Tool For Risk Research Articles

The complication-overall survival (CompOS) risk tool predicts risk of a severe postoperative complications relative to long-term survival among patients with primary liver cancer

BackgroundThis study aimed to develop a tool based on preoperative factors to predict the risk of perioperative complications based on the Comprehensive Complication Index (CCI) and long-term survival outcomes after liver resection for primary liver cancer. MethodsPatients with hepatocellular carcinoma (HCC) or intrahepatic cholangiocarcinoma (ICC) undergoing curative-intent hepatectomy between 1990 and 2020 were identified using a multi-institutional international database. ResultsAmong 1411 patients who underwent curative-intent hepatic resection (HCC: 997, 70.7%; ICC: 414, 29.3%), median patient age was 66.0 years (IQR, 57.0–73.0), and most patients were male (n = 1001, 70.9%). In the postoperative setting, 699 patients (49.5%) experienced a complication; moreover, 112 patients (7.9%) had major complications. Although most patients had a favorable risk complication-overall survival (CompOS) profile (CCI score > 40 risk of <30% and median survival of >5 years: n = 778, 55.1%), 553 patients (39.2%) had an intermediate-risk profile, and 80 patients (5.7%) had a very unfavorable risk profile (CCI score > 40 risk of ≥30% and/or median survival of ≤1.5 years). The areas under the curve of the test and validation cohorts were 0.73 and 0.76, respectively. ConclusionThe CompOS risk model accurately stratified patients relative to short- and long-term risks, identifying a subset of patients at a high risk of major complications and poor overall survival.

Clinical approaches to the ketogenic diet in the treatment of obesity and other chronic diseases: a systematic review

Introduction: The ketogenic diet, a restrictive diet, is mainly characterized by high fat content, low or absent carbohydrate content, and low or normal amounts of protein. Objective: It was to present the important role of the ketogenic diet in the treatment of obesity and other chronic diseases. Methods: The PRISMA Platform systematic review rules were followed. The research was carried out from September to October 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 111 articles were found, and 44 articles were evaluated, and 22 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 19 studies with a high risk of bias and 32 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2=65.7%&gt;50%. It was concluded that the therapeutic use of the ketogenic diet is relevant in the treatment of obesity and metabolic syndrome. Furthermore, this work also showed the benefits of the metabolism of ketone bodies in the adjuvant treatment of cancer, diabetes, and obesity, thus contributing to updating knowledge about the use of the ketogenic diet in the therapy of diseases of great clinical and epidemiological importance. When it comes to obese and diabetic people, it is important to highlight that due to the lower consumption of fiber, and an increased consumption of proteins (mainly of animal origin) and fat, the risk of heart disease, colon cancer, and intestinal constipation increases.

The malnutrition screening tool STRONGKIDS performed better than other screening tools for children hospitalised in Egypt.

To compare the accuracy of three different screening tools, namely, the Paediatric Yorkhill Malnutrition Score (PYMS), Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP), and Screening Tool for Risk on Nutritional Status and Growth (STRONGKIDS), in assessing malnutrition risk in hospitalised children. A cross-sectional study was conducted on 300 children aged 6 months to 15 years at Alexandria University Children's Hospital, Egypt. The sensitivity and specificity of each tool were calculated to detect acute and chronic malnutrition, and an agreement test was conducted between the nutritional screening tools. The patients were classified into different nutritional risk groups, and their classification was compared with anthropometric measures and clinical variables, such as the length of hospital stay (LOS). The prevalence of stunting and wasting on admission was found to be 3% and 6.6%, respectively. Children categorised as high-risk on admission had a longer LOS than those at low risk. The agreement test between the STAMP score and STRONGKIDS score on admission showed the most significant agreement, and STRONGKIDS had the best accuracy in detecting acute and chronic malnutrition. The comparison of the three screening tools revealed that STRONGKIDS exhibited the best accuracy in detecting acute and chronic malnutrition.

Nutrological and pharmacological approaches to cancer cachexia: a systematic review

Introduction: Cancer cachexia (CC) is a multifactorial syndrome that is generally characterized by the continuous loss of skeletal muscle mass with or without fat loss, often accompanied by anorexia, weakness, and fatigue. Cancer cachexia is associated with poor tolerance to antitumor treatments, reduced quality of life, and a negative impact on survival. Unintentional weight loss has been associated with a negative impact on multiple outcomes in cancer patients, including survival and quality of life. Objective: It was to present the main evidence of the nutrological and pharmacological treatment of cancer cachexia through a systematic review. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from October a December 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 127 articles were found. A total of 67 articles were evaluated and 24 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 10 studies with a high risk of bias and 10 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2=74.5%&gt;50%. Based on the results, symptoms associated with cancer cachexia are thought to be caused by tumor-induced changes in host metabolism that result in systemic inflammation and abnormal neurohormonal responses. The sarcopenia seen in many patients with cancer cachexia is caused, in part, by increased activation of circulating proteolysis-inducing factor (PIF) and skeletal muscle protein breakdown by the ubiquitin-proteasome pathways. The nutritional consequences of cancer treatments must be identified early with screening and assessment of nutritional status. Nutritional intervention includes screening and appropriate nutritional assessment, which should begin early in the disease course to reduce or delay negative effects on therapy and quality of life. Liquid nutritional supplements may be useful to help increase caloric intake. Numerous investigations have reported orexigenic activity associated with progestational agents such as megestrol acetate and medroxyprogesterone. Megestrol acetate has received the most attention in randomized controlled trials of cancer patients. Also noteworthy was the use of corticosteroids and mirtazapine for weight gain and pain control.

Major clinical outcomes of the regulation of metainflammation in patients with obesity in the light of nutrology: a systematic review

Introduction: Obesity stands out as a multifactorial disease that can cause several public health problems. There are 2.0 billion overweight and obese people in the world, and Brazil is in fifth place in the world ranking. A healthy nutritional status promotes immune function and can prevent the onset of a serious inflammatory process and severe infections, especially in times of pandemics such as COVID-19. Objective: It was to highlight the main clinical outcomes of the regulation of meta-inflammation in patients with obesity in the light of nutrology. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from August to September 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 130 articles were found. A total of 42 articles were fully evaluated and 29 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 29 studies at high risk of bias and 21 studies that did not meet the GRADE. Most studies showed homogeneity in their results, with X2=71.7%&gt;50%. Research has shown that unbalanced eating patterns, such as the Western diet, rich in simple sugars, refined carbohydrates, and saturated and trans fatty acids, lead to chronic inflammatory responses, increased adipose deposition, and future comorbidities associated with overweight and obesity. Calorie restriction decreased CRP in obese patients and diet administration over 12 weeks had a beneficial effect. Furthermore, obese patients with antioxidant supplementation had lower values of BMI, waist circumference, fasting blood glucose level, and assessment of the homeostasis model of insulin resistance when compared to the placebo group, as well as having lower levels of total cholesterol, triglycerides, LDL, malondialdehyde and tumor necrosis factor-alpha. n-3 PUFA supplementation can significantly reduce serum C-reactive protein (CRP), tumor necrosis factor α (TNFα), and interleukin 6 (IL-6) concentrations.

PREVALENCE OF MALNUTRITION AND MICRONUTRIENT DEFICIENCIES IN OLDER ADULTS WITH ULCERATIVE COLITIS WHO HAVE UNDERGONE BOWEL SURGERY

Abstract BACKGROUND There is little data on the older adult ulcerative colitis (UC) population. We aimed to evaluate the prevalence of malnutrition and micronutrient deficiencies among older adults who have undergone bowel surgery for their UC. METHODS This was a single-center, retrospective study of patients 65 years and older with UC. Malnutrition was defined using the European Society for Clinical Nutrition and Metabolism (ESPEN) definition. Eight micronutrient deficiencies and nutrition-related outcomes were measured. The Saskatchewan Inflammatory Bowel Disease–Nutrition Risk Tool was utilized to identify patients at risk for malnutrition. Descriptive statistics were used to summarize data. Characteristics of patients with and without malnutrition were compared using Fisher’s exact tests (analysis of variance for age). RESULTS Eighty-eight patients with a mean age of 74.7 years were included. The most common surgery was total proctocolectomy with end ileostomy (n=40,45%). Seven patients (8%) met criteria for malnutrition, 24 patients (31%) were moderate to high risk for malnutrition, and 55 (70%) of patients were low risk. Sixty-six patients (74%) had at least one micronutrient deficiency: 42% with vitamin D deficiency and 32% with iron deficiency. One-third of patients had bone-related disease (27 patients). No statistically significant associations were found among patients with or without malnutrition or among patients with low, moderate, or high risk of malnutrition. Our small study, however, likely lacked sufficient power to detect any differences which may exist. CONCLUSIONS The prevalence of malnutrition was low, however, the incidence of at least one micronutrient deficiency was high. Older adults with UC who have undergone bowel surgery should be followed carefully with annual labs to avoid nutrition-related complications. Table 1 Characteristics of Older Adults with Ulcerative Colitis who have undergone Surgical Resection Table 2 Rates of Malnutrition and Micronutrient Deficiencies in Older Adult Ulcerative Colitis Population

Evaluation of a COVID-19 Risk Tool.

Some of the most vexing issues with the COVID-19 pandemic were the inability of schools and work areas to track symptoms. Technology solutions to mitigate repercussions of the COVID-19 pandemic include tools that provide guidelines and interfaces to influence behavior, reduce exposure to the disease, and enable policy-driven avenues to return to a sense of normalcy (e.g., school and work). This presentation presents the implementation and early evaluation of a return-to-work COVID-19 symptom and risk assessment tool.

P563 Nutritional screening in patients with inflammatory bowel disease: a challenge in the timely diagnosis of malnutrition and sarcopenia

Abstract Background Malnutrition is prevalent in inflammatory bowel disease (IBD) and has been reported in up to 70% in patients with active disease and 38% in patients in remission, being related to sarcopenia, so different tools have been proposed for the nutritional screening of these patients taking into account the importance of early intervention avoiding consequences related to altered body composition such as inadequate response to treatment and poor quality of life, but the evidence in IBD patients is still unclear and there are no studies in Colombian IBD patients. Therefore, the aim of this study is to describe the nutritional status of patients using multiple nutritional screening and assessment tools. Methods Descriptive observational cross-sectional study in patients diagnosed with IBD with clinical activity, by applying nutritional screening tools such as the Malnutrition Universal Screening Tool (MUST) and the Malnutrition Inflammation Risk Tool (MIRT) to determine their nutritional status and degree of sarcopenia. Results Nutritional screening was performed in 20 patients with Inflammatory Bowel Disease, with mild to moderate clinical activity of the disease; patients in clinical remission were excluded. Sixty percent were men and 40% women; with an average age of 44.5 years, 19 years as minimum age and 73 years as maximum age. Taking into account the Malnutrition Universal Screening Tool (MUST), 30% have a high risk of malnutrition, with a higher percentage in men. On the other hand, the MIRT (Malnutrition Inflammation Risk Tool), which evaluates BMI, showed that 25% have a score greater than or equal to 3, which indicates a risk. In addition, and 40% of the population underwent nutritional status assessment in order to rule out sarcopenia. Muscle strength, muscle mass and muscle function were assessed and 25% of this population were diagnosed with sarcopenia and another 25% with possible sarcopenia. Conclusion Patients with IBD are at increased risk of malnutrition, This is the first Colombian study to approach the nutritional assessment of IBD patients with mild to moderate disease activity using nutritional screening tools such as the Malnutrition Universal Screening Tool (MUST) and the Malnutrition Inflammation Risk Tool (MIRT), showing that up to one third of patients are at high risk of malnutrition and 50% have a diagnosis or possible diagnosis of sarcopenia, which is slightly lower than that described in the literature, However, it does raise awareness of the importance of nutritional screening in IBD patients as these alterations have been shown to be associated with increased hospitalisation requirements, number of disease flares and associated complications.

P1161 Prevalence of undernutrition in patients with inflammatory bowel disease and improvement after nutritional advice

Abstract Background The prevalence of undernutrition ranges from 25% to 70% and severe undernutrition from 1% to 30% among individuals with active inflammatory bowel disease (IBD). The aetiology of malnutrition is multifactorial. There are not many studies that have assessed nutrition after therapy modification and dietary advice. Aim To study the prevalence of undernutrition in IBD and the change after nutritional advice. Methods In this single-centre prospective cohort study, 218 consecutive patients with IBD were screened. Patients with associated diseases that could lead to undernutrition were excluded (N=18). Nutritional assessment was done as per the European Society for Clinical Nutrition and Metabolism (ESPEN) definition: BMI &amp;lt;18.5 kg/m2 or unintentional weight loss &amp;gt;10% were defined as undernutrition and the Malnutrition Inflammation Risk Tool (MIRT) score was calculated. Obesity was defined as per the WHO Asian BMI classification: grade 1 (BMI 25-29.9 Kg/m2) and obesity grade 2 (BMI &amp;gt;30 Kg/m2)1. Patients were given nutritional advice and therapy was optimized as per disease activity. BMI and MIRT were calculated on subsequent visits to assess response to nutritional advice. Results Of 200 patients (median age 39 [IQR 28-53] years; 96 females), 105 had ulcerative colitis (UC), 93 Crohn’s disease (CD), and 2 IBD-unclassified. Fifty-four (27%) patients had undernutrition (28 UC, 25 CD, and 1 IBD-U). Sixty-one (30.5%) patients were obese. At follow up (median duration 24 months), of 37/54 patients with BMI &amp;lt;18.5 Kg/m2, BMI increased in 24 (64.8%) and decreased in 13 (35.1%); of 17 patients with &amp;gt;10% unintentional weight loss, 5 (29.4%) had increased weight on follow-up. MIRT score decreased in 24/54 patients (44.4%), remained same in 14 (25.9%), and increased in 16 patients (29.6%). Of the 24 patients with decrease in MIRT score, 7/24 (29.1%) received only dietary advice, 10 (41.6%) received dietary advice and optimization of IBD treatment, and 7 (29.1%) received only optimization of IBD treatment. Conclusion The prevalence of undernutrition and obesity in patients with IBD was 27% and 30.5%, respectively. After dietary advice and therapy optimization, nutrition improved in 53.7% while MIRT score decreased in 43.3% of patients.

P950 Advancing Precision Nutritional Assessment in Inflammatory Bowel Disease (IBD): Adding Fecal Calprotectin in the Malnutrition Inflammation Risk Tool (MIRT) score

Abstract Background Most of the nutritional assessment tools assess only nutrition. The Malnutrition Inflammation Risk Tool (MIRT) incorporates both malnutrition and inflammation (CRP).1 However, CRP is a less sensitive biomarker than fecal calprotectin for the assessment of inflammation. Adding fecal calprotectin (FC) in the MIRT score may improve the assessment of malnutrition risk. FC level cutoff of &amp;lt; 250 mg/kg in adults correlate with endoscopic remission with good sensitivity and specificity.2 Fecal calprotectin level greater than 800 µg/g is predictive of a need for rescue therapy.3 Aim To study if adding fecal calprotectin to CRP by improves the yield of MIRT score Methods This is a single center, prospective, cohort study including consecutive patients with IBD (Ulcerative colitis {UC} and Crohn’s disease {CD}). Malnutrition was defined as per European society for clinical nutrition and metabolism (ESPEN guidelines): BMI &amp;lt;18.5 kg/m2 or unintentional weight loss &amp;gt;10% (indefinite time). MIRT score was calculated with BMI, weight loss and CRP and MIRT-FC by adding FC to CRP with as shown in the table below: Results During 2019 to 2021, 200 patients included, median age 39 years (IQR 28-53) (105 UC, 93 CD and 2 IBD-U), 60 (30%) patients had malnutrition (32 UC, 26 CD and 2 IBD-U and 27 (45%) malnourished IBD patients had MIRT score &amp;gt; 3. CRP values were normal in 30 (50%). Adding fecal calprotectin to MIRT score malnourished IBD patients, 46 (76%) malnourished IBD patients had MIRT score &amp;gt; 3 (P=0.005). This modification (MIRT FC) increased the yield of existing MIRT score by 31%. Conclusion MIRT-FC score improved the yield of MIRT score. Prospective studies are required to validate this further.

Assessing risk of bias in the meta-analysis of round 1 of the Health Care Innovation Awards

BackgroundSystematic reviews of observational studies can be affected by biases that lead to under- or over-estimates of true intervention effects. Several tools have been reported in the literature that attempt to characterize potential bias. Our objective in this study was to determine the extent to which study-specific bias may have influenced intervention impacts on total costs of care (TCOC) in round 1 of the Health Care Innovation Awards.MethodsWe reviewed 82 statistical evaluations of innovation impacts on Medicare TCOC. We developed five risk-of-bias measures and assessed their influence on TCOC impacts using meta-regression.ResultsThe majority of evaluations used propensity score matching to create their comparison groups. One third of the non-randomized interventions were judged to have some risk of biased effects due largely to the way they recruited their treatment groups, and 35% had some degree of covariate imbalance remaining after propensity score adjustments. However, in the multivariable analysis of TCOC effects, none of the bias threats we examined (comparison group construction method, risk of bias, or degree of covariate imbalance) had a major impact on the magnitude of HCIA1 innovation effects. Evaluations using propensity score weighting produced larger but imprecise savings effects compared to propensity score matching.DiscussionOur results suggest that it is unlikely that HCIA1 TCOC effect sizes were systematically affected by the types of bias we considered. Assessing the risk of bias based on specific study design features is likely to be more useful for identifying problematic characteristics than the subjective quality ratings used by existing risk tools.

1906 Identifying Older Frail Patients Suitable for Same Day Emergency Care (SDEC); The Applicability of Patient Selection Scoring System

Abstract Aim Several patient selection scores have been developed to identify patients suitable for SDEC from triage in Emergency Departments (ED) and the acute medical intake. Scores are designed to improve system efficiency, overcrowding and patient experience. Studies have been conducted that compare these; none in frail older adults. This study compared the Glasgow Admission Prediction Score (GAPS), Sydney Triage to Admission Risk Tool (START) and the Ambulatory Score (Amb). Methods The Older Person’s Assessment service is ED based, accepting patients with frailty syndromes aged &amp;gt;70 years with same-day discharge for &amp;gt;75% of patients. The OPAS databank was retrospectively analysed from June 2020 to December 2021. Interactions with age, Charlson Co-morbidity index (CCI) and Clinical Frailty Score (CFS) were evaluated alongside each ambulatory score. ED documentation was used to gain triage data. Results 748 attendances, 274(36.6%) Male with mean age 82.8(±8.5) years, CFS 5.2(±1.4) and CCI 6.7(±2.6) with 584(78.1%) discharged same day. Mean Amb score 4.2(±1.7), GAPS 21.4(±5.8), START 23.5(±4.7) all within admission range with 29.1% Mortality within 12 months. There was a significant difference between those admitted and discharged with CFS (p&amp;lt;0.001), mortality (p&amp;lt;0.001), Amb score and START score but not GAPS (p&amp;lt;0.001 vs p=0.03 vs p=0.17). Conclusion Frailty is an important determinant in identifying whether ambulatory care is appropriate. No score could be reliably used as a screen for suitable patients for SDEC services although the Amb score was the most accurate when assessing each individual variable. We are developing our own SDEC score for older, frailer adults which is currently being validated in the OPAS and SDEC settings.

The Role of Smoking Status in Making Risk-Informed Diagnostic Decisions in the Lung Cancer Pathway: A Qualitative Study of Health Care Professionals and Patients.

Lung cancer clinical guidelines and risk tools often rely on smoking history as a significant risk factor. However, never-smokers make up 14% of the lung cancer population, and this proportion is rising. Consequently, they are often perceived as low-risk and may experience diagnostic delays. This study aimed to explore how clinicians make risk-informed diagnostic decisions for never-smokers. Qualitative interviews were conducted with 10 lung cancer diagnosticians, supported by data from interviews with 20 never-smoker lung cancer patients. The data were analyzed using a framework analysis based on the Model of Pathways to Treatment framework and data-driven interpretations. Participants described 3 main strategies for making risk-informed decisions incorporating smoking status: guidelines, heuristics, and potential harms. Clinicians supplemented guidelines with their own heuristics for never-smokers, such as using higher thresholds for chest X-ray. Decisions were easier for patients with high-risk symptoms such as hemoptysis. Clinicians worried about overinvestigating never-smoker patients, particularly in terms of physical and psychological harms from invasive procedures or radiation. To minimize unnecessary anxiety about lung cancer risk, clinicians made efforts to downplay this. Conversely, some patients found that this caused process harms such as delays and miscommunications. Improved guidance and methods of risk differentiation for never-smokers are needed to avoid diagnostic delays, overreassurance, and clinical pessimism. This requires an improved evidence base and initiatives to increase awareness among clinicians of the incidence of lung cancer in never-smokers. As the proportion of never-smoker patients increases, this issue will become more urgent. Smoking status is the most common risk factor used by clinicians to guide decision making, and guidelines often focus on this factor.Some clinicians also use their own heuristics for never-smokers, and this becomes particularly relevant for patients with lower risk symptoms.Clinicians are also concerned about the potential harms and risks associated with deploying resources on diagnostics for never-smokers.Some patients find it difficult to decide whether or not to go ahead with certain procedures due to efforts made by clinicians to downplay the risk of lung cancer.Overall, the study highlights the complex interplay between smoking history, clinical decision making, and patient anxiety in the context of lung cancer diagnosis and treatment.

Exercise influence on monocarboxylate transporter 1 (MCT1) and 4 (MCT4) in the skeletal muscle: A systematic review.

This review aims to systematically analyze the effect of exercise on muscle MCT protein levels and mRNA expression of their respective genes, considering exercise intensity, and duration (single-exercise session and training program) in humans and rodents, to observe whether both models offer aligned results. The review also aims to report methodological aspects that need to be improved in future studies. A systematic search was conducted in the PubMed and Web of Science databases, and the Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) checklist was followed. After applying inclusion and exclusion criteria, 41 studies were included and evaluated using the Cochrane collaboration tool for risk of bias assessment. The main findings indicate that exercise is a powerful stimulus to increase MCT1 protein content in human muscle. MCT4 protein level increases can also be observed after a training program, although its responsiveness is lower compared to MCT1. Both transporters seem to change independently of exercise intensity, but the responses that occur with each intensity and each duration need to be better defined. The effect of exercise on muscle mRNA results is less defined, and more research is needed especially in humans. Moreover, results in rodents only agree with human results on the effect of a training program on MCT1 protein levels, indicating increases in both. Finally, we addressed important and feasible methodological aspects to improve the design of future studies.

A polygenic risk score added to a QRISK®2 cardiovascular disease risk calculator demonstrated robust clinical acceptance and clinical utility in the primary care setting.

The aim of the study was to assess the real-world feasibility, acceptability, and impact of an integrated risk tool for cardiovascular disease (CVD IRT, combining the standard QRISK®2 risk algorithm with a polygenic risk score), implemented within routine primary practice in the UK National Health Service. The Healthcare Evaluation of Absolute Risk Testing Study (NCT05294419) evaluated participants undergoing primary care health checks. Both QRISK2 and CVD IRT scores were returned to the healthcare providers (HCPs), who then communicated the results to participants. The primary outcome of the study was feasibility of CVD IRT implementation. Secondary outcomes included changes in CVD risk (QRISK2 vs. CVD IRT) and impact of the CVD IRT on clinical decision-making. A total of 832 eligible participants (median age 55 years, 62% females, 97.5% White ethnicity) were enrolled across 12 UK primary care practices. Cardiovascular disease IRT scores were obtained on 100% of the blood samples. Healthcare providers stated that the CVD IRT could be incorporated into routine primary care in a straightforward manner in 90.7% of reports. Participants stated they were 'likely' or 'very likely' to recommend the use of this test to their family or friends in 86.9% of reports. Participants stated that the test was personally useful (98.8%) and that the results were easy to understand (94.6%). When CVD IRT exceeded QRISK2, HCPs planned changes in management for 108/388 (27.8%) of participants and 47% (62/132) of participants with absolute risk score changes of >2%. Amongst HCPs and participants who agreed to the trial of genetic data for refinement of clinical risk prediction in primary care, we observed that CVD IRT implementation was feasible and well accepted. The CVD IRT results were associated with planned changes in prevention strategies.

‘I tried to take my phone off my daughter, and i got hit in the face’: a qualitative study of parents’ challenges with adolescents’ screen use and a toolbox of their tips

BackgroundConcerns about adolescent screen use are often expressed but poorly understood, particularly in terms of how parents are supposed to respond in ways that balance safety, care and developing independence and autonomy. This qualitative study investigated parental perceptions and concerns about screen use of adolescents aged 13 to 17. Current strategies to manage screen use and barriers to doing so were explored, and parents were asked to outline recommended interventions for better outcomes.MethodsInterviews and focus groups were held with 33 adults in Auckland, Aotearoa New Zealand (mean age 48 years) who were parenting adolescents (mean age 14 years). Interviews were transcribed verbatim, then inductive analysis and interpretation by the research team distilled the key ideas and illustrative quotes. A table of recommendations for a practical ‘toolbox’ was developed from these in-depth conversations.ResultsParents reported extensive use of screens by their adolescents, constantly throughout the day (and night, instead of sleeping). Four areas of specific concern included: (1) addict-like behavior, (2) exposure to harmful (and inane) content, (3) living in a virtual world, and (4) negative impacts on physical, mental, and cognitive wellbeing. To manage adolescent screen use, family rules and restrictions (on time and place) were common. Some used technical control via software or accessing the adolescent’s devices and/or accounts to check for inappropriate content (such as pornography). Communication about device use and self-regulation were important. Barriers to managing screen use included trying to avoid conflict with their child; difficulties with consistency or follow-through on rules; lack of technical knowledge; parental screen use that set a bad example; and device use needed for school or other purposes. Recommendations from parents are presented in a toolbox of tips and techniques they shared, and their ‘wish list’ for better access to practical, local, scientific information, examples of techniques that have worked for other families, tools for problematic behavior and risk (including how to begin conversations with adolescents about their concerns), and having schools and young people involved in developing interventions to build digital citizenship.ConclusionsRich, nuanced accounts from parents about adolescent screen use in their families and communities underpinned their practical ideas for more skillful responses to young people grappling with an addictive digital existence.

Nutritional modulation of gut microbiota in inflammatory bowel disease: a systematic review

Introduction: Inflammatory bowel diseases (IBD) have shown an increase in incidence worldwide. The pathogenesis of IBD is that genetically susceptible individuals develop intolerance to dysregulated gut microbiota (dysbiosis) and chronic inflammation develops as a result of poor dietary triggers. Diet plays an important role in modulating the gut microbiota and can be applied as a therapeutic tool to improve the course of the disease. Objective: It was to carry out a systematic review of the main interactions between nutrology, gut microbiota, and inflammatory bowel disease, to elucidate the main clinical outcomes of the disease after nutrological treatment, analyzing the main macro and micronutrients. Methods: The PRISMA Platform systematic review rules were followed. The search was carried out from August to October 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: 144 articles were found. A total of 39 articles were evaluated in full and 30 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 27 studies with a high risk of bias and 22 studies that did not meet GRADE and AMSTAR-2. Most studies showed homogeneity in their results, with X2=59.9%&gt;50%. With nutritional treatment, several micronutrients have the potential to modulate intestinal inflammation. Immunonutrition has demonstrated its importance through vitamins A, C, E, and D, folic acid, beta-carotene, and trace elements such as zinc, selenium, manganese, and iron. The Specific Carbohydrate Diet, fermentable oligosaccharides, disaccharides, monosaccharides, and polyol diet, and the Mediterranean diet also appear to show strong anti-inflammatory properties and promise to improve symptoms of inflammatory bowel disease. Diet modulation can control IBD by reducing persistent intestinal symptoms, balancing the gut microbiota, and reducing markers of inflammation. Dietary therapy can improve the quality of life of IBD patients.

Validation of Three Models for Prediction of Blood Transfusion during Cesarean Delivery Admission.

Prediction of blood transfusion during delivery admission allows for clinical preparedness and risk mitigation. Although prediction models have been developed and adopted into practice, their external validation is limited. We aimed to evaluate the performance of three blood transfusion prediction models in a U.S. cohort of individuals undergoing cesarean delivery. This was a secondary analysis of a multicenter randomized trial of tranexamic acid for prevention of hemorrhage at time of cesarean delivery. Three models were considered: a categorical risk tool (California Maternal Quality Care Collaborative [CMQCC]) and two regression models (Ahmadzia et al and Albright et al). The primary outcome was intrapartum or postpartum red blood cell transfusion. The CMQCC algorithm was applied to the cohort with frequency of risk category (low, medium, high) and associated transfusion rates reported. For the regression models, the area under the receiver-operating curve (AUC) was calculated and a calibration curve plotted to evaluate each model's capacity to predict receipt of transfusion. The regression model outputs were statistically compared. Of 10,785 analyzed individuals, 3.9% received a red blood cell transfusion during delivery admission. The CMQCC risk tool categorized 1,970 (18.3%) individuals as low risk, 5,259 (48.8%) as medium risk, and 3,556 (33.0%) as high risk with corresponding transfusion rates of 2.1% (95% confidence interval [CI]: 1.5-2.9%), 2.2% (95% CI: 1.8-2.6%), and 7.5% (95% CI: 6.6-8.4%), respectively. The AUC for prediction of blood transfusion using the Ahmadzia and Albright models was 0.78 (95% CI: 0.76-0.81) and 0.79 (95% CI: 0.77-0.82), respectively (p = 0.38 for difference). Calibration curves demonstrated overall agreement between the predicted probability and observed likelihood of blood transfusion. Three models were externally validated for prediction of blood transfusion during cesarean delivery admission in this U.S. Overall, performance was moderate; model selection should be based on ease of application until a specific model with superior predictive ability is developed. · A total of 3.9% of individuals received a blood transfusion during cesarean delivery admission.. · Three models used in clinical practice are externally valid for blood transfusion prediction.. · Institutional model selection should be based on ease of application until further research identifies the optimal approach..

Heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics: a meta-analysis of randomized controlled trials

BackgroundIt is still controversial for neonates or children to choose normal saline or heparin solution in the care of peripheral intravenous catheters. This meta-analysis aimed to evaluate the effects of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics, to provide reliable evidence support for clinical care.MethodsTwo authors searched the PubMed, EMbase, Ovid Medline, Cochrane Library, Web of Science, CBM, WanFang Data and China National Knowledge Infrastructure (CNKI) databases for randomized controlled trial (RCT) of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics until July 16, 2023. The bias of risk tool recommended by Cochrane was used for the quality evaluation of included RCTs. Meta-analysis was carried out by using RevMan 5.4 software.ResultsA total of 22 RCTs involving 3988 peripheral intravenous catheters were finally included. Compare with normal saline, heparin could significantly increase the catheter indwelling time (MD = 9.10, 95%CI:3.30 ~ 14.90). Subgroup analysis indicated that for compare with normal saline, heparin could significantly increase the catheter indwelling time in the neonate (MD = 9.63, 95%CI: 0.38 ~ 18.88) and neonate + children population (MD = 6.22, 95%CI:2.72 ~ 9.73, P < 0.001). Heparin could significantly reduce the incidence of catheter-associated complications (RR = 0.84, 95%CI: 0.70 ~ 0.95). Subgroup analysis indicated that heparin could significantly reduce the incidence of catheter-associated complications in the neonate (RR = 0.70, 95%CI: 0.61 ~ 0.89). There was no publication bias amongst the synthesized outcomes by Egger’s test (all P > 0.05).ConclusionsHeparin may be worthy of being applicated in the neonate population in terms of prolonged indwelling time and less complications. Limited by the evidence quality, more studies from different area and populations with rigorous design are needed to investigate the role of heparin versus normal saline for the care of peripheral intravenous catheters in pediatrics.

ESTIMASI TAIL VALUE AT RISK SAHAM BLUE CHIPS MENGGUNAKAN COPULA ALI-MIKHAIL-HAQ

When making investments, investors definitely want high returns with low risk. However, high returns are usually accompanied by high risks and vice versa. Value at Risk (VaR) and other measurement tools help manage risk. VaR measures possible losses. However, VaR has weaknesses, thus Tail Value at Risk (TVaR) can be used to evaluate the likelihood of larger losses than VaR. Copula can be used in risk management because it does not require normal distribution assumptions so it is well applied to financial data. The purpose of this research is to use the Ali-Mikhail-Haq copula to estimate TVaR value of blue chip stock portfolios, including those of BRI, BCA, and Bank Mandiri. Data used is the closing price of daily stocks for the period Jan 1 2021 to Jun 30 2023. The results of calculating TVaR value at the 90%, 95%, and 99% confidence level of the combination of BMRI and BBRI stocks are 0,0574; 0,0668; dan 0,0807. At a confidence level of 90%, 95% and 99% TVaR value of the combination of BMRI and BBCA stocks is 0,0569; 0,0669; dan 0,0886. The combination of BBRI and BBCA stocks resulted in TVaR at 90%, 95% and 99% confidence levels are 0,0238; 0,0283; 0,0376.