The Performance Assessment of Self-Care Skills to Predict Adverse Events Post-Discharge

Background. The Performance Assessment of Self-Care Skills (PASS) is a standardized assessment of the ability to perform daily activities. Purposes. This preliminary exploratory study aimed to 1) explore the ability of four PASS tasks to predict adverse events (readmissions and injuries) in older adults following hospitalization; 2) compare PASS's predictive validity to that of a generic tool (SMAF) and OT clinical judgement. Method.Twenty-two older patients were assessed in hospital at discharge and at home one week later. Adverse events were documented for six months post-discharge. Sensitivity and specificity analyses (ROC curves, Fisher's exact tests) were performed. Findings. Two PASS tasks (telephone, medication), the SMAF-Social and OT clinical judgement could identify individuals at risk of readmission (AUC > 0.7; p < 0.05). Implications. Using the PASS to assess more cognitively demanding tasks could be a promising way to predict adverse events after discharge, as a complement to clinical judgment.

Single-center prognostic validation of the risk assessment of the 2015 ESC/ERS guidelines in patients with pulmonary arterial hypertension in Japan

The 2015 European Society of Cardiology/European Respiratory Society guidelines for the diagnosis and treatment of pulmonary hypertension include a multidimensional risk assessment for patients with pulmonary arterial hypertension (PAH). However, prognostic validations of this risk assessment are limited, especially outside Europe. Here, we validated the risk assessment strategy in PAH patients in our institution in Japan. Eighty consecutive PAH patients who underwent right heart catheterization between November 2006 and December 2018 were analyzed. Patients were classified as low, intermediate, or high risk by using a simplified version of the risk assessment that included seven variables: World Health Organization functional class, 6-min walking distance, peak oxygen consumption, brain natriuretic peptide, right atrial pressure, mixed venous oxygen saturation, and cardiac index. The high-risk group showed significantly higher mortality than the low- or intermediate-risk group at baseline (P < 0.001 for both comparisons), and the mortalities in the intermediate- and low-risk groups were both low (P = 0.989). At follow-up, patients who improved to or maintained a low-risk status showed better survival than those who did not (P = 0.041). Our data suggest that this risk assessment can predict higher mortality risk and long-term survival in PAH patients in Japan.

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Zusammenfassung. Lungenkranke mit COPD, einer der häufigsten Todesursachen in der Schweiz, leiden darunter, dass ihre Krankheit in der Bevölkerung zu wenig bekannt ist oder als selbst verschuldete «Raucherlunge» bezeichnet wird. Auch die Luftverschmutzung durch Feinstaub sollte als Ursache bekämpft werden. Dank Früherkennung mit Fragebogen und Lungenfunktionsmessung können die kosteneffizientesten Massnahmen wie Raucherentwöhnung, Inhalationstherapie und selbständiges Körpertraining eine Verbesserung der Lebensqualität bewirken. Mit pulmonalen Rehabilitationsprogrammen kann die Mitarbeit der Patienten, insbesondere zur Vermeidung von teuren COPD-Exazerbationen, verbessert werden.

Integrating groundwater into land planning: a risk assessment methodology

Generally, groundwater is naturally of good quality for human consumption and represents an essential source of drinking water. In Canada, small municipalities and individuals are particularly reliant on groundwater, since they cannot afford complex water treatment installations. However, groundwater is a vulnerable resource that, depending on its characteristics, can be contaminated by almost any land use. In recent decades, governments have launched programs to acquire more information on groundwater, in order to better protect it. Nevertheless, the data produced are rarely adequate to be understood and used by land planners. The aim of this study was to develop a method that helps planners interpret hydrogeological data in the Province of Quebec, Canada. Based on the requests and needs of planners during semi-directed interviews, a methodology was developed to qualitatively evaluate groundwater contamination risk by land uses. The method combines land planning data and hydrogeological data through the MACBETH multicriteria analysis method, to obtain maps of groundwater contamination risk. The method was developed through group and individual meetings with numerous hydrogeology, land planning, water's economics and drinking water specialists. The resulting maps allow planners to understand the dynamics of groundwater within their territory, identify problem areas where groundwater is threatened and analyse the potential impact of planning scenarios on the risk of groundwater contamination.