scholarly journals Undernutrition Risk Assessment in Elderly People: Available Tools in Clinical Practice

2019 ◽  
Author(s):  
Isabel Sospedra ◽  
Aurora Norte ◽  
José Miguel Martínez-Sanz ◽  
Enrique de Gomar ◽  
José Antonio Hurtado Sánchez ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Clinical Practice ◽  
Elderly People

scholarly journals POS1112 COMPARISON OF TWO APPROACHES IN FRACTURES RISK ASSESSMENT IN WOMEN WITH RHEUMATOID ARTHRITIS AND GLUCOCORTICOID USE

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 836.1-836
Author(s):  
N. Grygorieva ◽  
V. Povoroznyuk
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Assessment ◽  
Clinical Practice ◽  
Lumbar Spine ◽  
Femoral Neck ◽  
Fracture Risk ◽  
Fracture Risk Assessment ◽  
Lifestyle Modifications ◽  
Mineral Density ◽  
Dxa Scan

Background:Nowadays, FRAX is the most useful tool for osteoporotic fracture risk assessment that is included in many guidelines. Rheumatoid arthritis (RA) and glucocorticoid (CG) use are two crucial factors for osteoporotic fractures included in FRAX algorithm. According to the last ACR guidelines for the treatment of GC-induced osteoporosis [1], it was recommended to divide the patients into three groups of fracture risk (high, medium and low) that have a great impact on treatment decision. Recently, we received own Ukrainian thresholds [2] for the national version of FRAX that are age-dependent and now widely used in clinical practice.Objectives:Our study was aimed to compare two approaches (ACR-2017 and Ukrainian (2019) recommendations) in fracture risk assessment in women with RA and GC use.Methods:We examined 195 females with RA aged 40-89 years old who took GC (at dose ≥5 mg/d for ≥3 months) due to RA. The 10-year probabilities of major osteoporotic (MOFs) and hip fractures (HFs) were calculated with and without bone mineral density (BMD) using the Ukrainian FRAX model [3]. The DXA was used to measure the lumbar spine, femoral neck and total body BMDs; T and Z scores were calculated (DISCOVERY Wi, Hologic, Inc., USA).Results:FRAX indexes for MOFs and HFs without BMD in patients with RA and GC were (Me [25-75Q]) 12.0 [8.1-18.0] and 4.2 [1.7-7.2] %. The correspondent FRAX indexes with BMD were 13.5 [8.5-20.0] and 5.1 [1.8-8.7] %.50 % of examined women had previous fractures and 20 % had previous vertebral fractures. BMD of the femoral neck consisted of 0.62±0.13 and L1-L4 BMD was 0.85±0.15 g/cm2. 89 % of females had low BMD at the lumbar spine and / or femoral neck (49 % osteoporosis and 40 % osteopenia).61 % of women required antiosteoporotic treatment according to ACR-2017 guideline (17.4 % of them a hadhigh risk of MOF and 43.1 % moderate one) without BMD measurement and 64 % of subjects after DXA scan.According to Ukrainian national guideline, 57 % of patients required antiosteoporotic treatment without BMD measurement and 42 % – after additional DXA examination. After BMD measurement in subjects who required the DXA scan, 78.2 % of females with RA and GC use required antiosteoporotic treatment (additionally to calcium and vitamin D, lifestyle modifications).Conclusion:Approximately 60 % of subjects with RA and GC use required antiosteoporotic treatment without additional DXA measurement according to correspondent FRAX indexes from both guidelines. The proportion of women requiring treatment after DXA scan is slightly higher according to Ukrainian recommendations. It proves that both of them can be used effectively in daily clinical practice for fracture risk assessment in females with RA.References:[1]Buckley L, Guyatt G, Fink HA, Cannon M et al. 2017 American College of Rheumatology Guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis & Rheumatology, 2017;69(8), 1521–1537. DOI:10.1002/art.40137[2]Povoroznyuk V, Grygorieva N, Kanis JA et al. Ukrainian FRAX: criteria for diagnostics and treatment of osteoporosis. Pain. Joint. Spine. 2019;9(4):7-16. DOI: 10.22141/2224-1507.9.4.2019.191921[3]Povoroznyuk VV, Grygorieva NV, Kanis JA et al. Epidemiology of hip fracture and the development of FRAX in Ukraine. Arch Osteoporos. 2017;12(1):53. DOI: 10.1007/s11657-017-0343-2.Disclosure of Interests:Nataliia Grygorieva Consultant of: Servier, Redis, Vladyslav Povoroznyuk: None declared.

scholarly journals Clinical practice in febrile neutropenia risk assessment and granulocyte colony-stimulating factor primary prophylaxis of febrile neutropenia in Poland

2014 ◽  
Vol 6 ◽  
pp. 419-424
Author(s):  
Marek Wojtukiewicz ◽  
Ewa Chmielowska ◽  
Emilia Filipczyk-Cisarż ◽  
Krzysztof Krzemieniecki ◽  
Krzysztof Leśniewski-Kmak ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Clinical Practice ◽  
Febrile Neutropenia ◽  
Primary Prophylaxis ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Stimulating Factor

Abstract 66: Current Attitudes and Practice Patterns of Using New and Emerging Therapies to Manage Patients with Atrial Fibrillation (AF): a National Assessment of Cardiologists and Primary Care Physicians

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Gregory D Salinas ◽  
Caroline O Robinson ◽  
Nancy Roepke ◽  
B. S Burton ◽  
Debi Susalka ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Clinical Practice ◽  
Primary Care Physicians ◽  
Stroke Risk ◽  
Case Vignette ◽  
Independent Evidence ◽  
Patient Chart ◽  
Emerging Therapies ◽  
Chart Audits

Introduction: Stroke prevention is a cornerstone in the management of patients with AF at higher risk for ischemic events. This study assessed physician barriers to management of AF patients, including gaps in clinical knowledge and application of tools and guidelines for reducing stroke risk. Awareness, perception, and confidence in adopting newer anticoagulants were investigated, particularly related to balancing risk with treatment goals, and knowledge sources sought by physicians. Methods: The data for this study, conducted from March 2011 to May 2011, were collected through the use of a nationally-distributed case vignette survey to cardiologists and primary care physicians (PCPs), as well as patient chart audits nested within the physician sample. Each component of this study was reviewed and approved by the Western Institutional Review Board (WIRB). Results: Surveys from 142 cardiologists and 250 PCPs, and 632 patient chart audits, were analyzed. Nearly half of cardiologists and more than 75% of PCPs surveyed identified uncertainty regarding stroke risk assessment and lack of awareness of tools to guide risk assessment as barriers to determining appropriate antithrombotic therapy. Case vignette assessment found that 44% of PCPs familiar with the CHADS2 risk assessment tool were unable to appropriately assign a risk score, and they were less likely than cardiologists (53% vs 85%) to use this tool in clinical practice. Consistent with their greater familiarity, 65% of cardiologists are very confident in using emerging anticoagulants, while only 40% of PCPs have comparable confidence. The most frequently sought and valued resources for information about emerging anticoagulants were clinical practice guidelines, journal articles, CME activities, and communication with physician peers. Conclusion: Knowledge gaps and clinical barriers exist among physicians for stroke risk assessment, anticoagulation management, and use of emerging therapies in patients with AF. Physicians seek independent evidence-based information when deciding how to incorporate new anticoagulants into practice. The data suggest that physicians value education on safety and efficacy of therapies as well as practical guidance on applying clinical data to practice.

To Assess the Fall Risk among the Elderly in selected Urban Area Kachery, Thrissur

2021 ◽  
pp. 295-298
Author(s):  
Ann Mariya P.R ◽  
Delna Mary George ◽  
Elsamol Francis ◽  
Thasni R.A ◽  
Twinkle Joseph ◽  
...  
Keyword(s):  
Risk Assessment ◽  
High Risk ◽  
Urban Area ◽  
Elderly People ◽  
Fall Prevention ◽  
Fall Risk ◽  
Elderly Person ◽  
The Elderly ◽  
Previous Knowledge ◽  
Fall Risk Assessment

To assess the fall of risk among the elderly in selected urban area of Thrissur. Objectives a) To assess the fall risk among the elderly people in selected urban area of Kachery, Thrissur. b) To associate fall risk score with selected demographic variables. c) To correlate fall risk assessment questionnaire score and modified fall prevention checklist for personal risk factors score among elderly individuals. d) To teach the elderly people about fall prevention exercise. Methodology: Non-experimental descriptive research design is adopted in this study. We selected 60 samples through random sampling technique. Standardized fall risk assessment questionnaire built by national aging research institute and modified fall prevention checklist for personal risk factors built by Hamilton county was used to collect the data. Tool was administered by interview method for assessing fall risk. Fall preventive intervention module developed, validated and administered following data collection. The data collected were analyzed by using descriptive and inferential statistics. Result: The demographic profile of elderly people shows that 46.66% belongs to age group between 60-70 years and most of them 58.33% were females. The majority 73.33% of elderly person are at low risk for fall and 26.66% are at high risk for fall in questionnaire and 81.67% of elderly are low risk for fall, 18.33% are risk and there is no elderly person high risk for fall in checklist. The overall fall risk is high among elderly individual alone in home and low in elderly in nuclear families. The risk for fall among elderly based on previous history of fall shows that elderly with visual impairment those who don’t have previous knowledge about fall prevention and elderly age between 91-100 is high risk for fall. The risk for fall based on ability to perform ADL in elderly shows those who living alone in the home high risk for fall. There is significant association between score with selected variables like age, previous knowledge about fall prevention, elderly residing in their home alone. We found that there is perfect positive correlation r=1 between fall risk assessment, questionnaires and checklist score. Discussion: At the end of the study the investigator found that the risk for fall based on the assessment of fall history among elderly people shows that, there is significant association between age (p=0.0273) that is, age group between 91-100 years are high risk for fall. Previous knowledge about fall prevention shows that, elderly without previous knowledge about fall prevention is at high risk for fall (p= 0.03074). In sensory impairment that is, elderly having visual impairment (p=0.998) having risk for fall. The risk for fall among elderly people based on their ability to perform activities of daily living shows that, elderly residing in their home alone shows more risk for fall.

Implementing machine learning algorithms for suicide risk prediction in clinical practice: A focus group study

2021 ◽  
Author(s):  
Kate Bentley ◽  
Kelly Zuromski ◽  
Rebecca Fortgang ◽  
Emily Madsen ◽  
Daniel Kessler ◽  
...  
Keyword(s):  
Machine Learning ◽  
Risk Assessment ◽  
Clinical Practice ◽  
Risk Prediction ◽  
Suicide Risk ◽  
Prediction Models ◽  
Clinical Decision ◽  
Machine Learning Algorithms ◽  
Suicide Risk Assessment ◽  
Focus Group Study

Background: Interest in developing machine learning algorithms that use electronic health record data to predict patients’ risk of suicidal behavior has recently proliferated. Whether and how such models might be implemented and useful in clinical practice, however, remains unknown. In order to ultimately make automated suicide risk prediction algorithms useful in practice, and thus better prevent patient suicides, it is critical to partner with key stakeholders (including the frontline providers who will be using such tools) at each stage of the implementation process.Objective: The aim of this focus group study was to inform ongoing and future efforts to deploy suicide risk prediction models in clinical practice. The specific goals were to better understand hospital providers’ current practices for assessing and managing suicide risk; determine providers’ perspectives on using automated suicide risk prediction algorithms; and identify barriers, facilitators, recommendations, and factors to consider for initiatives in this area. Methods: We conducted 10 two-hour focus groups with a total of 40 providers from psychiatry, internal medicine and primary care, emergency medicine, and obstetrics and gynecology departments within an urban academic medical center. Audio recordings of open-ended group discussions were transcribed and coded for relevant and recurrent themes by two independent study staff members. All coded text was reviewed and discrepancies resolved in consensus meetings with doctoral-level staff. Results: Though most providers reported using standardized suicide risk assessment tools in their clinical practices, existing tools were commonly described as unhelpful and providers indicated dissatisfaction with current suicide risk assessment methods. Overall, providers’ general attitudes toward the practical use of automated suicide risk prediction models and corresponding clinical decision support tools were positive. Providers were especially interested in the potential to identify high-risk patients who might be missed by traditional screening methods. Some expressed skepticism about the potential usefulness of these models in routine care; specific barriers included concerns about liability, alert fatigue, and increased demand on the healthcare system. Key facilitators included presenting specific patient-level features contributing to risk scores, emphasizing changes in risk over time, and developing systematic clinical workflows and provider trainings. Participants also recommended considering risk-prediction windows, timing of alerts, who will have access to model predictions, and variability across treatment settings.Conclusions: Providers were dissatisfied with current suicide risk assessment methods and open to the use of a machine learning-based risk prediction system to inform clinical decision-making. They also raised multiple concerns about potential barriers to the usefulness of this approach and suggested several possible facilitators. Future efforts in this area will benefit from incorporating systematic qualitative feedback from providers, patients, administrators, and payers on the use of new methods in routine care, especially given the complex, sensitive, and unfortunately still stigmatized nature of suicide risk.

Personalized medicine in non-communicable diseases: latest advances and future prospects

Kardiologiia ◽  
2021 ◽  
Vol 61 (11) ◽  
pp. 98-103
Author(s):  
O. M. Drapkina ◽  
A. A. Ivanova
Keyword(s):  
Risk Assessment ◽  
Clinical Practice ◽  
Personalized Medicine ◽  
Human Genome ◽  
Communicable Diseases ◽  
Future Prospects ◽  
Significant Progress ◽  
Non Communicable Diseases ◽  
New Methods ◽  
Genomic Technologies

Since the human genome was decoded more than 15 years ago, there has been a huge leap forward in the development of genomic and post-genomic technologies. Personalized medicine is engaged in implementing these technologies in clinical practice by developing new methods for risk assessment, diagnosis, and treatment of diseases taking into account individual features of the patient. Significant progress has been achieved in decoding genetic bases of chronic noninfectious diseases; new markers for the risk of complications and targets for effects of drugs are being searched for. This review highlights promising directions in the development of personalized medicine, the problems facing modern scientists, and possible ways to solve them

scholarly journals The importance of embedding psychopathology and phenomenology in clinical practice and training in psychiatry

2020 ◽  
Vol 26 (5) ◽  
pp. 287-295
Author(s):  
Nandini Chakraborty
Keyword(s):  
Risk Assessment ◽  
Clinical Practice ◽  
Patient Experience ◽  
Performance Indicators ◽  
Current Position ◽  
Detailed Understanding ◽  
Psychiatric Expertise ◽  
The Uk ◽  
State Examination ◽  
And Training

SUMMARYPsychiatrists live and work in complex, clinically challenging times. Their paperwork is geared increasingly towards defensive practice, key performance indicators and risk assessment forms. Somewhere in the process, detailed understanding of patient experience and clinical formulation based on key psychiatric expertise and skill in mental state examination have taken a backseat. I review the history behind the Present State Examination, the realisation in the 1980s of the need for a common psychiatric language internationally and the current position on phenomenology in psychiatry curricula in the UK. I conclude that it is time to think seriously about a return to basics in psychiatric phenomenology and psychopathology.

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