Application of Viscosity Volume Screening Tool as a screening tool in swallowing disorders diagnosis

2018 ◽  
Vol 7 (2) ◽  
pp. 6-10
Author(s):  
Barbara Jamróz ◽  
Magdalena Milewska ◽  
Pere Clave ◽  
Joanna Chmielewska
Keyword(s):  
At Risk ◽  
Treatment Cost ◽  
Screening Tool ◽  
Risk Groups ◽  
Swallowing Disorders ◽  
Screening Tests ◽  
Non Invasive ◽  
Risk Of Mortality ◽  
Patients At Risk ◽  
Instrumental Methods

It is commonly known that dysphagia is associated with primary (malnutrition, dehydration, aspiration pneumonia) as well as secondary consequences (longer hospital stay, increased treatment cost, higher risk of mortality). Therefore screening tests in swallowing disorders, especially at risk groups are essential. The aim of screening is identification of patients at risk of dysphagia and referring patient to further instrumental methods. Test should be non invasive, quick, easy to perform by medical staff, with highest sensitivity and specifity. One of the test is Viscosity – Volume Screening Test (VVST) with 3 different consistencies at 3 volumes (5, 10 and 20 ml), what wider possibilities of these tool in safe consistency and volume indication.

scholarly journals Sarcopenia and Malnutrition Screening in Female Osteoporosis Patients—A Cross-Sectional Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2344
Author(s):  
Franca Genest ◽  
Dominik Rak ◽  
Elisa Bätz ◽  
Kerstin Ott ◽  
Lothar Seefried
Keyword(s):  
At Risk ◽  
Risk Groups ◽  
Cross Sectional Study ◽  
Mineral Density ◽  
Cross Sectional ◽  
Functional Deficits ◽  
Complementary Approach ◽  
Study Results ◽  
Patients At Risk ◽  
Not At Risk

Sarcopenia and malnutrition are important determinants of increased fracture risk in osteoporosis. SARC-F and MNA-SF are well-established questionnaires for identifying patients at risk for these conditions. We sought to evaluate the feasibility and potential added benefit of such assessments as well as the actual prevalence of these conditions in osteoporosis patients. We conducted a cross-sectional, single-center study in female osteoporosis patients ≥ 65 years (SaNSiBaR-study). Results of the sarcopenia (SARC-F) and malnutrition (MNA-SF) screening questionnaires were matched with a functional assessment for sarcopenia and data from patients’ medical records. Out of 107 patients included in the analysis, a risk for sarcopenia (SARC-F ≥ 4 points) and a risk for malnutrition (MNA-SF ≤ 11 points) was found in 33 (30.8%) and 38 (35.5%) patients, respectively. Diagnostic overlap with coincident indicative findings in both questionnaires was observed in 17 patients (16%). As compared to the respective not-at-risk groups, the mean short physical performance battery (SPPB) score was significantly reduced in both patients at risk for sarcopenia (7.0 vs. 10.9 points, p < 0.001) and patients at risk for malnutrition (8.7 vs. 10.5 points, p = 0.005). Still, confirmed sarcopenia according to EWGSOP2 criteria was present in only 6 (6%) of all 107 patients, with only 3 of them having an indicative SARC-F score. Bone mineral density was not significantly different in any of the at-risk groups at any site. In summary, applying SARC-F and MNA-SF in osteoporosis patients appears to be a complementary approach to identify individuals with functional deficits.

scholarly journals Identifying those at risk of reattendance at discharge from emergency departments using explainable machine learning

2020 ◽  
Author(s):  
F. P. Chmiel ◽  
M. Azor ◽  
F. Borca ◽  
M. J. Boniface ◽  
D. K. Burns ◽  
...  
Keyword(s):  
Machine Learning ◽  
At Risk ◽  
Emergency Departments ◽  
Risk Groups ◽  
Machine Learning Algorithms ◽  
Care Indicator ◽  
Number Of Patients ◽  
Increased Risk ◽  
Single Centre Study ◽  
Patients At Risk

ABSTRACTShort-term reattendances to emergency departments are a key quality of care indicator. Identifying patients at increased risk of early reattendance can help reduce the number of patients with missed or undertreated illness or injury, and could support appropriate discharges with focused interventions. In this manuscript we present a retrospective, single-centre study where we create and evaluate a machine-learnt classifier trained to identify patients at risk of reattendance within 72 hours of discharge from an emergency department. On a patient hold-out test set, our highest performing classifier obtained an AUROC of 0.748 and an average precision of 0.250; demonstrating that machine-learning algorithms can be used to classify patients, with moderate performance, into low and high-risk groups for reattendance. In parallel to our predictive model we train an explanation model, capable of explaining predictions at an attendance level, which can be used to help inform the design of interventional strategies.

scholarly journals Non-invasive detection of bladder cancer through the analysis of driver gene mutations and aneuploidy

2017 ◽  
Author(s):  
Simeon Springer ◽  
Maria Del Carmen Rodriguez Pena ◽  
Lu Li ◽  
Christopher Douville ◽  
Yuxuan Wang ◽  
...  
Keyword(s):  
At Risk ◽  
Bladder Cancer ◽  
Gene Mutations ◽  
Urine Samples ◽  
Driver Gene ◽  
Low Grade ◽  
Invasive Approach ◽  
Non Invasive ◽  
Patients At Risk ◽  
Copy Number Changes

AbstractCurrent non-invasive approaches for bladder cancer (BC) detection are suboptimal. We report the development of non-invasive molecular test for BC using DNA recovered from cells shed into urine. This “UroSEEK” test incorporates assays for mutations in 11 genes and copy number changes on 39 chromosome arms. We first evaluated 570 urine samples from patients at risk for BC (microscopic hematuria or dysuria). UroSEEK was positive in 83% of patients that developed BC, but in only 7% of patients who did not develop BC. Combined with cytology, 95% of patients that developed BC were positive. We then evaluated 322 urine samples from patients soon after their BCs had been surgically resected. UroSEEK detected abnormalities in 66% of the urine samples from these patients, sometimes up to 4 years prior to clinical evidence of residual neoplasia, while cytology was positive in only 25% of such urine samples. The advantages of UroSEEK over cytology were particularly evident in low-grade tumors, wherein cytology detected none while UroSEEK detected 67% of 49 cases. These results establish the foundation for a new, non-invasive approach to the detection of BC in patients at risk for initial or recurrent disease.

scholarly journals Identifying patients at risk of readmission for heart failure in the French national claim database

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
P Constantinou ◽  
N Pelletier-Fleury ◽  
V Olié ◽  
C Gastaldi-Ménager ◽  
Y Juillière ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Administrative Data ◽  
Mortality Risk ◽  
Risk Groups ◽  
Claim Database ◽  
Health State ◽  
Hazard Ratios ◽  
Patients At Risk ◽  
Competing Mortality

Abstract Background To reduce readmissions for heart failure (HF) among HF patients, most at-risk individuals could be targeted to benefit from adapted interventions. A better understanding of HF readmission predictors could help clinicians and regulators identify patients most at-risk. We focused, in particular, on distinguishing HF severity from overall health-state severity. Methods We studied predictors of HF readmission available in administrative data in a nationwide cohort of patients aged 65 years or older surviving an index hospitalization for HF in 2015 (N = 70 657). To take into account the competing mortality risk, we estimated subdistribution hazard ratios (sdHRs) of HF readmission and cause-specific hazard ratios (csHRs) for HF readmission and for death without HF readmission, over a 1-year follow-up period. We then computed cumulative incidences and daily rates of HF readmission for specific risk-groups. Results 31.8% of patients were readmitted at least once for HF, among which 27.2% (8.6% of study cohort) were readmitted 30 days after discharge. 17.6% of patients died without any HF readmission. HF severity and overall health-state severity were the strongest HF readmission predictors (sdHRs 2.66 [95% CI: 2.52-2.81] and 1.37 [1.30-1.45] respectively, when comparing extreme categories). HF severity and length of index stay were more strongly associated with the rate (csHRs) of HF readmissions, whereas overall health-state severity and age were more strongly associated with the competing rate of death without HF readmission. Risk-groups defined upon HF severity and overall health-state severity had approximately 40% of separation in HF readmission proportion (21.9% versus 60.4%). Conclusions Our results stress the importance of considering both HF severity and overall morbidity and of accounting for the competing mortality risk to identify patients at-risk of HF readmission. Such patients could benefit from targeted transitional or post-discharge HF care. Key messages Heart failure patients can be stratified into risk-groups of readmission using administrative data. Identifying at-risk patients could help clinicians and regulators to target interventions.

Non Invasive Assessment of Hepatic Fibrosis by Measurement of Liver Stiffness in Post Transfusional Iron Overload: Preliminary Results in 15 Patients.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 3740-3740
Author(s):  
T. Mirault ◽  
D. Lucidarme ◽  
B. Turlin ◽  
Y. Deugnier ◽  
P. Brissot ◽  
...  
Keyword(s):  
At Risk ◽  
Liver Fibrosis ◽  
Iron Overload ◽  
Predictive Value ◽  
Liver Stiffness ◽  
Liver Iron ◽  
Preliminary Results ◽  
Non Invasive ◽  
Patients At Risk ◽  
Severe Fibrosis

Abstract Background: The prognosis of liver iron overload is highly dependent on liver iron content (LIC) and the extent of liver fibrosis. Liver biopsy is the invasive reference method for fibrosis evaluation but with several limitations. Non-invasive biological methods (FibroTest, APRI) are not applicable in blood diseases. Transient elastography (TE) is a new non-invasive and rapid bedside method used to measure liver stiffness.This technique has been extensively studied with success in evaluation of liver fibrosis in HCV infection (Ziol, Hepatology 2005; Castera, Gastroenterology 2005). Until now, no data are available on evaluation of liver fibrosis by TE in highly transfused patients with iron overload. Methods: We assessed liver stiffness (kPa) by elastography measurement (Fibroscan; Echosens, Paris, France). Ishak’s and Metavir’s scales were used to stage fibrosis and hepatitis activity; LIC was measured by atomic absorption spectometry in a central laboratory (Rennes, France) and by MRI procedure according to Gandon (Lancet 2004). Cardiac MRI T2* (indirect estimation of iron heart content) was also measured by MRI according to Anderson (Eur Heart J 2001). Serum ferritin level and HCV serology were assayed in all cases. Correlation statistical analysis used Spearman’s Rho and Pearson tests and mean comparisons were done by a non-parametric Mann-Whitney test. Results: 15 liver samples (weight >1mg except 1) from monthly transfused patients (13 major beta Thalassemia, 1 sickle cell disease, 1 myelodysplastic syndrome) were analyzed. Median age was 37 years (7–75). Histological results were: 3 cirrhosis (METAVIR F=4 (F4), or Ishak’s Staging =6 (IS6)) among 5 patients with severe fibrosis (F3,F4) or (IS4-6) and 10 patients with no or mild fibrosis (F0-2) or (IS0-3). Mean ferritin was 2579 ng/ml CI 95% [1372–3786]. 2 patients were HCV positive. Correlation between LIC and ferritin was 0.82 (p<0,05); between LIC and MRI LIC: 0.88 (p<0,05); LIC and MRI Heart T2*: 0.72(p<0,05); METAVIR F score and Ishak’s grading score: 0.86 (p<0,05). A correlation was also observed between METAVIR F and elastography: 0.60(p<0,05); and mean values of elastography were significally different in patients with severe fibrosis: 9.1kPa CI95% [4.5–13.7] vs 5.9kPa CI95% [4.6–7.2] in those without sever fibrosis (p<0,05) (fig). A value of elastography above 6.25kPa (Se=80%; Sp=70%; AUROC=0.820) identified patients at risk for severe fibrosis (F3,F4 or IS 4–6) (Negative Predictive Value = 88%; Positive Predictive Value = 57%). Conclusion: A significant correlation between Metavir Fibrosis scale and elastography values was found. This new non-invasive method would be helpful to evaluate liver fibrosis and to determine patients who could avoid invasive procedures in particular in regularly transfused low risk myelodysplastic patients at risk of bleeding due to abnormal platelet function. These preliminary results will have to be confirmed in a larger population. Figure Figure

scholarly journals Malnutrition and cachexia among cancer out-patients in Nairobi, Kenya

2017 ◽  
Vol 6 ◽  
Author(s):  
L. U. Kaduka ◽  
Z. N. Bukania ◽  
Y. Opanga ◽  
R. Mutisya ◽  
A. Korir ◽  
...  
Keyword(s):  
At Risk ◽  
Screening Tool ◽  
Point Of Care ◽  
Cross Sectional Study ◽  
Fat Free Mass ◽  
Assessment Tools ◽  
Correct Identification ◽  
Cross Sectional ◽  
Cancer Management ◽  
Patients At Risk

AbstractCancer is the third leading cause of death in Kenya. However, there is scarce information on the nutritional status of cancer patients to guide in decision making. The present study sought to assess the risk of malnutrition, and factors associated with malnutrition and cachexia, among cancer out-patients, with the aim of informing nutrition programmes for cancer management in Kenya and beyond. This was a facility-based cross-sectional study performed at Kenyatta National Hospital and Texas Cancer Centre in Nairobi, Kenya. The risk of malnutrition was assessed using the Malnutrition Universal Screening Tool (MUST). Diagnoses of malnutrition and cachexia were done using the European Society of Clinical Nutrition and Metabolism (ESPEN) and Fearon criteria, respectively. A total of 512 participants were assessed. Those at risk of malnutrition were 33·1 % (12·5 % at medium risk, 20·6 % at high risk). Prevalence of malnutrition was 13·4 %. The overall weight loss >5 % over 3 months was 18·2 % and low fat-free mass index was 43·1 %. Prevalence of cachexia was 14·1 % compared with 8·5 % obtained using the local criteria. Only 18·6 % participants had received any form of nutrition services. Age was a predictor of malnutrition and cachexia in addition to site of cancer for malnutrition and cigarette smoking for cachexia. The use of the MUST as a screening tool at the first point of care should be explored. The predictive value of current nutrition assessment tools, and the local diagnostic criteria for malnutrition and cachexia should be reassessed to inform the development of appropriate clinical guidelines and future capacity-building initiatives that will ensure the correct identification of patients at risk for timely care.

scholarly journals P131: Emergency department falls risk management screening tool comparison

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S121-S122
Author(s):  
R. Tomlinson ◽  
T. Yokota ◽  
P. Jaggi ◽  
C. Kilburn ◽  
D. Bakken ◽  
...  
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Risk Management ◽  
Fall Risk ◽  
Screening Tool ◽  
Assessment Tool ◽  
Tertiary Care ◽  
Screening Tools ◽  
Procedural Sedation ◽  
Patients At Risk

Introduction: Emergency Department (ED) fall risk screening has been newly implemented in Alberta based on Accreditation Canada requirements. Two existing inpatient tools failed to include certain ED risk conditions. One tool graded unconsciousness as no risk for falling, and neither considered intoxication or sedation. This led to the development of a new fall risk management screening tool, the FRM (Tool1). This study compared Tool1 with inpatient utilized Schmid Fall Risk Assessment Tool (Tool2) and the validated Hendrich II Fall Risk Model (Tool3). Methods: Patients (≥17 years old) in a tertiary care adult ED with any of the following; history of falling in the last 12 months, elderly/frail, incontinence, impaired gait, mobility assist device, confusion/disorientation, procedural sedation, intoxication/sedated, or unconscious were included. Forms were randomized to score patients using different paired screening tools: Tool1 paired with either Tool2 or Tool3. Percent agreement (PA) between the tools based on identification of a patient at either risk/no risk for falling; higher PA indicating more tool homogeneity. Results: A total of 928 screening forms were completed within our 8-week study period; 452 and 443 comparing Tool1 to Tool2 and Tool1 to Tool3, respectively. Thirty-two forms included only Tool1 scores, excluding them from comparative analysis. The average patient age (n=895) was 64.8±21.4 years. Tool1 identified 66.4% of patients at risk, whereas Tool2 and Tool3 identified only 19.2% and 31.4%, respectively. Tool1 and 2 had a PA of 50.2%, whereas Tool1 and Tool3 had a PA of 65.9%. Conclusion: The FRM tool had higher agreement with the validated assessment tool, identifying patients at risk for falling but better identified patients presenting with intoxication, need for procedural sedation and unconsciousness. The other tools generally miss these common ED conditions, putting these patients at risk. Validation and reliability assessments of the FRM tool are warranted.

Validation of Serum Aspergillus Galactomannan Index as a Surrogate Endpoint for Outcome of Invasive Aspergillosis: Clinical and Research Implications.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 2861-2861 ◽  
Author(s):  
Gail Woods ◽  
Marisa Miceli ◽  
Monica Grazziutti ◽  
Somashekar Krishna ◽  
Nayyar Syed ◽  
...  
Keyword(s):  
At Risk ◽  
Clinical Outcome ◽  
Invasive Aspergillosis ◽  
Composite Endpoint ◽  
Surrogate Endpoint ◽  
Laboratory Findings ◽  
Hematological Cancer ◽  
Non Invasive ◽  
Patients At Risk ◽  
Neutropenic Patients

Abstract Background: Assessing clinical outcome of aspergillosis with conventional clinical and laboratory criteria is difficult. A composite “global outcome response” (clinical, radiologic, pathologic and microbiologic criteria) is frequently used but suffers from poor sensitivity and specificity, and has not been standardized or validated. A reliable, quantitative, non-invasive, and easy to measure laboratory test than can substitute for this composite endpoint, i.e. serve as a surrogate endpoint for aspergillosis outcome is highly desirable. Galactomannan (GM) is an Aspergillus-specific polysaccharide released during aspergillosis and detected by the serum GM test. The test which is reported as an index of optical density (OD) is an accepted diagnostic marker for aspergillosis and preliminary data suggest a correlation between GM index (GMI) and outcome. Purpose: To evaluate serum GMI as a surrogate endpoint for outcome of invasive aspergillosis in patients with hematological cancer. Patients and Methods: patients at risk for aspergillosis (11/03-2/06) underwent GMI screening during periods at risk. The clinical and laboratory findings of patients with ≥ 2 (+) GMI (OD ≥ 0.5) were reviewed. To validate GMI as a surrogate endpoint for aspergillosis, a k correlation concordance coefficient test between GMI and an objective clinical outcome of aspergillosis (death) was applied. The correlation is considered perfect when k is 1.0; excellent when ≥ 0.75. Results: 30 patients had GMI (+) aspergillosis of the respiratory tract [myeloma 92%; median age: 59 years (27–75); 15 males]. Aspergillosis developed following stem cell transplantation [autologous (11), allogeneic (1)], or after conventional chemotherapy (18). Among 25 neutropenic patients (<1000/ml), persistent GMI elevation was associated with death (5/5 patients) while return to negative values predicted survival (20/20 patients). Among 5 non-neutropenic patients, 1 with persistently elevated GMI died compared to no death among the remaining 4 whose GMI became negative. Overall, the GMI correlated with clinical outcome in all 30 patients with a perfect 1.0 k correlation concordance coefficient. Conclusion: we have validated GMI as an excellent surrogate endpoint for the outcome of invasive aspergillosis among patients with hematological cancer. This FDA-approved test is reproducible, quantitative, non-invasive, easy to measure and widely available. These findings have important implications for patient care and for the design of clinical trials of mould-active antifungal agents.

scholarly journals The DOWN Questionnaire: A Novel Screening Tool for Cervical Spondylotic Myelopathy

2018 ◽  
Vol 9 (6) ◽  
pp. 607-612
Author(s):  
Kaku Barkoh ◽  
Ifije E. Ohiorhenuan ◽  
Larry Lee ◽  
Joshua Lucas ◽  
Anush Arakelyan ◽  
...  
Keyword(s):  
At Risk ◽  
Cervical Spondylotic Myelopathy ◽  
Screening Tool ◽  
Case Control Study ◽  
High Sensitivity ◽  
Case Control ◽  
Advanced Imaging ◽  
Cord Injury ◽  
Patients At Risk ◽  
Control Study

Study Design: Case-control study. Objectives: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord injury in adults aged over 55 years. However, since the onset is typically insidious, accurately diagnosing CSM can be challenging, often requiring referral to a subspecialist and advanced imaging. To help identify patients at risk for CSM, this case-control study compared responses to a series of 4 questions (DOWN questionnaire) in myelopathic and non-myelopathic patients. Methods: Ninety-two patients, 46 with and 46 without myelopathy, were recruited for the study. Each patient answered 4 questions encompassing common symptoms associated with CSM. Responses between patient groups were compared, and Cohen’s κ was used to assess for agreement between responses and the diagnosis of myelopathy. Results: We found a sensitivity of 91% and a κ of 0.54 to 3 positive responses and a sensitivity of 72% and a κ of 0.61 to 4 positive responses. Conclusions: Positive responses to 3 or more DOWN questions has high sensitivity and moderate agreement with the diagnosis of myelopathy based on history, physical exam, and review of advanced imaging by an orthopedic or neurological surgeon. The DOWN questionnaire is a potentially useful screening tool to identify patients at risk for CSM.

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