scholarly journals LO78: Frailty Assessments of Older Canadians Using Emergency Health Services: The FOCUS Study

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S55 ◽  
Author(s):  
J.S. Lee
Keyword(s):  
Kappa Statistic ◽  
Adverse Outcomes ◽  
Future Research ◽  
Clinical Frailty Scale ◽  
Patient Assessments ◽  
Observational Cohort ◽  
Self Assessments ◽  
Research Assistants ◽  
Moca Score ◽  
Emergency Health Services

Introduction: The Clinical Frailty Scale (CFS) has been validated internationally to predict adverse outcomes and mortality. Frailty assessments in the Emergency Departments (ED) are challenging to due to a lack of training and time. We studied the use of a tablet-based CFS that used graphics and short descriptors to assist choice of the 9 frailty categories. Methods: We conducted a prospective observational cohort study of people >65 years seen in the ED of 3 Canadian academic centers. We excluded critically ill patients, and those with significant visual impairment or inability to communicate in English or French. We compared agreement on the tablet-based CFS between 4 categories of assessors: Patients, ED Physicians, trained Research Assistance and Caregivers using the kappa statistic. Results: We enrolled 274/380 eligible patients who provided complete data (72.1%). Their average age was 75.8 years, and 48.9% were female. Their median MOCA score was 23/30 (IQR=17-26) and their median OARS was 26/28 (IQR 22-28). Agreement between physicians and research assistants was good (κ=0.60, 95% CI 0.50-0.70), as was physician-caregiver agreement and patient-caregiver agreement (κ=0.66, 95% CI 0.40-0.93). Agreement between physicians and patients was only moderate (κ=0.47, 95% CI 0.36-0.58). Conclusion: There was less agreement between physicians and patient self-assessments for the CFS compared to physicians-research assistant agreement and care-giver patient assessments of frailty. Future research should validate whether MD, patient, or caregiver rated CFS have higher predictive validity.

scholarly journals LO14: Unrecognized delirium in a cohort of older ED patients assessed at a tertiary care center: signs of improvement?

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S12
Author(s):  
J. Lee ◽  
T. Tong ◽  
M. Tierney ◽  
A. Kiss ◽  
M. Chignell
Keyword(s):  
Cognitive Assessment ◽  
Care Center ◽  
Tertiary Care ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Clinical Staff ◽  
Future Research ◽  
Mini Mental Status Exam ◽  
Observational Cohort ◽  
Research Assistants

Introduction: BACKGROUND: Recognition rates of delirium in older ED patients were reported between 13 to 25% in studies conducted in the U.S in the 1990's. Recently, there has been increased attention to delirium in Emergency Medicine, with the development of Geriatric curriculums in Canada specifically focused on delirium. However rates of delirium recognition have not been reassessed in Canadian ED's. OBJECTIVES: To assess the rate of delirium recognition by ED staff in a cohort of older ED patients assessed at a tertiary care Canadian ED. Methods: STUDY DESIGN: Prospective observational cohort study at a Canadian teaching ED. PARTICIPANTS: Eligible patients were aged ≥70 years and older who had stayed in the ED for a minimum of 4 hours. We excluded patients who were critically ill, visually impaired or otherwise unable to communicate. DATA COLLECTION: Trained research assistants approached clinical staff prior to approaching patients to confirm that patients were delirium free. They then assessed demographics, ED length of stay (LOS) and cognition using the validated Montreal Cognitive Assessment scale (MOCA), mini-mental status exam (MMSE), delirium index and Richardson Agitation Scale (RASS) at baseline. Delirium was assessed using the validated Confusion Assessment Method (CAM). We report descriptive statistics and 95% confidence intervals (CI) where appropriate. Results: We enrolled 203 patients of which 102 (50.3%) were female. Their mean age was 81.0 years, mean LOS was 16.3 hours, mean MOCA was 23.4 and mean MMSE was 26.7. RA's detected delirium using the CAM in 16/203 patients (7.9%, 95% CI 4.6 to 12.5%). Mean MOCA and MMSE for delirious patients was 13.4 and 18.3 and their mean DI was 6.4. All CAM positive patients were deemed to be delirium free by clinical staff. RA alerted clinical staff in all cases where patients had delirium, but 3/16 were discharged home (18.8%, 95% CI 4.1 to 45.7%). Conclusion: Our findings confirm previous low delirium recognition rates in a Canadian Tertiary ED. Future research should explore barriers and facilitators to recognizing delirium in the ED.

scholarly journals The FRAIL-FIT 30 Study – Factors influencing 30-day mortality in frail patients admitted to ICU: A retrospective observational cohort study

2021 ◽  
pp. 175114372098516
Author(s):  
David Hewitt ◽  
Michael Ratcliffe ◽  
Malcolm G Booth
Keyword(s):  
Cohort Study ◽  
Single Point ◽  
Observational Cohort Study ◽  
Adverse Outcomes ◽  
Royal Infirmary ◽  
Clinical Frailty Scale ◽  
Icu Admission ◽  
Frail Patients ◽  
Observational Cohort ◽  
Retrospective Observational Cohort Study

Background Frailty is a multi-dimensional syndrome of reduced reserve, resulting from overlapping physiological decrements across multiple systems. The contributing factors, temporality and magnitude of frailty’s effect on mortality after ICU admission are unclear. This study assessed frailty’s impact on mortality and life sustaining therapy (LST) use, following ICU admission. Methods This single-centre retrospective observational cohort study analysed data collected prospectively in Glasgow Royal Infirmary ICU. Of 684 eligible patients, 171 were frail and 513 were non-frail. Frailty was quantified using the Rockwood Clinical Frailty Scale (CFS). All patients were followed up 1-year after ICU admission. The primary outcome was all-cause mortality at 30-days post-ICU admission. Key secondary outcomes included mortality at 1-year and LST use. Results Frail patients were significantly less likely to survive 30-days post-ICU admission (61.4% vs 81.1%, p < 0.001). This continued to 1-year (48.5% vs 68.2%, p < 0.001). Frailty significantly increased mortality hazards in covariate-adjusted analyses at 30-days (HR 1.56; 95%CI 1.14–2.15; p = 0.006), and 1-year (HR 1.35; 95%CI 1.03–1.76; p = 0.028). Single-point CFS increases were associated with a 30-day mortality hazard of 1.23 (95%CI 1.13–1.34; p < 0.001) in unadjusted analyses, and 1.11 (95%CI 1.01–1.22; p = 0.026) after covariate adjustment. Frail patients received significantly more days of LST (median[IQR]: 5[3,11] vs 4[2,9], p = 0.008). Conclusion Frailty was significantly associated with greater mortality at all time points studied, but most notably in the first 30-days post-ICU admission. This was despite greater LST use. The accrual effect of frailty increased adverse outcomes. Point-by-point use of frailty scoring could allow for more informed decision making in ICU.

Equitable Access, Locale, Funding, and the Alignment to Performance Ratings in Texas Gifted Programs

2021 ◽  
Vol 44 (1) ◽  
pp. 3-30
Author(s):  
Jaret Hodges ◽  
Kacey Crutchfield ◽  
Lindsay Ellis Lee
Keyword(s):  
Program Evaluation ◽  
Hispanic Students ◽  
Proportional Representation ◽  
Performance Ratings ◽  
Future Research ◽  
Gifted Children ◽  
Gifted Programs ◽  
Gifted Program ◽  
Self Assessments ◽  
Talented Students

Self-assessments utilizing designated, objective standards are critical in program evaluation. Although 2013–2014 Texas policy mandated districts self-assess their gifted programs using the community and student engagement performance rating system, little is known about how districts determined their self-assessment ratings. Following gifted program evaluation guidelines from the Texas State Plan for Gifted/Talented Students and the National Association for Gifted Children Pre-K–Grade 12 Gifted Programming Standards, researchers used logistic ordered regression to examine Texas districts’ 2014–2015 locale, proportional representation, and budgetary allotments in relation to gifted program self-assessed performance ratings. Results indicate proportional representation of Black and Hispanic students in gifted programs did not influence school district self-assessed ratings. On the contrary, locale, proportion of Black and Hispanic students to the overall district population, and budget allocation did relate to self-assessed ratings of gifted programs. Future research directions and implications for the use of self-assessments within gifted program evaluation are discussed.

Trajectory of Performance Status and Symptom Scores for Patients With Cancer During the Last Six Months of Life

2011 ◽  
Vol 29 (9) ◽  
pp. 1151-1158 ◽  
Author(s):  
Hsien Seow ◽  
Lisa Barbera ◽  
Rinku Sutradhar ◽  
Doris Howell ◽  
Deborah Dudgeon ◽  
...  
Keyword(s):  
Performance Status ◽  
Symptom Assessment ◽  
Well Being ◽  
Assessment System ◽  
Assessment Tools ◽  
Future Research ◽  
Patients With Cancer ◽  
Average Pain ◽  
Observational Cohort ◽  
Over Time

Purpose Ontario's cancer system is unique because it has implemented two standardized assessment tools population-wide to improve care: the Edmonton Symptom Assessment System (ESAS) measures severity of nine symptoms (scale 0 to 10; 10 indicates the worst) and the Palliative Performance Scale (PPS) measures performance status (scale 0 to 100; 0 indicates death). This article describes the trajectory of ESAS and PPS scores 6 months before death. Patients and Methods Observational cohort study of cancer decedents between 2007 and 2009. Decedents required ≥1 ESAS or PPS assessment in the 6 months before death for inclusion. Outcomes were the decedents' average ESAS and PPS scores per week before death. Results Ten thousand seven hundred fifty-two (ESAS) and 7,882 (PPS) decedents were included. The mean age was 65 years, half were female, and approximately 75% of assessments occurred in cancer clinics. Average PPS score declined slowly over the 6 months before death, starting at approximately 70 and ending at 40, declining more rapidly in the last month. For ESAS symptoms, average pain, nausea, anxiety, and depression scores remained relatively stable over the 6 months. Conversely, shortness of breath, drowsiness, well-being, lack of appetite, and tiredness increased in severity over time, particularly in the month before death. More than one third of the cohort reported moderate to severe scores (ie, 4 to 10) for most symptoms in the last month of life. Conclusion In this large outpatient cancer population, trajectories of mean ESAS scores followed two patterns: increasing versus generally flat. The latter was perhaps due to available treatment (eg, prescriptions) for those symptoms. Future research should prioritize addressing symptoms that worsen over time.

Canadian Study of Health and Aging Clinical Frailty Scale: Does It Predict Adverse Outcomes among Geriatric Trauma Patients?

2017 ◽  
Vol 225 (5) ◽  
pp. 658-665.e3 ◽  
Author(s):  
Annie Cheung ◽  
Barbara Haas ◽  
Thom J. Ringer ◽  
Amanda McFarlan ◽  
Camilla L. Wong
Keyword(s):  
Adverse Outcomes ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Canadian Study ◽  
Clinical Frailty Scale

scholarly journals Enhancing Students’ Understanding and Revision of Narrative Writing through Self-Assessment and Dialogue: A Qualitative Multi-Case Study

2015 ◽  
Author(s):  
Stephanie Baxa
Keyword(s):  
Self Efficacy ◽  
Fifth Grade ◽  
Future Research ◽  
Writing Conferences ◽  
Teacher Language ◽  
Self Assessment ◽  
Self Assessments ◽  
Teacher Assessments ◽  
The Impact

With students losing hope when faced with challenges in the classroom, daily student-involved formative assessment that contributes to a growth mindset is essential. Through self-assessment and dialogue, students can generate feedback used for improvement of their writing, and teachers can give feedback that fosters self-efficacy. The purpose of this qualitative multi-case study was to explore the growth of fifth-grade writers as they participated in self-assessment, writing conferences with their teacher, and story revision. Research questions focused on students’ ability to explain learning targets and strengths and weaknesses of their writing and their ability to revise their writing. The participants, two male and one female, were randomly chosen from the teacher/researcher’s fifth-grade classroom in a large public school in the Midwest. Data sources included audio-recorded interviews and writing conferences, student-written work and self-assessments, and teacher assessments and notes. Self-assessment and dialogue with the teacher served as tools for providing feedback to the student and the teacher. Throughout implementation of the instructional strategies, students were able to talk about the learning targets and the strengths and weaknesses of their writing and were motivated and able to revise their writing. Limitations of the study included the length of the study and diversity of participants. Suggestions for future research included exploring ways to elicit more student feedback and the impact of teacher language during writing conferences on the self-efficacy of students.

scholarly journals MO152CORRELATION OF PERCEIVED FRAILTY WITH MEASURED FRAILTY IN AN ADULT HAEMODIALYSIS POPULATION

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Ruth Fergie ◽  
Jennifer McCaughan ◽  
Peter Eves ◽  
Siddesh Prabhavalkhar ◽  
Girish Shivashankar ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Basic Education ◽  
Physiological Stress ◽  
Care Home ◽  
Adverse Outcomes ◽  
Categorical Variables ◽  
Chronic Haemodialysis ◽  
Continuous Variables ◽  
Clinical Frailty Scale ◽  
Dialysis Unit

Abstract Background and Aims Frailty is a measure of physiological reserve and the ability to respond to physiological stress. Increasing frailty predicts adverse health outcomes in patients with end stage renal disease (ESRD) Despite this, frailty is not routinely measured in clinical practice where clinician perception of frailty is used to inform decision making. The Clinical Frailty Scale (CFS) is a clinical judgement-based score that is a useful screening tool for frailty. Increasing frailty measured by CFS is predictive of adverse outcomes in patients with advanced chronic kidney disease (CKD) including falls, worsening disability, care home admissions, hospitalizations and ultimately mortality. It has been widely used in the assessment of patients with COVID-19 to help inform decisions regarding ceiling of care. This study aimed to assess the correlation between clinician perception of frailty and frailty as measured using the CFS. Method Frailty was assessed for all patients undergoing in centre hospital haemodialysis (n=53) in a single dialysis unit in Northern Ireland. A CFS score was calculated for all patients by a clinician who routinely uses the CFS in clinical practice. Patients with a score of 1-3 were classified as not frail, 4-5 as intermediately frail and 6-9 as frail. Nephrologists received basic education about frailty. They were then asked to categorize their patients as non-frail, intermediately frail or frail. The relationship between measured and perceived frailty was assessed using percent agreement. Participant characteristics of frail patients who were misclassified as intermediately frail or non-frail by clinicians were compared to those patients correctly classified as non-frail by clinicians. Fisher’s exact test was employed for categorical variables and t-tests were employed for pseudo normally distributed continuous variables. Results Of the 53 participants, the median age was 59 years (26-89). 41.5% were women. The median time on dialysis was 1.6 years. According to the CFS, 6 patients were categorised as non-frail, 30 patients as intermediately frail and 17 as frail. Among frail participants, 41% were correctly perceived as frail by their nephrologist. Among non-frail participants, 100% were correctly perceived as non-frail by their nephrologist. Among those who were frail according to the CFS, those misclassified as intermediately frail or non-frail, were younger (median age of those misclassified 49 years vs 62 years of those not mis-classified, P=0.03) but did not differ by sex (P=1), time on dialysis (P=0.39), presence of diabetes (P=0.30) or presence of vascular disease (P=1). Conclusion In this study of adult patients undergoing chronic haemodialysis, perceived frailty correlated with measured frailty using the CFS less than 50% of the time. This suggests that clinical perception is not an accurate surrogate for frailty status in this population group. Additionally, this study suggests that younger patients with ESRD are less likely to be correctly perceived as frail. Such misclassification could influence clinical decisions for treatment, including candidacy for kidney transplantation.

Influence of Cognitive Impairment on Rehabilitation Received and Its Mediating Effect on Functional Recovery

2021 ◽  
pp. 1-12
Author(s):  
Ilona Dutzi ◽  
Michael Schwenk ◽  
Marietta Kirchner ◽  
Eva Jooss ◽  
Jürgen M. Bauer ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Cognitive Status ◽  
Mediating Effect ◽  
Future Research ◽  
Rehabilitation Outcome ◽  
Rehabilitation Outcomes ◽  
Rehabilitation Programs ◽  
Observational Cohort ◽  
The Relationship ◽  
State Examination

Background: Cognitive impairment (CI) has been reported to negatively impact rehabilitation outcomes. Knowledge about differences in rehabilitation received in dependence of CI as a potential mediating factor is limited. Objective: To analyze whether CI affects amount and frequency of rehabilitation received and if associations between CI and rehabilitation outcome are mediated by the provided amount of therapy. Methods: Observational cohort study in ward-based geriatric rehabilitation consecutively including 373 patients (mean age 82.0±6.69 years, mean MMSE 23.66±5.31). Outcome measures were amount, frequency, and type of multi-professional therapy sessions and rehabilitation outcome assessed with the Barthel Index (BI). Cognitive status was measured with the Mini-Mental-State Examination (MMSE) classifying three patient subgroups according to cognitive status were considered. Results: Patients with more severe CI received least total therapy hours (TTH) (MMSE <  17, 13.67±6.58 versus MMSE 17–26, 16.12±7.19 and MMSE >  26, 17.79±8.88 h, p = 0.014) and were less often included in occupational therapy (MMSE <  17, 48.9%versus MMSE 17–26, 65.5%and MMSE >  26, 71.4%, p = 0.019) and group-based physiotherapy (MMSE <  17, 73.3%versus MMSE 17–26, 88.5%and MMSE >  26, 81.2%, p = 0.027). Regression models showed that CI negatively impacted TTH (β= 0.24, p = 0.003) and rehabilitation outcome (β= 0.41, p = 0.008). In the mediation model, TTH accounted for 23.18%(p <  0.001) of the relationship between CI and rehabilitation outcome. Conclusion: Cognitive impairment negatively impacted rehabilitation received. The lower TTH partly mediated the negative association between CI and rehabilitation outcome. Future research should identify specific barriers to therapy provision and optimal length, intensity, and dosage of rehabilitation programs to optimize rehabilitation outcomes in CI.

Validation of the Anger Expression Scale for Children With Fourth and Fifth Graders: Implications for Identifying Students at Risk for Behavior Problems

Assessment ◽  
2020 ◽  
pp. 107319111989711
Author(s):  
Michelle M. Cumming ◽  
Daniel Poling ◽  
Stephen W. Smith
Keyword(s):  
Factor Model ◽  
Fifth Graders ◽  
Anger Expression ◽  
Adverse Outcomes ◽  
Control Factor ◽  
Future Research ◽  
Anger Control ◽  
Special Education Placement ◽  
Upper Elementary School ◽  
Measurement Tools

An inability to successfully regulate anger has been linked to adverse outcomes for students, including psychological problems and special education placement due to significant emotional and behavioral difficulties. Early identification, therefore, is critical to provide timely intervention for students before anger-related problems escalate. The Anger Expression Scale for Children was developed to address some of the limitations of previous measurement tools designed to assess anger expression with children and adolescents. Yet validation is needed with upper elementary school populations—a key identification and prevention period. Thus, we examined the factor structure of the scale with 2,020 fourth and fifth graders. Results revealed support for a modified two-factor model, with a general Anger Expression factor and Anger Control factor. Criterion-related validity analyses indicated that Anger Expression was positively associated with aggression and externalizing problems, whereas Anger Control was related to emotion control and less internalizing behaviors. We discuss implications of findings for both informed school use and future research.

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