Use Of Risk Assessment Tools Research Articles

Bioavailability and bioaccumulation of heavy metals of several soils and sediments (from industrialized urban areas) for Eisenia fetida

Soils and sediments are susceptible to anthropogenic contamination with Metallic Trace Elements (MTEs) and it can present some risks to ecosystems and human health. The levels of Cd, Cu, Fe, Ni, Pb and Zn were assessed in soils (C, G, K, L) from Estarreja (Portugal) and sediments from a stormwater basin in Lyon (DJG), a harbour (LDB) and a Rhône river site (TRS) (France).An ecotoxicological study was performed with Eisenia fetida (E. fetida) to infer about potential transfer risks to the soil invertebrates. To assess risks associated with MTEs contamination, it is important to know their total concentrations, fractionation and the potential available fractions. CaCl2, DTPA and NaOAc extractions were performed to assess the extractable and available MTEs fractions. The studied sediments were much more contaminated than the soils for all the MTEs analysed. The trace elements fraction linked with DTPA extraction shows higher values when compared with the NaOAc and the CaCl2 pools.Low mortality effects were recorded in the tests with E. fetida. The MTEs levels in soils and sediments and the concentrations bioaccumulated in adult earthworms contributed to a reduction in the number of juveniles produced. E. fetida adults and juveniles accumulated ETMs as follows: Cd > Cu = Zn > Ni > Pb > Fe. Determined BAFs were mostly lower than 1 with some higher values for Cd, Cu and Zn. Calculated SET and ERITME indexes allowed to classify the samples from the most to the less toxic for E. fetida as: LDB > DJG > L > G > C > K > TRS. Despite this order of toxicity, the earthworms exposed to the sediment TRS presented the lowest reproduction rate. The combination of “chemical” measurements with the calculation of BAFs, but especially SET and ERITME indexes can be a useful tool in risk assessment.

Transport infrastructure equities in mixed-asset portfolios: estimating risk with a Garch-Copula CVaR model

Transport infrastructure is an important subsector within infrastructure, but knowledge of its equities in terms of risk-return characteristics and contribution to portfolio performance is still limited. This study assesses the subsector individually and in a multi-asset, index-based portfolio. In doing so, we apply a t-Copula-based Conditional Value-at-Risk model to simulate risk and returns. Our findings reveal that the subsector has a relatively low dependency on other equities, performs like other alternative asset classes such as general real estate, and does not grant significant risk diversification benefits for mainstream institutional investors such as pension funds. Investors aiming for higher target returns may however assign substantial weights to transport infrastructure, supporting our conjecture that it does not share the same asset class characteristics as general infrastructure. By contrasting Value-at-Risk (VaR) and Conditional Value-at-Risk (CVaR) scores for both the mean-variance framework and the t-Copula simulation, we further document the limitations of traditional VaR approaches. Hence, this study’s results support the use of risk assessment tools that incorporate non-normal distributions to represent multivariate dependence structures.

Fall risk assessment tools for use among older adults in long-term care settings: A systematic review of the literature.

To conduct a systematic review of published fall risk assessment tools (FRATs) tested for predictive validity among older adults in long-term care (LTC). A systematic search was conducted using five databases. Only studies reporting on sensitivity and specificity values, conducted in LTC on populations primarily aged over 60 years, were considered. Fifteen papers were included and three different categories of FRATs emerged: multifactorial assessment tools, functional mobility assessments and algorithms. Several FRATs showed moderate-to-good predictive validity and reliability, with the Modified Fall Assessment Tool and the Peninsula Health Falls Risk Assessment Tool (PHFRAT) also demonstrating good feasibility. Evidence for the best choice of FRAT for use in LTC remains limited. Further research is warranted for the PHFRAT, recommended for use in LTC by best practice guidelines, before its establishment as the tool of choice for these clinical settings.

Predictive Value of the Water Drinking Test and the Risk of Glaucomatous Visual Field Progression.

The purpose of this is to test the hypothesis the intraocular pressure (IOP) peaks during a stress test [the water drinking test (WDT)] can estimate the risk of future visual field progression in treated primary open-angle glaucoma (POAG) patients. Design: Prospective, longitudinal study. Clinical practice. Treated POAG patients whose IOP was ≤18 mm Hg and who had no IOP-lowering interventions between the date of the WDT and the last eligible visual field. At baseline examination, patients underwent the WDT and were then followed at regular intervals with office-based IOP measurements and visual field testing. Cox-proportional hazards survival analysis testing the predictive value of IOP peaks during the WDT versus IOP measurements during office hours on visual field progression. A total of 144 eyes of 96 patients with baseline visual field damage ranging from mild to severe followed for a mean of 28 months were analyzed. In the multivariable analysis adjusting for potential confounders, higher IOP peaks during the WDT were predictive of future visual field progression (hazard ratio=1.11; 95% confidence interval, 1.02 to 1.21; P=0.013). The average and peak IOP during office hours over the same follow-up period were not significantly associated with progression (P=0.651 and 0.569, respectively). IOP peaks detected with the WDT were predictive of future visual field progression in a treated POAG population. This stress test could be a useful tool for risk assessment in daily practice.

Places and people: the perceptions of men who have sex with men concerning STI testing: a qualitative study

ObjectivesTo explore the experiences and views of men who have sex with men (MSM) on attending clinical sexual health services and their preferences regarding service characteristics in the context of...

Identifying the key components of a ‘whole family’ intervention for families experiencing domestic violence and abuse

‘Whole family’ interventions for families living with domestic violence and abuse (DVA) are emerging and some international practice examples are available. This study reports a process evaluation of a pilot delivered in Northern England that aimed to work with all members of families experiencing DVA. The evaluation involved analysis of detailed accounts of practice from learning logs and case workbooks as well as interviews with practitioners and family members. The voluntary nature of families’ involvement with the pilot, together with an explicit service philosophy of ‘meeting families where they are at’ appeared successful in engaging families. Pilot staff worked flexibly, seeing family members together and separately, but there was evidence of lower levels of confidence in work with perpetrators. Co-work enabled skills to be transferred to other professionals and social workers increased their use of risk assessment tools in DVA cases. However, there was uncertainty as to whether interagency communication improved across local agencies, and joint protocols and tools were slow to develop. This study is one of the first evaluations of ‘whole family’ interventions in DVA, and it illustrates how, when additional resources and organisational support are made available, a non-blaming approach that families find engaging can be developed.

Does the use of risk assessment tools help prevent the development of pressure ulcers?

Does the use of risk assessment tools help prevent the development of pressure ulcers?

Abstract P207: Association Between a 20-year CVD-risk Score Based on Modifiable Lifestyles and Total and Cause Specific Mortality Among US Men and Women

Background: The previously validated Healthy Heart Score, based on modifiable health behaviors (diet, physical activity, alcohol intake, smoking, and body weight), effectively predicted the 20-year risk of CVD in mid-adulthood. While these lifestyle behaviors are independently associated with many chronic diseases, it remains unknown whether the Healthy Heart Score may extend to an association with overall mortality risk. Thus, we examined the Healthy Heart Score and total and cause-specific mortality in the Nurses’ Health Study (NHS) and Health Professional Follow-up Study (HPFS). Methods: We conducted a prospective analysis among 58,319 women in the NHS (1984-2010) aged 30-55 y and 30,713 in men in the HPFS (1986-2010) aged 40-75 y free of cancer and CVD at baseline. The Healthy Heart Score was calculated at baseline and included 9 factors that best estimated CVD risk: current smoking, higher BMI, low physical activity, lack of moderate alcohol consumption, low intakes of fruits and vegetables, cereal fiber, and nuts, and high intakes of sugar-sweetened beverages and red and processed meats). Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) and adjusted for various demographics, medical history, medication use and total energy. Results: During 2,075,504 years of follow-up, there were 19,181 total deaths, including 11,464 in women and 7,717 in men. Compared to participants with the lowest predicted 20-year CVD risk based on the Healthy Heart Score (1 st quintile, median CVD risk: 0.01%), participants with the highest predictive CVD risk (5 th quintile, median CVD risk: 0.03%) had a pooled HR (95%CI) of 2.26 (1.86, 2.13) for total mortality; 2.89 (95 CI%, 1.93, 4.32) for CVD mortality; and 2.55 (95% CI 2.39, 2.72) for cancer mortality. Participants in the 5 th quintile vs . the 1 st quintile of the Healthy Heart Score had also a significantly greater risk of death due to CHD (3.40 [2.20, 5.26]), stroke (1.77 [1.00, 3.14]), lung cancer (6.02 [2.83, 12.79]), breast cancer (1.45 [1.13, 1.85]), colon cancer (1.51 (1.17, 1.94)), respiratory disease (3.94 (1.03, 15.14)), and diabetes (3.63 (2.00, 6.59)). Conclusion: The Healthy Heart Score, comprised of 9 self-reported, modifiable lifestyle predictors of CVD, is strongly associated with a greater risk of all-cause and cause-specific mortality. This risk score is a potentially useful tool for risk assessment and counseling of healthy lifestyles to promote longevity

Are we good and are we safe? Measuring quality and assessing risk in an adult autism diagnostic service

PurposeLeeds autism diagnostic service is an adult autism diagnostic service for people of any intellectual ability which also offers consultancy to service users/carers or professionals, as well as a wide range of autism training. The service was set up as a pilot in 2011 and a paper describing the service development was published in this journal in November 2015. The purpose of this paper is to describe the approach taken to measure the quality of the service the authors provide and accurately assess risk in adults with autism.Design/methodology/approachThe process of evaluating appropriate outcome measures is described, along with considering appropriate risk assessment tools for use in the community. Over 200 people each year complete the autism diagnostic pathway, and 164 patients were invited to respond to service evaluation questionnaires in 2014.FindingsTo date, the most useful outcome measures for this group include a prospective service user questionnaire which enables service user opinion to influence service development. In the absence of any appropriate autism-specific risk assessment tools, the service has developed one which it is currently piloting. This has proved particularly useful in the consultancy settingOriginality/valueThis paper is a follow-up paper looking at the day-to-day issues that the team have had to grapple with – how do you assess whether what you are doing is providing the best possible service for the people that you serve and how do you accurately assess risk in this population?

HCR-20V3and the use of risk assessment tools for women

HCR-20^V3and the use of risk assessment tools for women

Acute coronary syndromes

In the UK, there are over 80,000 admissions annually with acute coronary syndromes (ACS). Management of ST-elevation myocardial infarction (STEMI) involves primary percutaneous coronary intervention (PCI), which is delivered via dedicated heart attack centres. Non-ST elevation-ACS (NSTE-ACS) accounts for two-thirds of ACS presentations, affecting an older cohort of patients - often with more complex comorbidities. Initial management is with anti-thrombotic therapy with a view to PCI within 24 hours for the most acute cases and within 72 hours for all others. However, varying management pathways and access to specialist cardiology services results in variable times to definitive treatment. Advances in the sensitivity of cardiac biomarkers and the use of risk assessment tools now enable rapid diagnosis within a few hours of symptom onset. Advances in invasive management and drug therapy have resulted in improved clinical outcomes with resultant decline in mortality associated with ACS.

Venous thromboembolism prophylaxis risk assessment in a general surgery cohort: a closed-loop audit.

Venous thromboembolism (VTE) is a potential source of morbidity and mortality in surgical in-patients. A number of guidelines exist that advise on prophylactic measures. We aimed to assess VTE prophylaxis prescribing practices and compliance with a kardex-based risk assessment tool in a general surgery population. Data on general surgery in-patients were collected on two separate wards on two separate days. Drug kardexes were assessed for VTE prophylaxis measures and use of the risk assessment tool. NICE and SIGN guidelines were adopted as a gold standard. The audit results and information on the risk assessment tool were presented as an educational intervention at two separate departmental teaching sessions. A re-audit was completed after 3months. In Audit A, 74 patients were assessed. 70% were emergency admissions. The risk assessment tool was completed in 2.7%. 75 and 97% of patients were correctly prescribed anti-embolic stockings (AES) and low-molecular weight heparin (LMWH), respectively. 30 patients were included in Audit B, 56% of whom were emergency admissions. 66% had a risk assessment performed, a statistically significant improvement (p<0.0001). Rates of LMWH prescribing were similar (96%), but AES prescribing was lower (36%). Rates of LMWH prescribing are high in this general surgical population, although AES prescribing rates vary. Use of the VTE risk assessment tool increased following the initial audit and intervention.

A Self-assessment Tool for Screening Young Adults at Risk of Type 2 Diabetes Using Strong Heart Family Study Data.

The purpose of this study is to characterize risk factors associated with type 2 diabetes in young adults aged 18 to 29 years to develop a noninvasive risk assessment tool for use with younger American populations. The self-assessment tool was developed with the Strong Heart Family Study data. A total of 590 young American Indian adults (242 men) who had normoglycemia and were not receiving diabetes treatment were included. Risk factors recommended by the American Diabetes Association were used to assess diabetes risk in these young adults. A logistic regression model was developed to calculate the predicted probability. The area under the receiver operating characteristic curve was used to evaluate the model. The final model showed that parental history of diabetes, obesity level, alcohol consumption, and high fasting glucose, even within normal range, were significantly associated with onset of prediabetes/diabetes in 5 years. The area under the receiver operating characteristic curve value was 0.68 with original and validated data, indicating that the risk assessment tool had reasonably good discrimination ability. This new noninvasive screening tool, based on data from American Indian young adults, has potential to screen young adults' early-onset diabetes risk. Future studies are warranted to test this risk assessment tool in other racial/ethnic young adults.

An angiotensin I-converting enzyme insertion/deletion polymorphism is associated with Pakistani asthmatic cases and controls.

Asthma is a chronic disease due to inflammation of the airways of lungs that is clinically characterized by variable symptoms including wheezing, coughing and shortness of breath. Angiotensin I-converting enzyme (ACE) plays a major role in fibrous tissue formation and is highly expressed in lungs. The main aim of this research work was to study the role of ACE insertion/deletion (I/D) polymorphism, rs4646994, in asthma in Pakistani patients. A total of 854 subjects, including 333 asthma patients and 521 ethnically matched controls, were studied. The ACE (I/D) polymorphism was genotyped using polymerase chain reaction (PCR). Chi-square, Fisher's exact and Hardy-Weinberg equilibrium tests were used to compare groups. Homozygous insertion genotype II (p less than 0.0001, OR=3.38) and insertion allele (I) was significantly more frequent in Pakistani asthmatics than in healthy controls (p=0.0007, OR=1.40). The ID genotype (p less than 0.0001, OR=0.43) and the deletion allele (D) were associated with protection of disease in Pakistani patients (p=0.0007, OR=0.71). These data suggest the involvement of ACE I/D polymorphism in asthma risk in the Pakistani population. This marker may be an important indication in the molecular mechanism of asthma and can become a useful tool in risk assessment and help in designing strategy to combat disease.

The limited utility of currently available venous thromboembolism risk assessment tools in gynecological oncology patients

Use of risk assessment tools, such as the Caprini score or Rogers score, is recommended by national societies to stratify surgical patients by venous thromboembolism risk and guide prophylaxis. However, these tools were not developed in a gynecological oncology patient population, and their utility in this population is unknown. The objective of the study was to examine the ability of both the Caprini and Rogers scores to stratify gynecological oncology patients by the risk of venous thromboembolism. Patients undergoing surgery for cervical, ovarian, uterine, vaginal, and vulvar cancers between 2008 and 2013 were identified from the National Surgical Quality Improvement Program Database using International Classification of Diseases, ninth revision, codes. The Caprini and Rogers scores were calculated for each patient based on the recorded demographic and procedure data. Venous thromboembolism events were recorded for 30 days postoperatively. Patients were categorized into riskgroups based on the calculated Caprini and Rogers scores and the incidence of venous thromboembolism, and the 95% confidence interval was estimated for each of these groups. The relationship between the riskscore and venous thromboembolism incidence was examined with Pearson's correlation coefficient. Of 17,713 patients, 1.8% developed a venous thromboembolism. No patients were classified by the Caprini score as low risk, 0.1% were moderate risk, 3.0% were higher risk (score 4), and 96.9% were highest risk (score ≥5). The Caprini score groupings did not correlate with venous thromboembolism. The high-risk group had a paradoxically higher incidence of venous thromboembolism of 2.5% compared with the highest-risk group, 1.7% (P= .40). However, when the highest-risk group of the Caprini score was substratified, it was highly correlated with venous thromboembolism (R(2)= 0.93). For the Rogers score, only 0.2% of patients were low risk (score <7), 36.9% were medium risk (score 7-10), and 63.0% were high risk (score >10). When the highest risk group of the Rogers score was substratified, it was also highly correlated with venous thromboembolism (R(2)= 0.99). Gynecological oncology patients score very high on current venous thromboembolism risk assessment models. The Caprini score is limited in its ability to discriminate relative venous thromboembolism risk among gynecological oncology patients because 97% are inthe highest-risk category. Substratification of the highest-risk groups allows for relative venous thromboembolism risk stratification among gynecological oncology patients, suggesting that further evaluation of risk stratification is needed in gynecological oncology surgery.

Survey of mental health nurses' attitudes towards risk assessment, risk assessment tools and positive risk.

Introduction Risk assessment and safety planning are considered core components of the role of the mental health nurse; however, little is known about nurses' attitudes towards risk assessment, use of tools to assess risk or therapeutic risk taking. Aim This study aimed to explore mental health nurses' attitudes towards completing risk assessments, use of tools as an aid, and therapeutic or positive risk. Method An anonymous survey which included 13 attitudinal statements, rated on a five-point Likert scale, was completed by 381 mental health nurses working in adult services in Ireland. Findings Findings indicate strong support for the practice of risk assessment in mental health practice. The vast majority of nurses believe that risk assessment tools facilitate professional decision making; however, there is concern that the use of these tools may negatively impact upon therapeutic engagement with service users. The majority of participants have positive attitudes towards therapeutic risk, believing that service users have the right to take informed risks in the context of recovery-orientated care. Discussion The provision of education on the use of risk assessment tools within the context of engagement may help minimize views that the use of assessment tools are incompatible with therapeutic engagement.

Use of risk assessment tools for people with intellectual disability: The latest evidence

A relatively high proportion of people detained in forensic psychiatric hospitals have intellectual disabilities (up to 3000 people in the UK; Royal College of Psychiatrists, 2013), and people with intellectual disability are significantly over-represented among those psychiatric patients with long lengths of hospital stay (CQC, 2013; Vollm, 2015). People with mild to borderline intellectual disabilities are also prevalent in the UK prison system.Although the relationship between intelligence and offending is complex, lower intelligence is a known actuarial risk factor for offending behaviour. Studies, which have investigated the prediction of re-offending risk in populations with intellectual disability, have nevertheless found lower rates of recorded re-offending compared to those in mainstream forensic populations (e.g. Gray et al., 2010). The relatively high rate of ‘offending-like’ behaviour, which is not processed through the criminal justice system in people with intellectual disability makes risk prediction a more complex exercise with this group of people. It also makes outcomes measurement more difficult.This paper will give an overview of the current research evidence and clinical practice in the field of risk assessment, risk management and outcome measurement with offenders with intellectual disability. It will summarise the findings of a recent NIHR funded systematic review by the author, which pertains to this area, and will point to future developments in the field.Disclosure of interestThe author has not supplied his declaration of competing interest.

Image-defined Risk Factors Correlate with Surgical Radicality and Local Recurrence in Patients with Neuroblastoma.

Neuroblastoma is the second most common solid pediatric tumor and the most common cancer to be detected in children younger than 12 months of age. To date, 2 different staging systems describe the extent of the disease: the International Neuroblastoma Staging System (INSS) and the International Neuroblastoma Risk Group Staging System (INRGSS). The INRGSS-system is characterized by the presence or absence of so called image-defined risk factors (IDRFs), which are described as surgical risk factors. We hypothesized that IDRFs correlate with surgical complications, surgical radicality, local recurrence and overall survival (OS). Between 2003 and 2010, 102 patients had neuroblastoma surgery performed in our department. We analyzed medical records for IDRF-status and above named data. 16 patients were IDRF-negative, whereas 86 patients showed one or more IDRF. Intra- or postoperative complications have been reported in 21 patients (21%). 19 of them showed one or more IDRF and 2 patients were IDRF-negative (p=n.s.). Patients who suffered from intra- or postoperative complications demonstrated a decreased OS (p=0.011). Statistical analysis revealed an inverse correlation between the extent of macroscopical removal and IDRF-status (p=0.001). Furthermore, the number of IDRFs were associated with a decreased likelihood of radical tumor resection (p<0.001). 19 patients had local recurrence; all of them were IDRF-positive (p=0.037). Pediatric surgeons should consider IDRFs as a useful tool for risk assessment and therefore planning for neuroblastoma surgery.

Drinking water risk assessment in practice: the case of Swedish drinking water producers at risk from floods

To achieve a safe and reliable drinking water supply, water producers need to manage a large range of risks regarding both water quality and quantity. A risk management approach where risks are systematically identified and handled in a preventive manner is promoted by the World Health Organization and supported by researchers and drinking water experts worldwide. Risk assessment is an important part of such a management approach, and a variety of tools for risk assessment are described in the literature. There is, however, little knowledge of how drinking water risk assessment is performed in practice, including which tools that are actually used. This study investigates the use of risk assessment tools, and the approach to risk management, on a local level in the Swedish water sector. It is based on interviews with key persons from a targeted selection of water producers. We find that the application of tools as well as the approach to risk assessment and management differs considerably between the water producers. The tools most frequently used are mainly the ones promoted or required by Swedish national organizations. Although many of the water producers have done some kind of risk assessment, most have not implemented a risk management approach. Furthermore, their knowledge of the concepts of risk and risk management is often limited. The largest challenge identified is to prioritize risk assessment, so that it is actually performed and then used as a basis for managing risk in a systematic way.

Hydrogeological modeling in Danube Valley using GIS techniques. Study case

&lt;p&gt;In hydrogeological and pedoclimatic conditions, specific to the Danube River, there is a danger of secondary salinization of soil excluded from the floods. The drought, with an increasing frequency, affects agricultural production in areas where the largest irrigation systems are found. These systems were built during 1960-1990, but they are dysfunctional and unused for 20 years.&lt;/p&gt;&lt;p&gt;The purpose of this study is to insure a model using GIS technologies, in order to reduce the negative effects of the drought and to propose redevelopment of irrigation. Such model is presented in a form of five thematic maps where the main morphometric parameters (hypsometry, slope, slope orientation), in quantitative terms, the types of soils and land use were analyzed for the entire surface of the villages Gostinu-Greaca-Arges, located in the Danube Floodplain. The GIS model provides important information for the investigated area and it is a useful tool for risk assessment and early-warning.&lt;/p&gt;&lt;p&gt;This study is based on observations from the maps interpretation of the studied area, but also from reports and studies published over the years.&lt;/p&gt;&lt;p&gt; &lt;/p&gt;&lt;p&gt;Keywords: The Danube River, drought, soil, irrigation.&lt;/p&gt;