Risk Assessment Score Research Articles

Framework for Detecting Breast Cancer Risk Presence Using Deep Learning

Cancer is a complicated global health concern with a significant fatality rate. Breast cancer is among the leading causes of mortality each year. Advancements in prognoses have been progressively based primarily on the expression of genes, offering insight into robust and appropriate healthcare decisions, owing to the fast growth of advanced throughput sequencing techniques and the use of various deep learning approaches that have arisen in the past few years. Diagnostic-imaging disease indicators such as breast density and tissue texture are widely used by physicians and automated technology. The effective and specific identification of cancer risk presence can be used to inform tailored screening and preventive decisions. For several classifications and prediction applications, such as breast imaging, deep learning has increasingly emerged as an effective method. We present a deep learning model approach for predicting breast cancer risk primarily on this foundation. The proposed methodology is based on transfer learning using the InceptionResNetV2 deep learning model. Our experimental work on a breast cancer dataset demonstrates high model performance, with 91% accuracy. The proposed model includes risk markers that are used to improve breast cancer risk assessment scores and presents promising results compared to existing approaches. Deep learning models include risk markers that are used to improve accuracy scores. This article depicts breast cancer risk indicators, defines the proper usage, features, and limits of each risk forecasting model, and examines the increasing role of deep learning (DL) in risk detection. The proposed model could potentially be used to automate various types of medical imaging techniques.

Derivation of a Risk Score (REVEAL-ECHO) Based on Echocardiographic Parameters of Patients With Pulmonary Arterial Hypertension

Multiparametric risk assessment tools determine mortality risk in patients with pulmonary arterial hypertension (PAH) by combining invasive and noninvasive variables so management strategies can be tailored to individuals. Can a risk score based on common echocardiographic parameters risk-stratify patients with PAH? A Registry to Evaluate Early and Long-Term PAH Disease Management (REVEAL) echocardiographic risk score (REVEAL-ECHO) was derived using retrospective echocardiographic data from 2,400 adult patients with PAH enrolled in the REVEAL registry database. A stepwise Cox regression model identified echocardiographic parameters significantly predictive of survival. Values were assigned to each selected parameter based on survival at 12months' follow-up (Kaplan-Meier estimates). The REVEAL-ECHO risk score was the sum of individual values. Patients were categorized as having low, intermediate, or high risk based on Kaplan-Meier-predicted 12-month survival. The risk score included four echocardiographic parameters-right ventricular (RV) chamber enlargement, reduced RV systolic function, tricuspid regurgitation severity, and pericardial effusion-and accounted for PAH etiology. Higher REVEAL-ECHO risk scores signaled lower probability of 12-month survival. Statistically significant separation of mortality risk was observed among the risk strata: intermediate vslow (hazard ratio [HR], 1.43; 95%CI, 1.17-1.75; P= .0004) and high vslow (HR, 2.60; 95%CI, 2.19-3.10; P< .0001). Augmentation of the REVEAL Lite 2 risk calculator with REVEAL-ECHO risk scores achieved separation of REVEAL Lite 2 into four risk groups and identified a subgroup of patients with a low REVEAL Lite 2 risk score who were at higher risk (intermediate-low risk) and a subgroup of patients with an intermediate REVEAL Lite 2 risk score who also were at higher risk (intermediate-high risk). A REVEAL-ECHO risk score, derived using four echocardiographic parameters, may discriminate risk further when used as an adjunct to current risk assessment scores. Further validation is required.

ОСОБЛИВОСТІ ВПЛИВУ ШТУЧНОГО ІНТЕЛЕКТУ НА БАНКІВСЬКИЙ СЕГМЕНТ ФІНАНСОВОГО РИНКУ УКРАЇНИ

Over the past couple of years, the global economy and financial sector have been increasingly affected by the development of digital technologies. Access to technology, advanced analytics, data and an innovative culture have given FinTech companies advantages that they have used to transform the banking ecosystem. It is these elements that have made it possible to influence access to financial services, payments, infrastructure, distribution and components of the safety and soundness of the banking sector. In today's conditions, artificial intelligence is one of the most important elements that affect the process of digitalization of the economy. With the help of artificial intelligence technologies, the subjects of the banking services market are able to reduce costs and gain remote access to consumers. Innovations related to the use of artificial intelligence enable the transformation of traditional automated remote banking customer service systems into a new technological and informational dimension, resulting in the formation of digital banking. The article examines the impact of artificial intelligence (AI) on the banking sector of Ukraine. The scope of the use of AI technologies in the banking sector, the types and methods of their application are considered. The article analyzes the use of AI in various aspects of the banking sector, including process automation, digitalization of banking services and improved customer service. Among the well-known areas of application of artificial intelligence in the banking sector are chatbots for customer support, risk assessment and credit scoring systems. However, it is emphasized that personalized services have also gained popularity in recent times, as building quality relationships with customers requires not only meeting their current requests, but also anticipating their needs at every stage of the customer journey. As practice shows, personalized sales have a higher conversion rate than selling an accessible assortment of goods for everyone, and this is where artificial intelligence can be applied. The trends in the development of the AI industry in Ukraine and the positive factors of the introduction of new financial services and products on the financial market of Ukraine are also indicated.

Relationships between clinico-biochemical markers and echo parameter including right ventricle strain with severity of pulmonary arterial hypertension (group I) in Ibn-albitar cardiac center

Background: A quickly developing condition, pulmonary arterial hypertension eventually results in right heart failure and death. Increasing research suggests that early intervention rather than postponing therapy produces better outcomes. Several factors, including functional classification, exercise ability, cardiac imaging results, and biomarker levels, have been proven to predict longevity both at the time of diagnosis and after therapy. Aim of study: To determined 6MWT, biological marker (CRP, S. URIC ACID, BNP) & RV strain as predictor of PAH of according to MRASP. Method: This a cross sectional study was conducted between the first of May, 2019 and the first of May, 2020 among patients with approved diagnosis of pulmonary artery hypertension and admitted to the Ibn AL- Baitar heart Center. This study excluded every patient with Poor image quality, Atrial fibrillation or Flutter, Pregnancy, Patients with other causes of PAH, Unable to perform 6MWT and Renal failure. BNP, CRP and uric acid were measured to all patients and echocardiography was done, also Six-minute walk distance measured than The modified risk assessment score of PAH was determined and according to it patients categorized into low-risk, intermediate-risk, and high-risk. Result: a total of 31 patients were enrolled in this study. The percentage of patients with impaired GLS was 26(86.6%) patients, BNP was raised in 73.3% (22) of patients and there were 14(45.2%) patients with low score and 17 (58.8%) patients with intermediate- high score. The mean CRP was significantly lower in low MRASP score than intermediate – high MRASP score (4.1 vs 7.4) with p value =0.001, The echocardiography parameters that shown significant difference between patients with low and intermediate - high MRASP were inferior vena cava diameter, RV pulse velocity and GLS. Conclusion: The approach to risk assessment is useful tool in assessing patient with PAH.

Frequency and etiological denominators of alveolar osteitis at Northern Province of Kingdom of Saudi Arabia-An observational study.

Alveolar osteitis is a painful complication that often arises after tooth extraction, presenting a significant clinical challenge. It is imperative to gain a comprehensive understanding of both its occurrence and the contributing factors to enhance the quality of dental care. The aim of this study was to assess the frequency and prevalence of alveolar osteitis among patients and compare these variables based on demographic characteristics (age and sex), the number of teeth extractions, operator experience, health status, and smoking habits in the target population. This cross-sectional observational study was conducted from May 2019 to April 2020. It included all patients above 16 years of age, of both genders, who underwent permanent tooth extraction for various reasons. Patient demographics, smoking habits, health status, operating dental surgeon's clinical experience, extraction technique, and the number of teeth extracted were recorded. Statistical analysis was performed using SPSS version 25. Chi-square test and regression analysis were used to assess differences between age, sex, smoking habit, dentist category, and the number of teeth extractions in relation to alveolar osteitis. A total of 679 permanent tooth extractions were performed in 438 patients. Alveolar osteitis was observed in 107 cases (15.7%) following tooth extractions. Among these, 36 cases (33.6%) occurred in single tooth extraction cases, while 71 cases (66.4%) were present in patients with multiple extractions. Moreover, 67 cases (62.6%) of alveolar osteitis were found in cigarette smokers. In addition, 61 cases (57%) of dry sockets were reported after tooth extractions performed by dental interns, while 46 cases (43.0%) were noted in extractions performed by experienced dental surgeons and specialists. The study found a 15.7% incidence of alveolar osteitis in tooth extraction patients in the Al-Jouf region. Alveolar osteitis was more prevalent in males and the age group of 56-77 years. Multiple tooth extractions were associated with higher alveolar osteitis incidence, while operator inexperience increased post-extraction complication risks. In addition, a promising novel protocol and risk assessment scoring system have been devised which require further validation and future research.

Comparison of Framingham Risk Scores (FRS), Joint British Society (JBS3), and American College of Cardiology/American Heart Association (ACC/AHA) Cardiovascular Risk Scores Among Adults With First Myocardial Infarction.

The prevalence of myocardial infarction (MI) among young Indian adults is on the rise with reports suggesting 32.7%of all deaths in men and 32.6% of all deaths in women between 2010-13 were due to cardiovascular diseases (CVDs). Though various long-term cohort studies have established risk assessment scores none of them are specific to the Indian population. In this study, we look to establish which scoring system among the American College of Cardiology (ACC), Joint British Society (JBS3) and Framingham Risk Scores (FRS) would be reliable for the Indian population. A timely intervention based on the most reliable score can help mitigate cardiovascular diseases. In this cross-sectional study, we included Indian adults, aged more than 40 years, with first MI. Patients previously on lipid lowering drugs were excluded. Demographic data, history, clinical information, laboratory data and other investigations were noted. Subsequently the predicted cardiovascular risk scores based on JBS3, ACC, and FRS were calculated and divided into low risk, intermediate andhigh risk based on the categorization of the risk scores individually. There were 102 (79.1%) males and 23 (17.8%) females with a mean age of 51.01years (standard deviation [SD]=12.82, p value <0.001). There was considerable prevalence of type 2 diabetes mellitus with 56 (47.1%) of the subjects being known diabetics. The mean 10-year risk of MI based on ACC was 12.42% (SD=10.45), mean JBS3 score was 14.45% (SD=12.67) and mean FRS score was 15.75% (SD=14.71). FRS scores when categorized, 48 (40.3%) patients had low risk, 30 (23.3%) had medium risk and 43 (33.3%) had high risk.As for ACC score, 39 (35.8%) patients were in low risk and29 (26.6%) in intermediate risk, borderline in 18 (16.5%) and high risk in23 (21.1%).InJBS3 scores, 53 (46.5%) patients were inlow risk, 32 (28.1%) were in moderate risk and 29 (25.4%) in high risk. The absolute value of 10-year risk scores was highest for FRS scores. The proportion of patients whose scores were under the category of high risk was highest for FRS.

PS-P10-4: A NOVEL AND NONINVASIVE RISK ASSESSMENT SCORE AND ITS CHILD-TO-ADULT TRAJECTORIES TO SCREEN SUBCLINICAL RENAL DAMAGE IN MIDDLE AGE

This study aimed to develop a noninvasive, economical and effective subclinical renal damage (SRD) risk assessment tool to identify the high-risk asymptomatic people from large-scale population and improve current clinical SRD screening strategies. 2303 participants were included from Hanzhong Adolescent Hypertension Cohort, an ongoing prospective study followed for 30 years. Three noninvasive prediction factors (SBP, DBP and BMI) were identified as SRD-associated variables. Based on these three variables., an SRD risk assessment score with excellent classification ability (AUC value of ROC curve: 0.778 for SRD estimation, 0.729 for 4-year SRD risk prediction), calibration (Hosmer-Lemeshow goodness-of-fit test P = 0.62 for SRD estimation, P = 0.34 for 4-year SRD risk prediction) and more potential clinical benefits was developed. In addition, we identified three child-to-adult SRD risk assessment score trajectories: increasing, increasing-stable and stable. Further difference analysis and logistic regression analysis also showed these SRD risk assessment score trajectories were highly associated with the incidence of SRD in middle age. In brief, we developed a novel and noninvasive SRD risk assessment tool with excellent performance to help identify high-risk asymptomatic people from large-scale population and assist in SRD screening. JOURNAL/jhype/04.03/00004872-202301001-01109/figure1/v/2023-10-24T163949Z/r/image-jpeg

Machine Learning-Based Scoring System for Early Prognosis Evaluation of Patients with Coronavirus Disease 2019

Abstract Background The global spread of coronavirus disease 2019 (COVID-19) continues to threaten human health security, exerting considerable pressure on healthcare systems worldwide. While prognostic models for COVID-19 hospitalized or intensive care patients are currently available, prognostic models developed for large cohorts of thousands of individuals are still lacking. Methods Between February 4 and April 16, 2020, we enrolled 3,974 patients admitted with COVID-19 disease in the Wuhan Huo-Shen-Shan Hospital and the Maternal and Child Hospital, Hubei Province, China. (1) Screening of key prognostic factors: A univariate Cox regression analysis was performed on 2,649 patients in the training set, and factors affecting prognosis were initially screened. Subsequently, a random survival forest model was established through machine analysis to further screen for factors that are important for prognosis. Finally, multivariate Cox regression analysis was used to determine the synergy among various factors related to prognosis. (2) Establishment of a scoring system: The nomogram algorithm established a COVID-19 patient death risk assessment scoring system for the nine selected key prognostic factors, calculated the C index, drew calibration curves and drew training set patient survival curves. (3) Verification of the scoring system: The scoring system assessed 1,325 patients in the test set, splitting them into high- and low-risk groups, calculated the C-index, and drew calibration and survival curves. Results The cross-sectional study found that age, clinical classification, sex, pulmonary insufficiency, hypoproteinemia, and four other factors (underlying diseases: blood diseases, malignant tumor; complications: digestive tract bleeding, heart dysfunction) have important significance for the prognosis of the enrolled patients with COVID-19. Herein, we report the discovery of the effects of hypoproteinemia and hematological diseases on the prognosis of COVID-19. Meanwhile, the scoring system established here can effectively evaluate objective scores for the early prognoses of patients with COVID-19 and can divide them into high- and low-risk groups (using a scoring threshold of 117.77, a score below which is considered low risk). The efficacy of the system was better than that of clinical classification using the current COVID-19 guidelines (C indexes, 0.95 vs. 0.89). Conclusions Age, clinical typing, sex, pulmonary insufficiency, hypoproteinemia, and four other factors were important for COVID-19 survival. Compared with general statistical methods, this method can quickly and accurately screen out the relevant factors affecting prognosis, provide an order of importance, and establish a scoring system based on the nomogram model, which is of great clinical significance.

Estimation of the risk of drug-related problems in nursing home residents : Aretrospective analysis of routine data

Polypharmacy and drug-related problems are major challenges in the care and treatment of nursing home residents. Many interventional studies showed disappointing results, which lead to the question if this could also be due to the selection of the target parameters of these studies. Aroutine data set from six long-term care facilities was retrospectively analyzed. The question is if the recently validated medication risk score (MERIS) is suitable for carrying out arisk assessment in apopulation of nursing home residents. Associations between MERIS and the dependent variables hospital admissions and falls over 12months and aweight loss of ≥ 5% over 3months were examined. Out of 495 residents 38.6% (n = 191) have ahigh risk of drug-related problems according to MERIS. Aunivariate regression analysis showed asignificantly increased risk of hospital admissions (OR 2.2; p < 0.001) and weight loss of ≥ 5% (OR 1.95; p = 0.041) with high MERIS, but no significant association with falls. In the multivariate regression the risk of hospitalization was increased by diabetes mellitus (OR 1.88; p = 0.004), falls in the same period (OR 1.91; p = 0.001), positive MERIS (OR 1.75; p = 0.006) and decreased with stable weight (OR 0.88; p = 0.004). The results indicate the potential of the score for future research projects and individual risk assessment; however, due to the limitations of retrospective secondary analyses further studies are required.

Risk assessment in delayed free flap reconstruction for severe lower extremity trauma.

This study aims to identify serum biomarkers that contribute to vascular thrombosis and complete flap failure in delayed reconstruction with free flaps, as well as to develop a scoring system of risk assessment including these biomarkers. A retrospective review of the database was conducted for lower extremity open fractures reconstructed between 7 and 90days from injury, from March 2014 to February 2022. We investigated changes in platelet count (PLT), D-dimer, creatine phosphokinase (CPK), and C-reactive protein (CRP) and then, developed a risk assessment system including these biomarkers as risk factors. A total of 62 free flaps were enrolled, and vascular thrombosis occurred in 14 flaps (22.6%), 9 of which (14.5%) developed complete flap failure. The risk assessment score was set to a maximum of 6 points for 6 items: age ≤ 40years, time from injury to coverage ≥ 14days, zone of injury from middle to distal leg, D-dimer on the day of injury ≥ 60µg/mL, maximum value of CPK ≥ 10,000 U/L, and maximum value of CRP ≥ 25mg/dL. The best cutoff score was 3 in the vascular thrombosis model (sensitivity: 0.79, specificity: 0.77) and 4 in the complete flap failure model (sensitivity: 0.78, specificity: 0.92). Our risk assessment system showed that the risk of vascular thrombosis was high at ≥ 3 points and that of complete flap failure was high at ≥ 4 points. Significantly, elevated levels of D-dimer, CPK, and CRP require more caution during reconstruction using free flaps.

External validation of the ADA score for predicting thrombosis among acutely ill hospitalized medical patients from the APEX Trial.

The ADA (Age-D-dimer-Albumin) score was developed to identify hospitalized patients at an increased risk for thrombosis in the coronavirus infectious disease-19 (COVID-19) setting. The study aimed to validate the ADA score for predicting thrombosis in a non-COVID-19 medically ill population from the APEX trial.The APEX trial was a multinational, randomized trial that evaluated the efficacy and safety of betrixaban vs. enoxaparin among acutely ill hospitalized patients at risk for venous thromboembolism. The study endpoints included the composite of arterial or venous thrombosis and its components. Metrics of model calibration and discrimination were computed for assessing the performance of the ADA score as compared to the IMPROVE score, a well-validated VTE risk assessment model.Among 7,119 medical inpatients, 209 (2.9%) had a thrombosis event up to 77 days of follow-up. The ADA score demonstrated good calibration for both arterial and venous thrombosis, whereas the IMPROVE score had adequate calibration for venous thrombosis (p > 0.05 from the Hosmer-Lemeshow test). For discriminating arterial and venous thrombosis, there was no significant difference between the ADA vs. IMPROVE score (c statistic = 0.620 [95% CI: 0.582 to 0.657] vs. 0.590 [95% CI: 0.556 to 0.624]; ∆ c statistic = 0.030 [95% CI: -0.022 to 0.081]; p = 0.255). Similarly, for discriminating arterial thrombosis, there was no significant difference between the ADA vs. IMPROVE score (c statistic = 0.582 [95% CI: 0.534 to 0.629] vs. 0.609 [95% CI: 0.564 to 0.653]; ∆ c statistic = -0.027 [95% CI: -0.091 to 0.036]; p = 0.397). For discriminating venous thrombosis, the ADA score was modestly superior to the IMPROVE score (c statistic = 0.664 [95% CI: 0.607 to 0.722] vs. 0.573 [95% CI: 0.521 to 0.624]; ∆ c statistic = 0.091 [95% CI: 0.011 to 0.172]; p = 0.026). The ADA score had a higher sensitivity (0.579 [95% CI: 0.512 to 0.646]; vs. 0.440 [95% CI: 0.373 to 0.507]) but lower specificity (0.625 [95% CI: 0.614 to 0.637] vs. 0.747 [95% CI: 0.737 to 0.758]) than the IMPROVE score for predicting thrombosis.Among acutely ill hospitalized medical patients enrolled in the APEX trial, the ADA score demonstrated good calibration but suboptimal discrimination for predicting thrombosis. The findings support the use of either the ADA or IMPROVE score for thrombosis risk assessment. The applicability of the ADA score to non-COVID-19 populations warrants further research.Clinical Trial Registration: http://www.clinicaltrials.gov . Unique identifier: NCT01583218.

Validation of the STARZ neonatal acute kidney injury risk stratification score in an independent prospective cohort.

A rapid AKI risk assessment score would allow for improving management and outcomes. STARZ (Sethi, Tibrewal, Agrawal, Raina, waZir) score was developed for acute kidney injury (AKI) risk stratification of critically ill neonates. This is the first independent validation for the novel score outside the original enrolled centres. 750 neonates were included in the study. The STARZ score was calculated after 12 hours of admission. Neonates admitted in NICU and receiving IV fluids for at least 48 hours were included. A total of 8.8% neonates had AKI in the first 7 days post admission. The duration of hospital stay was significantly higher among neonates with AKI [10.5 (7-19) vs. 7 (5-10) days; p < 0.001]. Mortality risk was 6.4 times higher among those with AKI [8 (12.1%) vs. 13 (1.9%); p < 0.001; RR (95% CI): 6.38 (2.74-14.83)]. In this study, the STARZ neonatal scoring model showed a sensitivity of 89.4% in detecting AKI with a 90.9% specificity and a high negative predictive value of 98.9%. The area under ROC was 0.958 (0.934-0981) - a high discriminative power. The STARZ score allows for AKI risk stratification, providing opportunity for therapeutic interventions which may improve outcomes in critically ill neonates.

Development and validation of a point-of-care clinical risk score to predict surgical site infection following open spinal fusion

BackgroundSurgical site infection (SSI) after open spine surgery increases healthcare costs and patient morbidity. Predictive analytics using large databases can be used to develop prediction tools to aid surgeons in identifying high-risk patients and strategies for optimization. The purpose of this study was to develop and validate an SSI risk-assessment score for patients undergoing open spine surgery. MethodsThe Premier Healthcare Database of adult open spine surgery patients (n = 157,664; 2,650 SSIs) was used to create an SSI risk scoring system using mixed effects logistic regression modeling. Full and reduced multilevel logistic regression models were developed using patient, surgery or facility predictors. The full model used 38 predictors and the reduced used 16 predictors. The resulting risk score was the sum of points assigned to 16 predictors. ResultsThe reduced model showed good discriminatory capability (C-statistic = 0.75) and good fit of the model ([Pearson Chi-square/DF] = 0.90, CAIC=25,517) compared to the full model (C-statistic = 0.75, [Pearson Chi-square/DF] =0.90, CAIC=25,578). The risk scoring system, based on the reduced model, included the following: female (5 points), hypertension (4), blood disorder (8), peripheral vascular disease (9), chronic pulmonary disease (6), rheumatic disease (16), obesity (12), nicotine dependence (5), Charlson Comorbidity Index (2 per point), revision surgery (14), number of ICD-10 procedures (1 per procedure), operative time (1 per hour), and emergency/urgent surgery (12). A final risk score as the sum of the points for each surgery was validated using a 1,000-surgery random hold-out (independent from the study cohort) sample (C-statistic = 0.77). ConclusionsThe resulting SSI risk score composed of readily obtainable clinical information could serve as a strong prediction tool for SSI in preoperative settings when open spine surgery is considered.

A highly predictive cardiac positron emission tomography (PET) risk score for 90-day and one-year major adverse cardiac events and revascularization

BackgroundWith the increase in cardiac PET/CT availability and utilization, the development of a PET/CT-based major adverse cardiovascular events, including death, myocardial infarction (MI), and revascularization (MACE-Revasc) risk assessment score is needed. Here we develop a highly predictive PET/CT-based risk score for 90-day and one-year MACE-Revasc. Methods and results11,552 patients had a PET/CT from 2015 to 2017 and were studied for the training and development set. PET/CT from 2018 was used to validate the derived scores (n = 5049). Patients were on average 65 years old, half were male, and a quarter had a prior MI or revascularization. Baseline characteristics and PET/CT results were used to derive the MACE-Revasc risk models, resulting in models with 5 and 8 weighted factors. The PET/CT 90-day MACE-Revasc risk score trended toward outperforming ischemic burden alone [P = .07 with an area under the curve (AUC) 0.85 vs 0.83]. The PET/CT one-year MACE-Revasc score was better than the use of ischemic burden alone (P < .0001, AUC 0.80 vs 0.76). Both PET/CT MACE-Revasc risk scores outperformed risk prediction by cardiologists. ConclusionThe derived PET/CT 90-day and one-year MACE-Revasc risk scores were highly predictive and outperformed ischemic burden and cardiologist assessment. These scores are easy to calculate, lending to straightforward clinical implementation and should be further tested for clinical usefulness.

Approach to Contemporary Risk Assessment, Prevention and Management of Thrombotic Complications in Multiple Myeloma.

Multiple myeloma (MM) is associated with an increased risk of thrombotic complications, which remains substantial despite the implementation of thromboprophylaxis. The procoagulant state that characterizes the disease is multifactorial, and a greater understanding of the underlying pathophysiology is required to inform appropriate thrombosis prevention. Currently, there is a shift towards using direct oral anticoagulants (DOACs) in this setting; head-to-head comparisons in the context of controlled clinical trials between class agents are still missing. MM-specific VTE risk assessment scores have been developed to optimize management and minimize the associated mortality/morbidity. Their clinical utility remains to be evaluated. The value of adding biomarkers to clinical scores to optimize their performance and increase their discriminatory power is also under assessment.

Risk factors for extended length of stay and non-home discharge in adults treated with multi-level fusion for lumbar degenerative pathology and deformity

PurposeTo identify independent risk factors, including the Risk Assessment and Prediction Tool (RAPT) score, associated with extended length of stay (eLOS) and non-home discharge following elective multi-level instrumented spine fusion operations for diagnosis of adult spinal deformity (ASD) and lumbar degenerative pathology.MethodsAdults who underwent multi-level (ge 3 segments) instrumented spine fusions for ASD and lumbar degenerative pathology at a single institution (2016–2021) were reviewed. Presence of a pre-operative RAPT score was used as an inclusion criterion. Excluded were patients who underwent non-elective operations, revisions, operations for trauma, malignancy, and/or infections. Outcomes were eLOS (> 7 days) and discharge location (home vs. non-home). Predictor variables included demographics, comorbidities, operative information, Surgical Invasiveness Index (SII), and RAPT score. Fisher’s exact test was used for univariate analysis, and significant variables were implemented in multivariate binary logistic regression, with generation of 95% percent confidence intervals (CI), odds ratios (OR), and p-values.ResultsIncluded for analysis were 355 patients. Post-operatively, 36.6% (n = 130) had eLOS and 53.2% (n = 189) had a non-home discharge. Risk factors significant for a non-home discharge were older age (> 70 years), SII > 36, pre-op RAPT < 10, DMII, diagnosis of depression or anxiety, and eLOS. Risk factors significant for an eLOS were SII > 20, RAPT < 6, and an ASA score of 3.ConclusionThe RAPT score and SII were most important significant predictors of eLOS and non-home discharges following multi-level instrumented fusions for lumbar spinal pathology and deformity. Preoperative optimization of the RAPT’s individual components may provide a useful strategy for decreasing LOS and modifying discharge disposition.

Ten Years Risk Prediction of Cardiovascular Disease among Adults in Rural Area of Dakshina Kannada, Karnataka

Background: Cardiovascular disease (CVD), one of the non-communicable diseases, has become a major public health problem and it is a leading cause of morbidity and mortality in both developing and developed countries. The important CVD risk factors are obesity, hypertension, diabetes, hyperlipidaemia, unhealthy diet, physical inactivity and tobacco use. Cardiovascular risk approach is feasible and cost-effective tool, which helps to identify those at high risk for developing CVDs, so that immediate preventive measures or action can be taken to reduce the risk. Objectives: estimate the ten-year risk of developing cardiovascular disease using Framingham heart risk assessment score. Materials and Methods: A community-based, cross-sectional study was conducted among adults residing in a rural area of Dakshina Kannada District for a period of 6 months from July 2013 to December 2013. The data was collected using pretested semi structured questionnaire through interview methods. Anthropometric measurement and blood investigation (fasting blood sugar and lipid profile) was done. The Framingham Risk Score is a gender-specific algorithm used to estimate the 10-year cardiovascular risk of an individual Results: Among 712 study participants, 95 (13.3%) and 20 (2.8%) participants had intermediate and high risk of developing cardiovascular disease in 10 years respectively. The proportion of intermediate CVD risk prediction and high-risk predication was more in males as compared to females. Conclusion: The cardiovascular risk factors like obesity, physical inactivity, diabetes and hypertension are widely prevalent among adults in rural areas. The high-risk prediction for developing CVD among study participants in next 10 years was 2.8%. Keywords: Cardiovascular risk factors, Framingham risk score, 10 years CVD risk prediction, Prevalence

Clinical implementation of suicide risk prediction models in healthcare: a qualitative study

BackgroundSuicide risk prediction models derived from electronic health records (EHR) are a novel innovation in suicide prevention but there is little evidence to guide their implementation.MethodsIn this qualitative study, 30 clinicians and 10 health care administrators were interviewed from one health system anticipating implementation of an automated EHR-derived suicide risk prediction model and two health systems piloting different implementation approaches. Site-tailored interview guides focused on respondents’ expectations for and experiences with suicide risk prediction models in clinical practice, and suggestions for improving implementation. Interview prompts and content analysis were guided by Consolidated Framework for Implementation Research (CFIR) constructs.ResultsAdministrators and clinicians found use of the suicide risk prediction model and the two implementation approaches acceptable. Clinicians desired opportunities for early buy-in, implementation decision-making, and feedback. They wanted to better understand how this manner of risk identification enhanced existing suicide prevention efforts. They also wanted additional training to understand how the model determined risk, particularly after patients they expected to see identified by the model were not flagged at-risk and patients they did not expect to see identified were. Clinicians were concerned about having enough suicide prevention resources for potentially increased demand and about their personal liability; they wanted clear procedures for situations when they could not reach patients or when patients remained at-risk over a sustained period. Suggestions for making risk model workflows more efficient and less burdensome included consolidating suicide risk information in a dedicated module in the EHR and populating risk assessment scores and text in clinical notes.ConclusionHealth systems considering suicide risk model implementation should engage clinicians early in the process to ensure they understand how risk models estimate risk and add value to existing workflows, clarify clinician role expectations, and summarize risk information in a convenient place in the EHR to support high-quality patient care.

Psychosis and conduct disorder in Greek forensic patients found not guilty by reason of insanity: Differences between patients with and those without a history of conduct disorder in childhood or adolescence

Much epidemiological evidence converges in identifying distinct types of individuals suffering from schizophrenia who exhibit aggressive behavior: those with and those without a history of conduct disorder (CD) in childhood or adolescence. In this study a sample of Greek forensic patients suffering from psychotic disorders was examined regarding demographic, clinical, legal and psychometric characteristics. All patients had committed a crime and were found not guilty by reason of insanity (NGRIs) in a court of law. This study aims to clarify whether history of conduct disorder leads to greater violence or shapes the index offense in some way. It also aims to examine new parameters, such as psychopathology, personality traits, substance abuse and risk assessment, not included in the relevant literature so far, and whether they are relevant and why in this specific group of patients. The sample was divided in two groups depending on the history of CD or not, and subsequently statistically significant differences were explored between the groups. The research aimed to highlight specific characteristics of both groups with the ultimate goal of making more accurate prognosis regarding risk assessment, as well as determining different needs for treatment in each group (e.g. drug abuse). Overall, 78 forensic psychiatric records of NGRI offenders were identified throughout a five-year period in the Psychiatric Hospital of Thessaloniki (January 2015 to January 2020), who were divided into two groups depending on the history of conduct disorder in childhood or adolescence (N = 30) or not (N = 48). The two groups were compared regarding hostility and aggression (with the Hostility and Direction of Hostility Questionnaire-HDHQ and the Aggression Questionnaire), personality traits (with the Zuckerman- Kuhlman Personality Questionnaire-ZKPQ), dangerousness (with the Historical, Clinical and Risk Management 20- HCR-20 scale), addiction (with the Addiction Severity Index-ASI), previous violent behavior or convictions (with a semi-structured tool), and psychopathology current and at the time of the index (with the Positive And Negative Syndrome Scale-PANSS). Comparing the two groups (with CD history vs. without CD history) we found that patients with a history of conduct disorder had significantly higher compulsory hospitalization rates up to the time of the perpetration of the offense and a significantly higher rate of illicit drug use. While they were more likely to exhibit violent behavior before the index offense, it was noted that they committed fewer crimes against life. They were younger at the index offense and they presented with more severe positive symptomatology at the time of the research and a steadily high risk assessment score. Our findings underline the importance of diagnosing CD in early life and subsequently raising awareness when this individual develops schizophrenic disorder, thus emphasizing the need for appropriately targeted interventions in each case. Our research also illustrates that forensic patients with both schizophrenia and a history of conduct disorder before the age of 15 exhibit more severe psychopathology after the index crime even after long hospitalization and treatment. Our findings illustrate that the diagnosis of CD in psychotic offenders found not guilty by reason of insanity affects their dangerousness in general, but not the severity of the crimes committed.

Adherence to the use of the caprini score among Russian specialists: results of an electronic survey

The aim of the study was to assess the adherence of Russian doctors to the use of the Caprini risk assessment score for venous thromboembolism complications in real clinical practice. On the basis of the Google Forms platform, an electronic questionnaire was created, with an invitation to complete it sent out by e-mail and through social networks of the educational project «School of Thrombosis». The survey was conducted from October 20 to October 30, 2021. The answers were received from 270 respondents, of which 260 questionnaires from specialists working in Russia were included in the analysis. Among the doctors, specialists in vascular surgery, including phlebology, and general surgery from private clinics and city clinical hospitals prevailed. Up to 90 % of the Russian doctors of various medical specialties are aware of the Caprini scale, up to 77 % actively use it in clinical practice, up to 74 % of the specialists use the score results to make decisions on the tactics of primary prevention of venous thromboembolism complications, and up to 28 % of the respondents interact with the scale integrated into medical records in paper or electronic format. Most respondents noted the availability of modern means of pharmacological prevention, in particular, LMWH and DOAC, in their medical institutions. As for mechanical prophylaxis, elastic bandages and compression stockings were almost equally available, but methods of actively accelerating blood flow could be afforded by no more than 15 % of the respondents. Conclusions: most of the Russian doctors surveyed note a high adherence to the use of the Caprini scale to assess the risk of venous thromboembolic complications in real clinical practice.