Venous thromboembolism risk assessment and prophylaxis in hospitalised medical patients in the Cape Town metropole, South Africa

Background. Venous thromboembolism (VTE) is regarded as the most preventable cause of inpatient death in hospital settings globally. VTE can be prevented through the provision of non-pharmacological and/or pharmacological thromboprophylaxis following individualised risk screening. The Caprini risk assessment model (RAM) offers a validated and well-established approach for VTE risk assessment in medical inpatients. Literature findings describe a trend towards inappropriate and under-prescribing of thromboprophylaxis in this population. Together with concerns regarding clinicians' perceived importance of VTE risk assessment, the need to clarify these aspects of practice is evident. Objectives. To describe VTE risk assessment and prophylaxis practices of medical practitioners in public sector hospitals in Western Cape Province, South Africa (SA). Methods. A retrospective, cross-sectional study design was employed in the medical wards of two district hospitals and one regional hospital in the Cape Town metropole, Western Cape. Medical folders of adult medical inpatients admitted between January and July 2020 were reviewed to assess VTE risk using the Caprini RAM. Thromboprophylaxis therapy prescribed and contraindications to chemoprophylaxis were also evaluated. Results. Of 380 patients included in the review, 51.6% were female, and the average age was 52.1 years (range 18 - 96); 21.3% had their weight recorded, while none had their height documented. Infectious disease was the predominant diagnosis (49.2%) detected in the sample. Common VTE risk factors identified included bed rest/restricted mobility for <72 hours (76.3%) and serious infection (67.4%). A total of 97.1% of patients (n=369) were found to be at moderate or higher risk of VTE (Caprini score ≥2). Of this at-risk group, 24.1% were eligible to receive chemoprophylaxis, yet no prescription for thromboprophylaxis was identified. Seventy percent of patients (n=266) were prescribed chemoprophylaxis, with enoxaparin accounting for 98.5% of regimens. Contraindications to chemoprophylaxis were recorded in 13.4% of patients. Conclusions. Although rates of VTE prophylaxis in medical inpatients may be improving, thromboprophylaxis still remains critically underutilised in this population. This study highlighted a consequence of this trend, with inappropriate chemoprophylaxis prescribing becoming more evident. Mechanical prophylaxis prescribing in medical inpatients is lacking, despite the associated benefits. RAMs should be adapted for the SA setting, where infectious diseases are prevalent. Future research should assess RAM use by clinicians, as this could provide insight into improving RAM uptake and thromboprophylaxis prescribing.

Risk prediction for deep venous thrombosis after total knee arthroplasty based on modified Caprini risk assessment model:a confirmatory study / 中国骨伤

OBJECTIVE@#To investigate the effectiveness of modified Caprini risk assessment model(Caprini MRAM) in predicting the risk of deep venous thrombosis (DVT) after total knee arthroplasty (TKA).@*METHODS@#A case-control study was used to collect 43 patients with DVT after TKA in lower limb department of Sichuan Orthopedic Hospital from January 2016 to November 2020 in the positive group, and 172 patients without DVT after TKA in the same period according to the 1∶4 ratio between positive and control group were selected in the control group. Caprini MRAM was used to score and grade the risk of DVT. The clinical data, score and risk classification of the two groups were compared. The relationship between the risk of DVT in the patients after TKA and the risk factors in the risk ckassification and assessment of Caprini MRAM was analyzed by multivariate logistic regression model.@*RESULTS@#The average score of caprini in DVT group was significantly higher than that in control group[(8.11±2.91) vs(4.07±2.12), P<0.001];DVT group was mainly at medium and high risk group(66.67%), while the control group was mainly at low risk (77.33%). There was a significant difference between the two groups in risk classification composition (P<0.001). BMI≥30 kg/m2, lower extremity edema (<1 month), severe pulmonary disease (<1 month), acute myocardial infarction (<1 month), bed rest (> 2 h), history of superficial or deep vein or pulmonary embolism and family history of thrombosis were the main risk factors for DVT in patients after TKA(all P<0.05). Preoperative D-dimer elevation (OR=4.380), BMI≥30 kg/m2(OR=2.518), lower extremity edema(<1 month)(OR=7.652), acute myocardial infarction (<1 month) (OR=1.994), bed rest (> 72 h)(OR=3.897), history of superficial or deep vein or pulmonary embolism (OR=13.517) and family history of blood embolism (OR=6.551) were independent risk factors for DVT in patients after TKA (all P<0.05). The risk of DVT was 13.457 and 2.739 times higher in high and moderate risk TKA patients with Caprini MRAM classification, respectively.@*CONCLUSION@#Caprini MRAM can be used to predict the risk of DVT in patients after TKA, especially for patients with high risk.

Progress of researches on the application of risk assessment models in assessment of the schistosomiasis transmission risk / 中国血吸虫病防治杂志

With the deepening of the schistosomiasis research, risk assessment models have been widely used in schistosomiasis research and control. This paper reviews the theoretical basis and applications of common schistosomiasis risk assessment models and the Bayesian model, so as to provide insights into national schistosomiasis elimination program in China.

Strategies for prevention and treatment of acute pulmonary embolism in patients with ground-glass nodules resection / 中国胸心血管外科临床杂志

@#Acute pulmonary embolism (PE) is a common disorder with significant morbidity and mortality in patients who underwent pulmonary ground-glass nodules (GGN) resection. We should make efforts to increase surgeons' awareness of risk factors of PE and their understanding of the effectiveness of prevention strategies. Using the optimal risk assessment model to identify high-risk patients and give them the individualized prophylaxis. Early diagnosis and accurate risk stratification is mandatory to reduce the rates of PE, to decrease health care costs and shorten the length of stay. This article summarizes the risk factors, diagnostic process, risk assessment models, prophylaxis and therapy for the PE patients who underwent GGN resection.

Establishment and verification of preeclampsia risk assessment model / 中华疾病控制杂志

Objective To analyze the risk factors affecting pre-eclampsia, to establish a pre-eclampsia risk assessment model, and to assess the risk of pre-eclampsia early. Methods A face-to-face questionnaire survey was conducted for all women who gave birth in the Department of Obstetrics, the First Hospital of Shanxi Medical University from March 2012 to September 2016. A total of 10 319 qualified questionnaires were collected to exclude 9 623 cases of other hypertensive diseases related to pregnancy. A total of 70% of the subjects were randomly selected as training samples to analyze the influencing factors of pre-eclampsia, and a Logistic regression model was established. The remaining 30% of the objects are used as test samples to verify the effect of the model. Results Logistic regression model was established with training samples. Logit P=-2.517-0.696×Pre-pregnancy lean +0.200 ×Pre-pregnancy overweight +0.944×Pre-pregnancy obesity -1.995×Residential in city -0.409×Folic acid supplemented before pregnancy +1.323×Twin and multiple pregnancy +1.708× History of previous pregnancy hypertension. Homer-Lemeshow test P=0.377. Model AUC=0.767 (95%CI:0.747-0.786, P<0.001). Using the test sample to verify the model, the model sensitivity was 81.68%, the specificity was 75.05%, the positive likelihood ratio was 3.27, and the negative likelihood ratio was 0.24. The test sample model AUC = 0.771 (95%CI=0.763-0.790,P<0.001). Conclusion This study establishes a simple and effective pre-eclampsia risk assessment model with controllable factors. The model has good fit and sensitivity and specificity.

Perioperative Venous Thromboembolism (VTE) Prophylaxis in Thoracic Cancer Patients: Chinese Experts Consensus - Interpretation of Screening of High-risk Patients / 中国肺癌杂志

Venous thromboembolism (VTE) is a common perioperative complication in patients with thoracic malignant tumor. Once it occurs, it will not only affect the prognosis of patients, but also occupy a lot of medical resources, which is gradually causing our widespread attention. However, the understanding of VTE in thoracic surgery in our country is relatively late, and the recognition and attention are not enough, and there is still a lack of guidance support for perioperative VTE. Based on the current understanding and preventive measures of VTE in thoracic surgery in China, The China National Research Collaborative Group released the first edition of Chinese experts consensus on the perioperative VTE prophylaxis in 2018. This article will interpret the high-risk patients with perioperative VTE in patients with thoracic malignant tumors, in order to provide a better understanding of Chinese experts consensus for readers.

Exploration and application of occupational disease risk assessment model based on information diffusion theory / 中华劳动卫生职业病杂志

Objective@#To research build a kind of occupational disease risk assessment model which provides scientific basis for prevention and control of occupational diseases.@*Methods@#Based on the principle of information diffusion, this paper uses spread function to extend the incomplete gathered information, establishes the mapping relationship between observation samples and risk probability distributions, and constructs the occupational disease risk assessment model, to analyzes the risk data of occupational disease reported cases in Guangdong Province in the past five years.@*Results@#Through evaluation analysis, every year, 200-300 cases of pneumoconiosis probability is 67.77%, 100-200 cases of occupational poisoning probability is 68.52%, 20-40 cases of occupational cancers probability is 71.62%, each year, the incidence of occupation otorhinolaryngology and oral diseases in 200 cases was 62.23%.@*Conclusion@#A model of occupational disease risk assessment based on information diffusion theory is constructed, the evaluation result is basically consistent with the actual situation of occupational disease, which can provide reference for occupational disease prevention and control.

Risk factors of venous thromboembolism and evaluation of existing risk assessment models for predicting venous thromboembolism in medical oncology inpatients / 中国实用内科杂志

OBJECTIVE: To investigate the risk factors of venous thrombosis(VTE) and to evaluate the predictive ability of the existing risk assessment models(RAM) in medical oncology inpatients. METHODS: In this study, 252 medical oncology inpatients were divided into study group(63) and control group(189) according to VTE. Logistic regression analysis was performed to identify the risk factors of VTE and to evaluate the predictive ability of KRS and PPS. RESULTS: This study showed that previous VTE, staying in bed≥3 d,platelet count≥350×10~9/L, D-dimer>0.55 mg/L and stage IV cancer were associated with VTE risks(OR=12.149, 3.672, 3.144, 5.263,1.439, 1.382, P0.55 mg/L, and stage IV cancer are independent risk factors of VTE. Compared with the limited predictive ability of PPS,KRS can predict VTE very well for low-and intermediate-risk patients.

The value of Caprini thrombosis risk assessment in postoperative patients with lung cancer / 中国实用护理杂志

Objective To analyze the effectiveness of Caprini thrombosis risk assessment model in the screening of patients with non-metastatic lung cancer after venous thromboembolism (VTE). Methods A retrospective analysis of 136 patients with postoperative lung cancer who were admitted to our department between October 2015 and October 2017 was followed up for 2 months. According to the follow-up results, the patients were divided into VTE group and non-VTE group. The VTE group was further divided into the PE group and the deep venous thrombosis (DVT) group according to the embolization type. Comparisons were made between the two groups for general clinical data, surgically related parameters, and differences in Caprini scores. Univariate analysis was used to assess the risk factors associated with postoperative VTE in the relevant clinical parameters in the Caprini thrombosis risk assessment model. Statistically significant parameters in the single factor were included in multivariate analysis to assess independent risk parameters for VTE. Results There were 39 cases in VTE group and 97 cases in non-VTE group. Among them, 28.2% (11/39) of VTE events occurred after discharge. The hospitalization time and Caprini risk scores in VTE group were (16.3±3.6) days, (10.5±2.4) points, which were significantly higher than (8.9±3.4) days, (9.3±2.1) points in non-VTE group (t=11.287, 2.891, P<0.01). In the VTE event, the onset time in the PE group was significantly advanced (P=0.019), and both the length of hospital stay and Caprini score were significant. It was worse than DVT group (P<0.05). When Caprini's high-risk risk cut-off was 9 points, the accuracy was 76.5%, the positive predictive value was 58.1%, the negative predictive value was 84.9%, and the sensitivity and specificity were 64.1% and 81.4% , respectively. Multivariate analysis of relevant clinical parameters in the caprini thrombosis risk assessment model showed swelling in the lower extremities (P<0.01), varices (P<0.01), sepsis (P<0.01), and severe acute lung disease (P<0.01). Congestive heart failure (P<0.01), central venous catheter (P<0.01), and VTE history (P<0.01) were all independent risk factors associated with VTE events. The risk of developing VTE in postoperative patients with moderate-and high-risk lung cancer was 3.5 and 8.4 times higher than that in low-risk patients. Conclusion Combining the Caprini thrombosis risk assessment model during postoperative care is most likely to predict the risk of developing VTE in postoperative patients with lung cancer, and the use of 9 points as a high-risk cutoff for the Caprini Thrombotic Risk Score has better sensitivity and Specificity.

Risk factors of lower limb DVT and thrombosis risk assessment after breast cancer surgery / 中国肿瘤临床

Objective:To investigate the risk factors of breast cancer complicated with deep venous thrombosis (DVT) in lower limb and to explore the predictive significance of the thrombus risk assessment model for patients with breast cancer. Methods:A total of 703 patients with breast cancer in Tianjin Medical University Cancer Institute and Hospital who suffered from DVT after operation dur-ing January 2013 to June 2016 were retrospectively selected as the thrombosis group. A total of 706 cases for the control group were selected by systematic sampling. The risk factors of lower limb DVT after surgery were investigated. The predictive values of the Khora-na and Caprini thrombosis risk assessment models for these patients were also presented in this research. Results:Age, BMI≥30 kg/m2, diagnosis by excisional biopsy, neoadjuvant chemotherapy, operation time>2 h, lipoprotein a (Lpa)>475.5 mg/L, protein C (PC)<102.5%, blood coagulation factor-Ⅷ(F-Ⅷ)>129.8%, and D-Dimer (D-D)>289.99 ng/mL had statistical differences between in the two groups (P<0.05). Significant difference between the groups was found in the Caprini scores (P<0.001) but not in the Khorana thrombo-sis risk assessment model (P=0.207). Conclusion:Age, BMI≥30 kg/m2, diagnosis by excisional biopsy, neoadjuvant chemotherapy, op-eration time>2 h, Lpa>475.5 mg/L, PC<102.5%, F-Ⅷ>129.8%, and D-D>289.99 ng/mL are the independent risk factors of thrombo-sis. The Caprini thrombosis risk assessment model may require complicated evaluation. Hence, a new model that is suitable for pa-tients with breast cancer must be developed.

Application of two health risk assessment models in the occupational health risk assessment of chemicals in different industries / 预防医学

Objective To explore the applicability of Singapore semi-quantitative risk assessment mode and Romania risk assessment model in occupational health risk assessment. Methods We employed two risk assessment models to evaluate the risk of key positions in papermaking factories, electroplating factories, and chemical factories. Then we compared the results with occupational exposure limits, classification of occupational hazards and literature reports. Results The results of Singapore model showed that the total risk ratio was 0.40 ±0.16. The risk levels of papermaking factories, electroplating factories, and chemical factories were low-medium, negligible-low and low-very high, respectively. The risk ratio of three industries were 0.42±0.04, 0.31±0.10 and 0.62±0.15. The results of Romania model showed that the total risk ratio was 0.43 ±0.11. The risk levels of papermaking factories, electroplating factories, and chemical factories were respectively low-high, minimal-low and low-very high. The risk ratio of three industries was 0.46±0.13, 0.38±0.08 and 0.52±0.11, respectively. The risk levels of electroplating factories were higher than papermaking factories and chemical factories (P<0.05) . There was no significant difference between risk levels of papermaking factories and chemical factories (P>0.05) . There was significant difference between the occupational health risk levels assessed by the two models (P >0.05) . Conclusion These findings suggest that Singapore semi-quantitative risk assessment model and Romania risk assessment model both can be applied for the occupational health risk assessment of different workplaces, such as papermaking factories,electroplating factories, and chemical factories. The risk assessment results of the two methods are basically identical.

Application of Caprini risk assessment model for preventing venous thromboembolism / 中国实用护理杂志

Objective To explore the Caprini risk assessment model for the application of the prevention of VTE in clinical nursing. Methods With a cross:sectional survey research, 6 624 patients were interviewed of a hospital from March to June in 2015.The Caprini risk assessment model was used to screen patients with VTE risk assessment. Results Patients have VTE risk in 6 229 cases, accounting for 94.04%. The patients of low risk, moderate risk, high risk, and super high-risk was 1 889 cases, 1 507 cases, 1 930 cases, 903 cases, accounted for 28.52%, 22.75%, 29.14%and 13.64%respectively. Surgical patients with VTE risk, low risk, moderate, high risk and super high-risk rate was 5.15% (79/1 533), 15.72%(241/1 533), 28.77%(441/1 533), 30.59%(469/1 533), 19.77%(303/1 533), the no-surgery group were 6.21% (316/5 091), 32.37% (1 648/5 091), 20.94% (1 066/5 091), 28.68% (1 461/5 091), 11.79%(600/5 091), two groups compare was statistically significant (χ2= 53.46, P = 0.000); High-risk ratio of trauma surgery,thoracic surgery, neurosurgery, orthopedics, mammary gland and thyroid surgery were63.2%、62.9%、61.5%、58.3%、55.8%; High-risk ratio of oncology medical, respiratory medical, neurology medical, cardiology medical were 92.0% , 68.2% , 55.9% and 64.4% . Conclusions Hospitalized patients have high risk of VTE, it is suggested that include VTE in nursing quality evaluation standard, establish an effective system of VTE risk management. Caprini risk assessment model has been clear about the VTE patients should be special attention, and has been great significance to early screening and prevention of VTE.

A Study on Application of Inhalation Risk Assessment Model of USEPA in Occupational Health Risk Assessment / 预防医学

Objective To evaluate the applicability of inhalation risk assessment model provided by US Environmental Protection Agency (USEPA ) in occupational health risk assessment in paper -making,chemical and electroplating industries.Methods A total of 1 1 factories in paper-making,chemical and electroplating industries were investigated. The risk assessment model of USEPA was used to assess occupational health risk levels,including cancer and non-cancer risks.These results were compared with occupational exposure limits,classification of occupational hazards and related literatures.Results The hazard quotient (HQ)of nasal lesions of the olfactory mucosa caused by hydrogen sulfide in paper-making industry was 36.3.The HQs of hyperplasia of nasal mucosa larynx and trachea caused by hydrogen chloride and cerebellar lesions caused by methyl chloride in organosilicon synthesis factory were 8.2 and 1.4 respectively.The HQs of decreased pulmonary function or increased severity of rhinitis and pneumonia caused by ammonia in pesticide factory were 1.2 and 1 .5 respectively.The HQ of impaired motor coordination caused by xylenes in chemical solvent factory was 2.4. The HQs of hyperplasia of nasal mucosa larynx and trachea caused by hydrogen chloride and nasal septum atrophy caused by hexavalent chromium in electroplating industry were 2.3-75.3 and 1 92.5 -25 675 respectively .The risk levels of paper-making,chemical and electroplating industries were all identified as high on the basis of evidence showing that HQs were all higher than 1 .The risk of lung cancer caused by hexavalent chromium in electroplating industry was 0.001 -0.1 647.The results of risk assessment were consistent with the reported literature.Conclusion Inhalation risk assessment model provided by USEPA can be used to assess the occupational health risks of paper -making, chemical and electroplating industries and have better identification ability.

Application of Gail model for assessment on breast cancer risk / 上海预防医学

To discuss the application value of the Gail model in evaluation of breast cancer risk in Huangpu District , Shanghai. [Methods] Case-control study was adopted for 156 cases of breast cancer and 198 age-matched controls .From the subjects were collected information of age , history of breast disease , family history , age at menarche , age at first birth , breast biopsy and race .Gail model was used to evaluate the risk of breast cancer for these women 5 years before. [Results] A total of 72 cases and 11 controls had high risk of breast cancer within 5 years.As the evaluation results of the diagnos-tic test, the sensitivity of the Gail model was 50.3 percent and the specificity 92.0 percent.The positive predictive value was 86.7 percent and the negative predictive value 64.0 percent (The Chi square was 60. 09 and P value 0.000, The McNemar Chi square was 43.90 and P value 0.000).The Youden's index was 0.423.The total agreement was 70.7 percent. [ Conclusion] The Gail model did not achieve the de-sired results for assessment of population with high risk of breast cancer .The tool needs to be further studied as a tool for screening population with high risk of breast cancer .

Risk factors of breast cancer in Asian women: a Meta-analysis / 中华流行病学杂志

Objective To evaluate the risk factors of breast cancer in Asian women and to provide evidences for establishing a risk assessment model. Methods Published studies concerning risk factors of breast cancer in Asian women were searched systemically and assessed by NOS (Newcastle-Ottawa Scale) items between 1995 and 2010. RevMan 4.2 software was used for data analysis and for calculating OR and its 95%CI on every risk factor. Results 27 studies including 403170 women were selected for Meta-analysis. According to NOS items, 20 studies were classified as A degree and 7 studies were evaluated as B degree. The risk factors of breast cancer and its pooled odds ratio values with statistical significance were as follows: 3.00 (95%CI: 1.68-5.36) when number of abortions≥3; 2.39 (95%CI: 1.78-3.21 ) when with family history of breast cancer; 1.54(95%CI: 1.30-1.82) when age at first live birth ≥30 (year); smoking was 1.50(95%CI: 1.03-2.20); 1.48(95%CI:1.20-1.83) with no live births; 1.29 (95%CI: 1.12-1.47) with no breast feeding; 1.26 (1.07-1.49)with age at menarche ≤12 (year) and 1.16(95%CI: 1.01-1.32) with alcohol drinking. Conclusion Number of abortions≥3, family history of breast cancer, age at first live birth ≥30 (year) ,smoking, no live births, no breast feeding, age at menarche ≤ 12 (year), and alcohol drinking were among the priorities in the establishment of breast cancer risk assessment model for Asian women.