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

10.2196/23606 ◽  
2020 ◽  
Author(s):  
Yaqi Zhang ◽  
Peng Gao ◽  
Yifu Mo ◽  
Shiying Hao ◽  
Jia Huang ◽  
...  
Keyword(s):  
At Risk ◽  
Case Finding ◽  
The State ◽  
Cardiac Dysrhythmia ◽  
Patients At Risk ◽  
One Year

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 Protocol for Take home naloxone In Multicentre Emergency setting (TIME): Feasibility Study

2020 ◽  
Author(s):  
Matthew Jones ◽  
Fiona Bell ◽  
Jonathan Benger ◽  
Sarah Black ◽  
Penny Buykx ◽  
...  
Keyword(s):  
At Risk ◽  
Feasibility Study ◽  
Adverse Event Rate ◽  
Opioid Overdose ◽  
Emergency Setting ◽  
Risk Of Death ◽  
Emergency Ambulance ◽  
Patients At Risk ◽  
One Year

Abstract Background Opioids, such as heroin, kill more people worldwide by overdose than any other type of drug, and death rates associated with opioid poisoning in the UK are at record levels (1, 2). Naloxone is an opioid antagonist which can be distributed in ‘kits’ for administration by witnesses in an overdose emergency. This intervention is known as Take Home Naloxone (THN). We know that THN can save lives on an individual level, but there is currently limited evidence about the effectiveness of THN distribution on an aggregate level, in specialist drug service settings or in emergency service settings. Notably, we do not know whether THN kits reduce deaths from opioid overdose in at-risk populations, if there are unforeseen harms associated with THN distribution or if THN is cost-effective. In order to address this research gap, we aim to determine the feasibility of a fully-powered cluster Randomised Controlled Trial (RCT) of THN distribution in emergency settings. Methods We will carry out a feasibility study for a RCT of THN distributed in emergency settings at four sites, clustered by Emergency Department (ED) and catchment area within its associated ambulance service. THN is a peer-administered intervention. At two intervention sites, emergency ambulance paramedics and ED clinical staff will distribute THN to adult patients who are at risk of opioid overdose. At two control sites, practice will carry on as usual. We will develop a method of identifying a population to include in an evaluation, comprising people at risk of fatal opioid overdose, who may potentially receive naloxone included in a THN kit. We will gather anonymised outcomes up to one year following a 12 month ‘live’ trial period for patients at risk of death from opioid poisoning. We expect approximately 100 patients at risk of opioid overdose to be in contact with each service during the one year recruitment period. Our outcomes will include: deaths; emergency admissions; intensive care admissions; and ED attendances. We will collect numbers of eligible patients attended by participating emergency ambulance paramedics and attending ED; THN kits issued; and NHS resource usage. We will determine whether to progress to a fully-powered trial based on pre-specified progression criteria: sign-up of sites (n = 4); staff trained (>= 50%); eligible participants identified (>= 50%); THN provided to eligible participants (>= 50%); people at risk of death from opioid overdose identified for inclusion in follow up (>= 75% of overdose deaths); outcomes retrieved for high risk individuals (>= 75%); and adverse event rate (<10% difference between study arms).Discussion This feasibility study is the first randomised, methodologically robust investigation of THN distribution in emergency settings. The study addresses an evidence gap related to the effectiveness of THN distribution in emergency settings. As this study is being carried out in emergency settings, obtaining informed consent on behalf of participants is not feasible. We therefore employ novel methods for identifying participants and capturing follow up data, with effectiveness dependent on the quality of the available routine data.Trial registration ISRCTN13232859 (Registered 16/02/2018)

Case-finding for COPD: Developing strategies to identify patients at risk populations

2015 ◽  
Author(s):  
Cecilia Rodriguez Flores ◽  
María Victorina Lopez Varela ◽  
Edilberto Pacheco ◽  
Mónica Mamchur ◽  
Jimena Nuñez ◽  
...  
Keyword(s):  
At Risk ◽  
Case Finding ◽  
Patients At Risk ◽  
At Risk Populations ◽  
Developing Strategies

A valid depression case finding instrument to assist dietitians in identifying patients at risk of depression in an enhanced HIV care setting

2011 ◽  
Vol 68 (1) ◽  
pp. 47-52
Author(s):  
Aaron DI GUILMI ◽  
Sarangapany JEGANATHAN ◽  
Louise HOUTZAGER ◽  
Julianita PURNOMO ◽  
Kim BEGLEY
Keyword(s):  
At Risk ◽  
Care Setting ◽  
Case Finding ◽  
Hiv Care ◽  
Patients At Risk

scholarly journals Case finding for patients at risk of readmission to hospital: development of algorithm to identify high risk patients

BMJ ◽  
2006 ◽  
Vol 333 (7563) ◽  
pp. 327 ◽  
Author(s):  
John Billings ◽  
Jennifer Dixon ◽  
Tod Mijanovich ◽  
David Wennberg
Keyword(s):  
At Risk ◽  
High Risk ◽  
Case Finding ◽  
High Risk Patients ◽  
Patients At Risk ◽  
Risk Patients ◽  
Hospital Development

scholarly journals Protocol for Take home naloxone In Multicentre Emergency setting (TIME): Feasibility Study

2020 ◽  
Author(s):  
Matthew Jones ◽  
Fiona Bell ◽  
Jonathan Benger ◽  
Sarah Black ◽  
Penny Buykx ◽  
...  
Keyword(s):  
At Risk ◽  
Feasibility Study ◽  
Adverse Event Rate ◽  
Opioid Overdose ◽  
Emergency Setting ◽  
Risk Of Death ◽  
Emergency Ambulance ◽  
Patients At Risk ◽  
One Year

Abstract Background Opioids, such as heroin, kill more people worldwide by overdose than any other type of drug, and death rates associated with opioid poisoning in the UK are at record levels. Naloxone is an opioid antagonist which can be distributed in ‘kits’ for administration by witnesses in an overdose emergency. This intervention is known as Take Home Naloxone (THN). There is a lack of rigorous experimental research into the effectiveness of THN distribution, with fundamental questions remaining unanswered: do THN kits reduce deaths? are there unforeseen harms associated with THN distribution? and is THN distribution cost-effective? We seek to establish the feasibility of a fully-powered cluster Randomised Controlled Trial (RCT) of THN distribution in emergency settings to answer these questions.Methods We will carry out a feasibility study for a RCT of THN distributed in emergency settings at four sites, clustered by Emergency Department (ED) and catchment area within its associated ambulance service. At two intervention sites, emergency ambulance paramedics and ED clinical staff will distribute THN to adult patients who are at risk of opioid overdose. At two control sites practice will carry on as usual. THN is a peer-administered intervention. We will develop a method of identifying a population to include in an evaluation, comprising people at risk of opioid overdose, who may potentially receive THN. We will gather anonymised outcomes up to one year following a 12 month ‘live’ trial period for patients at risk of death from opioid poisoning. We expect approximately 100 patients at risk of opioid overdose to be in contact with each service during the one year recruitment period. Our outcomes will include: deaths; emergency admissions; intensive care admissions; and ED attendances. We will collect numbers of eligible patients attended by participating emergency ambulance paramedics and attending ED; THN kits issued; and NHS resource usage. We will determine whether to progress to a fully powered trial based on pre-specified progression criteria: sign-up of sites (n = 4); staff trained (>= 50%); eligible participants identified (>= 50%); THN provided to eligible participants (>= 50%); people at risk of death from opioid overdose identified for inclusion in follow up (>= 75% of overdose deaths); outcomes retrieved for high risk individuals (>= 75%); and adverse event rate (<10% difference between trial arms).Discussion This feasibility study is the first randomised, methodologically robust investigation of THN distribution in emergency settings. The study addresses an evidence gap related to the effectiveness of THN distribution in emergency settings. As this study is being carried out in emergency settings, obtaining informed consent on behalf of participants is not feasible. We therefore employ novel methods for identifying participants and capturing follow up data, the effectiveness of which are dependent on the quality of the available routine data.

scholarly journals Patterns of prescription, hospitalizations and costs of herpes zoster in patients at risk, from a large Italian claims database

2020 ◽  
Vol 7 (1) ◽  
pp. 66-71
Author(s):  
Silvia Calabria ◽  
Giulia Ronconi ◽  
Letizia Dondi ◽  
Carlo Piccinni ◽  
Antonella Pedrini ◽  
...  
Keyword(s):  
At Risk ◽  
Herpes Zoster ◽  
Average Cost ◽  
National Health System ◽  
Incidence Rates ◽  
Chronic Obstructive ◽  
Specialist Care ◽  
Obstructive Pulmonary Disease ◽  
Patients At Risk ◽  
One Year

Purpose: This observational study aimed to investigate the incidence of herpes zoster (HZ) among at-risk subjects aged ≥50 years, characterize them and assess annual healthcare utilization and costs from the Italian National Health System (NHS) perspective. Methods: Records of reimbursed drug prescriptions, hospitalizations and outpatient specialist care from the Fondazione ReS database were linked to identify patients aged ≥50 years at HZ risk (i.e. cardiovascular disease/chronic obstructive pulmonary disease/diabetes/immunosuppression, according to the Italian National Vaccine Prevention Plan – PNPV 2017-2019) in 2013. New HZ events (incidence per 1,000) were researched in 2 years, and subjects with HZ in the previous year were excluded. Antiviral and pain therapy consumptions, hospitalizations for HZ and costs paid by NHS were assessed annually. Results: From 12,562,609 inhabitants in 2013, a total of 1,004,705 patients (18.5% aged ≥50 years) at risk without a previous event were selected. The 2-year incidence of HZ was 5.9 per 1,000 (mean age 74 ± 10 years; 54.3% female). Patients aged 80-89 (7.2 per 1,000), females (6.7 per 1,000) and immunosuppressed subjects (6.9 per 1,000) had the highest incidence rates. One year after the new HZ episode, 82.2% were treated with specific antivirals (79.3% brivudine), generating an annual average cost/treated of €106; 8.0% were hospitalized for HZ, with an average cost/hospitalized of €3,927; the overall mean cost/incident patient was €402. Conclusions: This analysis provided HZ incidence in subjects aged ≥50 years considered at risk by the PNPV and its burden from the NHS perspective. Our findings can help health governance to improve clinical decisions and economic positioning concerning zoster vaccine plan.

Early identification of patients at risk for significant left ventricular dilation one year after myocardial infarction

1995 ◽  
Vol 8 (2) ◽  
pp. 175-184 ◽  
Author(s):  
Patricia E. Assmann ◽  
Wim R. Aengevaeren ◽  
Jan G.P. Tijssen ◽  
Cornelis J. Slager ◽  
Wim Vletter ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
At Risk ◽  
Early Identification ◽  
Left Ventricular ◽  
Ventricular Dilation ◽  
Left Ventricular Dilation ◽  
Patients At Risk ◽  
One Year
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