scholarly journals MEASURING THE EFFECT OF CARERS ON PATIENTS’ RISK OF ADVERSE HEALTHCARE OUTCOMES USING THE CAREGIVER NETWORK SCORE

2016 ◽  
pp. 1-7
Author(s):  
R. O’CAOIMH ◽  
N. CORNALLY ◽  
A. SVENDROVSKI ◽  
E. WEATHERS ◽  
C. FITZGERALD ◽  
...  
Keyword(s):  
High Risk ◽  
Primary Caregiver ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Low Risk ◽  
Healthcare Outcomes ◽  
Simple Method ◽  
Perceived Difficulty ◽  
One Year ◽  
Caregiver Network

Background: Although caregivers are important in the management of frail, community-dwelling older adults, the influence of different caregiver network types on the risk of adverse healthcare outcomes is unknown. Objective: To examine the association between caregiver type and the caregiver network subtest of The Risk Instrument for Screening in the Community (RISC), a five point Likert scale scored from one (“can manage”) to five (“absent/liability”). To measure the association between caregiver network scores and the one-year incidence of institutionalisation, hospitalisation and death. Design: Observational cohort study. Setting and Participants: Community-dwelling adults, aged >65,attending health centres in Ireland,(n=779). Procedure and Measurements: The caregiver network subtest of the RISC was scored by public health nurses. Caregivers were grouped dichotomously into low-risk (score of one) or high-risk (scores two-five). Results: The majority of patients had a primary caregiver (582/779;75%), most often their child (200/582;34%). Caregiver network scores were highest, indicating greatest risk, when patients had no recognised primary caregiver and lowest when only a spouse or child was available. Despite this, patients with a caregiver were significantly more likely to be institutionalised than those where none was required or identified (11.5% versus 6.5%,p=0.047). The highest one-year incidence of adverse outcomes occurred when state provided care was the sole support; the lowest when private care was the sole support. Significantly more patients whose caregiver networks were scored high-risk required institutionalisation than low-risk networks; this association was strongest for perceived difficulty managing medical domain issues, odds ratio (OR) 3.87:(2.22-6.76). Only perceived difficulty managing ADL was significantly associated with death, OR 1.72:(1.06-2.79). There was no association between caregiver network scores and risk of hospitalisation. Conclusion: This study operationalizes a simple method to evaluate caregiver networks. Networks consisting of close family (spouse/children) and those reflecting greater socioeconomic privilege (private supports) were associated with lower incidence of adverse outcomes. Caregiver network scores better predicted institutionalisation than hospitalisation or death.

GAIT SPEED AND HANDGRIP STRENGTH AS PREDICTORS OF INCIDENT DISABILITY IN MEXICAN OLDER ADULTS

2014 ◽  
pp. 1-4
Author(s):  
T. LOPEZ-TEROS ◽  
L.M. GUTIERREZ-ROBLEDO ◽  
M.U. PEREZ-ZEPEDA
Keyword(s):  
Older Adults ◽  
Gait Speed ◽  
Daily Living ◽  
Handgrip Strength ◽  
Statistical Significance ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Performance Tests ◽  
One Year

Physical performance tests are associated with different adverse outcomes in older people. Theobjective of this study was to test the association between handgrip strength and gait speed with incidentdisability in community-dwelling, well-functioning, Mexican older adults (age ≥70 years). Incident disability wasdefined as the onset of any difficulty in basic or instrumental activities of daily living. Of a total of 133participants, 52.6% (n=70) experienced incident disability during one year of follow-up. Significant associationsof handgrip strength (odds ratio [OR] 0.96, 95% confidence interval [95%CI] 0.93-0.99) and gait speed (OR0.27, 95%CI 0.07-0.99) with incident disability were reported. The inclusion of covariates in the models reducedthe statistical significance of the associations without substantially modifying the magnitude of them. Handgripstrength and gait speed are independently associated with incident disability in Mexican older adults.

scholarly journals Prophylaxis of venous thromboembolism in general surgery: guidelines differ and we still need local policies

2011 ◽  
Vol 93 (5) ◽  
pp. 370-374
Author(s):  
D Veeramootoo ◽  
L Harrower ◽  
R Saunders ◽  
D Robinson ◽  
WB Campbell
Keyword(s):  
At Risk ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Risk Groups ◽  
Low Risk ◽  
Vte Prophylaxis ◽  
Risk Patients ◽  
Local Policies ◽  
One Year ◽  
The Uk

INTRODUCTION Venous thromboembolism (VTE) prophylaxis has become a major issue for surgeons both in the UK and worldwide. Sev-eral different sources of guidance on VTE prophylaxis are available but these differ in design and detail. METHODS Two similar audits were performed, one year apart, on the VTE prophylaxis prescribed for all general surgical inpatients during a single week (90 patients and 101 patients). Classification of patients into different risk groups and compliance in prescribing prophylaxis were examined using different international, national and local guidelines. RESULTS There were significant differences between the numbers of patients in high, moderate and low-risk groups according to the different guidelines. When groups were combined to indicate simply ‘at risk’ or ‘not at risk’ (in the manner of one of the guidelines), then differences were not significant. Our compliance improved from the first audit to the second. Patients at high risk received VTE prophylaxis according to guidance more consistently than those at low risk. CONCLUSIONS Differences in guidance on VTE prophylaxis can affect compliance significantly when auditing practice, depending on the choice of ‘gold standard’. National guidance does not remove the need for clear and detailed local policies. Making decisions about policies for lower-risk patients can be more difficult than for those at high risk.

Adverse obstetric outcomes in two Brazilian maternity hospitals

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Alessa Leila Andrade ◽  
Zenewton André da Silva Gama ◽  
Marise Reis de Freitas ◽  
Wilton Rodrigues Medeiros ◽  
Kelienny de Meneses Sousa ◽  
...  
Keyword(s):  
Patient Safety ◽  
High Risk ◽  
Adverse Outcome ◽  
Obstetric Care ◽  
Care Quality ◽  
Adverse Outcomes ◽  
Content Type ◽  
Maternity Hospitals ◽  
One Year

PurposeObstetric adverse outcomes (AOs) are an important topic and the use of composite measures may favor the understanding of their impact on patient safety. The aim of the present study was to estimate AO frequency and obstetric care quality in low and high-risk maternity hospitals.Design/methodology/approachA one-year longitudinal follow-up study in two public Brazilian maternity hospitals. The frequency of AOs was measured in 2,880 randomly selected subjects, 1,440 in each institution, consisting of women and their newborn babies. The frequency of 14 AOs was estimated every two weeks for one year, as well as three obstetric care quality indices based on their frequency and severity as follows: the Adverse Outcome Index (AOI), the Weighted Adverse Outcome Score and the Severity Index.FindingsA significant number of mothers and newborns exhibited AOs. The most prevalent maternal AOs were admission to the ICU and postpartum hysterectomy. Regarding newborns, hospitalization for > seven days and neonatal infection were the most common complications. Adverse outcomes were more frequent at the high-risk maternity, however, they were more severe at the low-risk facility. The AOI was stable at the high-risk center but declined after interventions during the follow-up year.Originality/valueHigh AO frequency was identified in both mothers and newborns. The results demonstrate the need for public patient safety policies for low-risk maternity hospitals, where AOs were less frequent but more severe.

Discriminating Characteristics of Community-Dwelling Elderly at High and Low Risk for Frailty

2002 ◽  
Vol 10 (4) ◽  
pp. 413-431 ◽  
Author(s):  
Laura S. Ho ◽  
Harriet G. Williams ◽  
Emily A.W. Hardwick
Keyword(s):  
Physical Activity ◽  
Regression Analysis ◽  
High Risk ◽  
Daily Living ◽  
Cardiac Event ◽  
Community Dwelling ◽  
Low Risk ◽  
Functional Abilities ◽  
The Past ◽  
And Performance

The study’s objective was to examine the health status, physical activity behaviors, and performance-based functional abilities of individuals classified as being at high or low risk for frailty and to determine which of these characteristics discriminates between the 2 groups. Participants were 78 community-dwelling individuals with an average age of 74 years; 37 were categorized as being at high risk and 42 at low risk for frailty. Logistic-regression analysis indicated that individuals classified as being at high risk for frailty were more likely to have visited the doctor more than 3 times in the past year, experienced a cardiac event, taken more than 4 medications a day, and participated in little or no physical activity. High-risk individuals were more likely to have poor balance, difficulty with mobility, decreased range of motion, poor unimanual dexterity, and difficulty performing activities of daily living than were those classified as being at low risk for frailty.

scholarly journals Risk factor assessment of endoscopically removed malignant colorectal polyps

Gut ◽  
1998 ◽  
Vol 43 (5) ◽  
pp. 669-674 ◽  
Author(s):  
P Netzer ◽  
C Forster ◽  
R Biral ◽  
C Ruchti ◽  
J Neuweiler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Adverse Outcome ◽  
Venous Invasion ◽  
Colorectal Polyps ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Malignant Polyps ◽  
Grade Iii

Background—Malignant colorectal polyps are defined as endoscopically removed polyps with cancerous tissue which has invaded the submucosa. Various histological criteria exist for managing these patients.Aims—To determine the significance of histological findings of patients with malignant polyps.Methods—Five pathologists reviewed the specimens of 85 patients initially diagnosed with malignant polyps. High risk malignant polyps were defined as having one of the following: incomplete polypectomy, a margin not clearly cancer-free, lymphatic or venous invasion, or grade III carcinoma. Adverse outcome was defined as residual cancer in a resection specimen and local or metastatic recurrence in the follow up period (mean 67 months).Results—Malignant polyps were confirmed in 70 cases. In the 32 low risk malignant polyps, no adverse outcomes occurred; 16 (42%) of the 38 patients with high risk polyps had adverse outcomes (p<0.001). Independent adverse risk factors were incomplete polypectomy and a resected margin not clearly cancer-free; all other risk factors were only associated with adverse outcome when in combination.Conclusion—As no patients with low risk malignant polyps had adverse outcomes, polypectomy alone seems sufficient for these cases. In the high risk group, surgery is recommended when either of the two independent risk factors, incomplete polypectomy or a resection margin not clearly cancer-free, is present or if there is a combination of other risk factors. As lymphatic or venous invasion or grade III cancer did not have an adverse outcome when the sole risk factor, operations in such cases should be individually assessed on the basis of surgical risk.

Abstract 6088: Clinical and Angiographic Predictors of 30-Day and One-Year Cardiac Ischemic Events in Patients with Non-ST Elevation Acute Coronary Syndromes: Results from the ACUITY (Acute Catheterization and Urgent Intervention Triage strategY) Trial

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Alexandra Lansky ◽  
Kenji Goto ◽  
Ecatarina Cristea ◽  
Martin Fahy ◽  
Roxana Mehran ◽  
...  
Keyword(s):  
High Risk ◽  
Acute Coronary Syndromes ◽  
Multivariable Analysis ◽  
Flow Characteristics ◽  
Adverse Outcomes ◽  
Cardiac Events ◽  
Clinical Predictors ◽  
Target Vessel Revascularization ◽  
Coronary Syndromes ◽  
One Year

An early invasive strategy is of clinical benefit in moderate and high-risk acute coronary syndromes (ACS). Clinical predictors of short and long-term ischemic outcomes in pts with ACS have been well studied, whereas the extent, location and characteristics of angiographic coronary disease in predicting outcome is not well defined. The ACUITY trial randomized 13,819 pts with moderate and high risk ACS to unfractionated heparin or enoxaparin + GP IIb/IIIa inhibitors (GPI), versus bivalirudin + GPI, vs. bivalirudin alone. The angiographic substudy of ACUITY included the first 7000 consecutive randomized US patients. All angiograms were reviewed by an independent core laboratory for complete 3 vessel assessment of CAD extent and burden (total mm length of lesions>30%DS), as well as baseline and final lesion and flow characteristics. Clinical and angiographic predictors of ischemic outcomes at 30 days and 1 year (death, MI, or ischemic target vessel revascularization) were identified by univariate and multivariable analysis using logistic regression analysis. Of 6921 pts with interpretable angiograms, 3826 pts (55.3%) were treated with PCI, 755 (10.9%) with CABG, and 2340 (33.8%) with medical therapy. Composite ischemia occurred in 595 (8.6%) pts at 30 days and 1153 (17.4%) pts at one year. Independent predictors of 30 day and 1 year ischemic cardiac events by multivariable analysis are shown in the table . Among moderate- to high-risk ACS patients, beyond the well recognized clinical risk factors of renal insufficiency and diabetes mellitus, angiographic manifestations of coronary atherosclerosis including greater burden and severity of disease, and presence of calcified lesions, are important independent predictors of 30 day and 1 year adverse outcomes. Table. Multivariate Predictors of Composite Ischemia

scholarly journals Adherence to Anticoagulant Guideline for Atrial Fibrillation Improves Outcomes in Asian Population

Stroke ◽  
2020 ◽  
Vol 51 (6) ◽  
pp. 1772-1780
Author(s):  
Rungroj Krittayaphong ◽  
Arjbordin Winijkul ◽  
Rapeephon Kunjara-Na-Ayudhya ◽  
Sirin Apiyasawat ◽  
Khanchai Siriwattana ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
High Risk ◽  
Guideline Adherence ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Intermediate Risk ◽  
Nonvalvular Atrial Fibrillation ◽  
Increased Risk ◽  
Adherence Group

Background and Purpose— Guideline adherent oral anticoagulant (OAC) management of patients with nonvalvular atrial fibrillation has been associated with improved outcomes, but limited data are available from Asia. We aimed to investigate outcomes in patients who received guideline compliant management compared with those who were OAC undertreated or overtreated, in a large nationwide multicenter cohort of patients with nonvalvular atrial fibrillation in Thailand. Methods— Patients with nonvalvular atrial fibrillation were prospectively enrolled from 27 hospitals—all of which are data contributors to the COOL-AF Registry (Cohort of Antithrombotic Use and Optimal INR Level in Patients With Non-Valvular Atrial Fibrillation in Thailand). Patients were categorized as follows: (1) guideline adherence group when OAC was given in high-risk or intermediate-risk, but not in low-risk patients; (2) undertreatment group when OAC was not given in the high-risk or intermediate-risk groups; and (3) overtreatment group when OAC was given in the low-risk group or when OAC was given in combination with antiplatelets without indication. Results— A total of 3327 patients who had follow-up clinical outcome data were included. The mean age of patients was 67.4 years and 58.1% were male. The numbers of patients in the guideline adherence group, undertreatment group, and overtreatment group were 2267 (68.1%), 624 (18.8%), and 436 (13.1%) patients, respectively. The overall rate of ischemic stroke, major bleeding, all bleeding, and death was 3.0%, 4.4%, 15.1%, and 7.8%, respectively. Undertreated patients had a higher risk of ischemic stroke and death compared with guideline adherent patients, and overtreated patients had a higher risk of bleeding and death compared with OAC guideline-managed patients. Conclusions— Adherence to OAC management guidelines is associated with improved clinical outcomes in Asian nonvalvular atrial fibrillation patients. Undertreatment or overtreatment was found to be associated with increased risk of adverse outcomes compared with guideline-adherent management.

scholarly journals Prospective case finding for patients at risk of future one-year incident cardiac dysrhythmia in the State of Maine (Preprint)

2020 ◽  
Author(s):  
Yaqi Zhang ◽  
Peng Gao ◽  
Yifu Mo ◽  
Shiying Hao ◽  
Jia Huang ◽  
...  
Keyword(s):  
High Risk ◽  
Early Warning ◽  
Case Finding ◽  
The State ◽  
Machine Learning Algorithms ◽  
Low Risk ◽  
Common Disease ◽  
Cardiac Dysrhythmia ◽  
One Year ◽  
Very High

BACKGROUND Cardiac dysrhythmia is an extremely common disease among people today. While severe arrhythmias often cause a series of complications including congestive heart failure, fainting or syncope, stroke, and sudden death. OBJECTIVE The aim of this study was to predict incident arrhythmia prospectively within the next one year to provide early warning of impending arrhythmia. METHODS Retrospective (1,033,856 subjects registered between October 1, 2016 and October 1, 2017) and prospective (1,040,767 subjects registered between October 1, 2017 and October 1, 2018) cohorts were constructed from electronic health records integrated in the state of Maine. An ensemble learning workflow was built through multiple machine learning algorithms. Differentiated features including acute and chronic diseases, procedures, health status, laboratory tests, prescriptions, clinical utilization indicators, and social-economic determinants were compiled for incident arrhythmia assessment. The predictive model was retrospectively trained and calibrated using an isotonic regression method, and prospectively validated. RESULTS The cardiac dysrhythmia case finding algorithm (the areas under the receiver operating characteristic curve ROC AUC is: retrospective 0.854; prospective 0.819) divided the validation population into five risk subgroups: 53.348%, 44.832%, 1.757%, 0.060% and 0.003% cases in the very low-risk, the low-risk, the medium-risk, the high-risk, and the very high-risk subgroups. 51.85% patients in the very high-risk subgroup were confirmed with a new incident cardiac dysrhythmia within the next one year. CONCLUSIONS With the promise to predict future one-year incident cardiac dysrhythmias in a general population, we believe that our case finding algorithm can serve as early warning system to allow statewide population-level screening and surveillance to improve cardiac dysrhythmia care.

scholarly journals Prevalence of thyroid dysfunction in pregnant women and the need for universal screening: an observational study in Northern Andhra Pradesh population

2017 ◽  
Vol 6 (6) ◽  
pp. 2536
Author(s):  
Krishnamma B. ◽  
Prabhavathi V. ◽  
Prasad D. K. V.
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Universal Screening ◽  
Thyroid Dysfunction ◽  
Adverse Outcomes ◽  
Low Risk ◽  
Overt Hypothyroidism ◽  
Free T4 ◽  
Increased Risk ◽  
Tsh Levels

Background: The maternal thyroid dysfunction is associated with adverse outcomes such as miscarriage, preterm delivery, preeclampsia, postpartum haemorrhage in mother whereas increased risk of impaired neurological development in foetus. The present study was designed with an aim to determine the prevalence of thyroid dysfunction and the need for universal screening in pregnant women.Methods: Three hundred and eighty pregnant women between 8-36 weeks of gestation with age group 20-32 years were recruited. Serum free T3, free T4 and TSH levels were assayed by chemiluminescence method. The pregnant women were classified into euthyroid, subclinical hypothyroid (SH), overt hypothyroid (OH) and overt hyperthyroid groups based on the results obtained in the study.Results: In the present study, the mean ± SD age (in years) and BMI of all pregnant women was 23.9±3.9 and 22.9±1.6 respectively. The maternal age was high in OH and overt hyperthyroid and was statistically significant (p<0.05). Similarly, women with high BMI were prone to OH than normal BMI (p<0.05). The prevalence of thyroid dysfunction was found to be 18.7%. The prevalence of hypothyroidism was 17.4% in which the SH was 13.4% and overt hypothyroidism 3.9%, but overt hyperthyroidism was 1.3%. TSH levels increased with the advancement of gestational age from 2.72±1.85 in first trimester to 3.4±2.05 µIU/mL in third trimester, and the difference was statistically significant (p<0.05). Finally, it was also noticed that the prevalence of raised TSH in high-risk pregnant women was high compared to low-risk women (35.6% vs 5.1%) relative risk (RR) 7.64, 95% confidence interval (CI) 4.62-12.65, (p<0.0001). However, 14 out of 51 (27.5%) with SH were in low-risk group.Conclusions: The present study states that the prevalence of thyroid dysfunction was 18.7% and also emphasizes the importance of screening all pregnant women for thyroid dysfunction rather than targeted high-risk pregnant women to prevent both maternal and fetal morbidity.

Children’s Heart Assessment Tool for Transplantation (CHAT) Score: A Novel Risk Score Predicts Survival After Pediatric Heart Transplantation

2019 ◽  
Vol 10 (3) ◽  
pp. 296-303 ◽  
Author(s):  
Charles D. Fraser ◽  
Joshua C. Grimm ◽  
Xun Zhou ◽  
Cecillia Lui ◽  
Kate Giuliano ◽  
...  
Keyword(s):  
High Risk ◽  
Heart Transplantation ◽  
Risk Score ◽  
Assessment Tool ◽  
Low Risk ◽  
Similar Distribution ◽  
Intermediate Risk ◽  
Increased Risk ◽  
Pediatric Heart Transplantation ◽  
One Year

Background: Given the shortage of donor organs in pediatric heart transplantation (HTx), pretransplant risk stratification may assist in organ allocation and recipient optimization. We sought to construct a scoring system to preoperatively stratify a patient’s risk of one-year mortality after HTx. Methods: The United Network for Organ Sharing database was queried for pediatric (<18 years) patients undergoing HTx between 2000 and 2016. The population was randomly divided in a 4:1 fashion into derivation and validation cohorts. A multivariable logistic regression model for one-year mortality was constructed within the derivation cohort. Points were then assigned to independent predictors ( P < .05) based on relative odds ratios (ORs). Risk groups were established based on easily applicable, whole-integer score cutoffs. Results: A total of 5,700 patients underwent HTx; one-year mortality was 10.7%. There was a similar distribution of variables between derivation (n = 4,560) and validation (n = 1,140) cohorts. Of the 12 covariates included in the final model, nine were allotted point values. The low-risk (score 0-9), intermediate-risk (10-20), and high-risk (>20) groups had a 5.18%, 10%, and 28% risk of one-year mortality ( P < .001), respectively. Both intermediate-risk (OR = 2.46, 95% confidence interval [95% CI]: 1.93-3.15; P < .001) and high-risk (OR = 9.24, 95% CI: 6.92-12.35; P < .001) scores were associated with an increased risk of one-year mortality when compared to the low-risk group. Conclusions: The Children’s Heart Assessment Tool for Transplantation score represents a pediatric-specific, recipient-based system to predict one-year mortality after HTx. Its use could assist providers in identification of patients at highest risk of poor outcomes and may aid in pretransplant optimization of these children.

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