Risk Scale Research Articles

Abstract 4112869: Development of a Sitosterolemia Risk Prediction Scale (SRPS): A Screening Tool

Introduction: Sitosterolemia, a hereditary disorder marked by elevated plant sterol levels, presents diagnostic challenges due to its similarity to other lipid disorders. The development of the Sitosterolemia Risk Prediction Scale (SRPS) aims to address this by synthesising genetic, clinical, and dietary data into a coherent risk assessment model. Research Question: We propose that a structured risk scale, integrating diverse factors known to affect sitosterolemia, can significantly improve the accuracy of predicting the disorder. The SRPS is hypothesised to facilitate early detection and inform targeted interventions. Aim: The primary aim is to conceptualise and outline the SRPS, which categorises individuals into risk categories based on a point system reflecting genetic predispositions, clinical symptoms, dietary habits, and response to treatments. This scale seeks to enhance the clinical identification of sitosterolemia, promoting timely and personalised management strategies. Methods: A detailed table was generated to present the SRPS, categorising risk factors into genetic, clinical, dietary, and response to treatment. This innovative method allowed for the efficient synthesis and visualisation of complex data. Results: The SRPS table methodically organizes risk factors into low (0-2 points), moderate (3-5 points), and high (6+ points) categories. This stratification guides further diagnostic actions, ranging from exploring alternative causes of hyperlipidemia to necessitating comprehensive genetic and lipid analyses. Conclusion: The SRPS represents an innovative framework for assessing sitosterolemia risk, highlighting the potential benefits of integrating genetic, clinical, and dietary information. It further underscores the importance of a multifactorial approach in the early detection and management of sitosterolemia.

Rituximab Treatment in Adult Patients With Idiopathic Inflammatory Myositis

Objective This systematic review and meta-analysis assess the efficacy and safety of rituximab (RTX) in treating idiopathic inflammatory myositis (IIM). Methods PubMed and Embase were systematically searched for trials and observational studies involving RTX use in IIM. Data were analyzed using a random-effects model to generate pooled estimates for overall response, complete remission, partial response, and adverse events, with subgroup analyses by myositis type and RTX dosage (PROSPERO registered number CRD42022353740). Risk of bias assessments were done using the Newcastle-Ottawa Scale for observational studies and risk of bias 1 tool for trials. Results Seventeen studies (1 randomized controlled trial and 16 observational studies), encompassing 362 patients, were included. The overall pooled response rate was 70% (95% confidence interval [CI]: 57%–82%; I 2 = 74%, p < 0.001). Complete remission occurred in 13% (95% CI: 3%–25%; I 2 = 79%, p < 0.001) and partial response in 48% (95% CI: 30%–67%; I 2 = 87%, p < 0.001), both with significant heterogeneity. Subgroup analysis revealed high response rates across all myositis types: polymyositis 69%, dermatomyositis 67%, antisynthetase syndrome 70%, juvenile dermatomyositis 60%, and immune-mediated necrotizing myopathy 86%. Response rates were similar between RTX induction doses of 1 g IV on days 0 and 14 (68%) and 375 mg/m2 weekly for 4 weeks (71%). Reported adverse events totaled 120, including infusion reactions (18.5%) and infections (12.4%). Conclusions RTX shows a favorable clinical response in IIM treatment, though response rates vary. There was a significant heterogeneity in treatment effect estimates that are based on a small number of patients. The incidence of infusion reactions and infections highlights the need for careful monitoring. Further controlled trials are essential to refine treatment protocols and evaluate long-term outcomes for RTX's role in IIM.

Emotional Disorders, Distress Tolerance and Suicide Risk: A Mediation Model

Background: Suicide has been linked to psychopathology, particularly emotional disorders. This study seeks to investigate the mediating role of distress tolerance in the relationship between emotional symptoms and suicide risk. Method: The sample included 1014 adults (33.82% male; M = 33.0, SD = 15.15). Four mediation analyses were performed, controlling for sex, for depressive, anxious, somatizing and obsessive symptoms measured with the Brief Symptom Checklist as the independent variable, distress tolerance, measured with the Distress Tolerance Scale as the mediating variable, and the risk of making a suicide attempt, measured with Risk of Suicide, as the dependent variable. Results: Distress tolerance partially mediated the relationship between emotional symptoms and suicide risk, with Appraisal and Absorption scales positively mediating, and Tolerance negatively mediating. Conclusions: Tolerance of distress plays a role in risk of suicide attempts. Distress tolerance needs to be addressed as a key transdiagnostic factor in reducing suicidal risk.

Preoperative bleeding risk assessment in cardiac surgery patients

One of the most important aspects in achieving successful outcomes in cardiac surgery is the evaluation of the risk of bleeding during and after the procedure. Preoperative anemia, intraoperative bleeding, and transfusion therapy contribute to a cumulative risk of adverse events. Given the limitations of traditional coagulation tests, a more comprehensive and patient-centered approach is necessary. Factors affecting the risk of bleeding should be considered from the perspective of both individual patient characteristics and the specific type and extent of the planned surgical intervention. The risk assessment should be informed by individual and familial history, as well as previous episodes of bleeding or other relevant information. The use of bleeding risk scales can play a crucial role in this process, providing valuable insights into the likelihood of bleeding complications. In conclusion, a comprehensive approach that takes into account the unique characteristics of each patient and the specific details of the surgical procedure is essential for minimizing the risk of complications and ensuring successful outcomes.

Effectiveness of Self-Management Programs Among Athletes With Patellofemoral Pain Syndrome: Protocol for a Systematic Review.

Patellofemoral pain syndrome is a highly prevalent overuse knee injury in athletic populations associated with pain and functional limitations, exacerbated by activities such as running, pivoting, cycling, and jumping. Self-management programs empowering athletes to take an active role in controlling their symptoms for chronic musculoskeletal conditions such as patellofemoral pain syndrome have grown in popularity. However, the efficacy of self-management programs specifically for athletes with patellofemoral pain syndrome is unclear due to limited and heterogeneous evidence. The systematic review study will evaluate the effectiveness of self-management programs on pain and function, in athletes with patellofemoral pain syndrome. PubMed/MEDLINE, Cochrane Library, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO databases will be systematically searched using terms related to "patellofemoral pain syndrome," "self-management," and "athletes." Interventional studies that are randomized and nonrandomized controlled trials will be included, comparing self-management programs to other treatments or control conditions among athletes with patellofemoral pain syndrome. Four reviewers will independently screen studies, extract data using the COVIDENCE software, and assess the quality of the study and evidence using the Pedro scale of risk of bias tool and GRADE approach, respectively. If feasible, a meta-analysis will be performed using the RevMan (version 5.4; the Cochrane Collaboration). The systematic review is currently in the search phase, with the authors refining search strings for the selected databases. The final search strings are expected to be ready by March 2024, and the review is projected to be completed by July 2024. This systematic review protocol outlines a rigorous methodology for evaluating the effectiveness of self-management programs among athletes with patellofemoral pain syndrome. The findings will inform clinical practice and guide the development of tailored interventions to optimize outcomes for athletes with patellofemoral pain syndrome. PROSPERO CRD42023492746; https://tinyurl.com/c5jze9ca. PRR1-10.2196/58340.

Cognitive impact of anticholinergic and sedative burden in people with HIV.

This study aims to estimate the extent to which anticholinergic and sedative burden is associated with cognitive ability and self-reported cognitive difficulties (SCD) in middle-aged and older adults living with HIV. This cross-sectional analysis examined data from the inaugural visit of participants enrolled in the Positive Brain Health Now (BHN) study. Cognitive ability was measured using the Brief Cognitive Ability Measure (B-CAM; higher is better) and SCD using the Perceived Deficits Questionnaire (PDQ; higher is worse). Medication burden was quantified using several scoring systems, including the Anticholinergic Cognitive Burden (ACB), Anticholinergic and Sedative Burden Catalog (ACSBC), Anticholinergic Drug Scale (ADS), Anticholinergic Risk Scale (ARS), and the Sedative Load Model (SLM). Multivariable Ordinary Least Squares and quantile regression were utilized to estimate average effects and distribution-specific impacts, respectively. Of 824 participants (mean age 53 years, 84.7% men), 41.4% used anticholinergics (ACSBC) and 39% used sedatives (SLM). High anticholinergic burden was linked to worse cognitive ability [ β = -3.81; 95% confidence interval (CI): -7.16, -0.46] and SCD ( β = 3.89; 95% CI: 1.08, 6.71). Using three or more anticholinergics worsened cognitive ability ( β = -4.45; 95% CI: -8.54, -0.35), and using three or more sedatives increased SCD ( β = 4.35; 95% CI: 0.92-7.78). Stronger negative associations were observed in participants with lower cognitive ability and more difficulties. These results suggest that anticholinergic and sedative burden may contribute to cognitive impairment in people with HIV. Personalized medication management and regular cognitive assessments could mitigate these adverse effects.

Patterns of referral to interprofessional services among frail older adults presenting to emergency departments in Canada.

Geriatric Emergency Department (ED) Guidelines recommend optimizing transitions of care for older patients with complex needs. In this study, we investigated referral patterns to interprofessional services, including occupational therapy, physiotherapy, dietician, social work, home care, and specialized geriatric services, among older adults presenting to the ED with high-risk characteristics. We recruited community-dwelling older adults presenting to 10 EDs across Ontario, Quebec, and Newfoundland, Canada, from April 2017 to July 2018. To observe processes of care in the ED, we deployed a two-stage high-risk case-finding and focused comprehensive assessment process based on the interRAI ED-Screener and ED Contact Assessment to identify and characterize older adults at high risk. We analyzed the secondary data using descriptive statistics and logistic regression. We screened 5265 individuals with the ED Screener, further assessed 1479 with the ED Contact Assessment, and analyzed data from a subset of 1055 community-dwelling older adults assessed with the ED Contact Assessment. Participants in our study sample had a mean age of 83 years, 58% were female, and many had a complex burden of cognitive and functional impairment and social needs. Over half of this high-needs sample were referred to general home care services (62.7%), occupational therapy (59.3%), and physiotherapy services (55.2%), while 16% were referred to specialized geriatric services. We also found a significant positive association between interprofessional referrals and the Assessment Urgency Algorithm and Institutional Risk Scale. The most important determinants of referral to interprofessional services were hospital province, functional, clinical, and social burden and support measures. The referral patterns identified suggest that patient needs and risk intensity did not always guide referral patterns in the Canadian EDs investigated. We suggest that EDs critically examine the appropriateness of their documentation and referral systems for supporting person-centered care provision.

Global Warming and Climate Change – Need of Nuclear Energy

Global warming and climate change are the central point of scientific discussion and research around the world in 21st Century, the endeavor to alleviate the adverse impacts. The looming crisis of rising of global mean surface temperature by 1.5 oC and/or 2 oC over and above the pre-industrial level compelled the international community to execute the Paris Agreement in 2015. This is an agreement negotiated by 196 countries emphasizing the exigency to reduce the emission intensity of greenhouse gases and adopt measures to mitigate the adverse effect on the ecosystem. Extreme temperatures; more intense and frequent storms, droughts & floods; ocean acidifications; warmer ocean; loss of biodiversity; disruption of crops and increased health risks are reported across the regions which reflects the adverse effects of global warming and climate change. Intensity, frequency and scale of these man-made risks are going to follow an upward trend till the reduction of emissions of greenhouse gases to limit the anticipated temperature rise [1].

The MESH-RTL Project for prevention of abdominal wound dehiscence (AWD) in high-risk patients: noninferiority, randomized controlled trial.

To compare reinforced tension line (RTL) and mesh techniques in the onlay position for preventing abdominal wound dehiscence (AWD) in a noninferiorityclinical trial. Patients > 18 years old who underwent midline laparotomy and who were considered at high risk on the modified Rotterdam risk scale were included. The outcomes analyzed were the incidence of AWD and surgical site occurrence (SSO). 239 patients were included: 121 mesh group and 118 RTL group. Five (4.1%) of the 121 patients in the mesh group and 7 (5.9%) of the 118 patients in the RTL group presented with AWD (p = 0.56, RR = 0.69, 95% CI = 0.22-2.13) in the per-protocol analysis. The median time of presentation was 6 days. The 95% CI (-0.0567, 0.0231) for the difference in incidence between the two groups was entirely within the predefined noninferiority margin of 5%. The incidence of complications did not significantly differ between the two groups: the mesh group (27, 22.3%) and the RTL group (16, 12.8%) (p = 0.09, RR (95% CI) = 1.64 (0.93-2.89)). The use of the RTL technique for preventing AWD was not inferior to the use of mesh in the onlay position, nor did it increase the risk of complications. This study was registered on clinicaltrials.gov: Mesh-RTL Project (NCT04134455).

Thoracic trauma in the geriatric population and possible preventive measures: a retrospective analysis of 261 cases.

The increase in the proportion of the elderly population within society is concurrently escalating their vulnerability to traumas, notably falls associated with age-related comorbidities. This retrospective analysis involved the examination of data pertaining to patients aged 65 and above who were admitted to our clinic for inpatient treatment following thoracic trauma. Various parameters were statistically compared between the groups with indoor and outdoor traumas. Of the 261 patients included in the study, 59.4% were male, and the average age in the entire sample was 75.52 ± 7.79. Moreover, 136 (52%) patients had indoor trauma, while 125 (48%) had outdoor trauma. The mean value for all the patients on the Itaki Fall Risk Scale (FRS) II score was 11.04 ± 4.18. The Itaki FRS II score was significantly higher for indoor accidents (11.90 ± 4.34) compared to outdoor accidents (10.10 ± 3.78) (p < 0.001). Additionally, the absence of a fall history and low risk according to the Itaki FRS II score were higher for outdoor accidents compared to indoor accidents, and the difference was statistically significant (p < 0.001). In geriatric trauma occurring outdoors, bilateral rib fractures and extrathoracic findings were significantly more prevalent (p = 0.011 and p = 0.010, respectively). The majority of patients were followed-up without any surgical intervention (73.9%), the most common surgical interventions were catheter (10.3%) and tube thoracostomy (10.3%), and 1.5% of the patients required surgical exploration. Trauma resulted in mortality in 1.5% of the patients. In the future, specialized measures and prospective studies tailored to the geriatric population, which will constitute the largest demographic segment of society, can facilitate the prevention of trauma-related morbidity and mortality, including associated financial costs.

AZERBAIJAN'S NATIONAL SECURITY POLICY IN THE SYSTEM OF MODERN INTERNATIONAL RELATIONS

With the end of the Cold War, the political situation in the world has changed dramatically. The emergence on the world stage of new independent states, non-governmental organizations, transnational companies and threatening the world at the regional and global levels, such as ethnic conflicts, the spread of political and economic instability, imbalance, weapons of mass destruction, terrorism, the struggle for natural resources, etc. contributed to the transformation of international relations. As a result of the process, also accelerated by globalization, the state’s perception of security has changed in parallel with the increase in the types and scale of risks and threats.

Predictive Validity of Tools for Assessing Recidivism Risk in Men Convicted of Sex Offending: Static-99R, Static-2002R and BARR-2002R.

Recidivism risk assessment is crucial for effective case management of men convicted of sex offending. The use of empirical actuarial risk tools has become routine in the field. However, the development of actuarial risk scales for assessing general, violent and/or sexual recidivism in these men is ongoing: The Static-99 led to the Static-99R and the Static-2002R, and the BARR-2002R emerged to assess violent recidivism risk. A study was undertaken to evaluate and compare the inter-rater and predictive validity of the Static-99R, the Static-2002R, and the BARR-2002R in a sample of 328 men convicted of sex offending released from prison in French Belgium. When the instruments were considered integrally, the two versions of the Static-the Static-99R and the Static-2002R-proved better at predicting sexual recidivism and the BARR-2002R was better at predicting violent recidivism. And, the predictive and incremental predictive validity of the factor structure identified by Brouillette-Alarie et al. (2016) was examined. Results proved consistent in that the Youthful stranger aggression and General criminality factors were better at predicting general recidivism and violent non-sexual recidivism while the Persistence/paraphilia factor was better at predicting sexual recidivism.

Differences in Health Care Expenditures by Cancer Patients During Their Last Year of Life: A Registry-Based Study.

During the last year of life, persons with cancer should probably have similar care needs and costs, but studies suggest otherwise. A study of direct medical costs (excluding costs for expensive prescription drugs) was performed based on registry data in Stockholm County, which covers 2.4 million inhabitants, for all deceased persons with cancer during 2015-2021. The data were mainly analyzed with the aid of multiple regression models, including Generalized Linear Models (GLMs). In a population of 20,431 deceased persons with cancer, the costs increased month by month (p < 0.0001). Higher costs were mainly associated with lower age (p < 0.0001), higher risk of frailty, as measured by the Hospital Frailty Risk Scale (p < 0.0001), and having a hematological malignancy. In a separate model, where those 5% with the highest costs were identified, these variables were strengthened. Sex and socio-economic groups on an area level had little or no significance. Systemic cancer treatments during the last month of life and acute hospitals as place of death had only a moderate impact on costs in adjusted models. Higher costs are mainly related to lower age, higher frailty risk and having a hematological malignancy, and the effects are both statistically and clinically significant despite the fact that expensive drugs were not included. On the other hand, the costs were mainly comparable in regard to sex or socio-economic factors, indicating equal care.

Cut-off point of the risk assessment scale for the 9-year risk of functional disability

Objectives This study aimed to examine the cut-off point of the Risk Assessment Scale (RAS) for predicting the 9-year risk of functional disability among older Japanese adults.Methods This prospective, 9-year follow-up study used data from the Sasaguri Genkimon Study in Fukuoka. Of the 2,629 older adults who did not have functional disabilities and participated in the baseline survey in 2011, 2,254 with complete data were included in the analysis. The RAS was assessed using a questionnaire that showed good predictive and external validity for the 3-year risk of functional disability. The outcome was the incidence of functional disability during follow-up, which was defined as a new certification for the need for support or care. The cut-off point of the RAS was estimated as the point indicating the maximum χ2 value of the log-rank test. The predictive validity of the RAS for functional disability was examined using C-statistics for the total score, and sensitivity and specificity for the cut-off point, respectively. Participants were then categorized into two groups according to the cut-off point (high-score and low-score groups). Hazard ratio (HR) and 95% confidence interval (95% CI) of the 9-year risk of functional disability for the high-score group compared with the low-score group were calculated using the Cox proportional hazard model. In the multivariate model, HR was adjusted for living alone, education, economic status, drinking, smoking, and multimorbidity.Results New functional disability was certified in 647 participants (28.7%) during a median follow-up period of 8.75 years. The cut-off point for functional disability was 13/14. The C-statistic was 0.774, and the sensitivity and specificity were 0.726 and 0.712, respectively. Compared to the low-score group (0-13 points), the HR (95% CI) of the high-score group (≥ 14 points) for incident functional disability in 9 years was 5.50 (4.62-6.54) in the crude model, and 4.81 (4.00-5.78) in the multivariate model (P<.001).Conclusion This study, with its long follow-up period of 9 years, demonstrated that the 13/14 cut-off point of the RAS is suitable for the long-term assessment of functional disability risk. Our results suggest the possibility of using the 13/14 cut-off point of the RAS as a promising tool to grasp the risk of functional disability over a longer time frame, highlighting the potential for early prevention and intervention.

10-year risk scale of cardiovascular events for middle-aged and elderly people with type 2 diabetes mellitus

The purpose of this study was to create a scoring scale for assessing the 10-year risk of cardiovascular events for middle-aged and elderly people with type 2 diabetes mellitus (DM).Material and methods. The analysis included data from 314 people with T2DM: 142 men, 242 women, the average age for both sexes was 60.81 ± 6.38 years. The baseline survey was carried out within the framework of the HAPIEE project; the observation period lasted from 2003–2005. to December 31, 2013 and averaged 10 years. Persons who had myocardial infarction and/or cerebral stroke before the examination were excluded from the analysis. Non-fatal cardiovascular (CV) diseases and CV death were established in accordance with the codes of the International Classification of Diseases, 10th revision. As part of the study, two groups were formed: the main group, which included people with T2DM who “developed CV events” over 10 years of observation – 50 (15.9 %) people, and a comparison group – people with T2DM who “did not develop CV events” during the observation period (264 people). Anthropometric indicators, blood pressure, socio-demographic data, and some biochemical parameters were determined. To analyze the association of the studied factors with the risk of CV events, multivariate stepwise Cox regression analysis was used.Results. As a result of multivariate Cox regression analysis, associations with the risk of developing CV diseases were obtained for the following factors: gender (men), age (≥ 55 years), heart rate (≥ 80 beats/min), SBP (≥ 150 mmHg), marital status single, education (not higher). Individuals with a score above 9 are considered to be at high 10-year risk of cardiovascular events.Conclusions. A model has been created that predicts the risk of developing CV events in relation to individuals with T2DM living in a large industrial city in Western Siberia. Based on the data obtained, it will be possible to select priority preventive areas and therapeutic interventions.

A-174 Comparison of Bleeding Risk Scales in Elderly Patients With Persistent Atrial Fibrillation

Abstract Background Atrial fibrillation is a significant cause of thromboembolism and sudden death in the world making anticoagulant treatment a cornerstone; however, it is associated with bleeding risk. Currently, there are no studies in Ecuador that support the prognostic validity of the recent bleeding risk scales, as well as the lack of research to discover novel methods that are applicable and more accessible to use within the medical care setting.The Hemorr2hages, ORBIT and ATRIA scores represent a promising approach for those health centers that do not have INR available and consequently cannot measure risk through HASBLED (internationally recommended score). In this way, hemorrhagic events can be prevented in patients with atrial fibrillation with anticoagulant treatment without exception. Our main goal is to compare the predictive bleeding risk scores of 3 scales (Hemorr2hages, ORBIT, ATRIA) versus traditional HASBLED score. Methods In this retrospective cohort study, we assessed chronic persistent atrial fibrillation in 100 patients using the electronic medical records in an outpatient clinic in Guayaquil, Ecuador. We calculated 3 bleeding risk scores for each patient according to the variables measured in each one of them and used those to compare the categories against HASBLED’s. A Pearson correlation index was obtained, and ROC performance curves were made. P value &amp;lt;0.05 was deemed statistically significant. Results Of the 100 patients included, 65% were males, and mean age was 75±10.73. We reported only 6% bleeding events during the follow up. According to HASBLED score: 31% were at high risk. In comparison: 40% and 37% were also at high risk in Hemorr2hages and ATRIA scores, respectively. HASBLED was fairly correlated with Hemorr2hages and ATRIA scores (Pearson’s R: 0.617, p:&amp;lt;0.001; R:0.528, p:&amp;lt;0.001, respectively). Only 22% were classified at high risk by the ORBIT score. ROC curve analysis showed ORBIT’s AUC was 0.963, while Hemorr2hages, ATRIA and HASBLED were 0.931, 0.925, and 0.732 (p:&amp;lt;0.001), respectively. Conclusions In our sample, ORBIT score was better correlated with bleeding episodes than the other scales. This a promising approach for those health centers that do not count with INR reactive materials available for it to be measured at their laboratories. Further research is needed to accurately analyze whether criterion included in ORBIT score might predict bleeding scores better than HASBLED, Hemorr2hages and ORBIT tools; since the items required to calculate it are more readily accessible.

External validation of the FAscore scale to evaluate the risk of atrial fibrillation in patients with arterial hypertension

Background and aimTo use a risk scale or predictive model outside the population of origin, it is necessary to evaluate the predictive indicators through external validation. The aim was to validate the FAscore, originally constructed in hypertensive patients in primary care in the Valencian Region, in an external cohort with hypertension in primary care in the Basque Country. MethodsA retrospective cohort study was designed to perform an external validation of the FAscore app in patients affiliated with 26 health centers in the municipality of Bilbao. The area under the ROC curve and predictive indicators were calculated with their 95% confidence intervals. ResultsThirty-six thousand eight hundred nine patients were included: 53.6% (n=19,719) were women, the mean age was 75.1 years, 41.8% (n=15,381). Over the four-year follow-up period, 1420 patients were diagnosed with AF (cumulative incidence 3.9%). The median risk estimated by FAscore was 4.5%, and the 5th, 25th, 75th, and 95th percentiles were 1.0%, 2.5%, 6.1%, and 14.8%, respectively. The ROC curve for the risk estimated by FAscore and the cases of atrial fibrillation observed was AUC 0.715 (95% CI 0.703–0.727). The 5% risk cutoff provides a sensitivity of 70.8%, specificity of 61.0%, positive predictive value of 6.8%, negative predictive value of 98.1%, and positive and negative likelihood ratios of 1.82 and 0.48, respectively. ConclusionThis study reports on the external validation of the atrial fibrillation risk scale in hypertensive patients, which shows an acceptable predictive capacity. The best-performing risk cutoff, providing good predictive indicators, can be set at 5%.

External validation of the FAscore scale to evaluate the risk of atrial fibrillation in patients with arterial hypertension

Background and aimTo use a risk scale or predictive model outside the population of origin, it is necessary to evaluate the predictive indicators through external validation. The aim was to validate the FAscore, originally constructed in hypertensive patients in primary care in the Valencian Region, in an external cohort with hypertension in primary care in the Basque Country. MethodsA retrospective cohort study was designed to perform an external validation of the FAscore app in patients affiliated with 26 health centers in the municipality of Bilbao. The area under the ROC curve and predictive indicators were calculated with their 95% confidence intervals. ResultsThirty-six thousand eight hundred nine patients were included: 53.6% (n=19,719) were women, the mean age was 75.1 years, 41.8% (n=15,381). Over the four-year follow-up period, 1420 patients were diagnosed with AF (cumulative incidence 3.9%). The median risk estimated by FAscore was 4.5%, and the 5th, 25th, 75th, and 95th percentiles were 1.0%, 2.5%, 6.1%, and 14.8%, respectively. The ROC curve for the risk estimated by FAscore and the cases of atrial fibrillation observed was AUC 0.715 (95% CI 0.703–0.727). The 5% risk cutoff provides a sensitivity of 70.8%, specificity of 61.0%, positive predictive value of 6.8%, negative predictive value of 98.1%, and positive and negative likelihood ratios of 1.82 and 0.48, respectively. ConclusionThis study reports on the external validation of the atrial fibrillation risk scale in hypertensive patients, which shows an acceptable predictive capacity. The best-performing risk cutoff, providing good predictive indicators, can be set at 5%.

Predictors of postsurgical retethering in pediatric fatty or tight filum terminale: a systematic review and meta-analysis of 1167 patients.

The objective of this study was to characterize pediatric patients with tight filum terminale (TFT) or fatty filum terminale (FFT) who experienced retethering after transection of the filum, and to determine the risk factors for retethering. A systematic review was conducted on May 31, 2023, using PubMed, Google Scholar, SCOPUS, and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies detailing retethering following transection for TFT or FFT. Studies were then screened using the Newcastle-Ottawa Scale for risk of bias assessment. Eleven articles met the inclusion criteria with an overall cohort of 1167 patients evaluated for retethering following transection for TFT or FFT. The combined retethering rate across all retrospective studies was 3.4% (95% CI 1.6%-5.2%). A random-effects model was used to estimate the prevalence of presenting symptoms, with the most common being lower-extremity weakness in the overall cohort (54.5%, 95% CI 32.6%-76.4%) and bowel or bladder dysfunction in the retethered cohort (57.9%, 95% CI 41.1%-74.8%). Patients who experienced retethering had a similar estimated prevalence of low-lying conus (71.1%, 95% CI 45.1%-97.1%) compared with the overall cohort (51.1%, 95% CI 39.3%-63.0%). The most common complication following surgery for the overall cohort was a wound complication (2.7%, 95% CI 0.8%-4.6%). Postoperative CSF leakage (OR 13.8, 95% CI 3.9-49.4) was a strong predictor of retethering. Sensory changes at initial presentation were also found to be a predictor of retethering (OR 2.9, 95% CI 1.3-6.5). Low-lying conus was not predictive of retethering. Preoperative sensory changes and postsurgical CSF leakage were associated with an increased retethering rate following transection of the filum in cases of tethered cord syndrome secondary to fatty filum terminale.

Validation of the Spanish Version of the Nurses' Global Assessment of Suicide Risk Scale (NGAR) in Nonclinical Settings.

To validate the Nurses' Global Assessment of Suicide Risk (NGASR) in Spanish for an early detection identification of the risk of suicide. A descriptive cross-sectional survey design was used for this work through face-to-face clinical interviews with each participant. Following EQUATOR TRIPOD checklist, the index was translated and administered to a sample of 30 mental health experts and 151 university students. To examine the psychometric properties of the NGASR, the questionnaires also included other standardised scales such as BDI, SBQ and SEEQ. The research was conducted between 2022 and 2023. The content validity index-scale (CVI-S) was 81% and the NGASR presented high reliability with a Kuder-Richardson coefficient of 0.83. Exploratory factor analysis (EFA) returned a six-factor structure for the NGASR items. The results showed that 21.7% of the students assessed had an intermediate to very high suicide risk. This study also revealed that people with mental health problems and depression had a higher risk of suicide. Beyond the sociolinguistic Spanish validation of the scale, it should be noted that it is carried out on a young population in a nonclinical environment, something that many authors have been requesting in their previous validations. The NGASR is a useful prevention tool in university educational settings.