Human resources allocation in oncologic day hospital: Validation of the Kohen-Gil Deza scale (KGD) for risk assesment.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 6596-6596
Author(s):  
Nelson Kohen ◽  
Ernesto Gil Deza ◽  
Natasha Gercovich ◽  
Eduardo L. Morgenfeld ◽  
Carlos Fernando Garcia Gerardi ◽  
...  

6596 Background: The oncological day hospital (ODH) at IOHM carries out 80 chemotherapies per day with 6 certified oncological nurses as staff. Human resources allocation in oncology has not been formally studied in relation to treatment risks. The objective of this paper is to present a risk assessment model for the rational allocation for human resources in the ODH using the KGD scale. Methods: The KGD scale was designed through a retrospective evaluation of more than 15,000 treatments (Tx). Between November 1st and December 1st, 2012, this instrument was validated with all new patients (Pt) beginning Tx at IOHM. The KGD scale evaluates risk according to: Five Pt characteristics (Elderly, Polymedicated, Without symptom control, Neuropsychiatric problems, Presence or absence of family members); Four Tx characteristics (New drugs, Complex protocol, High risk of acute toxicity, Infrequently used) and workplace context(New personnel, Holiday absences, With or without close medical support). The KGD scale was determined for each Tx and applied as follows: Low Risk (0-3 points): two nurses in the ODH, supervision is at the patient’s request and the chemotherapy can be administered at the beginning or end of the workday; Intermediate Risk (4-5 points): three nurses in the ODH, supervision is mandatory and the treatment can take place at any time in the workday; High Risk(6 or more points): four nurses in the ODH, supervision must be constant and the Tx must take place in the middle of the workday. The chemotherapy outcome was observed. Results: One hundred and thirty patients were admitted. Sex fem 74 (59%), male 56 (41%): age: 49y (range 22-87). Diagnosis: breast 40, colon: 21, lung: 16, ovaries:11, lymphoma: 11, testis:7, sarcoma: 5 ; others: 19 KGD risk assessment: Low Risk 25 pts (19 %); Intermediate Risk 77 pts (59%); High Risk 28 pts (21%). There were no complications in any of the 312 chemotherapy treatments administered to this cohort. Conclusions: 1) The KGD scale has shown to be a useful aid in the treatment risk assessment. 2) Use of the KGD scale allows for an efficient personnel allocation at the ODH according the Tx risk 3) The academic qualification of the nurses staff are mandatory to control the risk.

2018 ◽  
Vol 17 (5) ◽  
pp. 0-10
Author(s):  
Andrew J. Kruger ◽  
Fasika Aberra ◽  
Sylvester M. Black ◽  
Alice Hinton ◽  
James Hanje ◽  
...  

Introduction and aim. Hepatic encephalopathy (HE) is a common complication in cirrhotics and is associated with an increased healthcare burden. Our aim was to study independent predictors of 30-day readmission and develop a readmission risk model in patients with HE. Secondary aims included studying readmission rates, cost, and the impact of readmission on mortality. Material and methods. We utilized the 2013 Nationwide Readmission Database (NRD) for hospitalized patients with HE. A risk assessment model based on index hospitalization variables for predicting 30-day readmission was developed using multivariate logistic regression and validated with the 2014 NRD. Patients were stratified into Low Risk and High Risk groups. Cox regression models were fit to identify predictors of calendar-year mortality. Results. Of 24,473 cirrhosis patients hospitalized with HE, 32.4% were readmitted within 30-days. Predictors of readmission included presence of ascites (OR: 1.19; 95% CI: 1.06-1.33), receiving paracentesis (OR: 1.43; 95% CI: 1.26-1.62) and acute kidney injury (OR: 1.11; 95% CI: 1.00-1.22). Our validated model stratified patients into Low Risk and High Risk of 30-day readmissions (29% and 40%, respectively). The cost of the first readmission was higher than index admission in the 30-day readmission cohort ($14,198 vs. $10,386; p-value < 0.001). Thirty-day readmission was the strongest predictor of calendar-year mortality (HR: 4.03; 95% CI: 3.49-4.65). Conclusions. Nearly one-third of patients with HE were readmitted within 30-days, and early readmission adversely impacted healthcare utilization and calendar-year mortality. With our proposed simple risk assessment model, patients at high risk for early readmissions can be identified to potentially avert poor outcomes.


Open Heart ◽  
2021 ◽  
Vol 8 (2) ◽  
pp. e001725
Author(s):  
Fabio Dardi ◽  
Alessandra Manes ◽  
Daniele Guarino ◽  
Elisa Zuffa ◽  
Alessandro De Lorenzis ◽  
...  

ObjectiveTo optimise treatment of patients with pulmonary arterial hypertension (PAH), the 2015 European Society of Cardiology/European Respiratory Society guidelines recommend using risk stratification, with the aim of patients achieving low-risk status. Previous analyses of registries made progress in using risk stratification approaches, however, the focus is often on patients with a low-risk prognosis, whereas most PAH patients are in intermediate-risk or high-risk categories. Using only six parameters with high prognostic relevance, we aimed to demonstrate a pragmatic approach to individual patient risk assessment to discriminate between patients at low risk, intermediate risk and high risk of death.MethodsRisk assessment was performed combining six parameters in four criteria: (1) WHO functional class, (2) 6 min walk distance, (3) N-terminal pro-brain natriuretic peptide (BNP)/BNP plasma levels or right atrial pressure and (4) cardiac index or mixed venous oxygen saturation. Assessments were made at baseline and at first follow-up after 3–4 months.Results725 PAH treatment-naive patients were analysed. Survival estimates between risk groups were statistically significant at baseline and first follow-up (p<0.001), even when the analysis was performed within PAH etiological subgroups. Similar results were observed in 208 previously treated PAH patients. Furthermore, patients who remained at or improved to low risk had a significantly better estimated survival compared with patients who remained at or worsened to intermediate risk or high risk (p≤0.005).ConclusionThe simplified risk-assessment method can discriminate idiopathic, connective-tissue-disease-associated and congenital-heart-disease-associated PAH patients into meaningful high-risk, intermediate-risk and low-risk groups at baseline and first follow-up. This pragmatic approach reinforces targeting a low-risk profile for PAH patients.


2005 ◽  
Vol 23 (30) ◽  
pp. 7437-7444 ◽  
Author(s):  
Claudi Oude Nijhuis ◽  
Willem A. Kamps ◽  
Simon M.G. Daenen ◽  
Jourik A. Gietema ◽  
Winette T.A. van der Graaf ◽  
...  

Purpose To investigate the feasibility of withholding antibiotics and early discharge for patients with chemotherapy-induced neutropenia and fever at low risk of bacterial infection by a new risk assessment model. Patients and Methods Outpatients with febrile neutropenia were allocated to one of three groups by a risk assessment model combining objective clinical parameters and plasma interleukin 8 level. Patients with signs of a bacterial infection and/or abnormal vital signs indicating sepsis were considered high risk. Based on their interleukin-8 level, remaining patients were allocated to low or medium risk for bacterial infection. Medium-risk and high-risk patients received standard antibiotic therapy, whereas low-risk patients did not receive antibiotics and were discharged from hospital after 12 hours of a febrile observation. End points were the feasibility of the treatment protocol. Results Of 196 assessable episodes, 76 (39%) were classified as high risk, 84 (43%) as medium risk, and 36 (18%) as low risk. There were no treatment failures in the low-risk group (95% CI, 0% to 10%). Therefore, sensitivity of our risk assessment model was 100% (95% CI, 90% to 100%), the specificity, positive, and negative predictive values were 21%, 13%, and 100%, respectively. Median duration of hospitalization was 3 days in the low-risk group versus 7 days in the medium- and high-risk groups (P < .0001). The incremental costs of the experimental treatment protocol amounted to a saving of €471 (US $572) for every potentially low-risk patient. Conclusion This risk assessment model appears to identify febrile neutropenic patients at low risk for bacterial infection. Antibiotics can be withheld in well-defined neutropenic patients with fever.


Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1151-1151
Author(s):  
Caroline M Noone ◽  
Susan O'Shea ◽  
Maeve P Crowley ◽  
John Higgins

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.


2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A C Van Dissel ◽  
A P J Van Dijk ◽  
A L Duijnhouwer ◽  
B J M Mulder ◽  
B J Bouma

Abstract Background Current European guidelines advocate a goal-oriented treatment approach in pulmonary arterial hypertension (PAH), based on a comprehensive risk assessment. However, this instrument has been based predominantly on patients with idiopathic PAH and its accuracy has not been well established for PAH associated with congenital heart disease (CHD)–a patient population known to be distinctly different for other PAH aetiologies. Purpose To investigate the discriminatory ability of the guidelines risk assessment tool and explore the benefit of including other cut-offs or variables in PAH-CHD. Methods and results Data from 112 PAH-CHD patients (age 42.1±16 years, 70% Eisenmenger, 38% Down syndrome) seen between 2004 and 2016 at two specialized adult PAH-CHD expert centres were prospectively collected. Patients were classified as “Low”, “Intermediate”, or “High” risk following the strategy proposed by Kylhammar (Eur Heart J, 2017) based on N-terminal pro-brain natriuretic peptide (NT-proBNP), 6-minute walk distance, functional class and imaging parameters and analysed by Kaplan-Meier method, truncated at 5 years. At baseline, 25% (28) of patients were classified as “Low risk”, 69% (77) as “Intermediate risk” and 6% (7) as “High risk”. Although survival was better (P=0.012) for patients with higher proportions of “Low risk” variables, this method did not discriminate well between the three risk groups (Figure 1A, P=0.371). One-year survival estimates corresponded moderately to those proposed by the guidelines, 96.4% in the “Low risk” (vs. >95%), 94.8% in the “Intermediate risk” (vs. 90–95%), and 85.7% in the “High risk” (vs. <90%) baseline cohorts, respectively. Analysis of different cut-off values for NT-proBNP (i.e., “Low”, “Intermediate”, “High” as <500, 500–1440 and >1400 ng/l, respectively) and use of tricuspid annular plane systolic excursion (TAPSE) measurements (“Low”, “Intermediate”, “High” as <1.6, 2.6–2.7 and >2.7 cm, respectively) as imaging parameter instead of right atrial area improved discrimination between the risk groups (Figure 1B). With these adjustments to the risk assessment tool, survival differed between all three risk groups (P<0.001). Figure 1 Conclusion Our preliminary findings suggest that an updated version of the European guidelines risk assessment tool–with different cut-off values for NT-proBNP and use of TAPSE–discriminates more accurately in the PAH-CHD population. Further analysis will be performed to estimate the prognostic benefit of reaching a “Low risk” profile, as this is the recommended treatment goal.


2021 ◽  
Vol 11 ◽  
Author(s):  
Huijia Yin ◽  
Dongdong Wang ◽  
Ruifang Yan ◽  
Xingxing Jin ◽  
Ying Hu ◽  
...  

ObjectivesThis study aims to evaluate and compare the diagnostic value of DKI and APT in prostate cancer (PCa), and their correlation with Gleason Score (GS).Materials and MethodsDKI and APT imaging of 49 patients with PCa and 51 patients with benign prostatic hyperplasia (BPH) were collected and analyzed, respectively. According to the GS, the patients with PCa were divided into high-risk, intermediate-risk and low-risk groups. The mean kurtosis (MK), mean diffusion (MD) and magnetization transfer ratio asymmetry (MTRasym, 3.5 ppm) values among PCa, BPH, and different GS groups of PCa were compared and analyzed respectively. The diagnostic accuracy of each parameter was evaluated by using the receiver operating characteristic (ROC) curve. The correlation between each parameter and GS was analyzed by using Spearman’s rank correlation.ResultsThe MK and MTRasym (3.5 ppm) values were significantly higher in PCa group than in BPH group, while the MD value was significantly lower than in BPH group. The differences of MK/MD/MTRasym (3.5 ppm) between any two of the low-risk, intermediate-risk, and high-risk groups were all statistically significant (p &lt;0.05). The MK value showed the highest diagnostic accuracy in differentiating PCa and BPH, BPH and low-risk, low-risk and intermediate-risk, intermediate-risk and high-risk (AUC = 0.965, 0.882, 0.839, 0.836). The MK/MD/MTRasym (3.ppm) values showed good and moderate correlation with GS (r = 0.844, −0.811, 0.640, p &lt;0.05), respectively.ConclusionDKI and APT imaging are valuable in the diagnosis of PCa and demonstrate strong correlation with GS, which has great significance in the risk assessment of PCa.


Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 3385-3385
Author(s):  
Mia Djulbegovic ◽  
Kevin Chen ◽  
Soundari Sureshanand ◽  
Sarwat Chaudhry

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.


2021 ◽  
Vol 28 (1) ◽  
Author(s):  
Neda Gholizadeh ◽  
Peter B. Greer ◽  
John Simpson ◽  
Jonathan Goodwin ◽  
Caixia Fu ◽  
...  

Abstract Background Current multiparametric MRI (mp-MRI) in routine clinical practice has poor-to-moderate diagnostic performance for transition zone prostate cancer. The aim of this study was to evaluate the potential diagnostic performance of novel 1H magnetic resonance spectroscopic imaging (MRSI) using a semi-localized adiabatic selective refocusing (sLASER) sequence with gradient offset independent adiabaticity (GOIA) pulses in addition to the routine mp-MRI, including T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI) and quantitative dynamic contrast enhancement (DCE) for transition zone prostate cancer detection, localization and grading. Methods Forty-one transition zone prostate cancer patients underwent mp-MRI with an external phased-array coil. Normal and cancer regions were delineated by two radiologists and divided into low-risk, intermediate-risk, and high-risk categories based on TRUS guided biopsy results. Support vector machine models were built using different clinically applicable combinations of T2WI, DWI, DCE, and MRSI. The diagnostic performance of each model in cancer detection was evaluated using the area under curve (AUC) of the receiver operating characteristic diagram. Then accuracy, sensitivity and specificity of each model were calculated. Furthermore, the correlation of mp-MRI parameters with low-risk, intermediate-risk and high-risk cancers were calculated using the Spearman correlation coefficient. Results The addition of MRSI to T2WI + DWI and T2WI + DWI + DCE improved the accuracy, sensitivity and specificity for cancer detection. The best performance was achieved with T2WI + DWI + MRSI where the addition of MRSI improved the AUC, accuracy, sensitivity and specificity from 0.86 to 0.99, 0.83 to 0.96, 0.80 to 0.95, and 0.85 to 0.97 respectively. The (choline + spermine + creatine)/citrate ratio of MRSI showed the highest correlation with cancer risk groups (r = 0.64, p < 0.01). Conclusion The inclusion of GOIA-sLASER MRSI into conventional mp-MRI significantly improves the diagnostic accuracy of the detection and aggressiveness assessment of transition zone prostate cancer.


2021 ◽  
Vol 13 (2) ◽  
pp. 826
Author(s):  
Meiling Zhou ◽  
Xiuli Feng ◽  
Kaikai Liu ◽  
Chi Zhang ◽  
Lijian Xie ◽  
...  

Influenced by climate change, extreme weather events occur frequently, and bring huge impacts to urban areas, including urban waterlogging. Conducting risk assessments of urban waterlogging is a critical step to diagnose problems, improve infrastructure and achieve sustainable development facing extreme weathers. This study takes Ningbo, a typical coastal city in the Yangtze River Delta, as an example to conduct a risk assessment of urban waterlogging with high-resolution remote sensing images and high-precision digital elevation models to further analyze the spatial distribution characteristics of waterlogging risk. Results indicate that waterlogging risk in the city proper of Ningbo is mainly low risk, accounting for 36.9%. The higher-risk and medium-risk areas have the same proportions, accounting for 18.7%. They are followed by the lower-risk and high-risk areas, accounting for 15.5% and 9.6%, respectively. In terms of space, waterlogging risk in the city proper of Ningbo is high in the south and low in the north. The high-risk area is mainly located to the west of Jiangdong district and the middle of Haishu district. The low-risk area is mainly distributed in the north of Jiangbei district. These results are consistent with the historical situation of waterlogging in Ningbo, which prove the effectiveness of the risk assessment model and provide an important reference for the government to prevent and mitigate waterlogging. The optimized risk assessment model is also of importance for waterlogging risk assessments in coastal cities. Based on this model, the waterlogging risk of coastal cities can be quickly assessed, combining with local characteristics, which will help improve the city’s capability of responding to waterlogging disasters and reduce socio-economic loss.


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