Tool For Risk Research Articles

International Diabetes Federation Position Statement on the 1-hour post-load plasma glucose for the diagnosis of intermediate hyperglycaemia and type 2 diabetes

Many individuals with intermediate hyperglycaemia (IH), including impaired fasting glycaemia (IFG) and impaired glucose tolerance (IGT), as presently defined, will progress to type 2 diabetes (T2D). There is confirmatory evidence that T2D can be prevented by lifestyle modification and/or medications, in people with IGT diagnosed by 2-h plasma glucose (PG) during a 75-gram oral glucose tolerance test (OGTT). Over the last 40 years, a wealth of epidemiological data has confirmed the superior value of 1-h plasma glucose (PG) over fasting PG (FPG), glycated haemoglobin (HbA1c) and 2-h PG in populations of different ethnicity, sex and age in predicting diabetes and associated complications including death. Given the relentlessly rising prevalence of diabetes, a more sensitive, practical method is needed to detect people with IH and T2D for early prevention or treatment in the often lengthy trajectory to T2D and its complications. The International Diabetes Federation (IDF) Position Statement reviews findings that the 1-h post-load PG ≥ 155 mg/dL (8.6 mmol/L) in people with normal glucose tolerance (NGT) during an OGTT is highly predictive for detecting progression to T2D, micro- and macrovascular complications, obstructive sleep apnoea, cystic fibrosis-related diabetes mellitus, metabolic dysfunction-associated steatotic liver disease, and mortality in individuals with risk factors. The 1-h PG of 209 mg/dL (11.6 mmol/L) is also diagnostic of T2D. Importantly, the 1-h PG cut points for diagnosing IH and T2D can be detected earlier than the recommended 2-h PG thresholds. Taken together, the 1-h PG provides an opportunity to avoid misclassification of glycaemic status if FPG or HbA1c alone are used. The 1-h PG also allows early detection of high-risk people for intervention to prevent progression to T2D which will benefit the sizeable and growing population of individuals at increased risk of T2D. Using a 1-h OGTT, subsequent to screening with a non-laboratory diabetes risk tool, and intervening early will favourably impact the global diabetes epidemic. Health services should consider developing a policy for screening for IH based on local human and technical resources. People with a 1-h PG ≥ 155 mg/dL (8.6 mmol/L) are considered to have IH and should be prescribed lifestyle intervention and referred to a diabetes prevention program. People with a 1-h PG ≥ 209 mg/dL (11.6 mmol/L) are considered to have T2D and should have a repeat test to confirm the diagnosis of T2D and then referred for further evaluation and treatment. The substantive data presented in the Position Statement provides strong evidence for redefining current diagnostic criteria for IH and T2D by adding the 1-h PG.

"Better at home": Mixed methods report of intricacies in pediatric febrile neutropenia management.

Many febrile neutropenia (FN) episodes are low risk (LR) for severe outcomes and can safely receive less aggressive management and early hospital discharge. Validated risk tools are recommended by the Children's Oncology Group to identify LR FN episodes. However, the complex dynamics of early hospital discharge and burdens faced by caregivers associated with the FN episode have been inadequately described. An adapted quality-of-life (QoL) survey instrument was administered by a convergent mixed methods design; qualitative and quantitative data from two sources, the medical record and the mixed methods survey instrument, were independently analyzed prior to linkage and integration. Code book was informed by conceptual framework; open coding was used. Mixed methods analysis used joint display of results to determine meta-inferences. Twenty-eight patient-caregiver dyads participated with a response rate of 87%. Of the 27 FN episodes, 51.8% (14/27) were LR and 40.7% (11/27) had an early hospital discharge. The LR and early hospital discharge groups had higher mean QoL scores comparatively. Meta-inferences are reciprocal influencers and expand the complex situation; FN negatively affects the entire family, and the benefits of hospital management were outweighed by risks and worsened symptoms, so an individualized approach to management and care at home was preferred. Early discharge of LR FN episodes positively impacts QoL, yet risk-stratified management for FN is intricately complex. Optimal FN management should prioritize the patient's overall health; shared decision-making is recommended and can improve care delivery. These results should be confirmed in a larger, more heterogeneous population.

External validation and application of the Diabetes Population Risk Tool (DPoRT) for prediction of type 2 diabetes onset in the US population

IntroductionCharacterizing diabetes risk in the population is important for population health assessment and diabetes prevention planning. We aimed to externally validate an existing 10-year population risk model for type 2...

Piloting an Opioid Risk Screening Tool in Clinical Practice.

Background: Despite much research and many interventions, the opioid epidemic continues to plague the United States. According to the Centers for Disease Control and Prevention (2021), 136 people die daily from both prescription and illicit opioids. Objective: The goal of this pilot quality improvement project is to examine how the implementation of the Opioid Risk Tool (ORT) in clinical practice might impact the beliefs and attitudes of nurse practitioners (NPs) toward prescribing opioid therapy. Methods: A pre-post design was utilized. A convenience sample recruited participants from a private NP Facebook group. The intervention included a prerecorded presentation on the ORT and the use of the ORT for 8 weeks. Results: While 46 NPs completed the presurvey, only 19 NPs completed the postsurvey. Statistical results did not yield significance, but there were several significant clinical trends discovered. Conclusion: Utilizing the ORT to screen for opioid misuse risks has been shown to improve providers' confidence in opioid prescribing. ORT guides providers in discerning patient risk for developing dependence on opioids. Implications for Nursing: Screening for opioid misuse risk is feasible. ORT adds to the clinical context in deciding a course of treatment in pain management.

Major clinical and surgical approaches to treating orbitozygomatic and zygomatic maxillary complex fractures: a systematic review

Introduction: In the scenario of orbitozygomatic fractures, facial and head injuries account for half of deaths due to trauma, and thousands are left with long-term or permanent injuries. Fractures of the zygomatic-maxillary complex (ZMC) and zygomatic arch are common athletic injuries. Operative treatment is indicated in cases of significant displacement or functional disturbance. Technology such as virtual surgical planning, intraoperative navigation, and intraoperative imaging has the potential to improve the accuracy of treatment of challenging fractures. Objective: It was to develop a systematic review of the main clinical and surgical approaches to the treatment of orbitozygomatic and zygomatic maxillary complex fractures. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from October 2023 to January 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 102 articles were found, 26 articles were evaluated in full and 25 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 14 studies with a high risk of bias and 12 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=57.9%>50%. A single-piece fracture of the fronto-orbito-zygomatic-maxillary bone connected to a temporoparietal bone may require additional osteotomy to achieve successful results in an acute setting. Orbital volume analysis offers a valid modality for objectively evaluating the efficiency of the management of orbitozygomatic complex fractures. The success rate of the fixation procedure at 1 point of the zygomaticomaxillary complex is high, with minimal complications. Intraoperative CT/three-dimensional imaging should be used in the treatment of ZMC fractures requiring orbital floor reconstruction, where adjacent fractures require fixation and/or when ≥ 2 axes are displaced ≥ 5 mm.

A drink equals how many cigarettes? Equating mortality risks from alcohol and tobacco use in Canada.

To quantify and communicate risk equivalencies for alcohol-and tobacco-attributable mortality by comparing per standard drinks consumed to per number of cigarettes smoked in Canada. Alcohol-and tobacco-attributable premature deaths (≤75 years of age) and years of life lost (YLL) were estimated using a lifetime risk modeling approach. Alcohol-attributable death statistics were obtained from the 2023 Canadian Guidance on Alcohol and Health data source. Tobacco-attributable death statistics were derived from the Mortality Population Risk Tool (MPoRT) model. The risk of alcohol use on premature death and YLL increased non-linearly with the number of drinks consumed, while the risk for tobacco use on these two measures increased linearly with the number of cigarettes smoked. Males who consumed 5 drinks/day-a standard drink contains 13.45 grams of alcohol in Canada-had an equivalent risk as smoking 4.9 cigarettes/day (when modeling for premature death) and 5.1 cigarettes/day (when modeling for YLL). Females who consumed 5 drinks/day experienced an equivalent risk as smoking 4.2 cigarettes/day for premature deaths and YLL. At all levels of alcohol consumption females and males who consumed <5 drinks/day have less risks from consuming a standard drink than from smoking a cigarette. For males who consumed 5 drinks/day, the increased risks of death from per drink consumed and per cigarette smoked were equal. Risk equivalencies comparing alcohol use to tobacco use could help people who drink improve their knowledge and understanding of the mortality risks associated with increased number of drinks consumed per day.

Cardiometabolic Disease Staging and Major Adverse Cardiovascular Event Prediction in 2 Prospective Cohorts

BackgroundCardiometabolic risk prediction models that incorporate metabolic syndrome traits to predict cardiovascular outcomes may help identify high-risk populations early in the progression of cardiometabolic disease. ObjectivesThe purpose of this study was to examine whether a modified cardiometabolic disease staging (CMDS) system, a validated diabetes prediction model, predicts major adverse cardiovascular events (MACE). MethodsWe developed a predictive model using data accessible in clinical practice [fasting glucose, blood pressure, body mass index, cholesterol, triglycerides, smoking status, diabetes status, hypertension medication use] from the REGARDS (REasons for Geographic And Racial Differences in Stroke) study to predict MACE [cardiovascular death, nonfatal myocardial infarction, and/or nonfatal stroke]. Predictive performance was assessed using receiver operating characteristic curves, mean squared errors, misclassification, and area under the curve (AUC) statistics. ResultsAmong 20,234 REGARDS participants with no history of stroke or myocardial infarction (mean age 64 ± 9.3 years, 58% female, 41% non-Hispanic Black, and 18% diabetes), 2,695 developed incident MACE (13.3%) during a median 10-year follow-up. The CMDS development model in REGARDS for MACE had an AUC of 0.721. Our CMDS model performed similarly to both the ACC/AHA 10-year risk estimate (AUC 0.721 vs 0.716) and the Framingham risk score (AUC 0.673). ConclusionsThe CMDS predicted the onset of MACE with good predictive ability and performed similarly or better than 2 commonly known cardiovascular disease prediction risk tools. These data underscore the importance of insulin resistance as a cardiovascular disease risk factor and that CMDS can be used to identify individuals at high risk for progression to cardiovascular disease.

Nutrological aspects of polyphenols and gut microbiota in sports performance: a systematic review

Introduction: In the context of nutrology and sports performance, the focus for intake in athletes and physically active individuals has been directed to the main class of polyphenols. Interest in a personalized approach is increasing in sports to maximize each individual's athletic ability in endurance and strength sports. Polyphenols represent a heterogeneous class of compounds with marked antioxidant and anti-inflammatory properties. The impact of the gut microbiota on the bioavailability and activity of polyphenols is highlighted. Objective: It was to carry out a systematic review to highlight the main relationships between polyphenols, gut microbiota, and sports performance. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from May to July 2023 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 115 articles were found, and 81 articles were evaluated in full and 76 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 6 studies with a high risk of bias and 10 studies that did not meet GRADE. As a result and conclusion, it was shown that the metabolic mechanisms favored by polyphenols improve sports performance, improve cardiometabolic functions, reduce recovery times and post-exercise pain, maintain a low degree of oxidative stress, and avoid unregulated inflammatory processes. Thus, polyphenols are able, through their interaction with the gut microbiota, to favor the proliferation of bacterial genera of great importance for metabolic and cognitive functions, such as Akkermansia, Lactobacilli, and Bifidobacteria. Gut microbiota metabolizes polyphenols in the colon to produce small bioactive molecules that exert epigenetic mechanisms on biochemical pathways modulating gene expression. Polyphenols have multiple biological effects, and future exercise studies should be appropriately and specifically designed to determine the physiological interactions between exercise and the selected supplement, rather than just considering performance.

Too risky to use, or too risky not to? Lessons learned from over 30 years of research on forensic risk assessment with Indigenous persons.

Indigenous peoples are overrepresented in correctional systems internationally, reflecting a history of systemic racism and colonial oppression, and the practice of risk assessment with this population has been a focus of legal and sociopolitical controversy. We conducted a systematic review and meta-analysis of the risk assessment literature comparing Indigenous and non-Indigenous (White majority) groups. We retrieved 91 studies featuring 22 risk tools and 15 risk/need/cultural domains (N = 59,693, Indigenous; N = 237,729, non-Indigenous/White) and four documents identifying culturally relevant factors. Most measures demonstrated moderate predictive validity but often had significant ethnoracial differences, particularly for static measures. The Service Planning Instrument/Youth Assessment Screening Inventory, Level of Service Inventory youth variants, Psychopathy Checklist-Revised and Youth Version, and the Violence Risk Scale and its Sexual Offense version had the strongest predictive validity and least ethnoracial discrepancy. The Static Factors Assessment and Dynamic Factors Identification and Analysis-Revised had the weakest predictive validity. For Indigenous persons, the strongest individual predictors of recidivism were low education/employment, substance abuse, antisocial pattern, and poor community functioning, while mitigating factors that predicted decreased recidivism were measures of risk change (i.e., from culturally integrated programs combining mainstream and traditional healing approaches), cultural engagement/connectedness, and protective factors. In practice, static measures need to be supplemented with dynamic ones, and assessors should select measures with at least moderate predictive validity and ideally the least ethnoracial bias. These conclusions are tempered by the quantity and quality of the literature coupled with the circumstance that some study authors have coauthored tools in this review. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Comparison of Hand Grip Strength in Hypertensive and Non-Hypertensive Middle-Aged People

Background: Hypertension is a leading risk factor for cardiovascular diseases, affecting millions globally. Previous studies have suggested an inverse relationship between hand grip strength (HGS) and hypertension, indicating the potential of HGS as a non-invasive marker for cardiovascular health. However, research exploring this relationship within the middle-aged population of Pakistan remains limited. Objective: This study aims to compare hand grip strength between hypertensive and non-hypertensive middle-aged individuals and to assess the potential of HGS as a predictive marker for hypertension. Methods: A comparative cross-sectional study was conducted over six months, from August 2022 to February 2023, involving 220 participants (110 hypertensive and 110 non-hypertensive), aged 35-45 years, at PSRD and Jinnah Hospitals in Lahore, Pakistan. Hand grip strength was measured using a CAMRY digital dynamometer, and blood pressure was assessed with a Certeza sphygmomanometer. Participants were excluded if they had wrist joint problems, neurological disorders, a history of frozen shoulders, limb fractures, cognitive impairments, diabetes, or were pregnant. Data were analyzed using SPSS version 25, employing independent sample t-tests with a significance level set at p&lt;0.05. Results: The mean age of participants was 39.81±3.16 years. Hypertensive individuals showed significantly lower hand grip strength compared to non-hypertensive individuals, with mean dominant HGS at 34.10±8.75 kg for hypertensives and 39.40±7.37 kg for non-hypertensives. Non-dominant HGS followed a similar pattern, with hypertensives at 31.87±8.75 kg and non-hypertensives at 36.97±7.57 kg. Additionally, a higher proportion of males was observed in the hypertensive group compared to the non-hypertensive group. Conclusion: The study found a significant association between lower hand grip strength and hypertension among middle-aged individuals, supporting the potential of HGS as a screening tool for hypertension risk. This finding underscores the importance of incorporating hand grip strength assessment into routine health evaluations to identify individuals at higher risk of hypertension.

A Brief Screening Tool for Risk of Self-Medication of Pain With Substance Use.

Substance use and pain are both growing public health concerns globally. Evidence suggests that individuals may use substances in order to self-medicate their pain. The Catastrophizing, Anxiety, Negative Urgency, and Expectancy model was developed to provide a theoretical foundation for the modifiable risk factors implicated in self-medication of pain with substance use. This study aimed to use the outcomes in the Catastrophizing, Anxiety, Negative Urgency, and Expectancy model to develop a brief clinical screening tool to identify individuals at risk for self-medication. Participants (N = 520; M age = 38.8) were adults who endorsed the past three-month use of at least one substance and completed an online questionnaire. Logistic regression and receiver operator characteristic analyses were used to reduce the initial 104-item questionnaire to the items needed to achieve a minimum accuracy score of 0.95 and 0.90. A 14-item and a 7-item questionnaire were derived from the initial larger questionnaire. Both of these questionnaires were significantly correlated with the outcome variables and were significantly associated with health risk and percent of use because of pain. The R2 values between the 14- and 7-item versions were only significantly different for the percent of alcohol use because of pain. The study provides two brief screening tools to screen for individuals at risk for self-medication of pain with substance use that can be easily implemented within clinical settings. Further, the screening tools provide insight into modifiable risk factors for self-medication and may also be valuable to monitor treatment response.

Tyrosine kinase inhibitors for radioiodine refractory differentiated thyroid cancer: A systematic review and meta-analysis.

The poor overall prognosis of radioiodine refractory thyroid cancer is an inevitable challenge in managing this disease. A series of trials have demonstrated the antitumor activity of tyrosine kinase inhibitors (TKIs)in radioiodine refractory differentiated thyroid cancer (RAIR-DTC).However, the available evidence cannot determine the optimal choice of TKI in RAIR-DTC. This study searched PubMed, EMBASE, Cochrane databases, and the ClinicalTrials website. The Cochrane bias risk tool was used to assess the risk of bias, and to evaluate randomized clinical trials (RCT)of RAIR-DTCpatients treated with the TKI system. Outcomes, including progression-free survival (PFS),overall survival (OS),and adverse events (AEs)were reported. Seven studies involving 1310 patients with RAIR-DTCwas conducted to compare the PFS and OS of various TKImonotherapies with placebo. The results showed that all TKI monotherapies had a statistically significant benefit in terms of PFS compared with placebo, with lenvatinib demonstrating the greatest benefit (hazard ratio [HR]0.19, 95% credible interval [CrI] 0.14-0.25). In terms of OS, only apatinib (HR 0.42, 95% CrI 0.18-0.97) and anlotinib (HR0.36, 95% CrI 0.18-0.73) showed statistically significant benefits compared with placebo. TKIs also had a higher incidence of AEs of grade 3 or higher compared with placebo. The findings suggest that lenvatinib may be the preferred TKI for the treatment of RAIR-DTC,although its high incidence of AEs should be considered. The results also indicate that TKI treatment may be similarly effective in RAIR-DTCpatients with BRAF or RAS mutations and in those with papillary or follicular subtypes of the disease, regardless of prior TKI treatment. The results of this meta-analysis suggest that targeted therapy with TKIs may be beneficial for patients with radioiodine-refractory advanced or metastatic differentiated thyroid cancer. Among the TKIs analyzed, lenvatinib appeared to be the most effective at improving PFS, although it also had the highest incidence of AEs. Further research through direct randomized controlled trials is needed to determine the optimal choice of TKI for treating patients with RAIR-DTC.This study is beneficial for formulating patients' treatment plans and guides clinicians' decision-making.

Predicting and assessing bankruptcy risk: the role of accounting conservatism and business strategies

Purpose This study aims to investigate the effect of accounting conservatism and business strategies as mitigating tools for bankruptcy risk. It determines the association among these factors and provides insights into the effectiveness of accounting discretion and business strategies in decision-making. Design/methodology/approach The study uses a sample of 83 nonfinancial listed firms in ASE for the period from 2013 to 2019. Bankruptcy risk is measured using the Altman Z-score (1968). Accounting conservatism is measured using the accrual-based approach, and optimal business strategies are identified through cluster analysis. Findings The results indicate that accounting conservatism has a significant negative effect on bankruptcy risk. Increased application of accounting conservatism practices leads to a decrease in the level of bankruptcy risk. However, the type of business strategy adopted by firms does not have a significant impact on bankruptcy risk, suggesting that firms are not effectively implementing their strategies to mitigate this risk. Research limitations/implications This study focuses on nonfinancial listed firms in the ASE, limiting the generalizability of the findings to other contexts. The study's findings contribute to the understanding of the role of accounting conservatism in reducing bankruptcy risk but highlight the need for further research on the effectiveness of business strategies in mitigating this risk. Originality/value This study lies in understanding of the role of accounting discretion in financial evaluations and emphasizes the importance of accounting conservatism as a tool for mitigating bankruptcy risk. The study's insights provide valuable guidance to practitioners, regulators and researchers in this field.

Major clinical outcomes of the relationship of metabolic syndrome with the success of dental implants: the systematic review

Introduction: Studies show that around 55% of dental implants can be affected by peri-implantitis, a chronic inflammatory process induced by bacteria, which promotes osteoclast-mediated bone resorption and inhibits bone formation, leading to progressive bone loss around the implants. implants. Current evidence points to an increased risk of developing peri-implantitis in both obesity/metabolic syndrome (MS) and diabetes mellitus (DM) conditions compared to the healthy population. Objective: It was to develop a systematic review to present the main clinical outcomes of the relationship between metabolic syndrome and the success of dental implants. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from October to December 2023 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 92 articles were found, 26 articles were evaluated in full and 19 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 14 studies with a high risk of bias and 12 studies that did not meet GRADE and AMSTAR-2. Most studies did not show homogeneity in their results, with X2=53.5%&gt;50%. It was concluded that there is a correlation between the presence of metabolic syndrome and a higher prevalence of some bacterial species in the peri-implant groove, regardless of the peri-implant status. Metabolic syndrome has been shown to significantly reduce bone formation in the periimplant area in the short term. Metabolic syndrome and diabetes mellitus represent an increased risk of developing peri-implantitis. Peri-implantitis requires treatment to induce new bone formation around an implant. However, this is challenging as peri-implantitis, particularly in obese or diabetic conditions, has a microenvironment that is characterized by increased inflammation.

Major clinical outcomes of the use of biostimulators (L-PRF and coenzyme Q10) in the optimization of buccomaxillofacial surgery: a systematic review

Introduction: Tissue engineering combines three key elements matrix (three-dimensional structures that support growth, collagen cell, bone mineral), signaling molecules (growth factors (GF) and leukocyte cytokines), and cells (osteoblasts, fibroblasts or other adequate populations for tissue regeneration. Many studies suggest that antioxidants act as inhibitors of osteoclastogenesis and the inhibitory effect of CoQ10 on osteoclast differentiation. These findings highlight the potential therapeutic applications of CoQ10 for the treatment of bone diseases. Objective: The present study highlighted the main approaches to the use of fibrin-rich plasma (L-PRF) and coenzyme Q10 in buccomaxillofacial surgery through a systematic review. Methods: The systematic review rules of the PRISMA Platform were followed. The search was carried out from October 2023 to January 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases, using articles from 2006 to 2022. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed accordingly, according to the Cochrane instrument. Results and Conclusion: A total of 104 articles were found, 38 articles were evaluated and 23 were included and developed in this systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 36 studies with a high risk of bias and 20 studies that did not meet GRADE. The use of platelet and leukocyte-rich fibrin can reduce bone absorption, infection, pain, local edema, and wound healing. L-PRF presents itself as an autogenous biomaterial with great versatility, low cost, easy acquisition and wide use, and infinite possibilities. It can be combined with other materials in the most diverse areas of dentistry. Also, CoQ10 concentrations can suppress ROS, which is needed as a signaling intermediate. CoQ10 acts as an enhancer of all stages of osteoblastic differentiation. Thus, CoQ10 suppresses osteoclast differentiation by eliminating generated intracellular ROS. Furthermore, CoQ10 enhances bone regeneration in all differentiation processes through transcription factor activity.

A study protocol for a predictive model to assess population-based avoidable hospitalization risk: Avoidable Hospitalization Population Risk Prediction Tool (AvHPoRT)

IntroductionAvoidable hospitalizations are considered preventable given effective and timely primary care management and are an important indicator of health system performance. The ability to predict avoidable hospitalizations at the population level represents a significant advantage for health system decision-makers that could facilitate proactive intervention for ambulatory care-sensitive conditions (ACSCs). The aim of this study is to develop and validate the Avoidable Hospitalization Population Risk Tool (AvHPoRT) that will predict the 5-year risk of first avoidable hospitalization for seven ACSCs using self-reported, routinely collected population health survey data.Methods and analysisThe derivation cohort will consist of respondents to the first 3 cycles (2000/01, 2003/04, 2005/06) of the Canadian Community Health Survey (CCHS) who are 18–74 years of age at survey administration and a hold-out data set will be used for external validation. Outcome information on avoidable hospitalizations for 5 years following the CCHS interview will be assessed through data linkage to the Discharge Database (1999/2000–2017/2018) for an estimated sample size of 394,600. Candidate predictor variables will include demographic characteristics, socioeconomic status, self-perceived health measures, health behaviors, chronic conditions, and area-based measures. Sex-specific algorithms will be developed using Weibull accelerated failure time survival models. The model will be validated both using split set cross-validation and external temporal validation split using cycles 2000–2006 compared to 2007–2012. We will assess measures of overall predictive performance (Nagelkerke R2), calibration (calibration plots), and discrimination (Harrell’s concordance statistic). Development of the model will be informed by the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD) statement.Ethics and disseminationThis study was approved by the University of Toronto Research Ethics Board. The predictive algorithm and findings from this work will be disseminated at scientific meetings and in peer-reviewed publications.

Development and validation of self-screening tool for nutrition risk in patients with gastric cancer after gastrectomy: A study protocol.

This study aims to develop and validate a clinical nutrition risk screening tool to predict nutrition risk in home for the patients with gastric cancer after surgery at home so that high-risk patients can be targeted for preventive nutrition care. The development of self-screening tool for nutrition risk in patients with gastric cancer after gastrectomy (SNRSGC) through literature review, expert panel ratings and cognitive interview; the validation of SNRSGC is evaluated through prospective research on participants. This research is divided into four parts: Step 1, Identification of a potential referred nutritional risk screening; Step 2, Item generation and scoring are selected through literature review methods to screen sensitive indicators which can reflect the nutritional characteristics of patients after gastric cancer surgery, establish the frame and update according to the latest guidelines; Step 3, Item reduction is determined by the rating of SNRSGC items by an expert panel and cognitive interview; Step 4, During the validation stage, we conducted research design based on the Consensus-based Standards for the selection of health Measurement Instruments checklist to evaluate the validity, reliability, interpretability and acceptability of SNRSGC. SNRSGC is the first screening tool specifically to predict nutrition risk for stay-at-home postoperative patients with gastric cancer, which can help patients at home detect nutritional risks at home in time and guide patients to seek medical treatment as soon as possible to improve their nutritional status.

Clinical Profile and middle cerebral artery velocity of children with sickle cell anaemia seen in UUTH, Uyo, Akwa Ibom state, Nigeria.

The risk of stroke in individuals with Sickle Cell Anaemia (SCA) can be assessed by routine non-invasive measurement of their cerebral blood flow using a Transcranial Doppler (TCD) ultrasound scan. This study aimed to determine the difference in blood flow velocity parameters in the middle cerebral artery (MCA) of children with sickle cell anaemia compared to a normal age-matched population. This was a hospital-based comparative cross-sectional study among 40 SCA patients aged 3-16 years, in steady state and 40 age and sex-matched HbAA healthy subjects. This study lasted from June to October 2019. Medical history was retrieved using a structured questionnaire. The time-averaged mean of maximum velocity (TAMMV) of the right and left MCA was measured using non-imaging TCD. The mean age ± SD of the SCA patients was 9.1 ± 4.4 years. The SCA patients and sex and age-matched HbAA group consisted of 23 (57.5%) males and 17 (42.5%) females respectively. SCA patients had a significantly lower mean ± SD haemoglobin (Hb) than the controls (7.1 ± 1.1g/dl vs 11.1 ± 1.4g/dl; p<0.001). The right MCA of the patients with SCA had a significantly higher mean flow velocity compared to the controls (94.1 ± 23.1 vs 55.0 ± 8.8cm/sec, p<0.001). The mean TAMMV recorded in the SCA subjects were significantly higher than that of the non-SCA subjects. There is a need to ensure that TCD ultrasound is employed as a routine screening tool for stroke risk among SCA patients in Nigerian tertiary health institutions.

MSC-Derived Extracellular Vesicles Against Pulmonary Fibrosis of Rodent Model: A Meta-Analysis.

Pulmonary fibrosis (PF) is a fatal disease distinguished by structural destruction and dysfunction, accompanied by continuous accumulation of fibroblasts, which eventually leads to lung failure. Preclinical studies have shown that the administration of mesenchymal stem cell-derived extracellular vesicles (MSC-EVs) may be a safe and effective treatment for PF. The purpose of our meta-analysis is to evaluate the efficacy of MSC-EVs therapy and identify therapeutic aspects related to PF. Our study (up to April 6, 2022) identified English and Chinese, preclinical, controlled, and in vivo studies to examine the application of MSC-EVs in the treatment of PF. The risk of bias (ROB) is assessed using the SYRCLE bias risk tool. The primary outcomes include collagen content, α-smooth muscle actin (α-SMA), hydroxyproline (HYP) content, and transforming growth factor-β1 (TGF-β1). Thirteen studies were included in this meta-analysis. Ten studies evaluated the collagen content, five studies evaluated the α-SMA, five studies evaluated the HYP content, and six studies evaluated the TGF-β1. Compared to the control group, MSC-EVs therapy was associated with a significant reduction of collagen accumulation, α-SMA, HYP content, and TGF-β1. The administration of MSC-EVs is beneficial for the treatment of rodent PF models. However, the safety and effectiveness of the application in human PF diseases have yet to be confirmed. The application of MSC-EVs in the treatment of PF needs to be further standardized in terms of source, route of administration, and culture method.

To Remplissage or not to Remplissage Part 2: Recurrent Instability After Primary Stabilization Surgery (RIPSS) Risk Tool Assesses Preoperative Failure Rates in On-track Shoulders Undergoing Primary Arthroscopic Anterior Stabilization with or without Remplissage Augmentation

Objectives: Given the high rates of recurrent instability following the initial arthroscopic Bankart repair (ABR), it is crucial to provide recommendations for appropriate surgical interventions for patients at a higher risk of experiencing recurring instability. In Part 1 of the study, it was discovered that on-track Hill-Sachs lesions (HSL) with specific prognostic factors (i.e., younger age, increased shoulder laxity, lower DTD, and 2+ preoperative instability events) were associated with a greater risk of failure. Therefore, the objective of Part 2 was to develop a risk assessment tool that takes into account significant prognostic factors for recurrent shoulder instability following primary ABR and evaluate the role of remplissage augmentation given a patient’s risk profile. Methods: We retrospectively reviewed prospectively collected data of consecutive patients aged 14-40 who underwent either ABR (arthroscopic Bankart repair) or ABR+R (ABR with remplissage) procedures between 2013 and 2021 for anterior glenohumeral instability. Preoperative magnetic resonance imaging was used to determine the values of glenoid bone loss, Hills-Sachs Interval (HSI), glenoid track (GT), and distance-to-dislocation (DTD). On-track lesions have a distance-to-dislocation (DTD) value greater than zero. In addition, within the category of on-track lesions, there is a subset known as “near-track” lesions, with a DTD ranging from 0 to 10 mm. Capsuloligamentous laxity scores were categorized according to hyperlaxity status, defined as external rotation greater than 85 degrees and/or grade 2+ posterior and inferior load-and-shift on examination under anesthesia. Recurrent shoulder instability was defined as recurrent dislocation and/or subjective subluxation postoperatively. Patients were excluded if the indexed surgery was a revision procedure, &lt; 2-year follow-up, or glenoid bone loss (GBL) &gt;20%. A final multivariate survival analysis was constructed using categorical prognostic factors (i.e., patient age, “near-track” status, hyperlaxity, and 2+ preoperative instability episodes) identified in Part 1, while adjusting for GBL. Although contact athlete status was not identified as a significant predictor of recurrent shoulder instability in Part 1, the final model stratified by contact athlete status given its established importance in prior literature. Multivariate hazard ratio estimates were utilized to create a risk assessment tool and correlated with patient-specific risk estimates via post-estimation analysis. Results: One-hundred-and-fifty-five patients were included for analysis (ABR: 116 | ABR+R: 39) with an average age of 21.6 ± 6.2 years and an average follow-up of 5.1 ± 2.0 years (range: 2.0 – 8.7 yrs). Patients with near-track lesions had a three-fold higher risk of recurrent instability (Hazard Ratio [HR]: 2.5, p = 0.03) compared to on-track HSL with DTD &gt; 10mm. Individuals with evidence of hyperlaxity exhibited a five-fold increased risk (HR: 5.4, p=0.03) relative to patients without hyperlaxity. Younger patient groups had twice the risk of recurrent shoulder instability (HR: 2.2, p=0.003) compared to older adjacent groups. Patients with two or more preoperative recurrent instability episodes faced a four-times greater risk (HR: 4.2, p=0.004) for recurrent shoulder instability compared to patients who experienced a single instability event preoperatively. Lastly, patients who underwent primary ABR only had almost 10-times greater risk of recurrent shoulder instability (HR: 9.5, p=0.002) than those who underwent primary ABR+R. The Recurrent Instability after Primary Shoulder Stabilization (RIPSS) risk assessment score considers patient age, near-track status, hyperlaxity, preoperative instability episodes, and surgical technique (ABR vs. ABR+R) as important prognostic indicators, Table 2. The RIPSS score was created with risk stratifying subgroups: Low-risk (0 – 2), Moderate-risk (3 – 6), High-risk (7 – 9), and Extreme-risk (10+). Figure 1 illustrates a strong correlation between patient RIPSS scores with patient-specific hazard ratio estimates derived from the multivariate Cox regression modeling computed in “To Remplissage or not to Remplissage Part 1”. According to RIPSS score subgroups, recurrent shoulder instability rates range from 4.3% among low-risk groups to 54.6% among extreme-risk groups, Figure 1. Conclusions: Patients with a low-risk RIPSS score without ABR+R may not benefit from remplissage augmentation. Their risk for recurrent instability would remain low despite the addition of remplissage. However, patients with a high- or extreme-risk RIPSS score prior to considering ARB+R would likely benefit from remplissage supplementation. The RIPSS score may be an effective risk assessment tool that may help identify patients who may benefit from a primary Bankart repair with remplissage augmentation. The risk assessment tool developed may optimize surgical treatment and allow physicians to determine patient risk scores with and without remplissage augmentation.