Risk assessment in cancer patients with fever and neutropenia: a prospective, two-center validation of a prediction rule.

1992 ◽  
Vol 10 (2) ◽  
pp. 316-322 ◽  
Author(s):  
J A Talcott ◽  
R D Siegel ◽  
R Finberg ◽  
L Goldman
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Cancer Patients ◽  
Group Iv ◽  
Assessment Model ◽  
Medical Complications ◽  
Stepwise Logistic Regression ◽  
Medical Risk ◽  
Group I ◽  
Risk Of Cancer

PURPOSE The study was undertaken to validate a clinical model for predicting the medical risk of cancer patients with fever and neutropenia. PATIENTS AND METHODS A consecutive sample of 444 cancer patients with fever and neutropenia (granulocyte count less than 500/microL) at two hospitals, a specialized cancer referral center and a university-affiliated general medical hospital, was studied to identify clinical characteristics in the first 24 hours that predict subsequent serious medical complications during the hospital stay. To control for bias, major risk factors and complications were subject to blinded review. RESULTS Serious medical complications occurred in 34% of patients with risk factors identified in a prior study, including prior inpatient status (group I), outpatients with a serious independent comorbidity (group II), or uncontrolled cancer (group III), compared with 5% of the remaining patients (group IV) (P less than .000001). Two of the complications in group IV patients were transient asymptomatic hypotension, and the remaining three complications occurred after at least 1 week of progressive medical deterioration. These risk groups were independently significant in stepwise logistic regression analysis. Multiple complications (17%) and death (10%) were common among patients in groups I through III but did not occur in group IV patients. CONCLUSIONS This risk assessment model accurately stratified the medical risk of these patients using only clinical information available on the first day of their course. Low-risk patients are an appropriate population in which to study less intensive treatment strategies.

scholarly journals A Novel Risk Assessment Model to Predict Venous Thromboembolism (VTE) in Cancer Inpatients: The Canclot Score

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1181-1181 ◽  
Author(s):  
Dana E. Angelini ◽  
M. Todd Greene ◽  
Julie N Wietzke ◽  
Scott A Flanders ◽  
Suman L. Sood
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Cancer Patients ◽  
Research Funding ◽  
Assessment Model ◽  
Risk Assessment Model ◽  
Risk Models ◽  
Vte Prophylaxis ◽  
Increased Risk ◽  
Medical Inpatients

Abstract Background Current guidelines recommend all cancer inpatients receive pharmacologic VTE prophylaxis in the absence of contraindications. This is extrapolated from trials showing the benefit of VTE prophylaxis in general medical inpatients and the known increased risk of VTE in cancer patients. However, given the increased risk of bleeding in cancer patients on anticoagulation (AC), it is vital to better define a subpopulation of cancer inpatients who most benefit from VTE prophylaxis. Current inpatient VTE risk models, including Padua, Caprini and IMPROVE, contain cancer as a variable and thus are not discriminative among cancer patients. Although the Khorana score (KS) stratifies VTE risk by cancer type, it was originally derived for cancer outpatients, and has yet to be validated for inpatients. Using a large multi-center cohort, we developed a novel VTE risk assessment model (RAM) specific to cancer inpatients, the CANclot score. Methods The Michigan Hospital Medicine Safety Consortium, a 49 hospital collaborative, established a multicenter retrospective cohort of medical inpatients > 18 years of age. Exclusion criteria include surgical patients, pregnancy, admission to the ICU or for palliative care, therapeutic AC, diagnosis of acute VTE, history of VTE within 6 months, and length of stay < 2 days. Patient demographics, clinical characteristics, and VTE events (both hospital associated and 90 day post discharge) were recorded. The CANclot risk assessment model was derived from logistic regression analyses of an apriori list of risk factors. Significant risk factors included in the CANclot scale were weighted based on the respective odds ratio estimates and an optimal cut-off was chosen. Model discrimination of the CANclot score was compared with other published risk models. Results Between 7/2012-7/2015, 18,956 cancer admissions were included. 2,464 (13%) had a pre-defined contraindication to prophylaxis (active bleed within 3 months, coagulopathy, or high risk brain metastasis). Of all admissions, 52.8% received VTE prophylaxis. A total of 327 (1.7%) VTE events were observed; 51/327 (15.6%) VTE events occurred during admission and 276/327 (84.4%) within 90 day f/u. When comparing AUC's of different risk models, CANclot ≥ 3 was superior to Padua ≥ 4 (p=0.01), Caprini ≥ 5 (p=0.01) and IMPROVE ≥ 2 (p=0.02). In our dataset 4,695 (25%) of patients had a CANclot score ≥ 3. Conclusion: The CANclot score is a novel VTE risk assessment tool derived specifically for cancer inpatients. Compared to other published risk prediction tools used in the general population, CANclot ≥ 3 shows an improved predictive ability for VTE and good yield, applying to 25% of the population. Improving VTE prediction in hospitalized cancer patients is crucial because targeting only those at highest risk may spare low risk patients from untoward bleeding complications from AC. Additionally, we found the majority of VTE events occurred during the 90 day followup period which calls for further attention to the possible need for extended prophylaxis in this population. Limitations to our study include a low overall rate of VTE, lack of some cancer specific variables, and that risk score values have not yet been corrected for optimism. The CANclot VTE risk score is a promising new tool for cancer inpatients that warrants further validation. 1 Patell R et al. JCO 34, 2016 (suppl; abstr 6598) Disclosures Flanders: Blue Cross Blue Shield: Research Funding; Wiley Publishing: Patents & Royalties. Sood:Bayer: Research Funding.

Analytical model for assessing collapse risk during mountain tunnel construction

2016 ◽  
Vol 53 (2) ◽  
pp. 326-342 ◽  
Author(s):  
Guo-Hua Zhang ◽  
Yu-Yong Jiao ◽  
Li-Biao Chen ◽  
Hao Wang ◽  
Shu-Cai Li
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Index System ◽  
Assessment Model ◽  
Tunnel Construction ◽  
Assessment Index ◽  
Assessment Index System ◽  
Geological Prediction ◽  
Tunnel Collapse ◽  
Mountain Tunnel

Risk management for safety in mountain tunnel construction is of great significance. However, existing research lags behind engineering applications. In this paper, the risk of mountain tunnel collapse is used as an example to illustrate a new assessment method based on case-based reasoning, advanced geological prediction, and rough set theory. First, the risk surroundings and risk factors involved in tunnel collapse are integrated and summarized, and a risk assessment index system is established for tunnel collapse. At the same time, because the dynamic response parameters obtained by the advanced geological prediction usually indicate a typical geological structure, sensitive response parameters are introduced in the assessment index system. Advanced risk assessment can be performed for tunnel sections at a certain distance ahead of the tunnel face. Second, the major risk surroundings and the advanced geological prediction results are analyzed for the tunnel under assessment. Cases with similar attribute characteristics are selected via comparison with previous cases. Attribute reduction and calculation of weights are subsequently performed for the risk surroundings and risk factors of similar cases based on the attribute significance theory of rough sets. Finally, index screening and objective weights are applied in the fuzzy comprehensive assessment model. The results of this paper can be used to improve the theoretical level and reliability of risk assessment in tunnel safety and serve as a reference for tunnel construction.

scholarly journals Determination of Risk Factors for Venous Thromboembolism by an Adapted Caprini Scoring System in Surgical Patients

2019 ◽  
Vol 9 (3) ◽  
pp. 36 ◽  
Author(s):  
Bui My Hanh ◽  
Le Quang Cuong ◽  
Nguyen Truong Son ◽  
Duong Tuan Duc ◽  
Tran Tien Hung ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Scoring System ◽  
Risk Group ◽  
Risk Groups ◽  
High Risk Group ◽  
Assessment Model ◽  
Surgical Patients ◽  
Risk Scoring

Venous thromboembolism (VTE) is a frequent preventable complication among surgical patients. Precise risk assessment is a necessary step for providing appropriate thromboprophylaxis and reducing mortality as well as morbidity caused by VTE. We carried out this work to define the rate of VTE postoperatively, following a Caprini score, and to determine VTE risk factors through a modified Caprini risk scoring system. This multicenter, observational, cohort study involved 2,790,027 patients who underwent surgery in four Vietnamese hospitals from 01/2017 to 12/2018. All patients who were evaluated before surgery by using a Caprini risk assessment model (RAM) and monitored within 90 days after surgery. The endpoint of the study was ultrasound-confirmed VTE. Our data showed that the 90-day postoperative VTE was found in 3068 patients. Most of VTE (46.97%) cases were found in the highest risk group (Caprini score > 5). A total of 37.19% were observed in the high risk group, while the rest (15.84%) were from low to moderate risk groups. The likelihood of occurring VTE was heightened 2.83 times for patients with a Caprini score of 3–4, 4.83 times for a Caprini score of 5–6, 8.84 times for a score of 7–8, and 11.42 times for a score of >8, comparing to ones with a score of 0 to 2 (all p values < 0.05). Thus, the frequency of postoperative VTE rises substantially, according to the advanced Caprini score. Further categorizing patients among the highest risk group need delivering more appropriate thromboprophylaxis.

Prevalence of Risk Factors for VTE In Hospitalized Medical and Surgical Patients. Data From the Comparison of Methods for Thromboembolic Risk Assessment with Clinical Perceptions and AwareneSS In Real Life Surgical and Medical Patients (COMPASS) Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 3337-3337
Author(s):  
Grigoris T Gerotziafas ◽  
Miltos Chrysanthidis ◽  
Reda Isaad ◽  
Hela Baccouche ◽  
Chrysoula Papageorgiou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Gastrointestinal Disease ◽  
Real Life ◽  
Bleeding Risk ◽  
Hospitalized Patients ◽  
Assessment Model ◽  
Surgical Patients ◽  
Medical Patients ◽  
The Impact

Abstract Abstract 3337 Introduction: Risk assessment models (RAM) are helpful tools for the screening VTE risk in hospitalized patients. Most of the available RAMs have been constructed on a disease-based or surgery-based approach and include some of the most relevant risk factors for VTE. There is limited information on the impact and importance of individual and comorbidity related risk factors for VTE present during hospitalization on the global VTE risk. Incorporation of the most frequent VTE risk and bleeding risk factors related to comorbidities might improve the ability of RAM to detect real-life patients at risk VTE and to evaluate drawbacks for the application of thromboprophylaxis. Aim of the study: The primary aim of the COMPASS programme was to evaluate the prevalence of the all known VTE and bleeding risk factors reported in the literature in real-life surgical and medical hospitalized patients. Methods: A prospective multicenter cross-sectional observational study was conducted in 6 hospitals in Greece and 1 in France. All inpatients aged >40 years hospitalised for medical diseases and inpatients aged >18 years admitted due to a surgical procedure and hospitalisation for a period exceeding three days were included. Patients and their treating physicians were interviewed with standardised questionnaire including all VTE and bleeding risk factors described in literature (130 items) on the third day of hospitalisation. Patients not giving informed consent, or receiving anticoagulant treatment for any reason or hospitalised in order to undergo diagnostic investigation without any further therapeutic intervention were excluded. Results: A total of 806 patients were enrolled in the study (414 medical and 392 surgical). Most frequent causes of hospitalisation in medical patients were infection (42%), ischemic stroke (14%), cancer (13%), gastrointestinal disease (9%), pulmonary disease (4%), renal disease (3%) and rheumatologic disease (1,4%). Surgical patients were hospitalised for vascular disease (22%) cancer (19,4%) gastrointestinal disease (12,5%), infection (8%), orthopaedic surgery and trauma (14%) or minor surgery (7%). Analysis of the frequency of risk factors for VTE showed that active cancer, recent hospitalisation, venous insufficiency and total bed rest without bathroom privileges were frequent in both groups. Medical patients had significantly more frequently than surgical patients several important predisposing risk factors for VTE. Moreover, medical patient had more frequently than surgical ones bleeding risk factors. The data for the most frequent risk factors are summarised in Table 1. Conclusion: COMPASS is the first registry that provides key data on the prevalence of all known VTE and bleeding risk factors in real life medical and surgical patients hospitalised in two countries of European Union. The analysis of the data shows that in addition to risk stemin from the disease or surgical act both medical and surgical patients share common VTE risk factors. The careful analysis of the most frequent and relevant VTE risk factors will allow the derivation of a practical VTE and bleeding risk assessment model taken into account these factors. Disclosures: Chrysanthidis: Sanofi-Aventis: Employment.

Preliminary analysis and assessment of breast cancer risk in Japanese women.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e13092-e13092
Author(s):  
Michiyo Yamada ◽  
Takashi Ishikawa ◽  
Sadatoshi Sugae ◽  
Kazutaka Narui ◽  
Eiji Arita ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Risk Assessment ◽  
Family History ◽  
Breast Cancer Risk ◽  
Cancer Risk ◽  
Japanese Women ◽  
Assessment Model ◽  
Risk Assessment Model ◽  
Brinkman Index

e13092 Background: No comprehensive breast cancer risk assessment model for Japanese women exists. Consequently, we have collected Japanese women’s data to investigate key BC risk factors with an objective of deriving a Japanese-women specific BC risk assessment model. Methods: We conducted a retrospective case-control study (paper-based with postal survey) at 15 institutions during 2014-2015. A survey was distributed to Japanese females aged 20-80 who had BC check-up. All pertinent data of a total of 34 factors including demographic and reproductive factors, social history and eating habits was collected. Cases and controls were divided into three groups respectively, premenopausal (PRE; 20 ≤ age < 45), perimenopausal (PERI; 45 ≤ age ≤ 55) and postmenopausal group (POST; 55 < age ≤ 80). Cases and control variables were compared by t-test, chi-square test and Wilcoxon rank sum test. Preliminary BC risk was calculated by logistic regression analysis. Results: A total of 3975 female Japanese datasets were collected, of which 2494 were complete (all variables present) with 1401 controls and 1093 cases were used. There were 222 cases and 332 controls for PRE, 404 cases and 537 controls for PERI, and 467 and 532 controls for POST. The univariate analysis demonstrated that BMI was significantly higher in cases than in controls in all groups (P < 0.01) as was “number of deliveries” in PRE and POST (P < 0.001) and Brinkman index in PRE and PERI (p = 0.017). Multivariate analysis revealed that BC risk was positively associated with BMI (OR 1.080, 95% CI 1.017–1.148, p = 0.012) in PRE, BMI (OR 1.121, 95% CI 1.072–1.174, p < 0.01) and brinkman index (OR 1.000005, 95% CI 1.000002–1.000008, p < 0.01) in PERI, age (OR 1.054, 95% CI 1.028–1.081, p < 0.010), BMI (OR 1.153, 95% CI 1.076-1.171, p < 0.01) and family history (OR 1.497, 95% CI 1.103–2.033, p = 0.001) in POST, while negatively associated with regular exercise (OR 0.672, 95% CI 0.517–0.873, p = 0.003) in POST. Conclusions: BMI in all groups, in addition, the Brinkman index in PERI and age and family history in POST are BC risk factors. Exercise is a protective risk factor in POST. However, the preliminary results are incomplete and further analysis will be conducted before a full risk assessment model is proposed for Japanese women.

Developing a fuzzy risk assessment model for guaranteed maximum price and target cost contracts in South Australia

Facilities ◽  
2014 ◽  
Vol 32 (11/12) ◽  
pp. 624-646 ◽  
Author(s):  
Daniel W.M. Chan ◽  
Joseph H.L. Chan ◽  
Tony Ma
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Construction Projects ◽  
South Australia ◽  
Assessment Model ◽  
Risk Assessment Model ◽  
Content Type ◽  
Risk Levels ◽  
Target Cost ◽  
Fuzzy Risk Assessment

Purpose – This paper aims to develop a fuzzy risk assessment model for construction projects procured with target cost contracts and guaranteed maximum price contracts (TCC/GMP) using the fuzzy synthetic evaluation method, based on an empirical questionnaire survey with relevant industrial practitioners in South Australia. Design/methodology/approach – A total of 34 major risk factors inherent with TCC/GMP contracts were identified through an extensive literature review and a series of structured interviews. A questionnaire survey was then launched to solicit the opinions of industrial practitioners on risk assessment of such risk factors. Findings – The most important 14 key risk factors after the computation of normalised values were selected for undertaking fuzzy evaluation analysis. Five key risk groups (KRGs) were then generated in descending order of importance as: physical risks, lack of experience of contracting parties throughout TCC/GMP procurement process, design risks, contractual risks and delayed payment on contracts. These survey findings also revealed that physical risks may be the major hurdle to the success of TCC/GMP projects in South Australia. Practical implications – Although the fuzzy risk assessment model was developed for those new-build construction projects procured by TCC/GMP contracts in this paper, the same research methodology may be applied to other contracts within the wide spectrum of facilities management or building maintenance services under the target cost-based model. Therefore, the contribution from this paper could be extended to the discipline of facilities management as well. Originality/value – An overall risk index associated with TCC/GMP construction projects and the risk indices of individual KRGs can be generated from the model for reference. An objective and a holistic assessment can be achieved. The model has provided a solid platform to measure, evaluate and reduce the risk levels of TCC/GMP projects based on objective evidence instead of subjective judgements. The research methodology could be replicated in other countries or regions to produce similar models for international comparisons, and the assessment of risk levels for different types of TCC/GMP projects (including new-build or maintenance) worldwide.

scholarly journals Construction Schedule Risk Assessment and Management Strategy for Foreign General Contractors Working in the Ethiopian Construction Industry

2021 ◽  
Vol 13 (14) ◽  
pp. 7830
Author(s):  
Min-Yuan Cheng ◽  
Mohammadzen Hasan Darsa
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Construction Industry ◽  
Management Strategy ◽  
Assessment Model ◽  
Project Schedule ◽  
Schedule Delay ◽  
General Contractors ◽  
Schedule Risk ◽  
Construction Schedule

Construction project schedule delay is a worldwide concern and especially severe in the Ethiopian construction industry. This study developed a Construction Schedule Risk Assessment Model (CSRAM) and a management strategy for foreign general contractors (FGCs). 94 construction projects with schedule delay were collected and a questionnaire survey of 75 domain experts was conducted to systematically select 22 risk factors. In CSRAM, the artificial neural network (ANN) inference model was developed to predict the project schedule delay. Integrating it with the Garson algorithm (GA), the relative weights of risk factors with rankings were calculated and identified. For comparison, the Relative Importance Index (RII) method was also applied to rank the risk factors. Management strategies were developed to improve the three highest-ranked factors identified using the GA (change order, corruption/bribery, and delay in payment), and the RII (poor resource management, corruption/bribery, and delay in material delivery). Moreover, the improvement results were used as inputs for the trained ANN to conduct a sensitivity analysis. The findings of this study indicate that improvements in the factors that considerably affect the construction schedule can significantly reduce construction schedule delays. This study acts as an important reference for FGCs who plan to enter or work in the Ethiopian construction industry.

scholarly journals Application of the Caprini Risk Assessment Model for the Assessment of Risk Factors for Postoperative Venous Thromboembolism in the Surgery Department of Anosiala University Hospital

2021 ◽  
Vol 2 (3) ◽  
pp. 1-7
Author(s):  
Jean Baptiste Ramampisendrahova ◽  
Andriamanantsialonina Andrianony ◽  
Aina Andrianina Vatosoa Rakotonarivo ◽  
Mamisoa Bodohasina Rasamoelina ◽  
Eric Andriantsoa ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Venous Thromboembolism ◽  
Assessment Model ◽  
University Hospital ◽  
Risk Category ◽  
Risk Assessment Model ◽  
Moderate Risk ◽  
Risk Patients ◽  
Surgery Department

The purpose of this research is to ascertain the prevalence of postoperative venous thromboembolism in the Department of Surgery at Anosiala University Hospital and to identify risk factors for developing postoperative venous thromboembolism using the Caprini Risk Assessment Model. From December 2017 to October 2019, this was a 22-month prospective cohort research conducted at Anosiala University Hospital. It included all adult patients over the age of 18 who were operated on in an emergency or on a planned basis by the Department of Surgery. This research included 662 participants. Within 30 days after surgery, the risk of venous thromboembolism was 0.3 percent. According to the overall Caprini score, 25.2 percent of patients were classified as having a low risk of venous thromboembolism, 25.2 percent as having a moderate risk, 29.5 percent as having a high risk, and 20.1 percent as having the greatest risk. Patients in the highest risk category (scoring 5) had a substantially increased chance of having venous thromboembolism after surgery (p = 0.0007). Only major open surgery was related with a statistically significant increase in postoperative venous thromboembolism (p = 0.028). Age 75 years, elective arthroplasty, and hip, pelvic, or leg fractures were not linked with postoperative venous thromboembolism statistically significantly (p> 0.05). Our findings indicate that the Caprini risk assessment model might be used successfully to avoid postoperative venous thromboembolism in surgical patients in Madagascar, since patients in the highest risk category had a considerably increased chance of developing postoperative venous thromboembolism.

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