Risk Assessment Scale Research Articles

RISK OF INJURY DEVELOPMENT DUE TO SURGICAL POSITIONING: AN OBSERVATIONAL STUDY

Objective: To classify the risk of developing injury due to surgical positioning. Method: Observational, longitudinal, prospective study with a quantitative approach carried out in a public hospital, with 135 patients undergoing elective surgery. Instruments containing sociodemographic, clinical, and surgical characteristics and a risk assessment scale for the development of injuries due to surgical positioning were used. Descriptive analysis, Fisher’s exact test or χ2 test and odds ratio association measure were used as appropriate. Results: Most participants were male (51.11%), adults (52.59%) and were classified as having a higher risk for developing injuries due to surgical positioning (51.85%). Elderly, hypertension, diabetes mellitus and urological surgeries were statistically significant (p < 0.05) for a higher risk of developing lesions. The incidence of pressure injuries was 0.74%, with observation only in the sacral region. Conclusion: There was a greater risk of developing lesions due to surgical positioning and low incidence of pressure injury. Perioperative nursing should incorporate validated risk measurement tools into care practice for safe, individualized and quality care for surgical patients.

ПИЛОТНАЯ ВЕРСИЯ ШКАЛЫ СЛОЖНОСТИ ЛАПАРОСКОПИЧЕСКИХ ОПЕРАЦИЙ ПРИ НЕЙРОГЕННЫХ ОПУХОЛЯХ АБДОМИНАЛЬНОЙ ЛОКАЛИЗАЦИИ У ДЕТЕЙ

The purpose of this research was to develop a scale for risk, difficulty and complexity assessment of laparoscopic surgical interventions for neurogenic tumors of abdominal localization in children taking into account IDRF, tumor size and other criteria that affect the surgical outcome. Materials and methods used: 124 patients (68 (55%) boys/56 (45%) girls) aged 0 to 18 y/o (median age of 20.5 [5-50.5] months old) who have undergone laparoscopic surgery for neurogenic tumors of abdominal localization in Jan. 2018-Apr. 2022 were included in a single-center retrospective cohort study. An analysis was made of the relationship between the 24 criteria for the complexity of the surgical intervention and the parametric evaluation of its results (duration of surgical intervention; intraoperative blood loss; intraoperative blood transfusion; intraoperative complications and access conversion). As for the quantitative variables, the Spearman's rank correlation coefficient was used, and the eta coefficient for qualitative variables. Cluster analysis was used to distribute points by the difficulty levels. The ROC curve analysis with sensitivity and specificity for high level of complexity was used to check the scale of complexity. Results: median duration of surgical intervention was 105 [75; 150] min, volume of intraoperative blood loss - 5 [5; 20] ml. Blood transfusion was required in 15 (12%) cases, median blood transfusion was 0 [0; 0] ml. Intraoperative complications developed in 4 (3%) cases. Conversions were performed in 4 (3%) patients. 10 complexity criteria were selected: IDRF F1, F2, F3, F4, F5, location of the tumor center, extension beyond the midline, previous open surgery, contact of the tumor with the inferior vena cava, and the tumor volume (ml)/height (m) ratio of > or </= 28. A pilot difficulty scale with three levels of difficulty has been developed. Sensitivity for a high level of complexity (6 or over pts) was 60% (95% CI 23.1-88.2%), specificity was 98.3% (95% CI 94.1-99.5%). Conclusion: different IDRFs contribute differently to the complexity and risk of laparoscopic surgery. The ratio of tumor size to growth is more significant criterion of complexity than the absolute size of the neoplasm. Other criteria of complexity also play an important role, such as previous open surgeries and tumor localization, in particular. The Authors do not recommend this scale for clinical use because the results obtained in this research would form the basis for further prospective study aiming to the development of a more accurate scale of the complexity of laparoscopic operations in neurogenic tumors of the abdominal localization.

ПИЛОТНАЯ ВЕРСИЯ ШКАЛЫ СЛОЖНОСТИ ЛАПАРОСКОПИЧЕСКИХ ОПЕРАЦИЙ ПРИ НЕЙРОГЕННЫХ ОПУХОЛЯХ АБДОМИНАЛЬНОЙ ЛОКАЛИЗАЦИИ У ДЕТЕЙ

The purpose of this research was to develop a scale for risk, difficulty and complexity assessment of laparoscopic surgical interventions for neurogenic tumors of abdominal localization in children taking into account IDRF, tumor size and other criteria that affect the surgical outcome. Materials and methods used: 124 patients (68 (55%) boys/56 (45%) girls) aged 0 to 18 y/o (median age of 20.5 [5-50.5] months old) who have undergone laparoscopic surgery for neurogenic tumors of abdominal localization in Jan. 2018-Apr. 2022 were included in a single-center retrospective cohort study. An analysis was made of the relationship between the 24 criteria for the complexity of the surgical intervention and the parametric evaluation of its results (duration of surgical intervention; intraoperative blood loss; intraoperative blood transfusion; intraoperative complications and access conversion). As for the quantitative variables, the Spearman's rank correlation coefficient was used, and the eta coefficient for qualitative variables. Cluster analysis was used to distribute points by the difficulty levels. The ROC curve analysis with sensitivity and specificity for high level of complexity was used to check the scale of complexity. Results: median duration of surgical intervention was 105 [75; 150] min, volume of intraoperative blood loss - 5 [5; 20] ml. Blood transfusion was required in 15 (12%) cases, median blood transfusion was 0 [0; 0] ml. Intraoperative complications developed in 4 (3%) cases. Conversions were performed in 4 (3%) patients. 10 complexity criteria were selected: IDRF F1, F2, F3, F4, F5, location of the tumor center, extension beyond the midline, previous open surgery, contact of the tumor with the inferior vena cava, and the tumor volume (ml)/height (m) ratio of > or </= 28. A pilot difficulty scale with three levels of difficulty has been developed. Sensitivity for a high level of complexity (6 or over pts) was 60% (95% CI 23.1-88.2%), specificity was 98.3% (95% CI 94.1-99.5%). Conclusion: different IDRFs contribute differently to the complexity and risk of laparoscopic surgery. The ratio of tumor size to growth is more significant criterion of complexity than the absolute size of the neoplasm. Other criteria of complexity also play an important role, such as previous open surgeries and tumor localization, in particular. The Authors do not recommend this scale for clinical use because the results obtained in this research would form the basis for further prospective study aiming to the development of a more accurate scale of the complexity of laparoscopic operations in neurogenic tumors of the abdominal localization.

Evaluation of fall risk and associated factors in patients with dementia

AbstractBackgroundFalling, which is common in the elderly and leads to negative consequences, can also be seen in dementia patients. The aim of this study is to determine the risk of falls in patients with dementia and to evaluate the factors associated with falls.MethodThe sample of this cross‐sectional study consisted of 95 patients with a diagnosis of definite dementia who attended a dementia outpatient clinic in a university hospital in Istanbul between January and March 2020. Patients using assistive devices while walking were not included in the study. A sociodemographic form, DENN Fall Risk Assessment Scale, Mini Mental State Test (MMSE), Neuropsychiatric Inventory (NPI), Apathy Assessment Scale (AES), Clinical Dementia Rating Scale (CDR), Cornell Depression in Dementia Scale (CSDD), Lawton and Brody Instrumental Activities of Daily Living (Lawton IADL), and Katz Activities of Daily Living (Katz ADL) Scale were used for data collection.ResultsIt was determined that 53.7% of the patients were female and the mean age was 73.1±11.4. Most of the patients (64.2%) had Alzheimer’s type dementia, 49.5% had mild or moderate dementia, 75.8% had an additional chronic disease, 22.1% were semi‐dependent in movement activity. 47.4% of the individuals had a history of fall in the last month, 48.9% had fallen at least 2 times, the average number of falls was 1.5±0.5, 70.5% of the patients had injuries after falling, and the mean DENN Fall Risk score was found to be 10.4±3.4. In the group with a history of falling non‐Alzheimer dementias were more common (p = 0.018), NPI symptom (p<0.001) and bother (p<0.001) scores were higher, Lawton IADL scores were lower (p = 0.009), AES clinician (p = 0.054) and caregiver (p = 0.052) scores and Cornell depression score (CSDD) (p = 0.005) were higher.ConclusionFalling, which is the most common geriatric syndrome in dementia patients, can lead to negative patient outcomes. Most dementia patients have a history of falling and post‐fall injury. Factors associated with falls in dementia patients should be known, and appropriate nursing interventions should be made to prevent falls by recognizing the risk of falling. More work is needed on this subject.

Manajemen Nonfarmakologis dalam Mengurangi Resiko Konstipasi pada Pasien Ortopedi

This study aims to evaluate the results of published studies related to nonpharmacological management to reduce complaints of constipation in orthopedic patients. The research method used was Systematic Review which was carried out through a search strategy in 9 electronic databases with the keywords (orthopedic patient OR orthopedic patient) AND (nonpharmacological management OR nonpharmacological therapy) AND (constipation OR obstipation). The results showed that there was various nonpharmacological management used to treat and prevent the severity of constipation in orthopedic patients, including interventions such as chewing gum, abdominal massage, acupressure, hydrotherapy, biofeedback therapy, and nursing interventions based on the patient's active involvement in care. Various nonpharmacological strategies are used to treat constipation in orthopedic patients, and the best method to treat constipation in orthopedic patients cannot be ascertained due to the variety of instruments used and differences in sample characteristics in each study. Selected articles were assessed for quality using the Critical Appraisal Skill Program (CASP) guidelines. The six reviewed articles obtained that the range of patients who were given nonpharmacological interventions was ≥ 18 years. Instruments for measuring the incidence and severity of constipation are the Constipation Assessment Score, ROME III, Bristol Scale, Rasmusen measuring scale, Constipation Score Method, and Constipation Risk Assessment Scale. In conclusion, several nonpharmacological therapies can be applied to orthopedic patients to reduce their constipation complaints, thereby reducing the impact of hospitalization on patients and improving their quality of life.
 Keywords: Constipation, Orthopedics, Nonpharmacological Therapy

Effect of Nursing Intervention Based on Caprini Risk Assessment Scale for Venous Thromboembolism in Perioperative Patients with Liver Cancer

Objective: To explore the effect of nursing intervention based on Caprini risk assessment scale for venous thromboembolism (VTE) in perioperative patients with liver cancer. Methods: A total of 128 hepatocellular cancer (HCC) patients who were hospitalized in our department from January 2021 to March 2022 and met the research criteria were selected. According to odd and even numbers in the order of inclusion, 64 cases were divided into two groups: a control group and an observation group. The control group received routine nursing intervention during perioperative period, while the observation group received nursing intervention based on Caprini risk assessment scale for VTE. The incidence of VTE and complications were compared between the two groups. Results: The incidence of VTE and postoperative complications in the observation group were lower than those in the control group（P < 0.05). Conclusion: Nursing intervention based on Caprini risk assessment scale for VTE can reduce the incidence of perioperative deep vein thrombosis and complications in patients with liver cancer; thus, it is worthy of clinical application.

Development and validation of a risk assessment scale for pathological scarring.

To develop a risk assessment scale for pathological scarring and validate its psychometric properties. This was a methodological study. Researchers developed the scale based on a literature review, qualitative study and Delphi expert consultation. Subsequently, 409 patients participated in the study to test the psychometric properties of the scale. We evaluated construct validity, content validity, internal consistency reliability, and interrater reliability. The researchers developed a scale consisting of three dimensions and 12 items. Factor analysis extracted a total of four common factors that accounted for 62.22% of the total variance. The results revealed that the item-content validity index (I-CVI) ranged from 0.67 to 1, while the scale-content validity index (S-CVI) was 0.82. Internal consistency reliability: Cronbach's α of the items ranged from 0.67 to 0.76, while Cronbach's α of the whole scale was 0.74. Interrater reliability: the Kappa number was 0.73. The final scale showed adequate construct validity, content validity, and reliability. It is appropriate for use in research and clinical practice settings to identify patients with a risk of pathological scarring. Further study is needed to confirm the scale's validity and reliability in other settings and populations.

A potentially new thromboembolic event scoring system in polycythaemia vera patients: An audit of the Hungarian Philadelphia negative chronic myeloproliferative neoplasia register.

The Hungarian National Registry for Philadelphia chromosome negative myeloproliferative neoplasms was used to analyse the thromboembolic events (TE) of Hungarian patients with polycythemia vera (PV). Data from 351 JAK2 V617F-positive patients diagnosed with PV were collected online from 15 haematology centres reporting clinical characteristics, therapeutic interventions and thromboembolic events. TE events were evaluated before and after diagnosis based upon the Landolfi and Tefferi risk assessment scales. TE were reported on 102 patients before diagnosis and 100 during the follow-up period. Comparing to the frequency of major arterial events before PV diagnosis, we can notice a decreasing tendency after diagnosis: from 12.3% to 2.6% (p < .00003). There was no significant change in the rate of major venous events (from 5.1% to 8.5%; p = .1134) or minor arterial events (from 11.7% to 17.4%; p = .073). Bleeding events were recorded in 5.7% of patients. Despite treatment with HU + ASA, 44 patients (43.1%) with prior TE had recurrent thromboembolic complications. The particular analysis of our data revealed a new TE scoring system based on: age, gender, previous TE and iron deficiency at the time of diagnosis. Our registry enables characterisation of patients with PV. The high level of recurrent TE events highlights the need for more effective and risk-adapted therapy.

Assessment of the risk factors for intraoperative pressure injuries in patients

AimThis study was conducted to assess the risk factors for pressure injuries in patients during surgery. MethodsIn this descriptive cross-sectional study, the risk of pressure injuries during surgery was evaluated in 250 patients in a university hospital. Data were collected through a Patient Descriptive Information Form (PDIF) and the 3S Intraoperative Pressure Injury Risk Assessment Scale (IPIRAS). ResultsThe mean age of the patients was 44.15 ± 17.00, and 52.4% were female. In addition, it was determined that the mean 3S IPIRAS score was higher in patients who were male, were aged ≥60 years, were obese, had a chronic disease, and had low serum albumin and hemoglobin levels (p < .05). During the surgery of the patients included in the study, support surfaces were used in 67.6%, positioning aids were used in 82.4%, and 55.6% had normal skin. Patients who underwent CVS procedures for more than 6 h, did not use support surfaces during surgery, had moist skin, or used vasopressors had higher and significantly different mean 3S IPIRAS scores (p < .05). ConclusionsAccording to the results, all surgical patients were at risk for pressure injury in the intraoperative period. In addition, it was found that male gender was associated with risk factors and that being aged ≥60 years, obesity, chronic disease, low serum hemoglobin and albumin levels, CVS, operations lasting more than 6 h, moist skin, vasopressor drugs, and not using support surfaces during surgery increased the risk of pressure injuries significantly.

Development and validation of medical adhesive-related skin injury risk assessment scale at peripherally inserted central catheter insertion site in oncology patients.

To construct a risk assessment scale for medical adhesive-related skin injuries (MARSI) at the peripherally inserted central catheter (PICC) insertion site in oncology patients and test its reliability and validity. The STARD 2015 statement guided this study. Literature research and a modified Delphi method were adopted in this study. A total of 31 experts participated in two rounds of consultation to build the assessment scale. A convenient sampling method was used to select 195 oncology patients at the PICC clinic from January to June 2022. Inter-rater reliability was used to test the reliability of the scale. Validity was evaluated using the content validity index (CVI) and predictive validity. After the two rounds of consultation, the assessment scale with five dimensions and 13 primary entries and 36 secondary entries was developed, and the expert authority coefficients for both were 0.90. The inter-rater reliability was 0.968. The CVIs of the items ranged from 0.83 to 1.00. The area under the subject's work characteristic curve was 0.757, and the sensitivity and specificity of the scale were 80.0% and 65.6%, respectively, at a cutoff score of 15.5.

Effects of aerobic exercise on metabolic indicators and physical performance in adult NAFLD patients: A systematic review and network meta-analysis.

nonalcoholic fatty liver disease (NAFLD) is characterized by excessive accumulation of fat in the liver without alcoholism. We conducted a systematic review and meta-analysis to elucidate the efficacy of aerobic exercise on metabolic indicators and physical performance of adult patients with NAFLD. To conduct the systematic review and network meta-analysis, 2 researchers searched PubMed, EBSCO, and Web of science databases to identify randomized clinical trials of aerobic exercise interventions for adults with NAFLD published between inception and July 2022. We assessed the methodological quality of the included literature using the Cochrane Risk Assessment Scale and the PEDro Scale. Relevant data were extracted, variables were converted to the same units, and meta-analysis was performed using RevMan 5.4 software. We compared mean differences (MD) between experimental and control groups. For each outcome analyzed, we expressed data as MD with 95% CI to compare metabolic markers and exercise capacity between the experimental and control NAFLD patients. Eleven randomized clinical trials with a total of 491 individuals with NAFLD were included in accordance with the criteria of this study. Types of aerobic exercise include moderate or high-intensity interval running, cycling, Nordic walking, equipment training, etc; Training duration 4 to 16 weeks, 30 to 60 minutes 3 or more times a week. Compared with the control group, aerobic exercise group had reduced weight of patients, (MD) 1.20 kg (95% CI: -1.38 to -1.01 kg, P < .00001). Seven studies confirmed that aerobic exercise significantly reduced triglycerides, (MD) 3.00 mg/dL (95% CI: -5.80 to -0.21 mg/dL, P = .04); increased high density lipoproteins (MD) 5.96 mg/dL (95% CI: 2.95 to 8.96 mg/dL, P = .0001) and reduced low-density lipoproteins (MD) 6.45 mg/dL (95% CI: -8.53 to -4.37 mg/dL, P < .00001); the study also showed that aerobic exercise reduced the liver enzymes aspartate aminotransferase and alanine aminotransferase to varying degrees. Aerobic exercise can improve physical performance and increase peak oxygen consumption of (MD) 6.29 mL/Kg*minutes, (95% CI: 3.05-9.53mL/Kg*minutes, P = .0001). Aerobic exercise significantly reduced weight and improved metabolic index and physical performance. Impacted by the limitations of various regimens, doses, duration, center settings, populations enrolled, the study had certain limitations. The randomized controlled trials with larger sample sizes, multiple centers, and high quality should be conducted to validate the above conclusion. Further studies will be required to focus on the total duration of the intervention, duration and frequency of sessions, and intensity that are optimal for the promotion of physical performance and metabolic capacity in this population.

External Validity of Two Scores for Predicting the Risk of Chemotherapy Toxicity Among Older Patients With Solid Tumors: Results From the ELCAPA Prospective Cohort.

Severe chemotherapy-related toxicities are frequent among older patients. The Chemotherapy Risk Assessment Scale for High-Age Patients (CRASH) and the Cancer and Aging Research Group Study (CARG) score were both developed to predict these events. The objective of this study was to evaluate the scores' predictive performance in a prospective cohort, which included patients aged 70 years and older referred for a geriatric assessment prior to chemotherapy for a solid tumor. The main endpoints were grades 3/4/5 toxicities for the CARG score and grades 4/5 hematologic toxicities and grades 3/4/5 non-hematologic toxicities for the CRASH score. A total of 248 patients were included, of which 150 (61%) and 126 (51%) experienced at least one severe adverse event as defined respectively in CARG and CRASH studies. The incidence of adverse events was not significantly greater in the intermediate and high-risk CARG groups than in the low-risk group (odds ratio (OR) [95% CI] = 0.3 [0.1-1.4] (P = .1) and 0.4 [0.1-1.7], respectively). The area under curve (AUC) was 0.55. Similarly, the incidence of severe toxicities was no greater in the intermediate-low, intermediate-high, and high-risk CRASH groups than in the low-risk CRASH group (OR [95%CI] = 1 [0.3-3.6], 1 [0.3-3.4], and 1.5 [0.3-8.1], respectively). The AUC was 0.52. The type of cancer, performance status, comorbidities, body mass index, and MAX2 index were independently associated with grades 3/4/5 toxicities. In an external cohort of older patients referred for a pretherapeutic GA, the CARG and CRASH scores were poor predictors of the risk of chemotherapy severe toxicities.

Development and validation of dynamic nomogram of frailty risk for older patients hospitalized with heart failure

ObjectiveThis study aimed to establish and validate a dynamic online nomograph for predicting the risk of frailty in older patients hospitalized with heart failure in China. MethodsA total of 451 older adults with heart failure hospitalized were selected between December 2021 and November 2022 at the Department of Cardiovascular Medicine in a Class A tertiary hospital in Shandong, China. The data of patients were obtained by using Barthel Index, instrumental activity of daily living scale, mini nutrition assessment-short form, Pittsburgh sleep quality index scale, Morse fall risk assessment scale and general information scale. The brain natriuretic peptide and echocardiographic indexes of patients were collected by electronic medical records. All participants were randomly divided into the training set (n = 319) and the validation set (n = 132) at the ratio of 7:3. The training set is used for model construction, and the validation set is used for internal validation. Using the Least Absolute Shrinkage and Selection Operator (LASSO) regression method to filter modeling variables, while the multivariable logistic regression was used to establish the nomogram based on the screened optimal variables. The performance of the model was evaluated by the area under the curve (AUC) of the receiver operator characteristic (ROC) curve, Hosmer-Lemeshow test, calibration plot, and decision curve analysis (DCA). ResultsThe prevalence of frailty in 451 patients was 50.6%, 51.4%, and 48.5% in the training and validation sets, respectively. Drinking, grip strength, New York Heart Association (NYHA) class, multimorbidity, hospitalization history of heart failure, Barthel Index, the instrumental activities of daily living, nutritional status, sleep, fall, and left atrial end-diastolic diameter were used for LASSO regression analysis as the significant predictors of frailty. According to internal validation, the AUC of the ROC curve for the nomogram was 0.920, with a sensitivity of 86.8% and specificity of 84.4%. Moreover, in the validation set, the P-values of the H-L test were 0.742, and the calibration curve had good concordance between the estimated frailty risk and actual observation, indicating the model was well-calibrated. The DCA results confirmed that the nomogram had a well-performance in clinical suitability. ConclusionsAn online dynamic nomogram predicting frailty for older patients hospitalized for heart failure in China was well-established and identified in this study. This model benefits medical professionals in identifying high-risk frailty in older hospitalized patients with heart failure, which could reduce the medical and disease burden of heart failure to a certain extent. However, further verification is needed in the future.

Identification of thrombotic biomarkers in orthopedic surgery patients by plasma proteomics

BackgroundDue to the poor specificity of D-dimer, more accurate thrombus biomarkers are clinically needed to improve the diagnostic power of VTE.MethodsThe plasma samples were classified into low-risk group (n = 6) and high-risk group (n = 6) according to the Caprini Thrombosis Risk Assessment Scale score. Data-independent acquisition mass spectrometry (DIA-MS) was performed to identify the proteins in the 12 plasma samples. Bioinformatics analysis including volcano plot, heatmap, KEGG pathways and chord diagram analysis were drawn to analyze the significantly differentially expressed proteins (DEPs) between the two groups. Then, another 26 plasma samples were collected to verify the key proteins as potential biomarkers of VTE in orthopedic surgery patients.ResultsA total of 371 proteins were identified by DIA-MS in 12 plasma samples. Volcano plotting showed that there were 30 DEPs. KEGG pathway enrichment analysis revealed that the DEPs were majorly involved in the blood coagulation pathway. The chord diagram analysis demonstrated that proteins SAA1, VWF, FLNA, ACTB, VINC, F13B, F13A and IPSP in the DEPs were significantly related to blood coagulation. VWF and F13B were selected for validation experiments. ELISA test showed that, as compared with those in the low-risk group, the level of VWF in the high-risk sera was significantly increased.ConclusionsThe level of VWF in the high-risk group of thrombosis after orthopedic surgery was significantly higher than that in the low-risk group of preoperative thrombosis, suggesting that VWF may be used as a potential thrombus biomarker in orthopedic surgery patients.

Development of a risk assessment scale for use by nurses to assess the risk of deep vein thrombosis in gynaecology in China: A Delphi-based study.

Risk assessment models for deep vein thrombosis (DVT) used worldwide are based on multidisciplinary data from Western countries. We aimed to establish a DVT risk assessment model that is applicable to Chinese patients with gynaecological conditions. A risk assessment tool for DVT in gynaecology using the Delphi method. A three-round Delphi study was conducted among experts who were asked to rate the importance of each risk factor in the Caprini scale. The consensus for each item was defined as a mean rating of >3 and a coefficient of variation (CV) of <0.5 in the first round, as CV <0.3 in the second round. Eleven experts participated in the Delphi method, with a response rate of 100%. Kendall's coefficients of concordance (W) were 0.264 and 0.322 in the first and second rounds, respectively (p< 0.001). The DVT risk assessment scale includes 8 dimensions and 34 items.

Characteristics and associated factors of violence in male patients with schizophrenia in China.

To investigate the characteristics and associated factors of violence in male patients with schizophrenia in China. A total of 507 male patients with schizophrenia were recruited, including 386 non-violent and 121 violent patients. The socio-demographic information and medical history of the patients were collected. Psychopathological characteristics, personality traits psychopathology, and factors related to risk management were assessed using the Brief Psychiatric Rating Scale (BPRS), the History of Violence, Clinical, Risk Assessment Scale (HCR-20), and the Psychopathy Checklist-Revised (PCL-R), as appropriate. Differences in these factors were compared between the violent and non-violent patients, and logistic regression analysis was performed to explore the risk factors for violence in male patients with schizophrenia. The results showed that the violent group had a lower level of education, longer duration of illness, as well as a higher rate of hospitalization, history of suicidal attempts, and history of alcohol compared with the non-violent group. The violent group scored higher in items of symptoms in BPRS, personality traits and psychopathy in PCL-R, and risk management in HCR-20. The regression analysis showed that previous suicidal behavior (OR = 2.07,95% CI [1.06-4.05], P = 0.033), antisocial tendency in PCL-R (OR = 1.21, 95% CI [1.01-1.45], P = 0.038), H2: young age at violent incident (OR = 6.39, 95% CI [4.16-9.84], P < 0.001), C4: impulsivity (OR = 1.76, 95% CI [1.20-2.59], P = 0.004), and H3: relationship instability (OR = 1.60, 95% CI [1.08-2.37], P = 0.019) in HCR-20 were risk factors of violence among male patients with schizophrenia. The present study found significant differences in socio-demographic information, history of treatment, and psychopathy characteristics between male patients with schizophrenia who had engaged in violent behaviors and their non-violent counterparts in China. Our findings suggested the necessity of individualized treatment for male patients with schizophrenia who had engaged in violent behaviors as well as the use of both HCR-20 and PCL-R for their assessment.

Ecological Risk Assessment and Prediction Based on Scale Optimization—A Case Study of Nanning, a Landscape Garden City in China

Analysis and prediction of urban ecological risk are crucial means for resolving the dichotomy between ecological preservation and economic development, thereby enhancing regional ecological security and fostering sustainable development. This study uses Nanning, a Chinese landscape garden city, as an example. Based on spatial granularity and extent perspectives, using 30 m land use data, the optimal scale for an ecological risk assessment (ERA) and prediction is confirmed. This study also explores the patterns of spatial and temporal changes in ecological risk in Nanning on the optimal scale. At the same time, the Patch-generating Land Use Simulation model is used to predict Nanning’s ecological risk in 2036 under two scenarios and to propose ecological conservation recommendations in light of the study results. The study results show that: a spatial granularity of 120 m and a spatial extent of 7 km are the best scales for ERA and prediction in Nanning. Although the spatial distribution of ecological risk levels is obviously different, the overall ecological risk is relatively low, and under the scenario of ecological protection in 2036, the area of high ecological risk in Nanning is small. The results can provide theoretical support for ERA and the prediction of landscape cities and ecological civilization construction.

Effects of repetitive transcranial magnetic stimulation on motor function and language ability in cerebral palsy: A systematic review and meta-analysis.

This review was conducted to assess the quality of the evidence of effectiveness of repetitive transcranial magnetic stimulation (rTMS) in treating motor and language ability of cerebral palsy (CP). Medline, Cochrane library, Web of Science, Embase, PubMed, and CNKI databases were searched up to July 2021 by two independent reviewers. Randomized controlled trials (RCTs) that were published in English and Chinese and met the following criteria were included. The population comprised patients who met the diagnostic criteria for CP. Intervention included the following: comparison about rTMS and sham rTMS or comparison about rTMS combine with other physical therapy and other physical therapy. Outcomes included motor function, as follows: gross motor function measure (GMFM), Gesell Development Diagnosis Scale, fine motor function measure (FMFM), Peabody developmental motor scale, and Modified Ashworth scale. For language ability, sign-significant relation (S-S) was included. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Finally, 29 studies were included in the meta-analysis. Results of evaluation using the Cochrane Collaborative Network Bias Risk Assessment Scale showed that 19 studies specifically explained randomization, among which two studies described allocation concealment, four studies blinded participants and persons and had low risk of bias, and six studies explained that the assessment of outcome measures was blinded. Significant improvements in motor function were observed. The GMFM of total score was determined by using the random-effect model [I2 = 88%; MD = -1.03; 95% CI (-1.35, -0.71); P < 0.0001] and FMFM was determined by using the fixed-effect model [P = 0.40 and I2 = 3%; SMDs = -0.48, 95% CI (-0.65, -0.30); P < 0.01]. For language ability, the language improvement rate was determined using a fixed-effect model [P = 0.88 and I2 = 0%; MD = 0.37, 95% CI (0.23, 0.57); P < 0.01]. According to the PEDro scale, 10 studies had low-quality, four studies had excellent quality, and the other studies had good quality. Using the GRADEpro GDT online tool, we included a total of 31 outcome indicators, as follows: 22 for low quality, seven for moderate quality, and two for very low quality. The rTMS could improve the motor function and language ability of patients with CP. However, rTMS prescriptions varied, and the studies had low sample sizes. Studies using rigorous and standard research designs about prescriptions and large samples are needed to collect sufficient evidence about the effectiveness of using rTMS to treat patients with CP.

Escala de Valoración del Riesgo de Violencia Grave contra la Mujer (VRVG-M). Ámbito de Pareja

Violence against the partner has various consequences in the victims and often has lethal consequences. This research developed the Risk Assessment Scale for Serious Violence against Women (RASV-W), which aims to identify the risk of occurrences of serious violence against the partner. The research was carried out in 7 cities in Perú and 598 women victims of intimate partner violence participated. The results showed adequate construct validity (CFI = .973, TLI = .964, RMSEA = .052, and RMRS = .0395, composite reliability > .70, and mean variance extracted > .50 for all factors) and diagnostic accuracy (AUC = .87), so the RASV-W scale is an adequate instrument that helps to assess the risk of serious violence against women within the sphere of the couple. The incorporation and predictive contribution of some risk factors in this type of instrument is discussed.

Comparison of risk assessments for venous thromboembolism during the puerperium

ObjectiveTo compare the predictive value of different risk assessment methods for puerperium venous thromboembolism (VTE). MethodsThis study included 55 women with and 165 women without puerperal VTE. Using the cases, 11 assessment methods were compared. ResultsThe area under the curve (AUC) value of the 11 assessments was highest for the modified Caprini risk assessment model for pregnancy (a modified risk scoring method from Caprini, AUC = 0.805). Pairwise comparison of the AUC values of the 11 assessment methods indicated no significant difference among the five methods with AUC values > 0.7. Among them, the modified Caprini, the risk scoring method recommended by the Swedish Guidelines (Swedish method), and the risk scoring method recommended by the Shanghai consensus (Shanghai method) performed better than the other six methods with AUC values < 0.7 (P < 0.05). The sensitivities of the five methods for predicting a high risk of VTE were 69.09–94.55% and the specificities were 25.45–77.58%. The sensitivity of the modified Caprini was higher than those of the risk management method from the Chinese consensus (Chinese consensus method), Royal College of Obstetricians and Gynaecologists risk assessment scale (RCOG), and Swedish method (P < 0.05), but the specificity was only 25.45%. No significant difference in sensitivity was detected among the Swedish, Shanghai, RCOG, and Chinese consensus methods, whereas the specificity of the Swedish method was higher than that of the Shanghai, RCOG, and Chinese consensus methods. ConclusionThe predictive value of different risk assessment methods for puerperium VTE varies greatly. Considering the sensitivity and specificity, the Swedish method may have better clinical application value among the 11 methods.