressure Variability ◽  
Hemodialysis Patients ◽  
Adverse Outcomes ◽  
Short Term ◽  
Ambulatory Bp Monitoring ◽  
Average Real Variability ◽  
Regular Hemodialysis ◽  
Sustained Increase

Background: Short-term blood pressure (BP) variability (BPV) is associated with increased cardiovascular risk in hemodialysis. Patients with intradialytic hypertension have high risk of adverse outcomes. Whether BPV is increased in these patients is not clear. The purpose of this study was to compare short-term BPV in patients with and without intradialytic hypertension. Methods: Forty-one patients with and 82 patients without intradialytic hypertension (intradialytic SBP rise ≥10 mm Hg to > 150 mm Hg) matched in a 1: 2 ratio for age, sex, and hemodialysis vintage were included. All subjects underwent 48-h ambulatory BP monitoring during a regular hemodialysis and the subsequent interdialytic interval. Brachial and aortic BPV were calculated with validated formulas and compared between the 2 groups during the 48-h and the 44-h periods and during the 2 daytime and nighttime periods respectively. Results: During 48-h or 44-h periods and daytime or nighttime, brachial SBP/DBP and aortic SBP/DBP were significantly higher in cases than in controls. All brachial SBP/DBP BPV indexes [SD, weighted SD (wSD), coefficient-of-variation (CV) and average-real-variability (ARV)] were not significantly different between groups during the 48- or 44-h periods (48-h: SBP-ARV 11.59 ± 3.05 vs. 11.70 ± 2.68, p = 0.844, DBP-ARV: 8.60 ± 1.90 vs. 8.90 ± 1.63, p = 0.357). Analysis stratified by day or night between days 1 and 2 revealed, in general, similar results. No significant differences in dipping pattern were observed between groups. Analysis of aortic BPV had similar findings. Conclusions: BPV is similar between those with and without intradialytic hypertension. However, those with intradialytic hypertension have a sustained increase in systolic and diastolic BP during the entire interdialytic interval.

Abstract 13: Patient-reported Health Status Changes are Associated With Subsequent Clinical Outcomes After Transcatheter Valve Therapies: Insights From the Sts/tvt Registry

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Vittal Hejjaji ◽  
Zhuokai Li ◽  
David J Cohen ◽  
John Carroll ◽  
Sreekanth Vemulapalli ◽  
...  
Keyword(s):  
Health Status ◽  
Clinical Outcomes ◽  
Lower Risk ◽  
Adverse Outcomes ◽  
Short Term ◽  
Patient Factors ◽  
Risk Of Death ◽  
Patient Reported ◽  
Reported Health ◽  
Procedure Type

Background: The goals of TAVR and transcatheter mitral valve repair (TMVr) are to prolong survival, reduce heart failure (HF) hospitalizations, and improve health status. Most patients report large improvements in health status within 30 days of these procedures. While this is an important patient-centered outcome on its own, if these changes were also associated with subsequent clinical outcomes, this would further support using short-term health status as a quality metric for valve procedures. Methods: Among patients who underwent transfemoral TAVR or TMVr, had KCCQ data at baseline and 30 days, and could be linked to CMS for 1-year outcomes; we constructed sequential models examining the association of KCCQ with death and HF hospitalization from 30 days to 1 year: 1) baseline KCCQ, 2) 30-day KCCQ, 3) baseline and 30-day KCCQ, 4) change in KCCQ from baseline to 30 days. In each model, we tested the interaction between procedure type and KCCQ, examined the linearity of the association of KCCQ with outcomes using restricted cubic splines, and adjusted for patient factors (Figure footnote). Results: Our cohort included 73,699 patients who underwent TAVR or TMVr from 2011-18 (median age 83 [IQR 77-87], 53% men, 92% TAVR). There were no significant interactions between procedure type and KCCQ, so all analyses used the combined cohort. Higher baseline KCCQ (model 1) and 30-day KCCQ (model 2) were both strongly associated with lower risk of death and HF hospitalization (Figure). When both were included in the model (model 3), each assessment was independently associated with subsequent outcomes, with the 30-day being most predictive. Change from baseline to 30 days was nonlinearly associated with outcomes (model 4), with increases up to 25 points associated with lower risk of death or HF hospitalization but no further risk reduction beyond 25 points. There were no meaningful changes in the associations after adjusting for patient factors. Conclusion: Short-term improvements in patient-reported health status after TAVR or TMVr were strongly associated with lower risk of death or HF hospitalization, with the 30-day assessment having a stronger association than baseline. These results support the routine use of 30-day KCCQ as a potential measure of quality after TVTs and to identify those at higher risk for adverse outcomes.

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