Risk Scale Research Articles

A Decision Tree Model to Help Treatment Decision-Making for Unruptured Intracranial Aneurysms: A Multi-center, Long-Term Follow-up Study in a Large Chinese Cohort.

Chinese population have a high prevalence of unruptured intracranial aneurysm (UIA). Clinical and imaging risk factors predicting UIA growth or rupture are poorly understood in the Chinese population due to the lack of large-scale longitudinal studies, and the treatment decision for UIA patients was challenging. Develop a decision tree (DT) model for UIA instability, and validate its performance in multi-center studies. Single-UIA patients from two prospective, longitudinal multicenter cohort studies were analyzed, and set as the development cohort and validation cohort. The primary endpoint was UIA instability (rupture, growth, or morphological change). A DT was established within the development cohort and validated within the validation cohort. The performance of clinicians in identifying unstable UIAs before and after the help of the DT was compared using the area under curve (AUC). The development cohort included 1270 patients with 1270 UIAs and a follow-up duration of 47.2 ± 15.5months. Aneurysm instability occurred in 187 (14.7%) patients. Multivariate Cox analysis revealed hypertension (hazard ratio [HR], 1.54; 95%CI, 1.14-2.09), aspect ratio (HR, 1.22; 95%CI, 1.17-1.28), size ratio (HR, 1.31; 95%CI, 1.23-1.41), bifurcation configuration (HR, 2.05; 95%CI, 1.52-2.78) and irregular shape (HR, 4.30; 95%CI, 3.19-5.80) as factors of instability. In the validation cohort (n = 106, 12 was unstable), the DT model incorporating these factors was highly predictive of UIA instability (AUC, 0.88 [95%CI, 0.79-0.97]), and superior to existing UIA risk scales such as PHASES and ELAPSS (AUC, 0.77 [95%CI, 0.67-0.86] and 0.76 [95%CI, 0.66-0.86], P < 0.001). Within all 1376 single-UIA patients, the use of the DT significantly improved the accuracy of junior neurosurgical clinicians to identify unstable UIAs (AUC from 0.63 to 0.82, P < 0.001). The DT incorporating hypertension, aspect ratio, size ratio, bifurcation configuration and irregular shape was able to predict UIA instability better than existing clinical scales in Chinese cohorts. CLINICAL TRIAL REGISTRATION: IARP-CP cohort were included (unique identifier: ChiCTR1900024547. Published July 15, 2019. Completed December 30, 2020), with 100-Project phase-I cohort (unique identifier: NCT04872842, Published May 5, 2021. Completed November 8, 2022) as the development cohort. The 100-Project phase-II cohort (unique identifier: NCT05608122. Published November 8, 2022) as the validation cohort.

Prospective validation of a preoperative scoring system for difficult laparoscopy cholecystectomy.

Difficult laparoscopic cholecystectomy (LC) is defined by its surgical outcomes, including operative time, conversion to open surgery, bile duct and/or vascular injury. Difficult LC can be graded based on intraoperative findings. The main objective of this study is to apply and validate the reliability of their proposed risk score to predict the operative difficulty of an LC, based on their own validated intraoperative scale. Single-center prospective cohort study from 01/2020-12-2023. 367 patients > 18years who underwent LC were included. The preoperative risk scale and intraoperative grading system were registered. Surgical outcomes were determined. Predictive accuracy was evaluated by the Receiver Operator Characteristic curve, sensitivity, specificity, positive, and negative predictive values, and Youden's Index (J). Patients' mean age was 44.1 ± 15.3years. According to the risk score, 39.5% LC were "low" risk difficulty, 49.3% were "medium" risk, and 11.2% were "high" risk difficult LC. Based on the intraoperative grading system, 31.9% were difficult LC (Nassar grades 3-4) and 68.1% were easy LC (Nassar grades 1-2). There was a statistically significant correlation (0.428, p < 0.05) between the preoperative risk score and the intraoperative grading system. The AUC for the preoperative risk score scale and intraoperative difficult LC was 0.735 (95% CI 0.687-0.779) (J: 0.34). A preoperative risk score > 1.5 had an 83.7% sensitivity and a 50.8% specificity for intraoperative difficult LC. A predictive preoperative score for difficult LC and a routine collection of the intraoperative difficulty should be implemented to improve surgical outcomes and surgical planning.

Clustering of methamphetamine users based on personality characteristics and self-efficacy in the west of Iran

With the substantial increase in the use of stimulants, especially methamphetamine, in recent years, the present study aimed to cluster methamphetamine users based on personality traits and self-efficacy, and compare their mental health, sleep quality, and the risk of relapse in the identified clusters. This cross-sectional study was conducted through convenience sampling on 501 methamphetamine users in addiction treatment centers in Kermanshah, western Iran. The data were collected using the Schwarzer General Self-Efficacy Scale, Zuckerman–Kuhlman Personality Questionnaire, Goldberg and Hiller General Health Questionnaire (GHQ), Zuckerman–Kuhlman Personality Questionnaire, and Stimulant Relapse Risk Scale (SRRS). A total of 501 methamphetamine users were distinguished into three clusters with frequencies of 111 (22.2%), 298 (59.5%), and 92 (18.4%) members through hierarchical cluster analysis. The participants in the first cluster were characterized by low self-efficacy, high neuroticism, sensation seeking, and aggressiveness, along with low extroversion and activity, low positive health, high negative health, low sleep quality, and high risk of drug relapse. The participants in the second cluster reported moderate levels of self-efficacy, neuroticism, sensation seeking, activity, and aggressiveness, high extroversion, and moderate levels of mental health, sleep quality, and the risk of relapse. Moreover, the participants in the third cluster reported the highest level of self-efficacy, the lowest level of neuroticism, sensation seeking, and aggressiveness, moderate extroversion and high activity, low relapse risk, high sleep quality, as well as high positive and low negative health symptoms. The third cluster was significantly different from the other two clusters in terms of the mentioned factors. The findings of this study suggest that low self-efficacy and the presence of neuroticism, sensation seeking, and high aggressiveness contribute to reduced mental health and sleep quality, as well as an increased risk of relapse in methamphetamine users.

Evaluation of Cardiovascular Risk in People with Type 1 Diabetes: A Comprehensive and Specific Proposed Practical Approach.

People living with type 1 diabetes (T1D) have an increased risk of cardiovascular disease (CVD), and it is the leading cause of morbidity and mortality in this population. CVD risk increases with each uncontrolled risk factor, even in individuals with good glycaemic control. Recommendations for assessing CVD risk in the T1D population are extended from those for type 2 diabetes (T2D) even though the physiopathology and underlying mechanisms of atherosclerosis in T1D are poorly understood and differ from those in T2D. Unlike the assessment of microvascular complications, which is well established in T1D, this is far from being the case for the comorbidities and risk associated with CVD. Aside from classical cardiovascular comorbidities, carotid ultrasound can be useful to stratify CVD risk. The utilization of specific risk scales such as the Steno Type 1 Risk Engine can help to more accurately classify cardiovascular risk in these individuals. The cornerstones of the management of cardiovascular risk in T1D are the promotion of the Mediterranean diet, tight glycaemic control (glycated haemoglobin (HbA1c) < 7%), blood pressure < 130/80mmHg in most patients, and low-density lipoprotein (LDL) cholesterol < 100mg/dL in moderate-risk individuals, < 70mg/dL in high-risk individuals, and < 55mg/dL in very high-risk individuals. Conventional medical follow-up of patients with T1D should be individualized (approximately 2-3 visits per year), and a carotid ultrasound evaluation is recommended every 5 years in the absence of significant preclinical atherosclerosis or more often in those with severe preclinical atherosclerosis. Antithrombotic therapy is recommended in those receiving secondary prevention, those with stenosis > 50% in any arterial bed, and those with an impaired ankle-brachial index. This document is a proposal of a practical approach for the evaluation, classification, and management of CVD risk in individuals living with T1D.

Psychometric validation of the Chinese Version of the stimulant relapse risk scale (SRRS) in patients with methamphetamine use disorder

BackgroundEvaluating the risk of relapse is a pivotal step in the treatment of patients with methamphetamine use disorder (MUD). The 30-item Stimulant Relapse Risk Scale (SRRS) was originally developed in Japan to meet the demand. This study examined the reliability, validity, and factor structure of the Chinese version of the SRRS for patients with MUD.Methods247 patients with MUD self-rated the Chinese version of the SRRS. Cronbach’s alpha coefficients and inter-item correlation analysis were used to assess the internal consistency reliability. Construct validity was determined through confirmatory factor analysis (CFA), and concurrent validity was examined using the visual analogue scale (VAS) for drug craving and the severity of dependence scale (SDS). We followed the participants for 1 year and assessed the predictive validity based on the correlation of the scores of the Chinese version of the SRRS with the relapse rate within 3, 6, and 12 months of follow-up.ResultsCFA revealed satisfactory model fit estimates for the 22-item Chinese version of the SRRS that consisted of four subscales. The four-factored 22-item Chinese version of the SRRS had adequate internal consistency with Cronbach’s alphas ranging from 0.76 to 0.92. The 22-item Chinese version of the SRRS scores were significantly correlated with the VAS and SDS scores as well as the relapse rate within 3, 6, and 12 months, indicating good concurrent and predictive validity of this scale. The receiver operating characteristic curve revealed a cutoff score of 40 could discriminate between participants with (SDS score ≥ 4) and without (SDS score < 4) methamphetamine dependence (area under the curve = 0.71, p < 0.01).ConclusionsThe 22-item Chinese version of the SRRS that consists of four subscales is a valid and reliable instrument to assess the relapse risk in patients with MUD.

Usefulness of Body Fat and Visceral Fat Determined by Bioimpedanciometry versus Body Mass Index and Waist Circumference in Predicting Elevated Values of Different Risk Scales for Non-Alcoholic Fatty Liver Disease.

Obesity constitutes a public health problem worldwide and causes non-alcoholic fatty liver disease (MALFD), the leading cause of liver disease in developed countries, which progresses to liver cirrhosis and liver cancer. MAFLD is associated with obesity and can be evaluated by validated formulas to assess MAFLD risk using different parameters such as the body mass index (BMI) and waist circumference (WC). However, these parameters do not accurately measure body fat. As MAFLD is strongly associated with obesity, we hypothesize that measuring body and visceral fat by electrical bioimpedance is an efficient method to predict the risk of MAFLD. The objective of our work was to demonstrate that electrical bioimpedance is a more efficient method than the BMI or WC to predict an elevated risk of MAFLD. A cross-sectional, descriptive study involving 8590 Spanish workers in the Balearic Islands was carried out. The study's sample of employees was drawn from those who underwent occupational medicine examinations between January 2019 and December 2020. Five MAFLD risk scales were determined for evaluating very high levels of body fat and visceral fat. The determination of body and visceral fat was performed using bioimpedanciometry. Student's t-test was employed to ascertain the mean and standard deviation of quantitative data. The chi-square test was used to find prevalences for qualitative variables, while ROC curves were used to define the cut-off points for body and visceral fat. The calculations included the area under the curve (AUC), the cut-off points along with their Youden index, sensitivity, and specificity. Correlation and concordance between the various scales were determined using Pearson's correlation index and Cohen's kappa, respectively. As both total body fat and visceral fat increase, the risk of MAFLD increases with a statistically significant result (p < 0.001), presenting a higher risk in men. The areas under the curve (AUC) of the five scales that assess overweight and obesity to determine the occurrence of high values of the different MAFLD risk scales were very high, most of them exceeding 0.9. These AUC values were higher for visceral and body fat than for the BMI or waist circumference. FLD-high presented the best results in men and women with the AUC at around 0.97, both for visceral fat and total body fat, with a high Youden index in all cases (women body fat = 0.830, visceral fat = 0.892; men body fat = 0.780, visceral fat = 0.881). In our study, all the overweight and obesity scales show a very good association with the scales assessing the risk of MAFLD. These values are higher for visceral and body fat than for waist circumference and the BMI. Both visceral fat and body fat are better associated than the BMI and waist circumference with MAFLD risk scales.

The Effectiveness of No or Low-Dose versus High-Dose Aspirin in Treating Acute Kawasaki Disease: A Systematic Review and Meta-Analysis.

This systematic review and meta-analysis assesses the effectiveness of no or low-dose versus high-dose aspirin on the incidence of coronary artery aneurysms (CAAs), intravenous immunoglobulin (IVIG) resistance, hospital stay length, and fever duration during the acute phase of Kawasaki disease. Our review adheres to the Preferred Reporting Items for Systematic Reviews guidelines. The PubMed and Google Scholar databases were comprehensively searched to identify relevant studies in the literature, including observational studies and randomized controlled trials (RCTs). The primary outcome was the incidence of CAAs. The secondary outcomes were the hospital stay length, fever duration, and IVIG resistance. The risk of bias was assessed using the Newcastle-Ottawa scale for cohort studies and Cochrane's Risk of Bias Tool for RCTs. The data were analyzed using the Review Manager software. Twelve studies with a total of 68,495 participants met the inclusion criteria. The incidences of CAAs (odds ratio [OR] = 0.93; 95% confidence interval [CI] = 0.64-1.34) and IVIG resistance (OR = 1.46; 95% CI = 1.00-2.12) did not differ significantly between no or low-dose versus high-dose aspirin in treating acute KD. Moreover, the fever durations (mean difference [MD] = 3.55 h; 95% CI = -7.99-15.10) and hospital stay lengths (MD = -0.54 days; 95% CI = -2.50-1.41) were similar in the no and low-dose aspirin group compared to the high-dose aspirin group. Our review indicates that there are no significant differences in the incidences of CAA and IVIG resistance, fever durations, and hospital stay lengths between no or low-dose versus high-dose aspirin in treating the acute phase of KD.

Transforming place-based management within watersheds in Fiji: The watershed interventions for systems health project

Watersheds offer opportunities for place-based interventions to transform systems health via preventative versus reactive approaches to management that achieve multiple co-benefits for public and environmental health. The Watershed Interventions for Systems Health in Fiji (WISH Fiji) project embraced participatory knowledge co-production and action-oriented research to identify risks to public and ecosystem health, prioritize interventions to address risks, and monitor responses of the system to interventions. We used screening filters and local knowledge to collaboratively identify five watersheds for action with high prior incidence of water-related diseases (Fiji’s “three plagues” of leptospirosis, typhoid and dengue) and high risk to downstream environmental health. We reviewed literature to identify disease risk factors, evaluated overlaps with risks for downstream environmental impact, and designed 13 instruments to collect information about baseline risk. Following consultations to obtain free, prior and informed consent, we enrolled 311 households across 29 communities. We synthesized data to identify key risks at the household, community, and landscape level, which were communicated to community water and resource management committees and government leaders as part of developing water and sanitation safety plans for each community. Local committees identified 339 priority risk reduction actions across nine main categories: animal management; drainage; health systems surveillance; hygiene; integrated planning; land use management; sanitation systems; waste management; and water systems. As of October 2022, 154 interventions were implemented in the five watersheds across different risk categories and scales. While we can track changes to factors that reduce risk of water-related disease and improve environmental health, direct evaluation of impacts to public health is limited due to poor geolocation of case records. The WISH Fiji project is a model of cross-sectoral coordination that efficiently progresses multiple Sustainable Development Goals, but scaling requires sustained investment in interventions to realize full benefits, particularly for nature-based solutions that exhibit lagged responses.

Incidence and Risk Factors for Medical Device-Related Pressure Injury in Hemodynamically Unstable Intensive Care Unit Patients: A Prospective Cohort Study.

The purpose of this study was to determine the incidence and identify potential risk factors for medical device-related pressure injury (MDRPI) in critically ill and hemodynamically unstable adults (patients classified class III or IV on the Therapeutic Intervention Scoring System-28; TISS-28). Prospective cohort study. The target population was critically ill adults who were using one or more medical devices and categorized as class III or IV on the TISS-28. The study sample comprised 77 participants followed daily until discharge, death, transfer, or lesion development. Data were collected from January to March 2020. The study setting was an intensive care unit with 40 beds in a large hospital in a municipality in the state of Minas Gerais, Brazil. Sociodemographic and pertinent clinical data, pressure injury (PI) risk assessed using the Braden Scale for Pressure Sore Risk, and head-to-toe skin inspections were completed. The incidence rate of MDRPIs was calculated, and survival analyses were completed via the Kaplan-Meier method and Cox regression model. Forty-nine of 77 participants developed an MDRPI, reflecting an incidence rate of 63.6%. Collectively, 71 MDRPIs occurred in these 49 participants. Univariate analysis indicated significant associations between MDRPI occurrences and level of consciousness ( P =<.001), use of tube holder for ventilation devices ( P =.013), nasal cannula ( P =.034), nasogastric cannula ( P =.034), presence of edema ( P =.001), infection ( P =.007), higher TISS score ( P =.047), and greater number of medical devices ( P =.022). Survival analysis indicated that a high or very high-risk score on the Braden Scale for Pressure Sore Risk ( P =.043) and edema ( P =.030) are risk factors for MDRPI occurrences in this vulnerable population. The incidence rate of MDRPIs was 63.6%. The categories with the highest high or very high risk scores on the Braden Scale for Risk of Pressure Pain and Edema emerged as risk factors for MDRPI in this critically ill and vulnerable population.

Investigation of The Incidence and Risk Factors of Falls, An Undesirable Incident in Hospitals: A Retrospective Study of Eight Years

Objective: Falls are undesirable incidents that must be reported in hospitals. Duration of hospital stay and cost of treatment may increase due to post-fall injuries. Therefore, it is very important to investigate the incidence and risk factors of falls to prevent them. The aim of the study was to investigate the incidence and risk factors of falls. Methods: The retrospective descriptive study was conducted in one of the largest medical faculty hospitals located in the western of Türkiye. The study data of 160,119 cases of falls between 2012 and 2019 were examined retrospectively using a “Socio-demographic Information Form” and “HARIZMI” and “ITAKI” Fall Risk Scales. Results: Statistically significant differences were found between fall rates by year (p &lt; .05). It was detected that the risk of falls in adults was 2.3 times higher than in children (95% CI: 1.86-2.89); the risk of falls in men was 1.2 times higher than in women (95% CI: 1.04-1.43), and the risk of falls in internal medicine units was 4.2 times higher than in surgical units (95% CI: 3.57-5.06). Conclusion: The falls mostly occurred in internal medicine units. The risk of falls was higher in internal medicine units than in surgical units. The risk of falls was higher in adults than in children and men than in women. Necessary precautions should be taken for adult ve men patients who are at risk of falls. Institutional procedures and flowcharts should be established to rapidly evaluate cases of falls and make the necessary interventions. Warning signs should be placed in the rooms of patients who are at risk of falling.

Clinical Significance of Sarcopenia in Elderly Patients Undergoing Endoscopic Submucosal Dissection: A Systematic Review and Meta-analysis.

As global life expectancy rises and gastrointestinal tumor incidence increases, more elderly patients are undergoing endoscopic submucosal dissection (ESD) for tumor treatment. The current situation highlights the importance of sarcopenia assessment before ESD. This systematic review and meta-analysis aim to assess sarcopenia's role in predicting post-ESD adverse outcomes in the elderly. We conducted a systematic review and meta-analysis to investigate the impact of sarcopenia on the prognosis of elderly patients undergoing ESD treatment. A comprehensive search was conducted across three databases (PubMed, Embase, Web of Science). We were using NEWCASTLE-OTTAWA ASSESSMENT SCALE for risk of bias assessment. The data were synthesized using Review Manager 5.3. A total of 9 reports were identified, analyzing 7 indicators, with a combined sample size of 6044. Through a series of analyses, we have derived several highly credible research findings: the overall OR and 95% CI for gastric and colorectal post-ESD perforation between sarcopenia and nonsarcopenia groups were 1.34 [0.92, 1.97], for CTCAE grade > 2 was 2.65 [1.45, 4.82], for upper gastrointestinal post-ESD pneumonia were 1.97 [1.30, 2.99], and for gastric post-ESD mortality within 5years were 2.96 [1.33, 6.58]. Sarcopenia is a risk factor for increased incidence of complications (CTCAE > 2) after undergoing gastric and colorectal ESD, increased pneumonia rates, and higher mortality rates within five years following gastric ESD treatment in elderly patients. However, sarcopenia does not lead to an increased perforation rate in elderly patients undergoing gastric and colorectal ESD treatments. Registration and protocol: The protocol for this study was registered on the Open Science Framework in 2024 https://doi.org/10.17605/OSF.IO/7B2CZ . We also conducted pre-registration on PROSPERO (CRD42024532547).

Hip fracture rate and osteoporosis treatment in Ontario: A population-based retrospective cohort study

SummaryThis population-based study analyzes hip fracture and osteoporosis treatment rates among older adults, stratified by place of residence prior to fracture. Hip fracture rates were higher among older adults living in the community and discharged to long-term care (LTC) after fracture, compared to LTC residents and older adults living in the community. Only 23% of LTC residents at high fracture risk received osteoporosis treatment.PurposeThis population-based study examines hip fracture rate and osteoporosis management among long-term care (LTC) residents > 65 years of age compared to community-dwelling older adults at the time of fracture and admitted to LTC after fracture, in Ontario, Canada.MethodsHealthcare utilization and administrative databases were linked using unique, encoded identifiers from the ICES Data Repository to estimate hip fractures (identified using the Public Health Agency of Canada algorithm and International Classification of Diseases (ICD)-10 codes) and osteoporosis management (pharmacotherapy) among adults > 66 years from April 1, 2014 to March 31, 2018. Sex-specific and age-standardized rates were compared by pre-fracture residency and discharge location (i.e., LTC to LTC, community to LTC, or community to community). Fracture risk was determined using the Fracture Risk Scale (FRS).ResultsAt baseline (2014/15), the overall age-standardized hip fracture rate among LTC residents was 223 per 10,000 person-years (173 per 10,000 females and 157 per 10,000 males), 509 per 10,000 person-years (468 per 10,000 females and 320 per 10,000 males) among the community to LTC cohort, and 31.5 per 10,000 person-years (43.1 per 10,000 females and 25.6 per 10,000 males). During the 5-year observation period, the overall annual average percent change (APC) for hip fracture increased significantly in LTC (AAPC = + 8.6 (95% CI 5.0 to 12.3; p = 0.004) compared to the community to LTC group (AAPC = + 2.5 (95% CI − 3.0 to 8.2; p = 0.248)) and the community-to-community cohort (AAPC − 3.8 (95% CI − 6.7 to − 0.7; p = 030)). However, hip fracture rate remained higher in the community to LTC group over the study period. There were 33,594 LTC residents identified as high risk of fracture (FRS score 4 +), of which 7777 were on treatment (23.3%).ConclusionOverall, hip fracture rates have increased in LTC and among community-dwelling adults admitted to LTC after fracture. However, hip fracture rates among community-dwelling adults have decreased over time. A non-significant increase in osteoporosis treatment rates was observed among LTC residents at high risk of fracture (FRS4 +). Residents in LTC are at very high risk for fracture and require individualized based on goals of care and life expectancy.

Equilibrium bifurcation and extreme risk in the EU carbon futures market

Considering the long-term memory and volatility clustering of the European Union (EU) Carbon Emission Allowances (EUA) futures returns, based on the economy–energy–environment system perspective and the assumption of investors' heterogeneity, this study proposes a joint modeling approach combining the fractionally integrated generalized autoregressive conditional heteroscedasticity model (FIGARCH) and the stochastic cusp catastrophe model (SCC) to examine the equilibrium bifurcations and extreme risks in the EU carbon futures market. The relevant results are threefold. (1) The SCC model has good fitting effect and interpretability, and is an effective method for investigating catastrophe reactions under time-varying volatility conditions. (2) In the EUA futures market, chartists are mainly affected by short-term price and trading volume changes, which leads to the emergence of equilibrium bifurcations, while fundamentalists make investment decisions based on the economy, the energy market, and market supply–demand, which affects the asymmetry of equilibrium bifurcations. (3) Using the catastrophe criterion (i.e., Cardan's discriminant of the equilibrium surface equation), we identify148 equilibrium bifurcation time points in the EUA futures market from December 3, 2009 to September 16, 2020, most of which are concentrated in two upward periods with an average scale of extreme risks is about 32.51 %. Our analysis provides theoretical support for regulatory authorities to stabilize the carbon futures market and build a collaborative extreme risk management framework covering energy and macroeconomics, also proposing suggestions for traders to effectively prevent extreme risks.

The effect of multiple types of workplace violence on burnout risk, sleep quality, and leaving intention among nurses.

The aim of our study is to explore the associations between multiple types of workplace violence (WPV) and burnout risk, sleep problems, and leaving intention among nurses. This cross-sectional survey recruited 1,742 nurses, and data on WPV experiences were collected through self-administered questionnaires. Work conditions, burnout risk scales, sleep quality, and leaving intentions were also evaluated. Multivariate logistic regression analyses were performed to examine the associations of WPV with burnout risk, sleep quality, and leaving intentions, adjusting for demographic characteristics and work conditions. The study found that 66.7% of nurses reported experience of WPV, with 26.9% experiencing both physical and nonphysical forms. Those who experienced multiple types of WPV reported worse work conditions, higher burnout risk, poorer sleep quality, and a stronger leaving intention compared to those without such experiences. Adjusting for working conditions, logistic regression analysis showed that nurses who experienced multiple types of WPV had 2.12-fold higher odds of high personal burnout risk, 2.36-fold higher odds of high client-related burnout risk, 1.95-fold higher odds of poor sleep quality, and 1.80-fold higher odds of high leaving intention, compared to those without WPV experiences. Strategies by hospital managers and policymakers to monitor and reduce workplace violence are vital for sustaining nurses' mental health, well-being, and preventing early attrition from the profession.

The Usage Of Bakamla Force In Safeguarding The Seas Of Indonesian Jurisdiction

This abstract aims to highlight Indonesia's maritime security challenges, including threats, jurisdictional defense, and Bakamla's role. It also discusses limitations in maritime operational capabilities. This study employs a qualitative research method to describe, explore, and understand the meaning perceived by individuals or groups regarding current social or human phenomena. The research adopts a juridical-normative approach with a focus on the principles of the use of force by Bakamla RI. Data is collected through literature reviews and analyzed using qualitative data analysis techniques proposed by Miles, Huberman, and Saldana (2014) which involve data condensation, data display, and conclusion drawing and verification. The result is maritime security is an important aspect for a country. Maritime security refers to threats to the maritime. The Indonesian Sea, which has abundant natural resource potential and as an international trade route, is vulnerable to maritime threats. The Maritime Security Agency or Bakamla exists as an effort to maintain and defend the jurisdiction of Indonesian waters for the sake of national interests. In its role, often the threat is faced with a situation in which the use of force must be carried out. The use of force is a last resort to address existing threats based on the basic principles of the use of force and firearms (BPUFF), codes of law enforcement, human rights and applicable national and international law. The use of force must be carried out based on the scale and level of risk of the existing threat, not necessarily the use of force is allowed under the pretext of self-defense.The conclusion is Indonesia's maritime richness faces increasing threats, necessitating careful use of force by Bakamla, guided by legal and ethical considerations.

Results of the use of an integrated risk scale for postoperative complications in patients with colorectal cancer

Inroduction. Polymorbidity significantly increases the risk of complications in the early postoperative period, especially in patients with colorectal cancer, taking into account the initial nutritional status disorder. At present, several scales of postoperative complications risk assessment (POSSUM, RCRI, MUST) are used, but they do not fully meet the needs of modern oncosurgery, so we consider it necessary to compare their effectiveness and propose a new integrated scale.Aim. To establish the most significant factors influencing the outcome of surgical treatment and length of hospitalization in comorbid patients with colon cancer with the development of a surgical risk assessment scale that is most adapted for this group of patients.Materials and methods. We analyzed the data of hospital charts of patients undergo surgery for colorectal cancer in the oncoproctologic department of the S. P. Botkin State Clinical Hospital of the Moscow Healthcare Department in the period from 2019 to 2022. Inclusion criteria: histologically verified colorectal adenocarcinoma; colorectal cancer in stage cT4, cN0, cM0 or cT1–4, cN1–2, cM0; presence of one or more concomitant diseases in the patient. Exclusion criteria: presence of distant metastases of colorectal cancer; absence of confirmed comorbidities; early forms of colorectal cancer (cT1–2, cN0). All patients were assessed for risk of perioperative complications using ASA, POSSUM, MUST, and RCRI scales. The study endpoints were number of days in intensive care, number of days of hospitalization, and 30-day mortality. An Excel database with POSSUM, RCRI, and MUST scale calculators was created for the study. The evaluation of parameters influencing the outcome of hospitalization was performed using ROC analysis and correlation analysis using Pearson’s criterion. To identify the most sensitive parameters affecting the outcome of hospitalization, commonly used calculators were studied in detail.Results. 200 patient records were analyzed. The results of treatment were compared with the data obtained using the postoperative risk scales POSSUM, MUST, RCRI. A comparative analysis of the scales presented above with our proposed integral scale of postoperative complications risk assessment was carried out. It was found that the parameters of our proposed integral scale showed the highest sensitivity (Se &gt;70 %) and specificity (Sp &gt;70 %) to the risk of postoperative complications. Our proposed integral scale showed a moderate correlation with the age of patients (r = 0.475, p = 0.01) and preoperative weight loss (r = 0.592, p = 0.01), as well as a high correlation with POSSUM (r = 0.649, p = 0.01; r = 0.852, p = 0.01) and MUST (r = 0.655, p = 0.01).Conclusion. The developed scale for assessment of surgical risk in comorbid patients with colorectal cancer showed a higher correlation with the outcome of surgical treatment than similar known scales, which indicates its effectiveness and possibility of application in clinical practice after its validation in prospective studies.

A Comparative Study of Trochanteric Fractures Treated with Hip Hemiarthroplasty or Proximal Femoral Nail — A Secondary Publication

Objective: The aim of this study was to compare the clinical and functional outcomes of patients treated with partial hip prosthesis (PHP) or double lag screw proximal femoral nailing (PFN) for unstable femoral intertrochanteric region fractures. Material and method: In this study, the data of 101 patients who developed grade 3-4-5 femoral intertrochanteric fractures according to the Evans-Jensen classification between 2019–2020 and were treated with cemented PHP or double screw PFN were evaluated retrospectively. The patients were evaluated in terms of postoperative follow-up time, age, gender, trauma side, American Anesthesia Society Anesthesia Risk Scale (ASA), number of comorbid diseases, total hospitalization time, amount of intraoperative bleeding, duration of surgery, and postoperative complications. Results: 101 patients evaluated within the scope of the study were divided into groups of 51 patients who underwent PHP (Group 1) and 50 patients who underwent PFN (Group 2). When the results were compared in terms of mean length of hospital stay, duration of surgery, amount of intraoperative bleeding, and postoperative 1-year mortality, the results were found to be statistically significant. Conclusion: Our study results showed that the PFN method has clinical advantages over PHP. The PFN technique is a method that can be applied quickly and safely.

Psychometric evaluation of the Chinese version of alcohol relapse risk scale (C-ARRS) in patients with alcohol use disorder

Alcohol use disorder (AUD) is recognized as a chronic relapsing disorder. Alcohol Relapse Risk Scale (ARRS), a multidimensionally self-rating scale, was developed initially by the Japanese to assess the risk of alcohol reuse. The study aimed to validate the reliability and factor structure of the Chinese version of the ARRS (C-ARRS) for patients with AUD. A total of 218 patients diagnosed with AUD according to DSM-5 were recruited for self-administering C-ARRS. We assessed the internal consistency of C-ARRS using Cronbach's α coefficients and examined the factor structure through confirmatory factor analysis (CFA). Additionally, we investigated the concurrent validity by correlating C-ARRS with the Visual Analog Scale of Alcohol Craving (VAS), Penn Alcohol Craving Score (PACS), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) scores. CFA demonstrated inadequate data fit for the original 32-item C-ARRS, prompting the development of a revised 27-item version consisting of 6 subscales with satisfactory model fit estimates. The 27-item C-ARRS exhibited favorable internal consistency, with Cronbach's α ranging from 0.611 to 0.798, along with adequate factor loadings. The 27-item C-ARRS scores displayed significant correlations with the scores of VAS, PACS, BDI and BAI (p < .001). Our results indicated favorable reliability and factor structure of the 27-item C-ARRS. The significant correlation between the 27-item C-ARRS and clinical measures (such as depression, anxiety, and craving) demonstrates satisfactory concurrent validity. These observations collectively support the feasibility of using 27-item C-ARRS to assess the risk of alcohol relapse in patients with AUD.

Concordance between risk scales for venous thromboembolism in patients treated in emergency departments.

To evaluate agreement between risk-assessment models for venous thromboembolism (VTE) in patients hospitalized for medical conditions and to analyze variables associated with the decision to prescribe pharmacological thromboprophylaxis in hospital emergency departments (EDs). Conclusions. Prospective observational multicenter cohort study. We included adults attended in 15 hospital EDs who were hospitalized for medical conditions, calculating VTE risk according to the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) score, the Padua Prediction Score (PPS), and the National Institute for Health and Care Excellence (NICE) score. In addition to assessing interscore concordance, we analyzed variables associated with the prescription of thromboprophylaxis in the ED. A total of 1203 patients were included. The PADUA, IMPROVE, and NICE scales assigned high risk scores for 68.7%, 47.4%, and 69.5% of the patients, respectively. The κ statistic for agreement between the PADUA and NICE scores was 0.80 (95% CI, 0.76-0.84); 102 patients (8.5%) had discordant scores. The κ statistics for agreement between the IMPROVE score and the PADUA and NICE classifications were 0.47 (95% CI, 0.43-0.52) and 0.37 (95% CI, 0.33-0.42), respectively; 322 (26.8%) and 384 patients (31.9%), respectively, had discordant scores. Variables associated with starting thromboprophylaxis in the ED were a diagnosis of acute myocardial infarction or stroke (adjusted odds ratio [aOR], 4.26), immobility in the last 2 months (aOR, 2.19), chronic obstructive pulmonary disease (aOR, 1.97), ischemic heart disease (aOR, 1.51), reduced mobility of 3 days or longer (aOR, 1.14), body mass index (aOR, 1.04), age (aOR, 1.02), recent trauma or surgery (aOR, 0.40), and risk for bleeding (aOR, 0.56). There is disagreement among the recommended models for predicting risk for VTE in patients hospitalized for medical conditions. The basis for emergency physicians' clinical judgment regarding thromboprophylaxis extends beyond risk scales to include multiple risk factors for VTE and bleeding.

Urinary Catheter-Related Meatal Pressure Injury Risk Factors in Male Critical Care Patients: A Prospective Repeated-Measures Study.

Urinary catheter-related meatal pressure injury (UCR-MPI) is a preventable and serious complication of indwelling urinary catheter use. This prospective study aimed to determine the prevalence and risk factors of UCR-MPI in male critical care patients. A total of 138 male patients 18 years and older using an indwelling urinary catheter were included in the study. Participants' perineal areas were assessed daily for the development of MPI. The UCR-MPI prevalence was 26.1% (n = 36/138). Most patients (61.1%) had a grade I UCR-MPI with intact skin and mucosa and nonblanchable erythema. Urinary catheter irrigation (P = .001), lower Braden Scale scores (P = .040), lower Glasgow Coma Scale score (P = .002), higher Itaki Fall Risk Scale score (P = .040), higher dependency level (P = .027), hypoalbuminemia (P = .002), and perineal edema (P = .001) were risk factors for UCR-MPI. The prevalence of UCR-MPI was high in this sample. Providers should take preventive measures to prevent UCR-MPI in patients with a penis including early and frequent risk assessment.