Overuse of DVT Prophylaxis in Medical Inpatients

Abstract Introduction: Unfractionated heparin (UFH), or low-molecular-weight heparin (LMWH), is commonly used with mechanical prophylaxis as an anticoagulant to reduce the risk for venous thromboembolism (VTE). However, overuse of these prophylaxes can increase the risk of bleeding, heparin-induced thrombocytopenia (HIT) and associated medical cost. PURPOSE: The aim of this study is to determine the incidence of DVT prophylaxis among hospitalized nonsurgical patients in a community medical center. To evaluate the use of the prophylaxes as described above, the investigators collected data on medical inpatients and addressed how to avoid overuse. Method: A retrospective inpatient chart review of 100 general internal medicine patients analyzed data using Padua Prediction Score as the risk estimate for deep venous thrombosis (DVT). High risk for VTE was defined by a cumulative score >=4 and low risk was a score <4. Only patients at increased risk for DVT but not at high risk for bleeding qualified for heparin treatment. Results: A total of 100 patients were surveyed. 54/100 (54%) patients had low risk of DVT with score < 4, and of those 29/54 (53.7%) patients received DVT prophylaxis with SCDs and/or heparin, and 17/54 (31.5%) patients were treated with heparin. All 46 patients with score >= 4 were treated with DVT prophylaxis of which 10 patients were only treated with heparin and 36 patients were given both mechanical and chemical prophylaxis. Collectively, 53.7% of the patients received treatment with DVT prophylaxis (p < 0.001, Chi-Square test). Discussion: In hospital settings, physicians want to avoid DVT or PE so they tend to consider patients as being at moderate risk for DVT without using any method of DVT risk assessment. This leads to unnecessary overuse of DVT prophylaxis on patients and may increase the risk of bleeding and injury. Conclusion: Our data suggests that there DVT prophylaxis including UFH and LMWH was over prescribed among patients with who had marginal risk for DVT in hospitalized nonsurgical patients in a community medical center. Clinical implications: To avoid the overuse of DVT prophylaxis, physicians need to follow guidelines. Education and inclusion of the guidelines in EHRs of information on VTE risk assessment for hospitalized medical patients upon admission may reduce unneeded DVT prophylaxis and the risk of bleeding and costs associated with additional care needs. Disclosures No relevant conflicts of interest to declare.

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Do FISH Lesions Have Any Role in the Pathogenesis and Outcome of Chromosomally Normal MDS?

Blood ◽

10.1182/blood.v118.21.1472.1472 ◽

2011 ◽

Vol 118 (21) ◽

pp. 1472-1472

Author(s):

Paolo Bernasconi ◽

Irene Dambruoso ◽

Marina Boni ◽

Paola Maria Cavigliano ◽

Ilaria Giardini ◽

...

Keyword(s):

High Risk ◽

Conflicts Of Interest ◽

Low Risk ◽

Dna Double Strand Breaks ◽

Disease Evolution ◽

Molecular Tests ◽

Single Defect ◽

Increased Risk ◽

Rad52 Protein ◽

Conventional Cytogenetics

Abstract Abstract 1472 Background: The chromosomal pattern is one of the most relevant parameters to make an accurate diagnosis and predict disease outcome of MDS patients. However, in about 40–50% of patients, mostly low-risk MDS, conventional cytogenetics (CC) does not reveal any defect and thus it is not informative. In this MDS subset FISH with specific probes may identify clonal defects and improve CC results. In addition, recent aCGH data suggest that these patients may present novel lesions affecting unsuspected chromosomal regions harbouring genes with a crucial role in MDS pathogenesis. Objectives: Based on these findings the principal goal of the present study was to establish whether FISH with probes specific for chromosomal regions most commonly involved in MDS along with additional probes exploring chromosomal areas which alteration has been revealed by recent aCGH studies was truly able to unmask clonal cryptic defects in chromosomally normal MDS. Additional aims were to establish whether these defects consisted in either gains/losses or balanced rearrangements, to identify the potential affected genes and to evaluate any possible influence on OS and progression free interval (PFI). Methods: The ninety-eight consecutive chromosomally normal MDS patients analysed in the present study came to our observation in the period January 2005-December 2010. They were thirty-seven females and sixty-one males, median age 64 years (range 22–77). Eighteen patients were classified as RARS, 27 as RA, one as CRMDS, 15 as RCMD, 16 as RAEB-1 and 21 as RAEB-2. Considering IPSS score, 38 patients were considered low-risk, 36 intermediate-1 risk and 18 intermediate-2 risk and 6 as high-risk. Median follow-up was 33 months (range 1–84). At the time of the study four patient have died. FISH probes were chosen based on the frequency of their involvement in MDS and their Mb position determined using UCSC genome browser on Human Mar. 2003 assembly. They were obtained from BACPAC Resources Center at C.H.O.R.I. (Oakland, USA), labelled and applied as previously described. The probes applied were the followings: RP11-912D8 (19q13.2); RP11-196P12 (17q11.2); RP11-269C4 (14q12); RP11-351O1 (10q21.3); RP11-144G6 (10q11.2); RP11-122A11 (7q34); RP11-951K18 (5q13.1); RP11-101K5 (4p14); RP11-544H14 (2q33). i-FISH cut-off values were fixed at 10%. Results: An abnormal FISH pattern was revealed in 30 patients (33.7%). A single defect was revealed in 31 patients (31.6%) and more than two defects in 8 (26.7). Twenty-two patients (22.4%) presented a single defect, whereas 9 (9.1%) more than two defects. Band 19q13.2, 14q12, 4p14, 5q13.1, 7q34, 17q11.2, 7q22, 10q11.2, 10q21.3 and 2p33 deletions had an incidence of 54.8%, 25.8%, 16.1%, 12.9%, 12.9%, 12.9%, 9.6%, 6.4% and 3.2%. The RP11-196P12 covers the RDM-1 gene which encodes for a motif found in the RAD52 protein involved in DNA double strand breaks and homologous recombination and the RP11-144G6 covers the ANXA8L1 gene over-expressed in AML. Thus, these two genes are now analysed with additional molecular tests in order to check whether they may be affected by mutations. An abnormal FISH pattern was observed in 4/18 (22.2%) RARS, in 5/27 (18.5%) RA, in 4/15 (26.6%) RCMD, in 6/16 (37.5%) RAEB-1 and in 12/21 (57.1%) RAEB-2. Considering IPSS, an abnormal FISH pattern was revealed in 7/38 (18.4%) low-risk, in 12/36 (33.3%) intermediate-1 risk, in 9/18 (50%) intermediate-2 risk and in 3/6 (50%) high-risk patients. Disease evolution occurred in a total of 21 patients (2 RARS, 5RA, 6 RAEB-1 and 7 RAEB-2), 11 (one RARS, 2 RA, 5 RAEB-1 and 2 RAEB-2) presented an abnormal FISH pattern. At least two chromosomal deletions were observed in 7/11 patients. Conclusions: i) FISH reveals novel not expected karyotype defects, mostly deletions, in about 32% of chromosomally normal MDS; ii) some deletions pinpoint genes involved in DNA repair; iii) an abnormal FISH pattern correlates with advanced and int-2, high-risk MDS; iii) the presence of more than two lesions seems to associate with an increased risk of disease progression. Disclosures: No relevant conflicts of interest to declare.

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Venous Thromboembolism (VTE) Risk Assessment & Prophylaxis In Irish Hospitalized Obstetric Patients: A Nationwide Cross-Sectional Study

Blood ◽

10.1182/blood.v122.21.1151.1151 ◽

2013 ◽

Vol 122 (21) ◽

pp. 1151-1151

Author(s):

Caroline M Noone ◽

Susan O'Shea ◽

Maeve P Crowley ◽

John Higgins

Keyword(s):

Risk Factors ◽

Risk Assessment ◽

High Risk ◽

Conflicts Of Interest ◽

Mode Of Delivery ◽

Low Risk ◽

Average Weight ◽

Intermediate Risk ◽

Cross Sectional ◽

Risk Patients

Abstract Background Pulmonary embolism continues to be the second leading cause of mortality in pregnancy and the puerperium. VTE complicates 1 - 2/1000 pregnancies, and the risk increases with age, mode of delivery, and presence of co-morbidities. Literature has shown that the use of low molecular weight heparin (LMWH) is safe in this patient cohort. Aims Assessment of the prevalence of VTE risk in hospitalised women in both the antenatal and postnatal groups to determine the proportion of at-risk patients who receive LMWH prophylaxis appropriately. Methods The study period was September 2011 to November 2012. All inpatients in the participating hospitals on the day of investigation were assessed for risk of VTE on the basis of hospital chart review. Risk profile was assessed in accordance with the 2009 Royal College of Obstetricians and Gynaecologist Guidelines. Patients undergoing procedures or on the labour ward at the time of review were excluded. Ethical approval was obtained from the ethics committees governing all centres. Results 610 pregnancies were reviewed across 19 centres. The average age of was 31+/- 5.65yrs (Range 16-47), with 21.87% aged over 35. 22% had a parity of 3 or more. The average weight was 71.51kg (Range 42-134kg, SD 14.482kg). Data on BMI was available for 77% - 34% were overweight and 21% were obese. 1% had a BMI>40. 31% were antenatal and 69% were postnatal. 63% of antenatal patients were low risk (<2 risk factors), 35% were intermediate risk (2 or more risk factors, prophylaxis should be considered) and 2% were high risk. All the high risk patients were on prophylaxis at an appropriate dose. 4% of the low risk patients were on prophylaxis unnecessarily. Only 7% of the intermediate risk patients were on correctly dosed prophylaxis. Among postnatal patients, 41% were low risk (<2 risk factors), 58% were intermediate risk (2 or more risk factors, require prophylaxis) and <1% were high risk. 80% were appropriately risk stratified and put on LMWH if necessary. 59% of patients should have been on LMWH but only 42% were (92% Tinzaparin and 8% Enoxoparin). This included 8 patients who were on LMWH unnecessarily. 38% were on too low a dose. Conclusion VTE prophylaxis remains a central issue in obstetric care given its prominent role in maternal morbidity and mortality and the increasing prevalence of risk factors such as obesity and increasing maternal age. It is clear that while there is good awareness of the risk in the postnatal period, there is less emphasis on risk assessment in antenatal patients where prophylaxis is rarely used. Those on prophylaxis are also likely to be on an incorrect dose. There is a clear role for a national guideline to standardize care for all pregnant women. On the basis of these findings, we have authored a guideline and this is now in use as a reference in all Irish maternity units. Disclosures: No relevant conflicts of interest to declare.

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"Has the Pendulum Swung Too Far? Evaluation of the Appropriate Use of VTE Prophylaxis for Medical Inpatients."

Blood ◽

10.1182/blood.v128.22.4745.4745 ◽

2016 ◽

Vol 128 (22) ◽

pp. 4745-4745

Author(s):

Courtney A Fay ◽

Marijeta Pekez ◽

Anna Thomas ◽

Bhakti Deshmukh ◽

Naveed Jan ◽

...

Keyword(s):

Risk Assessment ◽

High Risk ◽

Hospitalized Patients ◽

Low Risk ◽

Prediction Score ◽

Admission Criteria ◽

Vte Prophylaxis ◽

Medical Inpatients ◽

Current Guidelines ◽

Anticoagulated Patients

Abstract Introduction: Venous thromboembolism (VTE) is the most common cause of hospital death. Pharmacologic intervention has become the standard of care in the prevention of VTE in hospitalized patients. However, studies have not been able to show a consistent benefit of VTE prophylaxis on mortality in hospitalized medical patients. Medical inpatients are a very heterogenous group; not all of them need VTE prophylaxis. Current guidelines recommend the use of heparin or related drugs as VTE prophylaxis in medical inpatients at increased risk of thrombosis, and recommends against pharmacologic VTE prophylaxis in patients at low risk. Several risk assessment modules including the Padua Prediction Score, attempt to identify patients at high-risk for thromboembolism. The goal of the study was to evaluate if risk is assessed and defined by clinicians prior to prescribing VTE prophylaxis. Methods A retrospective chart analysis was performed for patients admitted to the medicine service from January 2015 to June 2015. The initial arrival orders as well as the history and physical documented by the admitting physician were reviewed to determine if the risk of VTE was recorded and if VTE prophylaxis was prescribed. Patients were stratified as either admission or observation and the type of anticoagulation was recorded. If the admitting physician did not perform a VTE risk assessment, risk of VTE was calculated using the Padua Prediction Score. Results: Data was collected on a total of 648 patients. 314 (48%) patients met admission criteria and 334 (52%) patients met observation criteria. Chemical VTE prophylaxis was prescribed for 262 of the 314 (83%) admissions and 215 of the 334 (64%) observation patients. Of the 262 admissions that received chemical VTE prophylaxis, 240 (92%) of these patients were considered low-risk based on the Padua Prediction Score (Figure 1). 201 of the 215 (93%) observation patients that received chemical VTE prophylaxis were calculated to be low-risk (Figure 2). Adverse events were found to occur in 7 of the 648 (1.1%) patients that received chemical VTE prophylaxis. Conclusion: Inappropriate use of chemical VTE prophylaxis was observed in a majority of medical inpatients. Discussion: Routine use of VTE prophylaxis is not recommended. Current guidelines advise practitioners to evaluate all hospitalized patients for risk of VTE and bleeding prior to the initiation of VTE prophylaxis. Risk assessment tools such as the Padua Prediction Score help discriminate those patients at high risk of VTE and bleeding. However, this study shows that most clinicians do not perform a proper risk assessment for thromboembolism and bleeding prior to the initiation of VTE prophylaxis. Significant bleeding and thrombocytopenia were the most common complications identified in patients who received pharmacologic intervention. Although the rate of complications was low, further studies are needed to address additional negative consequences from the overuse of anticoagulation such as cost, nursing time and patient discomfort. Figure 1 VTE risk assessment of anticoagulated patients who met admission criteria Figure 1. VTE risk assessment of anticoagulated patients who met admission criteria Figure 2 VTE risk assessment of anticoagulated patients who met observation criteria Figure 2. VTE risk assessment of anticoagulated patients who met observation criteria Disclosures No relevant conflicts of interest to declare.

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A Prospective Observational Cohort of Clinical Outcomes in Medical Inpatients prescribed Pharmacological Thromboprophylaxis Using Different Clinical Risk Assessment Models(COMPT RAMs)

Scientific Reports ◽

10.1038/s41598-019-54842-3 ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Nibal Chamoun ◽

Stephanie Matta ◽

Sandrine Sarine Aderian ◽

Rami Salibi ◽

Pascale Salameh ◽

...

Keyword(s):

Risk Assessment ◽

Clinical Outcomes ◽

Medical Center ◽

Bleeding Risk ◽

Risk Scores ◽

Medical Patients ◽

Vte Prophylaxis ◽

Risk Assessment Models ◽

Increased Risk ◽

Medical Inpatients

AbstractThe Caprini and Padua venous thromboembolism (VTE) risk assessment models (RAMs) are used to assess VTE risk in surgical and in medical patients respectively. This study aims to compare the proportion of medical inpatients eligible for VTE prophylaxis using the hospital Caprini-based RAM to using the Caprini and Padua RAMs and to assess the associated clinical outcomes. In a prospective observational study, we assessed 297 adult medical inpatients for whom VTE thromboprophylaxis was initiated according to the hospital Caprini-based RAM, referred to as the Lebanese American University Medical Center RAM (LAUMC-RAM). The Padua, Caprini and IMPROVE bleeding risk scores were also assessed for all patients. Bleeding and thromboembolism were evaluated at 14 and 30 days post VTE risk assessment. Pharmacologic thromboprophylaxis was warranted in 97.6%, 99.7%, and 52.9% of patients using the Caprini-based, Caprini, and Padua RAMs respectively. The Caprini-based and Caprini RAMs were highly correlated (r = 0.873 p < 0.001) and were significantly less correlated with the Padua RAM. Major and overall bleeding occurred in 1.4% and 9.2% respectively. VTE was reported in 0.4% with no VTE related mortality. In hospitalized medical patients, the Caprini-based RAM can accurately distinguish low and high VTE risk without resulting in increased risk of bleeding.

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Potential Overuse of Primary Thromboprophylaxis in Medical Inpatients at Low Risk of Venous Thromboembolism

Blood ◽

10.1182/blood-2019-131827 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 3385-3385

Author(s):

Mia Djulbegovic ◽

Kevin Chen ◽

Soundari Sureshanand ◽

Sarwat Chaudhry

Keyword(s):

Risk Assessment ◽

Venous Thromboembolism ◽

High Risk ◽

Clinical Pharmacy ◽

Low Risk ◽

Assessment Model ◽

Morbidity And Mortality ◽

Risk Assessment Model ◽

Medical Overuse ◽

Medical Inpatients

Background: Venous thromboembolism (VTE) is a common cause of morbidity and mortality in the United States. Annually, up to 1 in 120 people develop VTE, approximating the incidence of stroke. Given that hospitalization and acute medical illness increase the risk of VTE, hospital-associated VTE represents a preventable cause of morbidity and mortality. Accordingly, accreditation and regulatory agencies endorse inpatient pharmacologic VTE prophylaxis (PPX) as a quality measure. In order to raise rates of PPX prescribing, many health systems have adopted a default approach to electronic ordering, in which clinicians must "opt-out" of PPX prescription. However, this strategy may cause medical overuse and avoidable harms, which has prompted the American Society of Hematology (ASH) to recommend a risk-adapted approach to PPX. One risk model endorsed by ASH is the IMPROVE-VTE risk assessment model, which can identify patients who are at low risk for VTE and therefore may not warrant pharmacologic PPX. We therefore sought to compare the actual practice of PPX prescribing to the guideline-recommended strategy according the IMPROVE-VTE model in a large, contemporary population of medical inpatients. Methods: In this observational study, we used electronic health record data to identify adult, medical inpatients hospitalized on general medical and subspecialty services at Yale-New Haven Hospital from 1/1/14-12/31/18. We excluded patients who were pregnant, admitted for VTE, taking full dose anticoagulation on admission, admitted for bleeding, or had a platelet count of < 50,000/µL. For each patient, we calculated the IMPROVE-VTE score using the previously validated model weights: 3 points for a prior history of VTE; 2 points for known thrombophilia, lower limb paralysis, or active cancer; 1 point for immobilization, admission to the intensive care unit, or age ≥ 60 years. For each component other than age, we used ICD-9 and ICD-10 codes that were billed either prior to or upon admission to determine the presence of these risk factors. In order to simulate the decision to initiate PPX on hospital admission, we calculated each patient's IMPROVE-VTE score at the time of admission. In accordance with the ASH guidelines, we used an IMPROVE-VTE score of <2 to differentiate patients at low-risk of hospital-associated VTE from those at high-risk. We used inpatient medication order history data to determine receipt of pharmacologic PPX. We used χ2 testing to compare the relative frequency of PPX prescribing on admission between patients at low-risk and high-risk for VTE. Results: We identified 135,288 medical inpatients during the study period, of whom 99,380 met inclusion criteria. The average age was 63.5 years-old (standard deviation 18 years); 51% of patients were female; 68% of patients were white. Of all the included patients, 81% received pharmacologic prophylaxis; of these patients, 78% received unfractionated heparin subcutaneously and 22% received low molecular weight heparin subcutaneously. Among all hospitalized patients, 78% had an IMPROVE-VTE score of <2 (32% had a score of 0 and 46% had a score of 1). Among these patients at low risk of hospital-associated VTE, 81% received pharmacologic PPX. Differences in prophylaxis rates between patients at low vs high risk of VTE were statistically significant (p<0.001). Conclusion: In this contemporary cohort of adult, medical inpatients, >80% of patients who were at low risk of hospital-associated VTE received pharmacologic PPX, representing a group in whom PPX may be unnecessary. Using a risk-adapted approach such as the IMPROVE-VTE risk assessment model, rather than default PPX ordering, may reduce medical overuse and avoidable harms. Disclosures Chaudhry: CVS State of CT Clinical Pharmacy Program: Other: Paid Reviewer for CVS State of CT Clinical Pharmacy Program.

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Multidimensional dynamic healthcare personnel (HCP)-centric model from a low-income and middle-income country to support and protect COVID-19 warriors: a large prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2020-043837 ◽

2021 ◽

Vol 11 (2) ◽

pp. e043837

Author(s):

Usha Dutta ◽

Anurag Sachan ◽

Madhumita Premkumar ◽

Tulika Gupta ◽

Swapnajeet Sahoo ◽

...

Keyword(s):

High Risk ◽

Low Income ◽

Tertiary Care ◽

Low Risk ◽

Transmission Risk ◽

Healthcare Personnel ◽

Risk Zone ◽

Increased Risk ◽

Medium Risk ◽

Risk Zones

ObjectivesHealthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty.SettingOur tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless.ParticipantsWe recruited willing low-risk HCP, aged <50 years, with no comorbidities to work in COVID-19 zones. Social distancing, hand hygiene and universal masking were advocated in the low-risk zone.ResultsBetween 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (<1%), ensured satisfaction with training (92%), PPE (90.8%), medical and psychosocial support (79%) and improved acceptance of COVID-19 duty with 54.7% volunteering for re-deployment.ConclusionA multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.

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Polygenic risk scores predict diabetic complications and their response to therapy

10.1101/19010785 ◽

2019 ◽

Author(s):

J. Tremblay ◽

M. Haloui ◽

F. Harvey ◽

R. Tahir ◽

F.-C. Marois-Blanchet ◽

...

Keyword(s):

High Risk ◽

Prediction Model ◽

Risk Group ◽

Intensive Therapy ◽

Cardiovascular Death ◽

Response To Therapy ◽

Low Risk ◽

Number Needed To Treat ◽

Genome Wide Association Studies ◽

Increased Risk

AbstractType 2 diabetes increases the risk of cardiovascular and renal complications, but early risk prediction can lead to timely intervention and better outcomes. Through summary statistics of meta-analyses of published genome-wide association studies performed in over 1.2 million of individuals, we combined 9 PRS gathering genomic variants associated to cardiovascular and renal diseases and their key risk factors into one logistic regression model, to predict micro- and macrovascular endpoints of diabetes. Its clinical utility in predicting complications of diabetes was tested in 4098 participants with diabetes of the ADVANCE trial followed during a period of 10 years and replicated it in three independent non-trial cohorts. The prediction model adjusted for ethnicity, sex, age at onset and diabetes duration, identified the top 30% of ADVANCE participants at 3.1-fold increased risk of major micro- and macrovascular events (p=6.3×10−21 and p=9.6×10−31, respectively) and at 4.4-fold (p=6.8×10−33) increased risk of cardiovascular death compared to the remainder of T2D subjects. While in ADVANCE overall, combined intensive therapy of blood pressure and glycaemia decreased cardiovascular mortality by 24%, the prediction model identified a high-risk group in whom this therapy decreased mortality by 47%, and a low risk group in whom the therapy had no discernable effect. Patients with high PRS had the greatest absolute risk reduction with a number needed to treat of 12 to prevent one cardiovascular death over 5 years. This novel polygenic prediction model identified people with diabetes at low and high risk of complications and improved targeting those at greater benefit from intensive therapy while avoiding unnecessary intensification in low-risk subjects.

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RISK ASSESSMENT PERUSAHAAN EXPORT SEPATU PADA BAGIAN LINE UPPER PT. X

The Indonesian Journal of Occupational Safety and Health ◽

10.20473/ijosh.v4i1.2015.22-32 ◽

2015 ◽

Vol 4 (1) ◽

pp. 22

Author(s):

Novita Dewi Vebriyana Dankis ◽

Mulyono Mulyono

Keyword(s):

Risk Assessment ◽

High Risk ◽

Risk Control ◽

Consumer Products ◽

Hazard Identification ◽

Low Risk ◽

Residual Risk ◽

Control Measures ◽

On Line ◽

Punch Hole

ABSTRACTRevolution in the industry sector has been rapidly grown to fill up all the needs of the consumer products. One involves supporting advanced machinery such as “Cutting, Skiving, Stitching, Emboss Logo, Roving, Punch Hole, Juki, BrushingEdge, Hammer Over Lapping and Two Molding”. In the factory production process, there are various types of high-risk activities, especially on line upper. The main of this research is to study the risk assessment on export companies line the upper part of the shoes export company using Job Safety Analysis. This research was conducted observational crosssectional design. Observations made to the hazards and control measures. Interviews were conducted to 12 employees. Variables in this research is production activity, hazard identification, risk assessment, risk control and residual risk. The results of hazard identification has been done, there are 91 known potential hazards, for risk assessment found 7 high risk and low risk 5. Machine classified as high risk on the risk assessment is roving machine, whereas low-risk is two molding machine. Control efforts on the upper line in accordance with the hierarchy of controlling a number of 91 controls, whereas for the residual risk still remains as much as 30 residual risk. Control has been applied quite well by pressing the consequences of hazards and risk management.Keywords: risk assessment, controlling, residual risk

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Mutational Characteristics and Changing Pattern from Idiopathic Cytopenia of Undetermined Significance to High-Risk Myelodysplastic Syndrome Stratified By IPSS-R

Blood ◽

10.1182/blood-2019-125236 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 3009-3009

Author(s):

Eun-Ji Choi ◽

Young-Uk Cho ◽

Seongsoo Jang ◽

Chan-jeoung Park ◽

Han-Seung Park ◽

...

Keyword(s):

Bone Marrow ◽

High Risk ◽

Myelodysplastic Syndrome ◽

Rna Splicing ◽

Conflicts Of Interest ◽

Low Risk ◽

International Prognostic Scoring System ◽

Intermediate Risk ◽

Sequencing Data ◽

Undetermined Significance

Background: Unexplained cytopenia comprises a spectrum of hematological diseases from idiopathic cytopenia of undetermined significance (ICUS) to myelodysplastic syndrome (MDS). Revised International Prognostic Scoring System (IPSS-R) is the standard tool to assess risk in MDS. Here, we investigated the occurrence, characteristics, and changing pattern of mutations in patients with ICUS and MDS stratified by IPSS-R score. Methods: A total of 211 patients were enrolled: 73 with ICUS and 138 with MDS. We analyzed the sequencing data of a targeted gene panel assay covering 141 genes using the MiSeqDx platform (Illumina). The lower limit of variant allele frequency (VAF) was set to 2.0% of mutant allele reads. Bone marrow components were assessed for the revised diagnosis according to the 2016 WHO classification. Lower-risk (LR) MDS was defined as those cases with very low- or low-risk MDS according to the IPSS-R. Higher-risk (HR) MDS was defined as those cases with high- or very high-risk MDS according to the IPSS-R. Results: Patients with ICUS were classified as very low-risk (39.7%), low-risk (54.8%), and intermediate-risk (5.5%) according to the IPSS-R. Patients with MDS were classified as LR (35.5%), intermediate-risk (30.4%), and HR (34.1%). In the ICUS, 28 (38.4%) patients carried at least one mutation in the recurrently mutated genes in MDS (MDS mutation). The most commonly mutated genes were DNMT3A (11.0%), followed by TET2 (9.6%), BCOR (4.1%), and U2AF1, SRSF2, IDH1 and ETV6 (2.7% for each). IPSS-R classification was not associated with mutational VAF and the number of mutations in ICUS. In the 49 LR MDS, 28 (57.1%) patients carried at least one MDS mutation. The most commonly mutated genes were SF3B1 (20.4%), followed by TET2 (12.2%), U2AF1 (10.2%), DNMT3A (10.2%), ASXL1 (10.2%), and BCOR (6.1%). Higher VAF and number of mutations were observed in LR MDS compared to ICUS patients. In the 42 intermediate-risk MDS, 27 (64.3%) patients carried at least one MDS mutation. The most commonly mutated genes were ASXL1 (23.8%), followed by TET2 (21.4%), RUNX1 (16.7%), U2AF1 (14.3%), DNMT3A (14.3%), SF3B1 (9.5%), and SRSF2, BCOR, STAG2 and CBL (7.1% for each). In the 47 HR MDS, 36 (76.6%) patients carried at least one MDS mutation. The most commonly mutated genes were TET2 (25.5%), followed by DNMT3A (14.9%), TP53 (14.9%), RUNX1 (12.8%), U2AF1 (10.6%), ASXL1 (10.6%), and SRSF2 and KRAS (6.4% for each). As the disease progressed, VAF and number of the MDS mutations gradually increased, and mutations involving RNA splicing, histone modification, transcription factor or p53 pathway had a trend for increasing frequency. Specifically, ASXL1, TP53, and RUNX1 mutations were the most striking features in patients with advanced stage of the disease. Cohesin mutations were not detected in ICUS, whereas these mutations were detected at a relatively high frequency in HR MDS. Our data were summarized in Table 1. Conclusions: We demonstrate that on disease progression, MDS mutations are increased in number as well as are expanded in size. Furthermore, a subset of mutations tends to be enriched for intermediate- to HR MDS. The results of this study can aid both diagnostic and prognostic stratification in patients with unexpected cytopenia. In particular, characterization of MDS mutations can be useful in refining bone marrow diagnosis in challenging situations such as distinguishing LR MDS from ICUS. Disclosures No relevant conflicts of interest to declare.

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Factors Associated With a Higher Risk of Undiagnosed Prediabetes in a Community-Dwelling Medicare Population

The Senior Care Pharmacist ◽

10.4140/tcp.n.2020.85 ◽

2020 ◽

Vol 35 (2) ◽

pp. 85-92

Author(s):

Cynthia S. Valle-Oseguera ◽

Carly A. Ranson ◽

Patricia Tam ◽

Jacqueline Le ◽

Brandon Le ◽

...

Keyword(s):

Type 2 Diabetes ◽

Risk Assessment ◽

High Risk ◽

Community Dwelling ◽

Screening Tools ◽

Medicare Beneficiaries ◽

Medication Therapy ◽

Medicare Population ◽

Increased Risk

OBJECTIVE: To identify characteristics in an ambulatory Medicare population that are significantly more likely to be associated with a high risk of undiagnosed prediabetes. DESIGN: Cross-sectional study. SETTING: Fourteen health clinics targeting Medicare beneficiaries were held throughout northern and central California during the fall of 2017. PATIENTS, PARTICIPANTS: Noninstitutionalized Medicare beneficiaries receiving medication therapy management services without self-reported diabetes. INTERVENTIONS: Beneficiaries were screened for their risk of type 2 diabetes mellitus (T2DM) through the use of the American Diabetes Association (ADA) risk assessment (score of ≥ 5 indicates increased risk of developing type 2 diabetes) by pharmacy students. For this study, patients with a score of ≥ 5 were considered to be at high risk for undiagnosed prediabetes. MAIN OUTCOME MEASURE(S): Characteristics significantly more likely to be identified in patients at high risk for undiagnosed prediabetes. RESULTS: A total of 683 Medicare beneficiaries without self-reported diabetes completed the ADA risk assessment, with 457 (66.9%) receiving a score of 5 or more. In those, the presence of hyperlipidemia, hypertension, obesity, coronary heart disease, and use of aspirin were all characteristics researchers identified as significantly more likely to be found in this group. In contrast, those of Asian race or who took dietary supplements were significantly less likely to score 5 or higher in the questionnaire. CONCLUSION: Identification of older adults at higher risk for undiagnosed prediabetes through the use of appropriate screening tools allows for targeted preventive interventions, potentially lowering risk of developing T2DM for selected patients.

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