scholarly journals Validation of HIV Risk Screening Tool to Identify Infected Adults and Adolescents >14 years at Community Level

2021 ◽  
Author(s):  
Kesetebirhan Delele Yirdaw ◽  
Justin Mandala
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Hiv Risk ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Hiv Test ◽  
Risk Assessment Tools ◽  
Hiv Risk Assessment ◽  
Sensitivity Specificity ◽  
Conventional Risk Factors

Abstract Background There are a number of risk factors being used to identify undiagnosed HIV infected adults. As the number of undiagnosed people gets lesser and lesser, it is important to know if existing risk factors and risk assessment tools are valid for use. In this study, we validate existing HIV risk assessment tools and see if they are worth using for HIV case finding among adults who remain undiagnosed. Methods The Tanzania and Zambia Population-Based HIV Impact Assessment (PHIA) household surveys were conducted during 2016. We used adult interview and HIV datasets to assess validity of different HIV risk assessment tools. We first included 12 risk factors (being divorced, separated or widowed (DSW); having an HIV+ spouse; having one of the following within 12 months of the survey: paid work, slept away from home for at least a month, had multiple sexual partners, paid for sex, had sexually transmitted infection (STI), being a tuberculosis (TB) suspect, being very sick for at least 3 months; had ever sold sex; diagnosed with cervical cancer; and had TB disease into a risk assessment tool and assessed its validity by comparing it against HIV test result. Sensitivity, specificity and predictive value of the tool were assessed against the HIV test result. A receiver operator characteristic (ROC) analysis was conducted to determine a suitable cut-off score in order to have a tool with better sensitivity, specificity, and PPV. ROC comparison statistics was used to statistically test equality between AUC (area under the curve) of the different scores. ROC comparison statistics was also used to determine which risk assessment tool was better compared to the tool that contained all risk factors. Results Of 14,820 study participants, 57.8% were men, and had a median age of 30 (IQR: 21-24). HIV prevalence was 2.3% (95% confidence interval (CI): 2.0-2.6). For the tool containing all risk factors, HIV prevalence was 1.0% when none of the risk factors were positive (Score 0) compared to 3.2% when at least one factor (Score ≥1) was present and 8.0% when ≥4 risk factors were present. Sensitivity, specificity, PPV, and NPV were 82.3% (78.6%-85.9%), 41.9% (41.1%-42.7%), 3.2% (2.8%-3.6%), and 99.0% (98.8%-99.3%), respectively. The use of a tool containing conventional risk factors (all except those related with working and sleeping away) was found to have higher AUC compared to the use of all risk factors (p value <0.001), with corresponding sensitivity, specificity, PPV, and NPV of 63.5% (58.9%-68.1%), 66.2% (65.5%-67.0%), 4.2% (3.6%-4.8%), and 98.7% (98.5%-98.9%), respectively. Conclusion Use of a screening tool containing conventional risk factors improved HIV testing yield compared to doing universal testing. Prioritizing people who fulfil multiple risk factors should be explored further to improve HIV testing yield.

scholarly journals Validation of HIV Risk Screening Tool To Identify Infected Adults And Adolescents >14 Years At Community Level

2021 ◽  
Author(s):  
Kesetebirhan Delele Yirdaw ◽  
Justin Mandala
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Hiv Risk ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Hiv Test ◽  
Risk Assessment Tools ◽  
Hiv Risk Assessment ◽  
Sensitivity Specificity ◽  
Conventional Risk Factors

Abstract BackgroundThere are a number of risk factors being used to identify undiagnosed HIV infected adults. As the number of undiagnosed people gets lesser and lesser, it is important to know if existing risk factors and risk assessment tools are valid for use. In this study, we validate existing HIV risk assessment tools and see if they are worth using for HIV case finding among adults who remain undiagnosed. Methods The Tanzania and Zambia Population-Based HIV Impact Assessment (PHIA) household surveys were conducted during 2016. We used adult interview and HIV datasets to assess validity of different HIV risk assessment tools. We first included 12 risk factors (being divorced, separated or widowed (DSW); having an HIV+ spouse; having one of the following within 12 months of the survey: paid work, slept away from home for at least a month, had multiple sexual partners, paid for sex, had sexually transmitted infection (STI), being a tuberculosis (TB) suspect, being very sick for at least 3 months; had ever sold sex; diagnosed with cervical cancer; and had TB disease into a risk assessment tool and assessed its validity by comparing it against HIV test result. Sensitivity, specificity and predictive value of the tool were assessed against the HIV test result. A receiver operator characteristic (ROC) analysis was conducted to determine a suitable cut-off score in order to have a tool with better sensitivity, specificity, and PPV. ROC comparison statistics was used to statistically test equality between AUC (area under the curve) of the different scores. ROC comparison statistics was also used to determine which risk assessment tool was better compared to the tool that contained all risk factors. Results Of 14,820 study participants, 57.8% were men, and had a median age of 30 (IQR: 21-24). HIV prevalence was 2.3% (95% confidence interval (CI): 2.0-2.6). For the tool containing all risk factors, HIV prevalence was 1.0% when none of the risk factors were positive (Score 0) compared to 3.2% when at least one factor (Score ≥1) was present and 8.0% when ≥4 risk factors were present. Sensitivity, specificity, PPV, and NPV were 82.3% (78.6%-85.9%), 41.9% (41.1%-42.7%), 3.2% (2.8%-3.6%), and 99.0% (98.8%-99.3%), respectively. The use of a tool containing conventional risk factors (all except those related with working and sleeping away) was found to have higher AUC compared to the use of all risk factors (p value <0.001), with corresponding sensitivity, specificity, PPV, and NPV of 63.5% (58.9%-68.1%), 66.2% (65.5%-67.0%), 4.2% (3.6%-4.8%), and 98.7% (98.5%-98.9%), respectively. Conclusion Use of a screening tool containing conventional risk factors improved HIV testing yield compared to doing universal testing. Prioritizing people who fulfil multiple risk factors should be explored further to improve HIV testing yield.

scholarly journals POPULATION- SPECIFIC FALL RISK ASSESSMENT TOOLS FOR ADULT INPATIENTS: A SYSTEMISED LITERATURE REVIEW

2020 ◽  
pp. 62-63
Author(s):  
Priya Padmanabhan ◽  
Salumon Chandrasekaran
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Literature Review ◽  
Fall Risk ◽  
Assessment Tool ◽  
Cleveland Clinic ◽  
Assessment Tools ◽  
Fall Risk Assessment ◽  
Specific Risk ◽  
Risk Assessment Tools

Fall is one of the most commonly reported adverse events from the hospitals and around one-third of them result in injury. A carefully tailored fall reduction program begins with the identification of the “at-risk” population. Commonly used adult fall risk assessment tools do not take into consideration the risk factors of some of the vulnerable patient populations. This paper provides a systemised literature review of the need and availability of population-specific risk assessment tools. One of the most commonly used tools - Morse Fall Scale- does not assess the effect of certain medications and population-specific risk factors. The Cleveland Clinic – Capone- Albert (CC-CA) Fall Risk Score is a tool that is specifically developed for cancer patients. Similarly, Obstetric Fall Risk Assessment Tool (OFRAS) helps in identifying the fall risk factors in perinatal women. Usage of such population-specific tools help in focused identification of risks, distinct implementation of interventions and thus, results in reducing the incidents of falls and injuries thereof.

Suicide risk assessment in a large public mental health service: do suicide risk classifications identify those at risk?

2021 ◽  
pp. 103985622098403
Author(s):  
Marianne Wyder ◽  
Manaan Kar Ray ◽  
Samara Russell ◽  
Kieran Kinsella ◽  
David Crompton ◽  
...  
Keyword(s):  
Mental Health ◽  
Risk Factors ◽  
Risk Assessment ◽  
High Risk ◽  
Suicide Risk ◽  
Public Mental Health ◽  
Assessment Tools ◽  
Suicide Risk Assessment ◽  
Public Mental Health Service ◽  
Risk Assessment Tools

Introduction: Risk assessment tools are routinely used to identify patients at high risk. There is increasing evidence that these tools may not be sufficiently accurate to determine the risk of suicide of people, particularly those being treated in community mental health settings. Methods: An outcome analysis for case serials of people who died by suicide between January 2014 and December 2016 and had contact with a public mental health service within 31 days prior to their death. Results: Of the 68 people who had contact, 70.5% had a formal risk assessment. Seventy-five per cent were classified as low risk of suicide. None were identified as being at high risk. While individual risk factors were identified, these did not allow to differentiate between patients classified as low or medium. Discussion: Risk categorisation contributes little to patient safety. Given the dynamic nature of suicide risk, a risk assessment should focus on modifiable risk factors and safety planning rather than risk prediction. Conclusion: The prediction value of suicide risk assessment tools is limited. The risk classifications of high, medium or low could become the basis of denying necessary treatment to many and delivering unnecessary treatment to some and should not be used for care allocation.

Analysis of Cerebral Vascular Lesion Pools in Ischemic Stroke Based on the Analysis and the Prognostic Assessment of Risk Factors in Patients with Primary and Recurrent Ischemic Stroke

2016 ◽  
pp. 65-68
Author(s):  
Oksana Mikitey
Keyword(s):  
Risk Factors ◽  
Risk Assessment ◽  
Ischemic Stroke ◽  
Recurrent Stroke ◽  
Significant Risk ◽  
Vascular Lesion ◽  
Assessment Tools ◽  
Vascular Lesions ◽  
Global Risk ◽  
Risk Assessment Tools

Stroke is an important medical and social problem, and stroke risk assessment tools have difficulty on the interaction of risk factors and the effects of certain risk factors with analysis by age, gender, race, because this information fully available to global risk assessment tools. In addition, these tools tend to be focused and usually do not include the entire range of possible factors contributing. The aim of the study was to conduct a comparison of brain vascular lesions pool with ischemic stroke (II) based predictive analysis and assessment of the main risk factors in patients with primary and recurrent ischemic stroke. Prognostically significant risk factors for recurrent ischemic stroke is not effective antihypertensive therapy, multiple stenoses any one pool vascular brain, duration of hypertension (AH) over 5 years and regular smoking patients (p<0.001). In the initial localization in the second vertebrobasilar recurrent stroke was significantly (p<0.05) more developed in the same pool in women than in men; and the localization of the primary carotid AI in the pool, re-developed stroke often unreliable in the same pool in women than in men.

scholarly journals Novel Approach to Inpatient Fall Risk Prediction and Its Cross-Site Validation Using Time-Variant Data (Preprint)

2018 ◽  
Author(s):  
Insook Cho ◽  
Eun-Hee Boo ◽  
Eunja Chung ◽  
David W. Bates ◽  
Patricia Dykes
Keyword(s):  
Risk Assessment ◽  
Error Rate ◽  
Fall Risk ◽  
Assessment Tool ◽  
Assessment Tools ◽  
Fall Risk Assessment ◽  
C Statistic ◽  
Risk Assessment Tools ◽  
Hospital Days ◽  
Cross Site

BACKGROUND Electronic medical records (EMRs) contain a considerable amount of information about patients. The rapid adoption of EMRs and the integration of nursing data into clinical repositories have made large quantities of clinical data available for both clinical practice and research. OBJECTIVE In this study, we aimed to investigate whether readily available longitudinal EMR data including nursing records could be utilized to compute the risk of inpatient falls and to assess their accuracy compared with existing fall risk assessment tools. METHODS We used 2 study cohorts from 2 tertiary hospitals, located near Seoul, South Korea, with different EMR systems. The modeling cohort included 14,307 admissions (122,179 hospital days), and the validation cohort comprised 21,172 admissions (175,592 hospital days) from each of 6 nursing units. A probabilistic Bayesian network model was used, and patient data were divided into windows with a length of 24 hours. In addition, data on existing fall risk assessment tools, nursing processes, Korean Patient Classification System groups, and medications and administration data were used as model parameters. Model evaluation metrics were averaged using 10-fold cross-validation. RESULTS The initial model showed an error rate of 11.7% and a spherical payoff of 0.91 with a c-statistic of 0.96, which represent far superior performance compared with that for the existing fall risk assessment tool (c-statistic=0.69). The cross-site validation revealed an error rate of 4.87% and a spherical payoff of 0.96 with a c-statistic of 0.99 compared with a c-statistic of 0.65 for the existing fall risk assessment tool. The calibration curves for the model displayed more reliable results than those for the fall risk assessment tools alone. In addition, nursing intervention data showed potential contributions to reducing the variance in the fall rate as did the risk factors of individual patients. CONCLUSIONS A risk prediction model that considers longitudinal EMR data including nursing interventions can improve the ability to identify individual patients likely to fall.

scholarly journals Urban Security and Counterterrorism: An Approach to Proportionality

2021 ◽  
Vol 14 (3) ◽  
pp. 70-85
Author(s):  
Tegg Westbrook ◽  
Thomas Schive
Keyword(s):  
Risk Assessment ◽  
Urban Design ◽  
Assessment Tool ◽  
Dead Reckoning ◽  
Assessment Tools ◽  
Risk Assessments ◽  
Design Strategies ◽  
Risk Assessment Tools ◽  
Urban Security ◽  
Security Returns

As cities and crowded areas increasingly become targets of terrorist plots and attacks, there is ample demand for risk assessment tools that consider proportional measures that reduce the threat, vulnerability, and possible impacts, whilst providing ‘security returns’ for those investments. There is a risk in this process of over- or under-fortifying places based on practitioners’ subjective biases, experiences, dead reckoning and conflicting agendas. Currently, risk assessments rely on qualitative tools that do not consider proportionality that removes these inherent biases. Critiquing well-known urban design strategies and national risk assessments, this article therefore seeks to develop a supplementary assessment tool – an equation for proportionality – that is more objective and is created to help practitioners make good choices, in particular on: (1) reducing the threat, (2) vulnerability, (3) impact, (4) accepting risk, and (5) measuring a security measure’s ability to deter, delay or stop an attack. It concludes that while no assessment is truly objective, the equation works to remove as much subjectivity as possible when assessing proportional urban security.

scholarly journals Tools for Assessing Cardiovascular Disease Risk Factors in Underserved Young Adult Populations: A Systematic Review

2021 ◽  
Vol 18 (24) ◽  
pp. 13305
Author(s):  
Audrey A. Opoku-Acheampong ◽  
Richard R. Rosenkranz ◽  
Koushik Adhikari ◽  
Nancy Muturi ◽  
Cindy Logan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Risk Assessment ◽  
Heart Disease ◽  
Young Adult ◽  
Disease Risk ◽  
Laboratory Data ◽  
Assessment Tools ◽  
Cvd Risk ◽  
Risk Assessment Tools

Cardiovascular disease (CVD, i.e., disease of the heart and blood vessels) is a major cause of death globally. Current assessment tools use either clinical or non-clinical factors alone or in combination to assess CVD risk. The aim of this review was to critically appraise, compare, and summarize existing non-clinically based tools for assessing CVD risk factors in underserved young adult (18–34-year-old) populations. Two online electronic databases—PubMed and Scopus—were searched to identify existing risk assessment tools, using a combination of CVD-related keywords. The search was limited to articles available in English only and published between January 2008 and January 2019. Of the 10,383 studies initially identified, 67 were eligible. In total, 5 out of the 67 articles assessed CVD risk in underserved young adult populations. A total of 21 distinct CVD risk assessment tools were identified; six of these did not require clinical or laboratory data in their estimation (i.e., non-clinical). The main non-clinically based tools identified were the Heart Disease Fact Questionnaire, the Health Beliefs Related to CVD-Perception measure, the Healthy Eating Opinion Survey, the Perception of Risk of Heart Disease Scale, and the WHO STEPwise approach to chronic disease factor surveillance (i.e., the STEPS instrument).

scholarly journals Fall Risk Assessment Scales: A Systematic Literature Review

2021 ◽  
Vol 11 (2) ◽  
pp. 430-443
Author(s):  
Veronica Strini ◽  
Roberta Schiavolin ◽  
Angela Prendin
Keyword(s):  
Risk Assessment ◽  
Fall Risk ◽  
Assessment Tool ◽  
Public Health Problem ◽  
Assessment Tools ◽  
Major Public Health Problem ◽  
Simultaneous Application ◽  
Fall Risk Assessment ◽  
Depth Analysis ◽  
Risk Assessment Tools

Background: Falls are recognized globally as a major public health problem. Although the elderly are the most affected population, it should be noted that the pediatric population is also very susceptible to the risk of falling. The fall risk approach is the assessment tool. There are different types of tools used in both clinical and territorial settings. Material and methods: In the month of January 2021, a literature search was undertaken of MEDLINE, CINHAL and The Cochrane Database, adopting as limits: last 10 years, abstract available, and English and Italian language. The search terms used were “Accidental Falls” AND “Risk Assessment” and “Fall Risk Assessment Tool” or “Fall Risk Assessment Tools”. Results: From the 115 selected articles, 38 different fall risk assessment tools were identified, divided into two groups: the first with the main tools present in the literature, and the second represented by tools of some specific areas, of lesser use and with less supporting literature. Most of these articles are prospective cohort or cross-sectional studies. All articles focus on presenting, creating or validating fall risk assessment tools. Conclusion: Due to the multidimensional nature of falling risk, there is no “ideal” tool that can be used in any context or that performs a perfect risk assessment. For this reason, a simultaneous application of multiple tools is recommended, and a direct and in-depth analysis by the healthcare professional is essential.

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