Risk Assessment Scale Research Articles

Prediction of Repeated Self-Harm in Six Months: Comparison of Traditional Psychometrics With Random Forest Algorithm.

Suicidal risk has been a significant mental health problem. However, the predictive ability for repeated self-harm (SH) has not improved over the past decades. This study thus aimed to explore a potential tool with theoretical accommodation and clinical application by employing traditional logistic regression (LR) and newly developed machine learning, random forest algorithm (RF). Starting with 89 items from six commonly used scales (i.e., proximal suicide risk factors) as preliminary predictors, both LR and RF resulted in a better solution with much fewer items in two phases of item selections and analyses, with prediction accuracy 88.6% and 79.8%, respectively. A combination with 12 selected items, named LR-12, well predicted repeated self-harm in 6-month follow-up with satisfactory performance (AUC = 0.84, 95% CI: 0.76-0.92; cut-off point by 1/2 with sensitivity 81.1% and specificity 74.0%). The psychometrically appealing LR-12 could be used as a screening scale for suicide risk assessment.

An overview of chemotherapy toxicity prediction tools in older adults with cancer: A young international society of geriatric oncology and nursing and allied health initiative

An overview of chemotherapy toxicity prediction tools in older adults with cancer: A young international society of geriatric oncology and nursing and allied health initiative

Properties of time, direction, and type of violence on the Risk Assessment Scale of Violence Adolescent

Evaluar la conducta violenta implica el uso de instrumentos que sean válidos y confiables, además, contar con propiedades que permitan hacer una valoración completa y eficaz. En este trabajo el propósito fue probar las propiedades de tiempo, dirección y el tipo de violencia de la Escala de Valoración de Riesgo de Violencia en Adolescentes. Se aplicó esta escala, un cuestionario sociodemográfico y un cuestionario de problemas en adolescentes a una muestra de 322 estudiantes de nivel secundaria, la finalidad fue diferenciar dichas propiedades entre adolescentes que refieren comisión de delitos con lo que no reportan comisión de delito y relacionar estas propiedades con los problemas de los adolescentes. Los resultados indican que los adolescentes que refieren comisión de delitos puntúan arriba en el riesgo de violencia futuro, riesgo de violencia contra otros y riesgo de violencia física; la propiedad de tiempo especialmente futuro suele relacionarse con los problemas de los adolescentes. Estos hallazgos permiten una mayor certeza al comprender la conducta violenta.

Accumulated long-term care benefits by risk assessment scales for incident functional disability: A six-year follow-up study of long-term care receipt data

Objectives This study aims to evaluate the differences in the cumulative benefit costs of public long-term care [LTC] insurance services, using a risk assessment scale score, which predicts incident functional disability among older people.Methods A baseline survey was conducted in 2010 involving individuals aged 65 and above from 12 municipalities in Japan who were not eligible for public LTC insurance benefits (response rate: 64.7%). Using public LTC claim records, we followed LTC service costs among 46,616 individuals over a period of about six years (up to 76 months). We used risk assessment scales to assess incident functional disability (0-48). We adopted a classical linear regression model, Tobit regression model, and linear regression with multiple imputation for missing values.Results Overall, 7,348 (15.8%) of the participants had used LTC services during the follow-up period. The risk assessment score for incident functional disability was positively associated with the cumulative costs of LTC services per person, length of usage period of LTC services, and proportion of people certified for long-term care/support need and for over long-term care level 2. After adjusting for confounding variables, the six-year cumulative costs of LTC services were around JPY 31.6 thousand higher per point of risk score (95% confidence interval [CI]: 28.3 to 35.0). The costs were around JPY 8.9 thousand (95%CI: 6.5 to 11.3)higher in the low score group (risk score ≤ 16), and JPY 75.3 thousand (95%CI: 67.4 to 83.1) higher in the high score group (risk score ≥ 17). When we adopted other estimated models, the major results and trends were not largely different.Conclusions In this study, the risk assessment scale score could estimate subsequent LTC benefit costs. Community interventions to improve and maintain variable aspects of risk assessment scores may help contribute to a reduction in public LTC benefits within municipalities.

Exploring Consensus on Preventive Measures and Identification of Patients at Risk of Age-Related Macular Degeneration Using the Delphi Process.

Background: Early identification of AMD can lead to prompt and more effective treatment, better outcomes, and better final visual acuity; several risk scores have been devised to determine the individual level of risk for developing AMD. Herein, the Delphi method was used to provide recommendations for daily practice regarding preventive measures and follow-up required for subjects at low, moderate, and high risk of AMD evaluated with the Simplified Test AMD Risk-assessment Scale (STARS®) questionnaire. Methods: A steering committee of three experts drafted and refined 25 statements on the approach to be recommended in different clinical situations [general recommendations (n = 2), use of evaluation tools (n = 4), general lifestyle advice (n = 3), and AREDS-based nutritional supplementation (n = 5)] with the help of a group of international experts, all co-authors of this paper. Thirty retinal specialists from Europe and the US were chosen based on relevant publications, clinical expertise, and experience in AMD, who then provided their level of agreement with the statements. Statements for which consensus was not reached were modified and voted upon again. Results: In the first round of voting, consensus was reached for 24 statements. After modification, consensus was then reached for the remaining statement. Conclusion: An interprofessional guideline to support preventive measures in patients at risk of AMD based on STARS® scoring has been developed to aid clinicians in daily practice, which will help to optimize preventive care of patients at risk of AMD.

Accurate Prediction of Stroke for Hypertensive Patients Based on Medical Big Data and Machine Learning Algorithms: Retrospective Study.

BackgroundStroke risk assessment is an important means of primary prevention, but the applicability of existing stroke risk assessment scales in the Chinese population has always been controversial. A prospective study is a common method of medical research, but it is time-consuming and labor-intensive. Medical big data has been demonstrated to promote disease risk factor discovery and prognosis, attracting broad research interest.ObjectiveWe aimed to establish a high-precision stroke risk prediction model for hypertensive patients based on historical electronic medical record data and machine learning algorithms.MethodsBased on the Shenzhen Health Information Big Data Platform, a total of 57,671 patients were screened from 250,788 registered patients with hypertension, of whom 9421 had stroke onset during the 3-year follow-up. In addition to baseline characteristics and historical symptoms, we constructed some trend characteristics from multitemporal medical records. Stratified sampling according to gender ratio and age stratification was implemented to balance the positive and negative cases, and the final 19,953 samples were randomly divided into a training set and test set according to a ratio of 7:3. We used 4 machine learning algorithms for modeling, and the risk prediction performance was compared with the traditional risk scales. We also analyzed the nonlinear effect of continuous characteristics on stroke onset.ResultsThe tree-based integration algorithm extreme gradient boosting achieved the optimal performance with an area under the receiver operating characteristic curve of 0.9220, surpassing the other 3 traditional machine learning algorithms. Compared with 2 traditional risk scales, the Framingham stroke risk profiles and the Chinese Multiprovincial Cohort Study, our proposed model achieved better performance on the independent validation set, and the area under the receiver operating characteristic value increased by 0.17. Further nonlinear effect analysis revealed the importance of multitemporal trend characteristics in stroke risk prediction, which will benefit the standardized management of hypertensive patients.ConclusionsA high-precision 3-year stroke risk prediction model for hypertensive patients was established, and the model's performance was verified by comparing it with the traditional risk scales. Multitemporal trend characteristics played an important role in stroke onset, and thus the model could be deployed to electronic health record systems to assist in more pervasive, preemptive stroke risk screening, enabling higher efficiency of early disease prevention and intervention.

Development of a method of assessment of ecological risk of surface water pollution by nitrogen compounds

A method has been developed for quantitative and qualitative assessment of the risk of surface water pollution by nitrogen compounds based on the use of the indicator of the total content of inorganic nitrogen forms in water (Ninorg), that is, This indicator is considered as the sensitivity coefficient kn. The choice of the indicator is dictated by the need to protect waters from pollution caused by nitrogen compounds during their flow from agricultural sources (Directive 91/676 /EU). The experience of developed countries has shown that nitrogen compounds deteriorate the quality of water and prevent the achievement of a "good ecological state" of water bodies. For territories with developed agriculture, it is important to establish environmental risks of damage depending on the degree of nitrogen pollution. Quantitative assessments of environmental risk are provided on the basis of a probabilistic approach. The risk was calculated as the product of the probability of a hazardous event occurring multiplied by the consequences of this event. The consequences of river pollution with nitrogen compounds were assessed as the ratio of the total concentration of nitrogen compounds (sensitivity index kn) to its threshold value (50 mg/dm3 or 11.3 mgN/dm3). In order to develop a scale for qualitative and quantitative risk assessment, relationships were established between the sensitivity indicators kн and the risk indicators R' for individual rivers, and for the study area as a whole, by means of spatio-temporal generalization. The probabilistic characteristics of possible environmental damage were determined on the basis of the obtained regression equations of the form R'=f(kn) and the statistical law of distribution of the risk value R'. The developed method will make it possible to determine the rank of the risk zone and the probability of getting into it, depending on the given sensitivity indicator kn

Unified Scale for Assessing the Risk of Thromboembolic Complications – Family Doctor’s Tool for COVID-19 Pandemic

At present one of the most discussed medical problem is a COVID-19 pandemic. The world has already registered 274 408 291 cases of infection, and 5 365 361 lethal consequences. This disease is already known for almost two years, but there are still no clear understanding of its pathophysiology, clinical course and optimal therapeutic tactics. In Ukraine during this period, 3,324,999 patients with COVID-19 were registered, 92,929 people died. It is known that in the course of the COVID-19, severe thromboeembolic complications are often observed. That is why the most important element of therapy in case of acute thromboembolic complications is the timely use of thromboprophylaxis. The objective: is to develop an integrative scale that will summarize the conditions associated with the risk of thrombogenic complications. Materials and methods. The literature was analyzed on the E-library, PubMed, Scopus and Web of Science Core Collection databases to study questionnaires that were previously used in the patients with a therapeutic profile. 143 patients were examined, including 119 healthy people of all ages and 24 patients with metabolic syndrome (MS) over 60 years. General clinical, neurological, instrumental and laboratory examination were conducted. Results. The «Unified scale for assessing the risk of thromboembolic complications» was developed, containing 17 questions and allowing to assess the presence of risk factors and the prognosis of thromboembolic complications. The idea of creating arose on the basis of many years of experience in studying the issues of hemorheological properties of blood, microcirculation and endothelial function in persons of different ages on the basis of the Department of Clinical Physiology and Pathology of Internal Organs of the State Institution «D. F. Chebotarev Institute of Gerontology NAMS Ukraine» under the leadership of acad. NAMS of Ukraine Korkushko O.V. The questions used in the «Thromboembolic Complications Risk Assessment Scale» are intuitive and self-explanatory. It can be used in the form of a survey with a doctor, a nurse, and also independently in the form of a patient survey. The most convenient form of use is independently in the form of a questionnaire, and the most promising is when studying the health status of individuals in large samples, for example, in communities. The link to this questionnaire (https://forms.gle/XZwsGp5GaVuNqZeS9) was presented for the first time at the Ukrainian scientific and practical conference with international participation «Primary health care – the main component of health care in Ukraine (for the World Family Doctor Day)» of the P. L. Shupik (May 19–20, 2021). Conclusion. Blood circulation disturbances are accompanied by considerable number of pathological conditions, where early interventions and understanding of pathological mechanisms will reduce the risk of complications and prevent fatal consequences. The developed questionnaire allows, from the standpoint of both a doctor and a patient, to assess the risk of thromboembolic complications and identify risk factors for the development of thrombosis in routine clinical practice.

Ship Deficiency Data of Port State Control to Identify Hidden Risk of Target Ship

In the new inspection regime (NIR) of port state control (PSC), the criteria for being judged as a standard risk ship (SRS) is too broad. Some ships are classified as SRS even though they have a large number of ship deficiencies. This paper develops a selection system to identify the hidden risk of target ships in the SRS category using PSC inspection records. This system allows the target ship to be used to help reduce cases of flags being greylisted or blacklisted, which can cause huge shipping losses. This study analyzes ship deficiency data in the Tokyo memorandum of understanding (Tokyo MoU) database. It adopts the multiple criteria decision making (MCDM) model as a data processing technique to build a risk assessment scale. It uses fuzzy importance performance analysis (F-IPA) and technology for order preference by similarity to the ideal solution (TOPSIS) for its analysis. Subsequently, the weights of F-IPA and TOPSIS are adopted into the MCDM model. This article also consulted the Tokyo MoU database. It has been verified that the next time PSC inspection, the system hits 83.3% of the hidden risk ships in the SRS category. Thus, this system will help inspectors be more insightful for target ships.

Risk factors of Pressure Ulcers in hospitalized elderly Egyptian people

Background: Pressure ulcers affect a large scale of elderly people. Despite advances in technology, the rate continues to increase. This increases morbidity, health care costs and mortality. Aim: searching for risk factors of pressure ulcers in elderly patients admitted to acute geriatric care units. Methods: A case control study was conducted recruiting100 elderly male and female patients above the age of six ty. History and physical examination were done, as well as nutritional and functional assessment. Nursing care was assessed using a checklist and Braden scale was done as a risk assessment scale for pressure ulcers. Blood samples were collected for laboratory measures. Results: pressure ulcers result from contribution of many factors as cardiovascular and cerebrovascular diseases, urinary incontinence, poor nutrition, immobility. Patients free from pressure ulcers had better nursing care with more frequent repositioning and use of air mattress (in more than 80%, compared use of air mattress in about 40% only of patients acquiring pressure ulcers). Braden scale was highly sensitive for the occurrence of pressure ulcers (cutoff point ≤ 17) with 77.4% positive predictive value and 97.3% negative predictive value. Conclusion: Pressure ulcers are multifactorial in origin. Nursing care is of utmost importance for their prevention. Braden scale should be applied to elderly pa tients upon admission to hospitals

Predictive Role of Social Capital and Mental Health in Tendency to Risky Behaviors in Students

Background and aim: Identifying factors that affect high-risk behaviors is one of the fundamental ways to prevent high-risk behaviors. This study aimed to determine the predictive role of social capital and mental health in the tendency to high-risk behaviors in female students of Shahid Beheshti University. Methods: The research method was correlational. The statistical population of this study included all female students of Shahid Beheshti University of Tehran who were studying in the first semester of 2018-19, among which 150 students were selected. The sampling method was stratified random sampling. Data were collected using the Iranian Youth Risk Assessment Scale, General Health Questionnaire, and Social Capital Questionnaire. Data were analyzed using the Pearson correlation coefficient and multiple regression by spss.22. Results: The results showed a negative relationship between the components of social capital and the tendency to risky behaviors. Also, there was a positive relationship between general health components and the tendency to high-risk behaviors (p <0.001). There was a relationship between social capital and the tendency to risky behaviors (p <0.001).Conclusion: It can be concluded that social capital and mental health play a predictive role in the tendency to high-risk behaviors in female students.

Prevalence and determinants of frailty in older adult patients with chronic coronary syndrome: a cross-sectional study

BackgroundFrailty is an expression of vulnerability and decline of physical, mental, and social activities, more commonly found in older adults. It is also closely related to the occurrence and poor prognosis of coronary artery disease (CAD). Little investigation has been conducted on the prevalence and determinants of frailty in older adult patients with chronic coronary syndrome (CCS).MethodsA cross-sectional study was conducted, simple random sampling was used in this study. 218 older adults (age ≥ 60 years) with CCS with an inpatient admission number ending in 6 were randomly selected who hospitalized in Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, China, between January and December 2018. For measurement and assessment, we used the 5-item FRAIL scale (fatigue, resistance, ambulation, illnesses, and loss of weight), demographic characteristics, Barthel Index(BI), Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS-15), Mini Nutrition Assessment Shor-Form (MNA-SF), Morse Fall Scale (MFS), Caprini risk assessment, polypharmacy, and Numerical Rating Scale (NRS). Multivariate logistic regression analysis was used to confirme determinants.ResultsThe FRAIL scale showed 30.3% of the subjects suffered from frailty. Determinants were aging (OR1.12; 95% CI 1.04 ~ 1.62), out-of-pocket (OR18.93; 95% CI 1.11 ~ 324.07), hearing dysfunction (OR9.43; 95% CI 1.61 ~ 55.21), MNA-SF score (OR0.71; CI 0.57 ~ 0.89), GDS-15 score (OR1.35; 95% CI 1.11 ~ 1.64), and Caprini score (OR1.34; 95% CI 1.06 ~ 1.70).ConclusionsThe FRAIL scale confirmed that the prevalence of frailty in patients with CCS was slightly lower than CAD. Aging, malnutrition, hearing dysfunction, depression, and VTE risk were significantly associated with frail for older adult patients with CCS. A comprehensive assessment of high-risk patients can help identify determinants for frailty progression. In the context of CCS, efforts to identify frailty are needed, as are interventions to limit or reverse frailty status in older CCS patients.

Fall Prevalence and Associated Risk Factors in Geriatric Population

Aim: To determine the prevalence of fall among geriatric population and to find out risk factors associated with fall. Method: A cross-sectional study was conducted with a sample of 223, raised through non-probability convenient sampling technique. The inclusion criteria were older adults both genders, aged 60 years and above. The exclusion criteria were older persons with severe and uncontrolled co morbidities that include diabetes, hypertension, memory impairment, stroke, psychiatric disorders, and use of any walking aid. Data was collected through semi structured questionnaire. Fall risk assessment scale was used to categorize fall risk status in older persons. Data was analyzed using SPSS 24. Descriptive statistics and Chi-square test were applied. Results: The overall mean age of participants was 67.61±5.64 years. Out of 223 participants, females were 134(60.1%) and 89(39.9%) were males. The prevalence of falls reported in elderly was 42.6%. Most prevalent fall were reported under category of 1-2 falls, out of which females had 43(32.1 %) and males had 29 (32.6%) falls. Among study participants 87 (39.0%) were in high-risk group while 136(61.0%) participants were in low-risk group. Furthermore, weak eyesight, use of medications, vertigo/imbalance, and chronic medical conditions (p&lt;0.05) were considered as most significant risk factors with fall. Conclusion: The study showed significant number of older adults who had fall. Female were at high risk of fall. Weak eyesight, use of medications, vertigo/imbalance, and chronic medical conditions were found to be most prevalent risk factors associated with fall. Keywords: Fall, geriatrics, aging, fall risk, prevalence, old age

Wilson Sims Fall Risk Assessment Tool Versus Morse Fall Scale in Psychogeriatric Inpatients: a Multicentre Study.

To compare predictive validity of the Wilson Sims Fall Risk Assessment Tool (WSFRAT) with that of the Morse Fall Scale (MFS) in psychogeriatric inpatients. Psychogeriatric patients from Shatin Hospital, Tai Po Hospital, Castle Peak Hospital, and United Christian Hospital who had fall incident between April 2019 and April 2020 were identified. Their fall risks were assessed by the WSFRAT and the MFS, and their falls incidents during hospitalisation were recorded. Patients were classified as having high fall risk when their MFS score was ≥45 and when their WSFRAT score was ≥7. Sensitivity, specificity, and positive and negative predictive values of the two scales were calculated. We identified 183 (90 male and 93 female) psychogeriatric patients aged ≥65 years who had fall incident and were assessed by both the WSFRAT and the MFS during the study period. Among the 183 patients, four sustained a fall during hospital stay, giving a prevalence of 2.19%. All four patients were classified as having high risk of fall by WSFRAT, but only two of them were classified so by MFS. The sensitivity of WSFRAT was 100%, which was higher than the 50% by MFS, but specificity of MFS was higher than that of WSFRAT (45.81% vs 54.75%). WSFRAT is a better fall risk assessment scale for psychiatric inpatients than MFS, because of higher sensitivity (100% vs 50%). It has items specific to psychiatric patients and should replace MFS in psychiatric settings.

The effect of body mass index on osteoporosis and fracture risk in patients with type 2 diabetes mellitus

Aim: Type 2 diabetes mellitus (DM), osteoporosis and obesity are increasingly common diseases due to the increase in the elderly population and the change in eating habits. However, the relationship between diabetes, obesity and osteoporosis has not been fully clarified in studies in the literature. In our study, it was investigated whether the combination of diabetes and obesity caused osteoporosis and increased fracture risk. &#x0D; Material and Method: Our study was carried out with a total of 95 patients between the ages of 40 and 80, including 24 males and 71 females, who were tested due to the preliminary diagnosis of osteoporosis and diagnosed with type 2 DM in the physical medicine and rehabilitation outpatient clinic. The demographic characteristics, body mass index (BMI), bone mineral density (BMD) measurements, X-ray imaging, and fracture risk assessment scale (FRAX) calculations of patients were performed. Groups were compared in terms of BMD and FRAX according to the BMI classification. &#x0D; Results: BMD and FRAX hip values were higher in the obese group according to the BMI classification compared to the pre-obese/normal group (p0.05).&#x0D; Conclusion: As a result of our study, it was observed that type 2 DM and obesity were associated with increased fracture risk despite high BMD values.

Neonatal Intensive Care Nursing Pressure Injury Prevention Practices: A Descriptive Survey.

The purpose of this study was to explore neonatal nursing practices for neonatal pressure injury (PI) risk assessment, pressure redistribution surface use, and moisture management. A descriptive survey. A sample of 252 neonatal nurses mainly from the United States responded to a survey distributed electronically through the National Association of Neonatal Nurses, the Academy of Neonatal Nurses, and on the Wound Source Web site. Nurses responded to questions that explored what neonatal nurses used to assess PI risk, types of pressure redistribution surfaces used for neonates, and what moisture management strategies were used to prevent PIs. Descriptive statistics were used to describe nurses' practices. When assessing risk, 78% (n = 197/252) reported using a risk assessment scale: the 2 most common scales were the Neonatal Skin Risk Assessment Scale and the Braden Q Scale. Sixty-nine percent (n = 174/252) reported using a rolled blanket or small soft object as pressure redistribution surfaces. In addition, 15% (n = 39) reported the use of different types of positioners such as a fluidized positioner as pressure redistribution surfaces; however, these are marketed as a positioning devices. It appears that these interventions were considered redistribution surfaces by the nurses. For moisture management, petrolatum-based products (6.7%; n = 17/252) and ostomy powders (6%; n = 16/252) were most frequently used. Practices for PI prevention are different for neonatal patients due to their gestational age, size, and level of illness. Findings from this study create a beginning knowledge of and an opportunity for further research to determine how these practices affect outcomes such as PI incidence and prevalence.

Estimating the Risk of Chemotherapy Toxicity in Indian Geriatric Patient Population and Utility of Chemotherapy Risk Assessment Scale for High Age Patients (CRASH) Score.

Background Aging is a heterogeneous process, and elderly population is diverse in health status and functional reserve. The present study was undertaken to predict severe chemotherapy toxicity using the Chemotherapy Risk Assessment Scale for High-Age Patients’ (CRASH) score. Materials and Methods Elderly patients (age ≥65 years) with malignancy, who were planned to be treated with a new course of cytotoxic chemotherapy, were enrolled. The CRASH score was calculated, and patients were stratified into four categories, that is, low (0–3), intermediate (Int)-low (4–6), Int-high (7–9), and high (<9). Patients developing grade 3/4/5 nonhematologic (NH) or grade 4/5 hematologic (H) toxicity were taken as the development of severe toxicity. Results Of 100 enrolled patients, 64 (64%) were able to complete their prescribed treatment. Forty-four percent of patients (44 patients) of our study cohort experienced grade-4 H or grade 3/4 NH toxicity. The highest score in each category (heme/nonheme/CRASH) predicts nearly 100% toxicity risk. At a critical value of CRASH ≥ 6.5, the sensitivity is calculated as 100%, while specificity is 89.09%. The accuracy of prediction is 93.88%. The median time taken to develop toxicity was 39.5 days. Conclusion CRASH score utilizes clinical assessment and basic laboratory values. Yet, it accurately predicts severe chemotherapy toxicity above a critical value of 6.5. Based on the above study, the first 30 days are crucial as 45% of patients experienced toxicity in this time frame. With the help of these clinical predictive markers, the care of elderly will be optimized.

Clinical, Radiological And Laboratory Predictors Of Postcovid Interstitial Pulmonary Disease

The Fergana Valley model was used to study the risk of postcovid interstitial lung disease in patients who have had COVID-19 associated pneumonia with 50% or more of the pulmonary parenchyma affected. Predictors of the formation of postcovid pulmonary fibrosis were determined and a risk assessment scale was developed. It was found that the use of ultrasound scanners in the early postcovid period is informative and is not inferior in terms of predicting fibrosis by serial MSCT.

Classification of Electronic Health Record-Related Patient Safety Incidents: Development and Validation Study.

BackgroundIt is assumed that the implementation of health information technology introduces new vulnerabilities within a complex sociotechnical health care system, but no international consensus exists on a standardized format for enhancing the collection, analysis, and interpretation of technology-induced errors.ObjectiveThis study aims to develop a classification for patient safety incident reporting associated with the use of mature electronic health records (EHRs). It also aims to validate the classification by using a data set of incidents during a 6-month period immediately after the implementation of a new EHR system.MethodsThe starting point of the classification development was the Finnish Technology-Induced Error Risk Assessment Scale tool, based on research on commonly recognized error types. A multiprofessional research team used iterative tests on consensus building to develop a classification system. The final classification, with preliminary descriptions of classes, was validated by applying it to analyze EHR-related error incidents (n=428) during the implementation phase of a new EHR system and also to evaluate this classification’s characteristics and applicability for reporting incidents. Interrater agreement was applied.ResultsThe number of EHR-related patient safety incidents during the implementation period (n=501) was five-fold when compared with the preimplementation period (n=82). The literature identified new error types that were added to the emerging classification. Error types were adapted iteratively after several test rounds to develop a classification for reporting patient safety incidents in the clinical use of a high-maturity EHR system. Of the 427 classified patient safety incidents, interface problems accounted for 96 (22.5%) incident reports, usability problems for 73 (17.1%), documentation problems for 60 (14.1%), and clinical workflow problems for 33 (7.7%). Altogether, 20.8% (89/427) of reports were related to medication section problems, and downtime problems were rare (n=8). During the classification work, 14.8% (74/501) of reports of the original sample were rejected because of insufficient information, even though the reports were deemed to be related to EHRs. The interrater agreement during the blinded review was 97.7%.ConclusionsThis study presents a new classification for EHR-related patient safety incidents applicable to mature EHRs. The number of EHR-related patient safety incidents during the implementation period may reflect patient safety challenges during the implementation of a new type of high-maturity EHR system. The results indicate that the types of errors previously identified in the literature change with the EHR development cycle.

Simplifying and Testing the Psychometric Psychiatric Patients' Fall Risk Scale: An Analysis of One-Year Admissions.

This study aimed to simplify the number of items evaluated by fall risk assessment scales for psychiatric patients, conduct associated reliability, validity, and receiver operating characteristic analyses, and determine fall predictors for psychiatric patients. This methodological study was conducted in a hospital specializing in psychiatry, using data from 1101 patients who were hospitalized in 2018. This fall risk assessment scale was modified by the hospital for use in psychiatric patients. The mean age of the sample population was 44.88 (SD = 12.05) years, and the mean duration of hospital stay was 44.04 (SD = 48.14) days. Men comprised 66% of the study population, and women were 34%. Item reduction, psychometric testing for validity and reliability, and receiver operating characteristic analyses were conducted. Logistic regressions were used to analyze fall predictors, including “having anti-epileptic drugs”, “need for walking aids”, and “having experienced fall occurrence within one year”. This study successfully reduced the number of items assessed by the previous scale. The optimal cutoff point was reduced, and the sensitivity and accuracy of the newly revised scale were good. Three fall predictors for psychiatric patients were identified. The revised scale can facilitate the rapid and accurate identification of high-risk, fall-prone psychiatric patients by psychiatric nurses. Hospital information screening should include each patient’s fall history.