A review of literature on risk prediction tools for hospital readmissions in older adults

Purpose The purpose of this paper is to identify and analyse the readmission risk prediction tools reported in the literature and their benefits when it comes to healthcare organisations and management.Design/methodology/approach Readmission risk prediction is a growing topic of interest with the aim of identifying patients in particular those suffering from chronic diseases such as congestive heart failure, chronic obstructive pulmonary disease and diabetes, who are at risk of readmission. Several models have been developed with different levels of predictive ability. A structured and extensive literature search of several databases was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis strategy, and this yielded a total of 48,984 records.Findings Forty-three articles were selected for full-text and extensive review after following the screening process and according to the eligibility criteria. About 34 unique readmission risk prediction models were identified, in which their predictive ability ranged from poor to good (c statistic 0.5–0.86). Readmission rates ranged between 3.1 and 74.1% depending on the risk category. This review shows that readmission risk prediction is a complex process and is still relatively new as a concept and poorly understood. It confirms that readmission prediction models hold significant accuracy at identifying patients at higher risk for such an event within specific context.Research limitations/implications Since most prediction models were developed for specific populations, conditions or hospital settings, the generalisability and transferability of the predictions across wider or other contexts may be difficult to achieve. Therefore, the value of prediction models remains limited to hospital management. Future research is indicated in this regard.Originality/value This review is the first to cover readmission risk prediction tools that have been published in the literature since 2011, thereby providing an assessment of the relevance of this crucial KPI to health organisations and managers.

Soil loss estimation and severity mapping using RUSLE model and GIS: a case study in Megech Watershed, Ethiopia

AbstractBackground: Soil erosion is the most serious problem that affects economic development, food security, and ecosystem services which is the main concern in Ethiopia. This study focused on quantifying soil erosion rate and severity mapping of the Megech watershed for effective planning and decision-making processes to implement protection measures. The RUSLE model integrated with ArcGIS software was used to conduct the present study. The six RUSLE model parameters: erosivity, erodibility, slope length and steepness, cover management, and erosion control practices were used as input parameters to predict the average annual soil loss and identify erosion hotspots in the watershed. Results: The RUSLE estimated 1,399,210 tons yr-1 total soil loss from the watershed with a mean annual soil loss of 32.84 tons ha-1yr-1. The soil erosion rate was varied from 0.08 to greater than 500 tons ha-1yr-1. A severity map with seven severity classes was created for 27 sub-watersheds: low (below 10), moderate (10-20), high (20-30), very high (30-35), severe (35-40), very severe (40-45) and extremely severe (above 45) in which the values are in tons ha-1yr-1. The area coverage was 6.5%, 11.1%, 8.7%, 22%, 30.9%, 13.4%, and 7.4% for low, moderate, high, very high, severe, very severe, and extremely severe erosion classes respectively. Conclusion: About 82 % of the watershed was found in more than the high-risk category which reflects the need for immediate land management action. This paper could be important for decision-makers to prioritize critical erosion hotspot areas for comprehensive and sustainable management of the watershed.

The Italian strategy to fight illegal treatment with growth promoters: Results of the 2017-2019 histological monitoring plan

The Histological Control Plan has been introduced in Italy in 2008 as an indirect monitoring tool of illicit administration of sexual hormones and corticosteroids in bovine. Analysis of 2008-2016 results permitted to draw a new plan targeting risk category. This work presents the results of the histopathological monitoring plan that was carried out from 2017 to 2019. The overall prevalence of samples suspected of treatment with corticosteroid was 11.3% [95% confidence interval (CI) 6.6-17.8] in 2017; 10.2% (95% CI 6.6-16.9) in 2018 and 8.9% (95% CI 4.6-15.4) in 2019. The overall prevalence of samples suspected of treatment with sexual hormones was 2.3 % (95% CI 0.5-6.6) in 2017; 6.2% (95% CI 2.7-11.8) in 2018 and 12.4% (95% CI 7.4- 19.1) in 2019. Although not targeting and measuring specific molecules, this strategy allows to verify the trend of illicit treatments and identify farms to be submitted to further check.

Training of Cadres In The Context of Emergency Identification of Pregnant Women During The Covid 19 Pandemic

The Covid-19 pandemic has changed many things, including the policy direction for the schedule of examinations for pregnant women, which was initially at least four times during pregnancy to one time, as long as the pregnancy is not problematic. In the midst of the COVID-19 pandemic, many pregnant women are reluctant to check their pregnancy at the hospital for fear of contracting the Corona virus, even though pregnancy checks still need to be carried out regularly. The purpose of this community service is to provide training to health cadres regarding emergencies in pregnancy so that cadres can provide assistance in order to identify emergency conditions during pregnancy during the COVID-19 pandemic. The method of activities carried out is cadre training and assistance to pregnant women. The results showed that after the training activities, the level of knowledge of cadres on emergency services in pregnant women increased and pregnant women in the high risk category were 53.7%. In conclusion, this community service program has succeeded in increasing the knowledge of cadres in assisting pregnant women during the COVID-19 pandemic.

A new perspective on musculoskeletal disorders – emerging ergonomic risks in the European Union and Romania

According to the European Agency for Health and Safety at Work, changes in employment arrangements, new technologies and an increasing ageing population are key sources of emerging risks. New and emerging risks should be a major area of interest for every organisation, as a thorough risk prevention activity is key to high organisation efficiency and increased employee wellbeing. Musculoskeletal disorders (MSDs) are not a new risk category by themselves, but the changing characteristics of the work system generate new types of MSDs as a profession-related pathology (work-related MSDs). There is limited literature on this matter, hence the paper provides relevant insights and a new perspective on ergonomic risks and MSDs. Also, the paper presents a comparative analysis of ergonomic risks in the EU and Romania – based on secondary data – and identifies emerging risks in this category.

Main environmental variables influencing the abundance of plant species under risk category

Determining climatic and physiographic variables in Mexico's major ecoregions that are limiting to biodiversity and species of high conservation concern is essential for their conservation. Yet, at the national level to date, few studies have been performed with large data sets and cross-confirmation using multiple statistical analyses. Here, we used 25 endemic, rare and endangered species from 3610 sampling points throughout Mexico and 25 environmental attributes, including average precipitation for different seasons of the year, annual dryness index, slope of the terrain; and maximum, minimum and average temperatures to test our hypothesis that these species could be assessed with the same weight among all variables, showing similar indices of importance. Our results using principal component analysis, covariation analysis by permutations, and random forest regression showed that summer precipitation, length of the frost-free period, spring precipitation, winter precipitation and growing season precipitation all strongly influence the abundance of tropical species. In contrast, annual precipitation and the balance at different seasons (summer and growing season) were the most relevant variables on the temperate region species. For dry areas, the minimum temperature of the coldest month and the maximum temperature of the warmest month were the most significant variables. Using these different associations in different climatic regions could support a more precise management and conservation plan for the preservation of plant species diversity in forests under different global warming scenarios.

Uncertainty Handling in Genetic Risk Assessment and Counseling

In this paper, we consider genetic risk assessment and genetic counseling for breast cancer from the point of view of reliable uncertainty handling. In medical practice, there exist fairly accurate numerical tools predicting breast cancer (or gene mutation) probability based on such factors as the family history of a patient. However, they are too complex to be applied in normal doctors’ offices, so that several simplified, questionnaire-type support tools appeared. This process is highly affected by uncertainty. At the same time, reliability of test interpretations and counseling conclusions is especially important since they have direct influence on humans and their decisions. We show how expert opinions on mutation probabilities can be combined using the Dempster-Shafer theory. Based on multi-criteria binary decision trees and interval analysis, we combine the referral screening tool designed to determine patients at risk of breast cancer (and recommend genetic counseling or testing for them) with three further risk assessment tools available for this purpose. A patient’s confidence in the outcome of a genetic counseling session can be heightened by the proposed method since it combines different sources to provide score ranges leading to more information. Finally, based on this approach, a decision tree for assigning a risk category is proposed which enhances the existing methodology. The great impact of epistemic uncertainty is reflected through large overlapping intervals for the risk classes.

Risk-Oriented Approach in the Implementation of Control and Supervision Activities: Theoretical Justification and Problems of Application

The article discusses the theoretical justification of the risk-based approach in the implementation of state control and supervision, and also highlights the problems of the practical use of this approach in the context of the reform of control and supervision activities. The author compares the positions regarding the risk category in economic and legal studies, justifies the growing interest in the use of risk technologies in public administration. An analysis of the use of the risk category in the legal and regulatory field allows us to distinguish two positions in relation to risk: risk as a possible occurrence of an event that has a negative effect, and risk as the probability of its occurrence. The risk institute belongs to the general theory of law and at the same time finds development in industry research. In modern conditions, the law is inherent in the task of preventing, overcoming and minimizing risks in various areas of social reality with their simultaneous recognition and assumption. The author considers the evolution of the application of the risk management system in the implementation of customs and tax control, substantiates the transformation of its interpretation. Based on the analysis, it is concluded that the risk-based approach in relation to the system of state control and supervision should be interpreted as the principle of a modern system of state control and supervision; the condition of its selectivity and sufficiency; means of reducing the administrative burden on the controlled sphere; a means of stimulating the controlled sphere in a given direction and a modern method of organizing and implementing state control and supervision. Narrow and broad approaches in positioning risks in the implementation of state control and supervision are highlighted. In the first case, risk is understood as the probability of non-compliance with mandatory requirements. A broad approach involves two factors: the likelihood of non-compliance and the consequences of such non-compliance. A characteristic is given to such characteristics of a risk-based approach in the implementation of state control and supervision: staging, agile, stimulating the preventive component of state control and supervision, the development of interagency cooperation, the connection with the digitalization of control and surveillance activities. The following are identified as the problems of applying the risk-based approach in the implementation of state control and supervision: the problems of developing and using criteria for the risk categorization of controlled persons, correlating these criteria with indicators of the effectiveness and efficiency of control and supervision activities; lack of correlation between control and supervisory procedures and proceedings on administrative offenses; the problem of using the category of good faith in the implementation of control and supervision activities and others. Solving the identified problems will improve the effectiveness of state control and supervision in modern conditions.

Carbon Monoxide Diffusion Capacity as a Severity Marker in Pulmonary Hypertension

Carbon monoxide diffusion capacity (DLCO) is negatively associated with patient survival in idiopathic pulmonary hypertension (PH), but is not included in the risk stratification score proposed by the 2015 European guidelines. Since 2015, several new stratification scores based on a 3- or 4-severity scale have been explored. This retrospective cohort single-center study sought to investigate the association between DLCO and PH severity and survival. We included 85 treatment-naive patients with precapillary PH and DLCO measurement at diagnosis. DLCO status, based on lower and upper quartiles ranges, was added to a 3- and a 4-strata modified-risk assessment. DLCO was strongly associated with transplant-free survival (HR 0.939, 95% CI: 0.908–0.971, p < 0.001). In the intermediate and high-risk categories, DLCO was associated with transplant-free survival, irrespective of the risk category (HR 0.934, 95% CI: 0.880–0.980, p = 0.005). The correlation between modified-risk category and transplant-free survival was significant (HR 4.60, 95% CI: 1.294–16.352, p = 0.018). Based on the Akaike information criterion (AIC) levels, the 3- and 4-strata modified-risk stratification fits our results better than the conventional stratification. Low DLCO is associated with patient transplant-free survival, independently of the risk category. Inclusion of DLCO into a PH risk stratification score seems promising and needs further investigation.

Hygienic analysis of violations of sanitary and epidemiological requirements for working conditions in the field of "Mining" before and after the introduction of a risk-oriented model of control and supervisory activities (on the example of the Perm Region)

In the Russian Federation, "Mining" is a priority activity in the group "Activities in the field of industry and agriculture" for the potential risk of harm to health. The study aims to perform a hygienic analysis of violations of sanitary and epidemiological requirements for working conditions in the field of "Mining" (on the example of the Perm Region) before and after the introduction of a risk-oriented model of control and supervisory activities to manage risks to the health of the working population. Scientists performed a study according to the data of 49 inspection acts by the Rospotrebnadzor Department in the Perm Region to facilities operating in the field of "Mining," before and after the introduction of a risk-based approach (for the periods 2013-2016 and 2017-2019), using standard analysis methods. Implemented in practice in 2016, the risk-oriented approach to the control and supervision of working conditions provides for the attribution of the activities of a legal entity, an individual entrepreneur, and (or) production facilities used by them in the implementation of this activity to a particular risk category under MP 5.1.0116-17. The study used data from the Federal Register of economic entities (legal entities/sole proprietors) subject to sanitary and epidemiological supervision as of 2020; data from Rosstat and Permstat on the number of employees engaged in work with harmful and(or) dangerous working conditions, data from Rospotrebnadzor and the Department of Rospotrebnadzor in the Perm Region on occupational morbidity for 2019. The average number of violations of sanitary and epidemiological requirements to working conditions per year per economic entity in the field of Mining in the Perm Region since 2017 (since the introduction of the risk-based model of sanitary and epidemiological surveillance) has significantly decreased (p<0.05) from 62 violations (in 2013-2016) to 31 (in 2017-2019), mainly due to a significant 2.5-fold decrease in the number of breaches of the requirements of Federal Law No. 52-FZ per entity - from 30 violations to 12. In 2017-2019, the average number of violations of the requirements for working conditions per year per subject significantly decreased compared to 2013-2016 (p<0.05) due to a reduction in violations of the requirements for the maintenance of industrial and household premises (by 11.9 times). In the period 2017-2019, regarding 2013-2016, the contribution of violations under requirements for the maintenance of industrial and household premises, ventilation decreased by an average of 5.37 and 6.07 times, respectively, increased to overalls and PPE, production control by 3.16 and 1.67 times. The results obtained indicate that introducing a risk-based approach has led to a decrease in the number of violations of sanitary and epidemiological requirements for working conditions in the field of Mining in the Perm Region since 2017. As well as an increase in the overall structure of violations of the proportion of violations of requirements, non-compliance with which can lead to severe consequences for human health (increased the proportion of violations of requirements for overalls, PPE, working conditions with a PC, production control).