Venous thromboembolism in medical outpatients – a cross-sectional survey of risk assessment and prophylaxis

2011 ◽  
Vol 105 (01) ◽  
pp. 190-196 ◽  
Author(s):  
Holger Lawall ◽  
Andreas Matthiessen ◽  
Volker Hohmann ◽  
Peter Bramlage ◽  
Sylvia Haas ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Medical Condition ◽  
Assessment Tools ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Limited Mobility ◽  
Substantial Risk ◽  
Medical Outpatients

SummaryThe degree of thromboprophylaxis in medical outpatients is low despite a substantial risk for venous thromboembolism (VTE). This may be attributable to difficulties in assessing risk. Assessment tools like the Haas’ scorecard aid in determining the need for thromboprophylaxis. We aimed at evaluating how the use of this tool may aid physicians in appropriately using anticoagulants. This was an epidemiological, cross-sectional survey of acute medically ill patients with limited mobility treated by general practitioners and internists. Risk assessment for VTE by the treating physician was compared to calculated risk. Of 8,123 patients evaluated between August 2006 and April 2008, 7,271 fulfilled the in- and exclusion criteria. Mean age was 69.4 ± 13.6 years, and 45.2% were male. Of these 82.8% were high risk based on their acute medical condition, 37.9% based on their underlying chronic condition. Immobilisation, heart failure, pneumonia, age, obesity, and major varicosis were the most frequently encountered risk factors. The agreement between the Haas’ scorecard and physician indicated risk was high. At least 94.1% of patients with high risk received adequate anticoagulation mostly as low molecular weight heparins for a mean duration of 15.1 ± 30.5 days. There is a substantial risk for VTE in medical out-patients. Using a simple structured scorecard resulted in an overall appropriate risk assessment and high degree of anticoagulation. The scorecard may provide a tool to improve the overall awareness for VTE risk in medical outpatients, substantially improving the degree of prophylaxis in a patient population with largely underestimated risk.

Comparison of IDRS and ADA Diabetes Risk Assessment Tools Reveals Different Rsk Score in Same Population: A Cross-Sectional Analysis in a Tertiary Care Hospital

2021 ◽  
Vol 5 (1) ◽  
pp. 10-18
Author(s):  
N. Akter ◽  
N.K. Qureshi
Keyword(s):  
Type 2 Diabetes ◽  
Risk Assessment ◽  
High Risk ◽  
Risk Score ◽  
Diabetes Risk ◽  
Assessment Tools ◽  
Cross Sectional ◽  
Risk Assessment Tools ◽  
Predicted Risk

Background: To identify individuals at high risk of developing type2 diabetes (T2DM), use of a validated risk-assessment tool is currently recommended. Nevertheless, recent studies have shown that risk scores that are developed in the same country can lead to different results of an individual. The Objective of study was to reveal whether two different risk-assessment tools predict similar or dissimilar high-risk score in same population. Method: This cross-sectional analytical study was carried upon 336 non-diabetic adults visiting the outpatient department (OPD) of Medicine, MARKS Medical College & Hospital, Bangladesh from October 2018 to March 2019. Woman having previous history of Gestational Diabetes Mellitus (GDM) were also included. Both the Indian Diabetes risk Score (IDRS) and the American Diabetes (ADA) Risk Score questionnaire were used to collect the data on demographic and clinical characteristics, different risk factors of an individual subject, and to calculate predicted risk score for developing T2DM. Results: Among 336 subjects, 53.6% were female. The mean (±SD) age of the study subjects was 38.25±1.12 years. The average IDRS predicted risk score of developing T2DM was more in female subjects than male [p<0.05]. Whereas the ADA predicted increased risk score of developing type 2 diabetes was more in male subjects than female (p<0.05). IDRS categorized 37.2 % of individuals at high risk for developing diabetes; [p=0.10], while the ADA risk tool categorized 20.2% subjects in high risk group; [p<0.001]. Conclusions: The results indicate that risk for developing type 2 diabetes varies considerably according to the scoring system used. To adequately prevent T2DM, risk scoring systems must be validated for each population considered.

scholarly journals Acute Kidney Injury Risk Assessment and the Nephrology Rapid Response Team

2016 ◽  
Vol 43 (1-3) ◽  
pp. 82-88 ◽  
Author(s):  
Lilia Maria Rizo-Topete ◽  
Mitchell H. Rosner ◽  
Claudio Ronco
Keyword(s):  
Risk Assessment ◽  
Acute Kidney Injury ◽  
High Risk ◽  
Medical Condition ◽  
Journal Club ◽  
Kidney Injury ◽  
Rapid Response Team ◽  
Rapid Response ◽  
Assessment Tools ◽  
Response Team

Acute kidney Injury (AKI) is a serious medical condition affecting more than 10 million people around the world annually and resulting in poor outcomes. It has been suggested that late recognition of the syndrome may lead to delayed interventions with increased morbidity and mortality. Early diagnosis and timely therapeutic strategies may be the cornerstone of future improvement in outcomes. The purpose of this article is to provide a practical model to identify patients at high risk for AKI in different environments, with the goal to prevent AKI. We describe the AKI Risk Assessment (ARA) as a proposed algorithm that systematically evaluates the patient in high-risk situations of AKI in a simple way no matter where the patient is located, and allows different medical specialists to approach patients as a team with a nephrologist to improve outcomes. The goal of the nephrology rapid response team (NRRT) is to prevent AKI or start treatment if AKI is already diagnosed as a consequence of progressive events that can lead to progressive deterioration of kidney tissues and eventual decline in renal function and to ensure appropriate follow-up of patients at risk for progressive chronic kidney disease after the episode of AKI. Prevention is the key to avoid mortality and morbidity associated with AKI. Integration of these assessment tools in a global methodology that includes a multi-disciplinary team (NRRT) is critical to success. Video Journal Club ‘Cappuccino with Claudio Ronco' at http://www.karger.com/?doi=452402.

Bleeding Risk Assessment in Patients with Venous Thromboembolism

2021 ◽  
Author(s):  
Stephan Nopp ◽  
Cihan Ay
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Major Bleeding ◽  
Initial Treatment ◽  
Bleeding Risk ◽  
Assessment Tools ◽  
Clinical Prediction

AbstractThe recommended treatment for patients with venous thromboembolism (VTE) is anticoagulation for at least 3 months. However, anticoagulant treatment increases the risk of bleeding, and patients at high risk for major bleeding might benefit from treatment discontinuation. In this review, we discuss strategies for assessing bleeding risk and compare different bleeding risk tools. Bleeding risk assessment is best viewed as a continuous approach with varying challenges throughout the acute and chronic phase. At diagnosis, bleeding risk factors must be identified and reversible risk factors treated or modified. After initial treatment, repeated bleeding risk assessment is crucial for the decision on extended/long-term anticoagulation. Current clinical prediction models (e.g., HAS-BLED, RIETE, or VTE-BLEED scores) are externally validated tools with relevant differences in specificity and sensitivity, which can aid in clinical decision-making. Unfortunately, none of the current bleeding risk assessment tools has been investigated in clinical trials and provides evidence to withhold anticoagulation treatment based on the score. Nevertheless, the HAS-BLED or RIETE score can be used to identify patients at high risk for major bleeding during the initial treatment phase, while the VTE-BLEED score might be used to identify patients at low risk for bleeding and, therefore, to safely administer extended/long-term anticoagulation for secondary thromboprophylaxis. As clinical prediction scores still lack predictive value, future research should focus on developing biomarker-based risk assessment models.

scholarly journals Different type 2 diabetes risk assessments predict dissimilar numbers at risk: a cross-sectional analysis of diabetes risk-assessment tools

2020 ◽  
Vol 10 (3) ◽  
pp. 159-167
Author(s):  
Nazma Akter
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Score ◽  
Diabetes Risk ◽  
Assessment Tools ◽  
Cross Sectional ◽  
Type2 Diabetes ◽  
Risk Assessment Tools ◽  
Sectional Analysis ◽  
Diabetes Risk Score

Background: Use of a validated risk-assessment tool to identify individuals at high risk of developing type2 diabetes is currently recommended. It is under-reported, however, whether a different risk tool alters the predicted risk of an individual. This study explored any differences between two commonly used validated risk-assessment tools for type2 diabetes. Methods: This is a cross-sectional study conducted between July 2018 and June 2019 in the medicine outpatient department of a tertiary care hospital in Dhaka, Bangladesh. Total 518 subjects, aged ranging from 22 to 68 years was included in the study. Randomly sampled non- diabetic subjects, and those who had previous history of high blood glucose during pregnancy or other health examination (i.e. impaired fasting glucose, impaired glucose tolerance or gestational diabetes mellitus) were included for the study. With written informed consent, both the Indian Diabetes Risk Score (IDRS) and the Finnish Diabetes Risk Score (FINDRISC) questionnaire were used to collect the data including demographic characteristics and different risk factors of an individual subject, and to calculate total risk score for predictors the risk of developing T2DM within 10 years. Results: Among 518 subjects, 48.1% were male and 51.9% were female. Differences between the risk-assessment tools were apparent following cross-sectional analysis of individuals. IDRS (Indian Diabetes Risk Score) categorized 37.8 % (male vs. female: 14.8 % vs. 23.0%) of individuals at high risk. Whereas, 8.3% (male vs. female: 1.9% vs. 6.4%) were at high risk according to FINDRISC (Finish Diabetes Risk Score) system. Conclusions: The results indicate that the prevalence of participants at risk for developing type 2 diabetes varies considerably according to the scoring system used. To adequately prevent type2 diabetes, risk scoring systems must be validated for each population considered. Birdem Med J 2020; 10(3): 159-167

Suicide risk assessment in a large public mental health service: do suicide risk classifications identify those at risk?

2021 ◽  
pp. 103985622098403
Author(s):  
Marianne Wyder ◽  
Manaan Kar Ray ◽  
Samara Russell ◽  
Kieran Kinsella ◽  
David Crompton ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Risk Assessment ◽  
High Risk ◽  
Suicide Risk ◽  
Public Mental Health ◽  
Assessment Tools ◽  
Suicide Risk Assessment ◽  
Public Mental Health Service ◽  
Risk Assessment Tools

Introduction: Risk assessment tools are routinely used to identify patients at high risk. There is increasing evidence that these tools may not be sufficiently accurate to determine the risk of suicide of people, particularly those being treated in community mental health settings. Methods: An outcome analysis for case serials of people who died by suicide between January 2014 and December 2016 and had contact with a public mental health service within 31 days prior to their death. Results: Of the 68 people who had contact, 70.5% had a formal risk assessment. Seventy-five per cent were classified as low risk of suicide. None were identified as being at high risk. While individual risk factors were identified, these did not allow to differentiate between patients classified as low or medium. Discussion: Risk categorisation contributes little to patient safety. Given the dynamic nature of suicide risk, a risk assessment should focus on modifiable risk factors and safety planning rather than risk prediction. Conclusion: The prediction value of suicide risk assessment tools is limited. The risk classifications of high, medium or low could become the basis of denying necessary treatment to many and delivering unnecessary treatment to some and should not be used for care allocation.

scholarly journals Translation and validation of Training Needs Analysis Questionnaire among reproductive, maternal and newborn health workers in Tanzania

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tumbwene Mwansisya ◽  
Columba Mbekenga ◽  
Kahabi Isangula ◽  
Loveluck Mwasha ◽  
Eunice Pallangyo ◽  
...  
Keyword(s):  
Healthcare Workers ◽  
Professional Training ◽  
Health Workers ◽  
Newborn Health ◽  
Training Needs ◽  
Assessment Tools ◽  
Needs Analysis ◽  
Maternal And Newborn Health ◽  
Cross Sectional Survey ◽  
Cross Sectional

Abstract Background Continuous professional development (CPD) has been reported to enhance healthcare workers’ knowledge and skills, improve retention and recruitment, improve the quality of patient care, and reduce patient mortality. Therefore, validated training needs assessment tools are important to facilitate the design of effective CPD programs. Methods A cross-sectional survey was conducted using self-administered questionnaires. Participants were healthcare workers in reproductive, maternal, and neonatal health (RMNH) from seven hospitals, 12 health centers, and 17 dispensaries in eight districts of Mwanza Region, Tanzania. The training needs analysis (TNA) tool that was used for data collection was adapted and translated into Kiswahili from English version of the Hennessy-Hicks’ Training Need Analysis Questionnaire (TNAQ). Results In total, 153 healthcare workers participated in this study. Most participants were female 83 % (n = 127), and 76 % (n = 115) were nurses. The average age was 39 years, and the mean duration working in RMNH was 7.9 years. The reliability of the adapted TNAQ was 0.954. Assessment of construct validity indicated that the comparative fit index was equal to 1. Conclusions The adapted TNAQ appears to be reliable and valid for identifying professional training needs among healthcare workers in RMNH settings in Mwanza Region, Tanzania. Further studies with larger sample sizes are needed to test the use of the TNAQ in broader healthcare systems and settings.

scholarly journals Rates of violence in patients classified as high risk by structured risk assessment instruments

2014 ◽  
Vol 204 (3) ◽  
pp. 180-187 ◽  
Author(s):  
Jay P. Singh ◽  
Seena Fazel ◽  
Ralitza Gueorguieva ◽  
Alec Buchanan
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Risk Groups ◽  
Evidence Base ◽  
Assessment Tools ◽  
Current Evidence ◽  
Assessment Instruments ◽  
Individual Liberty ◽  
Current Evidence Base ◽  
Study Heterogeneity

BackgroundRates of violence in persons identified as high risk by structured risk assessment instruments (SRAIs) are uncertain and frequently unreported by validation studies.AimsTo analyse the variation in rates of violence in individuals identified as high risk by SRAIs.MethodA systematic search of databases (1995–2011) was conducted for studies on nine widely used assessment tools. Where violence rates in high-risk groups were not published, these were requested from study authors. Rate information was extracted, and binomial logistic regression was used to study heterogeneity.ResultsInformation was collected on 13 045 participants in 57 samples from 47 independent studies. Annualised rates of violence in individuals classified as high risk varied both across and within instruments. Rates were elevated when population rates of violence were higher, when a structured professional judgement instrument was used and when there was a lower proportion of men in a study.ConclusionsAfter controlling for time at risk, the rate of violence in individuals classified as high risk by SRAIs shows substantial variation. In the absence of information on local base rates, assigning predetermined probabilities to future violence risk on the basis of a structured risk assessment is not supported by the current evidence base. This underscores the need for caution when such risk estimates are used to influence decisions related to individual liberty and public safety.

PSIII-2 Effect of Piglet Characteristics on Blood Glucose Levels at Birth

2021 ◽  
Vol 99 (Supplement_1) ◽  
pp. 154-155
Author(s):  
Rafael Ovidio Bautista Rivas ◽  
Naomi C Willard ◽  
Katherine D Vande Pol ◽  
Jenny R Morris ◽  
Alicia Olivo Espinal ◽  
...  
Keyword(s):  
Blood Glucose ◽  
Birth Weight ◽  
Birth Order ◽  
Experimental Unit ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Blood Samples ◽  
Limited Mobility ◽  
Glucose Levels ◽  
Blood Glucose Levels

Abstract Blood glucose levels in piglets at birth are potentially associated with survival, however, there has been limited research to quantify these and to establish any associations with piglet characteristics. This study, which evaluated the effects of a number of piglet characteristics on blood glucose levels at birth, was conducted as a cross-sectional survey involving 32 litters. Litter was the experimental unit; piglet was a sub-sample of litter. At birth, piglets were weighed and assigned a vitality score [1 = high vitality; 2 = low vitality (limited mobility and/or respiration)]. Piglets were then dried with a cellulose-based desiccant, and blood samples were collected from half of the piglets in each litter with a vitality score of 1 (n = 226) and all piglets with a vitality score of 2 (n = 7). Samples (1.2 μL) were collected from the vena subcutanea abdominis; blood glucose was measured using a glucometer (Accuchek Aviva; Roche Diabetes Care, Inc., Indianapolis, IN). Effects of piglet characteristics and relationships with blood glucose levels were analyzed using PROC MIXED, PROC GLIMMIX, and PROC REG of SAS, as appropriate. There were no effects (P &gt; 0.05) of piglet birth weight or gender on blood glucose levels. Piglets with a vitality score of 2 had higher (P &lt; 0.05) blood glucose levels than those with a score of 1. Blood glucose levels increased linearly (P &lt; 0.05) with birth order (0.8 mg/dL for each piglet increase). In conclusion, blood glucose levels at birth were higher for piglets with low compared to high vitality and for those born later in the birth order. Further research is needed to establish relationships between blood glucose levels in piglets at birth and subsequent survival.

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