Risk Assessment Scale Research Articles

Security risk assessment and visualization study of key nodes of sea lanes: case studies on the Tsugaru Strait and the Makassar Strait.

Key nodes of sea lanes are important hubs for global trade and cargo transportation and play important roles in ensuring the safety of maritime transportation and maintaining the stability of the global supply chain. The safety guarantee of key nodes of sea lanes is facing more risks and higher requirements currently because the global shipping industry is gradually recovering. This paper focuses on key nodes of sea lanes, conducting regional security risk assessment and risk spatial scale visualization. A set of security risk assessment and visualization study methods for key nodes of sea lanes is constructed, which includes constructing a security risk assessment index system of key nodes of sea lanes with 25 indicators selected from three risk categories (hazard, vulnerability and exposure, and mitigation capacity) and using geospatial analysis to form the multi-criteria spatial mapping layers and then creating comprehensive risk layers to realize the risk visualization in the strait area by weighted overlaying based on the combined weights calculated by Analytic Hierarchy Process and Grey Relational Analysis. After taking the Tsugaru Strait and Makassar Strait as case studies, the results show that the comprehensive risk layers can effectively present the spatial distribution of security risks of key nodes of sea lanes, reflecting the spatial changes of risk levels (i.e., very low, low, medium, high and very high) and the methods can precisely identify and analyze crucial factors affecting the security risk of key nodes. These findings may strengthen the risk prevention and improve the safety of the navigation environment in the strait to ensure the safety and stability of maritime trade.

Risk assessment score of no-reflow phenomenon in predicting myocardial perfusion disorders by contrast echocardiography in ST-segment elevation myocardial infarction patients after endovascular revascularization

Aim. To study the capabilities of risk assessment score for angiographic no-reflow phenomenon in predicting myocardial perfusion disorders according to contrast echocardiography data in ST-segment elevation myocardial infarction (STEMI) patients after percutaneous coronary interventions (PCI).Material and Methods. A total of 40 STEMI patients after PCI were included in the analysis. The individual risk score for noreflow phenomenon was calculated using previously developed scale in all patients. Risk of no-reflow was assessed as high when the score was ≥ 35. All patients underwent contrast echocardiography with myocardial perfusion assessment within six hours after PCI. The clinical angiographic characteristics and in-hospital outcomes were analyzed including the lethality, myocardial infarction recurrence, and stent thrombosis rates.Results. High risk of no-reflow phenomenon was identified in 13 (32.5%) patients. The rates of angiographic no-reflow phenomenon (46.2% versus 11.1%, p = 0.038) as well as contrast-enhanced echocardiography-based myocardial perfusion disorders (61.5% versus 18.5%, p = 0.011) were significantly higher in the high-risk patient group. According to results of ROCanalysis, no-reflow risk assessment scale for identifying patients with myocardial perfusion disorders according to contrast echocardiography had sensitivity/specificity/area under the curve (AUC) of 62%/85%/0.789 (p = 0.003).Conclusions. Angiographic no-reflow risk assessment score allowed to identify patients with high risk of developing myocardial perfusion disorders according to contrast echocardiography.

A Multidisiplinary Program on Falling and Quality of Life in Older Adults

Aims The purpose of the study was to show the effects of drug management, home arrangements, and exercise combined program on falling and quality of life in older adults. Methods The multidisiplinary study was conducted with 41 participants aged 65-74 years registered with three Family Health Centers. A combined program which consist of drug management, home arrangements, and exercise program was applied them individually for six months. Data were collected by self-report using a Sociodemographic Form, Domestic Environmental Risk Factors of Falling Form, Fall Risk Assessment Scale, SF-36 Quality of Life Scale, and Follow-up Form. Results The mean age of the participants was 69.1 ± 3.1 years, and were (F/M:37/4). After three and six months the domestic environmental risk factors of falling, fall numbers, risk and SF-36 quality of life subscales decreased significantly compared to baseline assessment (p<.05). Conclusions The multidisciplinary program reduced the number of falls, the risk of falling and improved quality of life.

Risk and main contributing factors for constipation in patients with gastrointestinal cancer: a multicenter cross-sectional study in China

The purpose of this study is to determine the risk of constipation and to identify the significant risk factors for constipation in patients with gastrointestinal cancer using the Chinese version of the constipation risk assessment scale (CRAS-C), as well as to explore the complementary constipation risk factors in patients with gastrointestinal cancer, to improve the specificity of the CRAS-C in this population, and finally to provide a theoretical basis for constipation prevention. A cross-sectional study involving multiple centers was conducted. A total of 190 patients with gastrointestinal cancer completed surveys that included demographic information, defecation habits, and the CRAS-C. The mean, SD, median, maximum, minimum, frequency, and percentage were used as indicators for the constipation risk and significant risk factors. The t test and Chi-square tests were used to analyze constipation indicators in patients with gastrointestinal cancer. The mean (SD) age of the 190 participants was 61.68 (12.35) years. The total CRAS-C mean (SD) score was 13.22 (4.69). Fifty-one patients (26.8%) scored lower than 11, who were at the low-risk level of constipation. One hundred thirty-nine patients (73.2%) scored 11 or above, who were at the high-risk level of constipation. The top 10 factors were insufficient liquid intake (81.1%), failure to consume bran products daily (78.9%), insufficient fiber intake (77.9%), antiemetics (74.7%), cytotoxic chemotherapy (52.6%), colorectal/abdominal diseases (42.6%), female (35.3%), opioid analgesics(26.8%), calcium channel blockers (16.3%), and endocrine disorders (14.2%). Chi-square test showed that constipating for most of the past 3months, ascites and ECOG score were complementary constipation risk factors in gastrointestinal cancer patients. The findings indicate that most gastrointestinal cancer patients were at a high risk of constipation. There are also several complementary constipation risk factors, and CRAS-C can be further revised in future studies to make it more specific in gastrointestinal cancer patients. Integrating CRAS into the pathway of constipation management, carrying out constipation risk screening for hospitalized cancer patients, and building systematic constipation prevention plan based on risk assessment are important to reduce the incidence of constipation in patients with gastrointestinal cancer and improve the quality of life.

A Screening Tool for Self-Evaluation of Risk for Age-Related Macular Degeneration: Validation in a Spanish Population.

PurposeThe objectives of this study were the creation and validation of a screening tool for age-related macular degeneration (AMD) for routine assessment by primary care physicians, ophthalmologists, other healthcare professionals, and the general population.MethodsA simple, self-administered questionnaire (Simplified Théa AMD Risk-Assessment Scale [STARS] version 4.0) which included well-established risk factors for AMD, such as family history, smoking, and dietary factors, was administered to patients during ophthalmology visits. A fundus examination was performed to determine presence of large soft drusen, pigmentary abnormalities, or late AMD. Based on data from the questionnaire and the clinical examination, predictive models were developed to estimate probability of the Age-Related Eye Disease Study (AREDS) score (categorized as low risk/high risk). The models were evaluated by area under the receiving operating characteristic curve analysis.ResultsA total of 3854 subjects completed the questionnaire and underwent a fundus examination. Early/intermediate and late AMD were detected in 15.9% and 23.8% of the patients, respectively. A predictive model was developed with training, validation, and test datasets. The model in the test set had an area under the curve of 0.745 (95% confidence interval [CI] = 0.705–0.784), a positive predictive value of 0.500 (95% CI = 0.449–0.557), and a negative predictive value of 0.810 (95% CI = 0.770–0.844).ConclusionsThe STARS questionnaire version 4.0 and the model identify patients at high risk of developing late AMD.Translational RelevanceThe screening instrument described could be useful to evaluate the risk of late AMD in patients >55 years without having an eye examination, which could lead to more timely referrals and encourage lifestyle changes.

Comparison of Autar scale and Wells criteria in DVT risk assessment by nurses in patients with lower extremity trauma

BackgroundDeep vein thrombosis (DVT) is a common and preventable complication in patients with lower extremity trauma. DVT prediction is considered to be necessary. PurposeThis study aimed to compare the Autar DVT risk assessment scale with modified Wells criteria in predicting DVT by nurses in patients with lower extremity trauma. MethodsPatients with lower extremity trauma patients who met the requirements for this study were assessed by both the Autar and Wells tools for DVT risk assessment during the first 24 hours after their admission. Statistical analysis was performed using SPSS 18. ResultsThere was a significant and direct statistical relationship between the results of risk assessment of these two tools based on Pearson correlation (r= 0.731, P<0.0001). Kappa coefficient between the two was 53%. Sensitivity and specificity of the Autar scale were 100% and 68%, respectively, which revealed a higher degree of sensitivity than that of the Wells criteria. ConclusionAlthough the results of DVT prediction for the Autar scale and modified Wells criteria were consistent, the Autar DVT risk assessment scale showed higher sensitivity. Therefore, it is recommended that the Autar scale be used to achieve more precise DVT predictions.

Suicide risk management in clinical practice. Current challenges and future perspectives

There is still little reliable information about the psychological processes underlying suicidal behaviour, and suicide risk assessment scales also have only limited predictive value. However, the recently described suicide-specific syndromes such as acute suicidal affective disorder (ASAD) and suicide crisis syndrome (SCS) open up new possibilities for a complex interpretation and prediction of suicidal behaviour. We briefly summarize modern theoretical approaches explaining the development of suicidal behaviour, the possibilities of predicting suicide risk, and contemporary methods of assessing pre-suicidal psychopathological symptoms, highlighting the suicide-specific syndromes and their screening tools. The results of the systematic review of the suicide-specific syndrome literature indicate that both the ASAD construct and the SCS may be helpful in predicting suicidal behaviour and they correlate with other similar questionnaires. Suicide-specific syndromes and the measurement tools are proven to be effective in theoretical research as well as in the field of clinical applicability in the prediction of suicidal behaviour, so their adaptation and application in Hungary may be recommended.

Development of a risk assessment scale for perinatal venous thromboembolism in Chinese women using a Delphi-AHP approach

BackgroundThe treatment and prevention of perinatal venous thromboembolism (VTE) are challenging because of the potential for both fetal and maternal complications.MethodsThis study developed a rapid assessment scale for VTE and evaluate its validity based on Delphi-AHP (Analytic Hierarchy Process) method in China. The research was conducted by literature retrieval and two rounds of Delphi expert consultation. The item pools of the scale were developed and a questionnaire was designed according to literature retrieval published between 2010 and 2020. A survey was conducted among experts from 25 level A hospitals in China, and data of experts’ opinions were collected and analyzed by the Delphi method.ResultsA perinatal VTE risk assessment scale was formed, including 5 first-level items, 20 s-level items and 40 third-level items. The response rates in the two rounds of expert consultation were 97.4% and 98.0%, and the authoritative coefficients were 0.89 and 0.92. The coefficients of variation ranged from 0.04 to 0.28.ConclusionsThe scale is significantly valid and reliable with a high authority and coordination degree, and it can be used to assess the risk of perinatal VTE and initiate appropriate thrombophylactic interventions in China.

How Should the Risk of Absconding Be Assessed? Existing Approaches within Forensic Mental Health Systems and Examination of a New Scale

At present, there are few validated tools to assist clinicians in assessing absconding risk and formulating viable risk management plans. In this article, we review existing literature on instrument validity and reliability in relation to absconding among patients in forensic care. We examine the predictive validity of a new risk assessment scale for absconding, the Waypoint Elopement Risk Scale-Historical (WERS-H), and assess its incremental utility against a general violence risk assessment instrument (HCR-20V3). Results from all active inpatients in our service (N = 139) revealed 73 individuals who were responsible for 261 absconding events from 2014 to 2020, representing a similar event frequency from a previous census conducted in 2012, but also reflecting considerable annual fluctuations in rate. Confirming results of earlier studies, the presence of substance use and lengthy durations of forensic supervision emerged as key variables associated with absconding. The WERS-H was found to be a significant predictor of future absconding events (incident rate ratio = 1.21, 95% CI [1.07, 1.38], p = .002) and contributed incrementally over the HCR-20V3 Historical scale, suggesting that the use of an absconding-specific risk tool may yield better predictive accuracy compared to assessment instruments in the domain of general violence or offending.

Clinical Features and Factors Associated With Sepsis-Associated Encephalopathy in Children: Retrospective Single-Center Clinical Study.

BackgroundSepsis-associated encephalopathy (SAE) is a common complication in septic patients with a higher ICU and hospital mortality in adults and poorer long-term outcomes. Clinical presentation may range from mild confusion to convulsions and deep coma; however, little is known about SAE in children. We aimed to retrospectively analyze the data for children with sepsis, to illustrate the epidemiology, performance, and adverse outcome, and to evaluate the association between risk factors and SAE in children.MethodsAll children with sepsis who were admitted to the Department of Pediatrics, Guangdong Provincial People's Hospital, Guangzhou, Guangdong, China from January 2010 to December 2020 were retrospectively analyzed.ResultsA total of 210 patients with sepsis were retrospectively assigned to the SAE and non-SAE groups, of which 91 (43.33%) were diagnosed with SAE with a mortality of 6.70% (14/210). Significant differences were observed in the level of white blood platelet, platelets, international normalized ratio, prothrombin time, activated partial thromboplastin time, total protein, Ccr, UREA, blood urea nitrogen, alanine transaminase, aspartate transaminase, creatine kinase, creatine kinase isoenzymes, lactate dehydrogenase, procalcitonin, and lactic acid (p < 0.05). In the risk assessment scales, significant differences were observed in the modified Glasgow Coma score, PCIS, Pediatric Logistic Organ Dysfunction Score 2 (PELOD-2), Pediatric Sequential Organ Failure Assessment Score, and Pediatric Risk of Mortality III (p < 0.05). The incidence of septic shock, acute kidney disease, liver dysfunction, and coagulation disorder were higher in the SAE group (p < 0.05). The mechanical ventilation time ([6.57 d ± 16.86 d] vs. [2.05 d ± 5.79 d]; p < 0.001), CRRT time ([1.74 d ± 6.77 d] vs. [0.11 d ± 0.63 d]; p < 0.001), ICU stay time ([299.90 h ± 449.50 h] vs. [177.67 h ± 245.36 h]); p < 0.001 was longer than that of non-SAE. Both the PCT, Ca2+, septic shock, PELOD-2, and midazolam were identified as independent risk factors, and fentanyl was a protective factor for SAE in pediatric patients (p < 0.05). The main clinical neurological symptoms consisted of agitation, hypnosia, hypnosis alternates agitated, anterior fontanelle full/bulging/high tension, coma, muscle hypertonia, muscle hypotonia, hyperreflexia, focal seizure, and generalized seizure.ConclusionsThe incidence of SAE in children was found high and the prognosis poor. In this retrospective study, the identified patients were more susceptible to SAE, with an inflammatory storm with hypocalcemia or septic shock. The use of midazolam will increase the occurrence of SAE, whereas fentanyl will reduce the incidence of SAE, and PELOD-2 may predict the occurrence of SAE.

Mental health, suicide attempt, and family function for adolescents' primary health care during the COVID-19 pandemic.

Background: The study's purpose was to identify associations between mental health risk, suicide attempts, and family function. Methods: A correlational, descriptive, and cross-sectional study was carried out in a group of adolescents in the last grade of secondary school to establish the association between mental health risk, suicide attempt, and family functionality. The instruments used were the self-report questionnaire, the suicide risk assessment scale, and the family APGAR. Data analysis was performed using the artificial intelligence algorithm (gower clustering). Results: 246 adolescents responded to the three instruments, which made it possible to select those with correlations of sensitive interest and, based on these, an intervention plan. Psychological distress was found in 28%, psychotic symptoms in 85%, and problematic alcohol use in 9%. Good family functioning was identified in 34% and some type of family dysfunction in 66%. In terms of suicide risk, there was a low suicide risk of 74%, 24% medium risk, and 2% high risk. It could be shown that there is a correlation in a group of 15% of the respondents. Conclusions: The risk of suffering mental health deterioration and the suicide risk, during this pandemic period, seems to be related to family functionality.

MO539: Use of FRAX® Scale to Estimate Bone Fracture Risk in Patients Undergoing Haemodialysis

Abstract BACKGROUND AND AIMS Decreased bone mineral density in patients undergoing haemodialysis (HD) is related to the development of fractures that lead to increased morbimortality. There is limited evidence on fracture risk factors that would allow to identify patients at risk to prompt early treatment. In this context, FRAX® (Fracture Risk Assessment scale, which is freely available online at https://www.sheffield.ac.uk/FRAX/tool.aspx?country=4) scale aids in the risk prediction (as a percentage over a 10-year span) of both major and hip osteoporotic fractures in specific populations, including patients with chronic kidney disease (CKD) [1]. However, the evidence of its utility in HD patients is scarce [2]. The aim of our study is to identify patients on HD with increased risk of fractures based on FRAX® scale, blood-test and densitometric parameters. Also, we aim to demonstrate a correlation between a higher risk of fractures as assessed by FRAX® scale and densitometry-established osteoporosis. METHOD This is a single-centre retrospective study including patients undergoing periodic intermittent haemodiafiltration. Data regarding clinical and blood-test parameters were collected. FRAX® scale was used to estimate the risk of hip and major fractures. Patients were divided accordingly into high and low fracture risk, with a threshold set at a 10-year 3% risk of hip fracture and 10% for other major fractures, according to definitions for the general population given by FRIDEX (Fracture RIsk factors and bone DEnsitometry type central dual X-ray) and FROCAT cohorts[3]. The relationship between clinical, blood-test parameters and the degree of osteopaenia and osteoporosis was evaluated. Osteopaenia was defined as a T-score between −1 and −2.5 in femoral neck densitometry. Osteoporosis was established as a T-score lower than −2.5. Qualitative parameters were analysed using Fisher's exact test, whilst Mann–Whitney U test was employed in the analysis of quantitative parameters. RESULTS A total of 54 patients (59.26% male) with a median age of 60 years [interquartile range (IQR), 50–72.25] were recruited. Six low intensity fractures were observed (11.1%), five of them occurred in high-risk-FRAX-scale-classified patients (P 0.095). The observed median FRAX score for our sample was 7.35% (IQR, 4.97–13.25) for major fractures and 1.70% (IQR, 0.78–6.13) for hip fractures. Patients with a higher risk of major fracture, according to FRAX® scale (&amp;gt;7.5%), were older (P &amp;lt; 0.001) and had been on renal replacement therapy (RRT) for a longer period of time (P 0.008). Furthermore, a significantly higher proportion of patients with prior kidney transplantation (0.012) and osteoporosis (0.002) was found in this group. No differences were observed in blood-test parameters, KtV and dialysate composition between low and high-risk patients. Densitometry was performed in 26 patients (48.14%). In this subset, osteopaenia was observed in 14 patients (53.84%) and osteoporosis in 11 (42.31%). Patients with osteoporosis had a higher FRAX score for major fracture (21%, IQR 11.50–26.50; P 0.001) and hip fracture (7.80%, IQR 5.75–14.50; P &amp;lt; 0.001). No correlation was found between prior kidney transplantation or exposure to steroids and densitometry-established osteoporosis. CONCLUSIONS Despite not being validated yet in Spain, our results demonstrate that FRAX® scale significantly correlates with the degree of osteoporosis in patients undergoing HD, representing an effective tool for the identification of patients at high risk of suffering fractures, prompting early prevention and management.

Examining the Predictive Validity of Korean Sex Offender Risk Assessment Scale(KSORAS) from the Perspective of Offender Typology

Examining the Predictive Validity of Korean Sex Offender Risk Assessment Scale(KSORAS) from the Perspective of Offender Typology

Predicting the Risks of Aggressive-Intent Chemotherapy Toxicity in Older Patients With Lymphoma: A Prospective Observational Pilot Study

IntroductionLymphoma is a disease of older patients and while treatment is subtype specific, curative or aggressive intent combination chemotherapy is often recommended. However, there has been limited evidence on which to base treatment decisions for older adults. Our objectives were to assess the utility of risk stratification measures and serial functional tests in predicting chemotherapy toxicity and as well the feasibility of conducting these in older adults undergoing chemotherapy for lymphoproliferative disorders. Materials and MethodsThis prospective cohort study recruited lymphoma patients 70 years or older planned for systemic chemotherapy. The Cancer and Aging Research Group (CARG) risk stratification tool and Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) were calculated at baseline. The Clinical Frailty Scale (CFS), Charlson Comorbidity Index score, grip strength and gait speed test, and toxicity events, were assessed at baseline and serially throughout treatment. Sarcopenia was calculated on CT scans at baseline, midway through treatment, and 1-month after completion of therapy. The primary endpoint was to assess the feasibility of applying these measures in busy ambulatory clinics. These measures were also correlated with clinical outcomes including ≥grade 3 adverse events (AEs), hospitalizations and emergency department visits, dose changes or delays, and overall survival. ResultsIn total, 30 patients were enrolled (mean age 78.1 ± 6.4 years), of whom 20 were treated with curative intent. A total of 16 patients (53%) experienced grade ≥3 AEs, 9 (56%) of which led to a chemotherapy delay. On univariable analyses, CFS score, a high CARG score, medium to high CRASH score, and the gait speed were associated with grade ≥3 AEs, while only CFS remained significant on multivariable analysis. On univariable analysis, patients with a medium to high risk CRASH score were more likely than low risk patients to have an unplanned emergency department visit or hospitalization. ConclusionsThe CFS seems to predict toxicity in this cohort study, with gait speed, CARG and CRASH scores being potentially additional predictive methods of evaluation.

A Pilot Program of Interprofessional Care for the Patient with a History of Injectable Drug Use Requiring Intravenous Medication

Highlights Abstract Background: The use of injectable drugs and alcohol increased during the months of lockdown and continual uncertainty of the worldwide response to the COVID-19 virus and its variants. As the world adjusts to living with multiple transmissible viruses, the health care system needs a comprehensive approach to care for people who inject drugs. Although the problem of injectable drug use is wide-ranging, this article will focus on the intersection of the person who injects drugs and the health care system. Methods &amp; Findings: After an initial case involving a person who injects drugs requiring 42 days of intravenous antibiotics, the hospital began to develop plans to care for this patient population. Finding gaps in the research, a team at the hospital developed a Substance Use Risk Reduction Program that included a risk assessment scale, an interprofessional communication plan, and a set of protocols, then trialed these components between 2017 and 2019. The program successfully screened and collaborated care for patients with a history of injectable drug use. The goals to increase safety were addressed through the protocols that included tamper-evident technology and frequent observations by the staff. The risks of blood stream infection and overdose while a patient was in the hospital were reduced by using the risk reduction protocols. In addition, repudiated costs were decreased by thousands of dollars because of early planning for transfer from inpatient to outpatient, skilled nursing facility, or long-term acute care for the completion of intravenous therapy.

Earthquake-induced reactivation of landslides under variable hydrostatic conditions: evaluation at regional scale and implications for risk assessment

Earthquake-induced reactivation of landslides under variable hydrostatic conditions: evaluation at regional scale and implications for risk assessment

The Risk Factors for Preoperative and Postoperative Deep Vein Thrombosis in Surgical Patients

Objective: This paper investigated the risk of preoperative and postoperative deep vein thrombosis (DVT) in surgical patients.Methods: The sample consisted of 377 patients of the general surgery, orthopedics and traumatology, neurosurgery, and cardiovascular surgeryclinics of a university hospital. Data were collected using a demographic characteristics questionnaire, the Deep Vein Thrombosis DiagnosticCriteria Form, the Autar Deep Vein Thrombosis Risk Assessment Scale, the Caprini Risk Assessment Model, and the Padua Prediction Score. Thedata were analyzed using descriptive analysis.Results: According to the Autar Deep Vein Thrombosis Risk Assessment Scale, most participants were in the “low risk” category in thepreoperative period (91%), and more than a quarter of the participants were in the “high risk” category in the postoperative period (30%).According to the Caprini Risk Assessment Model, less than half of the participants were in the “moderate risk” group in the preoperativeperiod (39%), and more than half the participants were in the “high risk” group in the postoperative period (70.6%). According to the PaduaPrediction Score, most participants were in the “low risk” category in the preoperative period (82.2%), and more than half the participants werein the “high risk” group in the postoperative period (52.8%). More than half the participants who used graduated compression stocks in thepreoperative period misused them (62.7%). A bit more than half the participants who used graduated compression stocks in the postoperativeperiod used them correctly.Conclusion: The results show that surgical patients are at a higher risk for deep vein thrombosis in the postoperative period than in thepreoperative period.

Munro Pressure Ulcer Risk Assessment Scale in Adult Patients Undergoing General Anesthesia in the Operating Room.

Pressure ulcers are a common complication of immobility and frequently occur in surgical patients. The occurrence of pressure ulcers is affected by many factors, such as operation time and position, anesthesia method, and postoperative nursing. The aim of this study was to investigate the Munro Pressure Ulcer Risk Assessment Scale's value in predicting acute pressure ulcers in general anesthesia patients. This case-control study included patients who underwent more than 2 hours of general anesthesia in our hospital from January 2018 to December 2020. The case group comprised 42 patients who had pressure sores in surgical compression sites within 3 days after surgery. The control group consisted of 84 patients without acute pressure sores after surgery. Baseline patient data were compared between the two groups, and a logistic multivariate model was used to analyze potential risk factors for acute pressure ulcers. The Munro Pressure Ulcer Risk Assessment Scale scores and Braden scale scores were compared between the two groups during and after surgery. A receiver operating characteristic curve was used to evaluate the clinical value of the two scales (administered at the two time points) in predicting the occurrence of acute pressure ulcers after surgery. The operation and anesthesia times of patients in the case group were longer than those in the control group (P < 0.05). The proportion of comatose patients and patients with diabetes were significantly higher in the case group. While the case group had higher Munro scores during and after surgery compared to the control group (P < 0.05), Braden scores at the corresponding time points were lower (P < 0.05). The following variables were identified as independent risk factors of acute pressure ulcers: prolonged operation time and anesthesia time, increase in Munro scores during and after operation, decrease in Braden scores during and after operation, and comatose status (P < 0.05). The area under the receiver operating characteristic curve (AUC) of the postoperative Munro score for predicting postoperative pressure ulcer risk was 0.774; the sensitivity and specificity were 67.73% and 80.58%, respectively. The AUC of the intraoperative Braden score for predicting postoperative pressure ulcer risk was 0.836, with a sensitivity of 78.95% and specificity of 78.00%. The AUC of the postoperative Braden score for predicting postoperative pressure ulcer risk was 0.809, with a sensitivity of 73.58% and specificity of 64.26% (P < 0.05). Our results indicate that the intraoperative Munro Pressure Ulcer Risk Assessment Scale is highly effective for predicting the risk of postoperative pressure ulcers in surgical patients who require general anesthesia.

How to manage falls in hospitalized patients: A single center experience in allogeneic stem cell transplantation setting.

In allogeneic hematopoietic stem cell transplantation (AHSCT), falls can lead to immediate and late consequences and in some cases to death. We analyzed risks and causes of falls with root cause analysis (RCA) based on which improvement interventions were implemented.A retrospective observational study was conducted to analyze with RCA data of incidence reports and medical records of patients admitted; an expert panel identified actions to prevent falls, which were collected in a checklist.Between December 2017 and November 2019, 214 patients were admitted to ordinary hospital stays for AHSCT or AHSCTrelated complications. In this period, 15 falls, involving 11 patients, occurred resulting in a 2.32 d/patient incidence. In 66.67% of cases minor head trauma occurred. Diuretic drugs (93.33%), induced hyper-diuresis in nonbladder catheter patients (93.33%) and antihypertensive drugs (93.33%) were reported as most common cause in our incident reports. The most frequent fall time slot was between 10 PM and 7 AM (60%). We determined with RCA diuretics and consequent induced hyper-diuresis (80%), self-insufficiency (40%), antihypertensive (33.3%) and noncompliance (33.3%) as the most common cause of falls. Finally, 16 actions, collected in a "safe comfort" checklist, were identified to prevent falls.Diuretic drugs inducing hyper-diuresis, self-insufficiency, poor patient compliance, orthostatic hypotension, fever, night-time and obstacles within inpatient units are the most common contributing factors. Therefore, administration of diuretic and antihypertensive drugs should be rescheduled and a multidimensional risk assessment scale integrated with a preventive action plan, such as the safe comfort checklist, should be implemented to reduce falls.

The Fall Risk Screening Scale Is Suitable for Evaluating Adult Patient Fall.

(1) Background: This study aimed to test the feasibility of utilizing the screening tool for fall risk assessment in adult inpatient and verify its accuracy in a medical center in Taiwan. (2) Methods: This study retrospectively collected all adult fall cases among inpatients occurring in the general wards of a medical center between 1 January 2013 and 31 December 2015. This inpatient fall risk screening scale was measured by the sensitivity, specificity, and accuracy. (3) Results: There were 1331 (0.4%) falls among a total of 357,395 inpatients during this period. Factors predictive of falling risk included: age, consciousness, body shift assistance, use of fall risk medications, fall history, dizziness or weakness, toileting, and impaired mobility. Using the eight-factor assessment, two was the best cutoff point for identifying the fall risk group, with area under Receiver Operating Characteristic (ROC) curve (AUC) = 0.817, sensitivity = 80.93%, specificity = 73.0%, accuracy = 73.03%, and likelihood ratio = 11.48. (4) Conclusions: The accuracy of the eight-item fall risk assessment tool created for this study was validated. These results can serve as a reference for institutions to develop more effective fall risk assessment scale for inpatients, enabling clinical nurses to identify and more comprehensively assess the groups at highest risk for falling during their hospital stay.