Beyond the Flowsheet: A Text Mining Study of Hospital-Acquired Falls (Preprint)

2021 ◽  
Author(s):  
Ragnhildur Bjarnadottir ◽  
David Lindberg ◽  
Avirup Chakraborty ◽  
Mattia Prosperi ◽  
Marsha Crane ◽  
...  
Keyword(s):  
Risk Factors ◽  
Text Mining ◽  
Environmental Factors ◽  
Registered Nurses ◽  
Improve Patient Safety ◽  
Patient Factors ◽  
Dictionary Matching ◽  
Patient Falls ◽  
Progress Notes ◽  
Hospital Acquired

BACKGROUND Around 1 million patients fall in US hospitals annually, with an associated direct medical cost of $50 billion dollars. Substantial nationwide efforts to reduce hospital falls in the past decade have yet to produce sustained results. This may in part be due to limited understanding of fall risk factors and overreliance on limited data. OBJECTIVE The purpose of our study was to explore text patterns associated with patient falls in a previously understudied data source: registered nurses’ electronic health record progress notes. METHODS This study employed supervised and unsupervised text-mining methods using data from medical/surgical units in a large academic health center in North Florida between 2013 and 2015. The data corpus consisted of registered nurses’ progress notes for patient cases who fell during their hospitalization and patient controls who were at risk during the same period but did not fall. RESULTS The analytical sample comprised of 107,842 progress notes for 2,171 patients (734 fallers and 1,437 non-fallers who had registered nurses’ progress notes documented during their stay). Supervised text-mining with dictionary matching revealed significantly more frequent documentation of cognitive patient factors and environmental factors in fallers’ progress notes compared to non-fallers. Unsupervised text-mining through topic modelling highlighted text patterns indicative of workflow or communication factors. Predictive models for both supervised and unsupervised text-mining features were developed, with an F1 score ranging from 0.184-0.591. CONCLUSIONS Findings of this study indicate that registered nurses’ progress notes contain factors associated with risk of falling that may not be captured in structured data. These include environmental factors, cognitive patient factors, and factors related to documentation practices. The findings highlight previously under-examined risk factors for hospital-acquired falls and can be used for hypothesis generation for further clinical research to prevent falls and improve patient safety at the bedside.

scholarly journals Infectious events in patients with severe COVID-19: results of a cohort of patients with high prevalence of underlying immune defect

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anastasia Saade ◽  
Giulia Moratelli ◽  
Guillaume Dumas ◽  
Asma Mabrouki ◽  
Jean-Jacques Tudesq ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cumulative Incidence ◽  
Cumulative Risk ◽  
Incidence Density ◽  
Hospital Acquired Infections ◽  
Underlying Malignancy ◽  
Single Center Study ◽  
High Prevalence ◽  
Immune Defect ◽  
Hospital Acquired

Abstract Background Empirical antibiotic has been considered in severe COVID-19 although little data are available regarding concomitant infections. This study aims to assess the frequency of infections, community and hospital-acquired infections, and risk factors for infections and mortality during severe COVID-19. Methods Retrospective single-center study including consecutive patients admitted to the intensive care unit (ICU) for severe COVID-19. Competing-risk analyses were used to assess cumulative risk of infections. Time-dependent Cox and fine and gray models were used to assess risk factors for infections and mortality. Propensity score matching was performed to estimate the effect of dexamethasone. Results We included 100 patients including 34 patients with underlying malignancies or organ transplantation. First infectious event was bacterial for 35 patients, and fungal for one. Cumulative incidence of infectious events was 27% [18–35] at 10 ICU-days. Prevalence of community-acquired infections was 7% [2.8–13.9]. Incidence density of hospital-acquired infections was 125 [91–200] events per 1000 ICU-days. Risk factors independently associated with hospital-acquired infections included MV. Patient’s severity and underlying malignancy were associated with mortality. Dexamethasone was associated with increased infections (36% [20–53] vs. 12% [4–20] cumulative incidence at day-10; p = 0.01). After matching, dexamethasone was associated with hospital-acquired infections (35% [18–52] vs. 13% [1–25] at 10 days, respectively, p = 0.03), except in the subset of patients requiring MV, and had no influence on mortality. Conclusions In this population of COVID-19 patients with high prevalence of underlying immune defect, a high risk of infections was noted. MV and use of steroids were independently associated with infection rate.

scholarly journals 31.B. Workshop: Public health and urban design: an interdisciplinary approach to promote autism friendly environments

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
◽  
Keyword(s):  
Public Health ◽  
Risk Factors ◽  
Environmental Factors ◽  
Built Environment ◽  
Urban Design ◽  
Significant Role ◽  
Prevalence Rates ◽  
Environmental Characteristics ◽  
The Relationship

Abstract Autism is a set of heterogeneous neurodevelopmental conditions, characterised by early-onset difficulties in social communication and restricted, repetitive behaviour and interests. The worldwide population prevalence is about 1% with an increasing incidence and prevalence rates. Autism affects more male than female individuals, and comorbidity is common (>70% have concurrent conditions). Determinants of these changes in incidence and prevalence rates may also be related to exposure to environmental factors and to modifications in diagnostic concepts and criteria. In spite of the uncertainty in determinants of incidence of autisms, there is evidence that environmental characteristics play a significant role both as autism risk factors and as potential obstacles that influence the capabilities of autonomously and fully “using” everyday spaces. The workshop aims to provide a framework on risk factors of autism and explore the relationship with the built environment, focusing on the quality of the everyday spaces and projecting the effects that it could have in the long term on achieving a desirable level of quality of life. The 11th Sustainable Development Goals of United Nations “Make cities inclusive, safe, resilient and sustainable” underlines the necessity of designing policies and projects acting to enhance and promote healthy cities and communities by addressing the needs of the most vulnerable groups of inhabitants. Herewith we bring together the discipline of Public Health and Urban Design to promote an interdisciplinary debate on a little explored topic investigating how the approaches adopted during childhood to promote the wellbeing of people with ASD can be related or strengthen by focusing also on built environment design intervention to pursue and reach the same objectives even during adulthood. The workshop will consist of four presentations. The first focuses on giving an overview on current knowledge of intervention for people with autism, presenting also criteria for evidence-based interventions. The second explores the relationship between autism and built environment by providing an exhaustive framework of the available research literature in order to identify a first set of spatial requirements for autism friendly cities. The third examines the impact of built environment on ASD users with the aim of developing a specific evaluation tool for healthcare spaces and best practices formulation according to the specific sensorial hypo- or hyper-activation of people with autism. Finally, the fourth reports the results of a two years Research & Development project called “GAP REDUCE” finalized at developing an Assistive Technology tool to support people with ASD, adult and high-functioning, to plan urban itineraries towards daily destinations. Key messages World's incidence of autism is about 1% with an increasing incidence whose determining rates may also be related to environmental factors and to modifications in diagnostic concepts and criteria. Environmental characteristics play a significant role also as potential obstacles that influence the capabilities of people with autism of autonomously and fully “using” everyday spaces.

The relative and interactive impact of multiple risk factors in schizophrenia spectrum disorders: a combined register-based and clinical twin study

2021 ◽  
pp. 1-11
Author(s):  
C. Lemvigh ◽  
R. Brouwer ◽  
R. Hilker ◽  
S. Anhøj ◽  
L. Baandrup ◽  
...  
Keyword(s):  
Risk Factors ◽  
Environmental Factors ◽  
Childhood Trauma ◽  
Cannabis Use ◽  
Paternal Age ◽  
Interactive Effects ◽  
Polygenic Risk Score ◽  
Multiple Risk Factors ◽  
Schizophrenia Spectrum ◽  
Multiple Risk

Abstract Background Research has yielded evidence for genetic and environmental factors influencing the risk of schizophrenia. Numerous environmental factors have been identified; however, the individual effects are small. The additive and interactive effects of multiple risk factors are not well elucidated. Twin pairs discordant for schizophrenia offer a unique opportunity to identify factors that differ between patients and unaffected co-twins, who are perfectly matched for age, sex and genetic background. Methods Register data were combined with clinical data for 216 twins including monozygotic (MZ) and dizygotic (DZ) proband pairs (one or both twins having a schizophrenia spectrum diagnosis) and MZ/DZ healthy control (HC) pairs. Logistic regression models were applied to predict (1) illness vulnerability (being a proband v. HC pair) and (2) illness status (being the patient v. unaffected co-twin). Risk factors included: A polygenic risk score (PRS) for schizophrenia, birth complications, birth weight, Apgar scores, paternal age, maternal smoking, season of birth, parental socioeconomic status, urbanicity, childhood trauma, estimated premorbid intelligence and cannabis. Results The PRS [odds ratio (OR) 1.6 (1.1–2.3)], childhood trauma [OR 4.5 (2.3–8.8)], and regular cannabis use [OR 8.3 (2.1–32.7)] independently predicted illness vulnerability as did an interaction between childhood trauma and cannabis use [OR 0.17 (0.03–0.9)]. Only regular cannabis use predicted having a schizophrenia spectrum diagnosis between patients and unaffected co-twins [OR 3.3 (1.1–10.4)]. Conclusion The findings suggest that several risk factors contribute to increasing schizophrenia spectrum vulnerability. Moreover, cannabis, a potentially completely avoidable environmental risk factor, seems to play a substantial role in schizophrenia pathology.

scholarly journals Effects of Behavioral Risk Factors and Social-Environmental Factors on Non-Communicable Diseases in South Korea: A National Survey Approach

2021 ◽  
Vol 18 (2) ◽  
pp. 612
Author(s):  
Nam Jeong Jeong ◽  
Eunil Park ◽  
Angel P. del Pobil
Keyword(s):  
Risk Factors ◽  
Environmental Factors ◽  
South Korea ◽  
Communicable Diseases ◽  
Behavioral Risk Factors ◽  
Behavioral Risk ◽  
Non Communicable Diseases ◽  
Path Analyses ◽  
Social Environmental ◽  
Social Environmental Factors

Non-communicable diseases (NCDs) are one of the major health threats in the world. Thus, identifying the factors that influence NCDs is crucial to monitor and manage diseases. This study investigates the effects of social-environmental and behavioral risk factors on NCDs as well as the effects of social-environmental factors on behavioral risk factors using an integrated research model. This study used a dataset from the 2017 Korea National Health and Nutrition Examination Survey. After filtering incomplete responses, 5462 valid responses remained. Items including one’s social-environmental factors (household income, education level, and region), behavioral factors (alcohol use, tobacco use, and physical activity), and NCDs histories were used for analyses. To develop a comprehensive index of each factor that allows comparison between different concepts, the researchers assigned scores to indicators of the factors and calculated a ratio of the scores. A series of path analyses were conducted to determine the extent of relationships among NCDs and risk factors. The results showed that social-environmental factors have notable effects on stroke, myocardial infarction, angina, diabetes, and gastric, liver, colon, lung, and thyroid cancers. The results indicate that the effects of social-environmental and behavioral risk factors on NCDs vary across the different types of diseases. The effects of social-environmental factors and behavioral risk factors significantly affected NCDs. However, the effect of social-environmental factors on behavioral risk factors was not supported. Furthermore, social-environmental factors and behavioral risk factors affect NCDs in a similar way. However, the effects of behavioral risk factors were smaller than those of social-environmental factors. The current research suggests taking a comprehensive view of risk factors to further understand the antecedents of NCDs in South Korea.

An improved text mining approach to extract safety risk factors from construction accident reports

2021 ◽  
Vol 138 ◽  
pp. 105216
Author(s):  
Na XU ◽  
Ling MA ◽  
Qing Liu ◽  
Li WANG ◽  
Yongliang Deng
Keyword(s):  
Risk Factors ◽  
Text Mining ◽  
Safety Risk

scholarly journals Risk factors and biofilm formation analyses of hospital-acquired infection of Candida pelliculosa in a neonatal intensive care unit

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zhijie Zhang ◽  
Yu Cao ◽  
Yanjian Li ◽  
Xufang Chen ◽  
Chen Ding ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Biofilm Formation ◽  
Prevention And Control ◽  
Neonatal Intensive Care ◽  
Infection Prevention ◽  
Infection Prevention And Control ◽  
Anti Fungal ◽  
Hospital Acquired ◽  
And Control

Abstract Background Candida pelliculosa is an ecological fungal species that can cause infections in immunocompromised individuals. Numerous studies globally have shown that C. pelliculosa infects neonates. An outbreak recently occurred in our neonatal intensive care unit; therefore, we aimed to evaluate the risk factors in this hospital-acquired fungal infection. Methods We performed a case-control study, analysing the potential risk factors for neonatal infections of C. pelliculosa so that infection prevention and control could be implemented in our units. Isolated strains were tested for drug resistance and biofilm formation, important factors for fungal transmission that give rise to hospital-acquired infections. Results The use of three or more broad-spectrum antimicrobials or long hospital stays were associated with higher likelihoods of infection with C. pelliculosa. The fungus was not identified on the hands of healthcare workers or in the environment. All fungal isolates were susceptible to anti-fungal medications, and after anti-fungal treatment, all infected patients recovered. Strict infection prevention and control procedures efficiently suppressed infection transmission. Intact adhesin-encoding genes, shown by genome analysis, indicated possible routes for fungal transmission. Conclusions The use of three or more broad-spectrum antimicrobials or a lengthy hospital stay is theoretically associated with the risk of infection with C. pelliculosa. Strains that we isolated are susceptible to anti-fungal medications, and these were eliminated by treating all patients with an antifungal. Transmission is likely via adhesion to the cell surface and biofilm formation.

‘Genetics load the gun, but the environment pulls the trigger’: novel, emerging and non-traditional risk factors in cardiovascular disease

2021 ◽  
pp. 1-3
Author(s):  
Andrew Richardson
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Environmental Factors ◽  
Individual Risk ◽  
Traditional Risk Factors ◽  
Individual Risk Factors ◽  
The Impact

In this article, Andy Richardson, BANCC Educational Advisor, examines several important environmental and individual risk factors for cardiovascular disease. Following on from the meeting of Global Leaders at COP26 in Glasgow, he considers the impact of, and exposure to, environmental factors, including pollution and noise.

Risk factors for hospital-acquired bacteraemia – an explorative case–control study of hospital interventions

2021 ◽  
pp. 1-8
Author(s):  
Viggo Holten Mortensen ◽  
Mette Søgaard ◽  
Brian Kristensen ◽  
Lone Hagens Mygind ◽  
Henrik Carl Schønheyder
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Case Control ◽  
Hospital Acquired ◽  
Control Study

New Persistent Opioid Use and Associated Risk Factors Following Treatment of Ankle Fractures

2019 ◽  
Vol 40 (9) ◽  
pp. 1043-1051 ◽  
Author(s):  
Timothy D. Gossett ◽  
Fred T. Finney ◽  
Hsou Mei Hu ◽  
Jennifer F. Waljee ◽  
Chad M. Brummett ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Ankle Fracture ◽  
Opioid Use ◽  
Patient Factors ◽  
Distal Fibula ◽  
Opioid Prescription ◽  
Opioid Dose ◽  
Closed Treatment ◽  
Open Treatment

Background:The aim of this study was to define the rate of new persistent opioid use and risk factors for persistent opioid use after operative and nonoperative treatment of ankle fractures.Methods:Using a nationwide insurance claims database, Clinformatics DataMart Database, we identified opioid-naïve patients who underwent surgical treatment of unstable ankle fracture patterns between January 2009 and June 2016. Patients who underwent closed treatment of a distal fibula fracture served as a comparative group. We evaluated peritreatment and posttreatment opioid prescription fills. The primary outcome, new persistent opioid use, was defined as opioid prescription fulfillment between 91 and 180 days after the procedure. Logistic regression was used to evaluate the effect of patient factors, and the differences of the effect were tested using Wald statistics. The adjusted persistent use rates were calculated. A total of 13 088 patients underwent treatment of an ankle fracture and filled a peritreatment opioid prescription.Results:When compared with closed treatment of a distal fibula fracture, only 2 surgical treatment subtypes demonstrated significantly increased rates of persistent use compared with the closed treatment group: open treatment of bimalleolar ankle fracture (adjusted odds ratio [aOR], 1.32; 95% CI, 1.10-1.58; P = .002) and open treatment of trimalleolar ankle fracture with fixation of posterior lip (aOR, 1.47; 95% CI, 1.04-2.07; P = .027). Rates were significantly increased (aOR, 1.56; 95% CI, 1.34-1.82; P < .001) among patients who received a total peritreatment opioid dose that was in the top 25th percentile of total oral morphine equivalents. Factors independently associated with new persistent opioid use included mental health disorders, comorbid conditions, tobacco use, and female sex.Conclusion:All ankle fracture treatment groups demonstrated high rates of new persistent opioid use, and persistent use was not directly linked to injury severity. Instead, we identified patient factors that demonstrated increased risk of persistent opioid use. Limiting the peritreatment opioid dose was the largest modifiable risk factor related to new persistent opioid use in this privately insured cohort.Level of Evidence:Level III, retrospective cohort study.

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