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Search Results: 1 - 10 of 16179 matches for " risk stratification "
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El aumento del riesgo de mortalidad en la cirugía cardíaca: ?Realmente estamos operando pacientes con incremento del riesgo?
Borracci,Raúl A.; Rubio,Miguel;
Revista argentina de cardiolog?-a , 2006,
Abstract: international reports have shown that the average mortality risk of patients (p) undergoing heart surgery has been increasing throughout time. however, most surveys have focused on average increase in risk instead of reporting real frequency distribution according to risk groups. the aim of this report was to evaluate whether there is currently an increased mortality risk for cardiac surgery in our country compared to a decade ago, based not only on the average variation but also on the relative distribution of risk groups. parsonnet's risk score classification was used to compare two series of p undergoing cardiac surgery: 464 p operated between 1993 and 1995 versus 502 p operated between 2004 and 2005. relative frequency distribution analysis showed an increased proportion of patients in the higher risk group during 2004-5 (8 to 13%, p<.05) and a paradoxical increase in low risk cases (18 to 28%, p<.05) for the same period. because of these two opposite changes, the average risk score was not significantly different between the two series of p (8.2 versus 9.2, p=ns).
Identification of Patients at High Cardiovascular Risk
Igor V. Sergienko, PhD, ScD,Saule J. Urazalina, PhD,Valery V. Kukharchuk, PhD, ScD,Yuri A. Karpov, PhD, ScD
International Journal of BioMedicine , 2012,
Abstract: Objective: To identify individuals at high cardiovascular risk (CVR) to check for an additional estimate of CVR with the use of the ESH/ESC Guidelines (2003, 2007) in patients earlier classified as being at low and moderate risk on SCORE . Material and methods: The study included 600 people (155 men and 445 women) with low and moderate cardiovascular risk on the SCORE scale. All patients were examined with duplex scanning of the carotid arteries (DSCA) to the determined of the thickness of the intima – media (IMT), the presence of atherosclerotic plaques (ASP); it has also been performed sphygmographic computer (SC) with automatic estimation of brachial-ankle pulse wave velocity (baPWV), biochemical analysis of blood lipid spectrum. Results: The frequency of ASP was 59.5% (357 out of 600), and a thickening of thecomplex "intima-media" (IMT)> 0.9 mm was detected in only 5% of the cases (28 persons out of 600), that indicated a slight contribution to the magnitude of the risk of such parameters as the IMT. The total number of patients with signs of preclinicallesions of the arterial wall (the presence of ASP and/or increased baPWV) was 337 (56% of 600). Our results showed that the presence of subclinical atherosclerosis is in itself a risk factor. Conclusion: The usage of instrumental methods of research (DSCA, SC) allowed to detect 32% of individuals with high CVR from 600 previously classified as low and moderate risk on SCORE scale. In our opinion, the proposed algorithm is convenient and easy to use for transfer of the patients into high-risk group.
Reducing the use of seclusion for mental disorder in a prison: implementing a high support unit in a prison using participant action research
Yvette Giblin, Andy Kelly, Enda Kelly, Harry G Kennedy, Damian Mohan
International Journal of Mental Health Systems , 2012, DOI: 10.1186/1752-4458-6-2
Abstract: The prison studied is a committal centre for sentenced prisoners with an official bed capacity of 630. The forensic mental health in-reach team, in co-operation with the prison health service followed the 'spiral' of planning, action and fact finding about the results of the action. In December 2010 a 10 bed High Support Unit (HSU) was established within the prison. During the first year, 96 prisoners were admitted. A third (35%) reported psychotic symptoms, 28% were referred due to the immediate risk of self-harm, 17% were accommodated for medical treatments and increased observation, 13% received specialised treatment by the Addiction Psychiatry team, 6% presented with emotional distress. One prisoner was accommodated on the HSU due to the acute risk he posed to others. A major mental illness was diagnosed in 29%, 20% required short-term increased support for crisis intervention and were found not to have a mental illness. A further 10% were deemed to be feigning symptoms of mental illness to seek refuge in the HSU. 7% had personality disorder as their primary diagnosis and 4% had a learning disability. Stratifying risk within the prison population through the provision of the HSU decreased the total episodes of seclusion in the prison by 59% (p < 0.001) in addition to providing a more effective psychiatric in-reach service to the prison. Pathways between the prison and the forensic psychiatric hospital saw no change in activity but improved continuity of care.The next step is to further stratify risk by establishing a low support unit to serve as a step-down from the high support unit.In many jurisdictions prisons do not have a cap on numbers and are prone to overcrowding. Large numbers of mentally ill persons are committed to prisons internationally [1] and this has been confirmed in the prison population described here [2]. International conventions on human rights such as the Universal Declaration of Human Rights [3] and European Convention on Human Rights [4]
Factores sociales en la incidencia de tuberculosis pulmonar en el municipio "10 de Octubre"
Mu?oz Soca,Rafael; Fernández ávila,Roberto;
Revista Cubana de Higiene y Epidemiolog?-a , 2011,
Abstract: an analytical of cases/controls study was conducted to determine the influence of some social factors on the incidence of pulmonary tuberculosis in the "10 de octubre' municipality from 2001 to 2006 and five health areas were studied. sample included 52 adult patients diagnosed with pulmonary tuberculosis and control included 104 adult persons without a history of chronic respiratory diseases. information was collected by survey. the chi2 and odds ratio (or) statistically significant tests were used. the social factors with a great influence on pulmonary tuberculosis incidence were the family dysfunction (or l6,37), the poor structural conditions of housing (or 4,17) and the deficient home hygiene (or 4,14), as well as the deficient personal hygiene and the overcrowding. results offer information potentially useful for stratification of social risks in localization of pulmonary tb cases.
Estratificación para la vigilancia entomológica del dengue
Valdés Miró,Vivian; Díaz Castillo,Amparo Olga; Borrell Ferrer,María Catalina; Cabreras Cabreras,Ada Vivian;
Revista Cubana de Medicina Tropical , 2009,
Abstract: introduction: the entomological surveillance is used to determine the changes in the geographical distribution of the vectors and to obtain the relative measurements of their populations in the course of time, in order to facilitate prompt and adequate decisions about interventions. objectives: to submit a stratification system, based on some indicators of the aedes aegypti eradication program, which allows the entomological surveillance of dengue in boyeros municipality. methods: a retrospective descriptive study was made with the following indicators: house index, reservoir index, breteau index, positive neighbourhood index, collected sample index, useful and non useful reservoir index by season (dry and rainy). results: the entomological indicators allowed determining the most risky health areas during the two seasons. the infestation index per house increases in the rainy seasons as well as the number of non useful reservoirs that are positive to the vector. in the stratification, the most risky areas were boyeros and armada during the dry season, followed by mulgoba and wajay in the rainy season. conclusions: the stratification system presented in this paper responds to the integration of the entomological indicators that would make it possible to evaluate the functioning of the program and to promptly act in the anti-vector eradication campaign.
Validation of scoring system for preoperative stratification of intra-operative risks of complications during cataract surgery: Indian multi-centric study
Agrawal Vinay,Upadhyay Jinish,Indian Cataract Risk Stratification Study group
Indian Journal of Ophthalmology , 2009,
Abstract: Aim: To validate a system that uniformly and objectively assesses the risk of complications of cataract surgery performed with phacoemulsification technique in individual patients preoperatively. Materials and Methods: Outcome analysis of patient data entered into a standardized protocol. The data sheet was analyzed at a single center in terms of the risk assessed preoperatively and the incidence of surgical complications. This study did not assess the final visual outcome of eyes with complications. Each patient was categorized into a risk group according to the number of points scored. Group 1 (no added risk) 0 points, Group 2 (low risk) 1-2 points, Group 3 (moderate risk) 3-5 points, Group 4 (high risk) 6 points or more. Results: The number of eyes in each risk group was 2894 in Group 1 (44.1%), 1881 in Group 2 (28.6%), 1575 in Group 3 (23.9%), and 214 in Group 4 (3.3%). A total of 6564 eyes were assessed, of these 3669 eyes (55.9%) had a minimum of one risk factor and were thus not "routine". The group-specific events of complications were Group 1, 46 (1.6%), Group 2, 108 (5.7%), Group 3, 168 (10.7%), and Group 4, 69 (32.2%). The total incidence of complications was 5.7%. The group-specific rate of intraoperative complications increased through the risk groups ( P < 0.001). Conclusion: The study validates a scoring system that is predictive of intraoperative complications. This system uses information that is readily available from the preoperative history and assessment of the patient.
Is EuroSCORE applicable to Indian patients undergoing cardiac surgery?
Malik Madhur,Chauhan Sandeep,Malik Vishwas,Gharde Parag
Annals of Cardiac Anaesthesia , 2010,
Abstract: Indian patients undergoing cardiac surgery have different demographics, clinical profile as well as risk profile, compared to the western population. The purpose of this study was to validate the European System for Cardiac Operative Risk Evaluation (EuroSCORE) risk stratification model in Indian patients undergoing cardiac surgery in a single cardiac center. Data from 1000 consecutive adult patients undergoing cardiac surgery (coronary artery bypass grafting or valve surgery) were prospectively collected as per the EuroSCORE model. The model′s validity was assessed on the basis of its calibration power (Hosmer-Lemeshow test) and discriminatory power [area under receiver operating characteristic curve]. The patients were divided into three risk groups on the basis of their EuroSCORE. The Hosmer-Lemeshow test revealed a good calibration power (P = 0.73) and the area under the ROC curve was 0.8278, suggesting a good discriminative power. The predicted mortality was similar to observed mortality in low- and moderate-risk patients but the observed mortality in high-risk patients (15.6%) was double that of predicted mortality (7.5%). The risk factors prevalent in European population were not observed in Indian population. EuroSCORE accurately predicts mortality in low and moderate-risk Indian patients undergoing cardiac surgery but is less predictive for high-risk Indian patients. Updating and improvisation of EuroSCORE by incorporation of risk factors associated with rheumatic valvular heart disease which is more prevalent in India, may enable it to accurately predict mortality in high-risk patients also.
Challenges in Managing Hospitalized HIV Infected Persons with Low Absolute CD4 and Preserved CD4 Percentage  [PDF]
Steven M. Bobula, Carl J. Fichtenbaum
World Journal of AIDS (WJA) , 2012, DOI: 10.4236/wja.2012.23031
Abstract: Background: HIV infected persons are at risk for opportunistic illnesses based upon severity of immune deficiency. Management is generally based upon the most recent absolute CD4 count. We hypothesized there is a group of patients with a low absolute CD4 count and preserved CD4 percentage that are at low risk of AIDS-related opportunistic illnesses (OI). Methods: A retrospective review of medical records in HIV-infected persons hospitalized from 2004-2006. Individuals without CD4 counts available within 180 days of admission and during hospitalization were excluded. Patients with a decrease in the absolute CD4 count during hospitalization and stable CD4 percentage were compared to the rest of the cohort. Appropriate management was defined using DHHS guidelines for the prevention and treatment of opportunistic illnesses in HIV infection. Results: 464 patients had 978 hospitalizations. In 221 hospitalizations (N = 161 patients) inpatient and outpatient CD4 counts were available. In 35 hospitalizations (N = 25 patients) the absolute CD4 count declined with stable CD4 percent (cases). Cases had an average decline in CD4 of –197 cells/mm3 compared to –5 cells/mm3 in the comparator group. 30% of comparators had AIDS defining OI's compared to none in the case group (p = 0.01). Management outside of DHHS guidelines was more common in cases compared to the comparator group (49% vs 30%, p = 0.048). The median length of stay was prolonged in cases with management outside guidelines compared to appropriately managed persons in the comparator group (7 days vs 3.5 days, p = 0.03). Conclusion: In persons on potent antiretroviral therapy, abrupt declines in absolute CD4 counts without an accompanying change in CD4 percentage are associated with a low risk of AIDS related opportunistic infection, a higher rate of in-patient management outside DHHS guidelines, and a more prolonged length of stay.
Estratificando o risco na angina instável com a ecocardiografia sob estresse com dobutamina
Markman Filho, Brivaldo;Almeida, Maria Celita;Markman, Manuel;Chaves, Andrea;Moretti, Miguel A.;Ramires, José A. F.;César, Luiz A.;
Arquivos Brasileiros de Cardiologia , 2006, DOI: 10.1590/S0066-782X2006001600011
Abstract: objective: to evaluate the role of dobutamine stress echocardiography (dse) in the risk stratification of low to moderate risk unstable angina (ua) patients, to predict the combined clinical outcome of cardiovascular death, myocardial infarction (mi), recurrent ua and the need of revascularization procedures in a 6 month period. methods: multicenter prospective study. patients should be admitted to the hospital and asymptomatic in the last 24 hours. the exam was performed up to 72 hours from the hospital admission and no medication was stopped prior to the test. results: ninety-five consecutive patients were evaluated by dse. forty patients (42,1%) had a positive ischemic test and fifty five (57,9%) had a negative one. clinical events occurred in twenty eight patients, twenty six of whom had a positive test. the rest of the patients (67) did not have clinical events and fifty three of them, had a negative test. the sensibility, specificity, accuracy, positive predictive value and negative predictive value of the test related to the clinical events were: 92,9%, 79,1%, 83,2%, 65% and 96,4%, respectively. event-free survival after 6 months for pacients with a negative dse was 96% compared to 35% for those with a positive dse (p<0,001). the ua classification, left ventricular ejection fraction, rest and peak wall motion score index, dse result and history of previous mi were associated with the combined end point by univariate analysis. the test result was the only independent predictor of cardiac events by multivariate analysis (p<0.001). conclusion: o dse has shown an excellent negative predictive value allowing for early hospital discharge without further exams. the positive test result was the only independent predictor for adverse cardiac events.
Estratificación del riesgo de leptospirosis en el municipio pinare?o de San Luis
Montesino Valdés,Catalina;
Revista Cubana de Enfermer?-a , 2005,
Abstract: a descriptive, longitudinal study was conducted to stratify the leptospirosis risk in the municipality of san luis, pinar del río, from 2003 to 2004. the universe of study was composed of the population exposed to the risk, whereas the sample was made up of the 13 patients diagnosed in 2003. 10 patients who were diagnosed in 2004 were included in the sample, as well as members of the risk groups that were widened in 2003 as a result of the nurses's intenvention in the community. the variables identified in the sample of 13 patients were: age, sex, epidemiological history, affectations by months and people's councils. the information was obtained from the municipal departments of vectors, zoonosis, vaccination and veterinary. data were expressed in percentage, average values, mean, and minimum and maximum values. the strata at higher risk for acquiring leptospirosis were the people's councils of santa fe, santa maría, buenavista and retiro, all of them from the center of the territory. the main risks were found in the rice growers, in the presence of rodents, and in having animals. the epidemiological stratification made possible the application of intervention strategies with an adequate distribution of activities and resources. after the nursing intervention in the territory, morbidity from leptospirosis dropped by 23.1 %, although it may be concluded that the epidemiological pattern of leptospirosis in san luis is still invariable.
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