Development of a Novel Preoperative Venous Thromboembolism Risk Assessment Model

2020 ◽  
Vol 86 (9) ◽  
pp. 1098-1105
Author(s):  
Eli Mlaver ◽  
Grant C. Lynde ◽  
Claire Gallion ◽  
John F. Sweeney ◽  
Jyotirmay Sharma
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Data Entry ◽  
Predictive Ability ◽  
Clinical Decision ◽  
Assessment Model ◽  
Data Set ◽  
Improvement Project ◽  
Risk Assessment Models ◽  
American Society

Introduction Standardization of preoperative venous thromboembolism (VTE) risk assessment remains challenging due to variation in risk assessment models (RAMs) and the cumbersome workflow addition that most RAMs represent. We aimed to develop a parsimonious RAM that is automatable and actionable within the preoperative workflow. Methods We performed a case-controlled review of all 18 VTE cases reported over a 12-month period and 171 matched controls included in an institutional National Surgical Quality Improvement Project (NSQIP) data set. We examined the predictive value of the Caprini, Padua, and NSQIP RAMs. We identified the 5 most impactful risk factors in VTE development by contribution to the known RAMs. We compared the predictive ability of cancer, age, body mass index, black race, and American Society of Anesthesiologists Physical Status (ASA-PS) score, to the Caprini, Padua, and NSQIP RAMs for VTE outcomes. Finally, we evaluated concordance between each of the models. Results The Caprini Score was found to be 88.9% sensitive and 32.7% specific using a threshold of 5. The Padua score was found to be 61.1% sensitive and 47.4% specific using a threshold of 4. The novel 5-factor RAM was found to be 94.4% sensitive and 38.0% specific using a threshold of 4. The Caprini and Padua models were discordant in 26% of patients. Discussion Cumbersome manual data entry contributes to the ongoing challenge of standardized VTE risk assessment and prophylaxis. Universally documented information and patient demographics can be utilized to create clinical decision support tools that can improve the efficiency of perioperative workflow and improve the quality of care.

scholarly journals Credit Risk Assessment Models of Retail Microfinancing: The Case of a Malaysian National Savings Bank’s Branch

2020 ◽  
Vol 11 (3) ◽  
pp. 73
Author(s):  
Mazni Asrida Abdullah ◽  
Azlina Ahmad ◽  
Nor Azam Mat Nayan ◽  
Zubir Azhar ◽  
Abd-Razak Ahmad
Keyword(s):  
Risk Assessment ◽  
Default Risk ◽  
Credit Rating ◽  
Predictive Ability ◽  
Assessment Model ◽  
Accuracy Rate ◽  
Credit Score ◽  
Factors Associated ◽  
Risk Assessment Models ◽  
New Information

Internal ratings have been used by banks to evaluate the creditworthiness of their borrowers with diverse practices. This research aims to analyse the practice of assessing (or predicting) the credit performance of microfinancing loans of a Malaysian bank and to suggest how the existing performance of credit assessment model can be improved. Logistic regression was used to investigate the predictive ability of information on business operators’ management and accounting skills as factors to predict default risk of borrowers. The combination of these information formed the three (3) models that were used in the analysis. The accuracy rate of each model was then measured. A sample of respondents was selected among microfinance borrowers in a national savings bank’s branch in Malaysia. A total of 106 questionnaires were used for data analysis. The findings suggest that good credit rating, business experience, business financial and forecasting capability are factors associated with whether SMEs will default or not in their payments. The combination of credit score used currently by the bank and the new information produced by this research increases the bank’s ability to predict default.

scholarly journals The Application of Current Proposed Venous Thromboembolism Risk Assessment Model for Ambulatory Patients With Cancer

2017 ◽  
Vol 24 (3) ◽  
pp. 429-433 ◽  
Author(s):  
Hikmat Abdel-Razeq ◽  
Asem Mansour ◽  
Salwa S. Saadeh ◽  
Mahmoud Abu-Nasser ◽  
Mohammad Makoseh ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Stage Iv ◽  
Assessment Model ◽  
Risk Scores ◽  
Patients With Cancer ◽  
Risk Assessment Models ◽  
Ambulatory Patients ◽  
Treatment Paradigm ◽  
Outpatient Settings

Venous thromboembolism (VTE) is a commonly encountered problem in patients with cancer. In recent years, cancer treatment paradigm has shifted with most therapy offered in ambulatory outpatient settings. Excess of half VTEs in patients with cancer occur in outpatient settings without prior hospitalization, where current practice guidelines do not recommend routine prophylaxis. Risk assessment models (RAMs) for VTE in such patients were recently introduced. This study aims to assess the practical application of one of these models in clinical practice. Medical records and hospital electronic database were searched for patients with cancer having VTE. Known risk factors were collected, and risk assessment was done using the Khorana RAM. Over a 10-year period, 346 patients developed VTE in ambulatory settings. Median age was 57 and 59.0% were females. Lower extremities were involved in 196 (56.6%), while 96 (27.7%) had pulmonary embolism. Most (76.6%) patients had stage IV disease, only 9.0% had stage I or II disease. Only 156 (45.1%) patients were on active chemotherapy, for whom Khorana risk assessment score was calculated. In these patients, high risk was identified in 31 (19.9%) patients, while 81 (51.9%) had intermediate risk and 44 (28.2%) had low risk. No patients were on prophylaxis prior to VTE. Most ambulatory patients with cancer who developed VTE were not on chemotherapy, and many of those who were on active treatment had low Khorana risk scores. This illustrates the need to modify the model or develop a new one that takes into consideration this group of patients.

Risk assessment model for venous thromboembolism in hospitalized surgical and non-surgical patients in the 4th Hungarian Antithrombotic Guidelines entitled “Diminution and Treatment of Venous Thromboembolism”

2010 ◽  
Vol 151 (34) ◽  
pp. 1365-1374 ◽  
Author(s):  
Marianna Dávid ◽  
Hajna Losonczy ◽  
Miklós Udvardy ◽  
Zoltán Boda ◽  
György Blaskó ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Assessment Model ◽  
Surgical Patients ◽  
Risk Assessment Model

A kórházban kezelt sebészeti és belgyógyászati betegekben jelentős a vénásthromboembolia-rizikó. Profilaxis nélkül, a műtét típusától függően, a sebészeti beavatkozások kapcsán a betegek 15–60%-ában alakul ki mélyvénás trombózis vagy tüdőembólia, és az utóbbi ma is vezető kórházi halálok. Bár a vénás thromboemboliát leggyakrabban a közelmúltban végzett műtéttel vagy traumával hozzák kapcsolatba, a szimptómás thromboemboliás események 50–70%-a és a fatális tüdőembóliák 70–80%-a nem a sebészeti betegekben alakul ki. Nemzetközi és hazai felmérések alapján a nagy kockázattal rendelkező sebészeti betegek többsége megkapja a szükséges trombózisprofilaxist. Azonban profilaxis nélkül marad a rizikóval rendelkező belgyógyászati betegek jelentős része, a konszenzuson alapuló nemzetközi és hazai irányelvi ajánlások ellenére. A belgyógyászati betegek körében növelni kell a profilaxisban részesülők arányát és el kell érni, hogy trombózisrizikó esetén a betegek megkapják a hatásos megelőzést. A beteg trombóziskockázatának felmérése fontos eszköze a vénás thromboembolia által veszélyeztetett betegek felderítésének, megkönnyíti a döntést a profilaxis elrendeléséről és javítja az irányelvi ajánlások betartását. A trombózisveszély megállapításakor, ha nem ellenjavallt, profilaxist kell alkalmazni. „A thromboemboliák kockázatának csökkentése és kezelése” című, 4. magyar antithromboticus irányelv felhívja a figyelmet a vénástrombózis-rizikó felmérésének szükségességére, és elsőként tartalmazza a kórházban fekvő belgyógyászati és sebészeti betegek kockázati kérdőívét. Ismertetjük a kockázatbecslő kérdőíveket és áttekintjük a kérdőívekben szereplő rizikófaktorokra vonatkozó bizonyítékokon alapuló adatokat.

scholarly journals Prevention of venous thromboembolism in cancer patients: current approaches and opportunities for improvement

2011 ◽  
pp. 191-204
Author(s):  
Alpesh N. Amin ◽  
Steven B. Deitelzweig
Keyword(s):  
At Risk ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Assessment Model ◽  
Major Surgery ◽  
Medical Illness ◽  
Patients With Cancer ◽  
Increased Risk ◽  
National Quality ◽  
American Society

Venous thromboembolism (VTE), a common complication in patients with cancer, is associated with increased risk of morbidity, mortality, and recurrent VTE. Risk factors for VTE in cancer patients include the type and stage of cancer, comorbidities, age, major surgery, and active chemotherapy. Evidence-based guidelines for thromboprophylaxis in cancer patients have been published: the National Comprehensive Cancer Network and American Society for Clinical Oncology guidelines recommend thromboprophylaxis for hospitalized cancer patients, while the American College of Chest Physician guidelines recommend thromboprophylaxis for surgical patients with cancer and bedridden cancer patients with an acute medical illness. Guidelines do not generally recommend routine thromboprophylaxis in ambulatory patients during chemotherapy, but there is evidence that some of these patients are at risk of VTE; some may be at higher risk while on active chemotherapy. Approaches are needed to identify those patients most likely to benefit from thromboprophylaxis, and, to this end, a risk assessment model has been developed and validated. Despite the benefits, many at-risk patients do not receive any thromboprophylaxis, or receive prophylaxis that is not compliant with guideline recommendations. Quality improvement initiatives have been developed by the Centers for Medicare and Medicaid Services, National Quality Forum, and Joint Commission to encourage closure of the gap between guideline recommendations and clinical practice for prevention, diagnosis, and treatment of VTE in hospitalized patients. Health-care institutions and providers need to take seriously the burden of VTE, improve prophylaxis rates in patients with cancer, and address the need for prophylaxis across the patient continuum.

scholarly journals Prevention of venous thromboembolism in cancer patients: current approaches and opportunities for improvement

2011 ◽  
Vol 5 (3) ◽  
pp. 191
Author(s):  
Alpesh N. Amin ◽  
Steven B. Deitelzweig
Keyword(s):  
At Risk ◽  
Venous Thromboembolism ◽  
Cancer Patients ◽  
Assessment Model ◽  
Major Surgery ◽  
Medical Illness ◽  
Patients With Cancer ◽  
Increased Risk ◽  
National Quality ◽  
American Society

Venous thromboembolism (VTE), a common complication in patients with cancer, is associated with increased risk of morbidity, mortality, and recurrent VTE. Risk factors for VTE in cancer patients include the type and stage of cancer, comorbidities, age, major surgery, and active chemotherapy. Evidence-based guidelines for thromboprophylaxis in cancer patients have been published: the National Comprehensive Cancer Network and American Society for Clinical Oncology guidelines recommend thromboprophylaxis for hospitalized cancer patients, while the American College of Chest Physician guidelines recommend thromboprophylaxis for surgical patients with cancer and bedridden cancer patients with an acute medical illness. Guidelines do not generally recommend routine thromboprophylaxis in ambulatory patients during chemotherapy, but there is evidence that some of these patients are at risk of VTE; some may be at higher risk while on active chemotherapy. Approaches are needed to identify those patients most likely to benefit from thromboprophylaxis, and, to this end, a risk assessment model has been developed and validated. Despite the benefits, many at-risk patients do not receive any thromboprophylaxis, or receive prophylaxis that is not compliant with guideline recommendations. Quality improvement initiatives have been developed by the Centers for Medicare and Medicaid Services, National Quality Forum, and Joint Commission to encourage closure of the gap between guideline recommendations and clinical practice for prevention, diagnosis, and treatment of VTE in hospitalized patients. Health-care institutions and providers need to take seriously the burden of VTE, improve prophylaxis rates in patients with cancer, and address the need for prophylaxis across the patient continuum.

Leveraging HCA Results in an Advanced Pipeline Risk Assessment Model

2014 ◽  
Author(s):  
Otto Huisman ◽  
Ricardo Almandoz ◽  
Thomas Schuster ◽  
Adriana Andrade Caballero ◽  
Leonardo Martinez Forero
Keyword(s):  
Risk Assessment ◽  
American Petroleum Institute ◽  
Assessment Model ◽  
Mitigation Measures ◽  
South American ◽  
Risk Assessment Model ◽  
Industry Standards ◽  
Management Approaches ◽  
American Society ◽  
The Impact

Pipeline risk analysis is a common step carried out by operators in their overall Pipeline Integrity Management Process. There is a growing realization among operators of the need to adopt more proactive risk management approaches. This has brought about increased demand for more quantitative models to support risk reduction decision-making. Consequences of failure are a key component of these models where enhanced quantitative approaches can be deployed. Impacts to the environment and upon populations are key issues which both operators and regulatory bodies seek to minimize. Pipeline risk models and High Consequence Area (HCA) analyses play an increasingly important role in this context by allowing operators to identify a range of potential scenarios and the relative impact to receptors based upon the best available data sources. This paper presents the process and results of an HCA analysis project carried out by ROSEN for a major South American state-owned pipeline operator (hereafter referred to as ‘the Client’). This analysis was implemented using automated GIS processing methods and includes HCA analyses for approximately 2354 km of pipeline. The analysis was based on industry standards for both liquid and gas pipelines (i.e. American Petroleum Institute (API) and American Society of mechanical Engineers (ASME)), but customized for the specific needs of the Client and the South American geographical context. A key use for the results of this analysis is to serve as input for the pipeline risk assessment model jointly developed by ROSEN Integrity Solutions, MACAW Engineering and the Client. The methodology for development of this model is briefly discussed, and operational uses of HCA results are illustrated. The benefits of this project include, but are not limited to, identifying areas that could be severely impacted should a pipeline failure occur, being able to assess the risk profile of credible threats in HCAs, but also being able to prioritize preventative and mitigation measures at HCAs to either reduce the likelihood of failure or the impact of failure upon various receptors.

EP.FRI.857 Audit and quality improvement project; data entry into the NELA database from Royal Stoke university hospital

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Nandu Nair ◽  
Vasileios Kalatzis ◽  
Madhavi Gudipati ◽  
Anne Gaunt ◽  
Vishnu Machineni
Keyword(s):  
Quality Improvement ◽  
Data Entry ◽  
Quality Improvement Project ◽  
University Hospital ◽  
Emergency Laparotomy ◽  
Data Set ◽  
Improvement Project ◽  
Hospital Database ◽  
Case Ascertainment ◽  
Project Data

Abstract Aims During the period December-2018 to November-2019 a total of 84 cases were entered on the NELA website, corresponding to HES data suggesting 392 laparotomies. This suggests a possible case acquisition of 21% prompting us to look at our data acquisition in detail. Methods Interrogation of the NELA data from January–March 2020 was done from NELA website and hospital records. Results Analysis revealed that during this period 45 patients had laparotomy recorded whereas hospital database recorded 68 laparotomies. Of the 45 cases entered on the NELA database, only 1 patient had a complete data set entered.  22 cases had 87% data entry and 22 cases had <50% of the data fields completed. Firstly, we were not capturing all patients who underwent an emergency laparotomy and secondly our data entry for the patients we did report was incomplete.  This led us to engage in a quality improvement project with following measures - Conclusions We re-assessed the case ascertainment and completeness of data collection in the period April 2020 – June 2020 and case ascertainment rate increased to 54% and all the entries were complete and locked.

A New Risk Assessment Model for Hospital-Acquired Venous Thromboembolism in Critically Ill Children

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Julie Jaffray ◽  
Arash Mahajerin ◽  
Brian Branchford ◽  
Anh Thy H. Nguyen ◽  
E. Vincent S. Faustino ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Critically Ill ◽  
Assessment Model ◽  
Critically Ill Children ◽  
Risk Assessment Model ◽  
Hospital Acquired
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