Can Practical Nurses Identify Older Home Care Clients at Risk of Drug-Related Problems–Geriatricians’ Appraisal of Their Risk Screenings: A Pilot Study

Background: Home care (HC) clients are increasingly older, have many chronic diseases, and use multiple medicines and thus are at high risk for drug-related problems (DRPs). Objective: Establish the sensitivity of practical nurse (PN) administered DRP risk assessment tool (DRP-RAT) compared with geriatrician’s assessment of the medical record. Identify the clinically most significant DRPs needing action. Methods: Twenty-six PNs working in HC of Härkätie Health Center in Lieto, Finland, 46 HC clients (≥65 years), and a geriatrician participated in this pilot study. The geriatrician reviewed HC clients’ medications using 3 different methods. The reviews were based on the following: (1) the PN’s risk screening (ie, PN-completed DRP-RAT) and medication list, (2) health center’s medical records, and (3) methods 1 and 2 together. The main outcome was the number of “at-risk patients” (ie, the patient is at risk of clinically significant DRPs) by using each review method. Secondary outcomes were clinically most significant DRP-risk predicting factors identified by the geriatrician. Results: The geriatrician reviewed 45 clients’ medications using all 3 methods. Based on PN-completed DRP-RAT and medication list, 93% (42/45) of the clients were classified as “at-risk patients.” Two other review methods resulted in 45/45 (100%) “at-risk patients.” Symptoms suggestive of adverse drug reactions were the most significant risk predicting factors. Small sample size limits the generalizability of the results. Conclusions: The PN-completed DRP-RAT was able to provide clinically important timely patient information for clinical decision making. DRP-RAT could make it possible to more effectively involve PNs in medication risk management among older HC clients.

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303: Metabolite changes in second trimester amniotic fluid are predicative of spontaneous preterm birth in a pilot study of at risk patients

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2016.11.561 ◽

2017 ◽

Vol 216 (1) ◽

pp. S186

Author(s):

Maxim D. Seferovic ◽

Melissa A. Suter ◽

Derrick M. Chu ◽

Christopher J. Stewart ◽

James E. Cox ◽

...

Keyword(s):

At Risk ◽

Preterm Birth ◽

Pilot Study ◽

Amniotic Fluid ◽

Second Trimester ◽

Spontaneous Preterm Birth ◽

Risk Patients

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At-risk-states for bipolar disorder

European Psychiatry ◽

10.1016/s0924-9338(11)73802-0 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 2099-2099

Author(s):

P. Conus

Keyword(s):

At Risk ◽

Bipolar Disorder ◽

Psychotic Disorders ◽

Bipolar Disorders ◽

Small Sample ◽

First Episode ◽

Prodromal Phase ◽

Ultra High Risk ◽

Risk Patients ◽

New Research

Early intervention strategies have been developed over the past 20 years for psychotic disorders and recent studies have proven their efficacy. However, most of the attention has been drawn to schizophrenia, and affective psychoses have been neglected. In the recent past, new research has identified a similar need for earlier intervention in bipolar disorders, and prodrome to bipolar disorder has emerged as a key domain to investigate. Despite the complexity of this issue due to the lack of a clear consensus regarding definitions of the various stages of the disorder, some progress has been made in this domain.Two recent retrospective studies have identified a prodromal phase to first episode mania lasting between 6 and 18 months, and have identified a range of symptoms that occur during this period. It is however likely that on the basis of symptomatic profile, identification of at risk patients would be difficult, considering their low specificity. Two complementary directions have been recently proposed in order to refine such an approach. The first strategy, based on at-risk profiles inspired by the Ultra High Risk concept developed for psychosis, has yielded some promising results on a small sample of patients. The second is based on the combination of identified risk symptoms with both risk factors and markers of vulnerability into a First Episode Mania Prodrome Inventory which is currently under validation.

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Hand Edema in Patients at Risk of Breast Cancer–Related Lymphedema: Health Professionals Should Take Notice

Physical Therapy ◽

10.1093/ptj/pzy007 ◽

2018 ◽

Vol 98 (6) ◽

pp. 510-517 ◽

Cited By ~ 4

Author(s):

Cheryl L Brunelle ◽

Meyha N Swaroop ◽

Melissa N Skolny ◽

Maria S Asdourian ◽

Hoda E Sayegh ◽

...

Keyword(s):

Breast Cancer ◽

Risk Factors ◽

At Risk ◽

High Risk ◽

Clinical Examination ◽

Screening Program ◽

Significant Risk ◽

Small Sample ◽

Subjective Data ◽

Breast Cancer Related Lymphedema

Abstract Background There is little research on hand edema in the population at risk for breast cancer–related lymphedema (BCRL). Objectives Study aims included reporting potential importance of hand edema (HE) as a risk factor for progression of edema in patients treated for breast cancer at risk for BCRL, reporting risk factors for BCRL, and reporting treatment of HE. Design/Methods This was a retrospective analysis of 9 patients treated for breast cancer in Massachusetts General Hospital's lymphedema screening program who presented with isolated HE. Limb volumes via perometry, BCRL risk factors, and HE treatment are reported. Results Edema was mostly isolated to the hand. Three patients had arm edema >5% on perometry; and 2 of these had edema outside the hand on clinical examination. Patients were at high risk of BCRL with an average of 2.9/5 known risk factors. Arm edema progressed to >10% in 2 high-risk patients. Treatment resulted in an average hand volume reduction of 10.2% via perometry and improvement upon clinical examination. Limitations The small sample size and lack of validated measures of subjective data were limitations. Conclusions In this cohort, patients with HE carried significant risk factors for BCRL. Two out of 9 (22%), both carrying ≥4/5 risk factors, progressed to edema >10%. Isolated HE may be a prognostic factor for edema progression in patients treated for breast cancer at risk for BCRL. Further research is warranted.

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Exploring the Validity and Operational Impact of Using Allied Health Assistants to Conduct Dysphagia Screening for Low-Risk Patients Within the Acute Hospital Setting

American Journal of Speech-Language Pathology ◽

10.1044/2020_ajslp-19-00060 ◽

2020 ◽

Vol 29 (4) ◽

pp. 1944-1955 ◽

Cited By ~ 1

Author(s):

Maria Schwarz ◽

Elizabeth C. Ward ◽

Petrea Cornwell ◽

Anne Coccetti ◽

Pamela D'Netto ◽

...

Keyword(s):

At Risk ◽

Allied Health ◽

Assessment Tool ◽

Hospital Setting ◽

Low Risk ◽

False Negatives ◽

Exact Agreement ◽

Risk Patients ◽

Impact Phase ◽

Operational Impact

Purpose The purpose of this study was to examine (a) the agreement between allied health assistants (AHAs) and speech-language pathologists (SLPs) when completing dysphagia screening for low-risk referrals and at-risk patients under a delegation model and (b) the operational impact of this delegation model. Method All AHAs worked in the adult acute inpatient settings across three hospitals and completed training and competency evaluation prior to conducting independent screening. Screening (pass/fail) was based on results from pre-screening exclusionary questions in combination with a water swallow test and the Eating Assessment Tool. To examine the agreement of AHAs' decision making with SLPs, AHAs ( n = 7) and SLPs ( n = 8) conducted an independent, simultaneous dysphagia screening on 51 adult inpatients classified as low-risk/at-risk referrals. To examine operational impact, AHAs independently completed screening on 48 low-risk/at-risk patients, with subsequent clinical swallow evaluation conducted by an SLP with patients who failed screening. Results Exact agreement between AHAs and SLPs on overall pass/fail screening criteria for the first 51 patients was 100%. Exact agreement for the two tools was 100% for the Eating Assessment Tool and 96% for the water swallow test. In the operational impact phase ( n = 48), 58% of patients failed AHA screening, with only 10% false positives on subjective SLP assessment and nil identified false negatives. Conclusion AHAs demonstrated the ability to reliably conduct dysphagia screening on a cohort of low-risk patients, with a low rate of false negatives. Data support high level of agreement and positive operational impact of using trained AHAs to perform dysphagia screening in low-risk patients.

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