Risk Level Assignment Research Articles

Health impact assessment of the surface water pollution in China

China suffers from severe surface water pollution. Health impact assessment could provide a novel and quantifiable metric for the health burden attributed to surface water pollution. This study establishes a health impact assessment method for surface water pollution based on classic frameworks, integrating the multi-pollutant city water quality index (CWQI), informative epidemiological findings, and benchmark public health information. A relative risk level assignment approach is proposed based on the CWQI, innovatively addressing the challenge in surface water-human exposure risk assessment. A case study assesses the surface water pollution-related health impact in 336 Chinese cities. The results show (1) between 2015 and 2022, total health impact decreased from 3980.42 thousand disability-adjusted life years (DALYs) (95 % Confidence Interval: 3242.67–4339.29) to 3260.10 thousand DALYs (95 % CI: 2475.88–3641.35), measured by total cancer. (2) The annual average health impacts of oesophageal, stomach, colorectal, gallbladder, and pancreatic cancers added up to 2621.20 thousand DALYs (95 % CI: 2095.58–3091.10), revealing the significant health impact of surface water pollution on digestive cancer. (3) In 2022, health impacts in the Beijing-Tianjin-Hebei and surroundings, the Yangtze River Delta, and the middle reaches of the Yangtze River added up to 1893.06 thousand DALYs (95 % CI: 1471.82–2097.88), showing a regional aggregating trend. (4) Surface water pollution control has been the primary driving factor to health impact improvement, contributing −3.49 % to the health impact change from 2015 to 2022. It is the first city-level health impact map for China's surface water pollution. The methods and findings will support the water management policymaking in China and other countries suffering from water pollution.

Adapting sanitary inspections for the monitoring of small drinking water supplies in Iceland

Sanitary inspections (SIs) are checklists of questions used to identify actual and potential sources and pathways of drinking water contamination. Though the importance of SI adaptation to local contexts is widely acknowledged, there is currently limited guidance on how this should be undertaken in practice. During this research, World Health Organization (WHO) draft template SI forms for spring and borehole supplies were adapted for use in Iceland based on a series of desk reviews and field tests, an approach which may guide other future SI adaptation processes. SI results were collected from 25 spring supplies and nine borehole supplies in three regions of Iceland using adapted SI forms. These results were combined with 10-year historical water quality data from the same supplies to explore potential relationships between both data sets. Binary logistic regression test results indicated a statistically significant association (P = 0.025; odds ratio (OR) 1.864, 95% CI 1.080-3.220) between SI Question 3 (Does ponding from surface water occur around the spring/borehole?) receiving a 'High' risk level assignment and at least one historical incidence of water quality noncompliance for the parameters heterotrophic plate count 22 °C, total coliforms, Escherichia coli, and turbidity at the same supply. The significant modifications applied to the starting template during the testing and development of the Icelandic SI form emphasises the importance of a robust adaptation process to ensure SI forms are appropriate for the local context. Results from the analysis of SI and water quality test results demonstrated the potential for these data sets to identify the primary risks at a supply. This information may then be used to direct remedial actions, especially when the amount of relevant data increases over time.

Development and evaluation of a ceMDCT-based preoperative risk stratification model to predict disease-free survival after radical surgery in patients with gastric cancer

To develop and evaluate a preoperative risk stratification model for predicting disease-free survival (DFS) based on contrast-enhanced multidetector computed tomography (ceMDCT) images in patients with gastric cancer (GC) undergoing radical surgery. We retrospectively enrolled patients with GC who underwent ceMDCT followed by radical surgery. A preoperative risk stratification model was constructed (including risk factor selection, risk status scoring, and risk level assignment) using Cox proportional hazard regression and log-rank analyses in the training cohort; the model was tested in the validation cohort. A nomogram was used to compare the preoperative risk stratification model with a postoperative DFS prediction model. A total of 462 patients (training/validation: 271/191) were included. The ceMDCT features of T category (score of 0 or 2), N category (0, 1, 2, or 3), extramural vessel invasion (0 or 2), and tumor location (0 or 1) were selected to construct the preoperative risk stratification model, with 4 risk levels defined based on risk score. There were significant differences in DFS among the risk levels in both cohorts (p < 0.001). The predictive value of the preoperative model was similar to that of the postoperative model, with concordance indices of 0.791 (95% CI, 0.743-0.837) and 0.739 (95% CI, 0.666-0.812), respectively, in the training cohort and 0.762 (95% CI, 0.696-0.828) and 0.738 (95% CI, 0.684-0.792), respectively, in the validation cohort. A preoperative risk stratification model based on ceMDCT images could be used to predict DFS and thus classify GC cases into various risk levels.

Comparison between EPA UV index app and UV monitor to assess risk for solar ultraviolet radiation exposure in agricultural settings in Eastern North Carolina

Agricultural workers are exposed to solar ultraviolet (UV) radiation due to the significant amount of time spent working outdoors. Risk information on UV exposure from the EPA SunWise UV Index mobile app is conveniently available for timely advice on risk management, but its reliability is unknown. The purpose of this study was to determine the reliability of the EPA UV Index app in providing accurate risk information to reduce UV exposure and prevent related illnesses among agricultural workers in eastern North Carolina. UV radiation effective irradiance (UV eff ) indices were datalogged at two agricultural sites using radiometers from April–August 2019 and were assigned to risk levels (low, moderate, high, very high, extreme) based on the ACGIH® Threshold Limit Values (TLVs®). The UV index (UV app ) and its corresponding risk level were obtained using the app. Hourly UV app -based risk level assignments were time-matched to their corresponding UV eff /TLV-based risk level assignments (871 pairs) and analyzed using cross tabulation by determining the percentage of hourly UV eff /TLV-based risk levels (“gold standard”) with the same hourly UV app -based risk levels, with a larger percentage indicating higher app reliability. Results showed that the app correctly identified 100% of low risk conditions, but its reliability decreased as the UV risk condition became more severe. The app correctly identified 0% of moderate, high and very high risk conditions but instead assigned 100% of them to lower risk levels (30–100% as low risk, 5–70% as moderate risk), indicating that the app was less protective in assessing UV risk. The app correctly identified 0.6% of extreme risk conditions but assigned 99.4% of them to lower risk levels (9.4% as low, 29.7% as moderate, 24.6% as high, 35.8% as very high). It is concluded that the performance of the EPA UV Index app in assessing occupational UV risk is not protective of workers particularly for high risk conditions, and that the use of the app for the assessment of risk to UV exposure in agricultural settings is not recommended.

The Council of State Governments Justice Center Approach to Increasing Risk-Level Consistency in the Application of Risk Assessment Instruments.

Correctional and forensic mental health settings potentially have multiple risk assessment instruments administered on a single client. Because of the various methods of determining risk categories, risk-level consistency can become an issue. The Council of State Governments Justice Center developed a Five-Level System that can be applied to most risk assessment instruments. Using the Level of Service Inventory-Revised and two created risk assessment instruments, the present study assessed if the Five-Level System (vs. normative percentile categories) demonstrated greater agreement between the two instruments, and, if so, the percentage of greater agreement. The Five-Level System demonstrated 4% to 5% greater agreement for both risk-level placement and recidivism rates. The implications of this greater consistency among risk assessment instruments is an increased fairness in making risk-level assignments.

Automated Structured Reporting for Thyroid Ultrasound: Effect on Reporting Errors and Efficiency.

To compare the effectiveness of different reporting templates using the ACR Thyroid Imaging Reporting and Data System (TI-RADS) for thyroid ultrasound. In this retrospective study, four radiologists implemented ACR TI-RADS while dictating 20 thyroid ultrasounds for each of four different templates: free text, minimally structured, fully structured, fully structured and automated (embedded software automatically sums TI-RADS points, correlates with nodule size, and inserts appropriate recommendation into report impression). In total, 80 reports were constructed per template type. Frequencies of different errors related to ACR TI-RADS were recorded: errors in point assignment, point addition, risk-level assignment, and recommendation. Reporting times were recorded, and a survey about using the template was administered. Differences in error rates were compared using χ2 and Fisher's exact tests, and differences in reporting times were compared using Kruskal-Wallis tests. Across all readers, errors were identified in 27.5% of reports (22 of 80) for the free text template, 28.8% (23 of 80) for the minimally structured template, 18.8% (15 of 80) for the fully structured template, and 0% (0 of 80) for the fully structured and automated template (P < .0001). Frequency of each error type (number assignment, addition, TR categorization, recommendation) decreased across the four templates (P < .0005 to P < .005). Median reporting times for the less complex templates were 210 to 240 seconds, whereas the median automated template reporting time was 180 seconds (P= .41). Radiologists subjectively preferred using the automated template. A structured reporting template for thyroid ultrasound that automatically executed steps of ACR TI-RADS resulted in fewer reporting errors for radiologists.

Comparison between OSHA-NIOSH Heat Safety Tool app and WBGT monitor to assess heat stress risk in agriculture

Agricultural workers are exposed to heat stress due to spending significant amount of time outdoors. Risk information from mobile apps is more readily available for timely advice on risk management that is crucial in preventing severe acute illnesses and deaths, but its reliability is unknown. The purpose of this study was to determine the reliability of the OSHA-NIOSH Heat Safety Tool mobile app in providing accurate risk information to prevent heat-related illnesses among agricultural workers in eastern North Carolina. Wet bulb globe temperature (WBGT) indices were datalogged at two agricultural sites using heat stress monitors from April–August 2019 and were assigned to risk levels (minimal, low, moderate, high, extreme) by workload (light, moderate, heavy, very heavy) based on the ACGIH® Threshold Limit Values (TLVs®). Hourly heat index (HI) and its corresponding risk level were obtained using the app. Hourly HI-based risk level assignments were time-matched to their corresponding WBGT-based risk level assignments (682 pairs) and analyzed using cross-tabulation by determining the percentage of hourly WBGT-based risk level assignments (“gold standard”) with the same hourly HI-based risk level assignments under different workloads, with a higher percentage indicating higher app reliability. Results showed that the app correctly identified 60–100% of minimal risk conditions, depending on workload type, but its reliability decreased as the heat stress risk condition and workload became more severe. The app identified the majority of low risk conditions for a moderate workload (74%) and moderate risk conditions for a light workload (94%) only, indicating limited use in these specific conditions, while the app identified 0% of either the high risk or extreme risk conditions at any workload type. It is concluded that the performance of the OSHA-NIOSH app in assessing occupational risk to heat stress is not protective of workers particularly for heavy and very heavy workloads, and that the use of the app for the assessment of occupational heat stress risk in agricultural settings is not recommended.

Optimizing Youth Risk Assessment Performance: Development of the Modified Positive Achievement Change Tool in Washington State

The Positive Achievement Change Tool (PACT) was developed in 1997 using a theoretical construction of items, responses, and weights. While derived from an original tool created for a Washington State probation population, the risk-need assessment is one of the most widely used youth tools utilized today. To advance the model from its theoretical construction, the current study demonstrates tool updates making use of a large sample of Washington State youth ( N = 50,862). Specifically, several mechanisms were utilized to customize the assessment, including (a) item weighting, (b) outcome specificity, and (c) gender responsivity. Based on the updated design, we identify improvements in predictive validity of the continuous risk scale, accuracy of risk-level assignment, and reductions in racial/ethnic disparity. Scheduled to be implemented in the coming year, this article describes the development of the Modified Positive Achievement Change Tool (M-PACT).

Caries Management by Risk Assessment — Guidelines To Improve Caries Risk Level Assignments

Caries Management by Risk Assessment — Guidelines To Improve Caries Risk Level Assignments

The Effect of Calibration on Caries Risk Assessment Performance by Students and Clinical Faculty.

Caries management requires a complete oral examination and an accurate caries risk assessment (CRA). Performing Caries Management by Risk Assessment (CAMBRA) is inefficient when the caries risk level assignment is incorrect. The aim of this study was to evaluate the ability of faculty members and students at one U.S. dental school to correctly assign caries risk levels for 22 CRA cases, followed by calibration with guidelines on how to use the CRA form and a post-calibration test two months after calibration. Inter-examiner reliability to a gold standard (consensus of three experts) was assessed as poor, fair, moderate, good, and very good. Of the 162 students and 125 faculty members invited to participate, 13 students and 20 faculty members returned pre-calibration tests, for response rates of 8% and 16%, respectively. On the post-calibration test, eight students and 13 faculty members participated for response rates of 5% and 10%, respectively. Without guidelines and calibration, both faculty members and students when evaluated as one group performed only poor to fair in assigning correct caries risk levels. After calibration, levels improved to good and very good agreements with the gold standard. When faculty and students were evaluated separately, in the pre-calibration test they correctly assigned the caries risk level on average in only one-quarter of the cases (students 24.1%±13.3%; faculty 23.6%±17.5%). After calibration, both groups significantly improved their correct assignment rate. Faculty members (73.8% correct assignments) showed even significantly higher correct assignment rates than students (47.7% correct assignments). These findings suggest that calibration with a specific set of guidelines improved CRA outcomes for both the faculty members and students. Improved guidelines on how to use a CRA form should lead to improved caries risk assessment and proper treatment strategy for patients.

A risk matrix analysis method based on potential risk influence: A case study on cryogenic liquid hydrogen filling system

A risk matrix analysis framework is proposed for risk assessment and prioritization based on potential risk influence (PRI). First, a new principle for risk level assignment considers the potential impacts of risk, including controllability, criticality, manageability and uncertainty, is established. Next, the impacts of potential risk are divided into two risk influence factors in risk matrix: probability and consequence influence factor. A fuzzy probability method is used to calculate the failure probability of basic events when appropriate reliability data is unavailable. To take the dependence of basic events into account, Bayesian belief network models established to calculate the likelihood of failure. Finally, to demonstrate the validity of the proposed method, a risk assessment and a risk ranking process are performed for a cryogenic liquid hydrogen filling system (CLHFS). The results of the case study confirmed that the proposed methodology successfully manages risk level inconsistency, and is altogether a feasible and reasonable tool for risk management.

How Do Dental Students Determine Patients’ Caries Risk Level Using the Caries Management By Risk Assessment (CAMBRA) System?

Research has demonstrated the validation of specific caries risk assessment (CRA) systems, but little is known about how dental practitioners assign a caries risk level to their patients. The aim of this study was to explore dental students' decision making in caries risk assignment when using the Caries Management By Risk Assessment (CAMBRA) system. Multiple correspondence analysis and chi-squared automated interaction detector analysis were performed on data collected retrospectively for a period of six years (2003-09) at the University of California, San Francisco predoctoral dental clinic. The study population consisted of 12,952 patients from six years of age through adult who received a baseline CRA during the period, were new to CAMBRA, and had not received any prior CAMBRA recommendations. The results showed variation in decision making and risk level assignment, illustrated by the range of percentages for the three scores (low, moderate, and high/extreme caries risk) when CRA was assigned for the first time. For those first-time CRAs, decision making was mainly based on four factors: cavities or caries lesions into dentin on radiograph, restorations during the last three years due to caries, visible heavy plaque, and interproximal lesions into enamel (by radiographs). This study's findings provide important data regarding one group of CAMBRA users and thus contribute to the development of knowledge about the implementation of caries risk assessment in contemporary dental practice.

Quality Assurance Study of Caries Risk Assessment Performance by Clinical Faculty Members in a School of Dentistry

The goal of this quality assurance study was to explore the decision making of clinical faculty members at the University of California, San Francisco School of Dentistry predoctoral dental clinic in terms of caries risk level assignment using the caries risk assessment (CRA) as part of the Caries Management by Risk Assessment (CAMBRA) concept. This research was done in part to determine if additional training and calibration were needed for these faculty members. The study tested the reliability and reproducibility of the caries risk levels assigned by different clinical teachers who completed CRA forms for simulated patients. In the first step, five clinical teachers assigned caries risk levels for thirteen simulated patients. Six months later, the same five plus an additional nine faculty members assigned caries risk levels to the same thirteen simulated and nine additional cases. While the intra-examiner reliability with weighted kappa strength of agreement was very high, the inter-examiner agreements with a gold standard were on average only moderate. In total, 20 percent of the presented high caries risk cases were underestimated at caries levels too low, even when obvious caries disease indicators were present. This study suggests that more consistent training and calibration of clinical faculty members as well as students are needed.

Assessment of risk of prescription opioid abuse and aberrant behaviors in the primary care setting

This multicenter open-label trial in chronic-pain patients evaluated the effectiveness of once-daily morphine sulfate extended-release (AVINZA®) and the potential for prescription opioid abuse and misuse (POAM) for up to 4-months in primary care settings. Patients were opioid-tolerant and -naïve adults with pain scores ≥4/11-pt scale or unacceptable opioid side-effects (opioid-tolerant only). Primary care investigators (PCIs, N=268) determined doses of AVINZA® in adherence with prescribing information and used 7 assessment tools, including treatment-agreement, SOAPP-R®, and urine drug tests (UDTs), to provide initial and ongoing assessment of POAM risk, risk-stratification, and appropriate interventions. Post-study surveys were conducted at 3- and 6-months to determine clinical utility and subsequent use of assessment tools. Here we report results related to POAM risk. The safety population (N=1487) was primarily female (57%), opioid-tolerant (79%), aged 40-69 years (71%), with chronic pain history >1 year (92%). In total, 561 (38%) patients completed the study through 4-months. Five percent (5%) of patients were withdrawn due to high risk-level. At baseline, 14% and 10% of patients had positive UDTs for marijuana and cocaine, respectively; 54% had SOAPP-R® scores of 10-21 (moderate risk). At baseline, overall risk-level assignment was consistent with SOAPP-R® scores for most patients (54%); however, 45% and 1% of patients had an underestimated and overestimated risk-level, respectively, relative to their SOAPP-R® score. At study-end, the risk-level remained the same for most patients (77%), decreased for 15% and increased for 8% relative to baseline. At 3- and 6-months post-study, 94% and 92% of PCIs continued to use at least 1 of the assessment-tools, respectively. Results suggest that the majority of chronic-pain patients in primary care settings are at moderate risk for POAM. A combination of clinical tools and risk-stratification may have utility in assessing and monitoring the risk of POAM in these settings. (Supported by King Pharmaceuticals®, Inc.) This multicenter open-label trial in chronic-pain patients evaluated the effectiveness of once-daily morphine sulfate extended-release (AVINZA®) and the potential for prescription opioid abuse and misuse (POAM) for up to 4-months in primary care settings. Patients were opioid-tolerant and -naïve adults with pain scores ≥4/11-pt scale or unacceptable opioid side-effects (opioid-tolerant only). Primary care investigators (PCIs, N=268) determined doses of AVINZA® in adherence with prescribing information and used 7 assessment tools, including treatment-agreement, SOAPP-R®, and urine drug tests (UDTs), to provide initial and ongoing assessment of POAM risk, risk-stratification, and appropriate interventions. Post-study surveys were conducted at 3- and 6-months to determine clinical utility and subsequent use of assessment tools. Here we report results related to POAM risk. The safety population (N=1487) was primarily female (57%), opioid-tolerant (79%), aged 40-69 years (71%), with chronic pain history >1 year (92%). In total, 561 (38%) patients completed the study through 4-months. Five percent (5%) of patients were withdrawn due to high risk-level. At baseline, 14% and 10% of patients had positive UDTs for marijuana and cocaine, respectively; 54% had SOAPP-R® scores of 10-21 (moderate risk). At baseline, overall risk-level assignment was consistent with SOAPP-R® scores for most patients (54%); however, 45% and 1% of patients had an underestimated and overestimated risk-level, respectively, relative to their SOAPP-R® score. At study-end, the risk-level remained the same for most patients (77%), decreased for 15% and increased for 8% relative to baseline. At 3- and 6-months post-study, 94% and 92% of PCIs continued to use at least 1 of the assessment-tools, respectively. Results suggest that the majority of chronic-pain patients in primary care settings are at moderate risk for POAM. A combination of clinical tools and risk-stratification may have utility in assessing and monitoring the risk of POAM in these settings. (Supported by King Pharmaceuticals®, Inc.)

A simplified nutrition screen for hospitalized patients using readily available laboratory and patient information

Objective We assessed admission screening information that best identifies patients who are at risk for malnutrition-related complications (MRCs). Methods We evaluated 13 patient characteristics associated with MRC for adults screened over a 3-mo period ( n = 448) to determine which factors correlated best with the risk level assigned. The existing screen stratified patients into four levels defined as no risk, mild risk, moderate, and high risk for MRC. The analyzed variables were weight for height, wound, surgery/cancer therapy, fever, vomiting/diarrhea, poor oral intake, no oral intake, unplanned weight loss, malnutrition-related admission diagnosis, serum albumin, white blood cell count, hemoglobin, and total lymphocyte count. We modeled the relation between assigned MRC and the predictors by using state-of-the-art methods. Results The characteristics that correlated best with MRC risk level assignment were occurrence of a wound, poor oral intake, malnutrition-related admission diagnosis, serum albumin value, hemoglobin value, and total lymphocyte count. A model using four variables (malnutrition-related admission diagnosis, serum albumin value, hemoglobin value, and total lymphocyte count) was almost as good as that using six predictors. Conclusions The ability of admission information to accurately reflect MRC risk is crucial to early initiation of restorative medical nutritional therapy. There is currently no uniform or proved standard for identifying MRC risk within 24 h of acute care admission. The ideal nutritional screen correlates well with the occurrence of MRC and also uses data routinely obtained at admission. The models described can be uniformly used by hospitals to screen patients for MRC risk.

National Study of Physician Awareness and Adherence to Cardiovascular Disease Prevention Guidelines

Few data have evaluated physician adherence to cardiovascular disease (CVD) prevention guidelines according to physician specialty or patient characteristics, particularly gender. An online study of 500 randomly selected physicians (300 primary care physicians, 100 obstetricians/gynecologists, and 100 cardiologists) used a standardized questionnaire to assess awareness of, adoption of, and barriers to national CVD prevention guidelines by specialty. An experimental case study design tested physician accuracy and determinants of CVD risk level assignment and application of guidelines among high-, intermediate-, or low-risk patients. Intermediate-risk women, as assessed by the Framingham risk score, were significantly more likely to be assigned to a lower-risk category by primary care physicians than men with identical risk profiles (P<0.0001), and trends were similar for obstetricians/gynecologists and cardiologists. Assignment of risk level significantly predicted recommendations for lifestyle and preventive pharmacotherapy. After adjustment for risk assignment, the impact of patient gender on preventive care was not significant except for less aspirin (P<0.01) and more weight management recommended (P<0.04) for intermediate-risk women. Physicians did not rate themselves as very effective in their ability to help patients prevent CVD. Fewer than 1 in 5 physicians knew that more women than men die each year from CVD. Perception of risk was the primary factor associated with CVD preventive recommendations. Gender disparities in recommendations for preventive therapy were explained largely by the lower perceived risk despite similar calculated risk for women versus men. Educational interventions for physicians are needed to improve the quality of CVD preventive care and lower morbidity and mortality from CVD for men and women.

A SIMPLIFIED NUTRITION SCREEN FOR HOSPITALIZED PATIENTS USING READILY AVAILABLE LABORATORY PATIENT INFORMATION

bstract Objective: We assessed admission screening information that best identifies patients who are at risk for malnutrition-related complications (MRCs). Methods: We evaluated 13 patient characteristics associated with MRC for adults screened over a 3-mo period (n 448) to determine which factors correlated best with the risk level assigned. The existing screen stratified patients into four levels defined as no risk, mild risk, moderate, and high risk for MRC. The analyzed variables were weight for height, wound, surgery/cancer therapy, fever, vomiting/diarrhea, poor oral intake, no oral intake, unplanned weight loss, malnutrition-related admission diagnosis, serum albumin, white blood cell count, hemoglobin, and total lymphocyte count. We modeled the relation between assigned MRC and the predictors by using state-of-the-art methods. Results: The characteristics that correlated best with MRC risk level assignment were occurrence of a wound, poor oral intake, malnutrition-related admission diagnosis, serum albumin value, hemoglobin value, and total lymphocyte count. A model using four variables (malnutrition-related admission diagnosis, serum albumin value, hemoglobin value, and total lymphocyte count) was almost as good as that using six predictors. Conclusions: The ability of admission information to accurately reflect MRC risk is crucial to early initiation of restorative medical nutritional therapy. There is currently no uniform or proved standard for identifying MRC risk within 24 h of acute care admission. The ideal nutritional screen correlates well with the occurrence of MRC and also uses data routinely obtained at admission. The models described can be uniformly used by hospitals to screen patients for MRC risk. © 2005 Elsevier Inc. All rights reserved. Nutrition 21 (2005) 650–658 www.elsevier.com/locate/nut

Limitations of the Gail Model in the Specialized Breast Cancer Risk Assessment Clinic

The Gail model is a risk assessment tool that is accurate for general breast cancer risk screening. Because of the limited way that this model incorporates family history information, however, there are concerns that it may underestimate risk for many women attending specialized breast cancer risk assessment clinics. We collected comprehensive breast cancer risk factor information for 213 women attending a specialized breast cancer risk assessment clinic using a modified version of the CancerGene software. Breast cancer risk was calculated using the models of Gail and Claus as well as BRCAPRO and the tables of Bodian (for women with lobular neoplasia). Eighty-six percent of the women had a family history of breast cancer. Although 74% of women had risk factor histories that are thought to confound the Gail model (family history of breast cancer in second-degree relatives, family history of breast cancer before the age of 50, family history of bilateral breast cancer, family history of ovarian cancer, or personal history of lobular neoplasia), the inclusion of other models increased the risk level assignment in only 13% of the cases. We conclude that the Gail model is an appropriate risk assessment tool for most women attending specialized clinics, although the inclusion of models better able to account for family history information and personal history of lobular neoplasia is required to accommodate all women.

Critical Evaluation of a Pediatric Hospital Nutrition Screen

LEARNING OUTCOME: To evaluate the effectiveness of a pediatric nutrition screen, risk criteria, interventions and outcomes. Early identification of nutrition compromise and risk status is a priority for the health care team. A nutrition screen for pediatric patients was developed utilizing subjective (patient interview & caregiver's reports) and objective (diagnostic, clinical, anthropometric, & biochemical) data. Periodically, the nutrition screen and point system for ranking risk criteria have been evaluated and revised to meet the changing demands of the hospital environment and current standards. Three methods used to evaluate the screen are listed. 1) A one month comparison of the results from routine nutrition screening and concurrent assessments by the pediatric nutrition support team was evaluated with patient care outcomes in the intensive care unit. The levels of care provided to 23 out of 27 (85%) patients were consistant with the results of the initial nutrition screens. 2) 25 pediatric patients identified at nutrition risk were monitored for implementation of dietitian recommendations for nutrition care strategies. Six (100%) high risk care plans were initiated and 11 out of 19 moderate risk patients' feedings were altered as suggested. 3) A four month review of screening accuracy (n=208) and timeliness identified areas that the resulted in improvements implemented by the technicians. Screens reviewed revealed 98% of the risk level assignments were correct and the nutrition plans were appropriate for the level of care. The pediatric nutrition screen contributes to patient care with identification of patients in need of intervention to optimize treatment response, recognition of the signs of malnutrition by all staff, promoting consistency in care levels and facilitating the evaluation of effectiveness and appropriateness of care plans.