Reassessment Of Risk Research Articles

Oral Microbiota Alterations in Subjects with SARS-CoV-2 Displaying Prevalence of the Opportunistic Fungal Pathogen Candida albicans.

The oral cavity remains an underappreciated site for SARS-CoV-2 infection despite the myriad of oral conditions in COVID-19 patients. Recently, SARS-CoV-2 was shown to replicate in the salivary gland cells causing tissue inflammation. Given the established association between inflammation and microbiome disruption, we comparatively profiled oral microbial differences at a metagenomic level in a cohort of hospitalized COVID-19 patients and matched healthy controls. Specifically, we aimed to evaluate colonization by the opportunistic fungal pathogen Candida albicans, the etiologic agent of oral candidiasis. Comprehensive shotgun metagenomic analysis indicated that, overall, COVID-19 patients exhibited significantly reduced bacterial and viral diversity/richness; we identified 12 differentially abundant bacterial species to be negatively associated with COVID-19, and the functional pathways of certain bacteria to be highly associated with COVID-19 status. Strikingly, C. albicans was recovered from approximately half of the COVID-19 subjects but not from any of the healthy controls. The prevalence of Candida is likely linked to immune hypo-dysregulation caused by COVID-19 favoring Candida proliferation, warranting investigations into the interplay between Candida and SARS-CoV2 and potential therapeutic approaches directed toward oral candidiasis. Collectively, our findings prompt a reassessment of oral opportunistic infection risks during COVID-19 disease and their potential long-term impacts on oral health.

Oleoresin Capsicum (OC) Spray: An Assessment of Respiratory Health and its Management Following Accidental and Deliberate Exposures.

Introduced into law enforcement in 1976, the oleoresin capsicum (OC) spray has been labeled as one of the most significant and radical developments in law enforcement. However, epidemiological research on OC health effects is deficient, receiving little public support. The major responses to acute exposure to OC spray can be found in the pulmonary system. The molecular mechanism(s) involved in the action of capsaicinoids, the active constituents in OC, are complex cascades of reactions which end up in necrosis or apoptosis. OC may also damage and deplete biological redox systems in the epithelial lining fluids and within cells and mitochondria, modifying structural proteins and nucleic acids and leading to enzyme inactivation. Since there are no characteristic laboratory tests available for identification or confirmation of OC exposure, and on the basis of prevailing data, reassessment of the health risks of OC exposures in vulnerable populations and in-depth study of the molecular mechanics of receptors is the need of the hour for the development of effective countermeasures. This review aims to consider evidence for adverse effects of OC spray used in ways comparable to their application by law enforcement personnel and civilians, with possible treatment recommendations that are precedent for improved management.

Development of Risk Management Model for Research and Development Facilities Construction Project in Johor, Malaysia

The construction industry drives economic growth globally but faces challenges namely outdated practices and inadequate risk management. This research focuses on improving Risk Management in Research and Development (R&D) facilities construction projects, often poorly executed by Project Management Offices (PMOs). Most studies typically address risk identification and assessment, they neglect crucial processes like risk control and monitoring. In pursuit of developing a risk management model for R&D facility construction projects in Johor Industrial Park, Malaysia, conducted a descriptive analysis self-administered questionnaires from professionals in R&D and construction fields with utilizing Statistical Package for the Social Sciences software. Additionally, employed Structural Equation Modelling (illustrated through AMOS graphics) to establish a robust and valid model. The outcome of this research reveals a strong, positive, and significant correlation between PMO requirements of Risk Monitoring and Control Practices, which encompass risk reassessment, risk audits, contingency reserves analysis, risk status meetings and Project Success Factors which related to schedule, cost, facilities requirements, and customer satisfaction in the context of RDD facilities construction. This research successfully tackles the research objectives and developed practicable project risk monitoring and control practices of risk management model for R&D facilities construction projects. Therefore, by consistently integrating these practices into their daily project activities, R&D and construction professionals can mitigate risks and address challenges prevalent in the construction industry, contributing to improved project outcomes.

Coronary Artery Protection with Chimney Stent in High-Risk Case of Coronary Occlusion in Transcatheter Aortic Valve Implantation

Transcatheter aortic valve implantation (TAVI) has rapidly evolved in the last decade to become the treatment of choice for most patients with severe aortic stenosis. Acute coronary occlusion during TAVI is a rare and life-threatening complication with high morbidity and mortality rates. If coronary occlusion is considered highly likely to occur, a risk reassessment could favor surgical aortic valve replacement. An excessive surgical risk that mandates continuing with the transcatheter strategy requires coronary protection techniques. Coronary protection techniques include; Coronary wire protection, Chimney/snorkel stent technique, “Bioprosthetic Aortic Scallop Intentional Laceration to prevent Iatrogenic Coronary Artery obstruction,” (BASILICA) technique, Splitting devices, and UNICORN procedure. In this case report we present our first experience of the “Chimney/Snorkel stent technique” for coronary protection in a case where coronary occlusion risk was high due to low coronary height, small sinus of Valsalva, and use of balloon-expandable valve.

Long QT syndrome: importance of reassessing arrhythmic risk after treatment initiation.

Risk scores are proposed for genetic arrhythmias. Having proposed in 2010 one such score (M-FACT) for the long QT syndrome (LQTS), this study aims to test whether adherence to its suggestions would be appropriate. LQT1/2/3 and genotype-negative patients without aborted cardiac arrest (ACA) before diagnosis or cardiac events (CEs) below age 1 were included in the study, focusing on an M-FACT score ≥2 (intermediate/high risk), either at presentation (static) or during follow-up (dynamic), previously associated with 40% risk of implantable cardioverter defibrillator (ICD) shocks within 4 years. Overall, 946 patients (26 ± 19 years at diagnosis, 51% female) were included. Beta-blocker (βB) therapy in 94% of them reduced the rate of those with a QTc ≥500 ms from 18% to 12% (P < .001). During 7 ± 6 years of follow-up, none died; 4% had CEs, including 0.4% with ACA. A static M-FACT ≥2 was present in 110 patients, of whom 106 received βBs. In 49/106 patients with persistent dynamic M-FACT ≥2, further therapeutic optimization (left cardiac sympathetic denervation in 55%, mexiletine in 31%, and ICD at 27%) resulted in just 7 (14%) patients with CEs (no ACA), with no CEs in the remaining 57. Additionally, 32 patients developed a dynamic M-FACT ≥2 but, after therapeutic optimization, only 3 (9%) had CEs. According to an M-FACT score ≥2, a total of 142 patients should have received an ICD, but only 22/142 (15%) were implanted, with shocks reported in 3. Beta-blockers often shorten QTc, thus changing risk scores and ICD indications for primary prevention. Yearly risk reassessment with therapy optimization leads to fewer ICD implants (3%) without increasing life-threatening events.

2023 Australian guideline for assessing and managing cardiovascular disease risk.

The 2023 Australian guideline for assessing and managing cardiovascular disease risk provides updated evidence-based recommendations for the clinical assessment and management of cardiovascular disease (CVD) risk for primary prevention. It includes the new Australian CVD risk calculator (Aus CVD Risk Calculator), based on an equation developed from a large New Zealand cohort study, customised and recalibrated for the Australian population. The new guideline replaces the 2012 guideline that recommended CVD risk assessment using the Framingham risk equation. The new guideline recommends CVD risk assessment in people without known CVD: all people aged 45-79 years, people with diabetes from 35 years, and First Nations people from 30 years. The new Aus CVD Risk Calculator should be used to estimate and categorise CVD risk into low (< 5% risk over five years), intermediate (5% to < 10% risk over five years) or high risk (≥ 10% over five years). The following reclassification factors may be applied to recategorise calculated risk to improve accuracy of risk prediction, particularly in individuals close to a risk threshold: Indigenous status/ethnicity, estimated glomerular filtration rate, urine albumin to creatinine ratio measurements, severe mental illness, coronary artery calcium score and family history of premature CVD. A variety of communication formats is available to communicateCVD risk to help enable shared decision making. Healthy lifestylemodification, including smoking cessation, nutrition, physical activity and limiting alcohol, is encouraged for all individuals. Blood pressure-lowering and lipid-modifying pharmacotherapies should be prescribed for high risk and considered for intermediate risk individuals, unless contraindicated or clinically inappropriate. Reassessment of CVD risk should be considered within five years for individuals at low risk and within two years for those with intermediate risk. Reassessment of CVD risk is not recommended for individuals at high risk. CHANGES IN ASSESSMENT AND MANAGEMENT AS A RESULT OF THE GUIDELINE: The updated guideline recommends assessment over a broader age range and uses the Aus CVD Risk Calculator, which replaces the previous Framingham-based equation. It incorporates new variables: social disadvantage, diabetes-specific risk markers, diagnosis of atrial fibrillation and use of blood pressure-lowering and lipid-modifying therapies. Reclassification factors are also a new addition. Updated risk categories and thresholds are based on the new AusCVD Risk Calculator. The proportion of the population in the high risk category (≥ 10% over five years) is likely to be broadly comparable to more than 15% risk from the Framingham-based equation. The full guideline and Aus CVD Risk Calculator can be accessed at www.cvdcheck.org.au.

Discovering Subgroups of Children With High Mortality in Urban Guinea-Bissau: Exploratory and Validation Cohort Study.

The decline in global child mortality is an important public health achievement, yet child mortality remains disproportionally high in many low-income countries like Guinea-Bissau. The persisting high mortality rates necessitate targeted research to identify vulnerable subgroups of children and formulate effective interventions. This study aimed to discover subgroups of children at an elevated risk of mortality in the urban setting of Bissau, Guinea-Bissau, West Africa. By identifying these groups, we intend to provide a foundation for developing targeted health interventions and inform public health policy. We used data from the health and demographic surveillance site, Bandim Health Project, covering 2003 to 2019. We identified baseline variables recorded before children reached the age of 6 weeks. The focus was on determining factors consistently linked with increased mortality up to the age of 3 years. Our multifaceted methodological approach incorporated spatial analysis for visualizing geographical variations in mortality risk, causally adjusted regression analysis to single out specific risk factors, and machine learning techniques for identifying clusters of multifactorial risk factors. To ensure robustness and validity, we divided the data set temporally, assessing the persistence of identified subgroups over different periods. The reassessment of mortality risk used the targeted maximum likelihood estimation (TMLE) method to achieve more robust causal modeling. We analyzed data from 21,005 children. The mortality risk (6 weeks to 3 years of age) was 5.2% (95% CI 4.8%-5.6%) for children born between 2003 and 2011, and 2.9% (95% CI 2.5%-3.3%) for children born between 2012 and 2016. Our findings revealed 3 distinct high-risk subgroups with notably higher mortality rates, children residing in a specific urban area (adjusted mortality risk difference of 3.4%, 95% CI 0.3%-6.5%), children born to mothers with no prenatal consultations (adjusted mortality risk difference of 5.8%, 95% CI 2.6%-8.9%), and children from polygamous families born during the dry season (adjusted mortality risk difference of 1.7%, 95% CI 0.4%-2.9%). These subgroups, though small, showed a consistent pattern of higher mortality risk over time. Common social and economic factors were linked to a larger share of the total child deaths. The study's results underscore the need for targeted interventions to address the specific risks faced by these identified high-risk subgroups. These interventions should be designed to work to complement broader public health strategies, creating a comprehensive approach to reducing child mortality. We suggest future research that focuses on developing, testing, and comparing targeted intervention strategies unraveling the proposed hypotheses found in this study. The ultimate aim is to optimize health outcomes for all children in high-mortality settings, leveraging a strategic mix of targeted and general health interventions to address the varied needs of different child subgroups.

Is quitting an option? The power of brotherhood among non-scholarship college football players in risk decision-making

Football upholds traditional masculine ideals of toughness, aggression, and dominance despite the risk of serious injury. This study uses a qualitative framework to understand why non-scholarship National Collegiate Athletic Association (NCAA) Division III college football players risk their health through athletics. Interviews revealed that players go through two stages of risk reassessment wherein the player strongly weighs the costs and benefits of playing versus quitting. Once football players continue past the second stage, virtually nothing will prevent them from continuing their involvement with the team. They have determined that the costs of playing a high-contact sport with a high risk of injury are worth the friendships, forming a “Brotherhood” among the teammates. This paper discusses the implications for athletes, coaches, administrators, and health professionals.

Association between early postoperative hypoalbuminaemia and outcome after orthotopic heart transplantation.

In patients undergoing heart transplantation (HTX), preoperative liver impairment and consecutive hypoalbuminaemia are associated with increased mortality. The role of early postoperative hypoalbuminaemia after HTX is unclear. This study investigated the association between early postoperative hypoalbuminaemia and 1-year mortality as well as 'days alive and out of hospital' (DAOH) after HTX. This retrospective cohort study included patients who underwent HTX at the University Hospital Duesseldorf, Germany, between 2010 and 2022. The main exposure was serum albumin concentration at intensive care unit (ICU) arrival. The primary endpoints were mortality and DAOH within 1 year after surgery. Receiver operating characteristic (ROC) curve analysis was performed and logistic and quantile regression models with adjustment for 13 a priori defined clinical risk factors were conducted. Out of 241 patients screened, 229 were included in the analysis (mean age 55 ± 11 years, 73% male). ROC analysis showed moderate discrimination for 1-year mortality by postoperative serum albumin after HTX [AUC = 0.74; 95% confidence interval (CI): 0.66-0.83]. The cutoff for serum albumin at ICU arrival was 3.0 g/dl. According to multivariate logistic and quantile regression, there were independent associations between hypoalbuminaemia and mortality/DAOH [odds ratio of 4.76 (95% CI: 1.94-11.67) and regression coefficient of -46.97 (95% CI: -83.81 to -10.13)]. Postoperative hypoalbuminaemia <3.0 g/dl is associated with 1-year mortality and reduced DAOH after HTX and therefore might be used for early postoperative risk re-assessment in clinical practice.

His bundle pacing in a patient with atrioventricular conduction abnormalities, persistent atrial flutter at high thromboembolic and bleeding risk after hybrid coronary revascularization and left atrial appendage closure - case report

We present a case of a 78-year-old patient with persistent atrial &amp;#64258; utter, history of atrial &amp;#64257; brillation and atrioventricular conduction disturbances, including &amp;#64257; rst-degree atrioventricular block (AVB) and paroxysmal complete AVB. Echocardiography revealed mildly reduced left ventricular ejection fraction (LVEF, 44%). The patient had high thromboembolic risk, had previous ischemic stroke, suffered from chronic coronary artery disease treated with hybrid coronary revascularization (minimally invasive direct coronary artery bypass grafting and subsequent percutaneous coronary intervention) as well as left atrial appendage closure. Because of high bleeding risk, double antiplatelet therapy (acetylsalicylic acid and clopidogrel) combined with low dose of low-molecular-weight heparin after cardiac surgery were introduced. Due to persistent atrial &amp;#64258; utter, complete AVB, lack of intraventricular conduction abnormalities, mildly reduced LVEF and expected high right ventricle pacing burden, the patient was referred for dual-chamber pacemaker implantation using conduction system pacing (CSP), preferentially His bundle pacing (HBP). The procedure was performed with good outcome and CSP was utilized via HBP. After reassessment of thromboembolic and bleeding risk, the patient was discharged home on reduced dose of dabigatran. Short-term follow-up showed stable HBP parameters along with no additional symptoms. Despite good short-term outcomes and no complications in studied patient, large randomized controlled trials are needed to verify long-term safety and ef&amp;#64257; cacy of HBP to optimize clinical care of patients with atrioventricular conduction abnormalities using a personalized approach.&amp;nbsp;

The Critical Intersect of Regulations, Health Technology Assessment, and Drug Safety Assessments.

Health technology assessment (HTA) is a multidisciplinary process that determines the value of health technology at different points in its lifecycle. Safety issues have become more important since regulatory authorities are increasingly adopting flexible standards, processes, and evidentiary requirements for drug approval. In this article, we compared the different role of regulatory authorities and HTA agencies. Additionally, the experience of regulatory-HTA collaboration for assessment and/or decision-making on safety issues in the lifecycle of a health technology is illustrated, including olmesartan (angiotensin II receptor antagonist) and the direct-acting hepatitis C virus (HCV) antiviral agents. Post-licensing data can be derived from various sources such as electronic health records, medical claims, drug and disease registries, post-authorization safety studies (PASS) or post-authorization safety efficacy studies (PAES), periodic benefit-risk assessment reports, as well as HTA reassessment reports, which incorporate utilization information from patients in a real-world setting and provide crucial evidence for various purposes. With the ongoing accumulation of safety and efficacy information during post-regulatory approval, a standardized process for continuous data collection and active reassessment of risk and benefit becomes crucial for managing the lifecycle of health technologies. In order to define evidence requirements clearly, reduce uncertainty, and minimize delays in HTA approval, early engagement and collaboration of HTA agencies in the regulatory review processes have become more common. However, there is currently limited interaction and collaboration between regulatory authorities and HTA agencies. This article aims to identify the challenges faced by regulators and HTA agencies today, emphasizing the significance of conducting regulatory reviews and health technology assessments throughout a technology's lifecycle, underlining the value of utilizing real-world data and evidence, and emphasizing the necessity of enhancing collaboration between regulatory authorities and HTA agencies, all within the overarching context of drug safety.

Suppression of pathogens in properly refrigerated raw milk

Conflicting claims exist regarding pathogen growth in raw milk. A small pilot study was designed to provide definitive data on trends for pathogen growth and decline in raw bovine milk hygienically produced for direct human consumption. An independent laboratory conducted the study, monitoring growth and decline of pathogens inoculated into raw milk. Raw milk samples were inoculated with foodborne pathogens (Campylobacter, E. coli O157:H7, Listeria monocytogenes, or Salmonella) at lower (&lt;162 colony forming units (CFU) per mL) and higher levels (&lt;8,300 CFU/mL). Samples were stored at 4.4°C and quantified over time after inoculation (days 0, 3, 6, 9, 12, and 14) by standard culture-based methods. Statistical analysis of trends using the Mann-Kendall Trend Test and Analysis of Variance were conducted for 48 time series observations. Evidence of pathogen growth was documented for L. monocytogenes in 8 of 12 replicates (P = 0.001 to P = 0.028). Analysis of variance confirmed significant increases for L. monocytogenes at both initial levels in week 2. No evidence of growth was documented over 14 days for the three pathogens predominantly associated with raw milk outbreaks in the US (Campylobacter, E. coli O157:H7, and Salmonella). Further research is needed to characterize parameters for pathogen growth and decline to support re-assessment of risks that were based on incorrect assumptions about interactions of pathogens with the raw milk microbiota.

Perioperative risk reassessment of non-cardiac surgery during last 10 years in patients with asymptomatic significant aortic stenosis

Abstract Background Aortic valve stenosis (AS) is a common geriatric disease and the number of patients with significant AS in need of non-cardiac surgery is expected to increase. Significant AS is considered a major risk factor for non-cardiac surgery. Method There were 113078 patients who underwent non-cardiac surgery with intermediate-to high risk in general anesthesia from 2011 to 2019 at our Medical Center. There were 221 patients with asymptomatic significant AS among this population. First, to investigate the effect of significant AS on adverse events after surgery, Major adverse cardiovascular events (MACE) and Perioperative adverse cardiovascular events (PACE) occurrences were compared in the control group and asymptomatic significant AS group. Second, in order find out the factors affecting the occurrence of MACE and PACE in patients with asymptomatic significant AS, patients with and without MACE and PACE were compared and multivariable analysis was performed in patients with asymptomatic significant AS. Result There was no significant difference between the three groups in the ratio of primary and secondary outcomes, MACE (p value 0.971) and PACE (p value 0.185). Outcomes such as cardiac death, arrest, myocardial infarction, and stroke were also not significantly different. Significant factors with MACE were coronary artery disease (OR* 6.256, 95% CI** [1.258 - 31.115], p value = 0.026) and cardiac damage stage (OR 9.241, 95% CI [1.314 - 64.976], p value = 0.025). Factors significantly associated with PACE were dialysis (OR 13.486, 95% CI [1.742 - 104.371], p value 0.013), arrhythmia (OR 11.219, 95% CI [3.474 - 36.231], p value &amp;lt;0.001), LVEF (OR 0.928, 95% CI [0.882 - 0.977], p value 0.004), and cardiac damage stage (OR 2.199, 95% CI [1.055 - 4.584], p value 0.036). MACE increased at LVEF less than 62.5% and PACE increased at LVEF less than 61.7%. Conclusion There was no significant difference in major post-operative cardiovascular events between patients with asymptomatic significant AS and the control group. Advanced cardiac damage stage in significant aortic stenosis is an important factor in perioperative risk of non-cardiac surgery.Perioperative outcome in 30 daysRisk factor analysis for PACE

Management of the Risk of Blue-Green Algae Blooms in the Iskar Dam for Drinking Water Quality of Sofia City

The introduction of systems for ensuring quality and safe drinking water and risk management is the World Health Organization (WHO) good practice introduced as a legislative requirement for all water supply organizations (Directive EU 2020/2184) on the quality of water intended for human consumption. A specific object of this research is the implemented risk assessment and management system, part of the drinking water safety plan for Sofia city. The water supply system from the water source to the end user, operated by Sofiyska voda JSC and part of Veolia, was analyzed. The hazards and risk events were reviewed for each component of the system—the catchment, water source, supply water pipes, drinking water treatment plants (DWTPs) and distribution water network. The results of the risk evaluation show that the risk of an algal bloom falls from medium risk, with a value of 36 in 2018. This risk was new for the Iskar Dam—the main water source for Sofia city. The purpose of the current study is to analyze the risk of blue-green algae blooming and the potential release of toxins in the Iskar Dam. A data analysis of phytoplankton counts, temperature of the water in the dam, precipitation, algal diversity and quantity of microcystins for a period of three years shows that there is a low probability of algae blooming. The concentration of microcystin LR was below 0.6 µg/L and of microcystin YR was below 0.1 µg/L. The highest phytoplankton count was 70,000 cells/mL in 2018, and it decreased to 30,000 cells/mL in 2020. The impact of the risk of “blue-green algae blooms in the Iskar Dam” is assessed as moderate (3) and that has not changed between 2018 and 2022. The likelihood of occurrence of this risk decreased from possible (3) to unlikely (2) after risk reassessment, and the current control effectiveness changed from weakly controlled (4) in 2018 to well controlled (2) in 2022, because more risk management actions were included in Sofiyska voda JSC. The results of the risk evaluation show that the risk of an algal bloom falls into the low-risk category with a value of 12, after measures were considered and a reassessment. As a preventive measure for better management and risk minimization, it is necessary to continue monitoring the phytoplankton count, species composition, concentration of algae toxins (microcystin LR) and nutrients in raw water from the Iskar Dam. This research has added value to the global database for surface water sources intended for human consumption and is focuses on a potential problem, valid for agricultural as well as for urban territories rich in diffused sources of pollution. The specific risk evaluation and management steps could be used and adapted by other water supply companies.

Enfermedad tromboembólica venosa: embolia pulmonar aguda

Venous thromboembolism (VTE) is a chronic disease that is the third cause of vascular death following ischemic heart disease and cerebrovascular disease. VTE mainly includes pulmonary embolism (PE) and deep vein thrombosis (DVT). The etiopathogenesis of VTE is related to Virchow's triad (venous stasis, endothelial dysfunction, and hypercoagulability) as well as the hemostasis system and immune system (immunothrombosis). At present, VTE continues to be a diagnostic challenge for clinicians. The diagnosis of VTE is based on three pillars: pretest clinical probability (PCP), the determination of D-dimer values, and performing imaging tests only in cases in which the PCP is probable and/or which present high D-dimer values.Anticoagulant treatment is the cornerstone of VTE treatment and can be divided into three phases: the acute phase (the first five to ten days), the maintenance phase (the first three to six months), and the extended (or chronic) phase after the sixth month. Its goal is to prevent early death and the recurrence of VTE, with periodic reassessment of hemorrhagic risk.

Multi-immunoaffinity column for the simultaneous analysis of bisphenol A and its analogues in Chinese foods by liquid chromatography tandem mass spectrometry.

Bisphenol A (BPA) and its four analogues have been receiving considerable attention owing to their potential endocrine disrupting effects. The European Food Safety Authority has proposed 0.04ng/kg·body weight/day of thetemporary tolerable daily intake for BPA. Therefore, a more sensitive analytical method was urgently needed for the necessity of the risk reassessment of bisphenols (BPs). The matrix effect of Chinese foods is a challenge for the analysis of ultra-trace analytes due to the presence of various spices. A multi-immunoaffinity column (mIAC) was prepared for the purification of BPA, BPB, BPF, BPS, and BPAF in Chinese foods following ultra-high-performance liquid chromatography tandem mass spectrometry detection (UHLPC-MS/MS). The recoveries of each of BPs were ranged from 84.6% to 116.7%, and the intra-day precision and inter-day precision were ranged from 1.6% to 12.4%, and from 4.1% to 14.0%, respectively. This is the first report on the mIACs for simultaneous clean-up and analysis of BPs in complex Chinese foods.

1263 Venous Thromboembolism (VTE) Risk Assessment and Thromboprophylaxis Among Hospitalised Patients: A Single-Centre Closed Loop Audit

Abstract Aim With an estimated incidence rate of 1 to 2 cases per 1,000 population, venous thromboembolism (VTE) remains a significant cause of morbidity and mortality in the United Kingdom. It is reported that VTE is responsible for approximately 60,000 deaths per annum. Furthermore, VTE has a huge financial impact on the NHS. It is reported that VTE treatment costs the NHS approximately £640 million every year. Notably, at least two-thirds of hospital-acquired VTE are preventable. NICE guideline recommends that all patients should be risk-assessed on admission and re-assessed at the point of consultant review [NG89]. The purpose of this closed-loop audit was to evaluate the effectiveness of simple interventions in improving the efficiency of VTE risk assessments at a large teaching hospital. Method Results from the first cycle were analysed and interventions were implemented with the aim to improve the standard of practice. These include the utilisation of technology in VTE risk assessments, mandatory teaching sessions and the development of prompts within clerking proformas. A repeat audit was subsequently performed to re-assess the new standard of practice and the effectiveness of these interventions. Results Our VTE risk assessment completion rates increased substantially from 16.67% to 100% and the median time taken to complete VTE risk re-assessments also improved notably from 97 to 21 hours. Positive feedbacks have been received on the effectiveness of these interventions. Conclusions By implementing these simple interventions, we can see a substantial improvement in the standards of VTE risk assessments, in compliance with the NHS Standard Contract and NICE guidelines.

A Critical Reassessment of the Kidney Risk Caused by Tetrastarch Products in the Perioperative and Intensive Care Environments.

Purpose: To reassess the results of former meta-analyses focusing on the relationship between novel HES preparations (130/0.4 and 130/0.42) and acute kidney injury. Previous meta-analyses are based on studies referring to partially or fully unpublished data or data from abstracts only. Methods: The studies included in the former meta-analyses were scrutinized by the authors independently. We completed a critical analysis of the literature, including the strengths, weaknesses and modifiers of the studies when assessing products, formulations and outcomes. Results: Both the published large studies and meta-analyses show significant bias in the context of the deleterious effect of 6% 130/0.4-0.42 HES. Without (1) detailed hemodynamic data, (2) the exclusion of other nephrotoxic events and (3) a properly performed evaluation of the dose-effect relationship, the AKI-inducing property of 6% HES 130/0.4 or 0.42 should not be considered as evidence. The administration of HES is safe and effective if the recommended dose is respected. Conclusions: Our review suggests that there is questionable evidence for the deteriorating renal effect of these products. Further well-designed, randomized and controlled trials are needed. Additionally, conclusions formulated for resource-rich environments should not be extended to more resource-scarce environments without proper qualifiers provided.

The place of dabigatran in the treatment of patients with atrial fibrillation in the light of modern recommendations

This review is devoted to the aspects of anticoagulant therapy in patients with atrial fibrillation in the light of the modern understanding of this type of arrhythmia as a polymorbid continuously developing syndrome. According to experts, the management strategy of this category of patients is based on an integrated assessment, including the risk of stroke, the presence of symptoms, assessment of structural heart disease and mandatory accounting of concomitant pathology. In this approach, the appointment of anticoagulant therapy as a prevention of stroke in a patient with atrial fibrillation is put in the first place. At the same time, experts emphasize the need for a dynamic reassessment of risks, as well as the use of a multidisciplinary team of specialists to make a complex decision. The review summarizes the basic concepts of the integrated approach, describes various variants of clinical scenarios, including aspects of anticoagulant maintenance of cardioversion and catheter ablation, multicomponent therapy after percutaneous coronary intervention. A separate chapter is devoted to modern algorithms of perioperative management of a patient receiving oral anticoagulants, which is based on the stratification of interventions according to the risk of perioperative bleeding and the characteristics of the anticoagulant prescribed to the patient. The place of dabigatran in the primary and secondary prevention of stroke and systemic embolism in patients with atrial fibrillation is described, studies that served as the basis of the evidence base for the use of dabigatran in patients with atrial fibrillation are presented. The data of register observations, meta-analyses devoted to the evaluation of the efficacy and safety of dabigatran in certain categories of patients (elderly patients, patients with chronic heart failure, diabetes mellitus) are presented, which form the basis of decision-making in real clinical practice.

Description and Implications of Falls in Patients Hospitalized Due to COVID-19.

Many hospital quality indicators, including falls, worsened during the COVID-19 pandemic. Patients hospitalized with COVID-19 may be at risk for falling due to the disease itself, patient characteristics, or aspects of care delivery. To describe and explore falls in patients hospitalized with COVID-19. We pooled data from 107 hospitalized adult patients who fell between March 2020 and April 2021. Patients who fell had a current, pending, or recent diagnosis of COVID-19. We analyzed patient characteristics, fall circumstances, and patient and organizational contributing factors using frequencies, the chi-square test, and Fisher's exact test. Patient contributing factors included patients' lack of safety awareness, impaired physical function, and respiratory concerns. Organizational contributing factors related to staff and the isolation environment. Recommendations for managing fall risk in patients hospitalized with COVID-19 include frequent reassessment of risk, consideration of respiratory function as a risk factor, ongoing patient education, assisted mobility, and adequate staff training.