Control study of the intelligent calculation method and the traditional calculation method in risk assessments of hospitalization / 中华危重病急救医学

Objective:To explore the accuracy of intelligent calculation (IC) method for risk assessment of hospitalization for patients, aiming to build a more advantageous risk assessment system.Methods:The "Search Engine" program was developed based on hospital information system (HIS) of the Fifth Center Hospital in Tianjin, which automatically captured patient information and generated nutritional risk screening 2002 (NRS 2002) score, Caprini thrombosis risk assessment model and Padua thrombosis risk assessment model for venous thromboembolism (VTE), the CHA 2DS 2-VASc for predicting stroke risk stratification in atrial fibrillation and the HAS-BLED for predicting bleeding risk in anticoagulated patients with atrial fibrillation. A randomized controlled trial was conducted. According to the applicable conditions of each risk assessment, 100 risk scores from "Search Engine" program belonged to each risk assessment were randomly selected, defined as the IC group. Manual scoring with the data of the same case at the same time, defined as the traditional calculation (TC) group, compared the consistency of the scores and the difference in time-consuming between the two groups. Results:The Bland-Altman plots showed that the 95% limits of agreement (95% LoA) of NRS 2002 score, Caprini score, Padua score, CHA 2DS 2-VASc score and HAS-BLED score was -0.46 to 0.41, -0.49 to 0.52, -0.50 to 0.41, -0.67 to 0.60, -0.44 to 0.43, respectively, all P > 0.05. In this study, the Bland-Altman plot showed that 95%, 96%, 97%, 97%, 95% plots fell within the 95% LoA in NRS 2002 score, Caprini score, Padua score, wwCHA 2DS 2-VASc score and HAS-BLED score by the two methods, respectively. The all plots of 95% LoA were within the clinically acceptable range (-0.5 to 0.5 scores). The time-consuming of NRS 2002 score, Caprini score, Padua score, CHA 2DS 2-VASc score and HAS-BLED score in IC group were significantly shorter than those in TC group [0.72 (0.71, 0.73) seconds vs. 361.02 (322.41, 361.02) seconds, 0.72 (0.72, 0.73) seconds vs. 196.68 (179.99, 291.20) seconds, 0.72 (0.72, 0.73) seconds vs. 105.75 (92.32, 114.70) seconds, 0.72 (0.71, 0.72) seconds vs. 72.66 (56.24, 84.20) seconds, 0.72 (0.71, 0.72) seconds vs. 51.30 (38.88, 57.15) seconds, respectively, all P < 0.001]. Conclusion:For the above five risk assessments, the TC method and IC method has good consistency in scores, and the IC method is faster, which has good application prospect for clinical application.

Validación del puntaje de riesgo TIMI como predictor de mortalidad en pacientes chilenos con infarto agudo al miocardio con supradesnivel de ST / Prediction of hospital mortality of ST elevation myocardial infarction using TIMI score

Background: Thrombolysis in myocardial infarction risk score (TIMI-RS) was designed to predict early mortality in patients with a ST elevation acute myocardial infarction (STEAMI). Aim: To evaluate the predictive capacity for hospital mortality of TIMI-RS. Material and Methods: Patients with ≤ 12-hour evolution STEAMI were selected from a prospective registry of all patients hospitalized in our coronary unity within January 1988 and December 2005. Observed mortality was analyzed according to TIMI-RS and its predictive capacity was estimated. Results: We analyzed 1125 consecutive patients aged 61 ± 13 years (76% men). Fifty one percent were smokers, 47% hypertensive and 40% had a history of angina. Fifty eight percent of patients underwent reperfusion therapy. Most patients had TIMI-RS scores ≤ 5 points and only 3.6% had scores ≥ 10 points. Overall mortality was 14.8% and there was an 80% concordance between observed mortality and that predicted with the TIMI-RS score. The area under the curve for the receiver operating characteristic (ROC) curve was 0.7. Conclusions: TIMI-RS was acceptably useful to predict in-hospital mortality in this group of patients with STEAMI. Differences between the observed and originally predicted mortality are explained by the clinical profile and therapeutic protocols applied to patients in different studies. Thus, caution needs to be taken when interpreting the risk associated to a specific score, particularly within non-reperfused patients whose risk might be underestimated.

Protocolo de acolhimento com classificação de risco em pediatria: confiabilidade interobservadores / Care protocols with risk classification in pediatrics: inter-observer reliability

Resumo Objetivo Analisar a confiabilidade interobservadores da segunda edição do protocolo de Acolhimento com Classificação de Risco em Pediatria, na prática clínica de urgência/emergência. Métodos Estudo metodológico, desenvolvido por meio da confiabilidade interobservadores de dois Enfermeiros Classificadores Interobservadores Treinados (ECIT) e de dois ECI Não Treinados (ECINT) com a pesquisadora, totalizando 400 classificações. Dados analisados utilizando-se do Coeficiente Kappa, com Intervalo de Confiança (IC) de 95%. Resultados Predomínio de 80,0% de pacientes classificados como menor urgência (verde-50,7%) e não urgente (azul-29,3%); revelou-se substancial "quase perfeita" concordância entre os enfermeiros e a pesquisadora (Kappa entre 0,62 e 1,0). Houve "quase perfeita" concordância entre ECIT-2 e pesquisadora (Kappa 1,0), ECINT-2 e pesquisadora (Kappa 0,887) e ECIT-1 e pesquisadora (Kappa 0,725). Houve substancial concordância entre ECINT-1 e pesquisadora (Kappa 0,619). Conclusão O Protocolo de ACCR em Pediatria é uma tecnologia confiável para direcionar enfermeiros à classificação de risco em situações de urgência/emergência pediátrica.

Abstract Objective To analyze the inter-observer reliability of the second edition of the Care protocols with risk classification in pediatrics, in the clinical practice of urgent/emergency care. Method Methodological study, developed through assessment of the inter-observer reliability of two Trained Inter-observers Triage Nurses (TITN) and two Untrained ITNs (UITN) with the researcher, with a total of 400 classifications. Data was analyzed using the Kappa Coefficient, with a 95% Confidence Interval (CI). Results A total of 80.0% of patients were classified as standard(green-50.7%) and non-urgent (blue-29.3%); substantial and "almost perfect" agreement between the nurses and the researcher (Kappa between 0.62 and 1.0) was found. "Almost perfect" agreement was found between TITN-2 and the researcher (Kappa 1.0), UITN-2 and the researcher (Kappa 0.877) and TITN-1 and the researcher (Kappa 0.725). Substantial agreement was found between UITN-1 and the researcher (Kappa 0.619). Conclusion Care protocols with risk classification in pediatrics is a reliable technology to guide nurses in the triage of patients in pediatric emergency/urgent care situations.

Feasibility of the 2014 European guidelines risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy in Chinese patients / 中华心血管病杂志

Objective@#Exploring the feasibility of the 2014 European Society of Cardiology(ESC)guideline′s risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM Risk-SCD) in Chinese patients.@*Methods@#The study population consisted of a consecutive cohort of 172 Chinese patients with HCM without prior sudden cardiac death (SCD) event who were in patients in Nanjing Drum Tower Hospital from December 2010 to October 2015.The endpoint event was a composite of SCD and appropriate implantable cardioverter-defibrillator (ICD) therapy.Clinical data were collected to calculate the 5-year SCD risk using the HCM Risk-SCD formula and to observe the actual risk during the follow-up.Receiver operating characteristic curves (ROC) and the area under curve (AUC) were calculated for the HCM Risk-SCD and risk stratification methods of the 2011 American Heart Association (AHA) guideline.@*Results@#During follow-up of (2.69±1.36) years, five patients achieved the endpoint event.The predicated rate of SCD event using HCM Risk-SCD was (2.36±1.73)%, (1.93±0.78)%, (5.18±0.65)%, (8.77±2.38)% for all patients, low-risk group, medium-risk group and high-risk group respectively.However, the actual rate of SCD event was 2.91%, 1.27%, 25.00% and 14.29%, respectively.The AUC of 2014 ESC guideline and 2011 AHA guidelinewas 0.93(95%CI 0.85-1.00) vs. 0.87(95%CI 0.75-0.98).@*Conclusion@#The predicated rate of SCD event calculated by HCM Risk-SCD is lower than actual rate of SCD, but the prediction efficiency and indication for ICD implantation of HCM Risk-SCD are better than that of 2011 AHA guideline.

Insufficient regulatory supervision prior to release of genetically modified crops for commercial cultivation in India.

(1) Do we need GM crops? No. We have far better alternatives such as integrated pest management (IPM), biopesticides and appropriate agro-practices including organic farming for almost all crops. IPM is a part of the country’s stated national agriculture policy. It has been shown to be effective but is not being used. (2) Was appropriate risk assessment carried out in the case of the Bt-cotton crops that have been released? No. For example, our present system of testing for allergenicity does not take into account recent work (e.g., papers in this area – a paper titled “Allergic potential of novel foods” in the Proceedings of the Nutrition Society, volume 64, issue No.4, pp 487–490 of November 2005; a paper titled “Allergenicity Assessment of Genetically Modifi ed Crops – What makes sense?” in Nature Biotechnology of January 2008, volume 26, pp 73–81; a paper titled “Transgenic expression of bean alpha-amylase inhibitor in peas results in altered structure and immunogenecity” in Journal of Agricultural Food Chemistry, 2005, volume 53, pp 9023–9030). The Annexure lists 29 tests relevant to the release of GM crops. Only a few have been done for Bt-cotton and GM crops in the pipeline, and that too inadequately (see item 5 below).

A study on the concentration and health risk of trihalomethanes in drinking water / 예방의학회지

This study was conducted as a nationwide survey in Korea to determine the THM (trihalomethane) concentration levels in the drinking water of 14 selected cities. The survey was undertaken in one city (Kwangju) during September and October of 1988 and 14 cities in January through February of 1988. The results were as follows: 1. The KMnO4 consumption was 10.6 mg/l - 11.6 mg/l in Pusan and Ulsan, exceeding the drinking water standard of 10 mg/l. Pusan, Inchon, Kwangju, Ulsan, Mokpo and Junju areas also exceeded the ammonia nitrate standard of 0.5 mg/l, Other tap waters surveyed were detected below the drinking water standards. 2. The THM concentrations of tap water measured in January and February of 1989 were detected in the range 1.20 microgram/l - 150.8 microgram/l. 3. In the comparative study of the THM concentration of tap water measured in the Kwangju area during September and October of 1988, the average THM concentration of 145.63 +/- 70.72 microgram/l showed a sifford increase compared to that of 23.8 +/- 8.31 microgram/l surveyed in January and February 1989. 4. The proportion of the four THM compounds found in tap water was bromoform, 47%; chloroform, 30%; chlordibromomethane, 13%; and dichlorobromomethane, 10%. 5. Since the results indicate that the concentration of bromoform was 2 - 10 times higher than that of chloroform measured in the seaside district of Pusan, Ulsan and Cheju Island, it is reasonable to assume that the raw water was somehow influenced by seawater. 6. The average lifetime cancer rate of the population exposed to chloroform measured in the surveyed areas was 17 cancer incidences per 1 million population. From the above results, the existence of THM in the distribution systems seems to be inevitable, since chlorine disinfection is performed in water treatment plants in our country. There seems to be a trend of increasing. THM concentrations due to the contamination of raw water. In order to establish any form of regulations, health risk assessment is an imminent subject.