Search results for: risk stratification tool

Authors: Shreya Saxena

Abstract:

Background: Choledocholithiasis is a common complication of gallstone disease. Risk scoring systems exist to guide the need for further imaging or endoscopy in managing choledocholithiasis. We completed an audit to review the American Society for Gastrointestinal Endoscopy (ASGE) scoring system for prediction and management of choledocholithiasis against the current practice at a tertiary hospital to assess its utility in resource optimisation. We have now conducted a cost focused sub-analysis on patients categorized high-risk for choledocholithiasis according to the guidelines to determine any associated cost benefits. Method: Data collection from our prior audit was used to retrospectively identify thirteen patients considered high-risk for choledocholithiasis. Their ongoing management was mapped against the guidelines. Individual costs for the key investigations were obtained from our hospital financial data. Total cost for the different management pathways identified in clinical practice were calculated and compared against predicted costs associated with recommendations in the guidelines. We excluded the cost of laparoscopic cholecystectomy and considered a set figure for per day hospital admission related expenses. Results: Based on our previous audit data, we identified a77% positive predictive value for the ASGE risk stratification tool to determine patients at high-risk of choledocholithiasis. 47% (6/13) had an magnetic resonance cholangiopancreatography (MRCP) prior to endoscopic retrograde cholangiopancreatography (ERCP), whilst 53% (7/13) went straight for ERCP. The average length of stay in the hospital was 7 days, with an additional day and cost of £328.00 (£117 for ERCP) for patients awaiting an MRCP prior to ERCP. Per day hospital admission was valued at £838.69. When calculating total cost, we assumed all patients had admission bloods and ultrasound done as the gold standard. In doing an MRCP prior to ERCP, there was a 130% increase in cost incurred (£580.04 vs £252.04) per patient. When also considering hospital admission and the average length of stay, it was an additional £1166.69 per patient. We then calculated the exact costs incurred by the department, over a three-month period, for all patients, for key investigations or procedures done in the management of choledocholithiasis. This was compared to an estimate cost derived from the recommended pathways in the ASGE guidelines. Overall, 81% (£2048.45) saving was associated with following the guidelines compared to clinical practice. Conclusion: MRCP is the most expensive test associated with the diagnosis and management of choledocholithiasis. The ASGE guidelines recommend endoscopy without an MRCP in patients stratified as high-risk for choledocholithiasis. Our audit that focused on assessing the utility of the ASGE risk scoring system showed it to be relatively reliable for identifying high-risk patients. Our cost analysis has shown significant cost savings per patient and when considering the average length of stay associated with direct endoscopy rather than an additional MRCP. Part of this is also because of an increased average length of stay associated with waiting for an MRCP. The above data supports the ASGE guidelines for the management of high-risk for choledocholithiasis patients from a cost perspective. The only caveat is our small data set that may impact the validity of our average length of hospital stay figures and hence total cost calculations.

Keywords: cost-analysis, choledocholithiasis, risk stratification tool, general surgery

Procedia PDF Downloads 68

Authors: Ms Azam Najafkouchak, David Todem, Dorothy Pathak, Pramod Pathak, Joseph Gardiner

Abstract:

Propensity score (PS) methods have recently become the standard analysis as a tool for the causal inference in the observational studies where exposure is not randomly assigned, thus, confounding can impact the estimation of treatment effect on the outcome. For the binary outcome, the effect of treatment on the outcome can be estimated by odds ratios, relative risks, and risk differences. However, using the different PS methods may give you a different estimation of the treatment effect on the outcome. Several methods of PS analyses have been used mainly, include matching, inverse probability of weighting, stratification, and covariate adjusted on PS. Due to the dangers of discretizing continuous variables (exposure, covariates), the focus of this paper will be on how the variation in cut-points or boundaries will affect the average treatment effect (ATE) utilizing the stratification of PS method. Therefore, we are trying to avoid choosing arbitrary cut-points, instead, we continuously discretize the PS and accumulate information across all cut-points for inferences. We will use Monte Carlo simulation to evaluate ATE, focusing on two PS methods, stratification and covariate adjusted on PS. We will then show how this can be observed based on the analyses of the data from a case-control study of breast cancer, the Polish Women’s Health Study.

Keywords: average treatment effect, propensity score, stratification, covariate adjusted, monte Calro estimation, breast cancer, case_control study

Procedia PDF Downloads 70

Authors: M. G. M. Khan, V. D. Prasad, D. K. Rao

Abstract:

In this manuscript, we discuss the problem of determining the optimum stratification of a study (or main) variable based on the auxiliary variable that follows a uniform distribution. If the stratification of survey variable is made using the auxiliary variable it may lead to substantial gains in precision of the estimates. This problem is formulated as a Nonlinear Programming Problem (NLPP), which turn out to multistage decision problem and is solved using dynamic programming technique.

Keywords: auxiliary variable, dynamic programming technique, nonlinear programming problem, optimum stratification, uniform distribution

Procedia PDF Downloads 294

Authors: Azam Najafkouchak, David Todem, Dorothy Pathak, Pramod Pathak, Joseph Gardiner

Abstract:

Propensity score (PS) methods have recently become the standard analysis tool for causal inference in observational studies where exposure is not randomly assigned. Thus, confounding can impact the estimation of treatment effect on the outcome. Due to the dangers of discretizing continuous variables, the focus of this paper will be on how the variation in cut-points or boundaries will affect the average treatment effect utilizing the stratification of the PS method. In this study, we will develop a new methodology to improve the efficiency of the PS analysis through stratification and simulation study. We will also explore the property of empirical distribution of average treatment effect theoretically, including asymptotic distribution, variance estimation and 95% confident Intervals.

Keywords: propensity score, stratification, emprical distribution, average treatment effect

Procedia PDF Downloads 63

Authors: Prandesha Govender, Chris Cloete

Abstract:

Purpose: The objective of the paper is to develop a tool for the evaluation of the financial risk of a shopping center. Methodology: Important factors that indicate the success of a shopping center were identified from the available literature. Weights were allocated to these factors and a risk rating was calculated for 505 shopping centers in the largest province in South Africa by taking the factor scores, factor weights, and category weights into account. The ratings for ten randomly selected shopping centers were correlated with consumer feedback and standardized against the ECAI (External Credit Assessment Institutions) data for the same centers. The ratings were also mapped to corporates with the same risk rating to provide a better intuitive assessment of the meaning of the inherent risk of each center. Results: The proposed risk tool shows a strong linear correlation with consumer views and can be compared to expert opinions, such as that of fund managers and REITs. Interpretation of the tool was also illustrated by correlating the risk rating of selected shopping centers to the risk rating of reputable and established entities. Conclusions: The proposed Shopping Centre Risk Tool, used in conjunction with financial inputs from the relevant center, should prove useful to an investor when the desirability of investment in or expansion, renovation, or purchase of a shopping center is being considered.

Keywords: risk, shopping centres, risk modelling, investment, rating tool, rating scale

Procedia PDF Downloads 79

Authors: Mohammed El-Arbi Khalfallah, Mohamed Lakhdar Hadji

Abstract:

Managing and controlling risk is a topic research in the world of finance. Before a risky situation, the stakeholders need to do comparison according to the positions and actions, and financial institutions must take measures of a particular market risk and credit. In this work, we study a model of risk measure in finance: Value at Risk (VaR), which is a new tool for measuring an entity's exposure risk. We explain the concept of value at risk, your average, tail, and describe the three methods for computing: Parametric method, Historical method, and numerical method of Monte Carlo. Finally, we briefly describe advantages and disadvantages of the three methods for computing value at risk.

Keywords: average value at risk, conditional value at risk, tail value at risk, value at risk

Procedia PDF Downloads 404

Authors: Mohamed Faslan

Abstract:

This paper describes how caste-based differentiation functions among the Southern Muslims of Sri Lanka despite Islamic egalitarian principles. Such differences are not promoted by religious teachings, mosques, or the various Islamic religious denominations. Instead, it underpins a hereditary, hierarchical stratification in social structure. Since Islam is against social stratification and promotes egalitarianism, what are the persuasive social structures that organize the existing caste system among Southern Muslims? To answer this puzzle, this paper discusses and analyses the caste system under these five subsections: ancestry; marriage; geography; mosque ownership or trustees; and occupation. The study of caste in Sri Lanka is generally compartmentalized into separate Sinhala and Tamil systems. Most caste studies have focused on the characteristics, upward mobility, or discrimination of specific castes in relation to other castes within ethnic systems. As an operational definition, in this paper, by “southern” or the south of Sri Lanka, I refer to the Kalutara, Galle and Matara Districts. This research was conducted in these three districts, and the respondents were selected purposively. Community history interviews were used as a tool for collecting information, and grounded theory used for analysis. Caste stratification among the Southern Muslims of Sri Lanka is directly connected to whether they are descended from Arab or South Indian ancestors. Arab ancestors are considered upper caste and South Indian ancestors are considered lower caste. Endogamy is the most serious driving factor keeping caste system functioning among Muslims while the other factors—geography, mosques, and occupations—work as supporting factors.

Keywords: caste, social stratification, Sri Lanka Muslims, endogamy

Procedia PDF Downloads 143

Authors: P. J. Moore-Jones

Abstract:

Emirati students studying at the University of the Emirates, one of three major public institutions of higher learning in the United Arab Emirates (UAE), have a wide demographic of faculty members teaching them an equally wide variety of courses. These faculty members bring with them their own cultural assumptions, methods, expectations, educational practices and use of language. The history of multiculturalism in the UAE coupled with the contemporary multiculturalism that exists in higher education Dubai create intriguing phenomena within the classroom. This study seeks to delve into students’ and faculty members’ perceptions of the social stratification that exist in this context. Data were collected via semi-structured interviews with both and analyzed from an interpretive perspective. Findings suggest the social stratification with is deeply-seeded in the multicultural history of the region and country are reflected in the everyday interworkings of education in modern day Dubai. The relevance of this research lies in that these findings can provide valuable insights into not only the attitudes and perceptions of these Emirati students might also be applicable to any of those student populations may exist.

Keywords: social stratification, intercultural competence, Dubai, United Arab Emirates

Procedia PDF Downloads 207

Authors: Thitaporn Thoopputra, Tipaporn Pongmesa, Shuchuen Li

Abstract:

Aims: To evaluate the application of non-invasive diabetes risk assessment tool in community pharmacy setting. Methods: Thai diabetes risk score was applied to assess individuals at risk of developing type 2 diabetes. Interactive computer-based risk screening (IT) and paper-based risk screening (PT) tools were applied. Participants aged over 25 years with no known diabetes were recruited in six participating pharmacies. Results: A total of 187 clients, mean aged (+SD) was 48.6 (+10.9) years. 35% were at high risk. The mean value of willingness-to-pay for the service fee in IT group was significantly higher than PT group (p=0.013). No significant difference observed for the satisfaction between groups. Conclusions: Non-invasive risk assessment tool, whether paper-based or computerized-based can be applied in community pharmacy to support the enhancing role of pharmacists in chronic disease management. Long term follow up is needed to determine the impact of its application in clinical, humanistic and economic outcomes.

Keywords: community pharmacy, intervention, prevention, risk assessment, type 2 diabetes

Procedia PDF Downloads 469

Authors: Mohamed Hamada Abdelkader Fayed

Abstract:

Background: To evaluate the diagnostic accuracy of (ADD-RS) with D-dimer as a screening test to exclude AAS. Methods: We conducted research for the studies examining the diagnostic accuracy of (ADD- RS)+ D-dimer to exclude the diagnosis of AAS, We searched MEDLINE, Embase, and Cochrane of Trials up to 31 December 2020. Results: We identified 3 studies using (ADD-RS) with D-dimer as a diagnostic tool for AAS, involving 3261 patients were AAS was diagnosed in 559(17.14%) patients. Overall results showed that the pooled sensitivities were 97.6 (95% CI 0.95.6, 99.6) at (ADD-RS)≤1(low risk group) with D-dimer and 97.4(95% CI 0.95.4,, 99.4) at (ADD-RS)>1(High risk group) with D-dimer., the failure rate was 0.48% at low risk group and 4.3% at high risk group respectively. Conclusions: (ADD-RS) with D-dimer was a useful screening test with high sensitivity to exclude Acute Aortic Syndrome.

Keywords: aortic dissection detection risk score, D-dimer, acute aortic syndrome, diagnostic accuracy

Procedia PDF Downloads 182

Authors: Jerry Szatko, Edan L. Jorgensen, Stacia Jorgensen

Abstract:

A crucial component to the success of any financial advising relationship is for the financial professional to understand the perceptions, preferences and thought-processes carried by the financial clients they serve. Armed with this information, financial professionals are more quickly able to understand how they can tailor their approach to best match the individual preferences and needs of each personal investor. Our research explores the use of a quantitative assessment tool in the financial services industry to assist in the identification of the personal investor’s consumer behaviors, especially in terms of financial risk tolerance, as it relates to their financial decision making. Through this process, the Unitifi Consumer Insight Tool (UCIT) was created and refined to capture and categorize personal investor financial behavioral categories and the financial personality tendencies of individuals prior to the initiation of a financial advisement relationship. This paper discusses the use of this tool to place individuals in one of four behavior-based financial risk tolerance categories. Our discoveries and research were aided through administration of a web-based survey to a group of over 1,000 individuals. Our findings indicate that it is possible to use a quantitative assessment tool to assist in predicting the behavioral tendencies of personal consumers when faced with consumer financial risk and decisions.

Keywords: behavior-based advising, financial relationship building, risk capacity based on behavior, risk tolerance, systematic way to assist in financial relationship building

Procedia PDF Downloads 136

Authors: Olakunle Felix Adekunle

Abstract:

Risk management is recognised as an essential tool to tackle the inevitable uncertainty associated with business and projects at all levels. But it frequently fails to meet expectations, with projects continuing to run late, over budget or under performing, and business is not gaining the expected benefits. The evident disconnect which often occurs between strategic vision and tactical project delivery typically arises from poorly defined project objectives and inadequate attention to the proactive management of risks that could affect those objectives. One of the main failings in the traditional approach to risk management arises from a narrow focus on the downside, restricted to the technical or operational field, addressing tactical threats to processes, performance or people. This shortcoming can be overcome by widening the scope of risk management to encompass both strategic risks and upside opportunities, creating an integrated approach which can bridge the gap between strategy and tactics. Integrated risk management addresses risk across a variety of levels in the organisation, including strategy and tactics, and covering both opportunity and threat. Effective implementation of integrated risk management can produce a number of benefits to the organisation which are not available from the typical limited-scope risk process. This paper explores how to expand risk management to deliver strategic advantage while retaining its use as a tactical tool.

Keywords: risk management, success, organization, strategy, project, tactis, vision

Procedia PDF Downloads 355

Authors: Govind Sharma, Bahni Ray

Abstract:

Ubiquitous nature of particle settling is governed by the presence of the surrounding fluid medium. Thermally stratified fluid alters the settling phenomenon of particles as well as their interactions. Direct numerical simulation (DNS) is carried out with an open-source library Immersed Boundary Adaptive Mesh Refinement (IBAMR) to quantify the fundamental mechanism based on Distributed Lagrangian Multiplier (DLM). The presence of background density gradient due to thermal stratification replaces the drafting-kissing-tumbling in a homogeneous fluid to drafting-kissing-separation behavior. Simulations are performed with a varying range of particle-fluid density ratios, and it is shown that the stratification effect on particle interactions varies with density ratio. It is observed that the combined role of buoyancy and inertia govern the physical mechanism of particle-particle interaction.

Keywords: direct numerical simulation, distributed lagrangian multiplier, rigidity constraint, sedimentation, stratification

Procedia PDF Downloads 99

Authors: Alexander Kelíšek, Denisa Janasová, Veronika Mitašová

Abstract:

Weak signals using is often associated with early warning. It is possible to find a link between early warning, respectively early problems detection and risk management. The idea of early warning is very important in the context of crisis management because of the risk prevention possibility. Weak signals are likened to risk symptoms. Nowadays, their usefulness as a tool of proactive problems solving is emphasized. Based on it, it is possible to use weak signals not only in strategic planning, project management, or early warning system, but also as a subsidiary element in risk management. The main question is how to effectively integrate weak signals into risk management. The main aim of the paper is to point out the possibilities of weak signals using in small and medium enterprises risk management.

Keywords: early warning system, weak signals, risk management, small and medium enterprises (SMEs)

Procedia PDF Downloads 382

Authors: Maha Mourad

Abstract:

Higher education in any competitive European economy should serve the new information society by increasing the supply of good quality education services and by creating good international brands in the international higher education market. Hence, continuous risk management techniques through higher educational reforms programs became one of the top priorities within the European Union to control the quality of higher education. Risk is higher education is studies by several researchers who agreed that the risk in higher education has a direct influence on continuity of quality education and research contribution. The focus of this research is to highlights the Internal Quality Assurance (IQA) activities in the Polish higher education system as a risk management tool used to control the quality of education. This paper presents a qualitative empirical analysis in 5 different universities in Poland. In addition, it aims to help in finding global practical and create benchmark for policy makers concerning the risk management techniques based on the Polish experience.

Keywords: education development, quality assurance, sustainability, european higher education

Procedia PDF Downloads 430

Authors: Francis Edum-Fotwe, Tony Thorpe, Charles Afetornu

Abstract:

Risk perception informs the outcome of how issues are responded to in either solving or overcoming a problem or improving a situation. Risk perception is established to be affected by some key factors reflecting in the varying ways in which work is done as well as the level of efficiency achieved. These factors potentially would influence risk perception to different extents. Such that if these factors are said to determine risk perception, how does a change in any affect risk perception. Since the ability to address risk is influenced by risk perception, establishing and developing awareness of that perception should enable construction professionals to make viable decisions. Any act to improve the construction industry cannot be overemphasised, considering its contribution to national development. A survey questionnaire was conducted in Ghana to elicit data that measures the risk perception and the essential factors as well as the necessary demographics of the respondents, who are construction professionals. This study finds out the sensitivity of the critical factors of risk perception. It uses the Relative Importance Index analysis tool to investigate the differential effect of these essential factors on risk perception, such that a slight change in a factor makes a significant change in risk perception, having established that it is influenced by essential factors. The findings can lead to policy formation for employers on the prioritisation factors to undertake to improve the risk perception of employees. Other areas in which this study can be useful in team formation for sensitive and complex projects where efficient risk management is critical.

Keywords: construction industry, risk, risk management, risk perception

Procedia PDF Downloads 103

Authors: Christian Skowronski, Andrew Shanholtzer, Brent Yelton, Muayad Almahariq, Daniel J. Krauss

Abstract:

Prostate cancer has the third highest incidence rate and is the second leading cause of cancer death for men in the United States. Of the diagnostic tools available for intermediate-risk prostate cancer, magnetic resonance imaging (MRI) provides superior soft tissue delineation serving as a valuable tool for both diagnosis and treatment planning. Currently, there is minimal data regarding the practical utility of MRI for evaluation of intermediate-risk prostate cancer. As such, the National Comprehensive Cancer Network’s guidelines indicate MRI as optional in intermediate-risk prostate cancer evaluation. This project aims to elucidate whether MRI affects radiation treatment decisions for intermediate-risk prostate cancer. This was a retrospective study evaluating 210 patients with intermediate-risk prostate cancer, treated with definitive radiotherapy at our institution between 2019-2020. NCCN risk stratification criteria were used to define intermediate-risk prostate cancer. Patients were divided into two groups: those with pretreatment prostate MRI, and those without pretreatment prostate MRI. We compared the use of external beam radiotherapy, brachytherapy alone, brachytherapy boost, and androgen depravation therapy between the two groups. Inverse probability of treatment weighting was used to match the two groups for age, comorbidity index, American Urologic Association symptoms index, pretreatment PSA, grade group, and percent core involvement on prostate biopsy. Wilcoxon Rank Sum and Chi-squared tests were used to compare continuous and categorical variables. Of the patients who met the study’s eligibility criteria, 133 had a prostate MRI and 77 did not. Following propensity matching, there were no differences between baseline characteristics between the two groups. There were no statistically significant differences in treatments pursued between the two groups: 42% vs 47% were treated with brachytherapy alone, 40% vs 42% were treated with external beam radiotherapy alone, 18% vs 12% were treated with external beam radiotherapy with a brachytherapy boost, and 24% vs 17% received androgen deprivation therapy in the non-MRI and MRI groups, respectively. This analysis suggests that pretreatment MRI does not significantly impact radiation therapy or androgen deprivation therapy decisions in patients with intermediate-risk prostate cancer. Obtaining a pretreatment prostate MRI should be used judiciously and pursued only to answer a specific question, for which the answer is likely to impact treatment decision. Further follow up is needed to correlate MRI findings with their impacts on specific oncologic outcomes.

Keywords: magnetic resonance imaging, prostate cancer, definitive radiotherapy, gleason score 7

Procedia PDF Downloads 55

Authors: Puntarikorn Rungrattanakasin

Abstract:

Objectives: To develop the trigger tool to warn about the risk of bleeding as an adverse event from warfarin drug usage during admission in Medical Wards of Chumphae Hospital. Methods: A retrospective study was performed by reviewing the medical records for the patients admitted between June 1st,2020- May 31st, 2021. ADEs were evaluated by Naranjo’s algorithm. The international normalized ratio (INR) and events of bleeding during admissions were collected. Statistical analyses, including Chi-square test and Reciever Operating Characteristic (ROC) curve for optimal INR threshold, were used for the study. Results: Among the 139 admissions, the INR range was found to vary between 0.86-14.91, there was a total of 15 bleeding events, out of which 9 were mild, and 6 were severe. The occurrence of bleeding started whenever the INR was greater than 2.5 and reached the statistical significance (p <0.05), which was in concordance with the ROC curve and yielded 100 % sensitivity and 60% specificity in the detection of a bleeding event. In this regard, the INR greater than 2.5 was considered to be an optimal threshold to alert promptly for bleeding tendency. Conclusions: The INR value of greater than 2.5 (>2.5) would be an appropriate trigger tool to warn of the risk of bleeding for patients taking warfarin in Chumphae Hospital.

Keywords: trigger tool, warfarin, risk of bleeding, medical wards

Procedia PDF Downloads 113

Authors: Bouharati Lokman, Bouharati Imen, Bouharati Khaoula, Bouharati Oussama, Bouharati Saddek

Abstract:

Ionizing radiation exposure is an established cancer risk factor. Compared to other common environmental carcinogens, it is relatively easy to determine organ-specific radiation dose and, as a result, radiation dose-response relationships tend to be highly quantified. Nevertheless, there can be considerable uncertainty about questions of radiation-related cancer risk as they apply to risk protection and public policy, and the interpretations of interested parties can differ from one person to another. Examples of tools used in the analysis of the risk of developing cancer due to radiation are characterized by uncertainty. These uncertainties are related to the history of exposure and different assumptions involved in the calculation. We believe that the results of statistical calculations are characterized by uncertainty and imprecision. Having regard to the physiological variation from one person to another. In this study, we develop a tool based on fuzzy logic inference. As fuzzy logic deals with imprecise and uncertain, its application in this area is adequate. We propose a fuzzy system with three input variables (age, sex and body attainable cancer). The output variable expresses the risk of infringement rate of each organ. A base rule is established from recorded actual data. After successful simulation, this will instantly predict the risk of infringement rate of each body following chronic exposure to 0.1 Gy.

Keywords: radiation exposure, cancer, modeling, fuzzy logic

Procedia PDF Downloads 272

Authors: Rinaldo Diricchardi

Abstract:

In this paper, author theoretically and empirically explores the ethnic identity of the descendants of the Indian travelers in Slovenia Sinti, who are in modern time, for the researchers, still a "tabula rasa". He investigates the extent to which Sinti ethnic particular identities (e.g. Sinti chiefs, Sinti’s individual political structure…), the Sinti language (dialect, which is topic and it is not allowed to be spoken in public), culture and habits still in the impact of anachronism, moreover, to what extent the community is still “tabula rasa” (to non–Sinti population). The relationships within the Sinti entity: "in se–intra se" is a mirror of duality of the relation of "extra se". Is it possible that the concepts of social/economical relationships are reflecting the Sinti community, moreover, the possible influence of minority from outside to inside? Is the stratification of their ethnicity and their language ethnicism? In addition, is the result of stratification of discourse still inherited and discounted the Indian caste system? In present article, author uses the word Gypsy with high respect and with a large measure of prudentiality, without negative connotations. At the first Gypsy World Congress in 1971 in London the Sinti did not accept unification with Romani, but Sinti and others Gypsies still keep the name Gypsy/Romanichals, Gypsy/Kale, Gypsy/Manouches, Gypsy/Manoesje, Gypsy/Xoraxano, Gypsy/Machaways and Gypsy/Kalderashe. In addition, all of the European documents taken into account respect and use the name Gypsy.

Keywords: Sinti, Gypsy, identity, stratification, inclusion, exclusion

Procedia PDF Downloads 340

Authors: Saeed Pourhassan, Nastaran Maghbouli

Abstract:

Statement of the problem: The relationship between obesity and cardiovascular diseases has been studied widely(1). The distribution of fat tissue gained attention in relation to cardiovascular risk factors during lang-time research (2). American College of Cardiology/American Heart Association (ACC/AHA) is widely and the most reliable tool to be used as a cardiovascular risk (CVR) assessment tool(3). This study aimed to determine which anthropometric index is better in discrimination of high CVR patients from low risks using ACC/AHA score in addition to finding the best index as a CVR predictor among both genders in different races and countries. Methodology & theoretical orientation: The literature in PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched by two independent investigators using the keywords "anthropometric indices," "cardiovascular risk," and "obesity." The search strategy was limited to studies published prior to Jan 2022 as full-texts in the English language. Studies using ACC/AHA risk assessment tool as CVR and those consisted at least 2 anthropometric indices (ancient ones and novel ones) are included. Study characteristics and data were extracted. The relative risks were pooled with the use of the random-effect model. Analysis was repeated in subgroups. Findings: Pooled relative risk for 7 studies with 16,348 participants were 1.56 (1.35-1.72) for BMI, 1.67(1.36-1.83) for WC [waist circumference], 1.72 (1.54-1.89) for WHR [waist-to-hip ratio], 1.60 (1.44-1.78) for WHtR [waist-to-height ratio], 1.61 (1.37-1.82) for ABSI [A body shape index] and 1.63 (1.32-1.89) for CI [Conicity index]. Considering gender, WC among females and WHR among men gained the highest RR. The heterogeneity of studies was moderate (α²: 56%), which was not decreased by subgroup analysis. Some indices such as VAI and LAP were evaluated just in one study. Conclusion & significance: This meta-analysis showed WHR could predict CVR better in comparison to BMI or WHtR. Some new indices like CI and ABSI are less accurate than WHR and WC. Among women, WC seems to be a better choice to predict cardiovascular disease risk.

Keywords: obesity, cardiovascular disease, risk assessment, anthropometric indices

Procedia PDF Downloads 74

Authors: K. Sekulová, M. Šimon

Abstract:

This article focuses on upper-extremity musculoskeletal disorders risk assessment model at workplace. In this model are used risk factors that are responsible for musculoskeletal system damage. Based on statistic calculations the model is able to define what risk of MSD threatens workers who are under risk factors. The model is also able to say how MSD risk would decrease if these risk factors are eliminated.

Keywords: ergonomics, musculoskeletal disorders, occupational diseases, risk factors

Procedia PDF Downloads 503

Authors: Herng-Sheng Lee, Chi-Yi Chen, Wan-Ting Huang, Li-Jen Chang, Solomon Chih-Cheng Chen, Hsin-Yi Yang

Abstract:

A variety of gastrointestinal disorders, such as Crohn’s disease, ulcerative colitis, and coeliac disease, are recognized as risk factors for osteoporosis and osteoporotic fractures. One recent study suggests that individuals with irritable bowel syndrome (IBS) might also be at increased risk of osteoporosis and osteoporotic fractures. Up to now, the association between IBS and the risk of fractures at different anatomic sites occurrences is not completely clear. We conducted a population-based cohort analysis to investigate the fracture risk of IBS in comparison with non-IBS group. We identified 29,505 adults aged ≥ 20 years with newly diagnosed IBS using the Taiwan National Health Insurance Research Database in 2000-2012. A comparison group was constructed of patients without IBS who were matched according to gender and age. The occurrence of fracture was monitored until the end of 2013. We analyzed the risk of fracture events to occur in IBS by using Cox proportional hazards regression models. Patients with IBS had a higher incidence of osteoporotic fractures compared with non-IBS group (12.34 versus 9.45 per 1,000 person-years) and an increased risk of osteoporotic fractures (adjusted hazard ratio [aHR] = 1.27, 95 % confidence interval [CI] = 1.20 – 1.35). Site specific analysis showed that the IBS group had a higher risk of fractures for spine, forearm, hip and hand than did the non-IBS group. With further stratification for gender and age, a higher aHR value for osteoporotic fractures in IBS group was seen across all age groups in males, but seen in elderly females. In addition, female, elderly, low income, hypertension, coronary artery disease, cerebrovascular disease, and depressive disorders as independent osteoporotic fracture risk factors in IBS patients. The IBS is considered as a risk factor for osteoporotic fractures, particularly in female individuals and fracture sites located at the spine, forearm, hip and hand.

Keywords: irritable bowel syndrome, fracture, gender difference, longitudinal health insurance database, public health

Procedia PDF Downloads 199

Authors: Jemini Vyas, Oluwatobi Adeyoe, Jenny Branagan, Chandran Tanabalan, John Beatty, Aakash Pai

Abstract:

Introduction: The development of robotic surgery has accelerated centralisation to tertiary centres, where robotic radical prostatectomy (RP) is offered. The purpose of concentrating treatment in high volume specialist centres is to improve the quality of care and patient outcomes. The aim of this study was to assess the impact on clinical outcomes of centralisation for locally diagnosed patients undergoing RP. Methods: Clinical outcomes for 169 consecutive laparoscopic & open RP pre-centralisation were retrospectively compared with 50 consecutive robotic RP conducted over a similar period post-centralisation. Preoperative risk stratification and time to surgery were collected. Perioperative outcomes, including length of stay (LOS) and complications, were collated. Post-operative outcomes, including erectile dysfunction (ED), biochemical recurrence (BCR), and urinary continence, were assessed. Results: Preoperative risk stratification showed no difference between the two groups. The median time from diagnosis to treatment was similar between the two groups (pre-centralisation, 121 days, post-centralisation, 117 days). The mean length of stay (pre-centralisation, 2.1 days, post-centralisation, 1.6 days) showed no significant difference (p=0.073). Proportion of overall complications (pre-centralisation, 11.4%, post-centralisation, 8.7%) and complications, above Clavien-Dindo 2, were similar between the two groups (pre-centralisation1.2%, post-centralisation 2.2%). Post operative functional parameters, including continence and ED, were comparable. Five-year BCR free rate was 78% for the pre-centralisation group and 79% for the post centralisation group. Conclusion: For our cohort of patients, clinical outcomes have remained static during centralisation. It is imperative that centralisation is accompanied by increased capacity, streamlining of pathways, and training to ensure that improved quality of care is achieved. Our institution has newly acquired a robot, and prospectively studying this data may support the reversal of centralisation for RP surgery.

Keywords: prostate, cancer, prostatectomy, clinical

Procedia PDF Downloads 60

Authors: Eva Kirzner

Abstract:

Based on outcome studies published over the past two decades, in 2018, the ACC/AHA published new guidelines for the management of hypercholesterolemia that incorporate the use of coronary artery calcium (CAC) scanning as a decision tool for ascertaining which patients may benefit from statin therapy. This use is based on the recognition that the absence of calcium on CAC scanning (i.e., a CAC score of zero) usually signifies the absence of significant atherosclerotic deposits in the coronary arteries. Specifically, in patients with a high risk for atherosclerotic cardiovascular disease (ASCVD), initiation of statin therapy is generally recommended to decrease ASCVD risk. However, among patients with intermediate ASCVD risk, the need for statin therapy is less certain. However, there is a need for new outcome studies that provide evidence that the management of hypercholesterolemia based on these new ACC/AHA recommendations is safe for patients. Based on a Pub-Med and Google Scholar literature search, four relevant population-based or patient-based cohort studies that studied the relationship between CAC scanning, risk assessment or mortality, and statin therapy that were published between 2017 and 2021 were identified (see references). In each of these studies, patients were assessed for their baseline risk for atherosclerotic cardiovascular disease (ASCVD) using the Pooled Cohorts Equation (PCE), an ACC/AHA calculator for determining patient risk based on assessment of patient age, gender, ethnicity, and coronary artery disease risk factors. The combined findings of these four studies provided concordant evidence that a zero CAC score defines patients who remain at low clinical risk despite the non-use of statin therapy. Thus, these new studies confirm the use of CAC scanning as a safe tool for reducing the potential overuse of statin therapy among patients with zero CAC scores. Incorporating these new data suggest the following best practice: (1) ascertain ASCVD risk according to the PCE in all patients; (2) following an initial attempt trial to lower ASCVD risk with optimal diet among patients with elevated ASCVD risk, initiate statin therapy for patients who have a high ASCVD risk score; (3) if the ASCVD score is intermediate, refer patients for CAC scanning; and (4) and if the CAC score is zero among the intermediate risk ASCVD patients, statin therapy can be safely withheld despite the presence of an elevated serum cholesterol level.

Keywords: cholesterol, cardiovascular disease, statin therapy, coronary calcium

Procedia PDF Downloads 85

Authors: Mohammad H. Yarmohammadian, Fatemeh Rezaei

Abstract:

Introduction: Improving patient safety in health systems is one of the main priorities in healthcare systems, so clinical risk management in organizations has become increasingly significant. Although several tools have been developed for clinical risk management, each has its own limitations. Aims: This study aims to develop a comprehensive tool that can complete the limitations of each risk assessment and management tools with the advantage of other tools. Methods: Procedure was determined in two main stages included development of an initial model during meetings with the professors and literature review, then implementation and verification of final model. Subjects and Methods: This study is a quantitative − qualitative research. In terms of qualitative dimension, method of focus groups with inductive approach is used. To evaluate the results of the qualitative study, quantitative assessment of the two parts of the fourth phase and seven phases of the research was conducted. Purposive and stratification sampling of various responsible teams for the selected process was conducted in the operating room. Final model verified in eight phases through application of activity breakdown structure, failure mode and effects analysis (FMEA), healthcare risk priority number (RPN), root cause analysis (RCA), FT, and Eindhoven Classification model (ECM) tools. This model has been conducted typically on patients admitted in a day-clinic ward of a public hospital for surgery in October 2012 to June. Statistical Analysis Used: Qualitative data analysis was done through content analysis and quantitative analysis done through checklist and edited RPN tables. Results: After verification the final model in eight-step, patient's admission process for surgery was developed by focus discussion group (FDG) members in five main phases. Then with adopted methodology of FMEA, 85 failure modes along with its causes, effects, and preventive capabilities was set in the tables. Developed tables to calculate RPN index contain three criteria for severity, two criteria for probability, and two criteria for preventability. Tree failure modes were above determined significant risk limitation (RPN > 250). After a 3-month period, patient's misidentification incidents were the most frequent reported events. Each RPN criterion of misidentification events compared and found that various RPN number for tree misidentification reported events could be determine against predicted score in previous phase. Identified root causes through fault tree categorized with ECM. Wrong side surgery event was selected by focus discussion group to purpose improvement action. The most important causes were lack of planning for number and priority of surgical procedures. After prioritization of the suggested interventions, computerized registration system in health information system (HIS) was adopted to prepare the action plan in the final phase. Conclusion: Complexity of health care industry requires risk managers to have a multifaceted vision. Therefore, applying only one of retrospective or prospective tools for risk management does not work and each organization must provide conditions for potential application of these methods in its organization. The results of this study showed that the integrated clinical risk management model can be used in hospitals as an efficient tool in order to improve clinical governance.

Keywords: failure modes and effective analysis, risk management, root cause analysis, model

Procedia PDF Downloads 214

Authors: Mara Balestrieri, Clara Pusceddu

Abstract:

Issues relating to the destructive phenomena that can damage people and goods have returned to the centre of debate in Italy with the increase in catastrophic episodes in recent years in a country which is highly vulnerable to hydrological risk. Environmental factors and geological and geomorphological territorial characteristics play an important role in determining the level of vulnerability and the natural tendency to risk. However, a territory has also been subjected to the requirements of and transformations of society, and this brings other relevant factors. The reasons for the increase in destructive phenomena are often to be found in the territorial development models adopted. Stewardship of the landscape and management of risk are related issues. This study aims to summarize the most relevant elements about this connection and at the same time to clarify the role of environmental risk assessment as a tool to aid in the sustainable management of landscape. How planners relate to this problem and which aspects should be monitored in order to prepare responsible and useful interventions?

Keywords: assessment, landscape, risk, planning

Procedia PDF Downloads 432

Authors: Noor A. Hakim

Abstract:

Several studies in the developed countries investigated the prevalence of diabetes and obesity among individuals from different socioeconomic levels and suggested lower rates among the higher socioeconomic groups. However, studies evaluating diabetes risk and prevalence of obesity among the population of middle- to high-income status in developing countries are limited. The aim of this study is to evaluate the risk of developing type-2 diabetes mellitus (T2DM) and the weight status of female students in private universities in Jeddah City, Saudi Arabia. This is a cross-sectional study of 121 female students aged ≤ 25 years old was conducted; participants were recruited from two private universities. Diabetes risk was evaluated using the Finnish Diabetes Risk Score. Anthropometric measurements were assessed, and body-mass-index (BMI) was calculated. Diabetes risk scores indicated that 35.5% of the female students had a slightly elevated risk, and 10.8% had a moderate to high risk to develop T2DM. One-third of the females (29.7%) were overweight or obese. The majority of the normal weight and underweight groups were classified to have a low risk of diabetes, 22.2% of the overweight participants were classified to have moderate to high risk, and over half of the obese participants (55.5%) were classified to be at the moderate to high-risk category. Conclusions: Given that diabetes risk is alarming among the population in Saudi Arabia, healthcare providers should utilize a simple screening tool to identify high-risk individuals and initiate diabetes preventive strategies to prevent, or delay, the onset of T2DM and improve the quality of life.

Keywords: risk of type 2 diabetes, weight status, college students, socioeconomic status

Procedia PDF Downloads 144

Authors: Lamia Hammadi, Abdellah Ait Ouhman, Aomar Ibourk

Abstract:

It is widely assumed that the case of Customs Supply Chain is classified as a complex system, due to not only the variety and large number of actors, but also their complex structural links, and the interactions between these actors, that’s why this system is subject to various types of Risks. The economic, political and social impacts of those risks are highly detrimental to countries, businesses and the public, for this reason, Risk management in the customs supply chain is becoming a crucial issue to ensure the sustainability, security and safety. The main characteristic of customs risk management approach is determining which goods and means of transport should be examined? To what extend? And where future compliance resources should be directed? The purposes of this article are, firstly to deal with the concept of customs supply chain, secondly present our risk management approach based on Cross Activity Based Costing (ABC) Method as an interactive tool to support decision making in customs risk management. Finally, analysis of case study of Moroccan customs to putting theory into practice and will thus draw together the various elements of a structured and efficient risk management approach.

Keywords: cross ABC method, customs supply chain, risk, risk management

Procedia PDF Downloads 344

Authors: Abderrahmen Aloulou, Younes Boujelbene

Abstract:

The current paper displays a new method of extracting information content from options prices by eliminating biases caused by daily variation of contract maturity. Based on Kernel regression tool, this non-parametric technique serves to obtain a spectrum of interpolated options with constant maturity horizons from negotiated optional contracts on the S&P TSX 60 index. This method makes it plausible to compare daily risk neutral densities from which extracting time continuous indicators allows the detection traders attitudes’ evolution, such as, belief homogeneity, asymmetry and extreme Risk Perception. Our findings indicate that the applied method contribute to develop effective trading strategies and to adjust monetary policies through controlling trader’s reactions to economic and monetary news.

Keywords: risk neutral densities, kernel, constant maturity horizons, homogeneity, asymmetry and extreme risk perception

Procedia PDF Downloads 452